paediatric perio Flashcards
what were the aims of the 2012 guidelines
- to outline a method of screening children and adolescents for periodontal diseases during the routine clinical examination in order to detect the presence of gingivitis or periodontitis at the earliest opportunity
- to provide guidance on when it is appropriate to treat in practice or refer to specialist services, thus optimising periodontal outcomes for children and young people
what are the different classifications for perio as of 2019
PERIODONTAL HEALTH
- periodontal health
- Intact periodontist
- reduced periodontist
- gingivitis - dental biofilm induced
- Intact periodontist
- reduced periodontium
- gingival diseases and conditions - non-dental biofilm induced
PERIODONTITIS
- necrotising periodontal disease
- periodontitis
- periodontitis as a manifestation of systemic disease
OTHER CONDITIONS AFFECTING PERIODONTIUM
- systemic disease or notions affecting periodontal supporting tissue
- periodontal abscess and eno-perio lesions
- mucogingival deformities
- truamatic occlusal force
- tooth and prosthesis related factors
what is the mnemonic to remember the classifications
- Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight
what are the 4 stages of diagnosing perio
- staging
- grading
- assess current perio status
- risk assessment
how is perio staged
- interproximal bone loss at the worst site of bone loss
- stage I, stage II, stage III or stage IV
how is perio graded
- rate of progression
- %bone loss/age
- grade A, B or C
what are the different status of perio
- current stable
- currently in remission
- currently unstable
what are features of periodontal health
- gingival margin several millimetres coronal to CEJ
- gingival sulcus may be 0.5-3mm deep
- alveolar crest 0.4-1.9mm apical to CEJ
what is the biological width
- space between CEJ and alveolar bone crest
what is periodontal health considered as
- intact periodontium
- reduced periodontium
what is the score of BOP for clinical periodontal health
- <10%
what is gingivitis
- inflammation of the gingiva
what are the types of gingivitis
- dental biofilm induced = localised or generalised
- non-dental biofilm induced
how is dental biofilm induced gingivitis caused
- as supra-gingival plaque accumulates to teeth, an inflammatory cell infiltrate develops in gingival connective tissue
- junctional epithelium becomes disrupted
- allows apical migration of plaque and an increase in gingival sulcus depth
is gingivitis reversible
- yes
why is gingivitis still reversible
- the most apical extension of the JE is still at the CEJ
- there is no periodontal loss of attachment = why it is called a false pocket
how can gingivitis present
- marginal gingivitis and very puffy interproximal
- long-standing plaque causing irritation
why is classification really important
- because it should help diagnose status which then helps inform prognosis and strategy implied to help patient
what is the BOP score for localised gingivitis
- 10-30%
what is the BOP score for generalised gingivitis
- > 30%
what is the appearance of necrotising ulcerative gingivitis
- blunted papilla
- malodour
- painful gingival
- no attachment loss
what causes necrotising ulcerative gingivitis
- fusiform and spirochete bacteria
what are risk factors of necrotising ulcerative gingivitis
- smoking, spree, immunosuppression, poor diet
- HIV+
- common in developing countries
what can necrotising ulcerative gingivitis also be called (layman’s terms)
- trench mouth
what can cause pubertal gingivitis
- increased inflammatory response to palque
- mediated by hormonal changes
- local and systemic factors can influence progression
what are some causes of non-dental biofilm induced gingivitis
- infective = viral, fungal
- drug induced = immunosuppressants, Ca+ channel blockers, anti-convulsants
- genetic
- trauma
- manifestations of systemic disease = haematology, immunological conditions, granulomatous inflammation
what is cyclosporin
- immunosuppresant
- used in patients with underlying immune disorders such as Crohn’s disease, organ transplant
what is phenytoin
- anti-convulsant
- for epileptic patients
- can cause exuberant gingivitis with very inflamed interproximal papilla
what can be seen in patient with ooo-facial granulomatous
- full thickness gingiva
what has gingivitis been known to be an initial presentation of (rare)
- leukaemia
what is agranulocytosis
- a haematological systemic disease
- acute condition
- low white blood cell count
- can lead to gingivitis
what is cyclic neutropenia
- a haematological systemic disease
- low neutrophil count
- occurs every 3 weeks and lasts 4-6 days
- can lead to gingivitis
when can granulomatous inflammation occur
- crohns disease
- sarcoidosis
- granulomatosis = autoimmune vasculitis, affects multiple systems (mainly mouth, URT, kidney)
what is the treatment for gingivitis
- rigorous oral hygiene/home care
- frequent scaling
- surgery may be necessary = especially with drug induced
when is a greater incidence of gingivitis seen
- in puberty
what are the 4 mainfeatures of periodontitis
- apical migration of junctional epithelium beyond CEJ
- loss of attachment of periodontal tissues to cementum
- transformation of junctional epithelium to pocket epithelium
- alveolar bone loss
how much loss of attachment is classified as perio
- > 1mm
what pathogens can cause periodontal disease in both children and adults
- prophyromonas gingivalis
- prevotella intermedia
- aggregatibacter actinomycetemcomitans (AA)
what are the features of periodontitis in adolescents
- rapid attachment loss and bone destruction
- patient is otherwise healthy
- onset around puberty
- family history
what is stage I periodontitis
- <15% interproxima bone loss
what is stage II periodontitis
- coronal third of root bone loss
what is stage III periodontitis
- mid third of root bone loss
what is stage IV periodontitis
- apical third of root bone loss
what is grade A periodontitis
- <0.5 % bone loss/age
what is grade B periodontitis
- 0.5-1 %bone loss/age
what is grade C periodontitis
- > 1 %bone loss/age
what must you be aware of in mixed dentition around erupting teeth
- false pocketing
what needs to be recorded about the gingival condition
- gingival colour
- contour
- swelling
- recession
- suppuration
- inflammation
how is OH status assessed
- description of plaque status
- describe surfaces covered in plaque
- assess if any calculus present
what can be risk factors to assess
- plaque retention factors
- low frenal attachment
- malocclusion
- incompetent lip seal
what can reduced upper lip coverage in an incompetent lip seal patient cause
- labial and palatal gingivitis
- contributes to drying of oral mucosa
what can mouth breathing cause
- palatal gingivitis
what can complete overbite cause
- chronic continuous trauma to this area
- end up with recession and other issues occurring
in what children is a simplified BPE used
- 7-11
what is a simplified BPE
- rapidly guides clinicians to arrive at a provisional diagnosis of periodontal health
- does not consider attachment loss, staging or grading
how is a simplified BPE carried out
- performed with a WHO CPITN probe
- only do teeth 16, 11, 26, 36, 31 and 46
why is a simplified BPE used
- quick
- easy
- well tolerated
what kind of BPE do children aged 12-17 get
- normal BPE same as adults
what codes are used in a simplified BPE
- only codes 0-2
- 0 = healthy
- 1 = bleeding on gently probing
- 2= calculus or plaque retention factor
what codes are used for children 12-17
- all codes 0-4 and *
- 3 = pocketing 4-5mm
- 4 = pocketing ≥6mm
- = furcation involvement
what is a plaque score of 10/10 according to SDCEP
- perfectly clean tooth
what is a plaque score of 8/10 according to SDCEP
- line of plaque around the cervical margin
what is a plaque score of 6/10 according to SDCEP
- cervical 1/3 ro crown covered
what is a plaque score of 4/10 according to SDCEP
- middle 1/3 of crown covered
what happens if a patient has a score of 3 or 4
- need to do a 6PPC
- localised to that sextant if 3
- whole mouth for 4
how is the alveolar bone level checked
- bitewings for posteriors
- periodicals for anteriors
what are some generic treatment advice for patients with gingivitis and perio
- good toothbrushing
- emphasise need to systemically clean all surfaces
- standard toothbrushing and fluoride advice should be given to all patients
- supervised/assisted brushing = up to the age of 7 roughly
- disclosing tablets are helpful
- fluoride mouthwash recommended for those with fixed appliance therapy
what treatment is done for code 0
- none
- screen again at routine recall
what treatment is done for code 1
- OHI and prevention
- screen again at routine recall or after 6 month
what treatment is done for code 2
- OHI, prevention, scaling, removal of plaque retention factors
- screen again at routine recall or after6 months
what treatment is done for code 3 and 4
- full perio assessment, radiographs
- scaling, RSD, OHI, prevention
- if score 4 or * consider referral
- treat and review after 3 months
