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Need to Know > perio need to know > Flashcards

perio need to know Flashcards

1
Q

when would you result in treating a patient with periodontal surgery?

A
  • if at re-evaluation, pockets of 5mm or greater persist in the presence of excellent oral hygien
  • re-evaluation should be at least 4-6 weeks after completeion of non-surgical phase
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2
Q

why is non-surgical therapy always carried out before surgical?

A
  • surgery is more invasive and has more long term complications
  • HPT may be all that is required to help eliminate periodontal disease
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3
Q

what are the disadvantages of pocket elimination?

A
  • supporting bone may be removed
  • the exposed root surface may be un-aesthetic
  • the exposed root surface may be sensitive
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4
Q

what is ANUG?

A

acute necrotising ulcerative gingivitis

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5
Q

what are the risk factors of ANUG?

A
  • poor oral hygiene
  • smoking
  • stress
  • immunocompromised e.g. HIV
  • malnutrition
  • young adults
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6
Q

what pathogens are involved in ANUG?

A
  • fusobacterium
  • prevotella intermedia
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7
Q

how can smoking effect the periodontium?

A
  • greater periodontitis risk
  • reduced treatment response
  • recurrence of disease
  • tooth loss
  • reduced bone height
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8
Q

what are the symptoms of ANUG?

A
  • pain
  • bleeding
  • halitosis
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9
Q

what is the clinical presentation of ANUG?

A
  • punched out
  • , crater-like ulcers affecting interdental papillae, extending onto gingival margin
  • ulcers covered with greyish slough which can be wiped away leaving bleeding tissue
  • necrosis of gingival tissue eventually extending to PDL and bone
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10
Q

what is a periodontal abscess?

A

localised acute exacerbation of a pre-existing pocket caused by trauma or obstruction of the pocket entrance

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11
Q

what is a periapical abscess?

A

localised collection of pus around the apex of non-vital teeth as a result of pulp necrosis

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12
Q

what are the symptoms of a periodontal abscess?

A
  • pain on biting
  • swelling
  • discharge with halitosis
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13
Q

what are the clinical findings of a periodontal abscess?

A
  • swelling adjacent to periodontal pocket
  • tooth may be TTP
  • suppuration- discharging through sinus or pocket
  • tooth mobility
  • likely to have pain on lateral movement
  • likely to have generalised horizontal bone loss
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14
Q

what is the biological width?

A

the natural distance between the gingival sulcus and the height of the alveolar bone

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15
Q

define ‘Ante’s law’

A

the combined periodontal area of abutment teeth should be equal to or greater than the periodontal area of the tooth/teeth being replaced

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16
Q

how is ANUG treated?

A
  • debridement using an ultrasonic
  • oxidising mouthwash
  • chlorhexidine
  • oral hygine instruction
  • antibiotics;
    amoxicillin 500mg for 3-5 days
    metronidazole 200mg for 3-5 days
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17
Q

how is a periodontal abscess treated?

A
  • drainage- incision via pocket, dialte with instrument
  • gentle sub-gingival debridement
  • hot saline mouthwash
  • extraction of teeth with poor prognosis
  • antibiotics;
    amoxicilin 500mg for 5 days
    metronidazole 200mg for 5 days
  • follow up with HPT, surgery in indicated, maintenance
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18
Q

what is the rationale for using antiseptics and antibiotics for perio disease?

A
  • perio diseases have infectious aetiology
  • pathogenic bacteria associated with periodontitis are susceptible to antibiotics and antiseptics
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19
Q

what does substantivity depend on?

A
  • adsorption onto oral surfaces
  • maintenance of antimicrobial activity
  • slow neutralisation of antimicrobial activity
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20
Q

what are some of the problems with using antibiotics for perio disease?

A
  • biofilms resist antibiotics
  • allergic reactions
  • bacterial resistance to antibiotics
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21
Q

what is the aim of mechanical therapy for periodontitis?

A
  • disrupt the biofilm
  • reduce bacterial load
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22
Q

what are the advantages of local delivery, antibiotics and antiseptics?

A
  • high GCF concentration
  • low systemic uptake
  • high pt compliance
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23
Q

what is the periochip?

A

local delivary of chlorhexidine 2.5mg
biodegrades in 7-10 days

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24
Q

what are the 4 features of periodontitis?

A
  • bone loss
  • loss of attachment
  • transforamtion of junctional epithelium to pocket epithelium
  • apical migration of junctional epithelium
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25
Q

give examples of pulp and periodontal communication

A
  • perforation of root canal
  • facture of root
  • dentinal tubules
  • apical foramen
  • accessory canals
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26
Q

what are the iatrogneic effects of restorations on the periodontium?

A
  • overhangs can cause plaque accumulation at the gingival margin, leading to inflammation
  • irritants which are poorly placed during restorations can initiate or add to exisitng inflammation
  • subgingivally placed restorations or crowns can impinge on the biologic width - this promotes inflammation and loss of clinical attachment
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27
Q

what is the composition of dental plaque?

A
  • primarily composed of micro-organisms (1g of wet weight plaque contains 10x11 bacteria)
  • microorganisms exist within intracellular matrix that also contains epithelial cells, macrophages and leukocytes
  • intracellular matrix consists of organic (polysaccharides, proteins and lipids) and inorganic (calcium and phosphorus) materials derived from saliva, gingival crevicular fluid and bacterial products
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28
Q

what are the effects of uncontrolled diabetes mellitus on the periodontium?

A
  • tendancy towrds enlarged gingivae, abscess formation, periodontitis, mobile teeth
  • reduction in defence mechanisms and increased susceptibility leads to destructive periodontal disease
  • severe ginigval inflammation, deep periodontal pockets and rapid bone loss appear in diabetic patients with poor oral hygiene
  • diabetes mellitus alters the response of periodontal tissues to local factors, delaying post surgical healing
29
Q

what drugs are responsible for agranulocytosis?

A
  • benzene ring derivatives
  • amino pyrine
  • arsenical agents
  • gold salts
30
Q

give local causes of hyperpigmentation of the gingiva

A
  • chronic gingivitis
  • ANUG
  • herpetic gingivostomatitis
  • chemical irritation
  • metallic pigmentation in the areas of pre-existant inflammation e.g. mercury intoxication
  • amalgam tattoo
31
Q

give systemic factors which can cause hyperpigmentation of the gingivae

A
  • increased melanin e.g. addisons disease
  • increased billirubin e.g. jaundice
  • increased iron e.g. pregnancy/diabetes
32
Q

what is papillon-Lefe’vre syndrome?

A
  • inherited- follows autosomal recessive pattern
  • hyperkeratotic skin lesions
  • severe destruction of periodontium
  • calcification of dura
  • signs usually appear together before age 4
  • skin lesions consist of hyperkeratosis and ichthyosis of localised areas on palms, soles, knees, elbows
  • periodontal involvement consists of early inflammatory changes that lead to bone loss and exfoliation of teeth
33
Q

what are the characteristics of papillon-Lefe’vre syndrome?

A
  • primary teeth lost by age 5-6
  • permanent dentition erupts normally but are lost within a few years due to destructive periodontal disease
  • pt usually edentulous apart from third molars by age 15
  • third molars lost within a few years of eruption
34
Q

how is papillon-Lefe’vre syndrome managed?

A
  • extraction of primary teeth with poor prognosis allows for safer environment for eruption of permanent dentition
  • etretinate, isotretinoin and acitretin can be used to reduce chronic inflammation of gingivae
35
Q

name drugs which can cause gingival enlargment

A
  • anticonvulsants e.g. phenytoin
  • immunosuppressants
  • calcium channel blockers e.g. nifedipine
36
Q

how is drug induced gingival enlargement treated?

A
  • strict plaque control
  • substitution of drug by physician
  • gingivectomy
  • flap procedures
37
Q

a 5 year old presents with diffuse redness of oral mucosa including gingiva proceeded by vesicles. what is the most likely diagnosis?

A

acute herpetic gingivostomatitis

38
Q

what are the immunologic factors of localised aggressive periodontitis?

A
  • human leukocyte antigens
  • functional defects of PMNs and/or monocytes
  • autoimmunity
  • altered helper or suppressor T-cell function
  • polycolonal activation of B-cells
  • genetic predisposition
39
Q

define infrabony and suprabony periodontal pockets

A
  • suprabony pocket-base of pocket coronal to alveolar crest
  • infrabony pocket- base of pocket apical to alveolar crest
40
Q

give classifications of periodontal pocket

A
  • false pocket
  • true pocket (suprabony or infrabony)
  • simple
  • compound
  • complex
41
Q

outline management of periodontal pockets

A
  • strict plaque control
  • oral hygiene instruction
  • root surface debridement
  • gingivectomy for suprabony pockets
  • periodontal flap procedures
42
Q

what are the different methods of mechanical plaque control?

A
  • tooth brush
  • dental floss
  • interdental cleaning
43
Q

what are the indications of a gingivectomy?

A
  • gingival enlargment
  • suprabony periodontal pocket
  • suprabony periodontal abscess
44
Q

what are the contraindications of a gingivectomy?

A
  • need for bone surgery
  • situation in which the bottom of the pocket is apical to the mucogingival junction
  • aesthetic considerations - especially anterior maxilla
45
Q

name the different types of gingivectomy

A
  • surgical gingivectomy
  • gingivectomy by electro surgery
  • gingivecomty by chemo surgery
  • laser gingivectomy
46
Q

how does healing after a gingivectomy take place?

A
  • formation of protective surface clot
  • underlying tissue acutely inflamed with some necrosis
  • clot replaced by granulation tissue
  • 24 hours- increase in angioblasts beneath inflamed and necrotic area
  • 72 hours- increase young fibroblasts in area
  • 2 weeks- vessels of periodontium connect with gingival vessels
  • complete connective tissue repair takes 7 weeks
47
Q

classify periodontal flaps

A

bone exposure after flap reflection:
* full thickness
* partial thickness
placement of flap after surgery:
* undiplaced
* displaced
management of papilla:
* conventional
* papilla preservation

48
Q

what are the 2 basic incisions of periodontal flaps?

A
  • horizontal
  • vertical
49
Q

describe horizontal periodontal flaps

A
  • directed along margin of gingivae in mesial or distal direction
    3 types;
  • internal bevel incision
  • crevicular incision
  • interdental incision
50
Q

describe internal bevel incisions

A
  • horizontal incision
  • basic to most periodontal flap procedures
  • incision from hwich flap is reflected to expose underlying bone and root
  • aka first incision
  • # 11 or #15 surgical scalpel used
51
Q

describe crevicular incisions

A
  • a horizontal incision
  • starts at the bottom of the pocket and is directed towards the bone margin
  • beak shaped #12D blade usually used
52
Q

describe interdental incisions

A
  • horizontal incision
  • performed after the flap is elevated
  • orban knife used
53
Q

describe vertical incisions

A
  • can be used on one or both ends of the horizontal incision- depends on design and purpose of flap
  • vertical incisions at both ends are necessart if the flap is apically displaced
  • must extend beyond mucogingival line to alveolar mucosa to allow for release of flap to be displaced
  • avoided on lingual and palatal surfaces
  • incision should be made at line angles of tooth
54
Q

how many classifications of furcation involvement are there?

A

4

55
Q

define a grade I furcation involvement

A
  • incipient, early stage
  • pocket is suprabony and affects soft tissues
  • early bone loss with increased probing depth
  • no radiographic change
56
Q

define a grade II furcation involvement

A
  • cul-de-sac with definite horizontal component
  • vertical bone loss may be present
  • radiograph may/may not depict changes
57
Q

define a grade III furcation involvement

A
  • bone not attached to the dome of furcation
  • in early stage may be filled with soft tisse and not visible
  • radiograph will show a radiolucent area
58
Q

define a grade IV furcation involvement

A
  • interradicular bone is detroyed
  • soft tissue have receded apically so opening is clinically visible
59
Q

outline treatment for class IV furcation involvement in a mandibular first molar

A
  • nonsurgical inaffective because ability to instrument tooth surface adequately is compromised
  • periodontal therapy, endodontic therapy and restoration may be required
60
Q

what are the 2 types of periapical abscess?

A

chronic
acute

61
Q

what are the characterisitics of a chronic periapical abscess?

A
  • gradual onset
  • little or no discomfort
  • intermittent discharge of pus through an associated sinus tract
62
Q

how do chronic periapical abscesses appear radiographically?

A

signs of osseous destruction
radiolucency at the apex

63
Q

what are the characteristics of acute periapical abscesses?

A
  • rapid onset
  • spontaneous pain
  • extreme tenderness of tooth to pressure
  • pus formation and swelling of associated tissues
  • systemic signs of malaise, fever and lymphadenopathy
  • may not show radiographically
64
Q

what are the risk factors of chronic gingivitis?

A
  • pregnancy
  • leukaemia
  • puberty related
  • poor OH
65
Q

what is the treatment for chronic gingivitis?

A
  • OHI
  • HPT is required for removal of plaque and calculus
    *
66
Q

what are the indications for periodontal surgery?

A
  • Pockets 5mm or greater 4-6 weeks after non-surgical treatment in the presence of excellent oral hygiene
67
Q

what are the aims of periodontal surgery?

A

to arrest disease by gaining access to complete root surface debridement and to regenerate lost periodontal tissues

68
Q

what should a GDP check for when reviewing a patient with previous surgical root surface debridement?

A
  • poor oral hygiene with persistent inflammation
  • good oral hygiene with inflammation resolved
  • good oral hygiene with persistent deep pockets with bleeding on probing
69
Q

what treatment would you carry out at a follow up appointment for a patient who smokes and presents with ANUG?

A

debridement with LA
smoking cessation advice
OHI

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