Perio Exam 1 Flashcards
1) What legal ethical requirements are we obligated to provide. (4)
- Must diagnose disease 2. Must inform patient of existing disease
- Must offer appropriate treatment or refer
for treatment - Must treat to the standard of care
2) Know the variables associated with probing. (5)
Variables
- Inflammation
- Probe Diameter
- Tapered vs. Parallel
- Force (0.15 N to 0.75 N)
- Band Width (0.7 mm to 1.0 mm)
3) Localized vs. Generalized Chronic Periodontitis
Localized Chronic Periodontitis: ≤ 30% of teeth involved Slight Moderate Severe Generalized Chronic Periodontitis: > 30% of teeth involved Slight Moderate Severe
4) Know the initial, early, established, advanced lesions of gingivitis and periodontitis. When do things occur
A. Normal=Healthy B1. Initial Lesion=Gingivitis B2. Early Lesion=Gingivitis B3. Established Lesion=Gingivitis C. Advanced Lesion=Periodontitis
5) You will be asked to calculate clinical attachment loss, based on the data provided.
GM= Gingival Margin PD= Probing Depth CAL= Clinical Attachment Loss GM + PD = CAL ex. GM=CEJ, 3 mm coronal, 3 mm apical PD= 6mm, 9mm, 3mm CAL= 6mm, 6mm, 6mm
6) Know about probing, how to do it and factors involved, when is it worse, when is it less, when do we exaggerate it, etc.
Always check interproximal/interdental crater clinically. X-ray may not show bone loss well enough.
7) Know about biological width.
Junctional Epithelium + Connective Tissue Attachment = Biological Width.
CEJ to Crest of Alveolar Bone = 1.5-2mm (biological width)
8) Know about mobility. How do we detect it, what is class 1, what is class 2.
Detect Mobility using two instruments, never fingers.
Average width of PDL in adults is: 0.17mm Class I > 0.2 mm but < 1 mm Class II > 1 mm Class III > 1 mm + Axial Displacement
9) Important concept, commonly confused.
When we record data every time and over time it shows disease progression or disease stability. This is an important concept. Probing depth, one day tells you what it is today, but over the year it gives an indication of the patient’s disease. Bleeding on probing indicates disease activity for that day
10) Know the normal distance between CEJ and alveolar bone.
CEJ to Crest of Alveolar Bone = 1.5-2mm (biological width)
11) The average width of the PDL
0.17
13) When we measure furcations we use a particular type of probe and that probe measures??.
Cowhorn or Nabors Furca Probes for Horizontal Bone Loss.
14) Know the difference between gingivitis and periodontitis.
GINGIVITIS
Gingivitis:
- Plaque-Induced
- Gingival Diseases Modified by Systemic Factors
ex. puberty, pregnancy, diabetes, leukemia. - Gingival Diseases Modified by Med’s
ex. dilantin, ca channel blockers, cyclosporine ask zak
15) Know the clinical presentation of gingivitis versus periodontitis.
Everybody develops gingivitis but only susceptible patients will develop periodontitis. Therefore, patient’s immunology is extremely important in the pathogenesis of periodontal disease
16) What are the characteristics of clinically healthy gingiva? (5)
- Some neutrophils and macrophages present
- A few neutrophils migrating through the JE
- No collagen destruction
- Intact epithelial barrier
- Gingival crevicular fluid present
18) Know the data that we collect to diagnose.
- Probing Depth
- Bleeding on Probing
- Clinical Attachment Levels
- Width of Attached Gingiva
- Gingival Recession
- Furcation Involvements
- Tooth Mobility
- Radiographic Evidence of Bone Loss
- Plaque and Calculus
*****19) Know about chronic periodontitis. What does it look like clinically, what are the manifestations, is it associated with pain, etc.
Chronic Perio
Slight: 1-2mm CAL
Moderate: 3-4mm
Advanced: >5mm
20) Highlighted a few slides by Dr.Loe and Dr.Cobb that have some research data on them, those are important to know.
Loe: The average rate of clinical attachment loss
in patients with untreated chronic periodontitis
ranges from 0.1 to 0.3 mm per year for facial
and lingual surfaces and 0.3 mm per year for
interproximal areas.
Cobb: During the same time period, untreated periodontal patients will lose 3.5 times more teeth than will those patients who receive treatment.
OR
In a ten year period, untreated periodontal patients will lose 3.5 – 4.0 teeth while those patients who receive treatment will lose 1 tooth.
21) You will be asked about periodontal progression (4), the asynchronous burst model. (4)
- Plaque-induced
- susceptible host is required (immune system).
- Only a small % of the population experiences advanced destruction.
- The progression of the disease is probably
an asynchronous multiple burst model - Several sites have one or more bursts of activity
- Prolonged period of inactivity
- Cumulative extent of destruction varies among
sites - Some sites don’t develop attachment loss
22) Know how we diagnose.
Meaning slight, moderate, severe, how much clinical attachment loss for each. Is it localized or is it generalized. How do you know based on how many percentages of sites, know the numbers and the know how to come up with a diagnosis.
23) Different types of walls of a defect, definition of them, prognosis of them.
Intrabony Pockets (Vertical Bone Loss)
1 wall (worst prognosis)
2 wall
3 wall-best prognosis (most remaining walls)
circumferential
interdental: 35% max intrabony defects & 63% of mand. intrabony defects
24) There will be a drawing of the wall defect.
slide 13 chronic perio slide
25) You will be asked about diabetes in terms of periodontal disease, multiple abscesses, treatment of, and their response to treatment. A well-controlled diabetic responds just as well as a non-diabetic treatment.
Diabetes Causes: xerostomia obesity (increases susceptibility to bacterial infection- aka perio disease) Periodontal abscesses Rapid alveolar bone loss increased bone resorption increased plaque activity impaired wound healing altered pmn chemotaxis
26) The pyogenic granuloma associated with pregnancy comes from what bacteria?
what is p. intermedia because it’s tissue invasive and associated with gingival inflammation and pyogenic granuloma.
27) The medication induced gingival types of gingival inflammation or gingival excess.
Dilantin
Cyclosporine
Ca Channel Blockers
28) antibiotics for pregnant women
ok to use:
penecillin, erythromycin, clindamycin (with caution), cephalosporins, gentamicin (caution), vanocomycin (caution)
avoid:
tetracycline, ciprofloxacin, metronidazole, clarithromycin.
review slides 17-19
29) How many months do you need to wait if a patient reports an MI before you treat the patient?
6 months.
30) Red Complex
porphy ging
tannerella forsythia
treponema denticola
AA (aggresive) & prev intermedia (chronic)
31) There are pictures on the exam associated with the pictures you have seen in the power points; the wall defects for example, patterns of bone loss pictures (pseudopocket, intrabony..etc).
psuedopocket: gingivitis pocket
intrabondy: vertical loss
suprabony: horizontal loss
33) Diabetes, multiple abscess, how do you treat them.
chx, antibiotics??
1) Know the rational for treatment,
- Control etiology
- Control inflammation
- Control pain and discomfort
- Restore periodontal health
- Maintain long-term function of the dentition
- Regeneration of lost bone and soft tissues.
- Maintain or restore to esthetic level as desired by patient
- Control of the local inflammatory response contributes
to control of the systemic inflammatory response and
thereby promotes good general systemic health.
1) why do we treat the patient,
1. The disease in an INFECTION
Initiated by bacteria
Provokes both a local and systemic inflammatory
response in the host.
2. The disease is CHRONIC
Cannot be cured
Can be controlled
3. CANNOT REMOVE all plaque and calculus
Re-infection may occur3) Probing Depth
Rang of Probing Depth for Normal Periodontium is:
0-3mm
4) When do we see bleeding on probing, things of that nature.
BOP Negative: No Active Disease Healthy Microbial Flora Sulcus/Pocket Epithelial Integrity Intact BOP Positive: Active Disease Presence of Microbial Biofilm/Plaque Ulcerative Sulcus/Pocket Epithelium
14) Know the difference between gingivitis and periodontitis.
PERIODONTITIS
Chronic: localized and generalized
Aggressive: localized and generalized
Perio as manifestation of systemic disease: leukemia, neutropenia, and genetic disorders.
14) Know the difference between gingivitis and periodontitis.
slide 19-27 evolution inflam
Initial Lesion
2-4 days nuetrophils vasculitis loss of CT no bone loss or CAL
Early Lesion
4-7 days acute inflamm persists (nuetrophils) macrophages start to appear 70 % collagen loss pseudopocket formation begins increased GCF flow loss of stipling bleeding on probing
Established Lesion
2-3 weeks
nuetrophils persist but macrophages dominate
proliferation of JE
elongation of rete pegs
no bone loss
collagen and fibroblasts continue to degrade
final stage of gingivitis, can remain stable for months until=if it develops into periodontitis
Advanced Lesion
Alveolar Bone Resorption activation of osteoclasts, mmps, cytokines, prostaglandins, leukotrienes. pmns, plasma cells, macrophages loss of collagen continues CAL periodontal pocket formation radiographic bone loss 30-50 % volume
Important Cytokines
slide 39 evo
Stages of Gingivitis
slide 61 evo
Oral Signs and Symptoms of Diabetes (5)
- Xerostomia
- burning mouth
- perio abscesses
- dental caries
- candidiasis
Puberty
Increase estro/proges = increase gingivitis = increase levels of prevotella intermedia
management:
OHI, scaling, CHX,
Pregnancy
Primary Objectives: healthy oral enviro & maintain optimal oral hygiene
Elective: 1st tri = no tx, no radio
2nd tri = safest time frame for tx, but postpone perio surgery
3rd tri = selective tx
