Perio Therapy Flashcards
How wide is the gingival cuff around the neck of the tooth?
1-2mm
what symptoms are associated with plaque-induced gingivitis?
- red/ swollen/ bleeding gums
- blunting of papillae
- reversible on removal of aetiological angent- plaque
- false pocket - not associated with bone loss.
what symptoms are associated with periodontitis?
- loss of periodontal connective tissue attachment
- apical migration of junctional epithelium (formation of periodontal pocket, lined with pocket epithelium)
- alveolar bone loss.
what is the main aetiological agent in perio disease?
microbial plaque.
what are secondary modifying factors in perio disease?.
Local and systemic causes.
what kind of microbes are found in supragingival plaque?
- gram +ve cocci and rods.
- aerobic unless thick layer
- little species diversity initially but increases.
what kind of microbes are found in subgingival plaque?
- gram -ve rods and spirochaetes
- highly anaerobic
- great species diversity
what are the virulence factors that make plaque pathogenic?
- protese
- leukotoxin
- bone resorbing factors
- capsule
- cytotoxic metabolites
- intro of inflammatory response
what is calculus?
plaque calcified from saliva.
what does supragingival calculus look like?
- creamy yellow
- visible
- found close to opening salivary ducts.
what does subgingival calculus look like?
- dark brown/ black
- below gumline
- found in any tooth
- mineral salts from GCF.
what are local contributing factors to plaque induced gingivitis?
- lack of saliva
- tooth anatomic factors
- dental resprations/ applications.
what are systemic risk factors to plaque induced gingivitis?
- associated with endocrine system (eg puberty / menstal cycle / pregnancy / diabetes)
- associated with blood dyscrasias (eg leukaemia associated gingivitis)
what are the causes of non-plaque induced gingivitis?
- genetics
- development of disorders
- inflammatory and immune conditions
what are the possible modes of progression of attachment loss in perio disease?
- linear/ continuous
- bursts of activity (random)
what are the perio classification s for the stages of the disease?
- initial
- moderate
- severe
what are the perio classifications for the grades of the disease?
- slow
- moderate
- rapid
what is meant by necrotising perio diease? and what group of people are most likely to get it?
it means that it may not cause any pain. and is associated with HIV
what is epidemiology?
study of the distribution and determinants of health-related states / events in specified populations and the application of thid to control health problems.
which condition is more common : periodontitis or gingivitis?
gingivitis
what is the pathway a patient should take from exam to recall?
- exam and perio history
- diagnosis
- Tx plan
- Tx (emergency / initial/ corrective / supportive)
- recall
what should you do if you patient is on anticoagulants?
INR taken prior to sub-gingival scaling/ RSD / surgery / XLA
why should an INR be taken before tx for pts on anticoagulants?
as there is an increased risk of bleeding.
what kind of history needs to be gotten from a patient presenting you with a complaint?
- presenting complaint
- history of presenting complaint
- past dental history
- medical history
what is BPE used for?
screening for pts.
what are the indicators in a WHO probe?
- ball end = o.5mm
- black band = 3.5-5.5mm
- 1st line = 8.5mm
- 2nd line = 11.mm
with BPE what do you record?
worst score in each sextant
How many teeth must you have in the sextant to take a BPE?
at least 2 (wisdom teeth dont count)
what does a BPE score of 0 mean?
healthy
what does a BPE score of 1 mean?
bleeding on probing
what does a BPE score of 2 mean?
supragingival/ subgingival calculus or plaque retention factor
what does a BPE score of 3 mean?
shallow pocket 3.5mm-5.5mm
what does a BPE score of 4 mean?
deep pocket 5.5mm +
what does a BPE score of * mean?
furcation
what age should you start to take BPEs on children?
7 years old.
what BPE scores can you give children?
0-2
why do you we screen for perio disease? (why do we take a BPE)
- establish/ grade the level of disease
- assist in reaching a diagnosis
- monitor response to tx
- establish further need for tx post therapy.
when should perio index be taken?
- before tx
- after completion of tx
- at review appointments,
what is the real name for a plaque free score?
O’Leary plaque index.
when should a plaque score be taken?
carried out at the start of tx
on what patients should a 6 point marginal gingival bleeding index be taken?
on patients with BPE of 1 +2. at the start of tx and when required.
How is a 6 point marginal gingival bleeding index taken?
- PCP10 probe inserted into gingival sulcus midbuccally and run towards mesial papilla, and the same to the distal papilla. This should also be repeated on the lingual/palatal surface.
what probe should you use for a 6 point marginal gingival bleeding index?
PCP10
when should periodontal indices be taken?
at the start of tx / 6-8 weeks after tx / on sextants BPE codes 3,4,*
what are the periodontal indices?
- BOP
- probing pocket depth chart
- attachment levels
- recession
- mobility
- furcation involvement
- suppuration
- bone levels.
How is BOP taken?
PCP 10 probe to base of pocket - record 6 sites of each tooth , if positive bleeding with occur.
how is a probing pocket depth chart taken?
PCP probe to base of pocket depth - 6 sites per tooth
How are attachment level scores taken?
measure from a fixed reference (CEJ or restoration) to base of pocket.
For recession where to do measure from and then to?
from gingival margin to CEJ
what does grade 1 mobility mean?
1mm horizontal movement
what does grade 2 mobility mean?
more than 1 mm horizontal movement
what does grade 3 mobility mean?
vertical movement
what is meant by grade 1 furcation involvement?
horizontal bone loss less than 1/3rd width of tooth
what is meant by grade 2 furcation involvement?
horizontal bone loss greater than 1/3rd width of tooth but not through to the other side.
what is meant by grade 3 furcation involvement?
horizontal through and through involvement.
what is suppuration?
Pus
how are bone levels recorded?
from xrays - recorded in mm or %. - should also record pattern and location of the bone loss.
what is a treatment plan dependent on?
correct diagnosis
what are the 3 stages of perio tx?
- initial
- corrective
- supportive
what should be done in the initial therapy of perio tx?
- base line indices
- instruction in OH techniques
- smoking cessation
- scaling/ RSD / elimination of plaque retention factors.
- XLA/endo/restorations/ dentures.
- monitor response to tx.
how can a patient mechanically control plaque?
toothbrushing
interdental brushes
-floss
how can patients pharmacological control plaque?
use of Dentifrices and mouth rinses.
to monitor response to tx when should periodontal indices be retaken?
8-12 weeks after initial therapy. (except bone levels)
why are periodontal indicies retaken 8-12 weeks after tx?
to determine if corrective/supportive therapy is needed
which type of manual toothbrush is best?
multilevel is more effective.
what type of electric toothbrush is best?
osculating
what % plaque free score do we try and achieve?
80% and higher.
what is the best toothbrushing technique?
modified bass.
how does Triclosan aid in plaque control?
- broad antibiotic agent
- found in colgate total.
how do stannous salts aid in plaque control?
- activity agains caries, plaque and gingivitis
- found in Oral-B pro-expert.
what is an example of anti-calculus dentifrices?
pyrophosphates.
how do anti-calculus dentifrices work?
interrupt the process of mineralisation of plaque due to super saturation of saliva with calcium and phosphate ions.
what ingredients in dentifices aid with hypersensitivity?
- potassium nitrate (Sensodyne Total Care F)
- strontium chloride (Sensodyne original)
- strontium acetate (Sensodyne Rapid Relief)
- Calcium sodium phosphosilicate (Sensodyne Repair and protect)
- potassium citrate (colgate sensitive)
- Arginine ( Colgate Pro-relief)
- sodium citrate (Rembrandt sensitive)
- stannous fluoride (Colgate Gel Kam Sensitive)
in what toothpaste is potassium nitrate found? and what is its function ?
Sensodyne Total Care F - antihypersensitivity, also contains fluoride,
in what toothpaste is strontium chloride found? and what is its function?
Sensodyne original - antihypersensitivity, but doesnt contain fluoride.
what can be found i mouthrinses that is directed against supragingival plaque?
- enzymes
- antiseptics
- natural products
- metal ions.
what are the effects of Chlorhexide?
- antiplaque agent.
- slowly released in active form over 12-24 hours
what are some problems with using Chlorhexide?
- staining
- altered taste
- increased deposition of supregingival calculus
- milcosal erosion
- parotid swelling.
what are the 3 A’s you should follow when giving smoking cessation advice?
- Ask
- Advise
- Act
what are some non-pharmacological aids that can be used to stop smoking?
- will power
- advise and counselling
- hypnosis
- acupuncture
- behavioural therapy.
what are some pharmacological aids that can be used to stop smoking?
- Nicotine replacement therapy
- zyban and champix tablets
- E- cigarettes.
when should corrective therapy be carried out?
after initial therapy.
what is the aim of corrective therapy?
- restore function and provide a stable occlusion
- restore aesthetics after resolution of inflammation and healing after XLa.
why can initial therapy fail?
- inadequate instrumentation
- poor plaque control / motivation
- confounding systemic factors
- gross deposits
- smoking habit changes
- host factors
- microbial factors.
what are some limitations to corrective therapy?
- operator skill
- allergy
- pt comfort
- pt ability for repeated applications
- efficacy
- cost.
when is periodontal surgery performed?
- when there is localised persisten pockets over 6mm
- aid access for RSD in diseased furcation area.
- to section roots from teeth with gross bone loss
- to reduce frenal interferences to Oh.
what can be a problem with periodontal surgery?
patient tolerance.
what are some examples of periodontal surgery to aid in aesthetics?
- crown lengthening
- root coverage
- removal of overgrowth/ hyperplasia (gingivectomy)
- papillary enhancement
- per-prosthetic surgery
what are some benefits of corrective therapy?
- decreased gingival swelling and bleeding
- sharper gingival contours may return
- motivates pts to continue with good OH
- facilitates impression taking.
what can be the disadvantages from corrective therapy?
- could cause recession and exposure of cervical dentine.
- loss of papillary contour
- supragingival crown margins
- may complicate access for OH
when creating a treatment plan for a patient what must be taken into consideration?
- pts wishes and availability
- age and adaptability/ motivation
- medical status
- disease levels
- resources
- skill levels (for both pt and operator)
what does support therapy depend on?
- patiet removal of soft deposits
- professional tx to temporarily reduce plaque
what should happen in a supportive therapy appointment?
- exam, re-evaluation, diagnosis ( indices taken)
- motivation, re-instruction, instrumentation
- Tx of re-infected sites
- polishing, fluorides, dermine future visit
what is the best way of detecting disease?
- retrospectively, with BOP taken at several recall visits.
For OH to be effective what needs to happen at supportive therapy appointments?
- Motivation
- re-instrumentation
- scaling.
what does it mean if a patient after tx has BOP % of less that 10%?
that they have a low risk of recurrence of the disease.
what does it mean if a patient after tx has BOP % of more that 25%?
that they have a hight risk of recurrence of the disease.
after how many weeks of corrective therapy can you scale the teeth again and why?
after the first 6 weeks otherwise it can disrupt healing.
How often should patient have supportive therapy appointments?
3 months = most common, but if stable then can be 6 months.
what is a periodontal abscess?
localised purulent infection within the tissue adjacent to the perio pocket.
what can a periodontal abscess do damage to?
can lead to destruction of the PDL and alveolar bone.
what are the classifications for periodontal abscessed?
- pulp necrosis
- periodontal infection
- pericoronitis
- trauma or surgery
what is pericoronitis?
an abscess between the bone and the 3rd molar - normally due to it being a food trap.
what microbes are found in periodontal abscesses?
- S. Viridans
- P. Gingivalis
- P. intermedia
- F. nucleatum
- C. rectus
- Capnocytophagea spp
- Tannerella forsythia
- spirochaetes.
what is the only aerobe microbe found in periodontal abscesses?
- S. Viridans.
what type of microbes are found in periodontal abscesses?
mainly Gram -ve anaerobes.
what are some aetiological factors that can cause periodontal abscesses?
- occlusion of pocket orifice.
- furcation involvement
- systemic antibiotic therapy
- diabetes.
what kind of pain do you get with pulpal pain?
sharp pain
what kind of pain do you get with perio pain?
throbbing, dull pain.
How is an acute periodontal abscess managed?
- control of infection
- relief from pain
- assessment of prognosis or need for further tx.
- check no impacter material in pocket
- relieve occlusion
- advise hot water rinse
- advise pain killers
- if cannot drain and sever pain give A/B
- review.
How is a periodontal abscess with pus managed
- achieve drainage
- advise hot salt water
- relieve occlusion
- advise pain killers if needed
- review
what are the signs of a periodontal abscess with systemic involvement?
- extraoral swelling
- Lymphadenopthy
- rarely cellulitis
- malaise
- raised temp
how would youmanage a patient with a periodontal abscess with systemic involvement?
- drainage
- systemic a/b
- review.
what are effects of necrotising periodontal disease?
- rapid onset
- painful, inderdental necrosis, bleeding gingivae
- necrotic ulcers affecting interdental papillae
- ‘punched out’ appearance
- ulcers painful, covered by grey slough
- gingival bleeding and possiblr halitosis
- possible lymph node involvement.
what are the predisposing factors associated with necrotising periodontal disease?
- stress
- immune suppression
- pre-existing gingivitis / poor oral hygiene / previous history of NPD)
- poor diet / malnutrition
- smoking.
how is necrotising periodontal disease managed?
- removal of depositis / oxidising mouthway / gentle OH and chlorhexidine
- A/B = metronidazole 200 for 3 days.
after the acute phase of necrotising periodontal disease, how is it them managed?
through perio therapy.
what causes Primary Herpetic Gingivostomtits?
- Herpes simplex virus type 1.
how is Primary Herpetic Gingivostomtits diagnosed?
- acute onset
- fever
- malaise
- cervical lymphadenopthy
- gingiva very acutely inflamed
- Vesicles (painful 2-3mm dome shape found on any part of the oral mucose. when ruptured leaving circular shallow ulcers with yellowish or grey floors and red margins. )
How is Primary Herpetic Gingivostomtits mamanged?
should be left for 7-18 days.
- anti-viral therapy needs to be used early to be effective.
what can happen if a clinitian catches Primary Herpetic Gingivostomtits?
can get a painful ‘herpetic whitlow’ on their hands.
