Perio Flashcards
what host defences prevent gingivitis/perio
gingival crevicular fluid
antibodies, monocytes, lymphocytes, neutrophils
saliva
cells proliferating and shedding
what causes gingivitis
more bacterial colonisation - plaque build up
what changes happen to the host defences in gingivitis
increased plasma infiltrate - more monocytes, neutrophils, lymphocytes. increased flow of GCF, proliferation and ulceration of epithelium. increased inflammation due to more colonisation of bacteria. response upregulated
what does the gingiva look like in health and how does this change in gingivitis
health - knife edge margins, scalloped margins, pink
in gingivitis - knife egde is lost, more red, bleeding on probing
what is the difference between perio and gingivitis
apical migration of junctional epithelium, pocket formation and bone loss
what is the difference between true and false pockets
true - apical migration of junctional epi
false - no migration of junctional epi, but pocket due to enlarged gingiva, inflamed but but junction the same
what are the properties of the biofilm
communication between bacteria, preventing invasion of other species, taking up nutrients or expelling waste products, development of appropriate environment
what are the changes in the biofilm resulting in perio
changes in the colonisers of the biofilm, accumulation, virulence factors
give an example of a late coloniser in perio disease
porformona gingivalis
why do some people develop perio and some stay with gingivitis
dependant on the bodies host response to the bacteria, determines how it will progress
describe the mechanisms of destruction in perio
change in biofilm, t cells are normally first at site. they release cytokines and attract b cells. b cells release antibodies. results in activation of complement - inflammatory mediators interleukins and prostaglandins. these do well to attack the bacteria. but also activate collagenase, which activates MMP’s. these destruct connective tissue, attack the gingiva. also activate osteoclasts which results in bone resorption
what is the difference between horizontal and vertical bone loss
horizontal - all bone on one plane lost
vertical - 2mm radius of bone loss around site of inflammation, one side of bone is intact but one side is lost
what should normal bone levels be
1-2mm from amelocemental junction
what are some risk factors for perio disease
smoking, diabetes, socioeconomic status, genetics, stress, drugs
how does smoking affect periodontal disease
vasoconstriction - may be unaware, increased gingival keratinisation, impaired antibody function, increased pro-inflammatory cytokine production
what are the clinical signs of gingivitis
bleeding on probing, red and swollen gingiva, high plaque and bleeding scores, probing depths less than 3mm, no attachment loss or bone loss radiographically
what are the clinical signs of periodontitis
clinical attachment loss, pocket depths more than 4mm, radiographic bone loss, gingival recession
what is the relationship between diabetes and perio disease
if diabetes is uncontrolled, it can make gum disease worse. if gum disease is uncontrolled, it can make diabetes worse
how can you risk assess a patient for perio disease
asking about their dental history, their oral hygiene regime, can assess their motivation
what is a bpe useful for
screening tool for perio disease. can be used to assess what further investigations or treatment is required
what does a score of 0 mean on a bpe
no bleeding on probing, no plaque retentive factors, no probing depth >3.5mm
what does a score of 1 mean on a bpe
bleeding on probing, but no plaque retentive factors or probing depth >3.5mm
what does a score of 2 mean on a bpe
plaque retentive factors present e.g. over hang restoration or defective crown margins, probing depth >3.5mm
what does a score of 3 mean on a bpe
probing depth of 3.5-5.5mm
what does a score of 4 mean on a bpe
probing depth >6mm
what does * mean on bpe
furcation involvement
why might chlorhexidine mouthwash be given
to reduce plaque build up and bacteria but causes staining of teeth - not to be used for longer than 4 weeks
how should oral hygiene instructions be given
T - talk, about causes of dental diseases and discuss any barriers the patient has to effective plaque removal
I - instruct, the patient on the best ways for effective plaque removal
P - practise, get the patient to practise oral hygiene infront of you so you can guide them
P - plan, put a plan in place to help patient with daily oral hygiene in their routine
S - support, provide support for the patient with follow up appointments
what is the treatment plan for a patient with a score of 0
no treatment required, maintence of oral hygiene
what is the treatment plan for a patient with a score of 1
oral hygiene instruction
what is the treatment plan for a patient with a score of 2
oral hygiene instruction, removal of plaque retentive factors, scaling
what is the treatment plan for a patient with a score of 3
oral hygiene instruction, RSD and scaling, 6 point pocket chart post treatment in the sextant with 3 only
what is the treatment plan for a patient with a score of 4
OHI, RSD, scaling, 6 point pocket chart, may need referral to specialist
what is the aim of periodontal treatment
arrest disease process, restore tissue damage, maintain periodontal health, maintain teeth
what are the stages in hygiene phase therapy
dental education, oral hygiene instruction, root surface debridement, removal of plaque retentive factors, re-evaluation
what is involved in dental education
educating the patient about periodontal health, why it is important and what the consequences will be. can be done using leaflets
describe toothbrushing technique and flossing
modified bass technique - toothbrush at 45 degree angle, at cervical margin, vibrate toothbrush and sweep down
flossing - tape makes a c shape around the interproximal surface of teeth, down into gingiva and sweep up
what is scaling and what is the aim
removal of plaque supra-gingivally. to reduce inflammation of gingiva
why might gum recession be seen after scaling
removal of plaque and reducing inflammation can make the gums calm down. before they were enlarged due to inflammation, calmed down now to see where junctional epithelium is
what is root surface debridement
removal of plaque, calculus and biome from root surface
what is the aim of RSD
restores healthy biofilm, allows for re-attachment of junctional epithelium and reduce clinical attachment loss
why must both supra and sub gingival scaling be done
supra only - sub gingival bacteria will reinfect pocket and root surface. sub only - the gingiva will remain inflamed due to inflammation in pocket
what is measured at re-evaluation stage
plaque control, bleeding on probing, pocket depth, clinical attachment loss
how is a successful outcome gained
gingival recession and improved clinical attachment for reduced pocket depth. aim for pocket less than 4mm
what are possible reasons for failed treatment
poor RSD - plaque retained here, inflammation remains and unable to improve attachment. will be seen if patient has good oral hygiene but pockets not improving
poor oral hygiene - patient not complying, need to work out why they arent doing it, if patient seems motivated, can try again with RSD, if not, not worth it
if RSD good and good oral hygiene may require surgical treatment
what are some virulence factors for p gingivalis
inflammophilic - likes inflammation environment
gingipains - proteases with broad activity, degrade host proteins
what is activated with build up of bacteria
toll like receptor - increased permability and neutrophil influx
what is the role of neutrophils in perio disease
can be enough to resolve inflammation or can result in progression with excessive infiltrate, cytokine release and tissue destruction
how is bone lost in period
rank ligand is stimulated by cytokines, binds to rank for osteoclast activity and bone destruction. opg normally inhibits rankl but these levels are reduced with cytokines
what causes dysbiosis
inflammation preventing commensual bacteria, so pathogenic bacteria in higher numbers, caused by smoking, disease, genetics or poor oral hygiene
describe a BPE probe
ball ended with diameter of 0.5mm. black band at 3.5mm-5.5mm to assess bpe score and give rough guide of depth of pockets
describe a PCP probe
no ball end, 2 black bands - 3-6mm then 9mm-12mm
what do you record on a 6 point pocket chart
6 sites of tooth - mesiobuccal, midbuccal, distobuccal, mesiolingual, distolingual, midlingual
gingival recession - ACJ to gingiva
probing depth - from gingiva to base of pocket
bleeding on probing, furcation involvement, mobility
how do you calculate clinical attachment loss
gingival recession + probing depth
what probes can be used to assess furcation involvement
nabers probes - more likely to be seen on a radiograph
what are the stages of mobility
0 - 0.1-0.2mm of horizontal movement
1 - less than 1mm of horizontal
2 - more than 1mm of horizontal
3 - severe mobility in horizontal and vertical
