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Perio Flashcards

1
Q

What is the spectrum of risk in periodontics

A
  • Not all people respond the same to periodontitis
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2
Q

What are local risk factors to periodontal disease

A
  • Anatomical factors, restorations
  • Removable partial dentures
  • Orthodontic appliances
  • Root fracture or cervical root resorption
  • Local trauma
  • Frenal attachments
  • Mouth breathing/ lack of lip seal
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3
Q

What are the anatomical local factors

A
  • Root grooves
  • Furcation
  • Residual periodontal pockets
  • Enamel pearl
  • Tooth positioning: crowding, tipping, rotations.
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4
Q

How can restorations be a problem

A
  • Roughness
  • Overhangs
  • Marginal discrepancies
  • Sub gingival margins
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5
Q

How are dentures problematic

A
  • Increased plaque on the abutment teeth
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6
Q

What are systemic risk factors to perio

A
  • Diabetes type ½
  • Genetic/host response
  • Race/ethnicity
  • Neutrophil function
  • Socioeconomic status
  • Acquired systemic infection
  • Severe malnutrition
  • Stress?
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7
Q

How does diabetes effect perio

A
  • Impairs the immune response
  • Wound healing response poor/ increased infection
  • Inducing a hyperinflammatory state
  • Increased periodontal tissue destruction
  • Well controlled no increased risk
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8
Q

How to check diabetic control

A
  • Hba1c
  • Glycated Hb levels indicate long term diabetic control
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9
Q

How is smoking associated with perio

A
  • Hume immune response weakened
  • decreased vascularity
  • Treatment outcome is also less effective
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10
Q

Definition of periodontitis

A
  • Inflammation within the supporting tissues
  • Progressive attachment and bone loss
  • Interdental CAL is detectable at >= 2mm or
  • Buccal CAL >= 4mm with pocketing >3mm on 2 or more teeth
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11
Q

consequences periodontal disease would you describe to the patient

A
  • Gingival inflammation
  • Bleeding
  • Recession
  • Periodontal pockets
  • Loss of alveolar bone
  • Tooth mobility and drifting
  • Tooth loss
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12
Q

What are the furcation defects (basic)

A
  • Class 1-3
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13
Q

How is staging calculated?

A
  • Interdental CAL at site of greatest loss
  • Stages 1-4
  • IF CAL not available then use RBL
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14
Q

How do you calculate grading

A
  • Indicator of rate of progression
  • Grade A-C
  • %bone loss / age
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15
Q

what are the 3 class’s of current periodontal status

A
  • Stable
  • Currently in remission
  • Currently unstable
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16
Q

What is defined as stable perio

A
  • BoP <10%
  • PPD <= 4mm
  • No BoP at 4mm site
  • (no mobility, furcation involvement, caries)
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17
Q

What is currently in remission

A
  • BOP >= 10%
  • PPD <= 4mm
  • No BoP at 4mm sites
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18
Q

What is currently unstable perio

A
  • PPD >= 5mm
  • PPD >+ 4mm & BOP
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19
Q

What are non-surgical therapy

A
  • Education (OHI)
  • Risk factors analysis
  • Motivation and behaviour change
  • PMPR
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20
Q

What are the factors for an engaging patient according to BSP

A
  • Plaque scores <20%
  • Bleeding scores <30%
  • Or plaque/bleeding score improvement of 50%
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21
Q

What can patients say after Non-surgical therapy

A
  • Gums have shrunk
  • Gaps are big in my teeth
  • Teeth are really sensitive
  • Gums bleed less, teeth less loose
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22
Q

What occurs in the healing process after PMPR

A
  • Inflammation resolution and PPD reduction
  • Recession and sensitivity
  • Long junctional epithelium (LJE) attachment may occur
  • Repopulation of healthier less pathogenic microflora
  • Formation of new bone, cementum and new attachment (unpredictable)
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23
Q

What are some statistical expectations from perio therapy

A
  • 35% initial pathological pockets will not reach end point
  • 50% of 7mm sites will remain as non-successful sites
  • Deeper pockets will respond greater
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24
Q

When do you consider antimicrobials in periodontal disease

A
  • Acute gingival problems: necrotising gingivitis/necrotising periodontitis
  • Concerns over antimicrobial resistance
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25
Tell me about chlorhexidine and side effects
- Wide spectrum antimicrobial activity - The CHX molecule rapidly attracted to opposite charge bacterial surfaces and causes membrane damage - Side effects: Staining, taste distortion, mucosal desquamation - Periochip (placed in deep pockets)
26
What are the clinical features of necrotising gingivitis
- Necrosis and ulceration of interdental papillae - Gingival bleeding - Pain - Halitosis
27
What are the clinical features of necrotising periodontitis
- All the same as NG - Including periodontal attachment loss
28
What are the risk factors for Necrotising periodontal disease?
- Malnutrition - Stress - Poor OHI - Smoking/alcohol - Young adults - HIV/AIDS
29
What is the management of Necrotising periodontal disease
- Initial debridement under LA if possible - Prescribe chlorhexidine mouth wash - Consider antibiotics if systemic - Recommend analgesia
30
What is an acute periodontal abscess
- Sudden onset of pain on biting/ throbbing pain - Gingiva are red, swollen and tender - Pus and discharge from gingival crevice
31
What is chronic periodontal abscess
- Bad taste and discomfort - Tooth often tender on bite - Pus my be present, sinus in mucosa overlying.
32
How to manage periodontal abscess
- Drain usually through pocket - Mechanical debridement - Systemic then use antibiotics (FGDP)
33
What is Triclosan
- Broad-spec antibacterial in toothpaste - Reduction in plaque and bleeding
34
What is dentine hypersensitivity
- Pain - Exposed dentinal tubules - In response to chemical, thermal, tactile stimuli - Pain goes on removal of stimulus - Associated features: abrasion, attrition, erosion
35
What are some differentials for dentine hypersensitivity
- Cracked tooth. - Dental carries - Fractured teeth
36
What can you do for dentine hypersensitivity
- Desensitising toothpaste - Sensodyne
37
What is the case definition for gingivitis
- Dental plaque induced or non-dental plaque induced - Localised 10-30% BOP - Generalised >30% BoP
38
What are non-dental plaque induced factors
- Genetics - Infection - Neoplasma - Trauma
39
What tissues colonize the root surface?
- Epithelial cells - Gingival connective tissue - Bone cells - Periodontal ligament (PDL) cells
40
What should we expect from a regenerative material
- Promote proliferation and migration of cells originating from PDL - Inhibit proliferation of epithelial and gingival connective tissue to wound area - Enhance space provision and wound stability
41
What is needed to have periodontal regeneration?
- Site protection - Space - Blood clot stability
42
What is some membrane properties in regeneration
- Biocompatible - Not elicit inflammatory reaction - Maintain barrier function, non-collapsible
43
Talk about the formation of the tissues in the root surface in terms of cementum
- Enamel matrix proteins on the root surface allow cementum - Cementum allow PDL and alveolar bone formation on cementum
44
What is enamel matrix protein
- Forms a matrix on root surface & - mesenchymal cells migrate to lesion - bone formation starts at the Enamel Matrix Derivative treated root surface - EMP/EMD increases: attachment rate of PDL, inhibits epithelial downgrowth
45
When would non-surgical treatment fail?
- Increase periodontal pocket depth - Increased width of the tooth surfaces - Poor access to establish proper curette - Presence of tenacious calculus - Presence of root fissures, root concavities, -defective restoration margins
46
What are the surgical methods for perio
- Tunnelling - Root amputation - Osseous surgery - Guided tissue regeneration, emdogain - Gingivectomy - Bone graft
47
What is emdogain
- Made from enamel matrix derivative - ?
48
What is the classification of furcation’s
- Class 1: <3mm - Class 2: >3mm but not through - Class 3: through and through - Sub class is PAL-V (A to C)
49
What would you do for degree 1 furcation involvement
- OHI - Non-surgical maintence
50
What to do if degree 2
- Single furcation: regeneration - Combined both 2: tunnelling or regeneration
51
What are gingival tissue biotypes
- Thin - Thick: less translucent, resistant to trauma and inflammation
52
What are PROMs?
- Patient reported outcome measurements - Allows us to identify treatment needs and outcomes - Monitor progress
53
What is SPT?
- Supportive periodontal therapy - Regular assessment, removal of supra and sub gingival, motivation for OHI - Periodontal patients would need life long compliance with SPT
54
What are the indications for surgical therapy?
- Pockets that did not adequately respond to non-surgical therapy - PPD >= 4mm and BOP - PPD >= 6mm - Further access for instrumentation - Regeneration (GTR) - Resecting (recontour gingival margin to allow better cleaning)
55
What are non-modifiable factors
- Age - Sex - Ethnicity - Genetics
56
What are acquired/modifiable/environmental
- Smoking - Systemic disease (diabetes) - Medications - Stress - Malnutrition - Socio-economic status - Compliance with recall system
57
What is the periodontal risk assessment
- 6 parameters to assess risk 1) BOP (%) 2) Number of residual pockets (PPD > 4mm) 3) Number of teeth lost 4) Bone loss/ age 5) Systemic/genetic diseases 6) Environmental factors (smoking)
58
What would the recall intervals be based on the PRA
- Low risk: 12 months - Moderate risk: 6 months - High Risk: 3 months
59
What is an overview of periodontitis pathogenic mechanism?
- Bacteria invades. - Host cells arrive and release: - Prostaglandins, cytokines (messenger sort of), MMPs - Osteoclast activated - Bone resorption and connective tissue breakdown - Pockets and CAL
60
What are the 3 main things in periodontitis aetiology
- Bacterial virulence - Environmental factors - Host response
61
What is diabetes and how to diagnose
- Body unable to regulate blood glucose levels - Insulin used to move glucose from blood stream to cells - Type 1: not enough insulin, body destroying cells in the pancreas that produce insulin - Type 2: doesn’t respond properly to insulin, lifestyle factors, most common - Diagnosis: HbA1C tests (less than 6% is normal?)
62
How can a dentist monitor diabetes in clinic
- MH confirmation - Gum disease signs (common in diabetes) - Dry mouth (sign of uncontrolled diabetes)
63
How does diabetes cause perio
- Increased cytokines in gingival crevicular fluid (mainly T1DM) - High blood sugar levels (bacteria?) - Perio can result in increased insulin resistance
64
What are the problems with NSPT
- Gaining access to deeper pockets - Root angulation, root morphology for curettage - Enamel pearls - Overhanging margins - Residual calculus in deeper pockets
65
Describe what resection is
- Removing a portion of gum tissue - Can be internal bevelled incision or wingman’s incision - Usually 1mm from gingival margin
66
What is bone contouring
- Osteoplasty: remove boen without affect supporting bone of neighbouring teeth - Ostectomy: removal of supporting bone from the neighbouring teeth which is used in two wall crater defects to create a more predictable mucogingival contour - Tunnelling: easier to clean teeth with furcation defects
67
What is important in perio surgery regeneration healing
-Epithelial cells and gingival connective tissue cells are very quick at proliferating during healing -Bone cells and PDL cells are slower, these are the ones crucial for regeneration -A barrier is created using guided tissue regeneration or emdogain in order to prevent epithelial cells and gingival connective tissue cells and to allow proliferation of bone cells and PDL cells into the space -If the barrier collapses or fails, the periodontal regeneration will fail -Enamel matrix proteins (found in emdogain) are crucial to allow proliferation of the desired cells
68
What effects recall for SPT in general?
Affected by site factors: BoP, PPD, CAL -Tooth factors: crowding, overhangs, bone levels, furcation defects -Patient factors: non-modifiable (genetics, age, ethnicity) and modifiable (smoking, diabetes, medications, OH, compliance with recall -Risk profile assessment based on: BoP, PPD, environment, genetics, BL/age, tooth loss
69
What are the S3 perio guidelines
- EFP guidelines last updated 2020 more detail in the word doc
70
What is the Dentogingival junction
- Hard tissue protruding through the protective mucosal barrier - Weak point in the immune defence
71
What is the supracrestal tissue attachment
- Junctional epithelium + supracrestal CT attachment - Above that is the sulcular epithelium
72
What are the periodontitis treatment warnings
- Recession and longer teeth - Black triangles - Sensitivity - Increased spacing (food packing) - Mobility changes
73
What are some of the prosthodontic challenges in a periodontitis patients
- Drifting/rotations - Mobility - Occlusal stability and over eruption
74
How can you fix black triangles
- Composite additions - Crowns - Gingival veneers
75
What are gingival veneers
- Engage the embrasure space - Acrylic or silicone - Not always well tolerated
76
What are the problems with tooth drifting and rotation
- Loss of support leads to the movement - Aesthetic - Orthodontics can be done - Extraction if moves out of arch line - Denture/bridge path of insertion challenging - Loss of prosthetic space
77
What can you tell me about overeruption
- Overeruption prevalence 83% - Maxilliary > mandibular - Degree varies - Average is 1.68mm
78
Tell me about splinting teeth
- Mobile teeth - Improve comfort and function - Prevent drifting - Temporarily during regenerative periodontal surgery - Material: fibre-reinforced composite, Twistflex ortho wire, cast metal
79
What is the shortened dental arch
- Anterior and premolar teeth in general fulfil the requirements of a functional dentition - Shortened arch 20 teeth - Extreme shortened arch 16 teeth
80
What are cross-arch bridges in periodontal
- Needs optimal compliance and high risk of failure, costs - Could stabilise teeth with lack of periodontal support
81
What do subgingival margins cause
- Increased PPD - Bleeding - Plaque - CAL loss
82
What’s problem of implants in periodontitis patients
- Higher risk of peri-implantitis in patient with periodontitis - Challenging due to alveolar bone loss – grafting - Higher risk of implant loss
83
What are the problems of dentures?
- Increase plaque on abutment teeth - Can worsen perio?
84
How can you design the denture better
- Gingival coverage associated with reduced periodontal health - Lingual bar advantageous of lingual plate - Reduced plaque on abutments with longer guide planes, finishing close to the gingivae - Over denture abutments have increased BOP and inflammation - If plaque control is good and maintained, RPD not associated with greater plaque accumulation
85
What is PMPR
- Professional mechanical plaque removal
86
What is periodontal phenotype
- Gingival phenotype - Bone morphotype
87
What is a mucogingival deformity
- Deviation from the normal dimension and morphology relationship between the gingiva and the alveolar mucosa
88
What are the 3 periodontal biotypes
- Thin scalloped - Thick scalloped - Thick flat
89
What are some mucogingival deformities
- Lack of keratinized gingiva - Decreased vestibular depth. - Aberrant frenum - Gingival recession
90
What are the periodontal plastic surgery
- Frenectomy - Alveolar ridge preservation - Crown lengthening - Augmentation of keratinized attached gingiva - Soft tissue ridge augmentation - Ectopic tooth eruption - Papilla regeneration
91
What causes lack of keratinized attached gingiva
- Caused by recession - Abnormal frenum pull - Pocketing
92
Causes of recession
- Mechanical factors: brushing - Plaque induced inflammation - Periodontal disease - Iatrogenic factors: orthodontics, overhangs, clasps - trauma
93
What is the miller classification
- Classify recession - 5 levels
94
What is thick flat phenotype
- Square shape teeth - Large interproximal contact - Broad zone of keratinized tissue
95
What is thick scalloped
- Slender teeth shape - Narrower zone of Keratinized tissue - Pronounced gingival scalloping
96
What is thin scalloped
- Thin gingiva - Thin alveolar bone - Slender shaped teeth - Narrow zone of keratinized tissue
97
What are the recession treatments
- Graft - Flap - Biologics

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