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Perio III final > Perio III 4/23/14 Final exam > Flashcards

Perio III 4/23/14 Final exam Flashcards

1
Q

Focal Theory of Infection

A

infections in oral cavity having an adverse effect on other organs/tissues

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2
Q

Periodontitis &

Coronary Heart Disease

A

25% of those with both will die of CHD (risk esp high for men)

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3
Q

Periodontitis &
cardiovascular/stroke
mechanisms

A

Perio infection -> systemic circulation -> coronary & carotid artery-> atheroma dev.
Perio infection -> production of mediators-> systemic circulation -> atheroma dev.

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4
Q 
Chlamydia Pneumonia
Cytomegalovirus
actinobacillus actinomycetemcomitans
tanarella forsythensis
porphyromonas gingivalis
prevotella intermedia
A

bacteria ID’ed in atheromatous plaques in Hs carotid arteries

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5
Q

Do well controlled diabetics need antibiotic prophylaxis?

A

not in most cases

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6
Q

Does nonsurgical periodontal therapy improve glycemic control in a diabetic with periodontitis?

A

no

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7
Q

What does lower glycosylated hemoglobin in a diabetic with periodontitis?

A

Combination of mechanical therapy & systemic doxycycline:
~Debridement (SRP)
~2 wks of low dose doxycycline
~Frequent maintenance

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8
Q

When is the best time to give perio Tx for a diabetic?

A

before or after periods of peak insulin activity

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9
Q

Periodontitis and pregnancy

A

possible risk for pre-term birth
60-70% get gingivitis
90% heart murmurs
50% inc. in CO

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10
Q

when is the best time to treat a pregnant women with gingivitis?

A

2nd trimester
inform pt and maintain good OH
(estrogen/progesterone inc. partly to blame)… 0-0 anaerobic bacteria: Prevotella intermedia)

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11
Q

Does perio Tx significantly alter risk of pre-term delivery?

A

no

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12
Q

local antimicrobial delivery of Tetracycline hydrochloride

periodontal fiber therapy: 12.5 mg/fiber -10 days

A

Actisite

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13
Q

local antimicrobial delivery of Chlorhexidine- 2.5 mg
*pockets ≥ 5mm
*broad spectrum
*gelatin = carrier, no refrigeration
*decreased pockets
~mild-moderate sensitivity during 1st week
~continue toothbrushing & regular diet
~avoid flossing for 10 days

A 
Perio Chip ($16/chip... 1 tooth)
provided significantly greater improvement with this adjunct when used with SRP
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14
Q 
local antimicrobial delivery of Doxycycline- 8.5%
*pockets ≥ 5mm
*controlled release for 7 days
*decreased pockets, improved CAL & bop
Tx chronic periodontitis
A

Atridox ($45/ syringe… 6 teeth)

significantly reduced anaerobic bacteria without dev. of antibiotic resistant bacteria.

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15
Q

local antimicrobial delivery of minocycline powder (microspheres)
*25% more shift from PD 7mm to ≤5mm p 9mo

A

Arrestin
$14 per cartridge(tooth)
same contraindications as the systemic minocycline

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16
Q

what local antimicrobial delivery did not consistently show more effective than just SRP alone?

A

Elyzol

  • 25% Metronidazole
  • for PD ≥ 5mm
  • anaerobic bacteria (bacteriocidal)

Emdogain

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17
Q

7 indications for controlled antimicrobial delivery

local

A
  1. PD ≥ 5mm
  2. BOP
  3. Where esthetics is a concern & Sx may be contraindicated (uncontrolled diabetic, elderly, …)
  4. Not responding to SRP
  5. Dental phobic pt
  6. Refractory Periodontitis (aka recurrent)
  7. Medically compromised patients (Perio Sx contraindicated)
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18
Q

The only FDA approved oral, systemic Tx for chronic periodontitis that suppresses activity of destroying enzymes.
For maintenance pt with refractory/recurrent periodontitis & smokers trying to quit

A

Periostat: 20 mg capsule of doxycycline ($60/mo)
2x/day- 1 hr before meals with adequate fluids
max efficacy 9 mo… min efficacy 3 mo

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19
Q

The following are oral manifestations of what?
Severe gingival inflammation
Acute gingival or periodontal abscesses
Rapidly advancing periodontal disease

A

uncontrolled diabetes mellitus

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20
Q

Why re-evaluate after initial Tx?

A

Check lesion elimination (shallower pockets)
check if tissues are firmer
give time for pt education & comfort

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21
Q

purpose of Phase II (surgical) Tx

A

improve Px of teeth & their replacements

Improves esthetics

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22
Q

Advantages vs. disadvantages of local chemotherapeutics

A

*more concentration
*fewer side effects
*sustained delivery
*pt compliance
x More chairside time
x more expensive
x no effect on bacterial reservoirs

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23
Q

side effect of pseudomonas colitis from the toxin produced by Clostridium difficile

A

Tetracyclines= doxycycline, minocycline, etc..
Clindamycin (cleocin)
Penicillins = penicillin VK, amoxicillin, augmentin

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24
Q 
Bacteriostatic via protein synthesis -> G+/-
2 types of this drug's absorption may be lowered by:
-antacids (NaHCO3)
-laxatives (Mg, Ca, Al)
-antidiarrhea
-food/diary
-Fe, Zn
Other 1 Tx refractory periodontitis
x pseudomonas colitis side effect
A

Tetracycline & minocycline

Doxycycline

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25
Q

Bacteriostatic (some -cidal) -> G +/- anaerobes
Tx refractory periodontitis
x pseudomonas colitis side effect
x diarrhea, abdominal pain, blood in stools

A

Clindamyacin

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26
Q 
Bacteriocidal via DNA syn -> obligate anaerobes
Tx periodontitis/AIDS
x GIT
x inc. anticoagulant effect
x disulfuran-like rxn
A

Metronidazol (flagyl)

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27
Q

Bacteriocidal via CW syn -> rapidly growing bacteria
Tx perio abscess
x pseudomembranous colitis
x allergic rxn

A

Penicillins (pen VK, amoxillin, augmentin)

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28
Q

Amoxicillin advantage over penicillin VK

A 
better absorbed (95% vs. 65%)
longer serum 1/2 life (0.7-1.4 vs. 0.5)
may take with food
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29
Q

Bacteriocidal via protein synthesis
Stays in the tissue 9-10 days after finishing regimen
x 1 causes upset stomach/nausea more common
The other is the alt Tx for periodontal abscess due to its better anaerobic coverage, long serum 1/2 life (1 dose/day), & pregnant category B

A

Erythromycin (1)
azithromycin (other)
clarithromycin

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30
Q

These systemic drugs cause…:
Dilatin
Cyclosporine
Calcium channel blockers

A

hyperplastic gingiva

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31
Q

2 important antibiotic regimens

A

Amoxicillin & metronidazole

Doxycycline

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32
Q

Guidelines for antibiotics:

Are they necessary for most gingivitis or periodontitis?

A

No

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33
Q

Guidelines for antibiotics:
May be necessary for refractory periodontal disease which doesn’t respond to conventional therapy. What should be given? (give 4 regimens)

A
  1. Doxycycline 100 mg; 21 tabs, 2 for day 1 and then 1/day
  2. Amoxicillin & Metronidazole (500mg & 250 mg)
  3. (if allergic to penicillin) Ciprofloxacin & Metronidazole (250 mg each)
  4. (refractory & generalized aggressive periodontitis) Clindamycin 150 mg
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34
Q

Guidelines for antibiotics:

Tx for locally aggressive (juvenile) periodontitis

A

Doxycycline

Amoxicillin & Metronidazole (500mg & 250 mg) 22 tabs each- 2 tabs each, then 1 q 6 hrs

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35
Q

Guidelines for antibiotics:

List (10) systemic diseases that influences severity of periodontal disease

A
  1. Chediak-Higashi Syndrome
  2. Down’s Syndrome
  3. Papillon LeFevre Syndrome
  4. DIabetes
  5. AIDS
  6. Cancer
  7. Leukemia
  8. Neutropenia
  9. Hypophosphatasia
  10. Leukocyte Adhesion Deficiency
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36
Q

Guidelines for antibiotics:

Tx with Papillon LeFevre Syndrome

A

Augmentin (amoxicillin 500 mg, clavulonic acid 125 mg)

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37
Q

Guidelines for antibiotics:

Tx for AIDS & gingivitis

A

Chlorhexidine rinse

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38
Q

Guidelines for antibiotics:

Tx for AIDS & periodontitis (NUG, NUP)

A

Chlorhexidine rinse & Metronidazole

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39
Q

Guidelines for antibiotics:
for pregnant women with periodontitis
(avoid 3, safe 4, yes 2)

A

No: tetracyclines, clarithromycin, & ciprofloxacin
Safe to use: Penicillin (amoxicillin), cephalosporins, erthromycin base, azithromycin
Yes: Clindamycin, metronidazole

40
Q

Guidelines for antibiotics:
What should be given to pt with periodontal abscess that doesn’t respond to conventional therapy and have systemic involvement.

A

Must see pt and will want to curette the pocket involved

Penicillins & Erythromycin

41
Q

Guidelines for antibiotics:

Sign for when infection becomes systemic

A
  1. Fever
  2. Increased vital signs
  3. Lymphadenopathy
  4. Malaise
  5. Increased WBC count
    Local infection: pain, redness, edema, pus, fistula.
42
Q

Guidelines for antibiotics:

Pt with NUG/NUP who have systemic involvement

A

doxycycline, metronidazole

43
Q

3 advantages & 2 disadvantages of LASERS in perio therapy

A

*greater hemostasis
*greater bactericidal effects
*minimal wound contraction
x precautions of eyes & other tissues
x reflected beam (Diodes don’t have this pbm)
(limited evidence that lasers may provide an additional benefit when used as adjunct to SRP)

44
Q

Applications of LASERS in perio therapy

A

Gingival troughing- for impression taking
Fibroma removal
Frenectomy
Gingivectomy (removes epithelial lining…)
Implants **

45
Q

3 purported benefits of lasers in SRP

A
  1. curretage by laser (curretage has no added benefit over SRP)
  2. reduction of sub-G bacteria (unpredictable & inconsistent)
  3. SRP (Er:YAG laser show greatest potential for effective SRP… but potential for root or bone damage)
46
Q

An electronic device that generates ultrasonic microvibrations at variable frequencies… doesn’t cut soft tissue in sinus surgery

A

Piezoelectric Surgery

47
Q

3 goals of physiologic occlusion

A

(no signs of dysfunction or disease)
Stable endpoint of Mn closure
Bilateral distribution of occlusal forces
Axial loading of teeth

48
Q

excess occlusal force on a normal dentition is considered as …”

A

primary occlusal trauma

49
Q

normal force on a periodontally compromised dentition

A

secondary occlusal trauma

50
Q

Therapeutic priority is to control inflammation: what’s addressed 1st? 2nd?

A
  1. Control inflammation

2. Address residual mobility

51
Q
  • Tooth mobility, inc. displacement, stable pattern-adaptation
  • tooth migration
  • tooth pain on percussion
  • PDL widening apical resorption on vital tooth
  • TMJ dysfunction
  • xs wear facets or fractures
  • fremitus
A

Clinical features of occlusal trauma

*Evaluate pulpal vitality & parafunctional habits

52
Q 
Occlusal adjustment
Splinting
Stents
Orthodontic tooth movement
Occlusal reconstruction
Extraction
A

Treatment options for traumatic occlusion

53
Q

May eliminate need for osseous resection entirely
No loss of interproximal papillae
No postoperative sensitivity

A

Orthodontic extrusion
fast= 2-3mm /wk will bring ST mov, but not bone
slow= 2-3mm/mo will allow bone to reform with the tooth & ST mov.

54
Q

Concerns associated with orthodontic extrusion

A

harder to achieve a good emergence profile fo the final prosthesis, complicating OH
Tooth may be difficult to restore & maintain due to root form

55
Q

When used with orthodontic extrusion, this helps prevent rotation relapse… its done every 1-2 wks during the extursion and under LA

A

Circumcrestal fiberotomy

-severing supercrestal gingival fibers

56
Q

Why is bracket placement important in extrusive orthodontics?

A

need certain distance to get th eextrusive force

57
Q

Orthodontic extrusion can be done alone or in combination with properly timed…?

A

Traditional orthodontics
Palatal implants
Periodontal Sx- “Wickodontics”

58
Q

Goals of Orthodontics

to use the PDL & alveolar bone

A

Force to maximize movement
Without pain
Without root resorption
Maintains healthy of PDL thru-out the movement.

59
Q

Tooth Movement Fundamentals:

Trailing side vs. Leading side

A

Trailing side: tension, bone deposition, collagen fibers stretched
Leading: pressure, bone resorption, collagen fibers compressed

60
Q

Theory of Traditional Orthodontics

A 
Molars anchor teeth
Move teeth 1 at a time
Big root surafce area vs. small
Pit many teeth against few
Slow process...
61
Q

Theory of palatal implants

A

Absolute (no relative) anchorage
Movement all at once!
Simultaneous, not segmental movements
Any tooth movement

62
Q
  • access
  • angle of implant
  • midline suture
  • avoid nasal floor perforation
  • Later… explanation of the implant
A

Site determination for Sx for palatal implants.

63
Q

Burst of localized remodeling and healing following surgical wounding of cortical bone- basically recruiting osteoclasts & osteoblasts in the presence of damage to bone… peaks 1-3 mo
Corticotomies: cut cortical bone -> elevate flap -> “lines & dots” -> marrow space

A

Wickodontics …aka
POAA= periodontally accelerated osteogenic orthodontics
RAP= Regional Accelerated Phenomenon

64
Q

Root morphology (concavit, enamel pearl, etc…)
Platform switching
Injection material stuck in pocket
Impingement on biological width
Subgingival restorations or defects (pontic must be ≥2 mm from bone)

A

Iatrogenic causes of periodontal pathology

65
Q

What has no lasting adverse effect on the periodontium when used correctly?

A

Retraction cord

66
Q

Broadly, interproximal restorations & caries are associated with an increased risk for…

A

CAL or bone loss & gingival inflammation

67
Q

What’s associated with food impaction & are damaging to the periodontium (typically causing loss of attachment on both proximal surfaces)

A

narrow open contacts

68
Q

What will cause BOP from 0% -> 100% p 22 wks?

A

Presence of overhangs

-cause rapid changes in the subG microbiota and are associated with attachment loss

69
Q

5 Major steps for periodontal maintenance & supportive therapy

A
  1. update medical, dental, & social Hx
  2. detailed exam, clinically & radiographically
  3. update Dx & Px
  4. review OH & compliance
  5. perform supra & sub G instrumentation
70
Q

objectives of periodontal therapy

A

establish & preserve health

restore fxn

71
Q

Tooth loss according to maintenance frequency

  1. Tx + maintenance
  2. Tx - maintenance
  3. no Tx
A
  1. 0.11 teeth/yr
  2. 0.22 teeth/yr
  3. 0.36 teeth/yr
72
Q

Best predictors of attachment loss over 5 yrs

A

52% had PD > 7mm had CAL

plaque & bleeding aren’t very predictive

73
Q 
negative aggression & immaturity
passivity dependence &  depression
emotion-focused coping
external focus of control & poor coping abilities
low emotional intelligence
neuroticism
A

are linked with Non-Compliance

74
Q 
Older pt
non-smokers
female
those who spend longer in active Tx
Those with shorter recall itnervals
A

are more likely to be compliers

75
Q

3 mo recall interval for…

A

1st yr pt for routine therapy & uneventful healing

76
Q

1-2 mo recall interval for…

A

1st yr pt with difficult case:

complicated prosthesis, furcation involvement, poor crown-to-root ratios, questionable pt cooperation

77
Q

1-3 mo recall interval for..

A

generally poor results after periodontal therapy and/or several negative factors:
1-inconsistent or poor OH
2-heavy calculus formation
3-systemic disease that predisposes to periodontal bkdn
4-many remaining pockets
5-occlusal pbms
6-recurrent caries
7-complicated prosthesis
8-perio Sx indicated but can’t be performed or condition too advanced 2b Sx correctable
9.- many teeth with <50% alv bone support
10.smoking
11. Positive family Hx
12 BOP> 20%

78
Q

3-4 mo recall interval

A 
generally good results maintained for at least a yr, but pt displays some of these negative factors:
1-inconsistent or poor OH
2-heavy calculus formation
3-systemic disease that predisposes to periodontal bkdn
4-some remaining pockets
5-occlusal pbms
6-ongoing ortho
7-complicated prosthesis
8-recurrent caries
9.- some teeth with <50% alv bone support
10.smoking
11. Positive family Hx
12 BOP> 20%
79
Q

An adjunct that hasn’t led to significant improvement

A

Emdogain & Elyzol

80
Q

SRP + photodynamic therapy

A

soaking bacteria with a dye (methylene blue) & zapping them with a diode at a specific wavelength… very good results, but diode is expensive

81
Q

Tooth loss clusters are common.

A

false… will likely only find certain individuals

82
Q

Surgical or non-surgical procedures result in greater PD redn?

A

sugrical

83
Q

Open flap debridement or regenerative procedures produce greater improvement in infrabony pockets?

A

regenerative procedures

84
Q

From dental insurances:

What’re the most common perio Tx?

A

36% SRP
21% ST grafts & crown lengthening
17% perio maintenance
17% osseous Sx

85
Q

From dental insurances:

most common dental coverages

A 
26% restorative dentistry
21.5% fixed pros
13.5% preventive care
11.5% Dx
7.5% endo
7.5% ortho
7.5% OMS
6% Perio... 1/2 is performed by non-periodontist
86
Q

GP feels incompetent in the required procedure. A suggested guide to making the decision to refer is this: if the practitioner would not preform the procedure being on one of his or her own family members, the pt should be referred to someone more competent in the procedure. Usually in such cases, the generalist hasn’t had education in or experience with the procedure under consideration

A

GP should refer to dental specialist

87
Q

GP doesn’t have the interest in accomplishing the required procedure. Many dentists don’t enjoy accomplishing certain areas of dentistry, and they haven’t developed their abilities beyond the dental school level in those areas.

A

GP should refer to dental specialist

88
Q

The pt has experienced numerous failed attempts in achieving an acceptable result with a procedure as performed by a general dentist & would feel more comfortable and be more cooperative if treated by a specialist.

A

GP should refer to dental specialist

89
Q

The procedure is among the most difficult techniques within each specialty that’re considered to be primarily in the realm of practitioners in the respective specialty. In other words, few general dentists accomplish the procedure.

A

GP should refer to dental specialist

90
Q

The pt has had specialist treatment in the past & prefers to have the therapy accomplished by a specialist

A

GP should refer to dental specialist

91
Q

Pt has a rare or relatively unknown condition that’s best treated by a specialist who has seen & has treated these types of cases

A

GP should refer to dental specialist

92
Q

50% of perio pt are how old?

A

26-45 yo …GP Tx more early to moderate perio

Older pt will have more advanced perio

93
Q

Dental team involvement: dental team & practice style analysis

A

dental team: desire & motivation to make the transformation, and the role of each team member
practice style: willingness to critically analyze existing practice & commitment to invest time, energy & funds

94
Q

Legal standard of care

A

dentist should know general Tx responses

95
Q
  • female gender
  • practicing with one other dentist (vs solo or grp)
  • employing 2+ hygienists more hygienists refer pt to perio
  • being more than miles from the nearest periodontist
A

4 significant positive influence on the # of referrals/mo from a GP to a periodontist

Perio III final (1 decks)

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