Perio Cram Flashcards
What is the 2017 disease classification of perio
- Health
- Plaque induced gingivitis
- Non plaque induced gingival disease
- Periodontitis
- Necrotising periodontal disease
- Periodontitis due to systemic disease
- Systemic disease
- Periodontal abscess
- Perio-endo lesion
- Mucogingival deformities
Clinical gingival health - localised gingivitis - generalised gingivitis
<10% BOP
10-30% BOP
>30%
BSP guidelines for code 3
Post tx 6PPC
What is a dental sinus?
Abnormal channel that drains from a longstanding dental abscess associated with a necrotic tooth
List the different types of abscesses
- Gingival abscess
- Gingival margin - Periodontal abscess
- Pre-existing deep pocket - Periapical abscess
- Non vital/PAP - Perio-endo lesion
- Perio + endo involvement
Features of a periodontal abscess
Vital
Preexisting deep pocket
Bone loss on xray
TTP laterally
Features of a periapical abscess
Non vital
Deep caries
No bone loss
TTP vertically
Tx of periodontal abscess
LA, drain + incise if pus present
Gentle supra+subgingival PMPR
Analgesia
0.2% CHX MW + OHI
Review in 10 days
IF systemic prescribe pen V
Tx of periapical abscess
RCT
Features of endo perio lesion
Non vital
Deep perio pocket close to apex
Sinus tract
Spontaneous pain
TTP
Mobility
Tx of Endo perio lesion
RCT
Analgesia
0.2% CHX MW + OHI
Review within 10 days
PMPR if necessary
Symptoms of a periodontal abscess
Pain
Swelling
Bleeding
TTP laterally
Suppuration
Regional lymphadenopathy
Existing perio disease
Vital tooth
Causes of endo perio lesion
Root fracture
Perforation
Resorption
Pre existing perio
How does a periodontal abscess form?
Infection caused by plaque bacteria into periodontal tissues
List some causes of recession
Ortho
Abrasion
High renal attachments
Traumatic skeletal CLASS III
+ value on 6PPC
Recession
Work out LOA
Pocket depth + gingival margin
What are the furcation grades
1 - up to 3mm horizontal attachment loss
2 - 3-6mm horizontal attachment loss
3 - through and through
What are the mobility grades
1 - <1mm
2 - 1-2mm
3 - >2mm and/or rotations
Explain to a patient what gingivitis is
- Gingivitis is the term used to describe red, swollen and inflamed gums
- They may bleed on brushing
- Gingivitis is caused by plaque (white sticky material that is made up of leftover food + saliva mix)
- If plaque is not removed effectively it leads to gum disease
- With good OH and help from dentist gingivitis is reversible
- If not controlled, it can lead to a more severe form of irreversible gum disease called Periodontitis
- This causes irreversible destruction to the bone supporting teeth into place leading to bone loss
- A gum pocket is created, which is an ideal environment for bacteria to continue growing down the tooth
- We want to work to stabilise this condition preventing it getting any worse and limiting the amount of bone loss
List signs of periodontitis
Bleeding gums
Swollen/tender gums
Bad breath
Unexplained tooth loss
Tooth sensitivity
Recession
Mobility
Gum abscesses
List some risk factors to gum disease
Diabetes
Smoking
Stress
Diet
Obesity
Certain meds
CVD
What are the tx options for gum disease
- Do nothing
- Don’t recommend
- Gum disease leading cause of tooth loss
- W/O tx will just get worse, will worsen existing symptoms - Periodontal tx
- OHI - help to clean your teeth
- PMPR - targeted cleaning where you will not be able to reach
- Baseline charts/ can monitor your progress to look for signs of improvement and stabilisation
What are the benefits of perio tx
- Decreased risk of diabetes
- Fresher mouth, pinker tighter gums
- Teeth less wobbly
- Bleeding should stop
- Less discomfort
- Keep teeth longer
- Bad
What are the side effects of tx
Short term discomfort after LA wears off
Gum recession
Sensitivity to hot/cold
Temp increase in mobility
Root caries
Gaps between teeth
List the BSP guidelines
STEP 1
- Explain disease, RF’s, risks+benefits inc no tx
-OHI, removal of plaque retentive factors
- Smoking cessation
- PMPR
STEP 2
- Subgingival PMPR
- Reinforce OH
- Re-evaluate after 3mths
STEP 3
- Managing unstable sites
- Reinforce OHI
- Repeat sub for 4-5mm pockets
- Consider referral for unresponsive
STEP 4
- Stable
- Supportive perio care
- Reinforce OH + behavioural change
- Regular PMPR
- Recall within 3-12mths
Issues of recession
Dentine hypersensitivity
Cervical caries
Aesthetics
Tx for recession
DBA - desensitisation
Resto with RMGI
MPBS
Healthy Gums do Matter
MPS - 30%
MBS - 35%
How do you work out MPS
SITES:
Interprox
Buccal
Lingual
SCORES:
0 - nil
1 - skimmed
2 - visible
/36 x 100
How do you work out MBS
SITES:
D/M/B/L
SCORES:
0 - no BOP
1 - BOP
/24 x 100
Rfamjords teeth
16, 21, 24, 36, 41, 44
BPE probe
WHO 0.5mm ball ended probe
3.5-5.5
8.5-11.5
BPE for children teeth
16 11 26
46 31 36
Plaque scores for children
10/10
8/10 - cervical margin
6/10 - cervical 3rd
4/10 - mid 3rd
List the colours + sites for each hand scaler
Gracey 1/2 (grey)
Subgingival U+L anteriors
Gracey 7/8 (green)
Subgingival B+L posteriors
Gracey 11/12 (orange)
Subgingival M of posteriors
Gracey 13/14 (blue)
Subgingival D of posteriors
Mini Sickle
Supragingival B+L embrasures
Columbia
Subgingival anywhere, limited access to deep pockets
Hoe scaler (red)
Gross supra+sub on M+D surfaces
Hoe scaler (yellow)
Gross supra+sub on D of posteriors
