PERIO Flashcards
What is the diagnosis when observing the following?
- pink in colour
- stippled
- triangular interdental papilla
- firm in consistency
- knife-edged gingival margin
- probing pocket depths <3mm
- no bleeding when probing
- no recession
- no mobility
clinically healthy periodontium
How is level of health/disease assessed? (9)
- gingival colour
- gingival contour
- plaque levels
- bleeding on probing
- pocket depths
- mobility
- presence and location of calculus
- presence and location of PRFs
- radiographs
What is a BPE used for?
- screening tool to identify patients who do require treatment
- defines the level of health and disease clearly
What are the 3 type of probe used for a BPE measurement? (all the same)
- BPE probe
- WHO probe
- CPITN C probe
Which teeth are screened for a modified BPE?
UR6, UR1, UL6
LR6, LL1, LL6
From what age can a modified BPE be used?
ages 7-11
What scores can be used for a modified BPE?
0, 1, 2
From what age can a full BPE score be used? (0, 1, 2, 3, 4, *)
ages 12-17
When would third molars be included in a BPE?
when second molars are missing
How is a BPE measured when there is only one tooth in the sextant?
scored an X and the tooth score is included in the adjacent sextant
If a patient has a BPE of 4 or *, what assessment should be carried out?
full pocket probing depth required
Which BPE score is the following?
- pockets <3.5mm
- no calculus/overhangs, no bleeding on probing
- black band entirely visible
0
Which BPE score is the following?
- pockets <3.5mm
- no calculus/overhangs
- bleeding on probing
- black band entirely visible
1
Which BPE score is the following?
- pockets <3.5mm
- supra or sub gingival calculus/overhangs
- black band entirely visible
2
Which BPE score is the following?
- probing depth 3.5mm-5.5mm
- black band partially visible
- pocketing of 4mm-5mm
3
Which BPE score is the following?
- probing depth >5.5mm
- black band disappears
- pocketing of 6mm or more
4
What should be done if periodontal tissues are too painful upon probing?
- do not continue with BPE
- disclose and take photographs
- concentrate on OHI
- return to BPE at a later date
How can it be detected if a patient is engaging with with OHI?
- plaque score and marginal bleeding reduction of 50% or more
- plaque levels less than 20% and bleeding levels less than 30% (or equivalent to)
How can it be detected if a patient is not engaging with OHI?
- plaque score and marginal bleeding less than 50% improvement
- plaque levels above 20% and bleeding levels above 30%
- patient states preference to a palliative approach to periodontal care
In what order should full 6PPC charting be done?
1 - recession
2 - pocket depths
3 - bleeding on probing
4 - mobility
5 - furcation (naber probe)
Which periodontal probe is the following?
- a 15mm long probe with millimeter markings at each mm and colour coding at the 5th, 10th and 15th mm?
UNC 15 probe
Which periodontal probe is the following?
- markings at 1 2 3 4 5 7 8 9 10
williams probe
What are periodontal probes used to determine? (5)
- pocket depths
- attachment level
- amount of gingival recession
- presence of plaque and calc
- anatomical features of the root
What 4 factors can lead to probing errors?
- dimensions and shape of probe (use narrow probe point of 0.4mm)
- positioning of probe (parallel to long axis of root)
- probing force
- extent of inflammation
If probe is not parallel to long axis of root, how could this affect PPD?
underestimate pocket depths
What are 7 factors which influence probing depths?
- severity of disease (diseased tissue offers less resistance, therefore JE may be penetrated)
- thickness of probe
- technique (pressure 20-25g)
- accessibility and visibility
- tooth contours
- calculus
- restorations
When measuring mobility, what does a grade 0 indicate?
no detectable movement/physiological mobility (classically up to 0.2mm)
When measuring mobility, what does a grade 1 indicate?
mobility of the crown of the tooth 0.2-1mm in the horizontal direction
When measuring mobility, what does a grade 2 indicate?
mobility of the crown of the tooth >1mm in the horizontal direction
When measuring mobility, what does a grade 3 indicate?
mobility of the crown in both the horizontal and vertical planes
What are 3 risk factors for periodontal disease?
1 - plaque
2 - smoking
3 - calculus and other risk factors
What are 3 reasons to carry out PMPR?
- removes PRFs
- facilitates disrupting plaque biofilm
- cosmetic
What must be communicated to the patient if perio is detected?
Educate and motivate
* Explain “Gum Disease”
* Emphasise risk factors
* Encourage excellent oral hygiene * Explain (consent!) gums will recede and calculus will become visible and
teeth may become sensitive initially
What percentage is classed as localised perio?
≤ 30% teeth
What percentage is classed as generalised perio?
> 30% teeth
What pattern could a perio diagnosis also be classed as?
molar-incisor pattern
If a probing pocket depth is <4mm with no radiographic bone loss, what is the diagnosis?
health or gingivitis
If a probing pocket depth is >4mm and/or radiographic bone loss, what is the diagnosis?
periodontitis (localised, generalised or MI pattern)
What staging is interproximal bone loss of <15% or <2mm attachment loss from CEJ?
- no tooth loss due to perio
- PPD ≤4mm
- mostly horizontal bone loss
stage I (early/mild)
What staging is interproximal bone loss to coronal third of root?
- 3-4mm CAL
- 15%-33% bone loss
- tooth loss?
- PPD ≤5mm
- mostly horizontal bone loss
stage II (moderate)
What staging is interproximal bone loss to mid third of root?
- 5mm or more CAL
- bone loss beyond 33%
- tooth loss of four teeth or less
- PPD ≥6mm
- vertical bone loss ≥3mm
- class II/III furcations
stage III (severe)
What staging is interproximal bone loss to apical third of root?
- masticatory dysfunction
- pathologic migration of teeth
- severe ridge defects
stage IV (very severe)
How is the grading of periodontitis calculated?
% bone loss divided by patients age
What does a grading calculation of <0.5 indicate?
grade A (slow rate of progression)
What does a grading calculation of 0.5-1.0 indicate?
grade B (moderate rate of progression)
What does a grading calculation of >1.0 indicate?
grade C (rapid rate of progression)
What does the following indicate for current perio status?
- BoP <10%
- PPD ≤4mm
- no BoP at 4mm sites
currently stable
What does the following indicate for current perio status?
- BoP ≥10%
- PPD ≤4mm
- no BoP at 4mm sites
currently in remission
What does the following indicate for current perio status?
- PPD ≥5mm OR
- PPD ≥4mm & BoP
currently unstable
Which 6 factors aid in diagnosis of periodontal disease?
- extent of disease
- type of disease
- stage
- grade
- current status
- risk factors
What are 3 examples of necroitising peridontal conditions?
- necrotising gingivitis
- necrotising periodontitis
- noma
What are 6 risk factors for necrotising periodontal diseases?
- stress
- smoking
- previous necroitising perio diseases
- poor nutrition
- HIV/AIDs
- extreme living conditions
What are the 4 components of the periodontium?
- ginigiva and investing tissues
- alveolar bone
- periodontal ligament
- cementum
Remember labelled pic
What are the 3 putative pathogens for periodonal disease?
- p gingivalis
- tannerella forsythus
- treponema denticola
Within what timeframe does plaque mass change composition from mostly gram-positive coccoid and filamentous bacteria to gram-negative rods and spirochetes?
10-20 days
Which stage of the pathogenesis of peridontal disease is the following?
- classic acute exudative vasculitis with loss of perivascular collagen in gingival tissue (like acute injury)
initial lesion (2-4 days)
Which stage of the pathogenesis of peridontal disease is the following?
- dense infiltrate of lymphocytes and other mononuclear cells, fibroblast morphology alteration, initiation of connective tissue loss
early lesion (4-10 days)
Which stage of the pathogenesis of peridontal disease is the following?
- predominance of plasma cells but no bone loss yet, may remain stable for year or decades, or may become converted into an advanced lesion
established lesion (2-3 weeks)
Which stage of the pathogenesis of peridontal disease is the following?
- plasma cells continue to predominate, loss of alveolar bone and periodontal ligament occurs, disruption of the gingival tissue architecture
advanced lesion
What is the threshold for ‘moderate’ progression of perio based on smoking and diabetes status?
- smoking <10 per day
- hba1c <7.0%
What is the threshold for ‘rapid’ progression of perio based on smoking and diabetes status?
- smoking ≥10 per day
- hba1c >7.0%
What are 5 modifiable systemic risk factors for periodontal disease?
- smoking
- diabetes
- medications
- stress
- nutrition
What are 5 non-modifiable systemic risk factors for periodontal disease?
- genetic predispositions
- pregnancy
- hormonal changes
- immunodeficiency states
- age
What are 10 systemic conditions linked to periodontal disease?
- cardiovascular disease
- diabetes
- adverse pregnancy outcomes
- obesity
- respiratory diseases
- chronic kidney disease
- rheumatoid arthritis
- cognitive impairment
- metabolic syndrome
- cancer
What are 5 complications which can be seen in pregnancy associated with periodontitis?
- low birth weight
- preterm birth
- growth restrictions
- pre-eclampsia
- miscarriage/still birth
What is the possible mechanism for complications in pregnancy associated with perio?
presence of periodontal bacteria and by-products in foetal-placental unit may initiate local inflammatory response leading to adverse outcomes
What are 7 oral complications of diabetes?
- xerostomia
- opportunistic infections
- delayed wound healing
- caries
- susceptible to periodontal disease
- oral paraesthesia
- altered taste sensation
What is the management for patients with diabetes and periodontal disease?
- advise diabetic patients about increased risk of periodontal disease
- collect details of their diabetic history (via patient or GP)
- review MH frequently and update records
maintain periodontal health: - advice
- tailored OHI
- diet advice
- smoking cessation (if applicable)
- PMPR as indicated
What is the explanation for pregnancy gingivitis?
elevated oestrogen and progesterone during pregnancy increase vascular permeability, plaque alongside this will increase inflammation
What are factors which contribute to perio risk in diabetic patients?
- impaired chemotaxis, phagocytosis and adherence
- diabetics synthesise less collagen
- hyperglycaemic environment = AGE formation increased
- AGE products cause increased collagen cross-linking and so reduced turover/solubility and thus, wound healing is reduced
What is the possible mechanism for links between cardiovascular diseases and perio?
- periodontitis leads to entry of bacteria into the bloodstream
- bacteria then activate the host inflammatory response by multiple mechanisms
- the host immune response favours atheroma formation, maturation and exacerbation
What is the management for patients with cardiovascular diseases?
- patients who have had recent adverse CVD event diagnosed with perio should have staggered treatment
- multiple visits as perio treatment associated with transient impairment of endothelial function for a week after
- patients with perio and other known risk factors, should be advised to see their GP anually
- regular perio monitoring for those with CVD but no perio - every 12 months
