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CK REVISION LECTURES > PERIO > Flashcards

PERIO Flashcards

1
Q

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

A

clinically healthy periodontium

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2
Q

How is level of health/disease assessed? (9)

A
  • gingival colour
  • gingival contour
  • plaque levels
  • bleeding on probing
  • pocket depths
  • mobility
  • presence and location of calculus
  • presence and location of PRFs
  • radiographs
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3
Q

What is a BPE used for?

A
  • screening tool to identify patients who do require treatment
  • defines the level of health and disease clearly
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4
Q

What are the 3 type of probe used for a BPE measurement? (all the same)

A
  • BPE probe
  • WHO probe
  • CPITN C probe
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5
Q

Which teeth are screened for a modified BPE?

A

UR6, UR1, UL6
LR6, LL1, LL6

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6
Q

From what age can a modified BPE be used?

A

ages 7-11

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7
Q

What scores can be used for a modified BPE?

A

0, 1, 2

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8
Q

From what age can a full BPE score be used? (0, 1, 2, 3, 4, *)

A

ages 12-17

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9
Q

When would third molars be included in a BPE?

A

when second molars are missing

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10
Q

How is a BPE measured when there is only one tooth in the sextant?

A

scored an X and the tooth score is included in the adjacent sextant

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11
Q

If a patient has a BPE of 4 or *, what assessment should be carried out?

A

full pocket probing depth required

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12
Q

Which BPE score is the following?
- pockets <3.5mm
- no calculus/overhangs, no bleeding on probing
- black band entirely visible

A

0

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13
Q

Which BPE score is the following?
- pockets <3.5mm
- no calculus/overhangs
- bleeding on probing
- black band entirely visible

A

1

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14
Q

Which BPE score is the following?
- pockets <3.5mm
- supra or sub gingival calculus/overhangs
- black band entirely visible

A

2

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15
Q

Which BPE score is the following?
- probing depth 3.5mm-5.5mm
- black band partially visible
- pocketing of 4mm-5mm

A

3

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16
Q

Which BPE score is the following?
- probing depth >5.5mm
- black band disappears
- pocketing of 6mm or more

A

4

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17
Q

What should be done if periodontal tissues are too painful upon probing?

A
  • do not continue with BPE
  • disclose and take photographs
  • concentrate on OHI
  • return to BPE at a later date
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18
Q

How can it be detected if a patient is engaging with with OHI?

A
  • plaque score and marginal bleeding reduction of 50% or more
  • plaque levels less than 20% and bleeding levels less than 30% (or equivalent to)
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19
Q

How can it be detected if a patient is not engaging with OHI?

A
  • 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
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20
Q

In what order should full 6PPC charting be done?

A

1 - recession
2 - pocket depths
3 - bleeding on probing
4 - mobility
5 - furcation (naber probe)

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21
Q

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?

A

UNC 15 probe

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22
Q

Which periodontal probe is the following?
- markings at 1 2 3 4 5 7 8 9 10

A

williams probe

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23
Q

What are periodontal probes used to determine? (5)

A
  • pocket depths
  • attachment level
  • amount of gingival recession
  • presence of plaque and calc
  • anatomical features of the root
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24
Q

What 4 factors can lead to probing errors?

A
  • 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
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25
Q

If probe is not parallel to long axis of root, how could this affect PPD?

A

underestimate pocket depths

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26
Q

What are 7 factors which influence probing depths?

A
  • 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
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27
Q

When measuring mobility, what does a grade 0 indicate?

A

no detectable movement/physiological mobility (classically up to 0.2mm)

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28
Q

When measuring mobility, what does a grade 1 indicate?

A

mobility of the crown of the tooth 0.2-1mm in the horizontal direction

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28
Q

When measuring mobility, what does a grade 2 indicate?

A

mobility of the crown of the tooth >1mm in the horizontal direction

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29
Q

When measuring mobility, what does a grade 3 indicate?

A

mobility of the crown in both the horizontal and vertical planes

30
Q

What are 3 risk factors for periodontal disease?

A

1 - plaque
2 - smoking
3 - calculus and other risk factors

31
Q

What are 3 reasons to carry out PMPR?

A
  • removes PRFs
  • facilitates disrupting plaque biofilm
  • cosmetic
32
Q

What must be communicated to the patient if perio is detected?

A

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

33
Q

What percentage is classed as localised perio?

A

≤ 30% teeth

34
Q

What percentage is classed as generalised perio?

A

> 30% teeth

35
Q

What pattern could a perio diagnosis also be classed as?

A

molar-incisor pattern

36
Q

If a probing pocket depth is <4mm with no radiographic bone loss, what is the diagnosis?

A

health or gingivitis

37
Q

If a probing pocket depth is >4mm and/or radiographic bone loss, what is the diagnosis?

A

periodontitis (localised, generalised or MI pattern)

38
Q

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

A

stage I (early/mild)

39
Q

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

A

stage II (moderate)

40
Q

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

A

stage III (severe)

41
Q

What staging is interproximal bone loss to apical third of root?
- masticatory dysfunction
- pathologic migration of teeth
- severe ridge defects

A

stage IV (very severe)

42
Q

How is the grading of periodontitis calculated?

A

% bone loss divided by patients age

43
Q

What does a grading calculation of <0.5 indicate?

A

grade A (slow rate of progression)

44
Q

What does a grading calculation of 0.5-1.0 indicate?

A

grade B (moderate rate of progression)

45
Q

What does a grading calculation of >1.0 indicate?

A

grade C (rapid rate of progression)

46
Q

What does the following indicate for current perio status?
- BoP <10%
- PPD ≤4mm
- no BoP at 4mm sites

A

currently stable

47
Q

What does the following indicate for current perio status?
- BoP ≥10%
- PPD ≤4mm
- no BoP at 4mm sites

A

currently in remission

48
Q

What does the following indicate for current perio status?
- PPD ≥5mm OR
- PPD ≥4mm & BoP

A

currently unstable

49
Q

Which 6 factors aid in diagnosis of periodontal disease?

A
  • extent of disease
  • type of disease
  • stage
  • grade
  • current status
  • risk factors
50
Q

What are 3 examples of necroitising peridontal conditions?

A
  • necrotising gingivitis
  • necrotising periodontitis
  • noma
51
Q

What are 6 risk factors for necrotising periodontal diseases?

A
  • stress
  • smoking
  • previous necroitising perio diseases
  • poor nutrition
  • HIV/AIDs
  • extreme living conditions
52
Q

What are the 4 components of the periodontium?

A
  • ginigiva and investing tissues
  • alveolar bone
  • periodontal ligament
  • cementum
53
Q

Remember labelled pic

A
54
Q

What are the 3 putative pathogens for periodonal disease?

A
  • p gingivalis
  • tannerella forsythus
  • treponema denticola
55
Q

Within what timeframe does plaque mass change composition from mostly gram-positive coccoid and filamentous bacteria to gram-negative rods and spirochetes?

A

10-20 days

56
Q

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)

A

initial lesion (2-4 days)

57
Q

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

A

early lesion (4-10 days)

58
Q

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

A

established lesion (2-3 weeks)

59
Q

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

A

advanced lesion

60
Q

What is the threshold for ‘moderate’ progression of perio based on smoking and diabetes status?

A
  • smoking <10 per day
  • hba1c <7.0%
61
Q

What is the threshold for ‘rapid’ progression of perio based on smoking and diabetes status?

A
  • smoking ≥10 per day
  • hba1c >7.0%
62
Q

What are 5 modifiable systemic risk factors for periodontal disease?

A
  • smoking
  • diabetes
  • medications
  • stress
  • nutrition
63
Q

What are 5 non-modifiable systemic risk factors for periodontal disease?

A
  • genetic predispositions
  • pregnancy
  • hormonal changes
  • immunodeficiency states
  • age
64
Q

What are 10 systemic conditions linked to periodontal disease?

A
  • cardiovascular disease
  • diabetes
  • adverse pregnancy outcomes
  • obesity
  • respiratory diseases
  • chronic kidney disease
  • rheumatoid arthritis
  • cognitive impairment
  • metabolic syndrome
  • cancer
65
Q

What are 5 complications which can be seen in pregnancy associated with periodontitis?

A
  • low birth weight
  • preterm birth
  • growth restrictions
  • pre-eclampsia
  • miscarriage/still birth
66
Q

What is the possible mechanism for complications in pregnancy associated with perio?

A

presence of periodontal bacteria and by-products in foetal-placental unit may initiate local inflammatory response leading to adverse outcomes

67
Q

What are 7 oral complications of diabetes?

A
  • xerostomia
  • opportunistic infections
  • delayed wound healing
  • caries
  • susceptible to periodontal disease
  • oral paraesthesia
  • altered taste sensation
68
Q

What is the management for patients with diabetes and periodontal disease?

A
  • 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
69
Q

What is the explanation for pregnancy gingivitis?

A

elevated oestrogen and progesterone during pregnancy increase vascular permeability, plaque alongside this will increase inflammation

70
Q

What are factors which contribute to perio risk in diabetic patients?

A
  • 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
71
Q

What is the possible mechanism for links between cardiovascular diseases and perio?

A
  • 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
72
Q

What is the management for patients with cardiovascular diseases?

A
  • 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

CK REVISION LECTURES (8 decks)

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