Perio 2 Test 1 Flashcards by Casey Kariya

Perio health:

1-3 Probe depths
No history of Aloss
No clinical inflammation

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Gingival recession can also be known as:

Incidental attachment loss

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Stillman’s method of brushing

Modified stillman

Modified has a rolling stroke incisally

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Best way to clean interproximal spaces

Toothbrush and proxy brush

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6 abrasives found in toothpastes

Ca-phosphates
Ca-pyrophosphates
Ca-carbonate
Na-bicarbonate
Hydrated silica
Alumina

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Fluoride in toothpastes can be found in what 3 forms

NaF
Monofluoro-Phosphate
Stabilized Stannous Fluoride

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The bulk of the ingredients in toothpaste is _ such as _

Humectants

Glycerine
Sorbitol
Xylitol
Propylene glycol

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_ is clinically effective in reducing plaque and gingival inflammation compared with a fluoride toothpaste

Triclosan/copolymer toothpaste

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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

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Preventing periodontitis is done by preventing _ which is done through control of _ and _

Gingivitis

Plaque accumulation and gingival inflammation

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What is specific about pts with history of perio disease

Present with Aloss, ging. Recession, Furcation inv.

And

High risk of developing clinical Aloss

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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

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Efficacy vs. effectiveness

Efficacy = ideal circumstances

Effectiveness = usual circumstances

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6 risk factors for perio

Bad oral hygiene
History of perio
Aloss
Furcation inv
Smoking
Diabetes

BAD FHS

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2 local factors that play a role in gingival recession

Biotype of gingiva

Bone dehiscence

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3 main goals of perio therapy

Remove bacteria from tooth
Shift pathogenic microbes to healthy ones
Decrease inflammation and probing depth

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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

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When are systemic antibiotics indicated

Aggressive perio
Perio with secondary systemic involvement
Some types of chronic perio
Severe perio abscess
NUG

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3 host modulators agents

Bisphosphonates
NSAIDs
Low dose tetracyclines

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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

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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

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_ 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

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Local delivery devices of perio antimicrobials

Fibers
Strips
Films
Injectables

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3 ways to deliver antimicrobials subgingivally

Chlorhexidine - gelatin matrix film/chip
Doxycycline - flowable PLA gel
Minocycline - PLA/PLGA powder

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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

1. Eliminate CR-CO hit and slide 2. Eliminate non working side interferences 3. Establish working contacts 4. Anterior Protrusive contacts 5. Recontour sharp/irregular incisal edges 6. 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)