periodontal care Flashcards
What are the classifications for periodontal conditions as of the 2017 guidelines?
Please Give George Nine Percy Pigs Straight Past Meal Time Tonight.
- periodontal health
- Gingivitis
- Gingival diseases and conditions (non dental biofilm induced)
- Necrotising periodontal diseases
- Periodontitis
- Periodontitis as a manifestation of systemic disease
- Systemic diseases or conditions affecting the periodontal supporting tissues
- Periodontal abscesses
- Mucogingival deformities
- Traumatic occlusal forces
- Tooth and prosthesis related factors
What does staging periodontitis entail?
- Recording interproximal bone loss at the worst site of bone loss
- Stage 1, stage 2, stage 3, stage 4.
What does grading periodontitis entail?
- calculates rate of progression
- %bone loss/age
- Grade A, Grade B, Grade C
what does assessing periodontal status entail?
*Is it stable, in remission, or currently unstable?
Describe a healthy periodontium
- Gingival margin several millimetres coronal to the CEJ
- Gingival sulcus 0.5-3mm deep
- Alveolar crest 0.4-1.9mm apical to the CEJ in teenagers
what is the biological width of the tooth?
distance from cemento-enamel junction to alveolar bone crest
To diagnose clinical “periodontal health” you would expect to see what?
BPE screening showing bleeding on probing with intact or 10% reduced periodontium
what constitutes as gingivitis?
- gum inflammation
- Presence of plaque
- Is it biofilm induced - local/generalised?
- Is it non biofilm induced ?
describe the mechanisms of biofilm induced gingivitis
supragingival plaque accumulates on teeth, inflammatory cell infiltrate develops in gingival connective tissue. junction epithelium becomes disrupted. allows plaque to migrate apically and increases sulcus depth. creates false pocket.
When doing a BPE how would you diagnose gingivitis?
- 10-30% BOP = localised gingivitis
- > 30% BOP =Generalised gingivitis
- Presence of plaque retentive factors
necrotising ulcerative gingivitis is caused by what type of bacteria?
- fusiform
* Spirochete
how does pubertal gingivitis come about?
Increased inflammatory response to plaque mediated by hormonal changes. In teenagers can progress to periodontitis.
what are some non biofilm induced causes of gingivitis?
- Trauma
- Genetics
- Infection
- drug induced
- Systemic disease
What kind of drugs can cause gingivitis?
- cyclosporin
* Phenytoin
what systemic diseases can cause gingivitis?
- Haematological - Agranulocytosis
- cyclic neutropenia
- Granulomatous inflammations
- crohns
- sarcoidosis
- granulomatosis
what is the best approved method of treating gingivitis
- Rigourous oral hygiene/home care
- frequent scaling
- Surgery (especially in drug induced cases)
what are the 4 main distinguishing features of periodontitis?
- Apical migration of junctional epithelium beyond CEJ
- Loss of attachment of periodontal tissues to cementum
- Transformation of junctional epithelium to pocket epithelium
- Alveolar bone loss
How much attachment loss counts as periodontitis?
> 1mm
describe stage 1 periodontitis
<15% interproximal bone loss or <2mm
describe stage 2 periodontitis
interproximal bone loss around coronal 3rd of root
describe stage 3 periodontitis
interproximal bone loss around mid 3rd of root
describe stage 4 periodontitis
interproximal bone loss around apical 3rd of root
how do you describe the “extent” of periodontitis?
Localised up to 30% of teeth
Generalised if more than 30% (molar/incisor pattern)
describe grade A periodontitis
<0.5 when %bone loss/age (slow)
describe grade B periodontitis
0.5-1.0 when %bone loss/age (Moderate)
describe grade C periodontitis
> 1.0 when %bone loss/age (Rapid)
When recording and diagnosing during a periodontal screening what features of the gingival condition should be noted?
- gingival colour
- Contour
- swelling
- recession
- suppuration
- inflammation
When recording and diagnosing during a periodontal screening what features of the oral hygiene status should be noted?
- description of plaque status
- Describe surfaces covered in plaque
- presence of calculus
When recording and diagnosing during a periodontal screening what local risk factors should be noted?
- plaque retentive factors
- low frenal attachments
- malocclusion
- incompetent lip seal
- Mouth breathing
What is a simplified BPE?
Screening tool that has been simplified for 7-11 year olds. Performed with a WHO CPITN probe.
how much force should you apply to a CPITN probe when carrying out a simplified BPE?
20-25g - same as adults
What are the advantages of the simplified BPE technique?
- quick
- easy
- well tolerated
- Avoids false pocketing
what teeth are assessed in a simplified BPE?
UR6, UR1, UL6
LR6, LL1, LL6
What does a score of 0 mean in a simplified BPE?
Healthy
what does a score of 1 mean in simplified BPE?
Bleeding on gentle probing
what does a score of 2 mean in simplified BPE?
calculus or plaque retention factor
what does a score of 3 mean in BPE?
pocketing 4mm-5mm (black band visible but partially obscured)
what does a score of 4 mean in BPE?
pocketing of 6mm or greater (black band no longer visible)
what does a score of * mean in BPE?
Furcation involvement
How should gingivitis and periodontitis be treated in children and adolescents?
- Good toothbrushing
- Emphasise need to clean all surfaces
- Tooth brushing advice and fluoride advice
- Supervised/assisted brushing up to 7 years old
- Disclosing tablets
- fluoride mouthwash for patients undergoing fixed appliance therapy
Someone who gets a simplified BPE score of 1 should get what treatment and seen how regularly?
- OHI and prevention
* 6 months
Someone who gets a simplified BPE score of 2 should get what treatment and seen how regularly?
- OHI, prevention, scaling, removal of plaque retention factors
- 6 months
Someone who gets a simplified BPE score of 3 or 4 should get what treatment and seen how regularly?
- Full perio assessment, radiographs, scaling, RSD, OHI + prevention
- If they score 4 or * then refer to specialised periodontologist or paediatric dentist.
- Treat & review after 3 months
