perio

Question 1

How is loss of attachment measured?

Answer 1

1. Measure the distance between ACJ (amelocemental junction) and gingival margin.

If GM is BELOW ACJ then number is POSITIVE
(E.G. +2mm)

if GM is ABOVE ACJ then number is NEGATIVE

2. Measure probing depth (e.g. 4 mm)
3. Add together (2+4 = 6 mm)

Question 2

What is clinical attachment level?

Answer 2

Approximate position of periodontal attachment of a tooth

Question 3

How is tooth mobility graded and assessed

Answer 3

I - <1mm (can be moved horizontal)
II – 1-2mm (can be moved in a horizontal)
III - >2mm (can be moved in any direction)

Place a finger on the buccal surface of the tooth to support it then using the end of a mirror or another instrument move the tooth horizontally and record the mobility using the mobility grading system

Question 4

Which grade is given to a furcation lesion which is 5mm but not through and through

Answer 4

grade 2 furcation

Question 5

Two regions with same of loss of attachment. One has gingival margin above ACJ and other below. Which tooth has the deeper pocket

Answer 5

The region with the gingival margin below the ACJ will have the deeper pocket.

Question 6

3 changes you would see in a periodontal pocket chart post debridement

Answer 6

• Decrease in probing depths
• Decrease In loss of attachment
• Distance of GM from ACJ more positive
• Decrease in BOP

Question 7

CPTN probe

Answer 7

Used for BPE
No black band
A ball at the end

another name is WHO probe

Question 8

PCP-12 probe

Answer 8

used for 6PPC
doesn’t have a ball

Question 9

UNC-15 probe

Answer 9

6PPC chart probe
has multiple lines for each mm
don’t have one in dental hospital but one Jen uses

Question 10

furcation grade 1

Answer 10

the furcation ending can be felt on probing but involvement is LESS than 1/3rd of the tooth

Question 11

furcation grade 2

Answer 11

loss of support EXCEEDS 1/3 of the tooth width but doesn’t include full width of furcation

Question 12

furcation grade 3

Answer 12

through-and-through involvement
probe can pass through entire furcation

Question 13

5mm horizontal loss of attachment in furcation from lingual aspect. Not detectable from buccal aspect. What type of furcation involvement?

Answer 13

class 2

Question 14

Site A and B have the same LOA. Site A has gingival overgrowth, site b has gingival recession, which site has the deeper pocket?

Answer 14

Gingival recession

Question 15

BPE score 3

Answer 15

probing depth of 3.5-5.5mm
calculus and BOP
black band partially visible

this sextant should be reviewed and 6PPC done AFTER treatment

Question 16

BPE score 4

Answer 16

probing depth of >5.5mm
black band entirely within the pocket

Question 17

As the patient has scored a 4 on the BPE, further special investigations are required. Please list three further investigations you are most likely to carry out.

Answer 17

full mouth radiographs
6PPC
modified plaque and bleeding score or full mouth plaque and bleeding scores

Question 18

What factors might cause inaccuracy or variation in pocket probing depth measurement? (i.e. what factors might result in pocket depth being recorded that is not the true distance from gingival margin to depth of pocket?)

Answer 18

• Force applied
• Presence of calculus
• Inaccurate angle of insertion
• Presence of false pockets
• Inflammation
• Using wrong probe - PCP-12 and not UNC 15

Question 19

The lower right sextant had a * assigned to the code which indicates the presence of a furcation lesion. Complete the following table to describe the meaning of each furcation grade

Answer 19

1 Furcation involvement <1/3 of tooth width
2 Furcation involvement >1/3 of tooth width but not full tooth width
3 Furcation involvement the full distance of the tooth

Question 20

Oral Hygiene TIPPS is a behaviour change strategy to address inadequate plaque control. Complete the table below to describe TIPPS, and how you would apply this for this patient with periodontal disease?

Answer 20

T TALK
I INSTRUCT
P PRACTICE
P PLAN
S SUPPORT

Question 21

what microbes are found in periodontal disease?

Answer 21

Treponema denticola
Porphyromonas gingivalis
The microaerophile actinobacillus

Question 22

How can the inflammatory process worsen periodontitis?

Answer 22

increased production of pro-inflammatory cytokines:
interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α)

In periodontitis, the inflammatory process can ACTIVATE OCTEOCLASTS, leading to the destruction of the alveolar bone that supports the teeth.

Chronic inflammation can impair the immune response and lead to a reduced ability to fight off infection.

COLLAGEN DEGRADATION

DELAYED HEALING

Question 23

What do pattern recognition receptors recognise in perio disease?

Answer 23

Pattern recognition receptors (PRRs) are a class of receptors that recognise specific molecular patterns on microorganisms or host tissues, triggering innate immune responses.

lipopolysaccharides
peptidoglycan
flagellins
extracellular matrix molecules

Question 24

How would the immune system respond to a build up of plaque?

Answer 24

innate immune response - first line of defence - PRRs trigger production of cytokines and chemokines

inflammatory response - neutrophils, macrophages and dendritic cells - interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) - attracts more immune cells and causes inflammation of perio tissue

adaptive immune response - triggered by recognition of specific antigens by B and T cells and producing antibodies that stop colonising the plaque

tolerance - immune system learns to tolerate commensal bacteria and prevents overreacting and causing tissue damage

Question 25

bpe score 0

Answer 25

no pockets >3.5mm, no calculus, no BOP, black band completely visible

Question 26

bpe score 1

Answer 26

no pockets >3.5mm, no calculus, BOP, black band completely visible

Question 27

bpe score 2

Answer 27

no pockets >3.5mm, supra or sub gingival calculus, BOP, black band completely visible

Question 28

what risk factors contribute to the pathogenesis of periodontal disease?

Answer 28

family history - genetics
smoking
alcohol
poor OH
hormonal changes
medications
stress
poor nutrition

Question 29

What specific features of oral microorganisms does the host detect via pattern recognition receptors?

Answer 29

proteins that recognise specific pattern present on the surface of microorganisms
e.g. Lipopolysaccharides (LPS)can trigger an immune response via Toll-like receptor 4 (TLR4) on host cells.

Peptidoglycan (PGN) can activate TLR2 and nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) on host cells.

Flagella can activate TLR5 on host cells.

initiate a cascade of signaling events that lead to the activation of immune cells, including neutrophils, macrophages, and dendritic cells. These immune cells release pro-inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha), which help to clear the invading microorganisms and initiate tissue repair processes.

Question 30

What specific host responses occur following the activation of pattern recognition receptors to control overgrowth of dental plaque?

Answer 30

1. inflammatory response - PRRs recognise pathogen-associated molecular patterns (PAMPs) present in dental plaque, which activates the production and release of pro-inflammatory cytokines, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α).
   initiates and amplifies the inflammatory response
2. immune cell activation = neutrophils, macrophages and dendritic cells = helps to phagocytose and kill bacteria and produce antimicrobial peptides to inhibit bacteria growing
3. antimicrobial peptide production: PRR activation = defensins and cathelicidins = directly target and kill bacteria present in dental plaque, helping to control their overgrowth.
4. Regulation of cytokine production = by immune cells = ensures that the inflammatory response is controlled and does not become excessive, which could damage surrounding tissues.

Question 31

How does the host immune response contribute to periodontal tissue destruction?

Answer 31

1. inflammatory response - neutrophils, macrophages and dendritic cells - interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) - attracts more immune cells and causes inflammation of perio tissue
2. collateral tissue damage - during the response, immune cells and their mediators may cause collateral damage to the surrounding tissues.
   e.g. reactive oxygen species (ROS) and proteases can damage collagen and elastin in the periodontium
3. autoimmunity = autoantibodies can contribute to tissue destruction by promoting the recruitment and activation of immune cells, leading to inflammation and collagen degradation.
4. genetic susceptibility = certain genetic polymorphisms are associated with an increased risk for periodontitis

Question 32

effects of smoking on perio