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Spring 2018 > Perio 2 Test 1 > Flashcards

Perio 2 Test 1 Flashcards

1
Q

Perio health:

A

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

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2
Q

Gingival recession can also be known as:

A

Incidental attachment loss

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3
Q

Stillman’s method of brushing

Vs

Modified stillman

A

Modified has a rolling stroke incisally

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4
Q

Best way to clean interproximal spaces

A

Toothbrush and proxy brush

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5
Q

6 abrasives found in toothpastes

A 
Ca-phosphates
Ca-pyrophosphates
Ca-carbonate
Na-bicarbonate
Hydrated silica
Alumina
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6
Q

Fluoride in toothpastes can be found in what 3 forms

A

NaF
Monofluoro-Phosphate
Stabilized Stannous Fluoride

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7
Q

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

A

Humectants

Glycerine
Sorbitol
Xylitol
Propylene glycol

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8
Q

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

A

Triclosan/copolymer toothpaste

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9
Q

3 active ingredients of antimicrobial rinses and how they work

A

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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10
Q

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

A

Gingivitis

Plaque accumulation and gingival inflammation

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11
Q

What is specific about pts with history of perio disease

A

Present with Aloss, ging. Recession, Furcation inv.

And

High risk of developing clinical Aloss

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12
Q

Study designs from top down

A 
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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13
Q

Efficacy vs. effectiveness

A

Efficacy = ideal circumstances

Effectiveness = usual circumstances

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14
Q

6 risk factors for perio

A 
Bad oral hygiene
History of perio
Aloss
Furcation inv
Smoking
Diabetes

BAD FHS

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15
Q

2 local factors that play a role in gingival recession

A

Biotype of gingiva

Bone dehiscence

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16
Q

3 main goals of perio therapy

A

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

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17
Q

Where can bacteria remain even after mechanical therapy

A

Root surfaces not accessed
Gingival epithelial cells and conn tiss
Dentinal tubules
Supragingival plaque/other infected sites

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18
Q

When are systemic antibiotics indicated

A 
Aggressive perio
Perio with secondary systemic involvement
Some types of chronic perio
Severe perio abscess
NUG
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19
Q

3 host modulators agents

A

Bisphosphonates
NSAIDs
Low dose tetracyclines

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20
Q

What do bisphosphonates do?

Indicated for:

Side effects:

A

Incapacitated osteoclasts, reducing bone resorption

For: Paget’s disease, hypercalcemia, osteoporosis, metastatic bone diseases

SE: osteomalacia, allergic rxns

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21
Q

NSAIDs do what in cells?

Side effects

Effect on perio

A

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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22
Q

_ is a low dose of doxycycline which is a _

Cellular effect

How

A

Periostat, low dose tetracycline

Inhibits tissue destructive enzymes, concentrates in GCF and uses cementum as reservoir

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23
Q

Local delivery devices of perio antimicrobials

A

Fibers
Strips
Films
Injectables

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24
Q

3 ways to deliver antimicrobials subgingivally

A

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

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25
Q

T/F local antimicrobial delivery is indicated for localized aggressive chronic perio

A

FALSE. Slight to moderate chronic perio

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26
Q

T/F local antimicrobial delivery is adjunctive therapy

A

TRUE not primary

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27
Q

3 things not recommended by ADA to treat perio

A

Hydrogen peroxide
Nature’s soothing healer
Root instrumentation with laser

28
Q

When to use antibiotics to treat CHRONIC perio

A

Poor response to initial therapy

Pg or Aa in subgingival biofilm

Severe cases with generalized deep pocket depths

29
Q

Antibiotics are helpful in treating perio if they:

A

Distribute to the pocket and soft tissue wall

Reach inhibitory levels in pocket

Levels maintained long enough

Penetrate host cells and kill bacteria

30
Q

5 antibiotics used in perio therapy

A

Penicillins (amoxicillin)

Metronidazole

Tetracyclines (doxycycline)

Clindamycin

Macrolides (azithromycin, clarithromycin)

31
Q

Antibiotics good at killing strict anaerobes

Antibiotics that kill facultative microbes like A.a.

A

Anaerobes: metronidazole, clindamycin

Facultative: fluoroquinolones, macrolides

32
Q

Tetracyclines kill what?

How

A

Most perio pathogens

Inhibit collagenase

33
Q

Azithromycin levels are higher in _ than _

A

GCF

Blood

34
Q

Azithromycin decreases GCF conc. Of _ and _ in healthy subjects

A

IL-8 and TNF

35
Q

_ and _ are in higher levels in GCF than in blood serum

A

Azithromycin and clarithromycin

36
Q

When is micro testing most effective

A

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

37
Q

Main antibiotic regimen for aggressive perio or severe chronic perio

A

Amoxicillin (500mg)
Metronidazole (250mg)
For 8 days

38
Q

What is the difference b/t what’s in true vs pseudopockets

A 
Pseudo and true:
Biofilm
Calculus
Chronic inflammation
Destructive host response

True only:
Diseased root cementum
Apical migration of attachment apparatus
Bone loss

39
Q

Why remove calculus

A

NOT a chemical/mechanical irritant

It is plaque retentive

40
Q

Diseased soft tissue is removed by _

Diseased hard tissue is removed by _

A

Curettage

Root planing

41
Q

Root planing:

Subgingival Scaling:

A

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

42
Q

3 keys to effective root planing

A

Sharp instruments
Access cemental surface
Correct angulation of instrument face

43
Q

How long for comprehensive subgingival treatment of one tooth by hand instruments

A

6-8 min

44
Q

Endotoxin does what to tissues

A

Stimulates inflammation

45
Q

_ rendered roots endotoxin free

A

Root planing

46
Q

Cementum thickness at cervical vs apical

A

Cervical = 20-50 um

Apical = 150-250 um

47
Q

Critical probing depth

A

Pocket depth below which is Aloss and above is attachment gain

48
Q

Root planing critical probing depth

A

2.9 mm

49
Q

Lasers in treating perio. Effect?

A

Can help heal

Adjunctive to SRP

50
Q

Contraindications to occlusal adjustment

A

Severe malocclusion

Tolerated occlusion (non-ideal)

Severe wear (adjustment exposes dentin)

Patient in pain

No suitable end point can be reached

51
Q

3 goals in occlusal adjustment

A

Occlusal stability over time

Axial loading of forces

Anterior guidance in excursions

52
Q

Comprehensive vs. limited adjustment

A

Comprehensive: centric relation or excursions

Limited: mainly excursive movements, eliminating jiggling movments

53
Q

6 steps in comprehensive occlusal adjustment by selective grinding

A
  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
54
Q

Best contact relationship to grind into

Worst?

A

Cusp to fossa

Cusp to cusp

55
Q

Centric relation interferences for max and mand

A

Mesial max

Distal mand

56
Q

What do you grind if you have premature contact in centric, working and non working (all 3) contacts

A

Trim maxillary palatal cusp

57
Q

What to grind if there is premature contact in centric only

A

Deepen fossa

58
Q

General rule:
Don’t reduce _
Adjust on _

A

Don’t reduce holding cusp tip

Adjust on inclines

59
Q

When should you flatten the cusp tip?

A

There is a cusp to embrasure relationship

Then place the contact on flat areas

60
Q

Non-working side contacts = _ = _

A

Balancing = mediotrusive

61
Q

To adjust non working contacts _ _ _ _

A

LUBL

62
Q

Rule for working contacts

A

BULL

63
Q

When are perio splints used

A

To immobilize excessively mobile teeth by sharing forces with more stable teeth

To stabilize teeth in new position after ortho tx

64
Q

3 goals of initial therapy

A

Reduce/eliminate gingival inflammation by removing plaque retentive factors

Reduce/eliminate perio pockets caused by swollen, inflamed tissue

Achieve surgical manageability

65
Q

Initial perio therapy includes what

A 
Perio scaling and root planing
OHI
Prophy
Occlusal therapy
Possible anti-microbial or other drugs
66
Q

What do you compare from pre to post treatment to determine effectiveness of perio tx

A 
Gingival color, contour, consistency
Clinical probing depth and attachment level
Furcation invasion severity
Bleeding on probing
Suppuration
Tooth mobility
Oral hygiene status
67
Q

What is bleeding on probing an indicator of

A

Moderate predictor of future Aloss

If absent, useful indicator of health (non-smoker)

Spring 2018 (18 decks)

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