Paediatrics: Periodontology Flashcards
What are features of periodontal health in children?
- absence of gum inflammation and calculus
- no more than one sextant with plaque
- gingival margin several mm coronal to the CEJ
- gingival sulcus 0.5-3mm on a fully erupted tooth
- in teenagers the alveolar crest is situated 0.4-1.9mm apical to CEJ
- BOP <10%
What occurs to the gingivae during gingivitis?
- plaque accumulates on teeth (large number of bacteria) and inflammatory cells accumulate
- this causes inflammation of the gingivae and the junctional epithelium is disrupted
- allows apical migration of plaque and an increase in gingival sulcus depth
When can gingivitis occur in a reduced periodontium patient?
- successfully treated periodontitis patient
- root lengthening
Name the sub-classifications of gingival diseases and conditions that are non-dental biofilm induced?
Genetic/Developmental disorders
Specific infections
Inflammatory and immune conditions and lesions
Reactive processes
Neoplasms
Endocrine
Nutritional and metabolic diseases
Traumatic lesions
Gingival pigmentation.
What is the microbial aetiology of necrotising gingivitis?
fusiform spirochaetal
What is the socioeconomic factors of necrotising gingivitis?
developing countries
what are the modifiable risk factors of necrotising gingivitis?
- smoking
- immunosuppression
- stress
- malnourishment
- poor diet
- diabetes
- pharmaceutical drugs (cyclosporin, calcium channel blockers)
What are the local risk factors of necrotising gingivitis?
- root proximity
- tooth malposition
- dental trauma
- orthodontic appliances
- overhangs
- tooth anatomy
- incompetent lip seal
What are the systemic non -modifiable risk factors of necrotising gingivitis?
- HIV positive
- underlying undiagnosed pathology in a immunosuppressed host
- haematological conditions (leukaemia)
- increase in sex steroids (period/pregnacy)
- genetics, age
What are the features of necrotising gingivitis?
- pain
- punch out gingivae
- ulceration
- spontaneous bleeding
- halitosis
- pseudomembrane may be present
- fever
What are the treatment options for gingival overgrowth?
- rigorous home care
- frequent appointments for professional mechanical plaque removal (PMPR)
- +/- surgery, especially with drug-induced gingival overgrowth
If an extent of a patients condition is inconsistent with level of oral hygiene observed and have unexplained bleeding, gingival enlargement, inflammation and tooth mobility what should you do?
consider urgent referral to a physician and haematinic screening
What are the 4 main distinguishing features of periodontitis?
- apical migration of the junctional epithelium
- loss of attachment of PDL to bone
- transformation of junctional epithelium to pocket epithelium
- alveolar bone loss
What is early clinical signs of periodontitis in teenagers classified as?
1mm loss of attachment
What pathogens can be found in the subgingival flora of teenagers with periodontitis?
- similar to adults
- p. gingivalis, p. intermedia, T. forsythia
What do you need to consider when taking BPE around erupting permanent dentition?
false pocketing
What are the features of molar-incisor periodontitis in adolescents?
- rapid attachment loss and bone destruction
- patient is otherwise healthy
- onset at puberty
- family history
- Caucasians and African ancestry
What teeth does localised molar-incisor periodontitis usually effect?
incisors and first permanent molars
What teeth does generalised molar-incisor periodontitis usually effect
- Traditionally > or = 3 permanent teeth other than the incisors and first molars
What things are you looking for when assessing gingival condition?
- contour
- recession
- bleeding
- suppuration
- swelling
- gingival colour
- inflammation
How would you asses oral Hygiene status on a patient?
- look for visible plaque or plaque on probing
- score (modified plaque and bleeding chart)
What 4 things would you look at when recording and diagnosing periodontal disease?
- gingival condition
- oral hygiene (plaque)
- calculus present
- local risk factors
What type of tool is a BPE?
screening tool- helps to aid in diagnosis and any special test/further investigations needed
What does a BPE not consider?
- bone levels
- historical attachment loss
What age would you start doing a BPE on children and how would you do it?
- all co-operative patients from 7-18 years
- only use 6 teeth (all 6s and UR central and LL central)
- insert parallel to the root surface and walk around margins
What force should be applied when using a BPE probe?
20-25g
What BPE codes would you use for 7-11 year olds?
0-2
What BPE codes would you use for 12-18 year olds?
0-4*
How would you carry out a plaque score on children according to the SDCEP guidelines?
- record worst tooth in each sextant
- run probe over crown of tooth
- 10/10 no plaque
- 8/10 cervical plaque
- 6/10 a 1/3 of crown covered
- 4/10 middle 1/3 of crown covered
When would you next screen your patient if they scores BPE of 0 or 1?
1 year at next recall visit
When would you next screen your patient if the scored a BPE of 2?
6 months
When would you next screen your patient if the scored BPE of 3?
3 months
What are 3 basic treatments you would give to your patient with BPE score 1-4?
- preventative advice
- health education
- oral hygiene instruction
What are the 4 steps in the treatment guidelines for periodontitis?
step 1 - Building foundations for optimal treatment outcomes
Step 2 - Cause related therapy
Step 3- Management of non responding sites (BoP >4mm or sites >6mm)
Step 4 - Supportive periodontal care (maintenance)
What is the treatment in Step 1 of periodontitis?
- OHI and DHE
- control risk factors
- PMPR (supragingival)
- adjunctive therapies for gingival inflammation
What is the treatment in Step 2 of periodontitis?
- sub gingival PMPR
- use of physical or chemical agents
What is the treatment of periodontitis in Step 3 of the guidelines?
Aims to gain access to further subgingival instrumentation or to achieve regeneration or resection in lesions (infrabony or furcation) that increase complexity in managing periodontitis.
What is the treatment of periodontitis in step 4 of the guidelines?
Aims to maintain periodontal stability in all treated periodontitis patients. Combines preventive/therapeutic interventions from Steps 1 and 2. Regular recall intervals are needed, tailored to patient’s individual needs. Recurrent disease to be managed with updated diagnosis and treatment plan. Compliance with OHI/ healthy lifestyle are integral.
When would you refer a periodontitis patient to a specialist?
- stage 2/3 perio not responding to treatment
- Grade C or stage 4 perio
- MH that significantly affects perio treatment or requiring multi disciplinary care
- periodontitis as a direct manifestation of systemic disease
- systemic/genetic disease that can effect periodontal supporting tissues
- root morphology that adversely affecting prognosis on key teeth
- non -plaque induced conditions requiring specialist care
- cases requiring diagnosis/management or rare/complex clinical pathology
- drug-induce gingival overgrowth requiring surgery
- ## cases requiring evaluation for periodontal surgery
