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Perio III Flashcards

1
Q

There are more bacteria than cells in a human body by a factor of _____

A

20

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2
Q

Undisturbed oral biofilm grows at ____to _____ micrometers/day

A

82 - 200

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3
Q

T/F
CHX can affect plaque that’s been in place from 24-48 hours.

T/F
CHX can affect 6 hour plaque

A

False

True

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4
Q

If PD is over 7mm, what is the average reduction in PD after Scaling and Root Planing?

A

2.16 mm

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5
Q

If PD is over 7mm, what is the average reduction CAL after Scaling and Root Planing?

A

1.19 mm

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6
Q

What is the main function of Scaling/Root Planing?

A

Decreases surface area

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7
Q

What is the deepest Scaling and Root Planing generally goes on the root?

A

5 mm

*even if PD much bigger than 5 mm

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8
Q

6 problems of Restricted Access when Scaling/Root planing

A

PD

Furcations

Root Proximity

Root Flutings

CEJ relationships

Restorations

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9
Q

Periodontal _____ lesions can limit soft tissue management

A

Infrabony

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10
Q

Perio OHI clinical protocol:

3 items

A

Electric toothbrush

Waterpik (or floss)

CHX 2x/day

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11
Q

SRP is part of Perio clinical protocol and is done with ______

A

local anesthesia

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12
Q

What low dose antibiotic is preferred?

What is the dose?

A

Doxycycline

20 mg

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13
Q

When is the re-eval post-SRP?

A

4-6 weeks

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14
Q

At 4-6 weeks SRP, what sites are re-treated after re-eval?

In what 2 ways?

A

greater than 5 mm

SRP, Site-specific drugs

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15
Q

When are surgical treatments considered in the Perio Clinical Protocols?

A

Post re-eval, after second SRP, site specific drugs, etc if response not achieved

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16
Q

Low Dose Doxycycline (originally Periostat) is 20 mg doxy, _____ tabs, every ____ hours

A

180 tabs

12 hours

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17
Q

20 mg concentration of doxy has no bacterial effect, but does chelate metals (Ca, Zn, Mg) and inactivates ________

A

Matrix metalloproteinases

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18
Q

The matrix metalloproteinases inactivated by low dose Doxy are what 2 specific products?

Produced by what 2 specific cells?

A

Gelatinases, Collegenases

PMN’s, Macrophage

*so low-dose Doxy fights our own immune system and its degrading factors

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19
Q

When is it appropriate to use SRP + Local delivery?

A

Post re-eval

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20
Q

6 conditions SRP + local delivery can be used:

A

Pockets greater than 5mm

Maintenance PD 5-6mm

Early perio abscess

PD distofacial 2M’s for 3M extraction

Ailing implants

Furcations

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21
Q

3 locally delivered Antimicrobials (brand names)

A

PerioChip

Atradox

Arestin

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22
Q

What is in PerioChip:

Atradox:

Arestin:

A

CHX

Doxycycline (gel)

1 mg minocycline (powder)

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23
Q

T/F
In terms of reaching the disease site, achieving adequate concentration and duration, killing the target microbe, and not harming the patient, Locally Delivered antimicrobials are the best

(when compared to mouth rinse, subgingival irrigation, and systemic antibiotics)

A

True

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24
Q

Arestin is __mg of _____ in powder

A

1 mg

minocycline

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25
GCF concentration minocycline after Arestin therapy: 3 days out: 14 days: 28 days:
90,000 ug/ml 3250 ug/ml 340 ug/ml 10-20 ug/ml
26
5 bacteria that are susceptible to minocycline (Arestin) concentrations at 2-8 ug/ml
P. gingivalis P. intermedia F. nucleatum E. corrodens A.a.
27
Low dose doxy targets cytokines, prostanoids, MMP's and therefore inhibits _____ and _____ metabolism
CT bone
28
T/F | Local antimicrobial + Low Dose Doxy goes after both microbial challenge and CT/Bone metabolism
True
29
It is possible to get a pocket reduction of 3mm, but more realistically it will be ____mm. Pocket reduction of ___mm is not realistic
2mm 4mm
30
Open Flap Debride can get a Pocket Reduction of ___mm
3.00
31
SRP + Arestin reduction in PD: SRP + Atridox: SRP + PerioChip:
1. 65 mm 1. 2 mm 0. 9 mm (bout half mm less reduction in CAL)
32
What systemic antibiotic is the drug of choice in treatment of Agressive Perio?
Amoxicillin
33
Other than Amoxicillin, name 6 drugs prescribed for Aggressive Perio:
Metronidazole (NOT w/ EtOH) Tetracycline (photosentitive) Doxy Clindamycin Amoxicillin + Clavulanic Acid (Augmentin) Azithromycin (Z-pak not used much any more)
34
T/F The advantages of systemic antibiotics is wide dispersement, reduction of chair time to treat pts, and a wide range of drugs to choose from.
True
35
What is the primary disadvantage to systemic antibiotic use for chronic perio?
pt compliance
36
Aside from compliance, allergy, GI problems, DDI's, cost and the inability to penetrate intact ______ are disadvantages for systemic antibiotic use for chronic perio.
biofilm
37
T/F | Frequency (of taking drug) and compliance are inversly related
True
38
GI, nausea, photosensitivity, bacterial resistance, _____, and ______, are common side effects of systemic antibiotics.
Esophagitis Candidiasis
39
Name 4 antibiotics commonly prescribed for systemic use in perio
Tetracycline Doxycycline Minocycline Amoxicillin
40
Systemic antibiotics has a positive effect on ____
CAL
41
What antibiotic combination has the greatest effect on CAL? This reduces CAL by ___mm Best results are obtained when prescribed for ____ days
Amoxicillin + Metronidazole 0.4 mm 7 *either aggressive or chronic
42
T/F | Systemic antibiotics should be used in most pts with periodontitis
False
43
Systemic antibiotics should be used in conjunction with _____ treatment over a period of 7 days
SRP
44
SRP + Arestin decreases ______ and _______
hsCRP IL-6
45
SRP + low dose Doxy degreases what 4 things?
MMP's hsCRP HDL apolipoprotein-A
46
Most changes in a perio Tx plan occur when?
Re-evaluation
47
After all non-surgical therapy is considered in the Re-Evaluation, what are the 3 options?
Control Etiology (or modifying factors) Surgical Therapy (phase II) Compromised maintenance therapy
48
When should the pt proceed to a Maintenance Phase?
When Stable
49
If the pt is not stable upon re-evaluation, then proceed to...
Personalized re-treatment
50
What are the 3 options in Personalized Re-treatment?
Antimicrobial therapy Surgery Combination
51
What is the most critical phase of successful periodontal therapy?
Maintenance
52
Maintenance visit: If PD is stable with no BOP, then Tx is routine - review OHI with same recall interval. If PD same but BOP is present, what is the Tx course?
OHI SRP on bleeding sites Consider - local antimicrobials Consider - shortening recall intervals
53
Maintenance visit: PD and BOP increase | 4 things
OHI SRP Adjuctive therapy (local/systemic antibiotics) ***Refer to Periodontist
54
Why is Perio maintenance interval 3 months?
Re-infections of pockets happens around 3 months (60+ days) *referrals tend to alternate GP/Periodontist
55
The only exception to initiating Tx without a Tx Plan:
Emergencies
56
A Tx Plan is a working ______
Document
57
An emergency begins a Treatment Plan at the _____ phase
Urgent
58
After the Urgent Phase is the ______ Phase
Control
59
Emergency therapy Initial therapy Determine Response: Corrective: Regular re-care examinations (reassessments):
Urgent Phase Control Phase Re-evaluation Phase Definitive Phase Maintenance Phase
60
What is the Initial Therapy (Phase I) for Gingivitis?
Med consult (if needed) OHI scale and polish re-eval 4-6 wks phrophylaxis every 6 months if disease resolved
61
Mild Chronic Periodontitis has Inflammation extending to the ______. Attachment loss ____mm from CEJ PD ____mm Radiographic bone loss less than ____% furcation:
bone 1-2mm 3-4mm 20% Class I or no furcation involvement
62
Initial (phase I) therapy for Mild Chronic Periodontitis:
Med consult (if needed) OHI SRP w/ anesthesia 2-4 appointments Re-eval 4-6 weeks 3-4 month maintenance interval (depending on OH)
63
Moderat Chronic Periodontitis has inflammation extending to the _____. Attachment loss ___mm from CEJ PD ___ mm Radiographic bone loss ___% to ___% Furcation involvement Mobility:
bone 3-4 mm 5-6 mm 20%-40% Class I or II furcations Class I and II mobility
64
Moderate Chronic Periodontitis Initial Therapy (Phase I):
Med consult if indicated OHI SRP 2-4 appointments Re-eval 4-6 weeks Locally delivered antimicrobials in 5-6mm pockets Periodontist referral
65
Advanced Chronic Periodontitis has inflammation extending to the bone, bleeding on provocation, attachment loss greater than ___ mm from CEJ PD greater than ___mm Radiographic bone loss greater than ___% furcation mobility
5 mm 7 mm 40% Class I, II, or III furcation Class I, II, or III mobility
66
Advanced Chronic Periodontitis: Med consult if needed, OHI, SRP, 2-4 appointments, Re-eval in 4-6 weeks, locally delivered antimicrobials in ___mm residual pockets, and referral to periodontist ***this is exactly the same treatment as Moderate Chronic Periodontitis
5-6 mm
67
What is prognosis without treatment? What type of prognosis takes into account what effect the periodontal treatment will have on the course of the disease?
Diagnostic prognosis Therapeutic prognosis
68
What type of prognosis anticipates the results of perio treatment and forecasts for the success of a prosthetic restoration? What prognosis is given prior to the initial phase of Treatment and may change according to the patient/tooth response?
Prosthetic prognosis Provisional prognosis
69
Prognosis is divided into:
Overall prognosis Individual tooth
70
What is the single most important factor in the Overall Prognosis/Systemic Background?
Smoking
71
Cigaretts smokers are __-___ times more likely than non-smokers to develop severe periodontitis
5 to 8 times
72
What 3 positive effects does 20 Minutes smoking cessation have?
BP drops to normal Pulse rate drops to normal Peripheral body temp increases to normal
73
What positive effect does smoking cessation have at 8 hours? At 24 hours?
CO drops to normal Chance of heart attack decreases
74
What positive benefit is seen related to smoking cessation at 2 weeks - 3 months? At 1 to 9 months?
Circulation improves, lung function increases 30% Coughing, sinus probs, breathing improve and Cilia Re-Grow
75
What positive benefit is seen by smoking cessation at 1 year? 5 years?
Heart disease reduced 50% Lung, oral, pharynx, esophageal cancer decreased 50% *stroke reduced to non-smoker in 5-15 year range
76
What positive benefit is seen by smoking cessation at 10-15 years
Lung cancer similar to nonsmoker heart disease like nonsmoker
77
What bacteria is increased by Type I diabetes? What bacteria is increased by Type II diabetes?
Captocytophaga spp. P. gingivalis
78
What 2 consequences does diabetes have in the GCF?
Decreased PMN function Increase glc
79
What vascular changes are seen in diabetes?
Increased thickness *decreases oxygen diffusion and waste elimination
80
How does diabetes impair wound healing?
Stimulates collegenase and alters collagen metabolism Also limits production of Growth Factors
81
Untreated moderate/advanced periodontitis pt loses ___ teeth/yr Treated w/ no maintenance loses ___ teeth/yr Treated w/ maintenance loses ___ teeth/yr
0. 36 0. 22 0. 11
82
Perio treatment is ___x as effective as no treatment
3.5x
83
T/F The level of oral hygiene at 1st treatment isn't as important as the level of OH at completion of initial phase of Tx (Phase I)
True
84
T/F | An inflammatory response and plaque calculus suggests a better prognosis
True
85
What has a better prognosis, chronic infection or perio abscess?
Abscess
86
In SRP, what is the instrumentation limit? Curette efficiency:
5. 52 mm *most of time calculus over 5 mm remains | 3. 73 mm
87
T/F | PD is more important than CAL when determining prognosis
False *invert - prognosis based on CAL
88
The ratio for a tooth with an average root length (13mm) is:
1:2
89
Individual tooth Prognosis Class I: Class II: Class III/IV:
Fair Questionable Poor/Hopeless
90
Prognosis based on tooth mobility Class I: Class II: Class III:
fair (slight mobility) questionable hopeless (severe mobility + depressive)
91
What's worse, a single rooted mobile tooth or multi rooted mobile tooth?
Multi-rooted tooth is worse
92
T/F | Prognosis can be Good, Fair, Poor Questionable, and Hopeless
True
93
T/F | Maxillary molars are lost more frequently than mandibular molars
True
94
The average tooth loss with furcations over a 20 year period is what?
35.7%
95
What is the Periodontal Treatment plan for someone that had PD of 3 mm?
Fluoride *no SRP

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