Perio 2 Test 1 Flashcards
Perio health:
1-3 Probe depths
No history of Aloss
No clinical inflammation
Gingival recession can also be known as:
Incidental attachment loss
Stillman’s method of brushing
Vs
Modified stillman
Modified has a rolling stroke incisally
Best way to clean interproximal spaces
Toothbrush and proxy brush
6 abrasives found in toothpastes
Ca-phosphates Ca-pyrophosphates Ca-carbonate Na-bicarbonate Hydrated silica Alumina
Fluoride in toothpastes can be found in what 3 forms
NaF
Monofluoro-Phosphate
Stabilized Stannous Fluoride
The bulk of the ingredients in toothpaste is _ such as _
Humectants
Glycerine
Sorbitol
Xylitol
Propylene glycol
_ is clinically effective in reducing plaque and gingival inflammation compared with a fluoride toothpaste
Triclosan/copolymer toothpaste
3 active ingredients of antimicrobial rinses and how they work
EO: broad spectrum activity against G+ and G- bacteria
- disrupts cell wall
- reduces endotoxin levels and pathogenicity
Cetylpridinium chloride: ruptures bact. Cell membrane, may alter bact. Metabolismi
Chlorhexidine: causes bact. Cell membrane to leak, binds salivary mucins reducing pellicle, binds bacteria
Preventing periodontitis is done by preventing _ which is done through control of _ and _
Gingivitis
Plaque accumulation and gingival inflammation
What is specific about pts with history of perio disease
Present with Aloss, ging. Recession, Furcation inv.
And
High risk of developing clinical Aloss
Study designs from top down
Systematic reviews and meta-analyses Randomized controlled double blind Cohort Case control Case series Case reports Opinions, ideas, editorials Animal research Test tube research
SRCCCCOAT
Efficacy vs. effectiveness
Efficacy = ideal circumstances
Effectiveness = usual circumstances
6 risk factors for perio
Bad oral hygiene History of perio Aloss Furcation inv Smoking Diabetes
BAD FHS
2 local factors that play a role in gingival recession
Biotype of gingiva
Bone dehiscence
3 main goals of perio therapy
Remove bacteria from tooth
Shift pathogenic microbes to healthy ones
Decrease inflammation and probing depth
Where can bacteria remain even after mechanical therapy
Root surfaces not accessed
Gingival epithelial cells and conn tiss
Dentinal tubules
Supragingival plaque/other infected sites
When are systemic antibiotics indicated
Aggressive perio Perio with secondary systemic involvement Some types of chronic perio Severe perio abscess NUG
3 host modulators agents
Bisphosphonates
NSAIDs
Low dose tetracyclines
What do bisphosphonates do?
Indicated for:
Side effects:
Incapacitated osteoclasts, reducing bone resorption
For: Paget’s disease, hypercalcemia, osteoporosis, metastatic bone diseases
SE: osteomalacia, allergic rxns
NSAIDs do what in cells?
Side effects
Effect on perio
Inhibit biosynthesis and release of prostaglandins in cells
SE: ulcers, allergic rxns, GI and renal toxicity
Perio: reduce inflammation but effects on attachment levels are modest
_ is a low dose of doxycycline which is a _
Cellular effect
How
Periostat, low dose tetracycline
Inhibits tissue destructive enzymes, concentrates in GCF and uses cementum as reservoir
Local delivery devices of perio antimicrobials
Fibers
Strips
Films
Injectables
3 ways to deliver antimicrobials subgingivally
Chlorhexidine - gelatin matrix film/chip
Doxycycline - flowable PLA gel
Minocycline - PLA/PLGA powder
T/F local antimicrobial delivery is indicated for localized aggressive chronic perio
FALSE. Slight to moderate chronic perio
T/F local antimicrobial delivery is adjunctive therapy
TRUE not primary
3 things not recommended by ADA to treat perio
Hydrogen peroxide
Nature’s soothing healer
Root instrumentation with laser
When to use antibiotics to treat CHRONIC perio
Poor response to initial therapy
Pg or Aa in subgingival biofilm
Severe cases with generalized deep pocket depths
Antibiotics are helpful in treating perio if they:
Distribute to the pocket and soft tissue wall
Reach inhibitory levels in pocket
Levels maintained long enough
Penetrate host cells and kill bacteria
5 antibiotics used in perio therapy
Penicillins (amoxicillin)
Metronidazole
Tetracyclines (doxycycline)
Clindamycin
Macrolides (azithromycin, clarithromycin)
Antibiotics good at killing strict anaerobes
Antibiotics that kill facultative microbes like A.a.
Anaerobes: metronidazole, clindamycin
Facultative: fluoroquinolones, macrolides
Tetracyclines kill what?
How
Most perio pathogens
Inhibit collagenase
Azithromycin levels are higher in _ than _
GCF
Blood
Azithromycin decreases GCF conc. Of _ and _ in healthy subjects
IL-8 and TNF
_ and _ are in higher levels in GCF than in blood serum
Azithromycin and clarithromycin
When is micro testing most effective
Do initial therapy
See how initial therapy worked
If it didn’t work well, test deepest pockets for presence of pathogens with molecular test
Give antibiotics that work against paths identified
Main antibiotic regimen for aggressive perio or severe chronic perio
Amoxicillin (500mg)
Metronidazole (250mg)
For 8 days
What is the difference b/t what’s in true vs pseudopockets
Pseudo and true: Biofilm Calculus Chronic inflammation Destructive host response
True only:
Diseased root cementum
Apical migration of attachment apparatus
Bone loss
Why remove calculus
NOT a chemical/mechanical irritant
It is plaque retentive
Diseased soft tissue is removed by _
Diseased hard tissue is removed by _
Curettage
Root planing
Root planing:
Subgingival Scaling:
RP: removing cementum or surface dentin that is rough, has calculus or contaminated
-modify root surface, perio only
Subgingival scaling: instrumentation of root surfaces to remove plaque, calculus, and stains
-remove deposits, gingivitis and perio
3 keys to effective root planing
Sharp instruments
Access cemental surface
Correct angulation of instrument face
How long for comprehensive subgingival treatment of one tooth by hand instruments
6-8 min
Endotoxin does what to tissues
Stimulates inflammation
_ rendered roots endotoxin free
Root planing
Cementum thickness at cervical vs apical
Cervical = 20-50 um
Apical = 150-250 um
Critical probing depth
Pocket depth below which is Aloss and above is attachment gain
Root planing critical probing depth
2.9 mm
Lasers in treating perio. Effect?
Can help heal
Adjunctive to SRP
Contraindications to occlusal adjustment
Severe malocclusion
Tolerated occlusion (non-ideal)
Severe wear (adjustment exposes dentin)
Patient in pain
No suitable end point can be reached
3 goals in occlusal adjustment
Occlusal stability over time
Axial loading of forces
Anterior guidance in excursions
Comprehensive vs. limited adjustment
Comprehensive: centric relation or excursions
Limited: mainly excursive movements, eliminating jiggling movments
6 steps in comprehensive occlusal adjustment by selective grinding
- Eliminate CR-CO hit and slide
- Eliminate non working side interferences
- Establish working contacts
- Anterior Protrusive contacts
- Recontour sharp/irregular incisal edges
- Polish all adjusted teeth
Best contact relationship to grind into
Worst?
Cusp to fossa
Cusp to cusp
Centric relation interferences for max and mand
Mesial max
Distal mand
What do you grind if you have premature contact in centric, working and non working (all 3) contacts
Trim maxillary palatal cusp
What to grind if there is premature contact in centric only
Deepen fossa
General rule:
Don’t reduce _
Adjust on _
Don’t reduce holding cusp tip
Adjust on inclines
When should you flatten the cusp tip?
There is a cusp to embrasure relationship
Then place the contact on flat areas
Non-working side contacts = _ = _
Balancing = mediotrusive
To adjust non working contacts _ _ _ _
LUBL
Rule for working contacts
BULL
When are perio splints used
To immobilize excessively mobile teeth by sharing forces with more stable teeth
To stabilize teeth in new position after ortho tx
3 goals of initial therapy
Reduce/eliminate gingival inflammation by removing plaque retentive factors
Reduce/eliminate perio pockets caused by swollen, inflamed tissue
Achieve surgical manageability
Initial perio therapy includes what
Perio scaling and root planing OHI Prophy Occlusal therapy Possible anti-microbial or other drugs
What do you compare from pre to post treatment to determine effectiveness of perio tx
Gingival color, contour, consistency Clinical probing depth and attachment level Furcation invasion severity Bleeding on probing Suppuration Tooth mobility Oral hygiene status
What is bleeding on probing an indicator of
Moderate predictor of future Aloss
If absent, useful indicator of health (non-smoker)
