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Paediatrics > Perio Screening + Management of Perio Conditions in Children > Flashcards

Perio Screening + Management of Perio Conditions in Children Flashcards

1
Q

What other treatments can cause perio problems?

A

Ortho

Crown lengthening surgery

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2
Q

Pnemonic for classification of perio conditions 2017

A

Please - periodontal health

Give - gingivitis (biofilm)

Greg - gingival disease (non biofilm)

Nine - necrotising perio disease

Percy - periodontitis

Pigs - perio as a manifestation of systemic disease

Straight - systemic disease or conditions affecting perio supporting tissues

Past - perio abscess+- endo perio lesions

Meal - mucogingival deformities

Time - traumatic occlusal forces

Tonight - tooth + prosthesis related factors

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3
Q

How is perio disease diagnosed? (4)

A
  1. Staging
    - Interprox bone loss at worst site of bone loss (due to perio)
    - Stage 1-4
  2. Grading
    - Rate of progression
    - Take a % of bone loss/age
    - Grade A,B,C
3. Assess current periodontal status
Is it:
- Currently stable
- Currently in remission
- Currently unstable
  1. Risk assessment
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4
Q

How deep is a healthy gingival sulcus?

A

0.5-3mm deep

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5
Q

How deep is a healthy alveolar crest in teens?

A

0.4-1.9mm apical to the CEJ

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6
Q

What is the biological width?

A

CEJ + alveolar bone crest

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7
Q

What is the BPE?

A

Basic Perio Exam

BPE - screening

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8
Q

BOP % for clinical periodontal health (intact or reduce periodontium)

A

<10%

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9
Q

Whats the different types of gingivitis (2)

A
  1. Dental biofilm - induced
    - Localised
    - Generalised
  2. Gingival diseases + conditions
    - Non dental biofilm induced
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10
Q

How does dental biofilm gingivitis occur? (4)

A
  1. As supragingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
  2. JE becomes disrupted as a result
  3. Apical migration of plaque and an increase in the gingival sulcus depth (gingival swelling increases)
  4. Leads to deeper Gingival pocket / false pocket / pseudo pocket
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11
Q

What type of gingivitis is reversible?

A

Dental biofilm induced

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12
Q

Does dental biofilm induced gingivitis have any periodontal loss of attachment?

A

No

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13
Q

How does dental biofilm induced gingivitis present? (2)

A
  • Puffy red interproximal areas

- Long standing plaque causing local irritation and inflammation all around the gingival margins

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14
Q

Name a plaque retentive factors

A

Overhangs

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15
Q

How does necrotising ulcerative gingivitis present?

A
  1. Blunted papillae
  2. Malodour
  3. Painful + tender gingivae
  4. No attachment loss
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16
Q

Patient risk factors for necrotising ulcerative gingivitis (5)

A
  1. Smoking
  2. Stress
  3. Immunosuppression (HIV/other)
  4. Poor diet (lacking vits+minerals)
  5. Common in developing countries
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17
Q

What is pubertal gingivitis?

A
  1. Increased inflammatory response to plaque

2. Influenced by hormonal changes around puberty

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18
Q

What are some local factors that can cause pubertal gingivitis? (2)

A
  1. Braces

2. Overhanging restorations

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19
Q

How does non dental biofilm induced periodontitis differ from biofilm induced?

A

Main aetiological agent for gingivitis is not plaque

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20
Q

What can cause non-dental biofim induced gingivitis? (5)

A
  1. Infective
    - Viral
    - Fungal
  2. Drug induced
    - CytotOXIC
    - Anti-convulstants
    - Immunosuppressants
  3. Genetic
    - Phenotype
  4. Trauma
    - Thermal/chemical
    - Physical
  5. Manifestation of systemic disease
    - Immunological conditions
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21
Q

Name an example of an immunosuppressant that can cause drug induced gingivitis

A

Cyclosporin

- Crohns disease

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22
Q

Name an example of an anticonvulsant that can cause drug induced gingivitis

A

Phenytoin

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23
Q

How does phentyoin induced gingivitis present clinically?

A

Very inflamed interprox papillae

Tender and red

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24
Q

What kind of gingivitis does OFG cause?

A

Full thickness gingivitis

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25
Q

List some haematological diseases that can lead to gingivitis (2)

A
  1. Agranulocytosis
    - Low WBC
  2. Cyclic neutropenia
    - Low neutrophil count
26
Q

List some granulomatous inflammations that can lead to gingivitis (3)

A
  1. Crohns disease
  2. Sarcoidosis
  3. Granulomatosis
27
Q

Tx for gingivitis

A
  1. Rigorous OH
  2. Frequent scaling
  3. Surgery may necessary
28
Q

List key features of periodontitis (4)

A
  1. Apical migration of junctional epithelium beyond CEJ
  2. Loss of attachment of periodontal tissues to cementum
  3. Transformation of JE to pocket epithelium
  4. Alveolar bone loss
29
Q

Pathogen for periodontitis

A

P gingivalis

30
Q

Features of periodontitis

A

Rapid attachment loss + bone destruction

31
Q

What makes up the staging and grading grid?

A

STAGING

  1. Interproximal bone loss
  2. Extent

GRADING
Grade A-C

32
Q

What should be checked as part of recording and diagnosis for periodontal screening?

A
  1. Gingival condition
  2. Assess OH status
  3. Assess if any calculus present
  4. Assess local risk factors
33
Q

What should we look out for in gingival condition? (6)

A
  1. Gingival colour
  2. Contour
  3. Swelling
  4. Recession
  5. Suppuration
  6. Inflammation
34
Q

How do we assess OH status?

A
  1. Description of plaque status
    - Describe surfaces covered by plaque
    - Is plaque easily visible
    - Detectable only on probing
    - Use of plaque free scores
35
Q

How do we assess calculus presence/

A

Chart location

36
Q

How do we assess local risk factors? (3)

A
  1. Plaque retention factors
    - Low frenal attachments
    - Malocclusion
  2. Incompetent lip seal
    - If pt has reduced upper lip coverage (labial + palatal gingivitis)
    - Increased lip separation
  3. Mouthbreathing
    - Palatal gingivitis
37
Q

What can an incompetent lip seal cause?

A

May contribute to drying or intraoral mucosa and potentially gingivitis

38
Q

Disadvantages of a BPE exam

A

Doesn’t consider:

  1. Historical attachment loss
  2. Bone loss
39
Q

When can a simplified BPE be carried out?

A

In all co-operative children ages 7-11years

40
Q

What probe is used for a BPE

A

WHO CPITN probe

41
Q

Describe the WHO CPITN probe (2)

A
  1. 0.5mm ball end
  2. 2 black bands up length of probe
    - 3.5-5.5mm
    - 8.5-11.5mm
42
Q

Application of force for simplified BPE for adults + children

A

20-25g of force

43
Q

Why is there a simplified BPE?

A

Quick
Easy
Well tolerated
Avoids false pocketing

44
Q

What teeth are included in the modified BPE?

A

16 11 26

46 31, 36

45
Q

When is a simplified BPE carried out?

A

Starts at 7 years (permanent teeth only)

46
Q

Why is a simplified BPE not carried out in primary teeth?

A

Periodontal disease is rare

47
Q

Different codes for simplified BPE (4)

A

0 - Healthy

1 - Bleeding on gentle probing

2 - Calculus or plaque retention factor

  1. Pocketing 4mm-5mm (black band visible but partially obscured)

4 - Pocketing > or equal to 6mm (black band obscured)

    • Furcation involvement
48
Q

What % of BOP indicates clinical gingival health

A

<10%

49
Q

What % of BOP indicates localised gingivitis

A

10-30%

50
Q

What % of BOP indicates generalised gingivitis

A

> 30%

51
Q

When using a simplified BPE what codes should we use up to?

A

Code 0, 1 or 2

52
Q

Course of action if code 3

A
  1. Radiograph

2. Interdental perio therapy + review in 3 months with localised 6PPC

53
Q

Course of action if code 4

A
  1. Radiograph

2. Full perio assessment (including 6PPC)

54
Q

How are plaque scores noted for a child? (4)

A
  • 10/10 perfect clean tooth
  • 8/10 line of plaque around cervical margin
  • 6/10 cervical third of crown covered
  • 4/10 middle 3rd of crown covered
55
Q

What is a Grade A bone value?

A

<0.5

56
Q

What is a Grade B bone loss value?

A

0.5-1

57
Q

What is a Grade C bone loss value?

A

> 1

58
Q

Code 0 tx

A

None

Screen at routine recall or within year

59
Q

Code 1 tx

A

OHI + Prevention

Screen at routine recall or after 6mths

60
Q

Code 2 tx

A

OHI
Prevention
Scaling
Removal of plaque retention factors

Screen again at routine recall or after 6 mths

61
Q

Code 3,4 * tx

A
  • Full perio assessment
  • Radiographs to establish whether false or true pocket
  • Scaling, RSD, OHI + prevention
  • Scores 4 or * require referral

Tx and review after 3mths

Paediatrics (12 decks)

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