Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endemic Oral disease > PAP 3- Periodontal disease and diagnosis > Flashcards

PAP 3- Periodontal disease and diagnosis Flashcards

1
Q

Name the features of healthy gingiva on an intact periodontium.

A
  • Pink
  • Stippled
  • Exhibits a knife-edge margin on the tooth
  • Papillae exactly fill the inter-dental space
  • Lack of bleeding on gentle probing from the base of the pocket.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 distinct areas of gingivae?

A
  1. The Free Gingiva
  2. The Attached Gingiva
  3. The Alveolar Mucosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where do the attached gingiva and alveolar mucosa meet?

A

Mucogingival line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name the features of gingival disease.

A
  • Red
  • Loss of stippling
  • Loss of knife-edge margin on the tooth
  • Papillae either over- or under-fill the inter-dental space
  • Bleeding on gentle probing from the base of the pocket
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what effects if people with poor oral hygiene will get gingival and periodontal disease?

A

susceptibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the precursor of periodontal disease?

A

Gingival disease - all periodontal disease patient have gingival disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is susceptibility?

A
  • People vary greatly in their innate susceptibility (their response as a host to dental plaque) to periodontal diseases
  • Susceptibility is evaluated on an individual basis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is susceptibility determined by relating?

A
  1. the level of periodontal disease (severity) in the mouth to
  2. the patient’s age &
  3. the oral hygiene standard.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the diagnosis and treatment of a young patient with good oral hygiene but severe periodontal disease (high susceptibility) ?

A
  1. Have a poorer periodontal prognosis
  2. Usually require more aggressive treatment
  3. Require shorter recall times.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the diagnosis and treatment of an elderly patient with poor oral hygiene but little periodontal disease (low susceptibility) ?

A
  1. Have a better periodontal prognosis
  2. Usually require only simple treatment
  3. Require longer recall times.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Can we change a patients susceptibility during periodontal treatment?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

why can’t we change a patient susceptibility?

A

The innate susceptibility is at least in part genetically

determined thus it cannot be improved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can susceptibility be worsened?

A

by the presence of risk factors such as some systemic illnesses, some drug therapies and habits such as smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what aims to identify and control risk factors?

A

Periodontal therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Does the amount of plaque present have an effect?

A

• While it is desirable for all patients to exhibit good oral hygiene, it
is not equally necessary for all to do so
• The higher the susceptibility, the better the OH standard needs to
be
• An adequate level of OH is one which is compatible with periodontal health in that patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Do plaque levels tell us about disease severity?

A

Plaque levels in isolation tell you NOTHING about the level of periodontal disease present in a mouth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe an early research study on plaque and gingivitis.

A
  • Cleaned teeth professionally and at home until little plaque and no signs of disease
  • Then they were asked to withdraw OH measures…
  • By day 4 they displayed inflammation
  • Between days 10 and 21 they all displayed gingivitis
  • They then were allowed to resume OH and the gingivitis resolved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What disease is reversible?

A

Gingivitis on an intact peridontium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What occurs in gingivitis?

A 
Signs of inflammation:
• Loss of gingival contour 
• Loss of stippling
• Puffy papillae
• Erythema
• Bleeding on probing (or brushing/flossing)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is loss of attachment?

A

Distance between the cemento-enamel junction (CEJ/ACJ) and the base of the pocket

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe gingivitis on an intact periodontium.

A 
• There is no Loss of Attachment
(LOA)
• Any pockets are ‘false pockets’ 
• This condition is reversible
• No bone loss.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What causes periodontitis?

A
  • calculus build up
  • bone is eroded due to patients immune response
  • now a true pocket, base of pocket is no longer at ACJ ,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe periodontitis.

A 
• There is Loss of Attachment
(LOA)
• The pockets are ‘true pockets’ 
• There is bone loss
• This condition is irreversible
24
Q

What is essential to diagnosing disease?

A

Probing

25
Q

what are the 2 main probes used in clinic?

A
  • WHO probe (used for the basic periodontal examination)

* CP12 (used to measure loss of attachment, pocket depths etc)

26
Q

what are the 5 points evaluated in a clinical examination?

A
  1. Bleeding on gentle probing from the base of the pocket, (bleeding on probing sites are what is recorded in the notes)
  2. Measurement of probing depth (PD)
  3. Measurement of Loss of Attachment (LOA)
  4. MeasurementofToothMobility
  5. Presence of Furcation Involvement
27
Q

what does lack of bleeding on probing (BOP) indicate?

A

a lack of disease activity at that site at that time

28
Q

what pocket depth is maintable by the patient?

A

3mm or less

29
Q

what is the probing depth?

A

distance from the gingival margin to the base of the pocket (mm)

30
Q

What is the distance for loss of attachment?

A

distance from the amelo- cemental junction to the base of the pocket (mm).

31
Q

what occurs if probing (pocket) depth is not maintainable?

A

Loss of attachment (& bone loss) Periodontitis

32
Q

Probing depth can be greater or smaller than what?

A

loss of attachment

33
Q

What are the degree of miller’s index use to measure tooth mobility?

A
  • Degree 0 = Horizontal movement up to and including 0.2mm considered physiological movement
  • Degree 1 = Horizontal movement of >0.2mm but <1mm.
  • Degree 2 = Horizontal movement of >1mm
  • Degree 3 = Movement in both horizontal and vertical planes.
34
Q

what teeth are measured for furcations?

A
  • Measure horizontally
  • Lower molars (buccal and lingual
  • Upper molars (buccal, MP and DP)
  • Upper 4s (Mesial and distal
35
Q

What are the 3 grades of furcation?

A
  • Grade1–probe goes in upto 1/3way
  • Grade 2 – probe goes in >1/3 way
  • Grade 3 –through and through defect
36
Q

what can be used for further investigation for periodontitis after clinical examination?

A

Radiographic examination

37
Q

what does the clinical examination that precedes radiographic examination allow an informed decision about?

A
  1. Whether radiographs are required
  2. Which radiographs are required
    Radiographic findings must be reported, in signed, dated patient records.
38
Q

what can radiographic examination be used to look for?

A
  • Bone Loss :– severity, pattern and distribution
  • Caries:- primary & secondary
  • Overhangs/Deficiencies
  • Calculus
  • Unerupted/Impacted Teeth
  • Peri-radicular Involvement
  • Suggestion of Furcation Involvement.
39
Q

what are the 2 types of bone loss pattern?

A
  • horizontal

- vertical (angular) (more severe)

40
Q

what are the 2 types of true pockets?

A
  • suprabony

- infrabony

41
Q

what are the disadvantages of radiographs in periodontal diagnosis?

A
  1. Superimposition –‘tooth on tooth’, ‘tooth on bone’ and ‘bone on bone’
  2. Underestimation of bone loss
  3. No indication of:
    i. duration/
    ii. activity of disease or
    iii. pocket depth/
    iv. loss of attachment or
    v. mobility as only hard tissue changes are seen
  4. Interpretation of small changes is difficult (Digital subtraction radiography could be used)
  5. Exposure to radiation
42
Q

Describe the diagnosis of gingival disease.

A
  • Gingival disease may be on an intact or reduced periodontium :
  • Pockets are maintainable by patient (<3mm)
  • More than 9% sites bleeding on probing (4 sites per tooth)
  • May be localised (10%<30%) or generalised (>30%)
43
Q

Describe the diagnosis of periodontal disease.

A
  • Pockets are not maintainable by patient (>4mm)
  • Radiographic bone loss
  • Maybe localised (30%)or generalised(>30%)
  • Maybe Stage I,II , III ,or IV
  • Maybe Grade A, B or C(depending on rate and risk of progression)
  • Can be stable or unstable or in remission
44
Q

what is the future of diagnosis?

A

Genetic testing is possible using the PST System from Medical Science Systems

45
Q

what is needed when patients develop mild disease?

A

some patients develop mild disease which will respond well to simple treatment and has a good prognosis

46
Q

what is needed when patients develop more severe disease?

A

Some develop more severe disease which requires aggressive treatment and has a poorer prognosis

47
Q

what initiate periodontal diseases?

A

bacteria

48
Q

what is desirable?

A

To know who will develop mild or severe disease

49
Q

What does not explain different disease experience?

A

Qualitative and quantitative studies of bacteria

50
Q

what can some markers of host immune-inflammatory response correlate?

A

correlate with disease once it has been initiated, but cannot predict individual disease susceptibility or disease course.

51
Q

Would prediction be valuable?

A
  • If prediction was possible, this would allow identification of patients requiring close monitoring and/or aggressive therapy before significant destruction had taken place
  • Target resources towards susceptible patients?
52
Q

what is the basis of the test?

A
  • The cytokines TNF and IL-1 are key mediators of the inflammatory process and modulate the extra-cellular matrix components and bone which comprise the periodontal tissues
  • Gene polymorphisms are a mechanism by which individuals may exhibit variations within the range of normal.
  • Several genetic polymorphisms of the IL-1 cluster have been identified and associated with increased severity of several chronic inflammatory diseases of which periodontitis is one
  • It is thought that affected individuals have a more vigorous immuno- inflammatory response to bacterial challenge, and this leads to more severe periodontitis.
53
Q

what is the test?

A
  • Finger-stick blood samples are collected on DNAase-free blotting paper and sent to USA for analysis
  • Cost is ~ $100
  • Only needs to be taken once in a life-time
54
Q

How effective were the results using the test?

A
  • Study by Kornman et al (1997) showed that individuals carrying the particular IL-1 genotype are 7-19x more likely to develop severe periodontitis
  • Predictive value greatest for non-smokers aged 40-60
  • Obscured in smokers suggesting smoking effect is strong enough to be seen in patients not genetically pre- disposed to the disease
55
Q

what were the results using the test?

A
  • Results also showed that 86% of patients over all age groups with severe periodontitis were either smokers or carried the important IL-1 genotype
  • In the 40-60 year age group, 84% with mild disease were genotype negative
  • Recent studies have not had the same results. The results of the test may be population sensitive.
56
Q

Is it the future of genetic testing for susceptibility?

A
  1. How should such a test be used?
  2. If an individual tests genotype positive will their management be any different?
  3. Are there ethical issues around genetic testing? Especially around the links with other inflammatory diseases and medical insurance

Endemic Oral disease (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions