Perio Flashcards
28 y/o fit and well, FM PAs showing bone loss on multiple teeth
diagnosis?
why? (5)
investigations?
generalised aggressive periodontitis
bone loss affecting 3 or more other teeth inc 6s and incisors age of pt rapid progression of bone loss vertical bony defects pt otherwise fit and well
thorough history (including family)
6ppc
swab of crevicular fluid -
How would you decide prognosis of individual teeth in cases of periodontitis?
loss of attachment
mobility
furcation involvement
give reasons for only partial removal of pocket bacteria during scaling? (5)
poor operator technique failure to disrupt biofilm poor pt OH pt immunocompromised difficulty accessing prevents removal
Why do antibiotics fail in aiding pocket bacteria removal?
-
- not in therapeutic range - inadequate concentration
- lack of vision - antibiotics do not reach site of disease activity
How would you manage a periodontal abscess with systemic involvement?
incise and drain gentle subgingival debridement hot salty MW advise optimal analgesia XLA if tooth poor prognosis Antibiotics (amoxycillin and metronidazole) follow up hpt
What would be clinical signs of improved periodontal health?
probing depth reduction to <4mm
BOP to <10%
plaque scores of <15%
Space between 13 and 14
Investigations and why?
impediment with implant placement here?
SI: BPE- screening tool PGI - plaque and bleeding record 6PPC - perio disease chart PA rads: path detection study models
implant :
periodontal disease
inadequate bone levels
inadequate space <7mm
What bacteria are involved with ANUG
p. intermedia
fusobacterium
spirochetes - treponema
Clinical signs and symptoms of ANUG
- blunted interdental papilla
- grey slough which when wiped reveals ulcerated tissue
- halitosis
- crater like ulcers
- reverse gingival architecture
5 risk factors for ANUG
smoking young age poor OH immunocompromised stress
Mgmt for ANUG
ultrasonic debridement oxygenating MW e.g 3% H202 CHX OHI Smoking cessation if needed Antibiotics if systemic/immunocompromsied - metronidazole 400mg tds/3days
What would you need to say for informed consent for open flap curettage
- Risks- gingival recession + normal oral surgery risks (bleeding, swelling, pain, infection)
- Other tx options - continue NSPT
- Risks of no tx- increased mobility, increased pocket depths, increased likelihood of losing teeth
- Benefits of tx- can effectively debride with DIRECT VISION
- Outcome- possible reduction in probing depth
- Recommendation
Pt feels central crushing pain during surgery. What do you think it is?
immediate mgmt?
Myocardial Infarction
GTN spray - 2 sublingual actuations
oxygen 15L/min
Aspirin chewed 300mg
In what forms would you deliver post surgical advice? and what would you say- for open flap curettage?
written and spoken
avoid smoking for min. 1 week
avoid rinsing for 1 day- after 1 day can rinse with CHX MW(2%, bid) or hot salty
avoid exercise, just rest
do not probe area
Review appt timeframe for open flap curettage?
8 weeks
to allow sufficient healing
Bacteria that cause periodontal disease
gram negative anaeobic
A. a
P.gingivalis
B.forsythia
T.denticola
What patients might benefit from antibiotics along side hygiene phase therapy?
- pt who is not responding favourably to scaling and debridement therapy/ HPT, with continuing clinical attachment loss
- pt who test positive for P.ging or A.a in subgingival biofilm - as can invade epithelium of periodontal pockets
- pt with severe chronic periodontitis and generalised deep pocket depths
Why might antibiotics not aid in reduction in bacteria numbers in perio cases?
- cannot kill bacteria in biofilm .:.
- biofilm not successfully disrupted during Scale and debridement
- not therapeutic range - not correct dose
- poor pt compliance to regime
- antibiotic resistance
- antibiotics inactivated by 1st pass metabolism
Why is it that azithromycin and tetracycline are perhaps considered more successful for perio tx than amoxycilin and metronidazole?
azi &tet- actively taken up and concentrated by cells
amo&met- enter cells by passive diffusion
What is SIRS
Criteria
systemic inflammatory response syndrome
any 2 or more of:
- tachycardia- HR >90bpm
- tachypnoea - RR >20breaths/pm
- leukopenia or bandemia or leukocytosis
<4000 cells/mm3 or >10% or >12000 cells/mm3
- fever or hypothermia - >38 degrees celcius or <36
Pt presents with suppurating abscess - How would you diagnosis
-sensibility test - if tooth vital then is perio abscess. if non-vital is endo abscess.
- if TTP laterally is perio lesion, if TTP vertically is endo lesion.
use gutta percha and PA to trace sinus tract to identify origin of lesion
What is a periodontal abscess?
localised collection of pus within tissues of periodontium
acute exacerbating of an existing periodontal pocket
caused by: untreated perio/ inadequate RSD/ food packing
Signs and symptoms of perio abscess
pain on biting/spontaneous TTP (laterally) swelling pus pocketing at swelling mobility
How do you manage occlusal trauma in a pt with perio?
- address issue - parafunction/ high restorations
- bite raising appliance worn at least at night
- hpt as necessary
What factors can influence localised mobility?
occlusal trauma - increasing pdl width
resorption/trauma
When would you advise splinting of mobile teeth?
to assist in rsd
when mobility causes discomfort
difficulty eating
Why is there a decrease in mobility after perio tx?
growth of junctional epithelium
What can you do to manage pt with widened pdl after rx?
Reduce contact in occlusion
What is the role of occlusion in periodontal disease?
occlusal trauma itself cannot cause loss of attachment but can exacerbate existing periodontal pockets
What is occlusal trauma?
signs and symptoms?
injury to the periodontium
resulting from occlusal forces
that exceed the reparative capacity
of the attachment apparatus
severe attrition
exposed dentine
increased sensitivity
mobility
fremitus?
vibration or movement of the tooth in functional occlusion
