Perio Test 1 (Ch 21, 25, 27)

Question 1

What are the 3 fundamental diagnostic questions?

Answer 1

1. Does the clinical assessment indicate periodontal health or inflammatory disease?
2. If the clinical assessment indicates inflammatory disease, is it periodontitis or gingivitis?
3. If the pt has gingivitis what type is it? If pt has periodontitis what type is it?

Question 2

What is the periodontal master treatment plan?

Answer 2

a sequential outline of the steps to be carried out by the DDS, DH and pt to eliminate disease and restore health in periodontium

Question 3

What does the assessment and preliminary therapy phase in the master trx plan consist of?

Answer 3

assessment of collected data & urgent care for any acute conditions (like emerg dental care).
* some refer to this phase as emergency therapy

Question 4

What does the nonsurgical periodontal therapy phase consist of in the master trx plan

Answer 4

all nonsurgical measures used to control gingivitis and periodontitis.
- intensive nonsurgical perio instrumentation & comprehensive pt education
- steps to minimize impact of local contributing factors

Question 5

nonsurgical periodontal therapy other names

Answer 5

initial periodontal therapy, phase I therapy, bacterial control and anti-infective therapy

Question 6

what does the surgical therapy phase of master trx plan consist of?

Answer 6

necessary perio surgery to control/eliminate perio disease that cant be managed by nonsurgical therapy alone.
-placement of implants if necessary

Question 7

what does the restorative therapy phase in master trx plan consist of?

Answer 7

placement of restorations and replacement of teeth by fixed or removable prosthesis

Question 8

what does the periodontal maintenance phase in the master trx plan consist of?

Answer 8

all measures used by dental team and pt to keep perio from recurring, once the inflammatory disease is brought under control

Question 9

___ can be observed and measured by the clinician

Answer 9

Signs

Question 10

___ are noted by the patient

Answer 10

symptoms

Question 11

What are the visible signs of disease?

Answer 11

color, contour and consistency changes in gingiva

Question 12

What are hidden signs of disease?

Answer 12

Bone loss, exudate, bleeding on probing

Question 13

What measurement determines the difference between gingivitis and periodontitis

Answer 13

attachment loss

Question 14

What does staging identify?

Answer 14

severity, complexity of management and extent of distribution of the disease

Question 15

Describe the 4 disease stages of perio

Answer 15

Stage 1: initial periodontitis
Stage 2: moderate periodontitis
Sage 3: severe periodontitis with potential for bone loss
Stage 4: advanced periodontitis with extensive tooth loss and potential for loss of dentition

Question 16

Grading is used as an indicator of

Answer 16

anticipated rate of progression of periodontal disease

Question 17

Describe the progression of the 3 grades

Answer 17

grade a: slow rate of progression
grade b: moderate rate of progression
grade c: rapid rate of progression

Question 18

Disease extent uses descriptive modifiers such as

Answer 18

localized, generalized, molar/incisor pattern

Question 19

Localized disease extent percentage

Answer 19

30% or less involvement

Question 20

Generalized disease extent percentage

Answer 20

more than 30% involvement

Question 21

What are the 4 goals of periodontal instrumentation

Answer 21

1. minimize bacterial challenge to pt
2. eliminate/ control local contributing factors for perio disease
3. minimize the impact of systemic factors of perio disease
4. stabilize attachment level

Question 22

What represents healing after periodontal instrumentation is complete?

Answer 22

formation of a long junctional epithelium, reduced pocket depths, reduced bleeding on probing

Question 23

How much time is left between completion of nonsurgical perio therapy and the re-eval appt?

Answer 23

4-6 weeks

Question 24

Why is 4-6 weeks left between completion of nonsurgical perio therapy and the re-eval appt.

Answer 24

allows time for tissue healing
*not possible to determine tru tissue response for at least 1 month after

Question 25

What happens/ what are the steps in a reevaluation appt

Answer 25

*Medical status update * Thorough periodontal clinical assessment * Compare results with initial assessment * Decide on the next step in therapy * Perform or schedule additional nonsurgical therapy * Determine periodontal maintenance schedule * Refer for periodontal surgery if needed

Question 26

What causes/triggers dentinal hypersensitivity?

Answer 26

When dentin loses its protected cemental cover, the dentinal tubules are then exposed to the oral environment, which causes the intense pain *areas of exposed dentin are subjected to mechanical, thermal, or chemical stimuli * Associated with gingival recession of the gingival margin

Question 27

What is the hydrodynamic theory?

Answer 27

Movement of dentinal fluid in the tubules results in nociceptor activation at the dentin-pulp complex. *Cold, hot, and pressure stimuli cause dentinal fluid to shift back and forth within the tubule * Movement of the fluid excites the nociceptors at the dentin-pulpal complex, and triggers sharp pain response

Question 28

traditional instrumentation terminology uses the terms scaling and root planing. How are they traditionally, each, defined?

Answer 28

scaling= instrumentation to remove plaque biofilm and calculus off the root surface root planing= trx procedure designed to remove diseased cementum that is contaminated with toxins or MOs

Question 29

Traditional terminology is being replaced with new terminology to better reflect modern therapy. What are the terms suggested to replace traditional terminology?

Answer 29

Periodontal instrumentation or periodontal debridement

Question 30

Traditionally the "toxic/infected" cementum was removed in root planing so the root would be glassy smooth. What is the modern beliefs about cementum removal?

Answer 30

conservation of cementum is of primary importance for optimal healing - root surfaces should only be instrumented to a level that results in resolution of tissue inflammation in periodontal tissues (bc cementum is necessary for new attachment)

Question 31

Nonsurgical therapy is the cornerstone of periodontal therapy. It is termed the

Answer 31

Gold standard

Question 32

What risk factors in pts would push you to co-manage your trx with a periodontist?

Answer 32

Unresolved inflammation and continued attachment loss despite nonsurgical perio therapy - crown lengthening or surgical procedures for tissue regeneration - significant medical issues of pt that affect management -stage 3 or 4 perio with severe destruction -intensive management of grade b or c perio

Question 33

What are some factors that would influence a necessary referral to a periodontist ?

Answer 33

*Pt wants a specialist * General practitioner may not have the depth of experience to treat advanced cases * Presence of complicating medical factors

Question 34

Within each dentinal tubule is an ___ ___, which is a direct extension of a cell in the tooth pulp known as an ___ and dentinal fluid

Answer 34

odontoblastic process ; odontoblast * dentinal fluid is extracellular fluid that surrounds the odontoblastic process

Question 35

To control dentinal hypersensitivity what are some measures that can be taken?

Answer 35

*In-office application of potassium oxalate, ferric oxalate * Fluoride and fluoride varnish * Potassium nitrate, strontium chloride, and sodium citrate—found in toothpaste for sensitive teeth

Question 36

How long do recently exposed roots take to decrease in sensitivity without sensitivity trx by the hygienist

Answer 36

within a few weeks * if exposed root surfaces are kept biofilm free by thorough self care

Question 37

What is the objective of patient-applied home irrigation?

Answer 37

diminish gingival inflammation by disrupting biofilms coronal to the gingival margin

Question 38

What is the goal of professional irrigation?

Answer 38

reduce the number of bacteria in the periodontal pocket space

Question 39

What is the dental water flosser mechanism of action?

Answer 39

Delivers a pulsating fluid that incorporates a compression and decompression phase * This creates two zones of fluid movement called hydrokinetic activity

Question 40

Describe the impact and flushing zones in hydrokinetic activity

Answer 40

*Impact zone---initial fluid contact near the gingival margin * Flushing zone---depth of fluid penetration within a subgingival sulcus or periodontal pocket

Question 41

What solutions can be used in home irrigators

Answer 41

*water *chlorhexidine (diluted with water) *listerine

Question 42

what is the ability of a chemical plaque control agent to be retained in the oral cavity and be released slowly over time with a continued antimicrobial effect

Answer 42

substantivity

Question 43

Subgingival irrigations is used to deliver medicament in?

Answer 43

deep pockets, furcations, around implants

Question 44

supragingival and subgingival irrigation role?

Answer 44

removal of biofilm, reduction in bleeding, reduction in gingival inflammation, reduction in periodontal pathogens and reduction in inflammatory mediators and destructive host response

Question 45

Indications for water flossers?

Answer 45

*Periodontal maintenance * Those noncompliant with dental floss * Individuals with special needs * Around dental implants * Individuals with diabetes * Around orthodontic appliances

Question 46

Depth of fluid penetration of a water flosser?

Answer 46

6mm

Question 47

Placement of standard irrigation tip

Answer 47

*Place the tip at a 90- degree angle at the neck of the tooth * Use the water spray to trace along the gingival margin

Question 48

Placement of ortho irrigation tip

Answer 48

* Place the tip at a 90- degree angle

Question 49

Placement of subgingival irrigation tip

Answer 49

*Adjust water pressure to lowest setting * Slide rubber tip gently beneath the gingival margin * Direct tip at 45- degree angle

Question 50

penetration of a toothbrush in mm

Answer 50

1-2mm

Question 51

oral rinsing penetration in mm

Answer 51

2mm

Question 52

toothpick/wooden wedge and interdental brush penetration in mm depends on

Answer 52

embrasure size

Question 53

dental floss penetration in mm

Answer 53

3mm