Perio Flashcards
1
Q
28 y/o fit and well, FM PAs showing bone loss on multiple teeth
diagnosis?
why? (5)
investigations?
A
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 -
2
Q
How would you decide prognosis of individual teeth in cases of periodontitis?
A
loss of attachment
mobility
furcation involvement
3
Q
give reasons for only partial removal of pocket bacteria during scaling? (5)
A
poor operator technique failure to disrupt biofilm poor pt OH pt immunocompromised difficulty accessing prevents removal
4
Q
Why do antibiotics fail in aiding pocket bacteria removal?
A
-
- not in therapeutic range - inadequate concentration
- lack of vision - antibiotics do not reach site of disease activity
5
Q
How would you manage a periodontal abscess with systemic involvement?
A
incise and drain gentle subgingival debridement hot salty MW advise optimal analgesia XLA if tooth poor prognosis Antibiotics (amoxycillin and metronidazole) follow up hpt
6
Q
What would be clinical signs of improved periodontal health?
A
probing depth reduction to <4mm
BOP to <10%
plaque scores of <15%
7
Q
Space between 13 and 14
Investigations and why?
impediment with implant placement here?
A
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
8
Q
What bacteria are involved with ANUG
A
p. intermedia
fusobacterium
spirochetes - treponema
9
Q
Clinical signs and symptoms of ANUG
A
- blunted interdental papilla
- grey slough which when wiped reveals ulcerated tissue
- halitosis
- crater like ulcers
- reverse gingival architecture
10
Q
5 risk factors for ANUG
A
smoking young age poor OH immunocompromised stress
11
Q
Mgmt for ANUG
A
ultrasonic debridement oxygenating MW e.g 3% H202 CHX OHI Smoking cessation if needed Antibiotics if systemic/immunocompromsied - metronidazole 400mg tds/3days
12
Q
What would you need to say for informed consent for open flap curettage
A
- 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
13
Q
Pt feels central crushing pain during surgery. What do you think it is?
immediate mgmt?
A
Myocardial Infarction
GTN spray - 2 sublingual actuations
oxygen 15L/min
Aspirin chewed 300mg
14
Q
In what forms would you deliver post surgical advice? and what would you say- for open flap curettage?
A
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
15
Q
Review appt timeframe for open flap curettage?
A
8 weeks
to allow sufficient healing
16
Q
Bacteria that cause periodontal disease
A
gram negative anaeobic
A. a
P.gingivalis
B.forsythia
T.denticola
17
Q
What patients might benefit from antibiotics along side hygiene phase therapy?
A
- 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
18
Q
Why might antibiotics not aid in reduction in bacteria numbers in perio cases?
A
- 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
19
Q
Why is it that azithromycin and tetracycline are perhaps considered more successful for perio tx than amoxycilin and metronidazole?
A
azi &tet- actively taken up and concentrated by cells
amo&met- enter cells by passive diffusion
20
Q
What is SIRS
Criteria
A
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
21
Q
Pt presents with suppurating abscess - How would you diagnosis
A
-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
22
Q
What is a periodontal abscess?
A
localised collection of pus within tissues of periodontium
acute exacerbating of an existing periodontal pocket
caused by: untreated perio/ inadequate RSD/ food packing
23
Q
Signs and symptoms of perio abscess
A
pain on biting/spontaneous TTP (laterally) swelling pus pocketing at swelling mobility
24
Q
How do you manage occlusal trauma in a pt with perio?
A
- address issue - parafunction/ high restorations
- bite raising appliance worn at least at night
- hpt as necessary
25
What factors can influence localised mobility?
occlusal trauma - increasing pdl width
| resorption/trauma
26
When would you advise splinting of mobile teeth?
to assist in rsd
when mobility causes discomfort
difficulty eating
27
Why is there a decrease in mobility after perio tx?
growth of junctional epithelium
28
What can you do to manage pt with widened pdl after rx?
Reduce contact in occlusion
29
What is the role of occlusion in periodontal disease?
occlusal trauma itself cannot cause loss of attachment but can exacerbate existing periodontal pockets
30
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
31
fremitus?
vibration or movement of the tooth in functional occlusion
32
types of occlusal trauma?
primary and secondary
primary- where excessive loads are placed on teeth with normal periodontal tissues
secondary- where normal loads become excessive due to loss of attachment
33
What findings would indicate aggressive periodontitis?
severe periodontal destruction inconsistent with OH findings
familial aggregation
early onset
pt otherwise fit and well
34
Differences between localised and generalised aggressive periodontitis?
localised:
- localised CAL
- 6s and incisors
- circumpubertal age
- robust antibody response
generalised:
- generalised CAL
- 6s and incisors and at least 3 other teeth
- onset before 30 y/o
- poor serum antibody response
- episodic in nature
35
bacteria indicated in aggressive periodontitis?
A.a
| P.gingivalis
36
Mgmt of aggressive periodontitis
start with NSPT - RSD
2 week CHX MW and SPRAY
Refer to specialist within 6/8 weeks
37
define gingivitis
inflammation of the gingiva, characterised by red, swollen tissues which bleed on probing or brushing
38
define chronic periodontitis
disease characterised by destruction of junctional epithelium and connective tissue attachment of the tooth, with bone destruction and formation of periodontal pockets
39
What perio features could make a tooth have a poor prognosis? (3)
and if so, what parts of history needed to determine if teeth poor prognosis or not?
mobility - less bone support
loss of attachment - less tissue support
furcation involvement- difficulty cleaning
non vitality
smoking, drug history, systemic disease
40
International 1999 Classification of Periodontal disease? (7)
```
gingivitis
chronic periodontitis
aggressive periodontitis
Periodontitis with systemic disease
necrotising ulcerative gingivitis
periodontal abscess
perio-endo lesion
gingival enlargement
developmental or acquired deformities
```
41
Causes of gingival recession
- chronic periodontal disease
- inadequate toothbrushing technique
- occlusal trauma
- high frenal attachments
- orthodontics
- poor fit restorations
- habits
- abrasive toothpaste
Generalised gingival recession - always chronic inflammatory periodontal disease
localised-
- if v shaped localised - occlusal trauma
- if u shaped localised -
- inadequate tooth brushing,
- chronic inflammatory periodontal disease
- high frenal attachment
42
Disease to cause vertical defects in bone?
| how does it cause this?
Localised angular periodontitis
Localised aggressive periodontitis/
radius of destruction of plaque is 2mm. .:. depends where plaque are situated. if interproximal bone is >2mm bony defect will be vertical/angular
43
how to classify degree of bone loss?
Mild <30%
Mod 30-50%
Severe >50%
44
difference in bacteria between localised and generalised aggressive?
localised only has A.a
| generalised has both A.a and P. ging
45
Management aggressive periodontitis
```
OHI
Complete Scaling and debridement
Antibiotic therapy- amoxycillin and metronidazole
CHX MW
OHI
```
46
Clinical signs of periodontal healing
Gingival recession
Reduction in BOP
Reduction in probing depth
47
How does each react to traumatic occlusion?
a) healthy periodontium
b) reduced periodontium
c) periodontium with periodontitis
a) widening of pdl .:. slight mobility. no LOA, will return to normal if trauma removed
b) widen of pdl but less pdl there. .:. increased mobility
c) loss of attachment when pdl widens, as pdl then breaks
48
What is CHX?
bisbiguanide antiseptic
49
Mode of action of CHX
dicationic
one cation adheres to pellicle
one cation disrupts bacterial membrane
bacteriocytic and -static
50
Substantivity of CHX
12 hours
51
Common doses of CHX
0. 2% 10/20ml bid
| 0. 15% 15/18ml bid
52
4 side effects of CHX
```
staining
taste disturbance
salivary gland enlargement
anaphylaxis
sls interaction
```
53
8 uses of CHX
```
pre op rinse
post intraoral surgery
ANUG
denture stomatitis
tx of dry socket
medically compromised pt
high caries risk pt
pt post jaw fixation for OH
Endo irrigant
Recurrent Oral Ulceration
```
54
What is included in HPT
NSPT non surgical periodontal therapy
Scale and RSD
Removal of plaque retentive factors
OHI
55
Method of proper OHI
```
TIPPS
talk
instruct
practice
plan
support
```
56
7 parts to record on periodontal chart
```
teeth missing
gingival margin
probing depth
loss of attachment
BOP
mobility
furcation
```
57
2 disadvantages of perio chart
- doesnt take into account root length - .:. severity misleading
- probing depths are SUBJECTIVE and can vary greatly
58
How can you measure recession
photos w/ probe
pocket chart
study models
59
Mgmt of localised gingival recession
```
atraumatic tooth brushing technique
minimise other risk factors
monitor
treat sensitivity
free soft tissue graft (palatal)
coronal advancement flap
```
60
Tx for multirooted teeth with furcation involvement (3)
guided tissue regeneration
tunnel preparation
hemisection
61
Previously root treated tooth with 9mm probing depth pocket and vertical bony defect. Dx?
initial tx?
perio-endo lesion
endo-perio lesion
true combined lesion
re-rct
62
implant factors?
```
pt motivation
smoking
bone quality and quantity
smoking
MH (bisphosphonates)
restorative options
```
63
How can bony defects be classified?
horizontal or vertical
by number of walls 1/2/3
2&3 have better prognosis
64
indications for regenerative periodontal therapy?
2&3 walled defects
grade 2 furcation in mandibular molars
grade 2 buccal furcation in maxillary molars
65
Why is diabetes a risk factor in perio disease?
WIPA
- delayed WOUND healing
- both are pro INFLAMMATORY diseases
- immunosuppression- impaired PMN neutrophil function
- ADVANCED glycation end (AGE) products increase tissue destruction
66
2 tests for diabetes diagnosis?
| and expected values?
RPG random plasma glucose <11.1mmol/L normal, above diabetics.
FPG fasting plasma glucose <7 mmol/L
both need 2 separate OCCASIONS
67
Test for diabetic control
normal value?
Hb1ac
<7%
68
4 ways in which smoking affects periodontal tissues
CCEB
CHEMOTAXIS and phagocytosis impaired
CYTOKINE production affected
ENZYME catalyse affected
BLOOD flow restricted
69
name the cytokine important in tissue destruction?
| what does it do
interleukin-1
pro-inflammatory cytokine
stimulates release of enzymes and osteoclasts .:. increasing tissue destruction
70
pt attends with inflamed gingiva extending beyond mucogingival junction. clinical description?
signs?
3 oral conditions that could cause this?
2 risk factors?
2 tx?
desquamative gingivitis - clinical description not a condition
erythematous, glazed, friable, haemorrhagic gingiva +/- pain
oral lichen planus OLP
pemphigus vulgaris PV
mucous membrane pemphigoid MMP
risk: smoking, plaque
tx:
- enhanced OHI
- scaling to remove supra and subgingival plaque
- removal of intraoral restorations/ prostheses
- topical or systemic corticosteroids:
- >local lesions: beclamethasone inhaler
- > generalised: betamethasone tablet dissolved as MW
71
Name the 3 meds associated with gingival hyperplasia?
phenytoin - antiepileptic
cyclosporin - immunosuppressant
nifedipine - calcium channel blocker
72
How do you manage gingival hyperplasia?
```
plaque still main causation .:.
OHI and RSD
then if not responding-
surgery
liaise with GP re: changing medication
```
73
Values for BPE
0 → black band showing completely, no BOP or plaque retentive factors – No Rx/OHI.
1 → band visible, BOP, no plaque retentive factors – Rx – OHI.
2 → band visible, BOP, supra/sub calc or plaque retentive factors. Rx – OHI, remove PRFs, S&P/RSI.
3 → band partly visible → 3.5-5.5mm – Rx – 6PPC sextant of full mouth if >2 grade 3 measured. OHI, RSI, remove
plaque retentive factors.
4 → band not visible → >5.5mm. Rx – 6PPC full mouth, RSI, remove plaque retentive factors, consider referral. * →
furcation involvement.
74
How is mobility graded?
0 - physiological movement (0-0.2mm)
1 - <1mm movement
2 - 1-2mm movement
2 - >2mm movement and vertical movements - rotations and depressions
75
How is furcation graded?
0- <3mm horizontal
1 - >3mm horizontal but not through and through
2 - through and through
76
How is gingival recession graded?
Miller's classification
77
How would you decide the prognosis of individual teeth in a pt with aggressive perio? (7)
```
symptoms
bone levels
angular defects
mobility
furcation involvement
is pt maintenance possible?
short tapered roots
```
78
5 signs and symptoms of periodontal disease
```
signs-
mobility
furcation involvement
increased probing depth
LOA
BOP
gingival recession
```
```
symptoms-
tooth "loose"
tooth movement
bleeding
food packing
"long in tooth"
```
79
localised risk factors for periodontal disease
```
overhanging restorations
defective margins
partial dentures
oral appliances
calculus
OH
tooth malposition
```
