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BDS2 PER > PER02-2004 > Flashcards

PER02-2004 Flashcards

1
Q

What is periodontology?

A

Study of the periodontium in health and disease

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2
Q

What are the four main tissues that form the periodontium?

A

Cementum

Periodontal ligament

Alveolar bone

Gingiva

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3
Q

What is the number 1 cause of tooth loss?

A

Periodontitis

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4
Q

What do healthy gingivae look like?

A

Pale pink and even colour

Scalloped appearance (gumline)

Flat, sharp, knife-edge, triangular interdental papillae

(Stippling of attached gingiva in ~30% of people)

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5
Q

What are the clinical signs of gingivitis?

A

Erythema/redness

Oedema/swelling

Bleeding on probing or brushing

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6
Q

Which of gingivitis and periodontitis is irreversible?

A

Periodontitis

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7
Q

What are the clinical signs of periodontitis?

A

Those seen in gingivitis as well as:

Pocket formation

Tooth mobility

Gingival recession

Tooth drifting

Halitosis

Tooth loss

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8
Q

Define periodontal disease.

A

Bacterially-induced, immune-mediated inflammatory disease of the tissues supporting the teeth

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9
Q

What is the primary aetiological factor in periodontal disease?

A

Plaque

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10
Q

What are the necessary prerequisites for periodontal disease initiation and progression?

A

Virulent periodontal pathogens

Local environment (favouring these pathogens)

Host susceptibility

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11
Q

How many micro-organisms can be found in the oral cavity?

A

> 700 species (multi-kingdom)

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12
Q

On what surfaces does dental plaque form?

A

Hard, non-shedding surfaces in the mouth

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13
Q

What factors might affect the growth of microbes in the mouth?

A

Temperature

Redox potential/oxygen tension

pH

Nutrient availability

Host defence

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14
Q

Name some resident bacteria in the mouth.

A

Streptococcus (most prevalent)

Actinomyces

Eubacteria

Lactobacillus

Neisseria

Veillonella

Haemophilus

(and many more)

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15
Q

What is the most common fungal genus in the mouth?

A

Candida

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16
Q

What is the difference between planktonic and sessile growth?

A

Planktonic = floating in saliva

Sessile = attached to a surface

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17
Q

Define dental plaque.

A

Biofilm

Complex microbial community that develops on the hard, non-shedding surfaces in the mouth, embedded in a matrix of polymers of bacterial and salivary origin

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18
Q

What is the difference in nutrients for supragingival and subgingival plaque?

A

Supra = nutrients from diet/saliva, carbohydrates mainly

Sub = nutrients from gingival crevicular fluid, proteins mainly

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19
Q

What are plaque-retentive factors?

A

Secondary local factors

Increase surface area for plaque and are usually hard to clean so increase risk of periodontal diseases

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20
Q

Give an example of a plaque-retentive factor.

A

Calculus

Restoration defects or overhangs

Lack of saliva/xerostomia

Tooth position, shape/abnormalities

Gingival anatomy

Removable prostheses

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21
Q

What kind of patients may have xerostomia?

A

Mouth breathers, incompetent lips

Those taking polypharmacy

Those with certain conditions, eg Sjogren’s syndrome

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22
Q

What are the key systemic factors affecting periodontal disease?

A

Smoking

Diabetes

Pregnancy

Medication

Genetics

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23
Q

How does smoking affect periodontal disease?

A

More likely to:

  • develop periodontitis
  • develop periodontal pockets
  • experience greater bone loss
  • lose teeth

Masks gingivitis/bleeding and impairs healing

Decreases efficacy of/response to treatment

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24
Q

How does uncontrolled diabetes affect periodontal disease?

A

Poor glycaemic control increases the risk of periodontal disease and its progression

Impairs the immune response and wound healing

Increases risk of recurrent/multiple periodontal abscesses

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25
Q

How does pregnancy affect periodontal disease?

A

Increases gingival response to plaque and increases gingival blood flow

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26
Q

Which drug groups may cause drug-induced gingival overgrowth?

A

Calcium channel blockers (hypertension, eg nifedipine/amlodipine/felodipine)

Phenyltoin (epilepsy)

Ciclosporin (immunosuppressant)

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27
Q

Why might a patient be taking calcium channel blockers?

A

Hypertension

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28
Q

Why might a patient be taking phenyltoin?

A

Epileptic

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29
Q

The lack of which immune cell is most detrimental in periodontal disease?

A

Neutrophils/PMNs

30
Q

Give examples of some hereditary neutropenic conditions.

A

Papillon Lefevre syndrome

Chediak-Higashi syndrome

Leukocyte adhesion syndrome

31
Q

What is epidemiology?

A

Study of distribution of disease/physiological condition in human populations and the factors that influence it

32
Q

What is descriptive epidemiology?

A

Description of the distribution of a disease in different populations

33
Q

What is aetiological epidemiology?

A

Considers the aetiology of a disease from the combination of the descriptive epidemiological data along with other information (eg genetics, microbiology, sociology)

34
Q

What is analytical epidemiology?

A

Evaluation of the consistency of epidemiological data with hypotheses developed clinically or experimentally

35
Q

What is the point of experimental epidemiology?

A

Provides a basis for developing and evaluating preventative programmes and public health practices

36
Q

What is the importance of epidemiology in periodontal disease?

A

Helps us to determine:

  • the impact of the disease
  • any aetiological factors
  • treatment needs and effects
37
Q

What are the issues with periodontal disease epidemiology?

A

Periodontal disease has a gradual onset and varies widely in severity

Periodontal disease is “site-specific”

Have to take partial recordings instead of full assessments for practicality (so may miss disease)

No universally agreed standards for defining its stages

No set parameters to measure

Hard to collect data in community settings (outside of dental practice)

38
Q

What does “incidence” mean?

A

Number of new cases per year (in a population)

39
Q

What does “prevalence” mean?

A

Total number of cases (in a population)

40
Q

Why is probing depth insufficient for measuring periodontal disease?

A

Must measure attachment loss so must consider recession (esp in elderly)

Also need to measure extent/number of teeth affected

41
Q

Why does the Adult Dental Health Survey most likely underestimate the amount of periodontal disease in a population?

A

Only uses partial mouth recordings

Not always conducted in the dental practice

42
Q

Describe the epidemiology of gingivitis.

A

Highly prevalent in adults >60%

Associated with levels of plaque

43
Q

Describe the epidemiology of periodontitis.

A

Mild-moderate periodontitis = 20-35% of pop.

Severe periodontitis = 10-15% of pop.

44
Q

What did the Natural History of Periodontal Disease in Man - Loe et al., 1986 study show?

A

(Parallel cohort longitudinal study)

In populations both educated and uneducated in oral hygiene practices, a similar pattern of periodontal disease is present

Most people will have moderate susceptibility to periodontal disease, but a small proportion will be either low or high susceptibility (bell-curve)

Some people have a resistance to periodontal disease even in the presence of poor plaque control

45
Q

What are the features of a low risk periodontal disease patient?

A

Little/no bone loss

Periodontal inflammation with no pocketing

Keep teeth until old age

46
Q

What are the features of a normal risk periodontal disease patient?

A

Slowly progressing periodontal disease

Associated with poor plaque control

Risk of some tooth loss with advancing age

Horizontal bone loss

47
Q

What are the features of a high risk periodontal disease patient?

A

Severe periodontal disease at an early age

Severe periodontal disease even with good plaque control

Risk of tooth loss by age 40

Irregular bone loss

48
Q

Describe the WHO probe.

A

0.5mm ball end

Black band from 3.5-5.5mm and 8.5-11.5mm

49
Q

What is the BPE?

A

Screening tool to give a provisional periodontal diagnosis

gives an insight into treatment needs

50
Q

What are the sextants in a BPE?

A

7-4, 3-3, 4-7 on both arches

51
Q

What leads to a code 0 BPE?

A

Health

No bleeding on probing, no calculus/overhangs

Black band is fully visible

52
Q

What leads to a code 1 BPE?

A

Bleeding on probing

Black band is fully visible

No calculus/overhangs

53
Q

What leads to a code 2 BPE?

A

Bleeding on probing

Black band is fully visible

Presence of calculus/overhangs

54
Q

What clinical sign shows localised gingivitis?

A

Bleeding on probing 10-30%

55
Q

What clinical sign shows generalises gingivitis?

A

Bleeding on probing >30%

56
Q

What is a reduced periodontium?

A

Stable/successfully treatment periodontitis (gums have receded due to attachment loss)

57
Q

What is the key feature of an intact periodontium?

A

No probing attachment loss

58
Q

What are the parts of a gingivitis diagnosis?

A

Extent of bleeding on probing (inflammation level)

Intact or reduced periodontium (attachment loss)

59
Q

Which BPE codes need radiographs? What feature is essential in these images?

A

Codes 3 and 4

Crestal bone levels

60
Q

What leads to a code 3 BPE?

A

Bleeding on probing

May or may not have calculus/overhangs

Black band partially covered

61
Q

What leads to a code 4 BPE?

A

Bleeding on probing

May or may not have calculus/overhangs

Black band fully covered

62
Q

What are the possible disease extent patterns for periodontitis?

A

Localised = <30% of teeth

Generalised = >30% of teeth

Molar-incisor pattern

63
Q

How is the staging of periodontitis calculated?

A

Periapical radiograph

Bone loss as a percentage of root length of the worst affected tooth

64
Q

What is staging of periodontitis?

A

Severity, how much bone loss has occurred

65
Q

What are the levels of staging in periodontitis?

A

Stage 1 (early/mild) = <15%

Stage 2 (moderate) = 15-33% (coronal third)

Stage 3 (severe) = 33-66% (middle third)

Stage 4 (very severe) = >66% (apical third)

66
Q

What is grading of periodontitis?

A

Rate of progress, susceptibility

67
Q

How is grading of periodontitis calculated?

A

Percentage bone loss of worst affected tooth ÷ age

68
Q

What are the levels of grading in periodontitis?

A

Grade A (slow) = <0.5

Grade B (moderate) = 0.5-1

Grade C (rapid) = >1

69
Q

What probing pocket depth suggests currently unstable periodontitis?

A

5mm

70
Q

What is the difference between currently stable and currently in remission diagnoses?

A

Currently stable has <10% BoP

Currently in remission has >10% BoP

(both have pocket depths ≤4mm)

BDS2 PER (4 decks)

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