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Periodontology > Perio > Flashcards

Perio Flashcards

1
Q

What is periodontal health?

A

Defined as the absence of clinically detectable inflammation

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2
Q

How does a healthy gingiva look?

A
  1. Pale pink
  2. Forms tight cuff at the gingival margin
  3. Fills the interdental space
  4. Doesn’t bleed when brushed or probed
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3
Q

What is gingivitis?

A

An inflammatory response that is caused by host parasite interactions, it remains localised to the gingival tissue not involving the periodontal ligament, cementum or alveolar bone

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4
Q

What is the major cause of gingivitis?

A

Caused by the accumulation of microbial plaque in the dento-gingival complex, when this is removed this resolves the issue and reduces inflammation

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5
Q

What is dental plaque?

A

A diverse community of microorganisms on the tooth surface originally as a biofilm and now has grown with extracellular matrix’s and polymers

It’s a bacteria biofilm which causes chronic gingivitis and periodontitis

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6
Q

How does the gingival tissue response to plaque?

A

Inflammation- this is dental-plaque induced gingivitis

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7
Q

What is periodontitis?

A

A periodontal disease caused by host parasite interactions that cause the loss of connective tissue fibre attachment from the root surface and then eventually alveolar bone loss

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8
Q

How is periodontal disease distinguished form gingivitis?

A

Bone loss and connective tissue attachment loss

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9
Q

What is the best brushing technique?

A

Modified bass technique

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10
Q

Explain the modified bass technique?

A
  1. Brush at a 45 angle, pointing to the gingival crevice
  2. Use genital circular motions, brushing upwards towards the occlusal surface
  3. Around 5 strokes on each surface
  4. Repeat for every tooth so the gum lines are cleared
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11
Q

What are good brush habits?

A

Soft/medium nylon brush - so gingiva isn’t irritated
Replaced every 3-4 months
Brush twice a with one being before bed
When possible spit and don’t rinse

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12
Q

Difference between powered and mechanical toothbrush?

A

No evidence that powered toothbrushes are better than mechanical when people use the mechanical toothbrush properly, however the electric toothbrush will ensure you get the right circular motion so it can be more effective for people who are unable to do the circular motions

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13
Q

What are disclosing tablets?

A

They make plaque more visible
2 types
1. Erthrosine - food dye
2. 2 tone dye - stains recent plaque pink, stains older plaque purple/blue

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14
Q

What are disclosing tablet used?

A
  1. Allows plaque score to be calculated
  2. Can be used to visually motivate the patient and see the areas they need to focus on brushing
  3. Allows patient to self evaluate
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15
Q

How to change patient behaviour

A
  • Enthusiasm
  • Realism - don’t attempt too much change at once
  • Practice - show patient how to apply changes
  • Praise - even fro small improvements
  • Expect relapse - our job to motivate patient to keep trying
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16
Q

What are oral hygiene TIPPS

A

T- Talk = with patient about periodontal disease and how to remove plaque
I- Instruct = best ways to perform plaque removal
P- Practice = ask patient to clean teach and use interdental tooling in front of u
P- Plan = specify how patient can in operate oral hygiene into routine
S- Support = follow up in subsequent visits

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17
Q

What are the 2 categories of gingivitis?

A
  1. Non -dental plaque bio-film induced
  2. Dental plaque biofilm induced
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18
Q

What is non dental plaque biofilm induced gingivitis?

A

Inflammation of the gingiva not caused by plaque but other systemic problems and plaque removal doesn’t resolve the gingivitis

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19
Q

What is dental plaque induced gingivitis?

A

Inflammation of gingiva is caused by plaque build up and is normally resolved with plaque removal
- Can effect periodontitis patients too

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20
Q

What are Clinical characteristics of plaque induced gingivitis?

A
  • Inflammation can be resolved by plaque removal
  • inflammation and other signs and symptoms are confined to gingiva
  • lots of plaque to irritate gingiva
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21
Q

What are clinical features of gingivitis?

A
  1. Redness - due to increased blood flow during inflammation
  2. Swelling - due to leaky blood vessels increasing fluid levels
  3. Pitting on pressure
  4. Loss of contouring - interproximal gingiva is more rounded
  5. False pocketing - due to swelling making it look like bone level has changed
  6. Bad breath
  7. Bad mouth taste
  8. Bleeding on probing
22
Q

What are 2 ways to record plaque build up

A
  1. Plaque score
  2. Plaque index
23
Q

What is an index?

A

A scoring system at semi-quantitatively grades the severity of clinical parameters e.g. plaque

  • used in research
24
Q

What are the plaque index grades?

A

0- no plaque present
1- plaque visible by disclosing and removable with probe
2- Moderate accumulation along gum line and can be seen via eyes
3- Heavy plaque accumulation and filling the interdental niche (between gingival margin and tooth surface)

25
Q

What are the grades for the gingival index?

A

0- Healthy gingiva
1- Mid inflammation, slight colour change, slight oedema , no bleeding on probing
2- Moderate inflammation, redness , oedema bleeding on probing
3 - sever inflammation, redness and oedema and spontaneous bleeding of gums

26
Q

What is a score?

A

This is a qualitative assignment of values that indicates the presence or absence of a clinical parameter
E.g. Plaque or gingivitis
Often a couple teeth are chosen to represent the whole mouth

27
Q

How to calculate a score?

A

Score (%) = Number of surfaces with plaque/ bleeding x100
———————————————————————
Number of teeth x 4

28
Q

What are method for interproximal cleaning? And when to use them?

A
  1. Flossing - use for areas where interporximal brush is too large, this will avoid trauma to gingiva
  2. Interdental brushes - Most effective
29
Q

What is the correct flossing technique?

A
  1. Use 16 inches of floss
  2. Wrap around 2 fingers and use short segments floss for each tooth
  3. He talk make a ‘C’ shape with the floss moving it towards the base of the tooth and under the gum line
    In the space between tooth and gum
  4. Use up and down movement with light pressure
  5. Repeat for all sides of the tooth on all teeth
30
Q

What are risk factors of gingival disease?

A
  1. Local factors - there are anatomical and acquired and can be corrected with cleaning and education
  2. Systemic factors- e.g. diabetes or smoking
31
Q

What is a BPE?

A

Basic periodontal exam, it is a quick and simple screening which involved probing the periodontal tissue

32
Q

What does a BPE asses?

A
  1. Presence of bleeding
  2. Plaque and calculus deposits
  3. Depth of periodontal pockets
33
Q

How to perform a BPE

A

Use light pressure
Divide mouth into sextant and record the highest score in each sextant

34
Q

What does the black band represent on a BPE probe?

A

Around 3.5-5.5 mm, so depth at that level is around that

35
Q

What is a BPE code 0

A

Black line of probe is visible (therefore less than 3.5mm pocket)
Healthy periodontal tissue, no bleeding or calculus deposits

36
Q

What is a BPE code 1?

A

Depth less than 3.5 mm therefore black band still seen
Periodontal tissue has some bleeding, no calculus

37
Q

What is a BPE code 2?

A

Black band still visible therefore less than 3.5mm pocket
Gingival bleeding and calculus deposits supra and subgigival areas

38
Q

What is a BPE code 3?

A

Probe is between 3.5-5.5, therefore some of the black band has disappeared and some is visible
Pocket is between 4-5mm

39
Q

What is a BPE code of 4?

A

This is when the black band completely disappears into the pocket and this shows a pocket size of 6mm or greater

40
Q

What is a BPE code of *?

A

This means there is Furcation

41
Q

What is Furcation?

A

Condition where the bone is lost

42
Q

What happened to patients with a code 1-2 from BPE?

A

There still have check up between every 6months - year
Receive tips to improve brushing to avoid progression to further stages

43
Q

What happens to patients with a 3 BPE code?

A

First they have initial therapy to remove calculus and get informed on mitigation techniques
They also receive a DPC in the affected sextants

44
Q

What happens with a BPE of 4?

A

They have a full mouth DPC( this is a 6 point pocket chart)

45
Q

What is a DPC?

A

Detailed periodontal charting
This involves a 6 point pocket chart

46
Q

How are bleeding score used in practice?

A

Used to assess periodontal health as healthy gums don’t bleed
Bleeding for gingival margins shows gingivitis
Bleeding from periodontal pocket shows periodontitis

47
Q

How are plaque scores used in clinic?

A

Plaque scores can influence treatments plans and even effect the outcome of a treatment

48
Q

What are risk factors for periodontal disease?

A
  1. Dental plaque accumulation
  2. Smoking- increases changes of periodontitis and makes it harder to treat
  3. Diabetes - when the ply code level is not controlled it can hurt the periodontal tissue
  4. Mediation - e.g. can cause dry mouth which leads to periodontal disease
49
Q

What’s good Advice to prevent periodontal disease?

A
  1. Brush twice a day, especially once at night
  2. Use a soft /medium brush and one with a small head to avoid gingiva trauma
  3. Using disco sling agents can help visualise area that needs better plaque control and can lead to better oral care
50
Q

What’s good Advice for people with periodontitis or at high risk for periodontitis?

A
  1. Cleans properly at the gun line
  2. Use interdental cleaning techniques
    - interdental brushes for large gaps - done push into small gaps as this cause trauma to gingiva
    - floss for tighter gaps
    Have regular check ups to asses progress and adjust treatment plan

Periodontology (2 decks)

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