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BDS3 Paediatric Dentistry > Paediatric Periodontology > Flashcards

Paediatric Periodontology Flashcards

1
Q

What are the 2 aims of the 2012 guidelines (children)?

A
  • To outline a method of screening children and adolescents for periodontal diseases during the routine clinical dental 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 adolescents
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2
Q

What is included in the old classifications of periodontal disease (2011)? (8)

A
  • Periodontitis associated with endodontic lesions
  • Developmental or acquired deformities and conditions
  • Gingival diseases
  • Chronic periodontitis
  • Aggressive periodontitis
  • Periodontitis as a manifestation of systemic disease
  • Necrotising periodontitis
  • Abscesses
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3
Q

What is included in the newer classification of periodontal conditions (2017)? (6)

A
  • Periodontal health (intact periodontium or reduced periodontium)
  • Gingivitis: dental biofilm induced (intact periodontium or reduced periodontium)
  • Gingival diseases and conditions: non-dental biofilm induced

Periodontitis:

  • Necrotising periodontal diseases
  • Periodontitis
  • Periodontitis as a manifestation of systemic disease

(There is another area for other conditions affecting the periodontium)

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4
Q

What is included in the section ‘other conditions affecting the periodontium’ in the 2017 classification of periodontal conditions? (5)

A
  • Systemic diseases or conditions affecting the periodontal supporting tissues
  • Periodontal abscesses and endodontic-periodontal lesions
  • Mucogingival deformities and conditions
  • Traumatic occlusal forces
  • Tooth and prosthesis related factors
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5
Q

What does the mnemonic ‘Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight’ stand for?

A
  • Periodontal health
  • Gingivitis: dental biofilm induced
  • Gingival diseases and conditions: non-dental biofilm induced
  • Necrotising periodontal diseases
  • Periodontitis
  • Periodontitis as a manifestation of systemic disease
  • Systemic disease or conditions affecting the periodontal supporting tissues
  • Periodontal abscesses and endodontic-periodontal lesions
  • Mucogingival deformities and conditions
  • Traumatic occlusal forces
  • Tooth and prosthesis related factors
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6
Q

What is ‘staging’ in the classification of periodontitis?

A
  • Interproximal bone loss at the worst site of bone loss (due to periodontitis)
  • Stage I, II, III or IV
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7
Q

What is ‘grading’ in the classification of periodontitis?

A
  • Rate of progression
  • % bone loss/age
  • Grade A, Grade B, Grade C
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8
Q

What are the categories for assessing the current periodontal status of a periodontitis patient? (3)

A
  • Currently stable
  • Currently in remission
  • Currently unstable
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9
Q

What are the 4 things you would include in a periodontitis diagnosis of a patient?

A
  • Stage
  • Grade
  • Current periodontal status (stability)
  • Risk assessment/factors
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10
Q

What would we expect in a patient with a healthy periodontium? (3)

A
  • Gingival margin may be several millimetres coronal to the CEJ
  • Gingival sulcus may be 0.5-3mm deep
  • Alveolar crest 0.4-1.9mm apical to the CEJ (teenagers)
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11
Q

What is the biological width of the tooth?

A
  • This is the distance between the CEJ and the alveolar bone crest
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12
Q

For a patient with periodontal health, what would we expect to get from the BPE in relation to BOP?

A

<10% for clinical periodontal health (intact or reduced periodontium)

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13
Q

What is gingivitis?

A

Inflammation of the gingivae

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14
Q

The 2003 child dental health survey showed that plaque and gingival inflammation were present in…? (3)

A
  • Two third of 8 and 12 year olds
  • One third of 5 year olds
  • Half of 15 year olds in the UK
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15
Q

What are the 2 types of gingivitis?

A
  • Dental biofilm induced

- Gingival diseases and conditions: non-dental biofilm-induced

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16
Q

What are the 2 types of dental biofilm induced gingivitis?

A
  • Localised

- Generalised

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17
Q

Explain dental biofilm gingivitis and how this occurs? (4)

A
  • As supra-gingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
  • The junctional epithelium becomes disrupted
  • This allows apical migration of plaque and an increase in the gingival sulcus depth
  • This results in gingival pockets/false pockets/ pseudo pockets
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18
Q

What are 2 other names for false pockets?

A
  • Gingival pockets

- Pseudo pockets

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19
Q

What is important about dental biofilm induced gingivitis?

A
  • The process is reversible
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20
Q

What happens if there is severe inflammation in dental biofilm induced gingivitis?

A
  • Gingival swelling increases

- Get even deeper false gingival pockets

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21
Q

In dental biofilm induced gingivitis, where is the most apical extension of the junctional epithelium?

A
  • This is still the CEJ

- There has been no periodontal loss of attachment (this is why it is called false pocketing)

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22
Q

Why is classification of periodontitis an important component of diagnosis?

A

because diagnosis informs prognosis and treatment plan

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23
Q

How would we split gingivitis into localised and generalised?

A

BOP:

  • 10-30% = localised gingivitis
  • > 30% = generalised gingivitis
  • Plaque retentive factors e.g. overhangs often present
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24
Q

What is the appearance of necrotising ulcerative gingivitis? (4)

A
  • Blunted papillae
  • Malodour
  • Painful gingivae
  • No attachment loss
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25
Q

What is the aetiology of necrotising ulcerative gingivitis? (2)

A

Bacteria:

  • Fusiform
  • Spirochete
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26
Q

What are risk factors for necrotising ulcerative gingivitis? (7)

A
  • Smoking, stress, immunosuppression, poor diet
  • HIV + status or other underlying conditions
  • Common in developing countries
  • Trench mouth
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27
Q

What is pubertal gingivitis?

A
  • Increased inflammatory response to plaque
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28
Q

What is pubertal gingivitis mediated by?

A

Hormonal changes

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29
Q

In teenagers, what can gingivitis progress into?

A
  • Early periodontitis
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30
Q

Give examples of factors that can influence the progression of pubertal gingivitis? (5)

A

Local

  • Plaque
  • Braces
  • Overhangs

and systemic factors can influence progression

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31
Q

Non-dental biofilm induced gingival diseases can be caused by an ‘infective’ reason. Give examples of these? (3)

A
  • Viral
  • Fungal
  • Deep mycoses
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32
Q

Non-dental biofilm induced gingival diseases can be caused by an ‘genetic’ reason. Give examples of these? (2)

A
  • Phenotype

- Hereditary fibromatosis

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33
Q

Non-dental biofilm induced gingival diseases can be caused by a ‘Trauma’ reason. Give examples of these? (2)

A
  • Thermal/chemical

- Physical

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34
Q

Non-dental biofilm induced gingival diseases can be caused by a ‘manifestation of systemic disease’ reason. Give examples of these? (3)

A
  • Haematology: benign/malignant
  • Immunological conditions
  • Granulomatous inflammation
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35
Q

Non-dental biofilm induced gingival diseases can be caused by a ‘drug induced’ reason. Give examples of these? (6)

A
  • Anti-retro-viral
  • Immunosuppressants
  • Ca+ channel blockers
  • Anti-convulsants
  • Cytotoxic
  • Immune complex reactions
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36
Q

Look at slide on drug induced aetiologies

A

Has pictures

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37
Q

One example of a haematological disease which can lead to gingivitis is Agranulocytosis. What is this?

A
  • Acute condition. Low white-blood cell count
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38
Q

One example of a haematological disease which can lead to gingivitis is Cyclic neutropenia. What is this?

A
  • Low neutrophil count. Occurs every 3 weeks and lasts 4-6 days
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39
Q

Give examples of granulomatous inflammations that can lead to gingivitis? (3)

A
  • Crohn’s disease
  • Sarcoidosis
  • Granulomatosis
40
Q

One example of a granulomatous inflammation which can lead to gingivitis is Granulomatosis. What is this?

A
  • Autoimmune vasculitis. Affects multiple systems. Most commonly mouth, URT and kidneys
41
Q

Gingival overgrowth beyond biofilm induction can relate to what? (4)

A
  • Systemic and metabolic disease
  • Genetic factors, local factors
  • Side effects of some medications (Cyclosporin, Nifedipine, Phenytoin)
  • Greater incidence seen in puberty
42
Q

What are the treatments of gingivitis? (3)

A
  • Rigorous oral hygiene/home care
  • Frequent scaling
  • Surgery may be necessary (esp with drug-induced) -> refer to specialist
43
Q

What are the 4 main distinguishable featured of periodontitis?

A
  • Apical migration of junctional epithelium beyond CEJ
  • Loss of attachment of periodontal tissues to cementum
  • Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated)
  • Alveolar bone loss
44
Q

Early clinical signs of periodontitis can be seen in a substantial proportion of teenagers. What is this classified as?

A
  • Classified as >1mm loss of attachment (of cementum to PDL)
45
Q

Similar pathogens to adults with periodontitis can be found in subgingival microflora of teenagers with periodontitis. What are they? (3)

A
  • Porphyromonas gingivalis
  • Prevotella intermedia
  • Aggregatibacter actinomycetemcomitans (AA)
46
Q

Periodontitis may be present in a small proportion of adolescents. What dot he features include? (5)

A
  • Rapid attachment loss and bone destruction
  • Patient is otherwise healthy
  • Onset around puberty
  • Family history
  • 0.1% Caucasians and 2.6% African ancestry
47
Q

Where is localised periodontitis in adolescents usually found?

A
  • Traditionally localised to incisors and first molars
48
Q

Where is generalised periodontitis usually found and who does this usually affect?

A
  • Traditionally > or equal to 3 permanent teeth other then incisors and first molars
  • Onset is usually older but sometimes under 30 years

(now based on number of sites as per new classification)

49
Q

What is essential for an up to date diagnosis of periodontitis?

A

Staging and grading

50
Q

What would stage 1 periodontitis be?

A
  • (early/mild)
  • Interproximal bone loss = <15% or <2mm

(measurement in mm from CEJ if only bitewing radiograph available or no radiographs clinically justified)

51
Q

What would stage 2 periodontitis be?

A
  • Moderate

- Interproximal bone loss = coronal third of root

52
Q

What would stage 3 periodontitis be?

A
  • Severe

- Interproximal bone loss = Mid third of root

53
Q

What would stage 4 periodontitis be?

A
  • Very severe

- Apical third of root

54
Q

How do we describe the extent of periodontitis?

A
  • Localised (up to 30% of teeth), generalised (more than 30% of teeth), molar/incisor pattern
55
Q

What would grade A of periodontitis be?

A
  • Slow progression

- % bone loss/age = <0.5

56
Q

What would grade B periodontitis be?

A
  • Moderate progression

- % bone loss/age = 0.5-1.0

57
Q

What would grade C periodontitis be?

A
  • Rapid progression

- % bone loss/age = >1%

58
Q

Can periodontitis occur in the primary dentition?

A
  • Some evidence that bone loss can occur around primary teeth in some children
59
Q

Can periodontitis occur in the mixed dentition?

A
  • Be aware of false pocketing around erupting permanent dentition
60
Q

Periodontal screening should be a routine and essential part of history and clinical examination. When looking at gingival condition what should we look at/for? (7)

A
  • Gingival colour
  • Contour
  • Swelling
  • Recession
  • Suppuration
  • inflammation (presence and location)
  • Consider use of marginal bleeding free chart
61
Q

Periodontal screening should be a routine and essential part of history and clinical examination. Part of this is to assess OH status. What would we include in this? (5)

A

Description of plaque status

Describe surfaces covered by plaque:

  • Is plaque easily visible?
  • Detectable only on probing?
  • Use of plaque free scores (%) - motivational aid to patient
62
Q

Periodontal screening should be a routine and essential part of history and clinical examination. How would we asses if any calculus is present?

A
  • Chart the location of calculus if found
63
Q

Periodontal screening should be a routine and essential part of history and clinical examination. Part of this is to asses local risk factors. What are examples of these that we would look for? (5)

A
  • Plaque retention factors
  • Low frenal attachments
  • Malocclusions
  • Incompetent lip seal: (reduced upper lip coverage - labial and palatal gingivitis or increased lip separation)
  • Mouth breathing (palatal gingivitis)
64
Q

When we are assessing local risk factors for periodontal disease we may find a patient with a complete overbite. Why could this be a problem?

A
  • Biting down on gingival margin of lower incisors so could end up with chronic continuous trauma to the area and could end up with recession and other problems
65
Q

When we are assessing local risk factors for periodontal disease we may find a patient with a malocclusion. Why could this be a problem?

A
  • This can make brushing more difficult and so could have poorer OH
66
Q

When we are assessing local risk factors for periodontal disease we may find a patient with an incompetent lip seal at rest. Why could this be a problem?

A
  • This may contribute to drying of their intra-oral mucosa and potentially gingivitis can occur
67
Q

What is a BPE used as?

A
  • A screening tool

- Rapidly guides clinicians to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis

68
Q

What information does a BPE not consider? (2)

A
  • Historical attachment loss

- Bone loss (staging and grading not done)

69
Q

When in children would we use a BPE?

A

In children aged 12-17 years old

70
Q

When would we used a simplified BPE in children?

A
  • In all co-operative children aged 7-11 years old
71
Q

which probe would we use for a BPE?

A

WHO CPITN probe (is this out of date?)

72
Q

How much force should we apply when doing a BPE?

A

20-25g of force application (for both adults and children)

73
Q

Where should a BPE probe be used?

A
  • Inserted parallel to the root surface and walked around the gingival margin
  • Should be coronal to the CEJ
74
Q

Why do we use the simplified BPE for children?

A

Because it has been modified for paediatrics to be:

  • Quick
  • Easy
  • Well tolerated
  • Avoid false pocketing
75
Q

Which teeth are a simplified BPE carried out on? (6)

A

16, 11, 26, 36, 31, 46

76
Q

At what age would you begin to take simplified BPE’s from a child?

A
  • Start at 7 years (permanent teeth only)
77
Q

What does the simplified BPE identify in children?

A
  • Identifies patients who would benefit from further investigation
78
Q

Do we often find periodontal disease where there is primary teeth?

A
  • Periodontal disease rare

- Mobility or gingival suppuration -> refer to a specialist

79
Q

Which BPE codes should we use for patients aged 7-11?

A

0-2

80
Q

Which BPE codes should we use for patients aged 12-17?

A

All BPE codes should be used

- 0-4 and *

81
Q

What does a plaque score of 10/10 mean?

A
  • Perfectly clean tooth
82
Q

What does a plaque score of 8/10 mean?

A
  • Line of plaque around the cervical margin
83
Q

What does a plaque score of 6/10 mean?

A
  • Cervical 1/3 of crown covered
84
Q

What does a plaque score of 4/10 mean?

A
  • Middle 1/3 of crown covered
85
Q

In 12-17 year olds where they are getting BPE scores of codes 3 or 4 what sound be done? (3)

A
  • 6PPC (localised to 3 BPE, or full if 4)
  • Check alveolar bone levels (BW’s for posteriors, periapicals for anterior’s, OPT
  • BPE should always be carried out prior to orthodontic treatment
86
Q

In adolescents when should a BPE always be carried out prior to?

A
  • Prior to orthodontic treatment
87
Q

How can plaque induced gingivitis be treated in children and adolescents?

A
  • Can be managed by good toothbrushing
  • Emphasise the need to systematically clean all surfaces
  • Standard toothbrushing and fluoride advice should be given to all patients
  • Supervised/assisted brushing (up to about 7 years old)
  • Disclosing tablets helpful
  • Fluoride mouthwash (225ppm) should be recommended for patients undergoing fixed appliance therapy
88
Q

What treatment should we give to a child with a BPE score of 0?

A
  • None
89
Q

How frequently should we see a child with a BPE score of 0?

A
  • Screen again at routine recall or within 1 year
90
Q

What treatment should we give a child with a BPE score of 1?

A
  • OHI and prevention

- Can do bleeding/plaque charts

91
Q

How frequently should we see a child with a BPE score of 1?

A
  • Screen again at routine recall or after 6 months
92
Q

What treatment should we give a child with a BPE score of 2?

A

OHI, prevention, scaling, removal of plaque retention factors
- Can do bleeding/plaque charts

93
Q

How frequently should we see a child with a BPE score of 2?

A
  • Screen again at routine recall or after 6 months
94
Q

What treatment should we give a child with a BPE score of 3, 4 or *?

A
  • Full periodontal assessment, radiographs, to establish whether false pocketing or true pocket
  • Scaling, RSD, OHI + prevention
  • Scores of 4 or * - consider referral to specialised periodontologist or paediatric dentist
95
Q

How frequently should we see a child with a BPE score of 3, 4 or *?

A

Treat and review after 3 months

96
Q

What in relation to periodontal diseases is important for optimum treatment outcome?

A
  • Early detection
97
Q

What in children can make periodontal diagnosis more challenging in the mixed permanent dentition?

A
  • False pocketing

BDS3 Paediatric Dentistry (9 decks)

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