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BDS2 Clinical Dental Science > Perio > Flashcards

Perio Flashcards

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1
Q

what host defences prevent gingivitis/perio

A

gingival crevicular fluid
antibodies, monocytes, lymphocytes, neutrophils
saliva
cells proliferating and shedding

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2
Q

what causes gingivitis

A

more bacterial colonisation - plaque build up

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3
Q

what changes happen to the host defences in gingivitis

A

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

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4
Q

what does the gingiva look like in health and how does this change in gingivitis

A

health - knife edge margins, scalloped margins, pink
in gingivitis - knife egde is lost, more red, bleeding on probing

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5
Q

what is the difference between perio and gingivitis

A

apical migration of junctional epithelium, pocket formation and bone loss

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6
Q

what is the difference between true and false pockets

A

true - apical migration of junctional epi
false - no migration of junctional epi, but pocket due to enlarged gingiva, inflamed but but junction the same

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7
Q

what are the properties of the biofilm

A

communication between bacteria, preventing invasion of other species, taking up nutrients or expelling waste products, development of appropriate environment

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8
Q

what are the changes in the biofilm resulting in perio

A

changes in the colonisers of the biofilm, accumulation, virulence factors

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9
Q

give an example of a late coloniser in perio disease

A

porformona gingivalis

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10
Q

why do some people develop perio and some stay with gingivitis

A

dependant on the bodies host response to the bacteria, determines how it will progress

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11
Q

describe the mechanisms of destruction in perio

A

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

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12
Q

what is the difference between horizontal and vertical bone loss

A

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

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13
Q

what should normal bone levels be

A

1-2mm from amelocemental junction

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14
Q

what are some risk factors for perio disease

A

smoking, diabetes, socioeconomic status, genetics, stress, drugs

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15
Q

how does smoking affect periodontal disease

A

vasoconstriction - may be unaware, increased gingival keratinisation, impaired antibody function, increased pro-inflammatory cytokine production

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16
Q

what are the clinical signs of gingivitis

A

bleeding on probing, red and swollen gingiva, high plaque and bleeding scores, probing depths less than 3mm, no attachment loss or bone loss radiographically

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17
Q

what are the clinical signs of periodontitis

A

clinical attachment loss, pocket depths more than 4mm, radiographic bone loss, gingival recession

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18
Q

what is the relationship between diabetes and perio disease

A

if diabetes is uncontrolled, it can make gum disease worse. if gum disease is uncontrolled, it can make diabetes worse

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19
Q

how can you risk assess a patient for perio disease

A

asking about their dental history, their oral hygiene regime, can assess their motivation

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20
Q

what is a bpe useful for

A

screening tool for perio disease. can be used to assess what further investigations or treatment is required

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21
Q

what does a score of 0 mean on a bpe

A

no bleeding on probing, no plaque retentive factors, no probing depth >3.5mm

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22
Q

what does a score of 1 mean on a bpe

A

bleeding on probing, but no plaque retentive factors or probing depth >3.5mm

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23
Q

what does a score of 2 mean on a bpe

A

plaque retentive factors present e.g. over hang restoration or defective crown margins, probing depth >3.5mm

24
Q

what does a score of 3 mean on a bpe

A

probing depth of 3.5-5.5mm

25
Q

what does a score of 4 mean on a bpe

A

probing depth >6mm

26
Q

what does * mean on bpe

A

furcation involvement

27
Q

why might chlorhexidine mouthwash be given

A

to reduce plaque build up and bacteria but causes staining of teeth - not to be used for longer than 4 weeks

28
Q

how should oral hygiene instructions be given

A

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

29
Q

what is the treatment plan for a patient with a score of 0

A

no treatment required, maintence of oral hygiene

30
Q

what is the treatment plan for a patient with a score of 1

A

oral hygiene instruction

31
Q

what is the treatment plan for a patient with a score of 2

A

oral hygiene instruction, removal of plaque retentive factors, scaling

32
Q

what is the treatment plan for a patient with a score of 3

A

oral hygiene instruction, RSD and scaling, 6 point pocket chart post treatment in the sextant with 3 only

33
Q

what is the treatment plan for a patient with a score of 4

A

OHI, RSD, scaling, 6 point pocket chart, may need referral to specialist

34
Q

what is the aim of periodontal treatment

A

arrest disease process, restore tissue damage, maintain periodontal health, maintain teeth

35
Q

what are the stages in hygiene phase therapy

A

dental education, oral hygiene instruction, root surface debridement, removal of plaque retentive factors, re-evaluation

36
Q

what is involved in dental education

A

educating the patient about periodontal health, why it is important and what the consequences will be. can be done using leaflets

37
Q

describe toothbrushing technique and flossing

A

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

38
Q

what is scaling and what is the aim

A

removal of plaque supra-gingivally. to reduce inflammation of gingiva

39
Q

why might gum recession be seen after scaling

A

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

40
Q

what is root surface debridement

A

removal of plaque, calculus and biome from root surface

41
Q

what is the aim of RSD

A

restores healthy biofilm, allows for re-attachment of junctional epithelium and reduce clinical attachment loss

42
Q

why must both supra and sub gingival scaling be done

A

supra only - sub gingival bacteria will reinfect pocket and root surface. sub only - the gingiva will remain inflamed due to inflammation in pocket

43
Q

what is measured at re-evaluation stage

A

plaque control, bleeding on probing, pocket depth, clinical attachment loss

44
Q

how is a successful outcome gained

A

gingival recession and improved clinical attachment for reduced pocket depth. aim for pocket less than 4mm

45
Q

what are possible reasons for failed treatment

A

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

46
Q

what are some virulence factors for p gingivalis

A

inflammophilic - likes inflammation environment
gingipains - proteases with broad activity, degrade host proteins

47
Q

what is activated with build up of bacteria

A

toll like receptor - increased permability and neutrophil influx

48
Q

what is the role of neutrophils in perio disease

A

can be enough to resolve inflammation or can result in progression with excessive infiltrate, cytokine release and tissue destruction

49
Q

how is bone lost in period

A

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

50
Q

what causes dysbiosis

A

inflammation preventing commensual bacteria, so pathogenic bacteria in higher numbers, caused by smoking, disease, genetics or poor oral hygiene

51
Q

describe a BPE probe

A

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

52
Q

describe a PCP probe

A

no ball end, 2 black bands - 3-6mm then 9mm-12mm

53
Q

what do you record on a 6 point pocket chart

A

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

54
Q

how do you calculate clinical attachment loss

A

gingival recession + probing depth

55
Q

what probes can be used to assess furcation involvement

A

nabers probes - more likely to be seen on a radiograph

56
Q

what are the stages of mobility

A

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

BDS2 Clinical Dental Science (6 decks)

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