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ODDR > Perio Therapy > Flashcards

Perio Therapy Flashcards

1
Q

How wide is the gingival cuff around the neck of the tooth?

A

1-2mm

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2
Q

what symptoms are associated with plaque-induced gingivitis?

A
  • red/ swollen/ bleeding gums
  • blunting of papillae
  • reversible on removal of aetiological angent- plaque
  • false pocket - not associated with bone loss.
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3
Q

what symptoms are associated with periodontitis?

A
  • loss of periodontal connective tissue attachment
  • apical migration of junctional epithelium (formation of periodontal pocket, lined with pocket epithelium)
  • alveolar bone loss.
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4
Q

what is the main aetiological agent in perio disease?

A

microbial plaque.

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5
Q

what are secondary modifying factors in perio disease?.

A

Local and systemic causes.

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6
Q

what kind of microbes are found in supragingival plaque?

A
  • gram +ve cocci and rods.
  • aerobic unless thick layer
  • little species diversity initially but increases.
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7
Q

what kind of microbes are found in subgingival plaque?

A
  • gram -ve rods and spirochaetes
  • highly anaerobic
  • great species diversity
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8
Q

what are the virulence factors that make plaque pathogenic?

A
  • protese
  • leukotoxin
  • bone resorbing factors
  • capsule
  • cytotoxic metabolites
  • intro of inflammatory response
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9
Q

what is calculus?

A

plaque calcified from saliva.

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10
Q

what does supragingival calculus look like?

A
  • creamy yellow
  • visible
  • found close to opening salivary ducts.
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11
Q

what does subgingival calculus look like?

A
  • dark brown/ black
  • below gumline
  • found in any tooth
  • mineral salts from GCF.
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12
Q

what are local contributing factors to plaque induced gingivitis?

A
  • lack of saliva
  • tooth anatomic factors
  • dental resprations/ applications.
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13
Q

what are systemic risk factors to plaque induced gingivitis?

A
  • associated with endocrine system (eg puberty / menstal cycle / pregnancy / diabetes)
  • associated with blood dyscrasias (eg leukaemia associated gingivitis)
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14
Q

what are the causes of non-plaque induced gingivitis?

A
  • genetics
  • development of disorders
  • inflammatory and immune conditions
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15
Q

what are the possible modes of progression of attachment loss in perio disease?

A
  • linear/ continuous

- bursts of activity (random)

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16
Q

what are the perio classification s for the stages of the disease?

A
  • initial
  • moderate
  • severe
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17
Q

what are the perio classifications for the grades of the disease?

A
  • slow
  • moderate
  • rapid
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18
Q

what is meant by necrotising perio diease? and what group of people are most likely to get it?

A

it means that it may not cause any pain. and is associated with HIV

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19
Q

what is epidemiology?

A

study of the distribution and determinants of health-related states / events in specified populations and the application of thid to control health problems.

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20
Q

which condition is more common : periodontitis or gingivitis?

A

gingivitis

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21
Q

what is the pathway a patient should take from exam to recall?

A
  • exam and perio history
  • diagnosis
  • Tx plan
  • Tx (emergency / initial/ corrective / supportive)
  • recall
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22
Q

what should you do if you patient is on anticoagulants?

A

INR taken prior to sub-gingival scaling/ RSD / surgery / XLA

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23
Q

why should an INR be taken before tx for pts on anticoagulants?

A

as there is an increased risk of bleeding.

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24
Q

what kind of history needs to be gotten from a patient presenting you with a complaint?

A
  • presenting complaint
  • history of presenting complaint
  • past dental history
  • medical history
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25
Q

what is BPE used for?

A

screening for pts.

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26
Q

what are the indicators in a WHO probe?

A
  • ball end = o.5mm
  • black band = 3.5-5.5mm
  • 1st line = 8.5mm
  • 2nd line = 11.mm
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27
Q

with BPE what do you record?

A

worst score in each sextant

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28
Q

How many teeth must you have in the sextant to take a BPE?

A

at least 2 (wisdom teeth dont count)

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29
Q

what does a BPE score of 0 mean?

A

healthy

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30
Q

what does a BPE score of 1 mean?

A

bleeding on probing

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31
Q

what does a BPE score of 2 mean?

A

supragingival/ subgingival calculus or plaque retention factor

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32
Q

what does a BPE score of 3 mean?

A

shallow pocket 3.5mm-5.5mm

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33
Q

what does a BPE score of 4 mean?

A

deep pocket 5.5mm +

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34
Q

what does a BPE score of * mean?

A

furcation

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35
Q

what age should you start to take BPEs on children?

A

7 years old.

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36
Q

what BPE scores can you give children?

A

0-2

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37
Q

why do you we screen for perio disease? (why do we take a BPE)

A
  • establish/ grade the level of disease
  • assist in reaching a diagnosis
  • monitor response to tx
  • establish further need for tx post therapy.
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38
Q

when should perio index be taken?

A
  • before tx
  • after completion of tx
  • at review appointments,
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39
Q

what is the real name for a plaque free score?

A

O’Leary plaque index.

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40
Q

when should a plaque score be taken?

A

carried out at the start of tx

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41
Q

on what patients should a 6 point marginal gingival bleeding index be taken?

A

on patients with BPE of 1 +2. at the start of tx and when required.

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42
Q

How is a 6 point marginal gingival bleeding index taken?

A
  • 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.
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43
Q

what probe should you use for a 6 point marginal gingival bleeding index?

A

PCP10

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44
Q

when should periodontal indices be taken?

A

at the start of tx / 6-8 weeks after tx / on sextants BPE codes 3,4,*

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45
Q

what are the periodontal indices?

A
  • BOP
  • probing pocket depth chart
  • attachment levels
  • recession
  • mobility
  • furcation involvement
  • suppuration
  • bone levels.
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46
Q

How is BOP taken?

A

PCP 10 probe to base of pocket - record 6 sites of each tooth , if positive bleeding with occur.

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47
Q

how is a probing pocket depth chart taken?

A

PCP probe to base of pocket depth - 6 sites per tooth

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48
Q

How are attachment level scores taken?

A

measure from a fixed reference (CEJ or restoration) to base of pocket.

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49
Q

For recession where to do measure from and then to?

A

from gingival margin to CEJ

50
Q

what does grade 1 mobility mean?

A

1mm horizontal movement

51
Q

what does grade 2 mobility mean?

A

more than 1 mm horizontal movement

52
Q

what does grade 3 mobility mean?

A

vertical movement

53
Q

what is meant by grade 1 furcation involvement?

A

horizontal bone loss less than 1/3rd width of tooth

54
Q

what is meant by grade 2 furcation involvement?

A

horizontal bone loss greater than 1/3rd width of tooth but not through to the other side.

55
Q

what is meant by grade 3 furcation involvement?

A

horizontal through and through involvement.

56
Q

what is suppuration?

A

Pus

57
Q

how are bone levels recorded?

A

from xrays - recorded in mm or %. - should also record pattern and location of the bone loss.

58
Q

what is a treatment plan dependent on?

A

correct diagnosis

59
Q

what are the 3 stages of perio tx?

A
  • initial
  • corrective
  • supportive
60
Q

what should be done in the initial therapy of perio tx?

A
  • base line indices
  • instruction in OH techniques
  • smoking cessation
  • scaling/ RSD / elimination of plaque retention factors.
  • XLA/endo/restorations/ dentures.
  • monitor response to tx.
61
Q

how can a patient mechanically control plaque?

A

toothbrushing
interdental brushes
-floss

62
Q

how can patients pharmacological control plaque?

A

use of Dentifrices and mouth rinses.

63
Q

to monitor response to tx when should periodontal indices be retaken?

A

8-12 weeks after initial therapy. (except bone levels)

64
Q

why are periodontal indicies retaken 8-12 weeks after tx?

A

to determine if corrective/supportive therapy is needed

65
Q

which type of manual toothbrush is best?

A

multilevel is more effective.

66
Q

what type of electric toothbrush is best?

A

osculating

67
Q

what % plaque free score do we try and achieve?

A

80% and higher.

68
Q

what is the best toothbrushing technique?

A

modified bass.

69
Q

how does Triclosan aid in plaque control?

A
  • broad antibiotic agent

- found in colgate total.

70
Q

how do stannous salts aid in plaque control?

A
  • activity agains caries, plaque and gingivitis

- found in Oral-B pro-expert.

71
Q

what is an example of anti-calculus dentifrices?

A

pyrophosphates.

72
Q

how do anti-calculus dentifrices work?

A

interrupt the process of mineralisation of plaque due to super saturation of saliva with calcium and phosphate ions.

73
Q

what ingredients in dentifices aid with hypersensitivity?

A
  • 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)
74
Q

in what toothpaste is potassium nitrate found? and what is its function ?

A

Sensodyne Total Care F - antihypersensitivity, also contains fluoride,

75
Q

in what toothpaste is strontium chloride found? and what is its function?

A

Sensodyne original - antihypersensitivity, but doesnt contain fluoride.

76
Q

what can be found i mouthrinses that is directed against supragingival plaque?

A
  • enzymes
  • antiseptics
  • natural products
  • metal ions.
77
Q

what are the effects of Chlorhexide?

A
  • antiplaque agent.

- slowly released in active form over 12-24 hours

78
Q

what are some problems with using Chlorhexide?

A
  • staining
  • altered taste
  • increased deposition of supregingival calculus
  • milcosal erosion
  • parotid swelling.
79
Q

what are the 3 A’s you should follow when giving smoking cessation advice?

A
  • Ask
  • Advise
  • Act
80
Q

what are some non-pharmacological aids that can be used to stop smoking?

A
  • will power
  • advise and counselling
  • hypnosis
  • acupuncture
  • behavioural therapy.
81
Q

what are some pharmacological aids that can be used to stop smoking?

A
  • Nicotine replacement therapy
  • zyban and champix tablets
  • E- cigarettes.
82
Q

when should corrective therapy be carried out?

A

after initial therapy.

83
Q

what is the aim of corrective therapy?

A
  • restore function and provide a stable occlusion

- restore aesthetics after resolution of inflammation and healing after XLa.

84
Q

why can initial therapy fail?

A
  • inadequate instrumentation
  • poor plaque control / motivation
  • confounding systemic factors
  • gross deposits
  • smoking habit changes
  • host factors
  • microbial factors.
85
Q

what are some limitations to corrective therapy?

A
  • operator skill
  • allergy
  • pt comfort
  • pt ability for repeated applications
  • efficacy
  • cost.
86
Q

when is periodontal surgery performed?

A
  • 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.
87
Q

what can be a problem with periodontal surgery?

A

patient tolerance.

88
Q

what are some examples of periodontal surgery to aid in aesthetics?

A
  • crown lengthening
  • root coverage
  • removal of overgrowth/ hyperplasia (gingivectomy)
  • papillary enhancement
  • per-prosthetic surgery
89
Q

what are some benefits of corrective therapy?

A
  • decreased gingival swelling and bleeding
  • sharper gingival contours may return
  • motivates pts to continue with good OH
  • facilitates impression taking.
90
Q

what can be the disadvantages from corrective therapy?

A
  • could cause recession and exposure of cervical dentine.
  • loss of papillary contour
  • supragingival crown margins
  • may complicate access for OH
91
Q

when creating a treatment plan for a patient what must be taken into consideration?

A
  • pts wishes and availability
  • age and adaptability/ motivation
  • medical status
  • disease levels
  • resources
  • skill levels (for both pt and operator)
92
Q

what does support therapy depend on?

A
  • patiet removal of soft deposits

- professional tx to temporarily reduce plaque

93
Q

what should happen in a supportive therapy appointment?

A
  • exam, re-evaluation, diagnosis ( indices taken)
  • motivation, re-instruction, instrumentation
  • Tx of re-infected sites
  • polishing, fluorides, dermine future visit
94
Q

what is the best way of detecting disease?

A
  • retrospectively, with BOP taken at several recall visits.
95
Q

For OH to be effective what needs to happen at supportive therapy appointments?

A
  • Motivation
  • re-instrumentation
  • scaling.
96
Q

what does it mean if a patient after tx has BOP % of less that 10%?

A

that they have a low risk of recurrence of the disease.

97
Q

what does it mean if a patient after tx has BOP % of more that 25%?

A

that they have a hight risk of recurrence of the disease.

98
Q

after how many weeks of corrective therapy can you scale the teeth again and why?

A

after the first 6 weeks otherwise it can disrupt healing.

99
Q

How often should patient have supportive therapy appointments?

A

3 months = most common, but if stable then can be 6 months.

100
Q

what is a periodontal abscess?

A

localised purulent infection within the tissue adjacent to the perio pocket.

101
Q

what can a periodontal abscess do damage to?

A

can lead to destruction of the PDL and alveolar bone.

102
Q

what are the classifications for periodontal abscessed?

A
  • pulp necrosis
  • periodontal infection
  • pericoronitis
  • trauma or surgery
103
Q

what is pericoronitis?

A

an abscess between the bone and the 3rd molar - normally due to it being a food trap.

104
Q

what microbes are found in periodontal abscesses?

A
  • S. Viridans
  • P. Gingivalis
  • P. intermedia
  • F. nucleatum
  • C. rectus
  • Capnocytophagea spp
  • Tannerella forsythia
  • spirochaetes.
105
Q

what is the only aerobe microbe found in periodontal abscesses?

A
  • S. Viridans.
106
Q

what type of microbes are found in periodontal abscesses?

A

mainly Gram -ve anaerobes.

107
Q

what are some aetiological factors that can cause periodontal abscesses?

A
  • occlusion of pocket orifice.
  • furcation involvement
  • systemic antibiotic therapy
  • diabetes.
108
Q

what kind of pain do you get with pulpal pain?

A

sharp pain

109
Q

what kind of pain do you get with perio pain?

A

throbbing, dull pain.

110
Q

How is an acute periodontal abscess managed?

A
  • 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.
111
Q

How is a periodontal abscess with pus managed

A
  • achieve drainage
  • advise hot salt water
  • relieve occlusion
  • advise pain killers if needed
  • review
112
Q

what are the signs of a periodontal abscess with systemic involvement?

A
  • extraoral swelling
  • Lymphadenopthy
  • rarely cellulitis
  • malaise
  • raised temp
113
Q

how would youmanage a patient with a periodontal abscess with systemic involvement?

A
  • drainage
  • systemic a/b
  • review.
114
Q

what are effects of necrotising periodontal disease?

A
  • 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.
115
Q

what are the predisposing factors associated with necrotising periodontal disease?

A
  • stress
  • immune suppression
  • pre-existing gingivitis / poor oral hygiene / previous history of NPD)
  • poor diet / malnutrition
  • smoking.
116
Q

how is necrotising periodontal disease managed?

A
  • removal of depositis / oxidising mouthway / gentle OH and chlorhexidine
  • A/B = metronidazole 200 for 3 days.
117
Q

after the acute phase of necrotising periodontal disease, how is it them managed?

A

through perio therapy.

118
Q

what causes Primary Herpetic Gingivostomtits?

A
  • Herpes simplex virus type 1.
119
Q

how is Primary Herpetic Gingivostomtits diagnosed?

A
  • 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. )
120
Q

How is Primary Herpetic Gingivostomtits mamanged?

A

should be left for 7-18 days.

- anti-viral therapy needs to be used early to be effective.

121
Q

what can happen if a clinitian catches Primary Herpetic Gingivostomtits?

A

can get a painful ‘herpetic whitlow’ on their hands.

ODDR (5 decks)

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