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BDS4 EXAM PREP > perio > Flashcards

perio Flashcards

1
Q

perio classifications

BSP2017

A

health
plaque induced gingivitis
non plaque induced gingivitis
gingival diseases and conditions
periodontitis
necrotising periodontal diseases
periodontitis as a manifestation of systemic diseases
systemic diseases or conditions affecting periodontal tissues
periodontal abscess
perio-endo lesions
mucogingival deformities and conditions

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2
Q

categories of perio health
features of each

A

pt with intact periodontium (no BoP, no attachment loss)
pt with reduced and stable peirodontium (BoP <10%, PPD<4mm)

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3
Q

clinical features of healthy periodontium

A

knife edged
scallopped gingival margin
pink/pale
stippling
firm and flat
painless
no bleeding

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4
Q

clinical features of gingivitis

A

BPE 2 or less
no bone loss
no loss of ID papilla
inflammation
loss of stippling
halitosis
BoP
red

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5
Q

local and generalised

A

localised <30%
generalised >30%

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6
Q

local factors for perio

A

calclus
poor resotration margins/overhangs
malpositioned tooth making it hard to clean

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7
Q

systemmic factors for perio

A

diabetes (hyperglyceamia)
sex hormones (puberty, pregnancy)
smoking
poor diet
drugs - nifidipine, phenytoin, cyclosporin

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8
Q

systemmic factors for perio

A

diabetes (hyperglyceamia)
sex hormones (puberty, pregnancy)
smoking
poor diet
drugs - nifidipine, phenytoin, cyclosporin

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9
Q

stageing

A

severity

1 - early/mild (<2mm or <15%)
2 - moderate (<1/3 bone loss on root)
3 -severe (1/3-2/3 root)
4 - very severe (>2/3 bone loss)

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10
Q

grading

A

rate

A - mild rate (<0.5 when %bone loss/age)
B - moderate rate of progrssion (0.5-1)
C - rapid rate >1

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11
Q

currently unstable

A

pockets >5mm
4mm pockets with BOP

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12
Q

currently stable

A

BoP<10%

PPD < or =4mm
no BOP at 4mm sites

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13
Q

currently in remission

A

BoP >10%
PPD <4mm
no BOP at 4mm sites

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14
Q

types of necrotising periodontal diseases

A

NUG - just gingiva
NUP - with bone loss
N stomatitis - bone denudation beyond mucogingival juntion

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15
Q

clinical features of NUG

6

A
  • gingivitis
  • hallitosis
  • loss of ID papilla (interproximal necrosis) puchned out appearance
  • bleeding
  • painful ulceration of ID papilla
  • pseudomembrous slough
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16
Q

risks factors for NUG

A

smoking
stress
immunocompromised
poor OH

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17
Q

tx for NUG

A

OHI
smoking cessation
PMPR - under LA
CHX 0.2% mouthwash

antibiotics
* metronidazole 400mg 3xdaiy for 5days
* amoxicillin 500mg 3xdaily for 5days

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18
Q

periodontal abscess
definition

A

localised collectioon of dead and dying neutrophils
Acute exacerbation of periodontal pocket

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19
Q

periodontal abscess
symptoms

A

swelling
pain
bleeding
pus suppuration
deep pocket
TTP

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20
Q

periodontal abscess tx

A

incise and drain - through pocket or incision
OHI - CHX 0.2% mouthwash advise
subgingival PMPR short of base of pocket
review in 10 days

antibiotics if systemic symptoms - PenV 500mg 4xdaily for 5days

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21
Q

methods of perio-apical communication

6

A

apical forament
lateral canal
fractures
resorption
iatrogenic perforations
furcal canals

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22
Q

recession

mucogingival deformities

A

lack of keratinised gingval attachment
displacement of gingval soft tissue margin to ACJ resulting in root exposure

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23
Q

RT1

A

recession with no loss of interproximal attachemetn
(interproximal ACJ clinically undetectable both M and D, most of ID papilla remains)

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24
Q

RT2

A

gingival recession associated with loss of some interproximal attachement

some ID papilla remains; amount of attachemnt loss less than or = to buccal attachemnt loss

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25
Q

RT3

A

gingival recession associated with more loss of IP attachment
* no ID papilla remains
* amount of IP attachment loss is greater than buccal attachement loss

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26
Q

reasons for recession

5

A
  • successful HPT
  • vigorous brushing
  • traumatic incisal realtionship
  • iatrogenic restorative damage
  • foreign body trauma
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27
Q

causes of tooth mobility

4

A

alveolar bone loss
clinical attachement loss
PDL widening
periodontal tissue disruption (due to inflammation)

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28
Q

effect of abnormal occlusal forces on healthy periodontium

A

areas of intermittent pressure and tension
* areas of widened PDL until forces adequately dissipated, inc in tooth mobility

  • if demand reduced - dec in tooth mobility and PDL returns to normal

normal physiological response

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29
Q

effect of abnormal occlusal force too great on healthy periodontium

A

if demand too great - PDL conts to widen until forces adequately dissipated or tooth is lost

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30
Q

effect of abnormal occlusal forces on healthy but reduced periodontium

A

tooth effefctively on alveolar bone fulcrum
hypermobile tooth
no plaque
gingival margin remains intact and perio disease will not restart

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31
Q

effect of abnormal occlusal forces on diseased periodontium

A

zone of co destruction

supra-physiological occlusal forces widen PDL width at base of pocket, hypermobile teeth
* pathological disease (inflammation) causing CAL or excessive bone loss when combined

32
Q

why to intervene in occlusal trauma

3

A

symptomatic mobility
progressively inc mobility
assoc with deep pockets

33
Q

BPE 1

A

pockets <3.5
BoP

no Plaque retentive factors

OHI

34
Q

BPE2

A

pockets <3.5mm
BOP
plaque retentive factors

PMPR and OHI

35
Q

BPE3

A

pockets 3.5-5.5mm

PMPR
OHI
6PPC after tx

36
Q

BPE 4

A

pockets >5.5

radiographs, 6PPC that sextant
PMPR and review

37
Q

BPE *

A

furcation involvement

38
Q

furcation grades

A

1 - <1/3
2 - >1/3 but not through
3 - through and through

39
Q

factors that affect toothmobility

A

height of PDL
width of PDL
presence of inflammation
nuber/shape/length of roots

40
Q

tx option for tooth mobility

pros and cons

A

splinting

when mobilty is due to LoA, there is discomfort/chewing diffiiculties
stabilises teeth for debridement
doesnt influence rate of disease
OH difficulties for pt

41
Q

causes of tooth migration

3

A

unfavourable occlusal forces
unfavourable soft tissue profiles
loss of attachemtn

42
Q

tx options for tooth migration

A

tx underlying perio disease

accept and stabilise
ortho and stabilise
extract
correct occlusal relations

43
Q

problems with antibiotic use for perio disease

5

A
  • unable to penetrate biofilm - need mechanical therapy
  • can be inactivated by non target organisms
  • superinfection possible
  • allergies
  • resistance
44
Q

causes of antibiotics resistance

5

A
  • can be inactivated against non target orgaisms
  • trapped and destroyed by enzymes
  • expression of biofilm specific resistance genes
  • may fail to penetrate beyond surface layer of biofilm
  • stress reponse to hostile environment denatures AB
45
Q

substantivity

A

persistence of action and ability to stick to target

how long agent works for

46
Q

substantivity depends on

A

maintenance of antimicrobial aactivey and slow neutralisation of antimicrobial activity

47
Q

chlorohexidine

A

antiseptic
bisbiguianide
dicationic action - one cation adsorbs to tooth/pellicle and other cation sticks on bacteria

in low conc causes inc cell permeability and at high conc causes cytoplasm precipitation (causing cell death)

48
Q

indications for CHX

A

pre surgical mouthwash/aseptic technique
immunocompromised pt
limited manual dexterity/unable to perform OH
oral candidiasis
RAS
NUG
post- PMPR
post extraction/surgery

49
Q

side effects of CHX

A

bitter taste
staining
taste disturbance
mucosal erosion
parotid swelling

50
Q

successful perio features

A

BOP <10% - reduced
reduced probing detph - gain in clinical attachement via junctional epithelium
improve OH - reduced plaque and bleeding scores
no worsening in furcation scores
reduced or stabilised mobility

51
Q

aims of perio tx

A

arrest disease
regenerate lost tissue
maintain longterm perio health
prevent tooth loss
improve soft tissue consistency so easier management

52
Q

side effects of perio tx

A

recession
sensitvity
initial bleeding

53
Q

components of perio tx

A

risk factor managenent - smoking, diet, diabetes etc
OHI
PMPR - supra and sub
removal of PRFs
re-eval

54
Q

when to re-eval

A

8-12 weeks after PMPR

most healing occurs at 6 weeks
longer allows better healing and replacement of junction epithelium

55
Q

reasons why PMPR may fail

A
  • inadequate operator technique
  • blunt instrument
  • pt not engaging with OHI regime
  • no correction of risk factors - smoking, poorly controlled diabetes
  • not debriding enitre pocket anatomy - unable to access
  • poor visiualisation of pocket meaning unable to assess when successful cleared pocket - not enough suction
56
Q

aims of periodontal surgery

2

A

arrest disease by gaining access to complete PMPR
regenerate loss perio tissues

57
Q

contraindications for perio surgery

A

non engaing pt

e.g. poor OH, smoking

58
Q

types of perio surgery

3

A

access - OFC
regenerative - GTR, GBR
mucogingival

59
Q

features of healing post OF PMPR

A

organisation of blood clot
replacement by collagenous connective tissue
attachement via long junctional epithelium
reduciton in probing depths (gain in clinical attachement and recession)

60
Q

aims of gingivectomy

A

facilitate pt OH
improve aesthetics
facilitate restorative dentistry

61
Q

indications for gingivectomy

4

A

gingival overgrowth/hyperplasia
areas with difficult acces
pseudopockets
idiopathic gingival fibromatosis
shallow suprabony pocket

62
Q

drugs that can cause gingival hyperplasia

A

anticonvuslants - phenytoin
immunosuppressants - cyclosporin m
Ca channel blockers - nifedipine

63
Q

inidications for GBR

A

2 or 3 walled proximal defetc

64
Q

indications for elimination perio surgery
types of

A

grade II furcation defects in mandible
grade II buccal furcation defects maxilla

tunnel prep and furcation plasty (make through and through)
hemisection or separation

65
Q

indications for XLA

A

non functional tooth
gross mobility
little remaining attachement and recurrent symtpms

66
Q

key perio pathogens

A

p gingivalis
t denticola
t forsythia

67
Q

pathophysiology of gingivitis

A

inc PRR stimulation
inc production of pro inflammatory mediators
inflammation
inc vasodilation and immune cell migration
amlification of healthy immune resopnse

68
Q

pathophysiologi of perio

A

biofilm extends into pocket and adaptive immune response predominates
further amplification of pro inflammatory processes
Connective tissue destruction - MMPs
Alveolar bone resorption - RANKL - due to exacerbated uncontrolled immune response

69
Q

perio biofilm formation

A

conditioning film - organisms ATTACHES to enamel and growth from supra to deep gingival crevice
* more harmful bacteria furhter in = anaerobic, Red Sockranskys

coaggregation of bacteria = dense biofilm formation

chronic inflammation but P.ging subverts immune response
* dysbiosis of biofilm

complement activated
* bone destruction and PDL loss

70
Q

bacteria in gingivitis and NUG

A

p.intermedia
anaerobic
-ve rod
black

w

71
Q

red sokranskys organisms

A

t.denticola
t.forsythia
p.gingivalis

72
Q

p.gingivalis

virulence

A
  • gingipains - nutrients to self, degrade host immune response
  • tissue toxic byproducts
  • endotoxic LPS
  • capcular polysaccharides
  • proteases
  • frimbriae - adherence and invasion
73
Q

smoking and perio

A

Acidic favours p.ging
Delayed wond healing
Vasocontriction
Impacted chemotaxis
Cytokine production dec
Enzyme catalase dec

74
Q

diabetes and perio

A

Healing delayed (dec collagen)
Inc chemotaxis by macrophages IL6 and TNF alpha
advanced Glycerin end products due to abnormal glucose
Heightened inflammatory reponse and dec neutrophils

HbA1c - ideal 48mmol/mol (below 6.5%)

birelational

75
Q

endo perio lesions with root damage

3

A

root fracture or cracking
root canal or pulp chamber perforation
external root resoprtion

76
Q

endo perio lesiosn without root damage
in periodontitis pts

3

A

grade 1 - narrow deep perio pocket in 1 tooth surface
grade 2 - wide deep pocket in one tooth surface
grade 3 - deep pocket in more than 1 tooth surface

77
Q

endo perio lesion in non perio pt

3

A

grade 1 - narrow deep pocket in 1 tooth surface
grade 2 - wide deep perio pocket in 1 tooth surface
grade 3 - deep pocket in more than 1 tooth surface

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