Perio Flashcards
Describe healthy periodontium in children
Abscence of gingival inflammation and calculus
No more than one sextant with plaque
What are the features of a healthy periodontium in children
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
How should a BPE present in periodontal health?
<10% bleeding on probing
Describe plaque biofilm-induced gingivitis in children?
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
What are pre-disposing factors for necrotising gingivitis in children?
Malocclusions
Traumatic dental injury
Dental plaque-biofilm retentive factors - tooth anatomy, restoration margins, orthodontic appliances, incompetent lip
What are modifying factors for necrotising gingivitis in children?
Smoking
Hyperglycaemia or type 1 diabetes
Cyclosporin
Vitamin C deficiency
Increase in sex steroid hormones
Haematological conditions - leukaemia
What is gingival overgrowth related to?
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
How is gingival overgrowth treated?
Rigorous home care
Frequent appointments for PMPR
Possible surgery, especially with drug-induced gingival overgrowth
What should be done when the extent of the condition is inconsistent with the patients level of OH?
Consider urgent referral to physician for hematinic screening
What are the 4 distinguishing features of periodontitis?
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
What early clinical sign of periodontitis is seen in many teens?
> 1mm loss of attachment of cementum to PDL
What are the stages of periodontitis diagnosis?
Staging
Grading
Assess current periodontal status
Risk assessment
What is important to remember about periodontitis in the mixed dentition?
There may be false pocketing around erupting permanent teeth
What are the features of periodontitis with a molar incisor pattern?
Rapid attachment loss and bone destruction
Patient otherwise healthy
Onset around puberty
Family history
What are common diseases seen in children that manifest as periodontitis?
Papillon-Lefevre syndrome (PLS)
Down’s syndrome
Neutropenias
What are the steps of periodontal recording and diagnosis?
Gingival condition
Assess OH status
Assess if any calculus present
Assess local risk factors
How should gingival condition be assessed?
Assess:
Gingival colour
Contour
Swelling
Recession
Suppuration
Inflammation
Consider use of marginal bleeding free chart
How should OH status be assessed?
Description of plaque status
Describe surfaces covered by plaque
Use of plaque free scores
What local risk factors for periodontitis are seen in children?
Plaque retention factors
Low renal attachments
Malocclusion
Incompetent lip
Mouth breathing
Describe the simplified BPE
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
What are the simplified BPE codes?
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
How is a gingivitis diagnosis made after BPE?
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
What are the different SDCEP plaque scores?
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
What should you do when there is a BPE code of 3 or 4?
6PPC - localised to 3, full if 4
CHeck alveolar bone level:
BWs for posteriors
Periapicals for anteriors
OPG esp if part of orthodontic tx
What oral health messages should be given to prevent periodontal diseases?
Tooth brushing instruction
Fluoride advice
Smoking cessation
When should patients be recalled for each BPE score?
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
How is a code 3 BPE treated?
OHI as for codes 1 and 2
Supragingival/subgingival PMPR in shallow 4-5mm pockets
Remove/manage plaque retentive factors
How is a code 4/* BPE treated?
Unusual in young patients
Full periodontal assessment, 6PPC
Consider referral to a specialist while doing initial therapy
