perio Flashcards
List 5 clinical features of a healthy periodontium
- coral pink
- knife-edge scalloped margins
- firm & resilient gingiva
- complete papilla fill
- keratinised gingiva with stippling
5 clinical features of gingivitis
- gingival redness/erythematous
- enlarged, swollen & hyper plastic with rolled margins
- oedematous & spongy
- shiny
- loss of stippling
- possible ulcerations
list 5 clinical feature of periodontitis
- gingival redness & erythematous that increases in extent and intensity (become cyanotic toward MGJ)
- enlarged, swollen & hyperplastic with rolled margins
- oedematous & spongy
- loss of stippling
- possible ulcerations
- gingival recession
- drifting of teeth
- shaky teeth
why is it important to identify gingival phenotype
if thin:
- expect probing depths to be shallow
- expect recession to happen after you treat
- can pre-warn the patients of the outcome (eg. after treatment when inflammation goes down, may see black triangles)
if thick:
- less susceptible to bacterial and mechanical insult
- less likely to have gingiva recession
- but pockets will form, giving deep probing depths
what to check for medical, dental and social history
medical:
- systemic conditions: diabetes, infection endocarditis (need antibiotic prophylaxis)
- drugs: DDI, caused oral clinical presentation, allergies, pregnancy-safe medications
- MRONJ (medication-related osteonecrosis of the jaw) risk
communicable disease
- medical emergencies risk
dental & social
- oral hygiene habits (frequency, types of hygiene aids used)
- history of tooth loss (due to caries or periodontal disease?)
- history of treatment (what treatment? receptiveness to the types of dental treatment? assess attitude)
- smoker?
- job?
- diet history
why are universal precautions and infection control important
to prevent transmission of disease - from patient to clinician, from clinician to patient & within dental team (assistants receptionists, lab technicians)
protect yourself for the people you love, and protect the people that you love from you
what does PPE include
wearing sequence & things to note
HAND RUB
1. Mask
2. eye shield
- eye protection even if you are wearing glasses
3. hairnet
- cap covers forehead and ears
- ensure all fringes are tucked into the hairnet
4. gown
- ensure back portion of gown overlaps each other
- tie at the neck first, then tie at the waist
HAND RUB
5. gloves
- ensure gloves fit well. snug fit
you are the assistant. list the steps you would take to change the bib for the patient
- with gloves on - remove bib & bib holder from patients neck
- remove & dispose soiled bib into the general bin
- place bib holder onto the paper covering assistant’s cabinet top
- remove gloves & hand rub
- open the drawer WITHOUT gloves
- retrieve a new bib & drop it on the paper covering assistant’s cabinet top without touching contaminated surfaces
- close the drawer with clean ungloved hands
- hand rub and put on new pair of gloves
- attach new bib to bib holder & put on patient
7 important clinical parameters
- probing depths
- gingival recession
- furcation involvement
- BOP
- plague score
- mobility
- CAL
how to probe? what to take note while probing?
- using perio probe
- measure the vertical distance from the FGM to the base of the gingival sulcus
- perio probe should be parallel to the long axis of the tooth & closely adapted to the tooth surface
- avoid excessive probing force & pressure – damage soft tissues
- readings taken at 6 points per tooth: DB, B, MB, DP, P, MP
how to calculate gingival recession
- using perio probe
- measure the vertical distance between CEJ & FGM
- perio probe should be parallel to the long axis of the tooth and
- measured at 6 sites (same as ppd)
how to calculate CAL + its significance
CAL (clinical attachment loss) = gingival recession (CEJ to FGM) + probing depth (FGM to base of sulcus)
- using perio probe
- readings taken at 6 points per tooth: DB, B, MB, DP, P, MP
- if FGM above CEJ, gingival recession is taken to be a negative value
gives indication of the amount of tissue loses & damages around a tooth – gives a sense of prognosis + treatment plan
since it is a reproducible parameter with fixed reference points, it can be used to monitor patients condition over time
HOWEVER, it is a measure of accumulated past disease at a site rather than the current disease activity level
clinical difficulties
- cannot see CEJ
-
elaborate on mobility
- applying pressure bucco-lingually using 2 blunt ends of the instrument
class 1: able to move crown by at most 1mm horizontally
class 2: able to move crown >1mm, and able to visualise crown’s mobility
class 3: severe mobility of crown horizontally & vertically impinging tooth function
subjective measure. only vertical depression is obvious
what is fremitus? how to check
fremitus is the movement of the tooth when in function i.e. when biting in MI or moving in lateral excursive and protrusive movements
check by observing the tooth moving as the patient bites down and move jaw left , right, forwards
can use interdental contact points or saliva as a reference
elborate on furcation
- using Naber’s probe
class I: horizontal loss of periodontal support ≤ 1⁄3 tooth width
class II: horizontal loss of periodontal support > 1⁄3 tooth width, but not through the whole width of the furcation
class III: horizontal ‘through & through’ destruction of the periodontal tissues in the furcation
for maxillary molars, mesial & distal furcation should be probed from the palatal side; buccal furcation from mid buccal
for mandibular molars, buccal furcation from mid buccal; lingual furcation from mid lingual
step by step how to do plaque disclosing
- prepare vaseline & plaque disclosing agent. soak a cotton pallet in the plaque disclosing agent
- use cotton roll to apply vaseline to patient lips
- remove excess saliva in the mouth with saliva ejector, and use airjet to gently dry
- Gently dab cotton pallet onto tooth surface along the gum line for all the tooth
- ask patient to gently rinse their mouth 1-2 times
- record pink/purple stain along FGM. if stain is away from FGM, it is not charted
charting done on 4 surfaces per tooth: M, D, B, P