Perio Swep 1.3

Question 1

Papillary-Marginal-Attachment (PMA)-Index

Answer 1

Background: “The number of units affected correlates with the severity of gingival inflammation”
Facial gingival surface is divided in 3 scoring units P - M - A
Gingival units affected with gingivitis are counted. Presence or absence of inflammation is counted as {1} and {0}, respectively
Severity component can be considered
Score computed for tooth subject population
First published by Schour & Massler (1947)

Question 2

Gingival Index (GI)

Answer 2

The severity of inflammation is assessed in 4 distinct gingival areas: distofacial papilla, facial margin, mesiofacial papilla, lingual gingival margin.
Scores: 0 to 3; bleeding is considered. Presence of bleeding automatically leads to a score ≥2
Score for tooth subject population
Useful for the calculation of prevalence and severity in population and individual
Frequently used index in clinical trials
First published by Löe (1961) and Löe & Silness (1963)

Question 3

The bleeding tendency is assessed upon probing a periodontal pocket using

Answer 3

standardized pressure
Periodontal probe is inserted to the bottom of the periodontal pocket. Bleeding is observed 15 seconds following retraction of probe.
Presence or absence of bleeding is scored as {1} and {0}, respectively.
Not to be confused with bleeding as scored in GI
B-o-P is a valid indicator for periodontal stability. However, it is a poor indicator of periodontal breakdown.

Question 4

The Extent and Severity Index (ESI)

Answer 4

Agreement
Disease is defined as attachment loss >1mm
Extent
Proportion of tooth sites in a patient showing signs of destructive periodontitis
Severity
Amount of attachment loss at the diseased sites, expressed as a mean value

Question 5

The Periodontal Index System (PI)

Answer 5

Score 0: Negative.
Score 1, 2: Gingivitis
Score 6: Gingivitis with pocket formation
Score 8: Advanced destruction with loss of masticatory function
All teeth are examined. The circumference of each tooth is inspected visually, and given a score.
Index computed for subject, population.

Question 6

The Periodontal Disease Index System:

This system includes several components:

Answer 6

Gingival status
Crevicular measurements
Periodontal Disease Index
Plaque criteria
Calculus Criteria

Question 7

The Periodontal Disease Index System

Answer 7

Score 1, 2, 3: Severity of gingivitis
Score 4: Initial attachment loss (£3 mm)
Score 5: Moderate attachment loss (>3 mm and
£6 mm)
Score 6: Advanced attachment loss (>6 mm)

4 areas per tooth are examined using a probe. The most severe score is tabulated and used for the calculation of the subject’s PDI
Index computed for subject, population

Question 8

Community Periodontal Index of Treatment Needs (CPITN)

Answer 8

Primarily designed to assess periodontal treatment needs in under served parts of the world
Uses a specially designed probe
Epidemiology: 10 index teeth are examined and worst finding is recorded per sextant
For individual subjects: worst finding of all teeth in a sextant is recorded, resulting in 6 scores per subject. The worst score determines the treatment needs score
Published and promoted by the World Health Organization (1982).

Question 9

Community Periodontal Index of Treatment Needs (CPITN)

Perio status

Answer 9

Periodontal Status
Score 1:   Bleeding on gentle probing
Score 2:   Calculus felt during probing,crevicular depth £3 mm
Score 3:   Probing depth 4 mm or 5 mm
Score 4:   Probing depth ³6 mm

Question 10

Community Periodontal Index of Treatment Needs (CPITN): treatment status

Answer 10

Treatment Needs
Code 0:   No treatment
Code I:    Improved oral hygiene
Code II:   I + professional scaling
Code III:  I + II + complex treatment

Question 11

Periodontal Screening & Recording® (PSR)

Purpose:

Answer 11

Periodontal Screening and Recording® (PSR®) is a rapid and effective way to screen patients for periodontal diseases and summarizes necessary information with minimum documentation.

Question 12

Periodontal Screening & Recording® (PSR)

Endorsement:

Answer 12

The ADA and the AAP support the use of PSR® by dentists as a part of oral examinations.

Question 13

PSR - Benefits: Early detection:

Answer 13

PSR® includes evaluation of all sites. For this reason, it is a highly sensitive technique for detecting deviations from periodontal health and a uniquely appropriate screening tool for periodontal diseases that are, by nature, site specific and episodic.

Question 14

PSR - Benefits:

Speed:

Answer 14

Once learned, PSR® takes only a few minutes to conduct for each patient. It can be readily incorporated into routine oral examinations.

Question 15

PSR - Benefits

Simplicity:

Answer 15

PSR® is easy to administer and comprehend. The simplicity of the scoring system aids in monitoring a patient’s periodontal status.

Question 16

PSR - Benefits

Cost-effectiveness:

Answer 16

PSR® utilizes a simple periodontal probe designed specifically for use with this screening system. It does not require the use of expensive equipment.

Question 17

PSR - Benefits:

Recording ease:

Answer 17

Documentation for PSR® requires the recording of six numerical scores, one for each sextant of the mouth. It does not require extensive charting or lengthy narrative explanation.

Question 18

PSR - Benefits:

Risk management:

Answer 18

Proper, consistent, and documented use of PSR® shows that the dentist is evaluating a patient’s periodontal status.

Question 19

PSR - Limitations

Answer 19

PSR® is a screening system designed to detect periodontal diseases. It is not intended to replace a comprehensive periodontal examination when indicated.
Patients who have been treated for periodontal diseases and are in a maintenance phase of therapy require periodic comprehensive periodontal examinations.
In addition, PSR® is designed primarily for use with adult patients and has limited utility in screening children and adolescents.

Question 20

Peri-implant Tissues and Indices

Answer 20

Modified PlI

Modified GI

Question 21

Reliability of gingival indices

Answer 21

(Reliability of an index to measure a condition in the same subject repeatedly and obtain the same score results each time)

Question 22

Validity of a diagnostic test

Answer 22

(Sensitivity and specificity of various diagnostic tools used to create an index)

Question 23

Halo Effect (Thorndike 1920):

Answer 23

The examiner’s general impression of target distorts his/her perception of the target on specific dimensions

Question 24

Leniency/Severity Error (Saal & Landy 1977):

Answer 24

The examiner’s tendency to be lenient or severe

Question 25

Central Tendency Error (Korman 1971):

Answer 25

The examiner’s reluctance to rate at either the positive or negative extreme, so all scores cluster in the middle

Question 26

Calibration involves:

Answer 26

- Several examiners at different experience levels - Subjects with various disease extend and severity - Follow-up appointments Main goal is to determine inter/intra-examiner variations.

Question 27

Sensitivity | =

Answer 27

The probability that a test result will be positive when the test is administered to people who actually have the disease in question Sensitivity = Pr(T+/D+)

Question 28

Specificity

Answer 28

The probability that a test will be negative when administered to people who are free of the disease in question Specificity = Pr(T-/D-)

Question 29

Predictive Value Positive (PVP)

Answer 29

The probability of disease in a subject with a positive test result PVP = Pr(D+/T+)

Question 30

Predictive Value Negative (PVN)

Answer 30

The probability of not having the disease when the test is negative PVN = Pr(D-/T-)

Question 31

Bone loss % =

Answer 31

CEJ-Crest - 2 mm divided by | CEJ-Apex - 2 mm

Question 32

Hemiseptal defect:

Answer 32

a vertical defect in the presence of adjacent roots; thus half of a septum remains on one tooth, AKA one-walled defect

Question 33

Bone Loss in Furcation AreasPathologic resorption of bone within a furcation. Shows up in radiograph as

Answer 33

radiolucency | Furcation radiolucency

Question 34

When radiographs of maxillary molars are observed, a small, triangular radiographic shadow is sometimes noted over either the mesial or distal roots in the proximal furcation area. However,

Answer 34

absence of the furcation arrow image does not necessarily mean absence of a bony furcation involvement because the arrow was not seen in a large number of furcations with Degree 2 or 3 involvement.

Question 35

PDL appears as the periodontal space of

Answer 35

0.4 to 1.5 mm on radiographs, a radiolucent area between the radiopaque lamina dura of the alveolar bone proper and the radio opaque cementum.

Question 36

Vessels within Interdental Bone appear as

Answer 36

They appear as radiolucent lines bordered by thin radiopaque lines

Question 37

IF the maxillary sinus is close to or has invaginated among the roots of the maxillary teeth, there may be difficulties with

Answer 37

surgical treatment of the periodontal problems.

Question 38

Mandibular Tori

Answer 38

A bony exostosis on the lingual aspect of the mandible, generally in the premolar-molar region; commonly bilateral

Question 39

If the roots are less than 2.5 mm apart

Answer 39

Periodontal bone loss will affect the entire interproximal

Question 40

Internal Resorption:

Answer 40

Tooth resorption beginning from within the pulp.

Question 41

External Resorption:

Answer 41

Resorption of tooth structure beginning on the external surface.

Question 42

To standardize the projection and to ensure the reproducibility of serial radiographs,

Answer 42

customized bite blocks was fabricated using XCP film holder (Dentsply) with impression material of hydrophilic addition reaction silicone (Dentsply) and direct conventional radiographic images (Figure 3).

Question 43

Gingival lesions of specific bacterial origin

Answer 43

Infective gingivitis and stomatitis. The lesions may be due to bacteria. The lesions may or may not be accompanied by lesions elsewhere in the body. Bacteria involved: Neisseria gonorrhea, Treponema pallidum, Streptococci, Mycobacterium chelonae or other org.s Clinical presentation … Variations Fiery red edematous painful ulcerations Asymptomatic chancres Mucous patches Atypical non-ulcerated, highly inflamed gingivitis. Diagnosis: Biopsy Microbiologic examination

Question 44

Herpes virus infections- | Herpes simplex viruses type 1 and 2

Answer 44

Varicella-zoster virus Herpes simplex 1 usually causes oral manifestations.

Question 45

Primary herpetic gingivostomatitis-

Answer 45

Symptoms: - painful severe gingivitis with redness - ulcerations with serofibrinous exudate - edema accompanied by stomatitis ``` Characteristics: - Incubation period is one week. - Formation of vesicles, which rupture, coalesce and leave fibrin-coated ulcers. - Healing within 10 to 14 days. ```

Question 46

Herpes virus can stay latent in trigeminal ganglion for years. Found in

Answer 46

gingivitis, Necrotizing Ulcerative Diseases (NUG/NUP) and periodontitis. More primary infections occur at older ages in industrialized society.

Question 47

Primary herpetic gingivostomatitis may be asymptomatic in childhood, but may also give rise

Answer 47

``` severe gingivostomatitis (painful severe gingivitis with redness, ulcerations with serofibrinous exudate and edema. The incubation period is 1 week A characteristic feature is formation of vesicles, which rupture, coalesce, and leave fibrin coated ulcers. Fever and lymphadenopathy are other classic features. ```

Question 48

Recurrent herpetic infections

Answer 48

herpes labialis Vermilion border and/or the skin adjacent to it. 20-40% of individuals with primary infection. Trauma, UV light exposure, fever, menstruation Diagnosis: - generally considered an aphtous ulceration. - ulcers in attached gingiva and hard palate.

Question 49

Recurrent infections occur in general more than once a

Answer 49

year, usually at the same location on the vermillion border and/or skin adjacent to it, where neural endings are known to be clustering. Factors that trigger recurrent infections are listed as trauma, UV light exposure, fever, menstruation and others.

Question 50

Herpes zoster- - Virocella-zoster virus causes varicella (chicken pox).

Answer 50

- Small ulcers usually on the tongue, palatal and gingiva. - Latent in the dorsal root ganglion. - Unilateral lesions. - 2nd and 3rd branch of the trigeminal ganglion.

Question 51

Gingival lesions of fungal origin

Answer 51

Candidosis Linear gingival erythema Histoplasmosis

Question 52

Candidosis- Candida species isolated from the mouth:

Answer 52

C.albicans, C.glabrata, C.krusei, C.tropicalis, C. parapsilosis and C. guillermondii. Oral carriage of C.albicans in healthy adults: 3-48%. Reduced host defense posture C.albicans is frequently isolated from the subgingival flora of patients with severe periodontitis.

Question 53

Linear gingival erythema-

Answer 53

- Distinct linear erythematous band limited to the free gingiva. - Lack of bleeding. Positive for C.albicans by culture: 50% of HIV associated gingivitis sites, 26% of unaffected sites of HIV seropositive patients, 3% of healthy sites of HIV negative patients.

Question 54

Histoplasmosis-

Answer 54

* Granulomatous disease caused by Histoplasma capsulatum * - Acute and chronic pulmonary histoplasmosis and a disseminated form… Immunocompromised patients. - Any area of the oral mucosa. - Nodular or papillary and later may become ulcerative type of lesions with pain. Diagnosis: Clinical view and histopathology

Question 55

Hereditary gingival fibromatosis-

Answer 55

- Diffuse gingival enlargement. - Disease entity or a part of a syndrome. (example: hypertrichosis, mental retardation, epilepsy, hearing loss, growth retardation, abnormalities of extremities) - May interfere with or prevent tooth eruption. - Possible mechanism(s): TGF-1 favor the accumulation of ECM. May be located on chromosome 2 in human.

Question 56

Gingival lesions of systemic origin

Answer 56

Allergic and traumatic reactions Other gingival manifestations Mucocutaneous disorders

Question 57

Type I reactions (immediate Type),mediated by

Answer 57

IgE, | or

Question 58

Type IV reactions (delayed type) mediated by

Answer 58

T-cells. Allergies to: Dental restorative materials (type IV, contact allergy) Oral hygiene products, chewing gum and food [generally flavor additives or preservatives] A diffuse fiery red edematous gingivitis sometimes with ulcerations or whitening.

Question 59

Chemical traumatic lesions-

Answer 59

Surface etching by various chemical products with toxic properties. Examples: chlorhexidine-induced mucosal desquamation, acetylsalicylic acid burn, cocaine burn. Incorrect use of caustics by the dentist.

Question 60

Physical traumatic lesions-

Answer 60

Hyperkeratosis, a white leukoplakia-like, frictional keratosis. Gingival laceration resulting in gingival recession. Traumatic ulcerative gingival lesion. (brushing and flossing techniques)

Question 61

Thermal injury-

Answer 61

Minor burns from hot beverages. Mostly seen on palatal and labial mucosa. Painful, erythematous lesions. Vesicles may develop.

Question 62

Foreign body reactions-

Answer 62

Epithelial ulceration that allows entry of foreign material into gingival connective tissue. Foreign body can be generally detected via X-rays. (Examples: amalgam tattoo, abrasives, toothpick etc.)