Perio Summary Flashcards
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
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
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
When do you take radiographs based on BPE scores?
BPE of 3 or more to assess alveolar bone levels
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
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)
What probe is used to record a 6PPC and what are the measurements on it?
PCP12
3mm increments
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.
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
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
What are the grades for mobility?
- Grade 1: <1mm
- Grade 2: 1-2mm
- Grade 3: >2mm and/or rotation or depression
What teeth are Ramfjord’s teeth?
16
21
24
36
41
44
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
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)
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
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
OR
Greater than 50% improvement in both
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
What are the stages and grades for perio and describe what they mean.
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
What are the possible extents of the disease? (perio)
loalised - less than 30% teeth affected
generalised - >30% affected
Molar incisor pattern
What makes someone a stable perio pt?
BoP <10%
PPD ≤ 4mm
No BoP at 4mm sites
What would suggest a pt is currently in remission?
BoP ≥10%
PPD ≤ 4mm
No BoP at 4mm sites
What would suggest a pt was currently unstable?
PPD ≥ 5mm OR BoP at 4mm (or more) sites
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
Cautions for metronidazole?
Should avoid alcohol
Anticoagulant effect of warfarin may be enhanced
(amoxycillin is an alternative)
How should acute necrotizing diseases be managed
- ultrasonic debridement
- OHI + prescription of 0.2% CHX twice daily if pain prevents brushing
- antibiotics only for those with malaise, fever, lassitude, lack of response to mechanical therapy & with impaired immunity
- Dealing with potential underlying causes: smoking cessation, vitamin supplementation, dietary advice
- 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
- carry out careful sub-gingival instrumentation which is short of the base of the pocket
- if pus is present then drain
- recommend optimal analgesia
- recommend use of 0.2% chlorhexidine mouthwash in substitute of brushing if too painful
- 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?
36
What is a bleeding score out of ?
24
What are modified plaque bleeding scores useful for
determining px engagement
What is considered an engaging patient
- Less than 30% plaque score
AND EITHER;
A. Less than 35% bleeding score
OR
B. >50% improvement in both scores
