Perio Flashcards
1
Q
function of the periodontium
A
- to attach the teeth to the jaws
- dissipate occlusal forces
2
Q
types of horizontal forces
A
- constant - orthodontic
- intermittent - occlusal (jiggling)
3
Q
excessive occlusal force definition
A
- occlusal force that exceeds the reparative capacity of periodontal attachment aparatus
- results in occlusal trauma and/or excessive tooth wear
4
Q
occlusal trauma definition
A
- injury which results in changes within periodontal attachment aparatus
- as a result of occlusal force(s)
- may occur in a intact periodontium or in a reduced periodontium caused by periodontal disease
5
Q
what is periodontal attachment aparatus
A
- periodontal ligament
- supporting alveolar bone
- cementum
6
Q
factors influencing tooth mobility
A
- width of PDL
- height of PDL
- inflammation
- number, shape and length of roots
7
Q
tooth mobility indicates
A
- successful adaptation of periodontium to functional demands
- reflects the nature of the remaining attachment
- does not necessarily represent a pathological state of affairs
8
Q
tooth mobility can be accepted unless
A
- it is progressively increasing
- it gives rise to symptoms
- it creates difficulty with restorative tx
9
Q
therapy to reduce tooth mobility (tx options)
A
- control of plaque-induced inflammation
- correction of occlusal relations
- splinting
10
Q
response of the healthy periodontium to primary occlusal trauma
A
- PDL width increases until forces dissapated
- tooth mobility increased
- this is successful adaptation to increased demand
- if demand is subsequently reduced the PDL width should return to normal
- if demand too great or PDL adaptibility reduces PDL width may continue to increase
11
Q
histological changes occuring during occlusal trauma to healthy periodontium
A
- on pressure side: increased vascularisation and permeability, necrosis of PDL, thrombosis, hameorrhage, bone resorption
- on tension side: elongation of PDL, apposition of alveolar bone and cementum
- density of alveolar bone decreases while width of PDL space increases
12
Q
secondary occlusal trauma
A
- injury which results in tissue changes
- from normal or excessive occlusal forces applied to tooth/teeth with reduced periodontal support
- occurs in presence of attachment loss, bone loss, and normal/excessive occlusal forces
13
Q
evidence of occlusal trauma
A
- tooth mobility which is progessively increasing
- tooth moblility associated with symptoms
- radiographic evidence of increased PDL width
14
Q
define fremitus
A
palpable or visible movement of a tooth when subjected to occlusal forces
15
Q
occlusal trauma
diagnosis made from
A
- progressive tooth mobility
- fremitus
- occlusal discrepancies
- wear facets
- tooth migration
- also…
- tooth fracture
- thermal sensitivity
- root resorption
- cemental tear
- widening of PDL space on radiograph
16
Q
tooth migration causes/results in
A
- loss of periodontal attachment
- unfavourable occlusal forces
- unfavourable soft tissue profile
17
Q
management of tooth migration
A
- treat the periodontitis
- correct oclusal relations
- either accept the position of the teeth and stabilise or move the teeth orthodontically and stabilise
18
Q
splinting for perio may be appropriate when
A
- mobility is due to advanced loss of attachment
- mobility is causing discomfort or difficulty in chewing
- teeth need to be stabilised for debridement
19
Q
negatives of splinting for perio
A
- does not influence the rate of periodontal destruction
- may create hygiene difficulties
- is a treatment of last resort
20
Q
effect of excessive occlusal forces on gingival recession
A
no correlation identified
21
Q
2017 perio disease classification
10 listed classifications
A
- health
- plaque induced gingivitis
- non plaque induced gingival disease and conditions
- periodontitis
- necrotising periodontal disease
- periodontitis as a manifestation of systemic disease
- systemic diseases or conditions affecting the periodontal tissues
- periodontal abscess
- periodontal-endodontic lesions
- mucogingival deformities and conditions
22
Q
2017 perio disease classification
gingival health
A
- intact periodontium - absence of bleeding on probing, erythema and edema, pt symptoms and attachment and bone loss
- reduced periodontium due to causes other than periodontitis
- <10% bleeding sites and probing depths <= 3mm
- physiological bone levels range from 1-3mm apical to CEJ
23
Q
2017 perio disease classification
plaque induced gingivitis
A
- BPE score 1 or 2
- associated with biofilm alone
- mediated by systemic or local risk factors - drug influenced gingival enlargement etc
- no radiological bone loss
- no interdental recession
- bleeding on probing <30% localised and >30% generalised
24
Q
plaque induced gingivitis modifying factors
A
- can exacerbate but not cause gingivitis
- drug induced gingival enlargement - amlodipine (ca channel blocker), anticonvulsants, immunosuppresants
- sex steroid hormones - puberty, pregnancy, oral contraception
- hyperglycemia
- smoking
- malnutrition
- prominent subgingival restoration margins
- hyposalivation
25
Q
2017 perio disease classification
non-plaque induced gingival diseases
A
- genetic/developmental disorders - eg hereditary gingival fibromatosis
- specific infections - herpetic gingival stomatitis
- endocrine, nutritional and metabolic diseases - vitamin c deficiency
- inflammatory and immune conditions - lichen planus
- traumatic lesions
- gingival pigmentation
26
Q
2017 perio disease classification
necrotising periodontal diseases
A
- necrotising gingivitis - necrosis and ulcer in interdental papilla
- necrotising periodontitis - signs and symptoms of NG plus periodontal attachment and bone destruction
- necrotising stomatitis - larger areas of osteitis and bone sequestrum
27
Q
predisoposing conditions for necrotising periodontal disease in chronically, severely compromised adults
A
- HIV +/ AIDS with CD4 counts < 200 and detectable viral load
- other severe systemic conditions eg immunosuppression
28
Q
predisoposing conditions for necrotising periodontal disease in chronically, severely compromised children
A
- severe malnourishments
- extreme living conditions
- severe (viral) infections
29
Q
predisoposing conditions for necrotising periodontal disease in temporarily/moderately compromised pt
A
- uncontrolled factors - stress, nutrition, smoking, habits
- previous NPD - residual craterss
- local factors - root proximity, tooth malposition
- common predisposing factors
30
Q
2017 perio disease classification
periodontitis as a manifestation of systemic disease
A
- mainly rare diseases that affect the course of periodontitis
- resulting in early presentation of severe periodontitis
- papillon lefevre syndrome
- leucocyte adhesion deficiency
- downs syndrome
31
Q
2017 perio disease classification
systemic diseases or conditions affecting the periodontal tissues
A
- mainly rare conditions affecting perio tissues independantly of dental plaque biofilm induced inflamation
- may mimic clinical presentation of periodontitis
- squamous cell carcinoma
- langerhans cell histocytosis
- does not include common systemic diseases that modify course of perio such as uncontrolled diabetes - instead included as descriptor in staging and grading process
32
Q
2017 perio disease classification
periodontal abscess
A
- in periodontitis patients - acute exacerbation or after treatment
- in non periodontitis patients
33
Q
causes of periodontal abscess in periodontitis patients
A
- acute exacerbation - untreated periodontitis, non-responsive to perio therapy
- after treatment - post-scaling, post-surgery, post-medication
34
Q
causes of periodontal abscess in non perio patients
A
- impaction - dental floss, rubber dam, popcorn hulls etc
- harmful habits - nail biting, clenching
- orthodontic factors - ortho forces, cross-bite
- gingival overgrowth
- alteration of root surface - perforations, cracked tooth syndrome, odontodysplasia
35
Q
2017 perio disease classification
periodontal endodontic lesions
A
- endo periodontal lesions with root damage - root #, root canal or pulp perforation, external root resoprtion
- endo-perio lesions without root damage - can either be in perio patients or not in perio patients
36
Q
2017 perio disease classification
mucogingival deformities and conditions
A
- gingival recession
- recession type 1 (RT1)
- recession type 2 (RT2)
- recession type 3 (RT3)
37
Q
mucogingival deformaties and conditions
recession type 1
A
- gingival recession with no loss of interproximal attachment
- interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth
38
Q
mucogingival deformaties and conditions
recession type 2
A
- gingival recession associated with loss of interproximal attachment
- amount of attachment loss measured from interproximal CEJ to depth of sulcus/pocket
- is LESS THAN OR EQUAL TO buccal attachment loss which is measured from buccal CEJ to end of buccal sulcus/pocket
39
Q
mucogingival deformaties and conditions
recession type 3
A
- gingival recession associated with loss of interproximal attachment
- amount of attachment loss measured from interproximal CEJ to end of sulcus/pocket
- is GREATER than the buccal attachment loss
40
Q
necrotising periodontal disease
characteristics
A
- rapidly destructive and debilitating
- most severe inflammatory periodontal disease caused by plaque
- painful, bleeding gums and ulceration
- necrosis of interdental papilla - punched-out appearance
- seen more in developing countries
- due to predisposing factors
41
Q
classification of necrotising periodontal disease
A
- necrotising gingivitis - when only the gingival tissues affected
- necrotising periodontitis - when necrosis progresses into PDL and alveolar bone leading to attachment loss
- necrotising stomatitis - when necrosis progresses to deeper tissues beyond mucogingival line - including lip or cheek mucosa, tongue etc
42
Q
diagnoses of necrotising periodontal disease
general overview
A
- based on symptoms not any test
- histopathology and microbiology not characteristic for NPD
- constant flora - prevotella intermedia, fusobacterium sp.
- bacteria isolated from large number of necrotic lesions but not always found in primary lesion so no evidence of primary etiologic importance
43
Q
diagnoses of necrotising periodontal disease
necrotising gingivitis
A
- ulcerated and necrotis papillae and gingival margin - punched-out appearance
- ulcers covered by a yellowish, white or greyish slaim (NOT psuedomembrane)
- when slaim removed the underlying CT becomes exposed and bleeds
- lesions develop quickly and are very painful
44
Q
diagnoses of necrotising periodontal disease
what is slaim
A
- yallowish, white or greyish slouthing covering ulcers
- made of fibrin, necrotic tissue, leucocytes, erythrocytes and mass of bacteria
45
Q
where are first lesions of necrotising gingivitis commonly seen
A
interproximally in mandibular anterior region
46
Q
diagnoses of necrotising periodontal disease
necrotising periodontitis
A
- ulcerations often associated with deep pockets formation
- gingival necrosis coincides with loss of alveolar crest bone
- ulcers with central necrosis develop into craters
- adenopathies (enlarged lymph nodes) found in most severe cases - affects submandibular LN more than cervical
- very rarely fever
47
Q
diagnoses of necrotising periodontal disease
necrotising stomatitis
A
- affected bone extends through alveolar mucosa
- larger bone sequestra (bone that has been separated from the surrounding bone during the process of necrosis) may occur
- large areas of osteitisand oral-antral fistulae
- greater severity in pt with severe systemic compromise - AIDS and pt with severe malnutrition
48
Q
necrotising periodontal diseases should be differentiated from the following
A
- oral mucositis
- HIV-associated periodontitis
- herpes simplex virus
- scurvy
- gingivostomatitis
- leukemia
- desquamative gingivitis
49
Q
risk factors for necrotising periodontal disease
A
- in developed countries - stress, sleep deprivation, poor oral hygiene, smoking, immunosuppression (HIV, leukemia) and/or malnutrition
- in developing countries - mostly in malnourished children
50
Q
how herpetic gingivostomatitis differs from necrotising periodontal disease
A
- caused by herpes simplex virus not bacteria
- affects gingiva and entire oral mucosa whereas NPD affects interdental papillae and rarely outside mouth
- lasts 1-2 weeks whereas NPD lasts 1-2 days if treated
- can get partial immunity
- is contageous
- no permanent destruction vs NPD destruction of periodontal tissue remains
51
Q
necrotising periodontal disease
treatment of the acute phase
A
- two main objectives:
1. arrest disease process/tissue destruction
2. control pt discomfort and pain - careful superficial debridement to remove soft and mineralised deposits - ultrasonics recommended
- performed daily deeper and deeper for as long as acute phase lasts
- limit mechanical oral hygiene - brushing into wound may impair healing and cause pain
- pt use chlorhexidine based mouthrinses twice daily
52
Q
necrotising periodontal disease
further treatment if debridement unsatisfactory
A
- use of systemic antimicrobials may be considered if unsatisfactory response to debridement or show systemic effects (fever and/or malaise)
- metronidazole 400mg TID 3 days
- locally delivered antimicrobials not recommended as drug will not be able to achieve adequate conc - because of large number of bacteria in tissues
53
Q
necrotising periodontal disease
treatment follow up
A
- have to be followed up very closely - daily if possible
- as symptoms and signs improved strict mechanical hygiene measures should be enforced
- complete debridement of the lesions
54
Q
necrotising periodontal disease
treatement of pre-existing condition
A
- pt with NPD usually have pre-existing gingivitis or periodontitis
- once acute phase controlled treat pre-existing condition
- professional prophylaxis and/or scaling and root planning
- OHI enforced
- evaluate local factors such as overhanging res, tooth malposition etc and treat
- control of systemic predisposing factors - smoking, stress reduction etc or tx of systemic conditions
55
Q
necrotising periodontal disease
corrective tx of disease
A
- correct altered gingival form/features
- gingival craters may favour plaque acculumation and disease recurrence
- gingivectomy or gingivoplasty procedures for superficial craters
- periodontal flap surgery, regenerative surgery for deep craters
56
Q
what to screen for if healthy individual without any predisposing factors has NPD
A
- HIV
- necrotising periodontal disease in healthy individuals suggestive of HIV infection
57
Q
acute perio conditions 2018 classification
types of abscesses
A
- periodontal abscess
- gingival abscess
- endo-perio abscess
- dentoalveolar abscess
- pericoronitis
- other - trauma, surgery
58
Q
abscesses of the periodontium
gingival abscess
A
- localised to the gingival margin
- can be caused by localised trauma, food packing etc
59
Q
abscesses of the periodontium
periodontal abscess
A
- usually related to preexisting deep pocket
- also associated with food packing and tightening of gingival marging post PMPR
- if bacterial plaque removal insufficient –> pocket constrained and virulent bacteria could cause localised abscess
- infection in a periodontal pocket which can be acute or chronic and asymptomatic if freely draining (SDCEP)
- rapid destruction of periodontal tissues - negative effect on prognosis of tooth
60
Q
abscesses of the periodontium
pericoronal abscess
A
- associated with partially erupted tooth
- most commonly 8s
- pericoronitis
61
Q
endodontic-periodontal lesion
A
- tooth is suffering from varying degrees of endodontic and periodontal disease
- endo-perio abscess
- pathological communication between the endodontic and periodontal tissues of a tooth
- can be acute or chronic
- swelling around apex
62
Q
periodontal abscess signs and symptoms
A
- swelling
- pain - not usually agonising
- tooth may be TTP laterally
- deep periodontal pocket
- bleeding
- suppuration - pus formation
- enlarged regional lymph nodes - submandibular, submental, cervical
- fever
- tooth usually vital
- tend to be more low-grade compared to dental abscesses
63
Q
periodontal abscess
SDCEP guidance
A
- careful sub-gingival instrumentation - short of the base of the pocket to avoid iatrogenic damage
- LA may be required
- if pus present drain by incision or through periodontal pocket - recommend optimal anaesthesia
- do not prescribe antibiotic unless signs of spreading infection or systemic involvement
- recommend the use of 0.2% chlorhexidine MW until acute symptoms subside
- review and carry out definitive perio instrumentation
64
Q
periodontal abscess
use of systemic antibiotics
A
- only if signs of spread and systemic effects - increased WCC, pyrexic >37.5 degrees C, increased RR, HR, trismus, difficulty swallowing etc
- penicillin V 250mg preferred or amoxicillin 500mg or metronidazole 400mg
- 5 day course
- must only be used in conjunction with careful RSD in order to reduce bacterial load and disrupt biofilm
65
Q
endo-perio lesion
acute/chronic
A
- acute - trauma, perforation during RCT
- chronic - pre-existing periodontitis, slow progression without evident symptoms
- swelling around apex - pus could drain buccally or up periodontal space
66
Q
endo-perio lesion
signs and symptoms
A
- deep periodontal pockets
- negative or altered response to pulp vitality tests
- bone resorption in apical or furcation region
- spontaneous pain
- pain on palpation and percussion
- pus
- tooth mobility
- sinus tract
67
Q
endo-perio lesion
possible routes of communication
A
- lateral canal
- furcal canal
- apical foramen
68
Q
endo-perio lesion
lateral and accessory canals
A
- 30-40% of all teeth have lateral and accessory canals
- most in apical third of root
- furcal canal - at the furcation of molars - may be direct pathway of communication between the pulp and periodontium
- not all furcal canals extend the full length from the pulp chamber to the floor of the furcation
69
Q
endo-perio lesion
apical foramen
A
- main route of communication between the pulp and periodontium
- microbial and inflammatory by-products may exit apical foramen - causing periapical pathoses
- apex also portal of entry for inflammatory by-products from deep periodontal pockets to affect the pulp
70
Q
endo-perio lesion
perforation
A
- results in communication between the root-canal system and peri-radicular tissues, PDL or oral cavity
- causes - extensive dental caries, resorption, operator error (RC instrumentation or post preparation)
71
Q
endo-perio lesion
developmental groove
A
- invagination/vertical radicular groove
- especially on upper incisors
- if periodontal attachment breached the groove can become contaminated - infrabony pocket can form along its length
- channel provides a place for accumulation of bacteria and route for progression of periodontitis - may also affect the pulp if it extends to the apex
- radiographically the area of bone destruction follows the course of the groove
72
Q
endo-perio lesion associated with trauma or iatrogenic factors
A
- root/pulp chamber perforation
- root fracture or cracking - trauma or prep for post
- external root resorption - trauma
- pulp necrosis because of trauma draining through the periodontium
73
Q
classification of endo-perio lesion
A
- by pulp infection that secondarily affects the periodontium or periodontal destruction that secondarily affects the root canal
- 2 catergories - endo-perio lesion with root damage or endo-perio lesion without root damage
- with root damage - fracture or cracking, perforation, external root resorption
- without root damage - split further into lesion in perio patients and lesion in non-perio patients
74
Q
endo-perio lesion
SDCEP tx
A
- carry out primary endodontic therapy of the affected tooth
- recommend optimal analgesia
- do not prescribe antibiotics unless signs of spreading infection or systemic involvement
- recommend use of 0.2% chlorhexidine MW until the acute symptoms subside
- following acute management of lesion - review within 10 DAYS and carry out supra and sub-gingival instrumentation if necessary
- arrange an appropriate recall interval
75
Q
endo-perio lesion
additional tx
A
- non surgical scaling unlikely to be successful
- surgical instrumentation and mechanical removal - open flap debridement etc
- guided tissue regeneration - bone regeneration etc
76
Q
perio tx step 1
A
- explain disease, risk facors, risks and benefits of tx
- give OHI - interdental cleaning
- reduce risk factors - remove overhangs, smoking cessation, diet control
- professional mechanical plaque removal (PMPR) supra and sub-ginival of clinical crown
- select recall period
77
Q
perio tx step 1
recall period
A
- 6-8 weeks
- might not be appropriate for certain parts
- can be flexible
- some 2 weeks
78
Q
perio tx step 1
what to evaluate
A
- non-engaging pt return to step 1 and repeat
- engaging pt move to step 2 or consider referral
79
Q
perio tx step 2
A
- subgingival instrumentation - root surface debridement/PMPR on root
- hand or powered (sonic/ultrasonic) either alone or in combination
- reinforce OHI, risk factor control, behaviour change
- use of adjunctive systemic antimicrobials if appropriate
80
Q
perio tx step 2 evaluation
A
- BDS - re-evaluate after 3 months
- unstable - go to step 3
- stable - go to step 4
81
Q
when to go to step 3 perio
A
- pt unstable after step 2 perio
- step 2 perio re-evaluated after 3 months and then pt goes to step 3
82
Q
perio tx step 3
A
- managing non-responding sites
- OHI, risk factor control, behaviour change
- moderate (4-5mm) residual pockets - re-perform subgingival instrumentation
- deep residual pockets (>6mm) consider alternative causes and referral for pocket management or regenerative surgery
- if referral not possible reperform subgingival instrumentation
83
Q
perio tx step 3 recall
A
- 3 months
- if all sites stable after step 3 proceed to step 4
84
Q
perio tx step 4
A
- maintenance
- supportive periodontal care encouraged
- reinforce OHI, risk factor control, behaviour change
- regular targeted PMPR as required to limit tooth loss
- maintenance recall - individually tailored intervals from 3-12 months
85
Q
BSP top tips
A
- pt should be aware that regular self-performed plaque removal offers largest tx benefits
- toothbrushing should be supplemented by use of interdental brushes
86
Q
BSP defining engaging pt
A
- > 50% improvement in plaque and marginal bleeding scores OR
- plaque levels <20% and bleeding levels <30% OR
- pt has met targets outlined in their personal self-care plan
87
Q
BSP defining non-engaging pt
A
- insufficient improvement in OH - <50% improvement in plaque and marginal bleeding scores OR
- plaque levels >20% and bleeding levels >30% OR
- pt states preference to a palliative approach to periodontal care
88
Q
define success at perio review
A
- good oral hygiene
- no BOP
- no pockets >4mm
- no increase in tooth mobility
- a functional and comfortable dentition
89
Q
perio tx step 3 tx options
A
PPD 4-5mm repeted subgingival instrumentation
PPD >= 6mm consider surgical approach
90
Q
factors influencing decision for periodontal surgery
A
- smoking
- compliance
- oral hygiene
- systemic disease
- suitability of site - access, soft and hard tissue factors
- prognosis of tooth and importance of tooth
- availability of specialist tx
- patient preference
91
Q
perio tx ideal endpoint
A
- no pockets >4mm
- BOP <10%
- functional and comfortable dentition
- plaque scores <20% or target for pt
92
Q
perio tx step 4 main aims
A
- maintain periodontal health
- detect and retreat recurrence
- maintain an accepted level of disease
- manage tooth loss
93
Q
why perio maintenance (step 4)
A
- pt not maintained in recall program show obvious signs of recurrent periodontitis
- the more often pt present for supportive periodontal therapy, the less likely are to loose teeth
- pt who do not return for regular recall 5 X greater risk for tooth loss than compliant pt
94
Q
how to do step 4 perio tx
A
- part 1 examination - history, OH status, pocket depth changes, mobility, update pocket charts and mod bleeding and plaque scores
- part 2 PMPR - supra and subgingival based on pocket chart
- care must be taken not to instrument normal sites with shallow sulci (1-3mm) with no calculus as studies show can lead to loss of attachment
95
Q
causes for periodontal disease recurrence
A
- inadequate plaque control - pt failure to comply with recommended SPT schedules
- failure to remove all potential plaque retentive factors
- incomplete calculus removal in areas of difficult access
- inadequate restorations placed after perio tx was completed
96
Q
periodontal maintenance
6PPC frequency/location
A
- for pt with BPE 4 - full mouth periodontal charting annually
- for BPE 3 in more than one sextant - full mouth periodontal charting annually
- BPE 3 in 1 sextant - full periodontal charting of that sextant annually
97
Q
supportive periodontal therapy
debridement
A
- carry out root surface instrumentation at sites >4mm where sub-gingival deposits present or bleeding on probing
- for sites <4mm only carry out sub-gingival instrumentation where deposits are present
98
Q
perio guidelines
why changes have been made
A
- perio quality improvement project
- new guidelines introduced
99
Q
key perio guidelines
A
- British society of periodontology:
- BPE
- UK clinical practice guidelines for tx of periodontal disease
- 2017 classification of periodontal disease
- Scottish Dental Clinical Effectiveness Programme
- no difinitive guideline on which charts to use when - at glasgow GDH complete 6PPC used as baseline and review charts for pts at review
100
Q
complete 6PPC advantages and disadvantages
A
- A - gives a full picture of periodontal attachment loss
- D - more time consuming
101
Q
abbreviated/review perio chart advantages and disadvantages
A
- quicker to complete
- can efficiently highlight areas requiring further tx
- does not record periodontal attachment loss - progress could be un-recorded
102
Q
genetic considerations associated with impairment of immune system
A
- papillon-lefevre syndrome
- LAS syndrome
- downs syndrome
- chronic granulomatous disease
103
Q
diseases leading to impairment of immunce system
A
- leukaemia
- agranulocytosis
- neutropenia
- HIV infection
104
Q
categories of periodontal risk factors
A
- local risk factors - aquired and anatomical
- systemic risk factors - non-modifiable and modifiable
105
Q
perio local risk factors
acquired
A
- plaque
- calculus
- overhanging and poorly contoured restorations
- orthodontic appliances
- occlusal trauma
106
Q
perio local risk factors
anatomical
A
- malpositioned teeth
- root grooves
- concavities and furcations
- enamel pearls
107
Q
systemic perio risk factors
non-modifiable
A
- ageing
- genetic factors
- down syndrome
- papillon-lefevre syndrome
108
Q
systemic perio risk factors
modifiable
A
- smoking
- poorly controlled diabetes
- HIV
- leukaemia
- osteoporosis
- stress
- medications
- poor nutrition
- socioeconomic status
109
Q
why is smoking a perio risk factor
A
- effect on oral microbiota - change to anaerobic bacteria
- increase activation of immune systm - due to chemicals
- decreased healing capacity - reduced blood flow
110
Q
why sub-optimally controlled diabetes is perio risk factor
A
- hyperglycaemia may modulate RANKL:OPG ratio - contribute to bone destruction
- in hyperglycaemia production of advanced glycation end products (AGE) leads to exacerbation of inflammation
111
Q
drugs which are risk factors for diabetes
A
- anticonvulsant - phenytoin
- immunosuppresants - cyclosporin
- calcium channel blockers - nifedipine etc
- interaction between drug and host fibroblasts - increased deposition of CT
112
Q
relationship between periodontitis and diabetes control
A
- untreated periodontitis can result in circulating bacteria and antigens - systemic inflammatory state and impaired insulin signalling and reistence - elevated HbA1c levels and exacerbation of diabetes
- periodontal tx results in reduced circulating bacteria and antigens and reduction in systemic inflammatory state - improvement in insulin signalling and resistance - reduction in HbA1c and improved diabetes control
113
Q
structure to supportive periodontal care
A
- part 1 examination - history, plaque chart, pocket depth changes, gingival changes, mobility changes, occlusal changes etc
- part II tx - OHI, supra PMPR, RSD, polishing
- part III report, cleanup and scheduling - write report in chart, discuss report with pt, schedule rext recall visit/further perio tx
114
Q
supportive periodontal therapy
examination
A
- updating medical history
- oral mucosa inspected for pathologic conditions
- evaluation of restoration, cariesm prosthesis, occlusion, tooth mobility, BOP, periodontal/periimplant probing depths
- analysis of current oral hygiene status
- primarily look for changes that have occurred since last evaluation
115
Q
supportive periodontal therapy
shallow sulci
A
- care to not instrument normal sites with shallow sulci
- 1-3mm deep
- that do not have any calculus
- studies show repeated subgingival scaling in normal periodontal sites result in significant loss of attachment
116
Q
supportive periodontal therapy
challenges
A
- periodontal pts at risk of disease recurrence for the rest of their lives
- pockets in furcation areas may not have been eliminated by inital tx
- no test accurately predicts disease activity - clinicians rely on clinical measurements etc
117
Q
A
118
Q
A
119
Q
A
