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D2 Fall > Perio Midterm > Flashcards

Perio Midterm Flashcards

1
Q

How many stages and grades are assigned to each perio pt?

A

1 stage + 1 grade

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2
Q

What is the severity of perio diagnosis based on?

A

Most severe tooth

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3
Q

Your assessment of expected outcomes of suggested tx modalities

A

Prognosis

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4
Q

What are the different prognoses?

A

Favorable
Questionable
Unfavorable
Hopeless

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5
Q

Which prognosis?

Perio status of the tooth can be stabilized with comprehensive periodontal tx and maintenance.

A

Favorable

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6
Q

Which prognosis?

Future loss of the periodontal supporting tissues is unlikely if these conditions are met

A

Favorable

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7
Q

Which prognosis?

Perio status of the tooth is influenced by local and/or systemic factors that may or may not be able to be controlled.

A

Questionable

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8
Q

Which prognosis?

The periodontium can be stabilized with comprehensive treatment and periodontal maintenance if these factors are controlled; otherwise, future periodontal
breakdown may occur

A

Questionable

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9
Q

Which prognosis?

Periodo status of the tooth is influenced by local and/or systemic factors that cannot be controlled

A

Unfavorable

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10
Q

Which prognosis?

Periodontal breakdown is likely to occur even with comprehensive periodontal tx and maintenance

A

Unfavorable

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11
Q

Which prognosis?

Tooth must be extracted

A

Hopeless

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12
Q

What is the only evidence based prognosis scheme for molars with furcations?

A

Miller prognosis

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13
Q

What is the goal for Miller prognosis?

A

Score of < 5

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14
Q

What are the 4 categories of perio health?

A

Pristine perio health
Clinical perio health
Perio disease stability
Perio disease remission/control

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15
Q

Which category of perio health?

Absence of pocket depth > 3mm
(exception = most distal molar)

A

Pristine perio health

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16
Q

Which category of perio health?

Absence of attachment loss

A

Pristine perio health

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17
Q

Which category of perio health?

BOP < 10%

A

Pristine perio health
Clinical perio health

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18
Q

Which category of perio health?

Absence of clinical erythema, edema, pus

A

Pristine perio health
Clinical perio health

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19
Q

Which catgeory of perio health?

Can contain attachment loss due to recession

A

Clinical perio health

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20
Q

Which category of perio health?

No pocket depths of clinical importance (pseudopockets)

A

Clinical perio health

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21
Q

Which category of perio health?

Absence of minimal levels of clinical inflammation

A

Clinical perio health

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22
Q

Which category of perio health?

Normal osseous support

A

Clinical perio health

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23
Q

Which category of perio health?

Absence of inflammation and infection, but reduced periodontium

A

Perio disease stability

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24
Q

Which category of perio health?

Goal of perio patients

A

Perio disease stability

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25
Q

Which category of perio health?

Reducing predisposing factors and controlling modifying factors

A

Perio disease stability

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26
Q

Which category of perio health?

Cannot fully control modifying and predisposing factors

A

Perio disease remission/control

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27
Q

Which category of perio health?

Decreased inflammation and improvement in clinical parameters

A

Perio disease remission/control

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28
Q

Which category of perio health?

Stabilization of disease progression to low disease activity

A

Perio disease remission/control

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29
Q

Which category of perio health?

May be an acceptable alternative therapeutic goal in long-standing disease

A

Perio disease remission/control

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30
Q

Minimal recession without pre-existing active perio disease (ex: brushing too hard, ortho, etc)

A

Health

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31
Q

Denotes a healthy state in a patient with a previously diagnosed perio disease (attachment loss)

A

Stability

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32
Q

For patients with reduced periodontium
for any reason (recession, crown
lengthening procedure, or history of
periodontal therapy), as long as PDs
are ≤3 mm, the diagnosis is _____________

A

Gingivitis/inflammation on a reduced periodontium

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33
Q

For patients with a history of periodontitis, PDs ≥4 mm with BOP (at the same sites) indicate _______________

A

Recurrence of disease

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34
Q

Describe Step 1: initial case overview to assess disease

A

Full mouth PDs
Full mouth X-Rays
Missing teeth
Mild-moderate perio is usually Stage I or II
Severe-very severe perio is usually Stage III or IV

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35
Q

Describe Step 2: establish stage (for mild-moderate perio)

A

Confirm CAL
Rule out non-perio causes of CAL
Determine max CAL or radiographic bone loss (RBL)
Confirm RBL patterns

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36
Q

Describe Step 2: establish stage (for moderate-severe perio)

A

Determine max CAL or RBL
Confirm RBL patterns
Assess tooth loss due to perio
Evaluate case complexity factors

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37
Q

Describe Step 3: establish grade

A

Calculate RBL (% of root length x 100) divided by age
Assess risk factors
Measure response to SRP & plaque control
Assess expected rate of bone loss
Conduct detailed risk assessment
Account for medical/systemic inflammatory considerations

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38
Q

Root length, CAL, and CP for Stage I chronic perio

A

Root length = 15%
CAL = 1-2
CP = slight

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39
Q

Root length, CAL, and CP for Stage III or IV chronic perio

A

Root length = >30%
CAL = >5mm
CP = severe

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40
Q

PDs and gingival margin enteries are required for ____ sites and _____ teeth present at time of evaluation

A

all; all

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41
Q

If you have a PD of 3mm or less, what do you put in the GM?

A

Negative reciprocal, or blank

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42
Q

If you have a PD of 4mm or greater with CAL, what do you put in the GM?

A

-2 or blank

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43
Q

What do you enter when you see recession?

A

Positive numbers

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44
Q

What do you enter when you see pseudo-pockets?

A

Negative numbers

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45
Q

What do you enter when gingival margin is at the CEJ?

A

0

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46
Q

Go through the diagnosis sequence for chronic perio

A

Start with generalized or localized
Enter stage and grade
Enter chronic perio at end

(Ex: Generalized Stage I Grade B chronic perio)

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47
Q

Probing is considered what type of procedure?

A

Invasive

(premed, other consults may be necessary)

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48
Q

How often must a dental exam be updated (D0180)?

A

Anually

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49
Q

What code is used for a dental exam?

A

D0180

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50
Q

What must you use during a dental exam?

A

Disclosure stain for plaque index

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51
Q

What are the 3 major components of a perio exam?

A

Diagnosis, treatment plan, prognosis

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52
Q

What code is used for OHI?

A

D1330

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53
Q

Chronic perio is most prevalent in what age group?

A

Adults

(can occur in children too tho)

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54
Q

Patients diagnosed with chronic perio under 25 years old must be evaluated for a differential diagnosis of what?

A

Molar/incisor pattern perio

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55
Q

What should you assess in a patient with chronic perio?

A

Localized bone loss of 1st molar and incisors
Assess OH

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56
Q

The amount of destruction present in chronic perio is consistent with the presence of what?

A

Local factors (ex: primary and secondary etiologic factors)

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57
Q

What is a frequent finding in chronic perio?

A

Subgingival calc

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58
Q

What is chronic perio associated with?

A

Variable microbial pattern
Predisposing factors
Systemic diseases (diabetes, HIV)

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59
Q

Describe the rate of progression of chronic perio

A

Slow/moderate

(but can have periods of rapid destruction)

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60
Q

How can chronic perio be further classified?

A

Extent and severity

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61
Q

What can chronic perio be modified by (other than systemic diseases)?

A

Cig smoking
Emotional stress

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62
Q

Localized vs generalized chronic perio is based on what?

A

% of sites affected

30% or greater = generalized
30% or less = localized

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63
Q

Describe severity CAL and Armitage system of diagnosis (outdated but seen in chart notes)

A

Slight chronic perio = 1-2mm CAL
Moderate chronic perio = 3-4mm CAL
Severe chronic perio = 5+mm CAL

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64
Q

What is “CAL”?

A

Clinical/calculated attachment loss

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65
Q

What should you do for a patient with > than 3mm pockets without loss in CAL?

A

Enter appropriate negative number OR leave blank

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66
Q

What must be entered into the appropriate charting for ID?

A

Pseudopockets

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67
Q

T/F: Pts with subgingival calculus on enamel w/o CAL are not appropriate for SRP codes

A

True

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68
Q

What is the code for scaling with inflammation?

A

D4346

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69
Q

What is the code for scaling/root planing?

A

D4341, D4342

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70
Q

Which types of patients are likely to have pseudo pockets?

A

Young pts with edema and subgingival calc
Pts with associated pharmacologic effects

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71
Q

Exposure of root surface by apical shift in position of gingiva

A

Recession

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72
Q

Apical migration of JE; apical shift of gingiva

A

Root exposure

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73
Q

CEJ to the attachment

A

Actual recession

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74
Q

Visible on clinical exam; gingiva margin to CEJ

A

Apparent recession

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75
Q

Level of attached perio tissue; not directly visible, but determined by probing

A

Actual position

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76
Q

Level of gingival margin or crest of free gingiva that is seen by direct vision

A

Apparent position

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77
Q

What are the 2 causes of recession?

A

Pt self-care
Anatomical

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78
Q

What are the reasons for recession due to pt self-care?

A

Incorrect brushing
Abrasive toothpaste
Hard brush

79
Q

What are the reasons for recession due to anatomy?

A

Eruption pattern
Position of tooth in alveolus

80
Q

What gingival phenotype?

Probe visible

A

Thin (<1mm)

81
Q

What gingival phenotype?

Probe not visible

A

Thick (>1mm)

82
Q

What recession type?

No loss of interproximal attachment. CEJ is clinically not detectable at both mesial and distal aspects of tooth

A

Recession Type 1

83
Q

What recession type?

Associated with loss of interproximal
attachment. The amount of inter-proximal attachment loss is less than or equal to the buccal attachment loss

A

Recession Type 2

84
Q

Measured from the interproximal CEJ to the depth of the interproximal sulcus/pocket

A

Interproximal attachment loss

85
Q

Measured from the buccal CEJ to the apical end of the buccal sulcus/pocket

A

Buccal attachment loss

86
Q

What recession type?

Associated with loss of interproximal attachment. The amount of inter-proximal attachment loss is higher than the buccal attachment loss

A

Recession Type 3

87
Q

What class? (Miller)

Recession not to MGJ; no interproximal bone or papilla loss; 100% coverage

A

Class 1

88
Q

What class? (Miller)

Recession past MGJ; no interproximal bone or papilla loss; 100% coverage; possibility of root coverage

A

Class 2

89
Q

What class? (Miller)

Recession past MGJ; interproximal bone or papilla loss; malposition; partial coverage

A

Class 3

90
Q

What class? (Miller)

Recession past MGJ; severe interproximal bone or papilla loss; malposition; no coverage

A

Class 4

91
Q

What scenarios does the gingival margin go to the CEJ (loss of attachment)?

A

Previous perio therapy
Recession
Attrition w/ age
Malposition teeth

92
Q

What is the easiest way to identify gingival margin at the CEJ (loss of attachment)?

A

Embrasure space btwn 2 teeth is NOT filled with gingival tissue/papilla

93
Q

What probe do you use to find furcations?

A

Nabers

94
Q

Which furcation class?

Depression that does not catch probe

A

Class I

95
Q

Which furcation class?

Furcation deep enough to catch probe, but not continuous w/ other furcations on same tooth

A

Class II

96
Q

Which furcation class?

Bone loss through and through, but covered with gingival tissue

A

Class III

97
Q

Which furcation class?

Bone loss through and through, directly exposed to oral environment, gingival margin is apical to entrance of furcation

A

Class IV

98
Q

Marker of disease activity

A

Bleeding on probing

99
Q

Should BOP be noted in chart?

A

YES - it is a marker of disease activity

100
Q

Measures actual positives correctly identified (% of population that has a condition)

A

Sensitivity

101
Q

Measures the actual negatives correctly identified (% of population that does NOT have a condition)

A

Specificity

102
Q

BOP specificity/sensitivty

A

High specificity
Low sensitivity

103
Q

Degree of looseness of a tooth when we move it

A

Mobility

104
Q

What is mobility caused by?

A

Inflammation, bone loss, trauma

105
Q

Which degree of mobility?

Within physiologic limits

A

0

106
Q

Which degree of mobility?

< than 1mm BL/MD direction

A

1

107
Q

Which degree of mobility?

1mm+ in BL/MD direction

A

2

108
Q

Which degree of mobility?

Exceeding 1mm and depressible occluso-apical direction

A

3

109
Q

Movement of teeth during function or parafunction

A

Functional mobility

110
Q

Often detected earlier than bidigital tooth mobility and has been associated in the presence of inflammation, with increased bone
and attachment loss; pocket formation

A

Fremitus

111
Q

How is fremitus seen/felt?

A

Place index finger on labial surface and pt grinds in lateral and protrusive movements

112
Q

How do you measure the amount of attached gingiva?

A

Measure probing depth (ex: 2mm)
Measure height of keratinized gingiva (ex: 7mm)

Attached gingiva = keratinized gingiva - PD
Attached gingiva = 7-2 = 5mm

113
Q

What do you enter in the GM in chart if there is recession?

A

+ number

114
Q

What do you enter in the GM in chart if there is a PD of 3mm or less?

A

Reciprocal of PD or blank

115
Q

What do you enter in the GM in chart if there is a pseudopocket?

A

Reciprocal of PD

116
Q

What do you enter in the GM in chart if there is a PD of 3mm or greater and the pt has perio?

A

-2

117
Q

What do you enter in the GM in chart if the free gingival margin is at the CEJ?

A

0

118
Q

If you have a PD of 4mm or greater, what should you be thinking based on X-Rays and clinical impression?

A

“Where am I headed”

119
Q

What should you do if you can’t probe?

A

Tell faculty
Triage X-Rays for exts
Plan SRP
Obtain baseline measurements quad by quad, appt by appt, AFTER removal of debris
Complete chart on last SRP if appropriate

Never do a full mouth debridement!!

120
Q

What are the 5 disadvantages of the Armitage severity guidelines?

A

Time consuming
Inaccuracies from probing angles
Root length disregarded
Difficult to determine CEJ
Systemic diseases/local infections disregarded

121
Q

What is the new classification based on?

A

Oncology

122
Q

What are the 2 main factors of the new classification?

A

Stage
Grade

123
Q

Severity and extent of disease at most affected area (CAL, RBL), tooth loss that has occurred bc of perio, complexity assessment of tx required

A

Stage

124
Q

Stage is based on the most ________ ______ of perio

A

severe area

125
Q

Estimate of future risks, rate of progression, response to therapy, systemic implications

A

Grade

126
Q

The apical migration of the attachment apparatus, measured as the distance from the CEJ to the base of the periodontal pocket/sulcus

A

Clinical attachment loss (CAL)

127
Q

The new disease classification system uses clinical attachment loss primarily at
___________ sites but may also include buccal/lingual sites

A

interdental

128
Q

What factors define perio?

A

Interdental CAL at 2 or more non-adjacent teeth

OR

Buccal or lingual CAL is 3mm or greater with pockets greater than 3mm at 2 or more teeth

129
Q

3 main factors to establish severity in staging

A
  1. Interdental CAL
  2. Radiographic bone loss (RBL)
  3. Tooth loss due to perio
130
Q

Severity Stage I

A

Interdental CAL = 1-2mm
RBL = Coronal 1/3 (<15%)
Tooth loss = None

131
Q

Severity Stage II

A

Interdental CAL = 3-4mm
RBL = Coronal third (15-33%)
Tooth loss = None

132
Q

Severity Stage III

A

Interdental CAL = 5mm+
RBL = Middle 1/3 of root+
Tooth loss = 4 teeth or less

133
Q

Severity Stage IV

A

Interdental CAL = 5mm+
RBL = Middle 1/3 of root+
Tooth loss = 5 teeth+

134
Q

7 main factors to establish complexity in staging

A
  1. PD
  2. Type of bone loss
  3. Furcation
  4. Ridge defect
  5. Masticatory dysfunction
  6. Occlusal trauma
  7. Bite collapse, drifting, flaring
135
Q

Complexity Stage I

A

PD = 4mm or less
Bone loss = horizontal

136
Q

Complexity Stage II

A

PD = 5mm or less
Bone loss = horizontal

137
Q

Complexity Stage III

A

PD = 6mm+
Bone loss = vertical, 3mm+
Furcation = class II or III
Ridge defect = moderate

138
Q

Complexity Stage IV

A

PD = 6mm+
Bone loss = vertical, 3mm+
Furcation = class II or III
Ridge defect = severe
Masticatory dysfunction
Secondary occlusal trauma (mobility degree 2+)
Bite collapse, drifting, flaring
Remaining teeth = <20

139
Q

For each stage, how do you describe extent as?

A

Localized (<30% teeth involved)
Generalized (>30% teeth involved)
Molar/incisor pattern

140
Q

Which stage?

Pt shows perio of mild to moderate severity

A

Stage I and II

141
Q

Which stage?

Pt has not lost any teeth due to disease

A

Stage I and II

142
Q

Which stage?

More complex; require more advanced perio tx

A

Stage III and IV

143
Q

Which stage?

Extent of tooth loss requires extensive rehab

A

Stage IV

144
Q

Allows the clinician to incorporate individual patient factors into the diagnosis, which are crucial to comprehensive case management

A

Grade

145
Q

Observed/inferred progression rate; risk for further deterioration due to environmental exposures (e.g., smoking) and co-morbidities (e.g., diabetes); risk that disease or treatment may adversely affect general healthy

A

Grade

146
Q

What are the 3 fundamental principles that grading is based on?

A
  1. Not everyone is equally susceptible to perio
  2. Perio progression/severity is due to many influences on a response to microbial challenge
  3. Some cases require more intensive control of biofilm/inflammation than achieved during current principles of care
147
Q

Grade A progression

A

Slow

148
Q

Grade B progression

A

Moderate

149
Q

Grade C progression

A

Rapid

150
Q

Assume Grade ____ until clinical or medical history provide evidence of more rapid or slower progression, or risk factors increase the probability of more rapid progression

A

B

151
Q

3 main factors to establish primary criteria in grading

A
  1. CAL or RBL
  2. % bone loss/age
  3. Case phenotype
152
Q

Primary Criteria Grade A slow rate

A

CAL or RBL = No loss over 5 yrs
% bone loss/age = <0.25
Case phenotype = heavy biofilm; low destruction

153
Q

Primary Criteria Grade B moderate rate

A

CAL or RBL = <2mm over 5 yrs
% bone loss/age = 0.25-1.0
Case phenotype = destruction commensurates w/ biofilm

154
Q

Primary Criteria Grade C rapid rate

A

CAL or RBL = 2mm+ over 5 yrs
% bone loss/age = 1.0+
Case phenotype = destruction exceeds expectations given biofilm

155
Q

2 main factors to establish grade modifiers in grading

A
  1. Smoking
  2. Diabetes
156
Q

Grade Modifiers Grade A slow rate

A

Smoking = non-smoker
Diabetes = non-diabetic

157
Q

Grade Modifiers Grade B moderate rate

A

Smoking = <10 cigs/day
Diabetes = HbA1c < 7%

158
Q

Grade Modifiers Grade C rapid rate

A

Smoking = 10+ cigs/day
Diabetes = HbA1c is 7%+

159
Q

Revision of Grade upwards is possible if the % bone loss / age ratio _________ substantially or the risk profile of the patient __________

A

increases; decreases

160
Q

What are the 3 steps to staging and grading a patient?

A
  1. Initial case overview
  2. Stage
  3. Grade
161
Q

Which step to staging/grading a patient?

Screen:
Full mouth PD
FMX
Missing teeth

A

Step 1 - initial case overview

162
Q

Which step to staging/grading a patient?

Mild/moderate perio:
Confirm CAL; rule out non-perio causes
Determine max CAL or RBL
Confirm RBL patterns

A

Step 2 - staging

163
Q

Which step to staging/grading a patient?

Moderate/severe perio:
Determine max CAL or RBL
Confirm RBL patterns
Assess tooth loss due to perio
Evaluate for complexity

A

Step 2 - staging

164
Q

Which step to staging/grading a patient?

Calculate RBL/age
Assess risk factors (smoking, diabetes)
Measure response to SRP/plaque control
Assess expected rate of bone loss
Detailed risk assessment
Medical and systemic inflammatory considerations

A

Step 3 - grading

165
Q

What are the 3 diagnostic aids for implant health?

A

Visual inspection
Probing
X-rays at 1 yr and after abutment connection

166
Q

Absence of erythema, bleeding on probing, swelling, and suppuration.

A

Peri-implant health

167
Q

The main characteristic is BOP on gentle probing; erythema, swelling, and/or suppuration may also be present

A

Peri-implant mucositis

168
Q

Increased PD; absence of additional bone loss beyond initial bone remodeling

A

Peri-implant mucositis

169
Q

What is the cause of peri-implant mucositis?

A

Plaque

170
Q

Plaque-associated pathological condition,
characterized by inflammation in the peri-implant mucosa and subsequent progressive bone loss

A

Peri-implantitis

171
Q

Clinical signs of inflammation, increased probing depths, and/or mucosal recession in addition to loss of supportive bone

A

Peri-implantitis

172
Q

Absence of erythema (inflammation), BOP, swelling, and suppuration with no bone loss < 2.0 mm

A

Peri-implant health

173
Q

Inflammation, presence of BOP, swelling, no BL < 2.0 mm, and strong evidence that plaque (biofilm) is the etiologic factor

A

Peri-implant mucositis

174
Q

Inflammation, plaque-associated pathological condition in tissue, PD ≥ 4–8 mm, and subsequent progressive BL

A

Peri-implantitis

175
Q

Records should include previous radiographs, PD at one-year postload.

In the absence of a previous exam, refer to the guidelines for peri-implantitis, PD ≥ 6 mm, BOP, and BL ≥ 3 mm with concurrent peri-implantitis diagnosis

A

Peri-implantitis in absence of previous exam

176
Q

Conditions following the normal healing process of tooth loss that leads to diminished dimensions of the alveolar process/ridge, resulting in both hard- and soft-tissue deficiencies

A

Peri-implant soft/hard tissue deficiencies

177
Q

All competencies must have an approved _____ entered in axium

A

plaque index

178
Q

T/F: DO NOT polish calc

A

True

179
Q

What is the code for dental prophylaxis?

A

D1110

180
Q

What must be present in order to do SRP (D4341/D4342)?

A

Attachment loss
PDs 4mm+

181
Q

When should you polish?

A

Only at re-eval appt

182
Q

What is the code for perio re-eval?

A

D0171P

183
Q

At the re-eval, PDs greater than what require referral to grad perio?

A

6mm

184
Q

At the re-eval, what Stages/Grades require referral to grad perio?

A

Stage III/IV and/or Grade C

185
Q

At the re-eval, how many sites with PDs of 5mm with BOP require referral to grad perio?

A

3+ sites

186
Q

What is the code for perio maintenance?

A

D4910

187
Q

What do you remove in a perio maintenance (D4910) appt?

A

Plaque, calc, stain

188
Q

What is part of the perio maintenance code explanation (D4910)?

A

Limited SRP w/ anesthesia

189
Q

Do NOT confused which 2 codes/appts?

A

Perio maintenance (D4910) and Prophy (D1110)

Insurance fraud!

190
Q

What is the order of the tx plan?

A

Begin with OHI
Choose btwn prophy, SRP, scaling w/ inflammation
Re-eval 4-6 weeks after SRP
Recall or maintenance

191
Q

What 2 clinical observations are an automatic Stage III?

A

Vertical bone loss 3mm+
Furcation involvement of Class II/III

192
Q

What clinical observation is an automatic Stage IV?

A

<20 remaining teeth

193
Q

Why should you not cross the midline during SRP?

A

Don’t want tongue to be completely numb
Want to give pt. one “good”/not sore side to chew on after tx

194
Q

At the re-eval, what should you never tx plan for?

A

Another round of SRP and re-eval

D2 Fall (45 decks)

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