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BDS3 OSCE > Perio Summary > Flashcards

Perio Summary Flashcards

1
Q

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

A

WHO BPE probe/CPITN probe

Ball end - 0.5mm

band from 3.5mm-5.5mm

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2
Q

What does each BPE score mean?

A

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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3
Q

What is the treatment for each BPE score?

A

0 - nothing

1 - OHI

2 - removal of plaque retentive factors, PMPR, OHI

3 -PMPR

4 - PMPR and consider referal

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4
Q

When do you take radiographs based on BPE scores?

A

BPE of 3 or more to assess alveolar bone levels

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5
Q

When should a 6PPC be done?

A

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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6
Q

What are the limitations of BPE?

A
  • 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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7
Q

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

A

PCP12

3mm increments

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8
Q

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

A

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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9
Q

What is recorded in a 6PPC?

A
  1. Recession
    • ACJ to gingival margin
  2. Probing depth
    • Gingival margin to base of pocket
  3. Loss of attachment
    • Probing depth + recession
  4. Bleeding on probing
    • Present = 1
    • Absent = 0
  5. Furcation involvement
  6. Mobility
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10
Q

What are the grades for furcation involvement?

A

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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11
Q

What are the grades for mobility?

A
  • Grade 1: <1mm
  • Grade 2: 1-2mm
  • Grade 3: >2mm and/or rotation or depression
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12
Q

What teeth are Ramfjord’s teeth?

A

16

21

24

36

41

44

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13
Q

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

A

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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14
Q

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

A

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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15
Q

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

A
  • 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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16
Q

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

A

Less than 30% plaque score

AND EITHER

less than 35% bleeding score

OR

Greater than 50% improvement in both

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17
Q

Advantages of modified plaque and bleeding scores?

A
  • 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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18
Q

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

A

1

Early/Mild

<15% or 2mm

2

Moderate

Coronal 1/3rd of root

3

Severe (potential for additional tooth loss)

Mid 1/3rd of root

4

Very severe (potential for loss of dentition)

Apical 1/3rd of root

Grade

Captures Progression

Percentage bone loss/age

Example

A

Slow

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

60 y/o with 20% bone loss

B

Moderate

0.5-1.0 (everything else)

58 y/o with 60% bone loss

C

Rapid

>1 (max bone loss more than patient age)

20 y/o with 60% bone loss

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19
Q

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

A

loalised - less than 30% teeth affected

generalised - >30% affected

Molar incisor pattern

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20
Q

What makes someone a stable perio pt?

A

BoP <10%

PPD ≤ 4mm

No BoP at 4mm sites

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21
Q

What would suggest a pt is currently in remission?

A

BoP ≥10%

PPD ≤ 4mm

No BoP at 4mm sites

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22
Q

What would suggest a pt was currently unstable?

A

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

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23
Q

Symptoms of NUP?

A
  • 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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24
Q

Cautions for metronidazole?

A

Should avoid alcohol

Anticoagulant effect of warfarin may be enhanced

(amoxycillin is an alternative)

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25
Q

How should acute necrotizing diseases be managed

A
  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
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26
Q

When should antibiotics be prescribed for acute necrotising diseases

A

if signs of systemic symptoms or signs of spreading dental infections

impaired immune system

lack of response to mechanical therapy

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27
Q

What are the local measures to be used for NUG

A

remove supra and sub gingival calculus and OHI

28
Q

What is the prescription for the antibiotics for NUP/NUG

A

metronidazole 400mg

3 times a day

3 day prescription

29
Q

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

A

malaise

fever

lassitude

lack of response to mechanical therapy

lymphatic involvement

30
Q

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

A

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

31
Q

What is the difference between NUP and NUG

A

NUP leads to attachment loss

32
Q

What is necrotizing stomatitis

A

progression of NUP into tissues beyond mucogingival junction

33
Q

What are the symptoms of NUP

A
  • Pain (general or localised)
  • Swelling
  • Bleeding
  • Halitosis
  • white/grey slaim
  • Ulcerated/necrotic gingival tissue
  • Loss of attachment
  • Malaise
  • Fever
34
Q

What periodontitis diagnosis can be prescribed antibiotics

A

Young people with grace B/C periodontitis

35
Q

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

A

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

36
Q

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

A

7 day regimen of:

amoxycillin 500mg 3 times daily WITH 200mg metronidazole 3 times daily

OR

metronidazole 400mg 3 times daily

37
Q

What is the protocol on dealing with a periodontal abscess

A
  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
38
Q

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

A

risk of increasing loss of attachment

39
Q

When should antibiotics be prescribed for a patient with periodontal abscess

A

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

40
Q

What is the antibiotic regimen for periodontal abscess

A

500mg amoxicillin 3 times daily

5 days

41
Q

Patient comes in with periodontal abscess + signs of spreading infection.

MH shows patient is allergic to penicillin

What will you prescribe

A

400mg metronidazole 3 times daily 5 days

42
Q

What are local risk factors for perio split into

A

acquired

anatomical

43
Q

What are local acquired risk factors

A
  • Plaque
  • Calculus
  • overhang
44
Q

What are local anatomical risk factors for perio

A
  • Furcation
  • malposition
45
Q

What are systemic risk factors split into

A

non modifiable

modifiable

46
Q

What are non modifiable risk factors

A
  • Age
  • Gender (men more prone)
  • Genetics
47
Q

What are modifiable risk factors

A
  • Smoking
  • Diabetes (poorly controlled)
  • Leukemia
  • stress
48
Q

What does the 2018 classification system include

A

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

49
Q

What is the diagnostic statement

A

extent

periodontitis

stage

grade

stability

risk factors

50
Q

What is extent

A

molar incisor pattern

<30% = localised

>30% = generalised

51
Q

What is staging

A

looking for worst site of interproximal bone loss

52
Q

What is stage 1

A

<15% or <2mm attachment loss

aka early mild

53
Q

What is stage 2

A

moderate

to coronal third of root

54
Q

What is stage 3

A

mid third of root

55
Q

What is stage 4

A

apical third of root

56
Q

What is grade

A

% bone loss / patient age

use worst site

57
Q

What is grade A

A

< 0.5

58
Q

What is grade B

A

0.5-1

59
Q

What is grade C

A

more than 1

60
Q

What makes up currently in remission perio

A

BOP ≥10 %

PPD ≤4mm

no NOP at 4mm sites

61
Q

What is currently unstable perio

A

PPD ≥ 5mm

PPD ≥ 4mm

+ BOP

62
Q

What is a plaque score out of?

A

36

63
Q

What is a bleeding score out of ?

A

24

64
Q

What are modified plaque bleeding scores useful for

A

determining px engagement

65
Q

What is considered an engaging patient

A
  1. Less than 30% plaque score

AND EITHER;

A. Less than 35% bleeding score

OR

B. >50% improvement in both scores

BDS3 OSCE (65 decks)

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