Perio

Question 1

Describe healthy periodontium in children

Answer 1

Abscence of gingival inflammation and calculus
No more than one sextant with plaque

Question 2

What are the features of a healthy periodontium in children

Answer 2

Gingival margin several mm coronal to the CEJ
Gingival sulcus 0.5-3mm on a fully erupted tooth
In teens, alveolar creat 0.4-1.9mm apical to CEJ

Question 3

How should a BPE present in periodontal health?

Answer 3

<10% bleeding on probing

Question 4

Describe plaque biofilm-induced gingivitis in children?

Answer 4

Accumulation of supragingival plaque causes inflammatory cell infiltrate to develop in gingival tissue
Junctional epithelium becomes disrupted
Allows apical migration of plaque and increase in gingival sulcus depth

Question 5

What are pre-disposing factors for necrotising gingivitis in children?

Answer 5

Malocclusions
Traumatic dental injury
Dental plaque-biofilm retentive factors - tooth anatomy, restoration margins, orthodontic appliances, incompetent lip

Question 6

What are modifying factors for necrotising gingivitis in children?

Answer 6

Smoking
Hyperglycaemia or type 1 diabetes
Cyclosporin
Vitamin C deficiency
Increase in sex steroid hormones
Haematological conditions - leukaemia

Question 7

What is gingival overgrowth related to?

Answer 7

Systemic and metabolic diseases
Genetic factors
Local factors
Medication side effects eg cyclosporin, Ca channel blockers
Greater incidence is seen in puberty and severity is more intense in children

Question 8

How is gingival overgrowth treated?

Answer 8

Rigorous home care
Frequent appointments for PMPR
Possible surgery, especially with drug-induced gingival overgrowth

Question 9

What should be done when the extent of the condition is inconsistent with the patients level of OH?

Answer 9

Consider urgent referral to physician for hematinic screening

Question 10

What are the 4 distinguishing features of periodontitis?

Answer 10

Apical migration of junctional epithelium beyond the CEJ
Loss of attachment of periodontal tissues to cementum
Transformation of junctional epithelium to pocket epithelium
Alveolar bone loss

Question 11

What early clinical sign of periodontitis is seen in many teens?

Answer 11

> 1mm loss of attachment of cementum to PDL

Question 12

What are the stages of periodontitis diagnosis?

Answer 12

Staging
Grading
Assess current periodontal status
Risk assessment

Question 13

What is important to remember about periodontitis in the mixed dentition?

Answer 13

There may be false pocketing around erupting permanent teeth

Question 14

What are the features of periodontitis with a molar incisor pattern?

Answer 14

Rapid attachment loss and bone destruction
Patient otherwise healthy
Onset around puberty
Family history

Question 15

What are common diseases seen in children that manifest as periodontitis?

Answer 15

Papillon-Lefevre syndrome (PLS)
Down’s syndrome
Neutropenias

Question 16

What are the steps of periodontal recording and diagnosis?

Answer 16

Gingival condition
Assess OH status
Assess if any calculus present
Assess local risk factors

Question 17

How should gingival condition be assessed?

Answer 17

Assess:
Gingival colour
Contour
Swelling
Recession
Suppuration
Inflammation
Consider use of marginal bleeding free chart

Question 18

How should OH status be assessed?

Answer 18

Description of plaque status
Describe surfaces covered by plaque
Use of plaque free scores

Question 19

What local risk factors for periodontitis are seen in children?

Answer 19

Plaque retention factors
Low renal attachments
Malocclusion
Incompetent lip
Mouth breathing

Question 20

Describe the simplified BPE

Answer 20

Done in all cooperative children aged 7-18
Uses 6 teeth - 16,11, 26, 36, 31, 46
Performed with CPITN probe
20-25g of applied force
Inserted parallel to the root surface and walked around the gingival margin

Question 21

What are the simplified BPE codes?

Answer 21

0 - healthy
1 - bleeding after gentle probing, black band fully visible
2 - calculus or plaque retentive factors, black band fully visible
3 - pocketing 4-5mm, black band partly visible
4 - pocketing ≥6mm, black band disappears
* - furcation involvement
If aged 7-11 use only codes 0-2

Question 22

How is a gingivitis diagnosis made after BPE?

Answer 22

If <10% BoP then clinical gingival health
If 10-30% BoP then localised gingivitis
If >30% BoP then generalised gingivitis
Comment on plaque retentive factors where a BPE code of 2 is present

Question 23

What are the different SDCEP plaque scores?

Answer 23

10/10 - perfectly clean tooth
8/10 - line of plaque around the cervical margin
6/10 - cervical 1/3rd of the crown covered
4/10 - middle 1/3rd of the crown covered

Question 24

What should you do when there is a BPE code of 3 or 4?

Answer 24

6PPC - localised to 3, full if 4
CHeck alveolar bone level:
BWs for posteriors
Periapicals for anteriors
OPG esp if part of orthodontic tx

Question 25

What oral health messages should be given to prevent periodontal diseases?

Answer 25

Tooth brushing instruction
Fluoride advice
Smoking cessation

Question 26

When should patients be recalled for each BPE score?

Answer 26

0 and 1- screen at routine recall or within 1 year
2 - screen at routine recall or within 6 months
3 - 3 months, full periodontal assessment including 6 point pocket probing depth chart in affected sextants

Question 27

How is a code 3 BPE treated?

Answer 27

OHI as for codes 1 and 2
Supragingival/subgingival PMPR in shallow 4-5mm pockets
Remove/manage plaque retentive factors

Question 28

How is a code 4/* BPE treated?

Answer 28

Unusual in young patients
Full periodontal assessment, 6PPC
Consider referral to a specialist while doing initial therapy