Perio textbook Flashcards
What are the symptoms of periodontal disease?
- Bleeding gums
- Tooth sensitivity
- Tooth mobility
- Bad breath
- Loss of taste
- Pain on chewing(due to tooth mobility)
- staining of teeth (There is a roughened surface for the stain to stick to)
Discuss smoking as a risk factor
Impairs WBC function- impaired wound healing
Reduces gingival blood flow- suppressing signs and symptoms of gingivitis
Increases the production of inflamation mediating cytokines- tissue breakdown.
Discuss the general oral health of smoker?
- Lots of plaque and calculus build up.
- Higher mean probing pocket depths and more sites with deep pockets.
- Greater gingival recession
- Alveolar bone loss and furcation involvement
- No bleeding on probing
*
How do we treat smokers?
- Good daily plaque control
- Regular supra and subgingival debridement
- Avoiding hard or soft tissue grafting (due to the reduced healing capacity)
Discuss diabetes as a risk factor for periodontal disease
Diabetes causes reduced wound healing.
When it is uncontrolled, there is an increased glucose level.
The glucose needs to be used, so is used to change cell conformation.
This confuses the immune system- activating it.
This results in:
- Glycation products infiltrating the vessels resulting inflammation.
- A reduced lumen causing less blood flow
- Less oxygen and nutrients.
- Poorer wound healing
How do we treat diabetic patients in perio?
We need to check the level of glycated haemoglobin before treatment (this indicates the patients glycaemic control by showing their haemoglobin turnover over the last of 3 months)
The level should be <= 48 mmol/mol
Discuss stress as a risk factor in perio?
Stress produces cortisol
Cortisol suppresses the immune system which allows periodontal disease.
Discuss malnutrition as a risk factor in perio.
Malnutrition means the patient does not have the right nutrients, this weakens their immune system and causes more inflammation.
Discuss medications as a risk factor for perio?
Some medications have side effects that impact perio e.g. calcium channel blockers/ anti-epileptic drugs/immunosuppresants
The drug interacts with host fibroblasts causing increased deposition of connective tissue (gingival overgrowth and plaque overgrowth)
Discuss why hormones are a risk factor for periodontal disease.
A change in hormones such as pregnancy or puberty
This can cause gingival overgrowth.
Why is oestoporosis a risk factor for periodontal disease.
Osteoporosis patients have bad bone quality.
The bone resorption progresses much faster.
Discuss some local risk factors that infleunce periodontal disease?
Anatomical- e.g. malpositioned teeth/ enamel pearls.
Acquired e.g. overhangs/ orthodontic appliances/ bad restoration margins.
Occlusal Trauma- periodontal bone loss is quicker if you start with less bone.
How does periodontitis impact systemic health.
Periodontitis activates the immune system and cells which can move to other parts of the body causing systemic inflammation elsewhere.
This inflammation also compromises the barrier function of the gingival epithelium, allowing an ingress of bacteria & bacterial products into systemic circulation.
What other diseases can be caused by periodontitis?
Hypertension- Inflammation of the blood vessels, decreases the lumen thereby increasing blood pressure.
Rheumatoid Arthritis- Inflammatory cells spread to the area of arthritis and increase the inflammatory response increasing cartilage loss.
Pre-eclampsia- High blood pressure problem
Indirectly caused by periodontal bacteria activating the immune system.
Directly caused by periodontal bacteria spreading to the baby.
Alzheimers-Activation of the immune system increases the production of plaques and tangles which build up in between nerve cells (causing impairment of memory and function)
Discuss the pocket size/ black band/ observation for BPE code 0
<3.5mm- black band visible- no observations
Discuss the pocket size/ black band/ observation for BPE code 1
<3.5mm- black band visible- bleeding on probing.
Discuss the pocket size/ black band/ observation for BPE code 2
<3.5mm- black band fully visible- bleeding on probing and calculus deposits.
Discuss the pocket size/ black band/ observation for BPE code 3
3.5mm-5.5mm/ partially visible black band
Discuss the pocket size/ black band/ observation for BPE code 4
>5.5mm- black band not visible
What does the * mean in a BPE
There is furcation involvement.
Compare your next step in periodontal testing for a BPE code 3 compared to a code 4.
Compare the BSP & SDCEP GUIDELINES.
code 3 in 1 sextant- a 6 point pocket chart for that sextant.
code 3 in more than 1 sextant- 6 point pocket chart for the full mouth.
code 4- a 6 point pocket chart for the whole mouth.
BSP- After initial treatment
SDCEP- before and after initial treatment.
List Ramfjords teeth?
16
21
24
36
41
44
What is the function of the modified plaque and bleeding score?
These are used to determine patient engagement and decide if the patient can advance to formal periodontal treatments (pocket charting and root surface debridement)
What scores are we aiming for in the modified plaque and bleeding scores and when?
To show patient engagement and progress with treatment (PMPR) we want:
<30% plaque score
<35% marginal bleeding score
or <50% improvement in both.
These mean our patient has the ability to maintain a high oral hygiene level. (we need this high level for periodontal treatment to be successful)
Whereas our aim for the end of treatment is:
<10% bleeding score
<15% plaque score.
No pockets >4mm- would be too large for the patient to be able to clean.


