OSPE Flashcards
What is a periodontal abscess?
It can be an acue infection that involves a localisd area of pus in the periodontium. Circumscribed - localised and confined to specific site.
z8 Rapid destruction of periodontal tissues: impacts prognosis. Can result in systemic infection.
What is the aetiology of PA?
Inflammatory process due to bacterial invasion (PMNS →cytokins - CT destruction). of soft tissues surrounding pocket.
What are 3 aetiological factors for patients with pre-existing periodontitis?
- Reduced ability to drain = ↑ suppuration due to change in subgingival microbiotia/↓ host defence
- Foreign object in surrounding structures
- Incomplete calc removal
What else could cause aetiology of pre-existing periodontitis?
Foreign object in supporting structures, harmful habits, ortho factors, gingival enlargement, altered root surface
What is a feature of abscess’ of the periodontium?
Symptoms:
Bad taste, difficulty chewing, pain
Signs: ↑ mobility, suppuration on probing, ↑ systemic involvement, odema is gingiva, BOP, can be deeper pockets
What is this? PIC
Periodontal abscess
On a radiograph how will PDA present?
Boneless in area of abscess but not involving tooth apex.
Tooth is usually vital.
How do you diagnose a PDA?
- History of cc
- Presence of perio pocket
- Vitality testing
- Location of abscess
- Caries
- Radiographic assessment
Differential diagnosis: PA, verticle root frac, perio-endo abscess, PO pain
What is the recommended treatment for PDA?
Establish aetiological factors and address.
LA
Establish path of drainage for pus via pocket, may require periodontal surgery - refer.
(REFER)
Debridement will drain this also.
Analgesics / antibiotic (only systemic)
Warm saline rinses
Review and or refer + full perio assessment
Define Necrotising Periodontal Diseases (NPD)
Acute infection of periodontal tissues that involve tissue necrosis. Appears to be related to diminished systemic resistance to bacterial infection.
What are the distinguishing characteristics of NPD (ANUG)
Tissue necrosis, ulceration, pseudomembrane, punched out papillae
What are risk factors for NDP?
Microbiology, host immune response and predisposing factors.
→→Stress, poor PH, age, alcohol+tobacco consumption, HIV/AIDS
What are the clinical features of NPD?
Sudden onset with intense pain. Punched out or cratered papillae, tissue necrosis. Pseudomembrane, erythametous, hallitosis.
Possible systemic involvement .
Mostly occurs in sextant 5 interproximally.
How do you manage first app NPD?
1st appointment:
- Subgingival debridement - under LA
- OHI - soft tbing
- Chlorhexadine/hydrogen peroxide 2x per day
- Smoking cessation
- Analgesics/antibiotics eg. Metronidazole
- Review 48-72
How do you manage 2nd app for NPD?
After 48-72: Further OHT Further instrumentation 3rd app: (5 days) - Reinforce OHI - Complete debridement if nec FU: review and full perio essessment
What is Necrotising Periodontitis?
Similar features of NPD, but affects periodontium (bone).
Necrosis progresses into PDL and alveolar bone → attachment loss. Extreme and rapid destruction.
(Systemic involvement - commonly reported in HIV pts).
How do you manage necrotising periodontitis?
Refer to periodontist.
Define periocoronitis
Inflammation and infection due to accumulation of debris and bacteria underneath the operculum. Most common in PE 8’s.
Whats the treatment for periocoronitis?
LA.
Periodontal instrumention and irrigation under operculum with chlorhexadine/sterile saline.
Analgesics, antibiotics if required.
Occlusal adjustment
Recommend warm saline/chlorhexidine rinses
Review + full perio assessment
Referral for exo
Define Primary Herpetic Gingivostomatitis
Caused y HSV, primary episode common in childhood.
Highly contagious, spread though kissing, contact with open sore, contact with infected saliva. Can spread from another part of body to another
What are symptoms of Primary herpetic gingivostomatits?
IO lesions, ulcers, lips, palate, tongue, gingivae tissues, difficulty eating and drinking, oedematous, erythematous gingiva.
May have fever
What is the management of PHG?
Oral fluids, anti-pyretic meds, analgesia, topical anaesthetic, refer to GF if unable to tolerate fluid.
Shold regress in 2 weeks
What is an endo-periodontal lesion?
Refers to concurrent endodontic and periodontic disease. Both of bacterial origins transferring to apical or surroinding tissues
What is the pathophysiology of an endo-periodontal lesion?
Communication pathways between pulp and periodontium.
- Apical foramen
- Accessory or lateral cancels
- Dentine tubules
What are causes of endo-periodontal lesions?
Trauma and iatrogenic factors such as:
root/pulp chamber/ furcation perforation
- Root frac or cracking
- External root resorption
How can you tell if it;s a endo-periodontal lesion?
Sensibility testing will come back negative
How do you manage a perio-endo lesion?
Refer to dentist -
Define peri-Implant disease
Refers to inflammation associated with dental implants.
Define osseointergration
Direct contact of bone to the surface of an implant body with no intervening CT.
What constitutes peri-implant health?
No erythema, no BOP, no swelling, no suppuration.
- Not defined by pocket depth reading.
Define peri-implant mucositis
Peri-implant mucosal inflammation in absence of continuous marginal peri-implant bone loss.
↑ Association with plaque accumulation.
What are features of peri-implant mucositis?
BOP, no loss of supporting bone.
Presence of:
Erythema, odema, suppuration, ↑ probing
PICWhat is this condition?
Peri-Implant mucositis
Define peri-implantitis
Inflammation associated with loss of supporting bone surrounding an implant.
What are features of peri-implanitis?
Vertical bone loss - as peri-implant mycositis
What are risk factors for peri-implantitis?
Poor plaque control, history of perio, smoking, dibetes, irregular recalls
How to diagnose peri-implantitis
Compare to baseline boneless. If not base line…
Combination of:
Bleeding/suppuration, probing depths 6mm.
Bone levels 3mm or more apical to the most coronal portion of the intraossous portion of implant.
What instruments do you use for implants?
Instruments made from plastic, titanium or carbon
What is the role of the OHT in peri care?
Post-non surgical tx phase is to work in conjucion with the periodontist in supportive care and ongoing management of OHT. OHT implements advice from periodontist,
What is the OHT role is surgical treatment phase?
Education.
Reduce bacterial load prior to surgery.
Educate pt; use mouth washes, tooth brushing soft tp modified stillmans technique,
What could you recommend for antimicrobial management?
Rinses such as savacol, hydrogen.
Gels; difflam, curasept. systemic antibiotics
What are some indications for referral for periodontal surgery?
Provide access for improved instrumentation.
- Reduce pocket depths
- Improve appearance of periodontium
- Regenerate periodontium
What are 5 types of periodontal surgeries undertaken by spec?
Gingivectomy, flap procedure, root separation and resection, surgical crown lengthening, regenerative techniques
What are possible indications for exo?
Acute periapical infection of carious teeth,
Chronic periapical infection
Pulp necrosis
Submerged primary tooth (anklyoses) - refer
Fractured or traumatised tooth
Tooth with carious exposure where resto no indicated
Tooth that is close to exfoluation
Abscessed tooth
What are contraindication for an exo?
Immunocompromised pts. Pts with ↑ infection risk Blood diseases: haemophilia, leukoemia. Uncontrolled diabetes Radiation to neck and head
When is prophylaxis indicated for exo?
Congenital heart disease, infective endocarditis, immunodeficiency
Upon clinical examination what should you be aware of?
Swelling, erythema, inflammation, sinus trct, ulceration - may inform indication for antibiotics
What are things you need to consider prior to exo?
Need for space maintainer, best to temp the tooth and refer for assessment PRIOR to exo.
Presence of permanent successor
What are POIG for exo?
Be careful not to bite lip, cheek or tongue.
If bleeding reoccurs bite for 15 min on gauze.
No spitting for rinsing for first 24hrs.
Eat soft food, avoid hot food drinks.
Take care when brushing teeth.
No vigorous exercise today, take your chosen pain relief 30 min prior to LA wearing off).
Warm salt mr tomorrow.
Seel help if continued bleeding or pain
What are predisposing factors are for trauma cases?
Class II div 1 malocculsion
Overjet 3-6mm
Overjet >6mm
What are potential causes and risk factors
Falls, bike/car accidents, sports related, violence, child abuse or neglect, children with poor reflexes, hyperactivity, substance abuse, mal-occulsion with protruding front teeth
Define infraction
Incomplete fracture/crack of enamel with no loss of tooth structure or abnormalities.
Define uncomplicated crown fracture (enamel only)
Involves loss of enamel only. All tests WNL.
What is the management of uncomplicated crown fracture in primary teeth
Smooth rough edges
What is the management of uncomplicated crown fracture in permanent teeth
Smooth rough edges, restore with CR.
FU exam & x-rays 6-8w
Define uncomplicated crown fracture (of enamel and dentine)
Involves loss of both enamel and dentine, exposing the dentine tubules. Not involving pulp.
Tests WNL
What is the management of uncomplicated crown fracture (enamel and dentine) in primary teeth
Seal with GI - vitreboond.
Larger fracture GIC - restore CR.
FU 3-4 weeks
What is the management of uncomplicated crown fracture (enamel and dentine) in permanent teeth
Seal dentine with GI and restore with CR.
Rebond frag if avail
FU 3-4 week
Define complicated crown fracture
Involves loss of enamel, dentine and exposure of pulp.
WNL mobility and percussion. Sensitive.
What is the management of complicated crown fracture in primary teeth
Consideration of how long that tooth is going to be in the mouth, vitality, and age.
- Pulpotomy, Ca+, restore.
Or exo
What is the management of complicated crown fracture in pernament teeth
Depends on root development.
Treatment options:
Direct placement of Ca+, temp and refer.
FU 6-8 weeks → 1 year
Define crown/root fracture
Loss of tooth structure involving enamel, dentine and cementum +- pulp exposure. Extending subgingivally TTP, mobility of coronal frag.
Usually positive to sensibility testing. (diagnose TPP and radiographs)
What is the management of crown and root fracture in primary teeth
Removal of frag if tooth small, tooth restorable, no pulpal involvment.
FU 1 week w exam and x-rays → 1 years until eruption of permanent successor.
Exo
What is the management of crown and root fracture in permanent teeth
Emergency maagment - stabilise coronal frag (confer with dentist - refer)
FU 3-4 weeks
Define Root fracture
Fracture of cementum, dentine and pulp. Coronal segment may be mobile or displaced,
TTP, bleeding from sulcus
What is the management of root fracture in primary teeth
No treatment, monitor for necrosis or exo
What is the management of crown and root fracture in permanent teeth
Emergency stabilisation under guidance of dentist/ referrak. FU 4 weeks, 6-8, 6m, 1y, 5y
Define Alveolar fracture
Fracture involving alveolar bone and possibly adjacent bone.
Molbile, dislocation.
Sensibility test may be -+
What is the management of alveolar fracture in primary/permanent teeth
Referral!
What is treatment of concussion primary teeth?
Monitor and advise soft diet and possibility of necrosis.
What is treatment of concussion permanent teeth?
Monitor pulpal condition for 1 year. Advise soft diet possible sequele. FU 4w, 6-8w, 1y
Define subluxation
Injury to tooth-suppporting structures with mobility but no displacement.
TTP, sulcular bleeding. Sensibility testing WNL.
What is treatment of concussion primary teeth?
Monitor, advice good OH, FU 1 week → 6-8 weeks.
What is treatment of concussion permanent teeth?
Monitor, soft diet, advice possible sequele.
May need splinting (2 weeks).
FU, 2w, 4w, 6-8w, 1year
Define lateral subluxation
Displacement of teeth away from normal position in horizontal direction.
Sensibility tests - neg.
Percussion.
No mobility.
What are some philosophies of MID?
Early diagnosis, evaulation of caries risk, stablisation of WSL, minimally invasive resto treatment, prevention
What are issues with restorations?
Fail over time or need replacing, weakened tooth strucutre, recurrent caries
Define hue
basic colour
Define saturtion
Amount of colour per unit, intensity, looking rich and full, low ones look dull and greyish
Define bleaching
Removal of intrinsic or acquired discolouration on natural teeth through the use of chemicals, sometimes in combination with application of auxillary means
Describe the process of bleaching
It is an oxidative process that alters the light absorbing or light reflecting nature of the tooth structure, ↑ ing it;s perception of whiteness.
Define whitening
Lower %, whitening toothpastes, whitening pen, cleaning extrinsic staining
What can bleaching efficacy be influenced by?
Pt factors such as age, gender, and initial tooth colour. Type of bleaching material used. Application method.
What percentage is dangerous with inchair bleach?
5%
MOA bleaching
H20Hydrogen peroxide in bleaching gel producs free radicals while diffusing through enamel and dentine, breaking double bonds of pigment molecules and changing the pigment molecule confirguration and/or size.
Who woul dyou not perform bleaching on?
Pts with amalgam restos
