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BDS3 paeds > Perio in Paeds > Flashcards

Perio in Paeds Flashcards

1
Q

who produceed Guidelines for periodontal screening and management of children and adolescents under 18 years of age

A

BSP and BSPD

(British Society of Periodontology and British Society of Paedriatric Dentistry)

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2
Q

aims of 2012 guideline (children)

A
  • Classification of periodontal conditions: 2011 and 2017
    • Periodontal health
    • Gingivitis
    • Periodontitis
  • Early recognition of gingival and periodontal conditions
  • Recording and diagnosis of periodontal conditions
  • A practical guide for primary care
  • Simplified BPE
  • Management of treatment
    • Appropriate treatment and early referral to paediatric or periodontal specialist services
    • Early OHI to encourage good dental habits for life
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3
Q

2 key roles/aims of 2012 guidances

A
  1. ‘ to outline a method of screening children and adolescents for periodontal diseases during the routine clinical dental examination in order to detect the presence of gingivitis or periodontitis at the earliest opportunity’
  2. To provide guidance on when it is appropriate to treat in practice or refer to specialist services, thus optimising periodontal outcomes for children and young adults
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4
Q

classification of periodontal conditions 2017

A
  • Periodontal health, gingival diseases and conditions:
    • Periodontal health
      • Intact periodontium
      • Reduced periodontium
        • Due to causes other than periodontitis e.g. orthodontic treatment, crown lengthening surgery
    • Gingivitis – dental biofilm induced
      • Intact periodontium
      • Reduced periodontium
        • Due to causes other than periodontitis e.g. orthodontic treatment, crown lengthening surgery
    • Gingival diseases and conditions – non dental biofilm induced
  • Periodontitis
    • Necrotising periodontal diseases
    • Periodontitis
      • All patients with evidence of historical or current periodontists should be staged and graded at initial consultation
    • Periodontitis as a manifestation of systemic disease
  • Other conditions affecting the periodontium
    • Systemic diseases or conditions affecting the periodontal supporting tissues
    • Periodontal abscesses and endodontic-periodontal lesions
    • Mucogingival deformities and conditions
    • Traumatic occlusal forces
    • Tooth and prosthesis related factors
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5
Q

mneumonic for remembering classification of periodontal diseases 2017

A

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

  • Periodontal health, gingival diseases and conditions:
    • Periodontal health
    • Gingivitis – dental biofilm induced
    • Gingival diseases and conditions – non dental biofilm induced
  • Periodontitis
    • Necrotising periodontal diseases
    • Periodontitis
    • Periodontitis as a manifestation of systemic disease
  • Other conditions affecting the periodontium
    • Systemic diseases or conditions affecting the periodontal supporting tissues
    • Periodontal abscesses and endodontic-periodontal lesions
    • Mucogingival deformities and conditions
    • Traumatic occlusal forces
    • Tooth and prosthesis related factors
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6
Q

4 aspects of diagnoisis of periodontitis

A
  1. Staging
    • Interproximal bone loss at the worst site of bone loss (due to periodontitis)
    • Stage I, Stage II, Stage III, Stage IV
  2. Grading
    • Rate of progression
    • % bone loss / age
    • Grade A, Grade B, Grade C
  3. Assess current periodontal status
    • Currently stable
    • Currently in remission
    • Currently unstable
  4. Risk assessment
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7
Q

a healthy periodontium

A
  • Gingival margin may be several millimetres coronal to the CEJ
  • Gingival sulcus may be 0.5-3mm deep
  • Alveolar crest 0.4-1.9mm apical to the CEJ (teenagers)
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8
Q

biologic width

A

Distance between CEJ and alveolar bone crest (filled with acellular extrinsic fibrillar cementum)

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9
Q

conditions for diagnosis of periodontal health

A

BPE Screening (Basic Periodontal Examination)

  • Bleeding on Probing
    • <10% for clinical periodontal health
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10
Q

2 states of periodontal health

A
  • Periodontal health – intact or reduced periodontium
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11
Q

gingivitis

A

inflammation of the gingiva

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12
Q

prevalence of gingivitis in children

A

2003 Child Dental Health Survey (White et al 2006) showed that plaque and gingival inflammation were present in: (england, wales and NI - not scotland)

  • 2/3 of 8- and 12- year olds
  • 1/3 of 5 year olds
  • Half of 15- year olds in UK

Slight decrease in 2013 survey – marginal improvements

  • Still issue
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13
Q

2 types of gingivitis

A
  1. Dental biofilm induced
    • Localised
    • Generalised
  2. Gingival diseases and conditions – non dental biofilm induced
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14
Q

dental biofilm gingivitis

A
  • As supra-gingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
  • The junctional epithelium becomes disrupted
  • This allows apical migration of plaque and an increase in gingival sulcus depth

= gingival pocket/ false pocket/ pseudo pocket

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15
Q

process of dental biofilm gingivitis

A

Severe Inflammation -> Gingival Swelling increases -> even deeper false gingival pocket

Process is reversible

The most apical extension of the junctional epithelium is still the CEJ

  • NO periodontal loss of attachment
    • Hence false pocket – distance increase due to swelling not bone loss/ loss of tissue
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16
Q

difference between gingivitis and periodontitis

A

The most apical extension of the junctional epithelium is still the CEJ

  • NO periodontal loss of attachment

Hence false pocket – distance increase due to swelling not bone loss/ loss of tissue

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17
Q

characteristic marginal gingivitis

A

puffy swollen interproximal areas

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18
Q

localised region gingivitis

A

due to anatomical difference – buccally placed canine, pt may not be brushing gingival margin (only tooth surface)

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19
Q

cause of gingivitis here

A

Long standing plaque caused local irritation and inflammation all the way round gingival margins

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20
Q

different steps between health -> gingivits -> periodontitis (in its different states)

A

Diagnosis needs to include current health/disease status

Aids Tx planning and prognosis of pts

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21
Q

BPE in gingivitis

A
  • Bleeding on probing
    • 10-30% Localised Gingivitis
    • >30% generalised Gingivitis
    • Plaque retentive factors – overhangs of restorations, prosthesis
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22
Q

necrotising ulcerative gingivitis

appearance

A
  • Blunted papillae
  • Malodour
  • Painful gingivae
  • No attachment loss
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23
Q

necrotising ulcerative gingivitis

aetiology

A
  • Fusiform and Spirochete
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24
Q

necrotising ulcerative gingivitis

patient risk factors

A
  • Smoking, stress, immunosuppression, poor diet
  • HIV + status or other underlying condition
  • Common in developing countries
  • ‘trench mouth’
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25
Q

pubertal gingivits

A
  • Increased inflammatory response to plaque
  • Mediated by hormonal changes
  • In teenagers, gingivitis can progress to early periodontitis – if left unmanaged
  • Local (plaque/ braces/ overhanging restorations) and systemic factors can influence progression
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26
Q

what is non-dental biofilm gingivitis

A
  • When main aetiological agents for gingivitis is not plaque

Use diagnostic sieve for non-dental biofilm induced gingivitis

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27
Q

possible causes of non-dental biofilm gingivitis

A

use diagnostic sieve

  • infective
  • genetic
  • traumatic
  • manifestations of systemic disease
  • drug induced
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28
Q

infective causes of non-dental biofilm gingivitis

A
  • fungal
  • viral
  • deep mycoses
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29
Q

genetic causes of non-dental biofilm gingivitis

A
  • phenotype
  • heriditary fibromatosis
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30
Q

trauma causes of non dental biofilm gingivitis

A
  • thermal/chemical
  • physical
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31
Q

manifestations of systemic disease that can cause non-dental biofilm gingivitis

A
  • Haematology e.g. leukaemia
    • Benign
    • Malignant
  • Immunological conditions
  • Granulomatous inflammation
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32
Q

drug induced causes of non-dental biofilm gingivitis

A
  • Anti-retro viral
  • Immunosuppressants
  • Ca+ channel blockers
  • Anti-convulsants – epilepsy drugs can cause gingival hypertrophy
  • Cytotoxic
  • Immune complex reactions
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33
Q

what causes this gingivitis

A

cyclosporin

  • Immunosuppressant
  • Used in pts with underlying immunological conditions (crohn’s) or organ transplant
34
Q

what caused this gingivitis

A

phenytoin

  • Anti convulsant
  • Exuberate gingivitis anteriorly and inflamed interproximal papillae
  • Tender and red
35
Q

what caused this gingivitis

A
  • Characteristic full thickness
  • Often seen in OFG (orofacial granulomatosis)
36
Q

what caused this gingivitis

A

gingivitos in leukaemia

  • Rare
    • Known to be initial presentation
37
Q

haemtological systemic diseases that can cause gingivitis

A
  • Agranulocytosis
    • Acute condition
    • Low white blood cell count
  • Cyclic neutropenia
    • Low neutrophil count
    • Occurs every 3 weeks, lasts 4-6 days
38
Q

granulomatous inflammation that can cause gingivits

A
  • Crohn’s disease
  • Sarcoidosis
  • Granulomatosis
    • Autoimmune vasculitis
    • Affects multiple systems
      • Most commonly mouth, URT, kidneys
39
Q

gingivitis - summary

A
  • Gingival overgrowth beyond biofilm induction can relate to:
    • Systemic and metabolic diseases
    • Genetic factors, local factors
    • Side effects of some medications
      • Cyclosporin, nifedipine, phenytoin
    • Greater incidence seen in puberty
40
Q

gingivitis treatment

A
  • Rigorous oral hygiene/ home care
  • Frequent scaling
  • Surgery may be necessary (esp with drug induced)  refer to specialist (persistent and hypertrophic)
41
Q

4 main distinguishing features of periodontitis

A
  • Apical migration of junctional epithelium beyond the CEJ
  • Loss of attachment of periodontal tissues to cementum
  • Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated)
  • Alveolar bone loss
42
Q

what early clinical sign of periodontitis can be seen in a substantial number of teenagers?

A
  • Classified as >1mm loss of attachment (of cementum to PDL)

Clerehugh (1990) longitudinal study on 167 teenagers (attachment loss in at least 1 tooth)

  • 3% of AL at 14 years
    • 37% of AL at 16 years
      • 77% of AL at 19 years

Progress rapidly

43
Q

what common pathogens can be found in subgingival microflora of adult and child periodontitis

A
  • Porphyromonas gingivalis
  • Prevotella Intermedia
  • Aggregatibacter actinomycetemcomitans (AA)

Clerehugh 1997

44
Q

old name for periodontitis in children

A

aggressive periodontitis

45
Q

featurs of periodontitis in children

A

May be present in a small proportion of adolescents

  • Features include
    • Rapid attachment loss and bone destruction
    • Patients otherwise healthy
    • Onset around puberty
    • Family history
    • 0.1% Caucasians and 2.6% African Ancestry
      • Uncommon

no longer localised or generalised (old classification) now based on number of sites as per new classification

  • Staging and grading essential for up-to-date diagnosis
46
Q

stage I periodontitis

A

early/mild

<15% or <2mm interproximal bone loss

47
Q

Stage II periodontitis

A

moderate

coronal third of root interproximal bone loss

48
Q

stage III

A

severe

mid third of root interproximal bone loss

49
Q

stage IV periodontitis

A

very severe

apical third of root interproximal bone loss

50
Q

extent classes of periodontitis

A
  • localised - up to 30% of teeth
  • generalised - more than 30%
  • molar incisor
51
Q

grading of periodontitis based on

A

% bone loss/ age

52
Q

Grade A periodontitis

A

slow

<0.5

53
Q

Grade B periodontitis

A

moderate

0.5-1.0

54
Q

grade C periodontitis

A

rapid

>1.0

55
Q

interproximal bone loss

A

is measurement (mm) from CEJ

56
Q

caution in periodontits in children

A
  • Primary dentition
    • Some evidence that bone loss can occur around primary teeth in some children
  • Mixed dentition
    • Be aware of false pocketing around erupting permanent dentition
57
Q

when should periodontal screening occur

A

should be a routine and essential part of history and clinical examination

58
Q

7 things to assess in gingival condition

A
  • Gingival colour
  • Contour
  • Swelling
  • Recession
  • Suppuration
  • Inflammation (presence and location)
  • Consider use of marginal bleeding free chart
59
Q

how to assess OH status

A
  • Description of plaque status
  • Describe surfaces covered by plaque
    • Is plaque easily visible?
    • Detectable only on probing
    • Use of plaque-free scores (%) – motivational aid to pt
60
Q

how to assess calculus

A

if present - chart location

61
Q

5 local risk factors to assess in periodontal screening

A
  • Plaque retention factors
  • Low frenal attachments
  • Malocclusion
  • Incompetent lip seal
    • Reduced upper lip coverage – labial and palatal gingivitis
    • Increased lip separation
  • Mouth breathing
    • Palatal gingivitis
62
Q

4 components periodontal assessment

A
  1. Gingival condition
  2. assess OH status
  3. assess calculus
  4. assess local risk factors
63
Q

issue here

A
  • complete overbite
  • Biting on gingival margin lower incisors thus cause chronic continuous trauma  recession and other issues
64
Q

issue here

A
  • Ortho tx
  • Malocclusion
  • Make OH harder – already poor and further complicated
65
Q

issue here

A

significant calculus and staining to lingual lower incisors and soft tissues

66
Q

issue here

A
  • Incompetent lip seal at rest  drying of intraoral mucosa and potentially gingivitis
67
Q

full BPE

A
  • Screening tool
  • Rapidly guides clinicians to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis
  • Does not consider:
    • Historical attachment loss
    • Bone loss (staging and grading not done)
  • Children 12-17
68
Q

simplified BPE

A
  • In all co-operative children aged 7-11 years (permanent teeth only)
  • 0-2 BPE scores
  • Carried out on (16, 11, 26, 36, 31, 46)
    • one reference tooth per sextant
  • Identifies patients who would benefit from further investigation
69
Q

probe used in BPE

A

Basic Periodontal Examination (BPE) performed with a WHO CPITN probe

  • The community periodontal index of treatment need

Black band 3.5-5.5 mm and 8.5-11.5mm

0.5mm ball end

20-25g force – blanch nail bed

  • Parallel to root surface
  • Walked around gingival margin
70
Q

benefits of modified BPE

A
  • Quick
  • Easy
  • Well tolerated
  • Avoid false pocketing
71
Q

teeth assessed in simplified BPE

A
  • Carried out on (16, 11, 26, 36, 31, 46)
72
Q

when to refer to specialist if detect perio issues in primary teeth

A
  • Mobility or gingival suppuration  refer to specialist
73
Q

BPE scores

A
74
Q

plaque free and marginal bleeding free charts

A

aim for 100% plaque free/not bleeding

motivational tool

75
Q

how to record plaque in a way child understands

A

out of 10

  • 10/10 - perferctly clean
  • 8/10 - line of plaque around cervcical margin
  • 6/10 - cervical 1/3 of crown covered
  • 4/10 middle 1/3 of crown covered
76
Q

when get BPE code 3 or 4 (12+)

action

A
  • 6PPC (localised to 3 BPE, or full mouth if 4)
  • Check alveolar bone levels
    • BWs for posterior
    • Periapicals for anteriors
    • OPG
  • BPE should be carried out prior to any ortho Tx
77
Q

treatment to aid OH

A
  • Plaque induced gingivitis in children and adolescents can be managed by good toothbrushing
  • Emphasise the need to systematically clean all surfaces
    • Aids - Brush DJ App
      • Child and parent
  • Standard tooth brushing and fluoride advice should be given to all patients
  • Supervised/ assisted brushing (up to around 7 years old)
    • In general – can they tie their own shoelaces?
  • Disclosing tablets useful (plaque creamy coloured and can be hard to see)
  • Fluoride mouthwash (225ppm) should be recommended for pts undergoing fixed appliance therapy
78
Q

treatment levels according to BPE scores in children

A
79
Q

following steps after

generalised periodontitis, stage II, grade C, currently unstable

Dx in 19yo f

A
  • Systematic periodontal treatment needed initiated
    • Outcome of Tx will not result in a change of the initial disease classification
      • This pt will always be a periodontitis pt with evidence of high disease susceptibility (indicated by grade C)
  • Requiring
    • careful and intensive periodontal maintenance
    • risk factor control
    • monitoring

Any sibling? (do they need reviewed so not similarly affected)

80
Q

what is imp for optimum treatment outcome in

A

early detection of perio diseases

81
Q

periodontal diseases in young (below 7)

A

rare - require onward referral

BDS3 paeds (15 decks)

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