Perio 1 Final (2nd half) Flashcards
1
Q
CAL
A
Measured pocket (probe depth) + visible recession below CEJ
2
Q
Fuchsia-colored erythrosine sodium solution
A
Plaque disclosing agents
3
Q
Visual aid for patients to see plaque build up
A
Plaque disclosing agents
4
Q
What drugs are associated with gingival enlargements (hyperplasia)?
A
- Calcium channel blackers (Nifedipine & Diltazem)
- Anticonvulsants (phenytoin)
- Immunosuppressants (cyclosporin)
5
Q
A tooth brush should have a ______ ______ head (about ________ in size for adults).
It should have ____, _______, ________ bristles, usually in ____ rows.
A
relatively small; 1-1.25 inches
soft nylon, multitufted, polished; 3
6
Q
The force of which bristles are applied to the tooth should not exceed
A
300-400g
7
Q
Effective toothbrush technique, ESPECIALLY for patients with ginigivitis & periodontitis
A
Modified Bass technique
8
Q
Describe the Modified Bass technique
A
Bristles at 45 degree angle, small vibratory/circular motions (known as sulcular brushing).
9
Q
Natural vs. Synthetic toothbrush bristles
A
Natural bristles = contain gaps that bacteria can colonize; don’t have rounded ends, which can cause lesions to the gingiva.
Synthetic bristles = have end-round filaments that reduce the damage to gingiva.
10
Q
Describe the Modified Stillman method
A
Vertical, Rotary brushing
A series of brush movements repeated 5-10 times in the same area
11
Q
When is vertical brushing indicated?
A
- Overlapped teeth
- Open interproximal areas
- Areas of recession
12
Q
Describe the Fones method of brushing
A
Max teeth closed, circular motion from max gingiva to mand gingiva
13
Q
Where is toothbrush trauma most frequently seen?
A
Facial surfaces of canines & premolars
14
Q
What is the purpose of interdental care?
A
Remove plaque, NOT food debris.
15
Q
Where does disease originate in the mouth?
A
Interproximal areas
16
Q
What dictates the effectiveness of dental floss?
A
The anatomy of the tooth (areas might be missed due to shape of the tooth)
17
Q
Which classification of gingival disease?
- Older classification system of gingivitis vs. periodontits based on probing depth (NOT attachment loss)
- Didn’t account for many systemic health considerations
- Had the term “refractory periodontitis”
A
Pre-Armitage
18
Q
Which classification of gingival disease?
- Gingival disease classification system that is based primarily on attachment level/loss
- Didn’t account for many systemic health considerations
A
Armitage
19
Q
Which classification of gingival disease?
- Oncology model
- Has stage and grade
A
Current
20
Q
In the new periodonal classification system, does the stage or grade improve with periodontal treatments?
A
The grade can improve with treatment and better oral hygiene, but the stage will never improve (can get worse).
21
Q
What does periodontal staging classify? What is it based off of?
A
Severity/extent of disease
Based off measurable data (helps assess complexity)
22
Q
How many stages are there in periodontal staging?
A
4
23
Q
What are the 4 stages of periodontal staging based on?
A
Severity, complexity, and extent/distribution
24
Q
What do “interdental CAL”, “RBL”, and “tooth loss” fall under for staging of perio?
A
Severity
25
What does "local" fall under for staging of perio?
Complexity
26
What does "add to stage as descriptor" fall under for staging of perio?
Extent/distribution
27
Interdental CAL, RBL, tooth loss of Stage I perio
Interdental CAL = 1-2 mm
RBL = coronal third (<15%)
Tooth loss = none
28
Local effects (complexity) of Stage I perio
Max probing depth < than or = to 4mm
Mostly horizontal bone loss
29
Interdental CAL, RBL, tooth loss of Stage II perio
Interdental CAL = 3-4mm
RBL = coronal third (15-33%)
Tooth loss = none
30
Local effects (complexity) of Stage II perio
Max probing depth < than or = to 5mm
Mostly horizontal bone loss
31
Interdental CAL, RBL, tooth loss of Stage III perio
Interdental CAL = > than or = to 5mm
RBL = extending to middle third of root & beyond
Tooth loss = < than or = to 4 teeth
32
Local effects (complexity) of Stage III perio
Probing depths > than or =to 6mm
Vertical bone loss > than or = to 3mm
Furcation involvement (class II/III)
Moderate ridge defects
33
Interdental CAL, RBL, tooth loss of Stage IV perio
Interdental CAL = > than or = to 5mm
RBL = extending to middle third of root & beyond
Tooth loss = > than or = to 5 teeth
34
Local effects (complexity) of Stage IV perio
Complex rehab needed
Masticatory dysfunction
Secondary occlusal trauma (tooth mobility degree >2)
Severe ridge defects
Bite collapse, drifting, flaring
<20 remaining teeth
35
What are things you would add to the stage of perio as a descriptor?
For each stage, describe extent as one of the following:
Localized (<30% of teeth involved)
Generalized
Molar/incisor pattern
36
What is periodontal staging used to indicate?
The rate of periodontitis progression, responsiveness to therapy, and potential impact on systemic health.
37
How many grades are there in periodontal staging?
3 (A-C)
38
Describe the 3 grades of periodontal staging
Grade A = slow
Grade B = moderate
Grade C = rapid
39
What are the 2 things grading for perio is based on?
Primary criteria
Grade modifiers
40
What does "direct and indirect evidence of progression" fall under when grading for perio?
Primary criteria
41
What is included under "direct and indirect evidence of progression"?
Direct = RBL or CAL
Indirect = % bone loss and case phenotype
42
What does "risk factors" fall under when grading for perio?
Grade modifiers
43
What is included under "risk factors"?
Smoking
Diabetes
44
What is the RBL/CAL, % bone loss, and case phenotype for Grade A perio?
RBL/CAL = no loss over 5 yrs
% bone loss = <0.25
Case phenotype = heavy biofilm w/ low levels of destruction
45
What are the smoking and diabetes risk factors for Grade A perio?
Smoking = non-smoker
Diabetes = normoglycemic (no diagnosis of diabetes)
46
What is the RBL/CAL, % bone loss, and case phenotype for Grade B perio?
RBL/CAL = <2mm over 5 yrs
% bone loss = 0.25 - 1.0
Case phenotype = destruction commensurate w/ biofilm
47
What are the smoking and diabetes risk factors for Grade B perio?
Smoking = <10 cigs/day
Diabetes = HbA1c < 7.0%
48
What is the RBL/CAL, % bone loss, and case phenotype for Grade C perio?
RBL/CAL = greater than or equal to 2mm over 5 yrs
% bone loss = >1.0
Case phenotype = destruction exceeds expectations given biofilm; specific clinical patterns suggestive of periods of rapid progression/early onset disease
49
What are the smoking and diabetes risk factors for Grade C perio?
Smoking = greater than or equal to 10 cigs/day
Diabetes = HbA1c greater than or equal to 7%
50
What does the initial exam determine?
Diagnosis
Tx plan
Prognosis
51
What is included in the exam/data collection of the initial exam? (6)
1. Medical hx
2. Chief complaint
3. Dental hx
4. Radiographs
5. Extra-oral exam
6. Intra-oral exam
52
What % of pateints at dental schools require medical consultation?
25%
53
What are the 4 categories of periodontal health?
1. Pristine periodontal health
2. Clinical periodontal health
3. Periodontal disease stability
4. Periodontal disease remission/control
54
How would you describe this patient?
-absence/minimal levels of clinical inflammation
-normal osseous support
-CAL exists, but due to predisposting factors (recession, fenestrations, toothbrush abrasion)
-NOT due to active periodontal disease activity
Clinical periodontal health
55
How would you describe this patient?
-absence of inflammation & infection (reduction in predisposing factors and control of modifying factors)
-reduced periodontium
-the goal of perio patients
Periodontal disease stability
56
How would you describe this patient?
-Cannot fully control modifying/predisposing factors
-decreased inflammation
-improved clinical parameters
-stabilization of disease progression to low disease activity
-an acceptable alternative threapeuting goal in long-standing perio disease patients
Periodontal disease remission/control
57
Health vs. Stability
Health= minimal recession w/out pre-existing active perio disease
Stability= healthy state of a patient with previous perio disease (has attachment loss)
58
How would you describe this patient?
Absence of :
-attachment loss
-BOP
-Clinical erythma, edema, & pus
-pocket depths greater than 3mm
Pristine clinical health
59
What cells are increased in the initial lesion of healthy gingiva (clinically)?
neutrophils
60
What cells are increased in early lesions of clinically evident early gingivitis?
T lymphocytes
61
What cells are increased in established lesions of established chronic gingivitis?
Plasma cells
*note, NO appreciable bone loss*
62
What cells are increased in advanced lesions (the transition from gingivits to periodontitis)?
Cytopathically altered plasma cells
63
Gingivitis is associated with ___________ __________.
It is mediated by _______ or ______ factors.
What external factor can influence gingival hypertrophy?
dental biofilm
systemic; local
medications
64
Plaque-induced gingivitis is exacerbated by ______ __________ ____________
sex steroid hormones (puberty, menstrual cycle, pregnancy, oral contraceptives)
65
Vascular epulis (tumor); almost exclusively in pregnant women
Pyogenic granuloma
66
A tiny cluster of WBCs and other tissue; non-cancerous
Granulmona
67
Leukoplakia (often associated w/tobacco use) and Erythroplakia
Pre-malignant neoplasms
68
Squameous cell carcinoma, Leukemic cell infiltration, and Lymphoma (Hodgkins & Non-Hodgkins)
Malignant neoplasms
69
When probing, when the gingival margin appears at a level between prob marks, do you read the higher or the lower mark as the measurement?
The higher mark
70
When charting in axium, if the pocket depth is 3mm and there is no sign of attachment loss, what value should you enter for the gingival margin?
-3 (put the negative value of the pocket depth)
71
When charting in axium, if the pocket depth is 5mm but the gingiva is inflamed and the gingival margin is above the CEJ (toward the crown), what value should you enter for the gingival margin?
Assume -2mm so that the pocket depth is at 3mm
72
When charting in axium, if the pocket depth is 4mm and the gingiva is located at the CEJ (can see black triangles), what value should you enter for the gingival margin?
0mm (reflects 4mm of attachment loss)
73
The instrumentation of the crown & root surfaces to remove plaque, calculus, & stains w/out removing tooth substance
Scaling
74
The removal of cementum & surface dentin that's impregnated w/calculus.
Objective= produce a smooth, hard, clean surface.
Root planing
75
Why is root planing necessary?
Calculus becomes embeded in the irregularities of the cementum, thus it needs to be removed & a smooth surface established
76
Indications for SRPs (4)
1. Inflamed, bleeding, edematous gingival tissues
2. Gingival hyperplasia
3. 4mm+ pockets
4. Plaque, calculus, diseased cementum, endotoxins
77
SRP results (5)
1. decreased inflammation & edema
2. decreased pocket depth
3. improved tissue tone
4. smoother root surface
5. decreased bacteria, plaque, and calculus
78
Subgingival calculus vs. Supragingival calculus
Subgingival = harder & more tenacious; removed in an open or closed surgical procedure
79
Does gingival curettage add any benefit to healing from SRPs?
No
80
For pocket depths >5mm, what is the success in total removal of calculus?
Failure of total removal of calculus dominates
81
What are the side effects of SRPs?
Increases sensitivity to air, tactile, and thermal stimuli
(It exposed the dentinal tubules, which exposes the dentin to irritants that can cause pain)
82
How long should you wait before scheduling a re-evaluation for SRP patients?
4-6 weeks
83
Healing after SRPs:
What happens immediately after (2-8 hrs) root planing?
1. Blood clot fills the gingival sulcus
2. Hemorrhagine within tissue
3. Appearance of PMNs leukocytes on the wound surface
84
Healing after SRPs:
8-24 hours after, what is the clinical appearance?
Gingiva appears hemorrhagic & bright red
85
Healing after SRPs:
2-7 days after what occurs?
1. Restoration & epithelialization of the sulcus (*note, this is keratinized epithelium*).
2. Reduction in the height of the gingival margin.
3. Gingiva is slightly redder than normal, but less so than the previous days.
86
Healing after SRPs:
After 2 weeks:
1. Gingiva regains normal color, consistency, surface texture, and contour
2. Gingival margin is well adapted to the tooth
3. Appearance of immature collagen
87
Healing from SRPs results in the formation of what?
Long junctional epithelium
(sometimes the long JE is interrupted by islands of CT attachment)
88
Antiseptic mouthwash that kills germs & destroys their protective coverings; can be used to prevent plaque; can be used prior to using a Cavitron
Chlorhexidine/Peridex
89
Side effects of Chlorhexidine/Peridex
Increased calculus formation
Staining
Altered taste
90
Chlorhexidine/Peridex works due to
Substantivity (it remains on the pellicle & works for an extended period of time)
91
When is periodontal surgical intervention indicated after SRPs?
1. Consistently acceptable levels of oral hygiene
2. A number of gingival sites are still BOP
3. Significant reduction in probing depths has NOT been achieved
92
When should a patient NOT be considered an acceptable candidate for periodontal surgery after SRPs?
1. Poor oral hygiene
2. Lack of motivation/ability to exercise proper home care
93
When does a patient NOT require further perio treatment (other than routine maintenance)? (4)
1. Acceptable oral hygiene
2. No gingival inflammation or BOP
3. Probing depths significantly reduced
4. Clinical attachment levels have improved
94
Any patient with probing depths of ______ or greater should be referred to a periodontist
6mm
95
In private practice, Stage ____ or _____ and Grade ___ perio patients should be IMMEDIATELY referred to a periodontitis.
III; IV; C
96
Which phase?
1. Elimination of active disease
2. Goal is to reduce gingival inflammation and reduction of pocket depth through reduction of swelling
Phase I therapy
(aka Hygienic Phase)
97
Which phase of therapy includes the following?
1. OH instructions
2. Prophy or SRP
3. Antimicrobial agents
4. Extraction of hopeless teeth
5. Caries control
6. Endo tx
Phase I therapy
98
Ideal goals of treatment of periodontitis
1. Form new attachment
2. Regeneration of lost structures (alveolar bone, PDL, cementum, surrounding tissues)
*note that there isn't "regeneration" after an SRP, but there is healing with the long junction epithelium*
99
Healing of a wound by tissue that does not fully restore architecture or function of the part
Repair
100
Reproduction or reconstitution of lost or injured part
Regeneration
101
The union of CT and epithelium w/root surface that was deprived of its original attachment
New attachment
102
Reunion of epithelium w/root surface & bone after incision/injury
Reattachment
103
What instruments are used for SRPs?
Hand instruments and ultrasonic instruments
104
What are the actions of ultrasonic scalers?
1. Allows for rapid removal of calculus
2. Mechanical
3. Cavitation (formation & collapse of bubbles by high-frequency waves surrounding ultrasonic tip)
4. Irrigation (therapeutic washing of the pocket & root surface)
105
________ are released from Gram negative bacterial cell walls and is toxic to humans.
Release from bacteria covering the cementum triggers the _______ ________.
______ penetrated deeply into the cementum and are held w/in calculus not removed during instrumentation.
Lipopolysaccharides
Immune response
Endotoxins
106
Prior to instrumentation of subgingival area, what microorganisms dominate?
What microorganisms dominate after SRPs?
Before: gram -, anaerobic, motile bacteria
After: gram +, aerobic, non-motile bacteria
107
Why are perio maintenance recall exams every 3-4 months?
Anaerobic bacteria will become more active and need to be removed
108
Contraindications of Ultrasonic instruments (10)
1. Certain pacemakers
2. Communicable diseases
3. Medically compromised patients
4. Patients at respiratory risk
5. Patients with swallowing difficulty
6. Titanium implants
7. Some restorative materials (porcelain, composite, laminate veneers)
8. Areas of demineralization
9. Hypersensitive teeth
10. Kids w/mixed dentition
109
Which ultrasonic tip?
Reaches all accessible surfaces
MOST effective on buccal & lingual surfaces of all teeth and interproximal surfaces of anteriors
Universal (Straight) tip for ultrasonic scalers
110
This ultrasonic tip is used for:
1. Interproximal surfaces of posteriors
2. Furcations
3. Mispositioned molars
4. Concave surfaces
Curved tips for ultrasonic scalers
111
Instrumentation fundamentals
Use light lateral pressure
Keep tip moving at all times
Let the tip do the work
112
If there's a 1mm loss of an instruments tip, what % efficiency is lost? If there's 2mm loss?
25% for 1 mm loss
50% for 2 mm loss
113
Manual curette vs. Sonic/Ultrasonic
Manual = more efficient but requires increased time, effort, and expertise
Ultrasonic = insert designs are an adjunct to hand instrumentation.
*The difference is clinically insignificant as long as you have achieved your goal of total debridement*
*Best results usually from starting with sonic/ultrasonic instruments followed by hand scaling*
114
From the end of the working end to the first bend
Terminal shank
115
From the working end to the handle
Functional shank
116
Hand instrument used to treat subgingival surfaces; it has a blade with an unbroken cutting edge that curves around the toe and a flat face set at a 90-degree angle to the lower shank
Universal curette
117
Curette with one cutting edge, "area specific"; it is designed to adapt to specific tooth surfaces (mesial or distal)
Gracey curette
118
Used to remove large amounts of deposits from supragingival surfaces
Curved sickle scaler
Straight sickle scaler
119
Excessive protrusion of the maxillary incisors; horizontal overlap
Overjet
120
No incisal contact; posterior teeth in normal occlusion
Open bite
121
Maxillary teeth are lingual to mandibular teeth
Underjet
122
Incisal edge to incisal edge of anterior teeth
Edge-to-edge
123
Maxillary incisors are lingual to the mandibular incisors
Anterior crossbite
124
Incisal edge of maxillary tooth is at the level of the cervical third of the facial surface of the mandibular anterior tooth
Deep (severe) anterior overbite
125
Pathologic alteration/adaptive changes which develop in the periodontium as a result of undue force
Trauma from occlusion
126
What can excessive occlusal force cause?
TMJ, injury to masticatory muscles, injury to pulp tissue
127
Traumatizing forces may act on an _______ tooth or groups of teeth in _______ _________.
This can occur in conjugation with ___________ _________ (like clenching/bruxing) or ______________ of premolars/molars.
individual; premature contact
parafunctional habits; loss/migration
128
A reaction that's elicited around a tooth w/normal height of the periodontium
Primary trauma from occlusion
129
Occlusal forces cause injury in a periodontium of reduced height
Secondary trauma from occlusion
130
Regardless of primary or secondary trauma from occlusion, the alterations which occur in the periodontium as a consequence of trauma from occlusion are __________ and _____________ of the height of periodontium.
similar; independent
131
Subjective symptoms of trauma from occlusion may develop only in situation when ___________ of the load elicited by occlusion is so high that the periodontium around the exposed tooth cannot properly withstand and distribute the resulting __________ with unalter position & stability of the tooth involved
magnitude; force
132
Causes of primary occlusal trauma (4)
1. High fillings
2. Prosthetic replacements that create excessive forces on abutments and antagonistic teeth
3. Drifting/extrusion of teeth into space created by unreplaced teeth
4. Ortho movement into fx unacceptable positions
133
Effect of occlusal forces on the periodontium is influenced by what 4 things?
Magnitude
Direction
Duration
Frequency
134
Tissue responses to increased occlusal forces (3 stages):
Stage I= Tissue Injury (produced by excessive occlusal forces)
Stage II= Repair
Stage III= Adaptive remodeling of the periodontium
135
Stage II (repair) of tissue responses to increased occlusal forces includes what?
Damaged tissues removed, new CT & fibers, bone, & cementum formed in attempt to restore the injured periodontium
Force remain traumatic ONLY as long as the damage produced exceeds the reparative capacity of the tissue.
136
Stage III (adaptive remodeling of the periodontium) of tissue responses to increased occlusal forces includes what?
Results in thickened PDL
Involved teeth can become loose
NO ATTACHMENT LOSS
137
Radiographic signs of occlusal trauma
Wide PDL w/thick lamina dura
Vertical appearance of destruction
Root resorption
138
T/F- Trauma from occlusion is reversible when the traumatic force is removed
True
139
Result of periodontal infection; tooth moves up and down w/in socket
Pathological migration of teeth
140
What happens with increasing the magnitude of occlusal forces?
The PDL thickens (increase in # and width of fibers)
141
What happens with changing the direction of occlusal forces?
1. Reorientation of the stresses & strains.
2. Note that principal fibers of the PDL are arranged to accommodated forces along the long axis of the tooth.
3. Lateral & rotational forces can injure the periodontium.
142
Constant pressure on the bone is more injurious than intermittent forces
Duration of occlusal forces
143
The more frequent the application of an intermittent force, the more injurious the force is to the periodontium
Frequency of occlusal forces
144
Within physiological limits
Tooth Mobility= 0
145
Less than 1mm movement in a BL/MD direction
Tooth Mobility= 1
146
1mm + movement in a BL/MD direction
Tooth Mobility= 2
147
Exceeds 1mm movement in a BL/MD direction AND depressible occluso-apical direction
Tooth Mobility= 3
148
Tipping movements occur when there are excessive forces directed _______.
horizontally
149
______ and _______ zones will develop within the _____ and _____ parts of the periodontium.
_________ _________ occur within theses zones, allowing the tooth to tilt in the direction of the force.
Pressure; tension; marginal; apical
Tissue alterations
150
When the tooth has escaped the trauma, __________ __________ of the periodontial tissues takes place.
complete regeneration
151
In the absence of inflammation, there is NO apical down-growth of the _____
JE
152
Movement of the tooth due to pressure & tension over the entire tooth surface; no inflammatory rx in gingiva of down-growth of JE (in the absence of inflammation)
Bodily movement
153
The bone formation that occurs to repair trauma from occlusion; attempt to reinforce weakened trabeculae; may produce a bulbous/ridge-like distortion (lamellar bone with osteoclasts & osteoblasts)
Buttressing bone
154
T/F- Trauma from occlusion, without inflammation, can induce periodontal tissue breakdown
FALSE
155
Which tooth has the worst prognosis in the mouth?
Maxillary 2nd molar
156
What bacterium can be found in hidden pockets of localized aggressive periodontitis?
Actinobacillus actinomycetemcomitans
157
Prophylaxis code in axium
(for healthy/gingivitis patients; 6mo recall)
D1110
158
Periodontal maintenance (STP) code in axium
(for patients who have completed SRPs; 3 month recall)
D4910
159
T/F- Metal instrumentation is used for calculus removal on implants
FALSE, plastic instruments ONLY
160
T/F- Acidic fluoride prophylactic agents are avoided for patients with implants
True, acidity damages the titanium abutments
161
Gingivitis around implant
Peri-implant mucositis
162
Periodontal disease around implants
Peri-implantitis
163
Attached gingiva equation
Attached gingiva = length of marginal gingiva to mucogingival junction - pocket depth
164
Attachment loss equation with deep pocket (4+) and nothing entered in axium
Attachment loss = pocket depth (4,5,6) + -2
165
Attachment loss equation and nothing entered in axium
Attachment loss = pocket depth (1,2,3) + reciprocal (-1, -2, -3)
