Perio VIVA Flashcards
What does BPE mean
Basic periodontal examination
What does CPITN mean
Community periodontal index of treatment needs
What is a BPE used for
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
Can aBPE used to diagnose periodontitis and gingivitis
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
Describe the numeric system for BPE scoring
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
What does a 6PPC record
Recession Pocket depth Mobility Bleeding on probing Furcation involvement
What probe is used for a BPE
WHO probe
Ball ended probe, ball is 0.5mm diameter
1st black band = 3.5-5.5mm
2nd black band 8.5-11.5mm
What are the limitations of using a BPE
- not designed to monitor patients
£ no distinction between true and false pockets - lack of detail within sextants
- no detail about recession or furcation involvement
What probe is used for a 6PPC
Williams probe
Incremented in my, up to 10mm with increments 4 and 6 missing so it is easier to read
What are the 5 signs of inflammation
Redness Heat Pain Swelling (loss of knife edged gingival margin, blunt papillae) Loss of function
What is gingivitis
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)
What is the difference between gingivitis and periodontitis
Gingivitis = reversible plaque induced inflammatory response to the gingiva Periodontitis = gingivitis progress and leads to periodontitis, irreversible and can lead to bone loss
Define the probing/pocket depth
Measurement from gingival margin to the base of pocket in mm
Williams probe used
Walking technique
What is the clinical attachment level
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
How do you calculate CAL in recession
Pocket depth + recession
Positive measurement
How do you calculate CAL in hyperplasia
Base pocket measurement - gingival margin level (CEJ)
= negative measurement
How do you measure gingival recession
Distance of gingival margin to CEJ
What are 5 possible sources of inaccuracy when measuring pocket depths
- position of gingival margin
- interference from calculus deposits/ overhangs
- amount of pressure applied
- misread probe
- probe position
Describe the clinical method you can use to distinguish between true and false pocketing
True pockets - increased probing depth due to loss of periodontal attachment
False pockets - increased probing depth due to gingival swelling or overgrowth, no CAL
What is bacterial plaque
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
How does plaque form
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
What features are significant to look at in radiographs for periodontal significance
Bone levels
Root length and shape
Furcation area in multi rooted tooth
Restorative status of tooth
What age can you use a BPE
Ages 7+
7-12 years = only codes 0, 1,2
12+ years = all codes
When doing a BPE how is the mouth divided up and why are 8s not recorded
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
What radiographs are useful for diagnosing periodontitis
Horizontal bite wings
Vertical bite wings
Periapicals
Sometimes panoramic
What does a horizontal bite wing show
Shows Crestal bone
Used if pockets less than 5mm
Gives detail of overhanging restoration
What does a vertical bite wing show
Bone levels shown in moderate or severe cases
Shows around teeth
What does a peri apical show
Indicated in severe periodontitis
Allows assessment of root morphology and furcation involvement
What is material alba
Soft accumulation of bacteria and tissue cells
No organised structure like plaque
Easily displaced with a 3 in 1 water spray
What is calculus
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
why does calculus form lingually
presence of salivary glands
what is a risk factor
likelihood that a disease will occur but doesn’t determine the presence of ti
what are the local risk factors for periodontitis
Anatomical =
furcations
root grooves + concavities, enamel pearls
Tooth position = mal-positioned teeth (crowding),
iatrogenic =
partial dentures, ortho
overhanging restorations
what are the systemic risk factors for periodontitis
modifiable =
smoking, diabetes, obesity, medications
non-modifiable =
age, genetics, hormonal influences (pregnancy), leukaemia
what are the 3 types of gingivitis
necrotising ulcerative gingivitis plaque-induced acute necrotising ulcerative gingivits hormonal drug induced
what drugs cause gingival hyperplasia (overgrowth)
nifedipine (Ca2+ channel blocker)
phenytoin (antiepileptic)
cyclosporin (immunosuppressant)
why do you measure recession
shows severity of periodontitis
2 methods of tooth brushing
BASS method
sulcus cleaning method
3 possible clinical features seen during periodontal healing
gum recession
reducing pocket size
dentine hypersensitivity
no effect on bone/cementum
4 reasons for deep scaling
- arrest progression of periodontitis
- increase effectiveness of patient self care by removing plaque retentive factors
- decrease probing depth
purpose of initial (non-surgical) periodontal therapy
- improve perio health
- decrease pocket depths
- remove plaque biofilms + calculus
- conservation of cementum
- arrest progression of periodontitis
4 common symptoms of periodontitis
red, swollen gums
bleeding while brushing
recessing gums
loose teeth
Name 3 different types of hand scaling instrument and indicate the sites where you would normally use them to remove calculus
Sickles
- Working end: Triangular, tip
- Supragingival
- H6/H7
Curettes
Working: Semi-circular, tow
-Supra/Subginigval
-2r2l 4r4l
Sonic Scalers
Describe 4 types of Oral Hygiene aids and briefly indicate their particular uses
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
name 2 periodontal diseases
chronic and aggressive
what are the differences between chronic and aggressive periodontal disease
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
what is a cavitron
hightech tool
uses ultrasonic waves through hand held tip -> gently vibrates plaque, bacteria + tartar off teeth
when should you not use/ contraindications for a cavitron
titanium implants restorative materials demineralisation areas hypersensitive teeth Older style pacemakers Infectious disease - AGP -, TB, Hep B Immunocompromised people
what is a sickle scaler used for
ONLY SUPRA-gingival scaling
working tip end can damage tissues if used sub-gingivally
common sites for calculus growth
near opening of salivary glands
- lingual aspect of lower incisors
- buccal aspect of upper 1st molars
common sites for plaque accumulation
all surfaces, but patients find difficult to clean
- interproximal surfaces
- lingual surfaces
what problems can gingival hyperplasia cause
- false pockets
- increased probing depth
- no attachment loss
- harder to brush
- negative recession
examples of plaque retentive factors
calculus deposits overhanging restorations caries + 2nd caries bad restorations/ bad quality overcrowding of teeth furcation areas
what is scaling/debridement
using instruments to remove plaque/calculus/stains from crown or root surfaces, and from within the pocket space
- supra + sub gingival scaling
what is root planning
treatment designed to remove cementum or surface dentine that is rough + contains impregnated calculus
what is RSD
- rigorous root planning not needed to restore perio health
- bacterial products can be removed without need of removing cementum
what are characteristics of healthy gums vs diseased
stippled, pink, firm
scalloped edge/contour
knife edged papilla
pocket depth <3mm
red, bleeding, soft
loss of scalloped edge
no stippling, inflammed, blunted papilla
difference between universal and specific curettes
universal = 2 cutting edges same level as each other specific = lower cutting edge automatically 70 angle to tooth surface when shank is parallel
how does smoking affect gingival bleeding
affects vasculature = ↓ blood flow in gums + supporting tissue, ⇡ chance inflammed + infected
smoking impair host response to infection + ↑ destruction of health perio tissues
what are indications to use ultrasonic scalers
calculus subgingival debridement NUG indication removeing ortho cements remove overhanging margins of restorations
advantages of using cavitron
- ↓operator time -> ↑ education time
- ↓ operator fatigue
- less damage to cementum
- penetrate deeper into pockets + removes more plaque subgingivally
- more patient comfot
- faster
disadvanatges of using cavitron
- hypersensitivity
- heat production can damage tissues
- AGP
what is the difference between bleeding indices (plaque distribution) and BoP
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
Advs + Disadsv of polishing after scaling
+ 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
difference between intrinsic and extrinsic staining + egs
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
What can a Williams probe be used for
Pocket depth, BoP, recession, mobility, furcation involvement
Determine size + extent of intramural lesions
Calculus presence
Remove excess material ( after cementing crown)
Determine various lesions
If 4 is given in BPE, should you continue with the sextant
Continue all sites in sextant
Help gain fuller understanding of perio condition and ensure furcation involvements aren’t missed
If patient with little supra gingival plaque but lots of BoP, what does this show
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
Teeth with receded gums, BPE code 0, why? Why no pockets?
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
Why is plaque important
Protects host from exogenous species, for immunity and innate host defences
Methods of non-surgical treatment can be used for periodontitis
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
What is biofilm
Layer of bacterial cells surrounded by extra cellular polymeric substances
Difference between bleeding score and BoP
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
