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Periodontology II > Perio Final > Flashcards

Perio Final Flashcards

1
Q

What are the four components of P I C O

A 
P = problem or population, 
I = intervention (what are you going to do), 
C = compassion = comparing two or more approaches to the problem, 
O = outcome (see results)
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2
Q

EB DM is used to sub what kind of problem

A

Clinical

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3
Q

What kind of study offers the highest quality research

A

Systemic reviews of random controlled studies

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4
Q

Systemic review

A 
Focused question 
Search method stated 
Studies selected by criteria 
rigorous appraisal 
database conclusion, may include meta analysis
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5
Q

Traditional (narrative) review

A 
Question broad in scope 
search method not stated 
no key criteria selected 
variable critical appraisal 
opinion based conclusion
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6
Q

What is the purpose of oral irrigation

A

An adjunct of method for the arrest and control of gingival infections as it targets the loosely attached bacterial plaque and lowers the bacterial level in the oral cavity through disrupting microbial colonization.

Modes are both power driven and manual (water piks, ultrasonics, and manuals syringes with cannula)

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7
Q

Characteristics of an effective mouth rinse

A

Non-toxic or toxicity (will not damage tissue)
None or limited absorption (absorbed through G.I. tract; confined to oral cavity)
Substantivity (Peridex, CHX), (ability to bind to the pellicle and tooth surface and be released over a period of time)
Bacterial specificity or high potency
Low induced drug resistance

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8
Q

Definition of controlled drug release agents

A

Intercrevicular medication that is professionally placed and provides delivery of a drug over a substained period of time

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9
Q

What is the advantage of controlled drug release agents

A

Drug delivers 1000 times the concentration of GCF but only 1/100 of this is systemic dose reaches the rest of the body

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10
Q

What are the bacteria associated with periodontal disease

A

Read complex bacteria (most periodontal pathogenic bacteria I gram-negative, non-motile and anaerobic)

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11
Q

What are the three major organisms found in 98% of periodontal diseases

A
  1. Actinobacillus actinomycetemcomitans (Aa)
  2. Porphyromanas gingivalis (Pg)
  3. Prevotella intermedia (Pi)

Others are: camplylobacter recta eikenella corrodens, fusobacterium nucliatum, spirochetes, bacteroikes forsynthus

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12
Q

What are the dental hygienist role?

A

Recognize, record, referred

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13
Q

Orthofunction (physiologic occlusion)

A

Health and comfort, no pathologic changes in the oral tissues

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14
Q

Dysfunction (morphofunctional disharmony)

A

Often a result of para functional activities = grinding, clenching, activities which stress the system

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15
Q

What is the range of morphofunctional harmony to disharmony

A

Dependent on the adaptive capabilities of the individuals oral system. When the para functional activities exceed what the system can sustain, dysfunctional results

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16
Q

Traumatic occlusion

A

Occlusion which has caused injury to the teeth, muscles or TMJ

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17
Q

Primary dramatic inclusion

A

Heavy occlusal forces exceed the adaptive range in normal periodontium, causing injury to the tissues and bone. The bite causes the injury

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18
Q

Secondary traumatic occlusion

A

Normal occlusal forces exceeded the capability of a periodontium already affected by disease. (The bite alters tissues already compromised.)

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19
Q

What does EBDM stand for

A

Evidence-based decision-making

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20
Q

What are the Primary Signs and Symptoms of TMJ Disorders?

A
  • pain in muscles (myalgia)most common
  • pain in TMJ (arthralgia)
  • painful clicking of the joint in function (crepitus)
  • limited range of motion (incoordination of joint)
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21
Q

Additional symptoms of TMJ include?

A
  • uncomfortable bite
  • incoordination of the jaw (dyskinesia)
  • ringing in the ears
  • muscles swelling
  • clinical signs of tooth wear, mobility and pulpitis
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22
Q

TMJ disorders

A

Musculoskeletal conditions that produce pain and or dysfunction of the masticatory system.

  • Extracapsular- involves muscle not joint
  • Intracapsular- occuring in the TMJ
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23
Q

If you have one or more symptoms of TMJ does not indicate a?

A

Positive diagnosis

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24
Q

Oral habits

A

repetitive masticatory activities. tooth-to-tooth or tooth-to-object. Wear faucets

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25
Q

Tobacco Cessation Statistics

A
  • chief avoidable (preventable) cause of illness and death in the USA
  • contributing factor in many medical conditions such as cancer, cardiovascular, respiratory, and reproductive, in addition to an increased risk of perio disease
  • contains nicotine which is a highly addictive drug
  • itself is not a carcinogen but it is the chemical that causes addiction
  • smokeless contains more nicotine than cigarettes
  • is harmful
  • on a milligram to milligram basis, nicotine is 10x more addictive than heroin or cocaine and 6-8x more addictive than alcohol
  • the extent of periodontitis is directly related to the number of cigarettes smoked and the number of years of smoking
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26
Q

Tobacco clinical clues

A

-normal clinical signs of diseased are masked: gingival inflammation and bleeding are often reduced or absent in smokers.
-the lack of bleeding on probing does NOT indicated healthy tissue as with a nonsmoker
-gingival recession and decay of exposed root surface adjacent to site of placement of smokeless tobacco
-white patches or red sores on buccal mucosa
nicotine stomatitis on maxillary palate

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27
Q

How Nicotine Affects the Body

A

manufacturers are able to control the level of free nicotine found in their product by controlling the PH levels.
-Free nicotine is ionized nicotine that passes rapidly through the oral mucosa into the bloodstream and into the brain. The more alkaline the product the faster the uptake into the bloodstream

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28
Q

Tobacco role of the dental hygienist

A

Ask
Advise
Assess

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29
Q

On a milligram to milligram basis, nicotine is __ times more addictive than heroin or cocaine and ___ times more addictive than alcohol

A

10

6-8

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30
Q

The more alkaline the product the ____ the uptake into the bloodstream

A

Faster

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31
Q

Ask

A
  • important to identify tobacco users

- most often done through health history form

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32
Q

Advise

A

Important to relate tobacco use to protecting current and future health

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33
Q

Assess

A
  • readiness to quit-open ended question

- States of change theory

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34
Q

How many stages of stage theory are there?

A

5

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35
Q

What are the 5 stages of change theory?

A

Stage 1: Pre-contemplation - no thought of quitting
Stage 2: Contemplation - thinking about quitting “someday”
Stage 3: Preparation- ready to quit and willing to set a “quit” date
Stage 4: Action-stopped their tobacco use for less than 6 months
Stage 5: Maintenance-stopped tobacco use for more than 6 months

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36
Q

Periodontal Abscesses

A

Inflammation of bacterial origin that is associated with exudates. The abscess is often caused by microbiota that has become established in the tissue as a result of trauma, advancing perio disease, or incomplete S/RP. the abscesses may be acute or chr

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37
Q

Acute

A

pre-existing periodontal disease. Inflammatory reaction occurs when the periodontal pocket becomes occluded. Often a result of a foreign object (such as residual calculus)

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38
Q

Chronic

A

Result of an overgrowth of pathogenic organisms in a periodontal pocket than drains the exudate. Often painless because of this drainage

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39
Q

Tobacco Information Patients should know

A
  • nicotine withdrawal lasts 2-4 weeks and is the brains way of healing
  • medications can minimize discomfort of nicotine withdrawal and cravings.
  • untreated nicotine withdrawal symptoms may include craving, irritability, frustration, anger, anxiety, difficulty concentrating, weight gain, insomnia, and gastrointestinal problems.
  • strategies that combine behavioral and FDA - approved adjunctive phamacologic support achieve the best outcomes for nicotine-dependent patients.
  • stages of readiness to quit are progressive levels of mental readiness. Not everyone moves through the steps a the same speed.
  • the type of assistance we provide or promote is determined by the patients readiness to quit.
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40
Q

Necrotizing Ulcerative Gingivitis (NUG)

A
  • Vincents Disease
  • associated with stress, lifestyle and chronic illness and conditions
  • spirochetes and gram-negative organisms
  • pseudomembrane on tissue
  • crated interdental papillae
  • severe halitosis
  • painful
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41
Q

Nectrotizing Ulcerative Periodontitis (NUP)

A

NUG like symptoms with attachment loss

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42
Q

Acute Herpetic Gingivostomatitis

A
  • herpes simplex virus 1
  • child, adolescence, young adults, most prevalent group
  • limit dental care with infected patients
  • after initial infection virus remains dormant in nerve ganglion until re-stimulated
  • oral lesions small yellow filled vesicles that will get larger with bright red boarders
  • painful
  • can have fever, malaise, irritability
  • herpetic whilow
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43
Q

Facts about Lasers

A
  • produce light energy absorbed by targeted tissues. Absorption dependent on wave length.
  • absorption causes thermal reaction within the tissue
  • can be used on wide range of population including children and pregnant women
  • unlike medications there are no allergic reactions, bacterial resistance or untoward side effects.
  • lasers disinfect and detoxify periodontal tissues
  • still controversial-not enough current studies to prove advantageous to initial periodontal therapy (Phase 1)
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44
Q

Healing 3 ways

A
  1. Primary intention - healing does not involve granulation tissue
  2. Secondary intention - heals with granulation tissue
  3. Tertiary intention- healing with granulation tissue and loss of surrounding tissue. Ex. infections, large excisional areas
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45
Q

Bone loss

A

Biological width: 1-2 mm of connective tissue attachment between the base of the sulcus or pocket and the alveolar bone. This 1-2 mm is the combined height of the gingival connective tissue and the junctional epithelium.

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46
Q

Periodontal surgeries

A
  • allow a minimum of 4 weeks after phase 1 treatment before recommending Phase II
  • most successful in 5-9mm pockets
  • disease must have progressed by a 2mm increase in probing depths (bone loss)
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47
Q

Incisional procedure

A

Flap

48
Q

Excisional procedure

A

gingivectomy and gingivoplasty. Procedure used to remove excess tissue from the wall of perio pocket. Useful for the rapid reduction of periodontal pockets.

49
Q

Full thickness flap

A

also called a mucoperiosteal flap, the gingiva, alveolar mucosaa nd periosteum are reflected from the root and underlying bone (exposed bone)

50
Q

Partial thickness flap

A

also called a split-thickness flap, the periosteum and some connective tissue are left attached to the bone and not included in the flap procedure (no bone exposure)

51
Q

Most common flap

A

Modified Widman and apically positioned

52
Q

based on the final positioning of the flap….

A

They may be classified as replaced or repositioned (ex. Modified Widman), apically positioned, coronally positioned and laterally positioned

53
Q

3 main components of implants

A
  • Body - implant fixture (replaces the root)
  • Abutment - extends from the implant through the soft tissue (transmucossal)
  • Restoration or prosthesis - attaches to the abutment
54
Q

Osseointegration

A

contact established between normal and remodeled bone and the implant surface without connective tissue interaction. An implant is never 100% osseointegrated.

55
Q

Osseointegration

A

contact established between normal and remodeled bone and the implant surface without connective tissue interaction. An implant is never 100% osseointegrated.

56
Q

Titanium

A

most common metal used for implants since it is biocompatible and 45% lighter than steel

57
Q

Contraindications for implant surgery

A
  • uncontrolled diabetes
  • heavy smokers
  • bisphosphonate therapy
  • refusal for oral health compliance
58
Q

Implant loading

A

placement of restoration on the implants

-no fixed time period-normal recommendation is 3 months mandibular and 6 months maxillary

59
Q

Two stage

A

-submerged protocol -restorative procedures usually begin 3-5 weeks after tissue healing

60
Q

One stage

A

-nonsubmerged protocol - similar to two stage except tissues are closed around the specially designed transmucosal portion of the implant. This eliminates need for second step.

61
Q

Most successful region of the mouth for implants

A

Posterior molars and pre-molars

62
Q

Least successful region of the mouth for implants

A

Anteriors - bone density is major contributing factor. Maxillary Anterior bone is the least dense.

63
Q

Criteria for successful implants

A
  • no peri-implant radiolucency
  • absence of mobility
  • bone loss not greater than 1/3 of implant
  • functional service for 5 years
  • absence of persistent pain, infection, paresthesia
  • bone loss less than 0.2mm annually after first year
  • allows satisfactory restoration option
  • absence of soft tissue complications
  • probing depths less than 4-5mm, bone loss less than 4mm
  • no mechanical failure
64
Q

What are the types of abcesses

A
  • Periodontal
  • Endodontic abscess and periapical abscess
  • gingival abscess
  • pericoronal
65
Q

Types of lasers

A
  • Erbium
  • Carbon Dioxide
  • Diode
66
Q

Common bone grafts

A
  • Graft
  • Autograft
  • Allograft
  • Alloplasty
  • Xenograft
67
Q

Graft

A

Source

68
Q

Autograft

A

Own body

69
Q

Allograft

A

Cadaver of bone bank

70
Q

Alloplasty

A

biocompatible, inorganic synthetic materials (hydroxyapatite, calcium sulfates, and tricalcium phosphates)

71
Q

Xenograft

A

another species (usually cow)

72
Q

Ostecomy

A

removal of supporting bone to obtain optimal contours

73
Q

Osteoplasty

A

recontouring nonsupporting bone to obtain physiologic contour

74
Q

Guided Tissue Regeneration (GTR)

A

Prevent gingival tissue from establishing contact with the root surface, creating space for the formation of a new attachment and new bone.

75
Q

Active ingredient in arestin

A

1 mg Minocycline hydrochloride

76
Q

active ingredient in Perio Chip

A

2.5 mg chlorhexidine gluconate

77
Q

Active ingredient in Actisite First used historically

A

Tetracycline

78
Q

Active ingredient in Atridox First resorbable

A

10% doxycycline hyclate

79
Q

How many levels of implant quality scale are there?

A

4

80
Q

Implant Quality Scale Level I Success

A
  • no pain, mobility or exudate history

- less than 2mm bone loss from initial surgery

81
Q

Implant Quality Scale Level II Satisfactory Survival

A
  • no pain, mobility or exudate history

- 2-4 mm bone loss form initial surger

82
Q

Implant Quality Scale

Level III Compromised Surviva

A
  • may have slight pain, and exudate history
  • no mobility
  • > 4 mm bone loss, shows radiographically less than 1/2 the implant length
  • probing depths >7mm
83
Q

Implant Quality Scale Level VI Failure

A
  • pain on function
  • mobility
  • bone loss of more than 1/2 the implant length. Show radiographically.
  • uncontrolled exudate
84
Q

Gingivoplasty

A

surgical reshaping of the tissue

85
Q

Gingivectomy

A

deep pockets with fibrous tissue as with drug induced gingival hyperpl

86
Q

Free gingival graft

A

donor site away from graft site. Most common area is palate

87
Q

Laterally positioned flap or pedicle graft

A

move gingiva from an adjacent tooth or edentulous area

88
Q

apically positioned flap

A

may be full or partial thickness. main objective is to surgically reduce deep pockets

89
Q

modified widman (repositioned flap)

A

gain access to root surfaces and reduce periodontal pockets

90
Q

Endosseous “in bone”

A

implant is placed directly into a socket. most conventional length is 8-14mm and diameter is 3-6 mm

91
Q

Subperiosteal “on bone”

A

custom-fabricated framework of metal that is supralveolar (on top of the bone) but beneath the oral tissues. 4 posts protrude through tissues to provide anchor for final bridge or denture

92
Q

Transperiosteal “through bone

A

penetrates entire mandibular jaw, 5-7 pegs protrude through tissue to provide anchor. used for atrophic mandible

93
Q

Biologic Environments Natural Tooth

A

gingival sulcus depth - shallow
PDL - perpendicular connective tissue inserts into cementum
gingival fibers -transseptal/circular
location of crestal bone - 1-2mm from CEJ
Cementum - cementum
Mobility - slight mobility - physiologic function of PDL
Plaque - more localized inflammation
Inflammation - inflammation not found in bone marrow
Proprioception - receptors within the PDL

94
Q

Biologic Environments Implant

A

gingival sulcus depth - dependent on type of implant and prosthetic component length
PDL - no PDL
gingival fibers -no limiting fibers; only circular or parallel
location of crestal bone -dependent on implant type; range 0.5-2.5 from implant shoulder to first thread
Cementum - No cementum
Mobility - mobility indicates implant failure
Plaque - more wide spread inflammation
Inflammation - inflammation into bone marrow
Proprioception - no receptors within interface

95
Q

What type of laser is a hard tissue laser?

A

Erbium

Don’t do often

96
Q

What type of laser(s) is/are soft tissue lasers?

A

Carbon Dioxide, Diode, and erbium

97
Q

Oral rinses

A 
Bis-biguanides
Phenolic Compounds
Quaternary Ammonium Compounds
Sanguinarine extracts (Herbal)
2nd generation antimictobial (CPC) 0.07%
Fluoride rinses
Oxygenating
Self made
98
Q 
Oral Rinse
Self Made (salt rinse) active ingredient
A

Iodine

99
Q

Oral Rinse Oxygenating (Gly-oxide amosan) active ingredient

A

Hydrogen peroxide

100
Q 
Oral Rinse
Fluoride rinses (Gel-Kam rinse and Stanimax) active ingredient
A

Stannous SnF2

101
Q

Oral Rinse 2nd Generation antimicrobial (CPC) 0.07% (Crest Pro-health) active ingredient

A

Cetylpyridium chloride a cationic quaternary ammonium compound (+ charge)

102
Q

Oral rinse Sanguinarine extracts (Herbal) (Viadent) active ingredient

A

alcohol extract from roots and herbs

103
Q

Oral rinse quaternary ammonium compounds (Scope, Cepacol) active ingredient

A

Cetylpyridinium chloride 0.045-0.05%) Domiphen bromide and benzthonium chloride

104
Q 
Oral Rinse
Phenolic Compounds (Listerine) active ingredient
A

Alcohol and Essential oils; thymol, eucalyptol, menthole, and methyl-salicylate

105
Q

Oral Rinse

Bis-biguanides (Peridex, Perio Guard) Active ingredient

A

Chlorhexine gluconate

106
Q

Active ingredient in a perio chip

A

Chlorhexidine

107
Q

Disease progression is determined by how many millimeters

A

2 mm increase in probing depths over a period of time

108
Q

Surgery is most successful in treating what millimeter pockets

A

5-9 mm

109
Q

What is the most critical factor in determining surgery

A

The mound of attachment loss. Clinical attachment laws is more accurate than probing depths, tooth mobility and presence of furcation involvement

110
Q

Biologic width

A

1-2mm area of connective tissue attachment covered by epithelium between the probing depths and alveolar bone

111
Q

Suprabony/horizontal boneloss

A

Olness parallels the CEJ of adjacent teeth. Normally generalized around several teeth. Bone destruction is not intra-osseous. Pocket base is coronal to the crest of the bow

112
Q

Types of suprabony pockets

A

Gingival pocket/pseudo-pocket

Periodontal pocket

113
Q

Vertical/infrabony boneloss

A

Bone loss not parallel with the CEJ and found around isolated

114
Q

How are osseous defects classified

A

By the number of walls remaining

115
Q

How do you determine the number of walls remaining

A

Through exploratory surgery. Radiographs Will not show the number of walls remaining

116
Q

What are the two critical factors in determining the prognosis of a tooth

A

Mobility and attachment loss. Attachment loss is the most critical

117
Q

How many wall defects yields the greatest success

A

A narrow three wall defect

Periodontology II (2 decks)

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