- ulcerated and necrotic papillae - ulcers covered in a yellowish, white or greyish slough (pseudomembrane) - quick development - severe pain - bleeding readily provkes - deep pocket formation - lymph node involvement - may cause fever

Perio Summary Flashcards by Roisin Mousa

What probe is used for BPE and what are the markings on it?

WHO BPE probe/CPITN probe

Ball end - 0.5mm

band from 3.5mm-5.5mm

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What does each BPE score mean?

BPE 0 - no calculus, no BoP, pockets <3.5mm

1 - BoP, pockets <3.5mm

2 - calculus/overhangs/plaque-retentive factors, pockets <3.5mm

3 - pockets between 3.5mm and 5.5.mm

4 - pockets >5.5mm

* = furcation involvement

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What is the treatment for each BPE score?

0 - nothing

1 - OHI

2 - removal of plaque retentive factors, PMPR, OHI

3 -PMPR

4 - PMPR and consider referal

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When do you take radiographs based on BPE scores?

BPE of 3 or more to assess alveolar bone levels

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When should a 6PPC be done?

Patient who has scored 3 in BPE, do 6PPC of affected segments only

o Patient who has scored 4 in BPE, do 6PPC of entire mouth

o Monitoring patients who have active periodontal disease to assess engagement in treatment and ability to progress with treatment

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What are the limitations of BPE?

pocket depth can be misleading e.g. gingival enlargement or incomplete eruption in the young leading to false pocketing
older pts will have more recession and less pocketing but may still have attachment loss
fails to indicate the extent of disease (is simply a screening tool)

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What probe is used to record a 6PPC and what are the measurements on it?

PCP12

3mm increments

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When would you repeat a 6PPC after tx? Why this length of time?

Approx. 8wks after treatment because most of the healing response leading to reduction in probing depth and gain in clinical attachment has taken place within 8 weeks.

If go back in too early can destroy the epithelium.

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What is recorded in a 6PPC?

Recession
- ACJ to gingival margin
Probing depth
- Gingival margin to base of pocket
Loss of attachment
- Probing depth + recession
Bleeding on probing
- Present = 1
- Absent = 0
Furcation involvement
Mobility

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What are the grades for furcation involvement?

Grade 1 = up to 3mm horizontal attachment loss

Grade 2 = >3mm horizontal attachment loss, but not through and through

Grade 3 = a through and through lesion

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What are the grades for mobility?

Grade 1: <1mm
Grade 2: 1-2mm
Grade 3: >2mm and/or rotation or depression

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What teeth are Ramfjord’s teeth?

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What are the scores for the HGDM plaque and bleeding scores?

plaque:

0 - no plaque

1 - no visible plaque but when run probe around amrgin some present

2 - visible plaque present

bleeding:

0 - no bleeding

1- bleeding

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How is the bleeding recorded for HGDM different from BoP scores?

It measures marginal bleeding and not actual bleeding on probing

(you just run the probe at a 45degree angle along the gingival sulcus and check fr 30secs after)

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What’s the difference in what marginal bleeding and BoP mean?

Marginal bleeding reflects how well the P is able to carry out effective plaque control daily, whilst B.O.P. indicated disease activity and periodontal breakdown

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With the modified bleeding and plaque indexes, what scores indicate an enegaing patient?

Less than 30% plaque score

AND EITHER

less than 35% bleeding score

Greater than 50% improvement in both

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Advantages of modified plaque and bleeding scores?

More objective way of assessing OH
Simple and quick to use
Clear, objective results that can be easily presents to patients
Allows objectively assessment of a p’s OH over a period of time
Objectively identifies patients who are engaging

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What are the stages and grades for perio and describe what they mean.

Early/Mild

<15% or 2mm

Moderate

Coronal 1/3^rd of root

Severe (potential for additional tooth loss)

Mid 1/3^rd of root

Very severe (potential for loss of dentition)

Apical 1/3^rd of root

Grade

Captures Progression

Percentage bone loss/age

Example

Slow

<0.5 (max bone loss less than half P age)

60 y/o with 20% bone loss

Moderate

0.5-1.0 (everything else)

58 y/o with 60% bone loss

Rapid

>1 (max bone loss more than patient age)

20 y/o with 60% bone loss

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What are the possible extents of the disease? (perio)

loalised - less than 30% teeth affected

generalised - >30% affected

Molar incisor pattern

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What makes someone a stable perio pt?

BoP <10%

PPD ≤ 4mm

No BoP at 4mm sites

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What would suggest a pt is currently in remission?

BoP ≥10%

PPD ≤ 4mm

No BoP at 4mm sites

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What would suggest a pt was currently unstable?

PPD ≥ 5mm OR BoP at 4mm (or more) sites

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Symptoms of NUP?

ulcerated and necrotic papillae
ulcers covered in a yellowish, white or greyish slough (pseudomembrane)
quick development
severe pain
bleeding readily provkes
deep pocket formation
lymph node involvement
may cause fever

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Cautions for metronidazole?

Should avoid alcohol

Anticoagulant effect of warfarin may be enhanced

(amoxycillin is an alternative)

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How should acute necrotizing diseases be managed

1. ultrasonic debridement 2. OHI + prescription of 0.2% CHX twice daily if pain prevents brushing 3. antibiotics **only** for those with **malaise, fever, lassitude, lack of response to mechanical therapy & with impaired immunity** 4. Dealing with potential underlying causes: smoking cessation, vitamin supplementation, dietary advice 5. For necrotising periodontitis, after remedy of acute symptoms, HPT needs to be carried out

When should antibiotics be prescribed for acute necrotising diseases

if signs of systemic symptoms or signs of spreading dental infections impaired immune system lack of response to mechanical therapy

What are the local measures to be used for NUG

remove supra and sub gingival calculus and OHI

What is the prescription for the antibiotics for NUP/NUG

metronidazole 400mg 3 times a day 3 day prescription

What are the symptoms for NUP/NUG that would indicate antibiotic prescription

malaise fever lassitude lack of response to mechanical therapy lymphatic involvement

Patient comes into practice presenting with the following symptoms * malaise * fever * swelling on the RHS of her face * painful gums When taking a history, the patient tells you she is on warfarin On clinical examination, patient has deep pockets, halitosis and you see ulcerated gingival tissue. What is your diagnosis, how will you treat this & what will you prescribe

Symptoms match **necrotising ulcerative periodontitis** The patient will require * ultrasonic debridement to remove the necrotic tissue * CHX mouthwash until px can brush their teeth again (if too sore) * antibiotics because of presence of **systemic symptoms** Prescribe **amoxycillin** 500mg TID 3 day course This is because metronidazole which is the first line drug in this case, interacts with warfarin and so is contraindicated in this patient

What is the difference between NUP and NUG

NUP leads to attachment loss

What is necrotizing stomatitis

progression of NUP into tissues beyond mucogingival junction

What are the symptoms of NUP

* Pain (general or localised) * Swelling * Bleeding * Halitosis * white/grey slaim * Ulcerated/necrotic gingival tissue * Loss of attachment * Malaise * Fever

What periodontitis diagnosis can be prescribed antibiotics

Young people with grace B/C periodontitis

When (in the tx plan) should young patients with grade B/C periodontitis be prescribed antibiotics

after initial HPT, ensure px has good OH and then do supragingival scaling and RSD of all sites indicated in pocket chart then start AB on the **morning** of the **first RSD visit**

What antibiotic regimen should be given to young people with grace B/C periodontits

7 day regimen of: amoxycillin 500mg 3 times daily WITH 200mg metronidazole 3 times daily OR metronidazole 400mg 3 times daily

What is the protocol on dealing with a periodontal abscess

1. carry out careful sub-gingival instrumentation which is short of the base of the pocket 2. if pus is present then drain 3. recommend optimal analgesia 4. recommend use of 0.2% chlorhexidine mouthwash in substitute of brushing if too painful 5. following acute management, review and carry out definitive periodontal instrumentation and arrange recall

For a periodontal abscess, why must the subgingival instrumentation be short of the base of the pocket

risk of increasing loss of attachment

When should antibiotics be prescribed for a patient with periodontal abscess

Only following **failed mechanical means** or **signs of spreading infection** or **systemic involvement**

What is the antibiotic regimen for periodontal abscess

500mg amoxicillin 3 times daily 5 days

Patient comes in with periodontal abscess + signs of spreading infection. MH shows patient is allergic to penicillin What will you prescribe

400mg metronidazole 3 times daily 5 days

What are local risk factors for perio split into

acquired anatomical

What are local acquired risk factors

* Plaque * Calculus * overhang

What are local anatomical risk factors for perio

* Furcation * malposition

What are systemic risk factors split into

non modifiable modifiable

What are non modifiable risk factors

* Age * Gender (men more prone) * Genetics

What are modifiable risk factors

* Smoking * Diabetes (poorly controlled) * Leukemia * stress

What does the 2018 classification system include

health plaque induced gingivitis non plaque induced gingival diseases and conditions periodontitis necrotising periodontal disease periodontal disease as a manifestation of systemic disease systemic diseases or conditions affecting the periodontal tissiues periodontal abscess periodontal endodontic lesions mucogingival deformities and conditions

What is the diagnostic statement

extent periodontitis stage grade stability risk factors

What is extent

molar incisor pattern \<30% = localised \>30% = generalised

What is staging

looking for worst site of interproximal bone loss

What is stage 1

\<15% or \<2mm attachment loss aka early mild

What is stage 2

moderate to coronal third of root

What is stage 3

mid third of root

What is stage 4

apical third of root

What is grade

% bone loss / patient age use worst site

What is grade A

\< 0.5

What is grade B

0.5-1

What is grade C

more than 1

What makes up currently in remission perio

BOP ≥10 % PPD ≤4mm no NOP at 4mm sites

What is currently unstable perio

PPD ≥ 5mm PPD ≥ 4mm + BOP

What is a plaque score out of?

What is a bleeding score out of ?

What are modified plaque bleeding scores useful for

determining px engagement

What is considered an engaging patient

1. **Less than 30%** plaque score AND EITHER; A. **Less than 35%** bleeding score OR B. **\>50%** improvement in both scores