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BDS2 - OSCE & VIVA > Perio VIVA > Flashcards

Perio VIVA Flashcards

1
Q

What does BPE mean

A

Basic periodontal examination

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2
Q

What does CPITN mean

A

Community periodontal index of treatment needs

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3
Q

What is a BPE used for

A

Used as rapid screening tool to assess the health of the periodontium . Establish individuals with established periodontal disease and assess the need for further investigation and treatment

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4
Q

Can aBPE used to diagnose periodontitis and gingivitis

A

NO
BPE used to identify pockets and records depth of the deepest pockets but you can’t diagnose the extent or severity of the disease, as it is not site specific.
BPE probe used as a screening tool to access periodontal condition ONLY

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5
Q

Describe the numeric system for BPE scoring

A

0- clinically healthy <3.5mm, oral hygiene reinforced, black band visible

1- Bleeding, OHI, plaque & bleeding index, black band visible, YES calculus/overhangs

2- can bleed might not, OHI, removal of plaque retentive factors (supra-gingival scaling, restore YES overhangs & calculus), <3.5mm, black band visible, plaque & bleeding indices, treat cervical caries

3 - 3.5 - 5mm pocket depth, black band partially visible, OHI, removal of plaque retentive factors, root surface debridement, YES calculus/overhangs
Special Investigation - 6PPC in sextant with 3s only, consider radiographs, supra/sub gingival scaling

4 - >5.5mm, black band fully submerged, OHI, removal retentive factors, root surface debridement, YES calculus/overhangs
Special Investigation : 6PPC full mouth, Radiographs determine sites affected from 6PPC, referral to specialist

    • furcation involvement , full mouth 6PPC, Refer to specialist, same as 4
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6
Q

What does a 6PPC record

A 
Recession
Pocket depth
Mobility
Bleeding on probing
Furcation involvement
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7
Q

What probe is used for a BPE

A

WHO probe
Ball ended probe, ball is 0.5mm diameter
1st black band = 3.5-5.5mm
2nd black band 8.5-11.5mm

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8
Q

What are the limitations of using a BPE

A
  • not designed to monitor patients
    £ no distinction between true and false pockets
  • lack of detail within sextants
  • no detail about recession or furcation involvement
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9
Q

What probe is used for a 6PPC

A

Williams probe

Incremented in my, up to 10mm with increments 4 and 6 missing so it is easier to read

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10
Q

What are the 5 signs of inflammation

A 
Redness
Heat
Pain
Swelling (loss of knife edged gingival margin, blunt papillae)
Loss of function
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11
Q

What is gingivitis

A

Reversible plaque induced inflammatory response limited to the gingiva
Clinical signs present after 4/5 days of undisturbed plaque inflammation with inflammation sings (redness, bleeding, redness, swelling- loss of knife edged papillae)

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12
Q

What is the difference between gingivitis and periodontitis

A 
Gingivitis = reversible plaque induced inflammatory response to the gingiva
Periodontitis = gingivitis progress and leads to periodontitis, irreversible and can lead to bone loss
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13
Q

Define the probing/pocket depth

A

Measurement from gingival margin to the base of pocket in mm
Williams probe used
Walking technique

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14
Q

What is the clinical attachment level

A

Clinical attachment loss is loss of periodontal ligaments causing a pocket formation
Caused by apical migration of the junction along epithelium, destruction on connective tissues and reabsorption of alveolar bone

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15
Q

How do you calculate CAL in recession

A

Pocket depth + recession

Positive measurement

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16
Q

How do you calculate CAL in hyperplasia

A

Base pocket measurement - gingival margin level (CEJ)

= negative measurement

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17
Q

How do you measure gingival recession

A

Distance of gingival margin to CEJ

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18
Q

What are 5 possible sources of inaccuracy when measuring pocket depths

A
  • position of gingival margin
  • interference from calculus deposits/ overhangs
  • amount of pressure applied
  • misread probe
  • probe position
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19
Q

Describe the clinical method you can use to distinguish between true and false pocketing

A

True pockets - increased probing depth due to loss of periodontal attachment
False pockets - increased probing depth due to gingival swelling or overgrowth, no CAL

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20
Q

What is bacterial plaque

A

Complex community embedded in a matrix of salivary and bacterial origin
visible acumulation of biofilm resilient yellow/grey substance adheres strongly to introral hard surfaces

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21
Q

How does plaque form

A

Once Pellicle layer formed, pioneering species adhere to it and multiply
Then co-aggregation occurs (confluent layer)
Cell to cell interactions of bacteria takes 2-7days
Decrease in O2 tension and increase in anaerobic bacteria

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22
Q

What features are significant to look at in radiographs for periodontal significance

A

Bone levels
Root length and shape
Furcation area in multi rooted tooth
Restorative status of tooth

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23
Q

What age can you use a BPE

A

Ages 7+
7-12 years = only codes 0, 1,2
12+ years = all codes

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24
Q

When doing a BPE how is the mouth divided up and why are 8s not recorded

A

Sextants
7-4, 3-1, 1-3, 4-7
No 8s recorded because it’s common to have lots of false pocketing around those teeth

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25
Q

What radiographs are useful for diagnosing periodontitis

A

Horizontal bite wings
Vertical bite wings
Periapicals
Sometimes panoramic

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26
Q

What does a horizontal bite wing show

A

Shows Crestal bone
Used if pockets less than 5mm
Gives detail of overhanging restoration

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27
Q

What does a vertical bite wing show

A

Bone levels shown in moderate or severe cases

Shows around teeth

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28
Q

What does a peri apical show

A

Indicated in severe periodontitis

Allows assessment of root morphology and furcation involvement

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29
Q

What is material alba

A

Soft accumulation of bacteria and tissue cells
No organised structure like plaque
Easily displaced with a 3 in 1 water spray

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30
Q

What is calculus

A

Hard deposit formed by mineralisation of plaque, mineralised from the minerals in saliva
Often larger deposits found on lower lingual and upper buccal molars due to presence of salivary glands
Often covered by a layer of unmineralised plaque

31
Q

why does calculus form lingually

A

presence of salivary glands

32
Q

what is a risk factor

A

likelihood that a disease will occur but doesn’t determine the presence of ti

33
Q

what are the local risk factors for periodontitis

A

Anatomical =
furcations
root grooves + concavities, enamel pearls

Tooth position = mal-positioned teeth (crowding),

iatrogenic =
partial dentures, ortho

overhanging restorations

34
Q

what are the systemic risk factors for periodontitis

A

modifiable =
smoking, diabetes, obesity, medications

non-modifiable =
age, genetics, hormonal influences (pregnancy), leukaemia

35
Q

what are the 3 types of gingivitis

A 
necrotising ulcerative gingivitis
plaque-induced 
acute necrotising ulcerative gingivits
hormonal
drug induced
36
Q

what drugs cause gingival hyperplasia (overgrowth)

A

nifedipine (Ca2+ channel blocker)
phenytoin (antiepileptic)
cyclosporin (immunosuppressant)

37
Q

why do you measure recession

A

shows severity of periodontitis

38
Q

2 methods of tooth brushing

A

BASS method

sulcus cleaning method

39
Q

3 possible clinical features seen during periodontal healing

A

gum recession
reducing pocket size
dentine hypersensitivity
no effect on bone/cementum

40
Q

4 reasons for deep scaling

A
  • arrest progression of periodontitis
  • increase effectiveness of patient self care by removing plaque retentive factors
  • decrease probing depth
41
Q

purpose of initial (non-surgical) periodontal therapy

A
  • improve perio health
  • decrease pocket depths
  • remove plaque biofilms + calculus
  • conservation of cementum
  • arrest progression of periodontitis
42
Q

4 common symptoms of periodontitis

A

red, swollen gums
bleeding while brushing
recessing gums
loose teeth

43
Q

Name 3 different types of hand scaling instrument and indicate the sites where you would normally use them to remove calculus

A

Sickles

  • Working end: Triangular, tip
  • Supragingival
  • H6/H7

Curettes
Working: Semi-circular, tow
-Supra/Subginigval
-2r2l 4r4l

Sonic Scalers

44
Q

Describe 4 types of Oral Hygiene aids and briefly indicate their particular uses

A

Dental Flosses
-Subgingival cleaning
Between teeth
-Remove food particles and plaque between teeth Cant remove by brushing

Interdental cleaners

  • Help cleaning between teeth
  • Gentle on gums

Mouth rinses
-Fluroide release

Tongue cleaners

  • Remove buildup of bacteria
  • Help with bad breathe

Toothpaste

45
Q

name 2 periodontal diseases

A

chronic and aggressive

46
Q

what are the differences between chronic and aggressive periodontal disease

A

Chronic:

  • slow onset
  • relative to plaque + calculus
  • can be linked to systemic disease (diabetes)
  • very common

Aggressive:

  • rapid progression rate
  • not relative to plaque + calculus
  • no underlying conditions
  • not common
47
Q

what is a cavitron

A

hightech tool

uses ultrasonic waves through hand held tip -> gently vibrates plaque, bacteria + tartar off teeth

48
Q

when should you not use/ contraindications for a cavitron

A 
titanium implants
restorative materials
demineralisation areas
hypersensitive teeth
Older style pacemakers
Infectious disease - AGP -, TB, Hep B
Immunocompromised people
49
Q

what is a sickle scaler used for

A

ONLY SUPRA-gingival scaling

working tip end can damage tissues if used sub-gingivally

50
Q

common sites for calculus growth

A

near opening of salivary glands

  • lingual aspect of lower incisors
  • buccal aspect of upper 1st molars
51
Q

common sites for plaque accumulation

A

all surfaces, but patients find difficult to clean

  • interproximal surfaces
  • lingual surfaces
52
Q

what problems can gingival hyperplasia cause

A
  • false pockets
  • increased probing depth
  • no attachment loss
  • harder to brush
  • negative recession
53
Q

examples of plaque retentive factors

A 
calculus deposits
overhanging restorations
caries + 2nd caries
bad restorations/ bad quality
overcrowding of teeth
furcation areas
54
Q

what is scaling/debridement

A

using instruments to remove plaque/calculus/stains from crown or root surfaces, and from within the pocket space
- supra + sub gingival scaling

55
Q

what is root planning

A

treatment designed to remove cementum or surface dentine that is rough + contains impregnated calculus

56
Q

what is RSD

A
  • rigorous root planning not needed to restore perio health

- bacterial products can be removed without need of removing cementum

57
Q

what are characteristics of healthy gums vs diseased

A

stippled, pink, firm
scalloped edge/contour
knife edged papilla
pocket depth <3mm

red, bleeding, soft
loss of scalloped edge
no stippling, inflammed, blunted papilla

58
Q

difference between universal and specific curettes

A 
universal = 2 cutting edges same level as each other
specific = lower cutting edge automatically 70 angle to tooth surface when shank is parallel
59
Q

how does smoking affect gingival bleeding

A

affects vasculature = ↓ blood flow in gums + supporting tissue, ⇡ chance inflammed + infected
smoking impair host response to infection + ↑ destruction of health perio tissues

60
Q

what are indications to use ultrasonic scalers

A 
calculus
subgingival debridement
NUG indication
removeing ortho cements
remove overhanging margins of restorations
61
Q

advantages of using cavitron

A
  • ↓operator time -> ↑ education time
  • ↓ operator fatigue
  • less damage to cementum
  • penetrate deeper into pockets + removes more plaque subgingivally
  • more patient comfot
  • faster
62
Q

disadvanatges of using cavitron

A
  • hypersensitivity
  • heat production can damage tissues
  • AGP
63
Q

what is the difference between bleeding indices (plaque distribution) and BoP

A

Bleeding indicies
swiping motion, detects inflammation on marginal tissues, WHO or Williams probe

BoP
Williams + walking technique, measure inflammatory lesions deeper - base of sulcus
in 6PPC - red dot above probing depth. 6PPC not record plaque distribution

64
Q

Advs + Disadsv of polishing after scaling

A

+ polishing prepares for fissure sealant,ortho brackets
+ smoother surfaces easier to keep clean
+ formation of new deposits slowed down
+ fluoride better accepted into enamel

  • abrasives can remove small parts of enamel
65
Q

difference between intrinsic and extrinsic staining + egs

A

intrinsic = pigments present in enamel/dentine (grey/amber/purple)

  • excess F- exposure during tooth develop
  • tetracycline staining - ingestion
  • trauma in perm tooth - necrosis

Extrinsic = pigments from diet (tea, coffee, paan, smoking) black/brown

66
Q

What can a Williams probe be used for

A

Pocket depth, BoP, recession, mobility, furcation involvement
Determine size + extent of intramural lesions
Calculus presence
Remove excess material ( after cementing crown)
Determine various lesions

67
Q

If 4 is given in BPE, should you continue with the sextant

A

Continue all sites in sextant

Help gain fuller understanding of perio condition and ensure furcation involvements aren’t missed

68
Q

If patient with little supra gingival plaque but lots of BoP, what does this show

A

Low levels of long term OH
May have just brushed teeth on the day to impress dentist
Shows high level of inflammation in gingival tissues - increased blood flow to tissues

69
Q

Teeth with receded gums, BPE code 0, why? Why no pockets?

A

Patient had perio, so CAL and recession existed
Healed after treatment, long JE formed and no pocket present
Pocket depth decreased but CAL remained
Inflammation reduced so recession can now be seen

70
Q

Why is plaque important

A

Protects host from exogenous species, for immunity and innate host defences

71
Q

Methods of non-surgical treatment can be used for periodontitis

A

Scaling - using instruments to remove plaque/calculus/staining from crown or root surfaces or from within a pocket. Includes supra and sub gingival scaling

Root planing - treatment designed to remove cementum or surface denting that is rough and contains impregnated calculus

72
Q

What is biofilm

A

Layer of bacterial cells surrounded by extra cellular polymeric substances

73
Q

Difference between bleeding score and BoP

A

Bleeding score = measurement of inflammation at gingival margin, relates to OH status of patient, ideal for long term OH control

BoP = measures presence of inflammatory lesions located at base of perio pocket. Insertions of probe causes bleeding if gingiva inflamed and pocket epithelium ulcerated or atrophic. Red dot in 6PPC

BDS2 - OSCE & VIVA (2 decks)

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