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Periodontics D2 > Periodontal Considerations > Flashcards

Periodontal Considerations Flashcards

1
Q

During Puberty:
Levels of Prevotella intermedia _____________

Occurs during age _____ to _______

Estrogen/Progesterone levels ______

Gingivitis levels _________________

A

INCREASE

Age 11 to 14

INCREASE

INCREASE

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2
Q

How to manage puberty gingivitis?

A

1) OHI (frequent reinforcement)
2) Scaling & polishing
3) Antimicrobial mouth rinses (CHX)
4) Local/systemic antimicrobials if severe & medical history indicates need

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3
Q

During Pregnancy, estrogen levels are _____________, and progesterone levels are ___________

A

DECREASED (estrogen)

INCREASE (progesterone)

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4
Q

What are the adverse pregnancy outcomes (4) ?

A

1) Pre-term Birth
2) Low Birth Weight
3) Preeclampsia
4) Fetal Growth Restriction & Development

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5
Q

Menadione is an essential nutrient for ___________

A

P. intermedia

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6
Q

Menadione =

A

Methyl-naphthalenedione

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7
Q

Progesterone =

A

Naphthoquione

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8
Q

P. intermedia can substitute naphthoquione for _____________________

A

methyl-naphthalenedione.

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9
Q

Elevated progesterone levels will facilitate ________ and _________ of ____________

A

Growth
colonization
P. intermedia

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10
Q

P. Intermedia is tissue invasive and associated with _______________ and ____________ formation

A

Gingival inflammation

Pyogenic granuloma formation

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11
Q

What are the inflammatory mediators for pregnancy?

A

IL1, IL 6 TNF-alpha, and PGE 2

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12
Q

What are the Acute Phase Responses ?

A

1) C-reactive protein
2) Haptoglobin
3) Fibrinogen
4) Amyloid A

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13
Q

What are the Periodontal pathogens associated with pregnancy?

A

1) P. gingivalis
2) T. forsythia
3) Campylobacter rectus
4) Provetella intermedia
5) Treponema denticola
* *Endotoxins

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14
Q

Periodontal disease + P. i, Fusobacterium, &

Campylobacter recta —–>

A

Placental invasion w/ fetal exposure to bacterium, LPS, and bacterial antigens

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15
Q

Periodontal disease can lead to increased levels of ?

A

1) Inflammatory mediators (IL 1, 6, TNF-a and PGE2)

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16
Q

PGE2 can lead to ____________ contraction

A

Pre-mature uterine

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17
Q

Premature uterine contraction leads to what?

A

Pre-term low birth weight delivery

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18
Q

What are the primary objectives for managing periodontal disease in pregnancy ?

A

1) Achieve a health oral environment

2) Maintain optimal oral hygiene (patient education)

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19
Q

What is the effective Dental Treatment for the 1st Trimester?

A

No treatment/Emergency only

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20
Q

What is the effective Dental Treatment for the 2nd Trimester?

A

Safest time frame for treatment

  • control active disease
  • eliminate potential problems
  • postpone periodontal surgery
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21
Q

Last month of 3rd Trimester_________________

A

Selective treatment

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22
Q

Dental radiographs in Pregnancy?

A

1) Lead apron
2) High speed film
3) safety established but desirable not to have irradiation during 1st trimester
4) 2008 ADA guidelines: ONLY required to aid in establishing a definitive diagnosis

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23
Q

Medications in Pregnancy?

A

1) Consult FDA classification system

2) 1-2% of material drug dose is excreted in breast milk

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24
Q

Avoid which drugs during pregnancy?

A

1) Lidocaine
2) Bupivacaine
3) Procaine
* *Use all these with caution

4) ASPIRIN (AVOID in 3rd trimester)
5) Ibuprofen (AVOID in 3rd trimester)

6) Codeine
7) Oxycodone
8) Hydrocodone
* **AVOID PROLONGED USE

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25
Q

Which ABX should a pregnant woman avoid?

A

1) Tetracycline **
2) Clarithromycin **
3) Ciprofloxacin
4) Metronidazole

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26
Q

Which drugs to avoid while breast feeding?

A

1) Aspirin

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27
Q

Which ABX to avoid while breast feeding?

A

1) Tetracycline **
2) Ciprofloxacin
3) Metronidazole
4) Gentamicin
5) Vancomycin
6) Benzodiazepines
7) Barbiturates

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28
Q

What is considered a medically compromised patient?

A

1) hypertension
2) Ischemic heart disease
3) congestive heart disease
4) cardiac pacemakers/defibrillators
5) Infectious Endocarditis
6) Ischemic Cerebrovascular disease

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29
Q

Bacteremia leads to what in Atherosclerosis, Cardiovascular & Cerebrovascular disease?

A

Bacterial induced platelet aggregation & endothelial invasion

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30
Q

Immune response leads to what in Atherosclerosis, Cardiovascular & Cerebrovascular disease?

A

Antibodies to bacteria and cross-reactive antigens (e.g heat shock protein)

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31
Q

What is the effect of inflammation of the vessel wall in periodontal disease?

A

Smooth muscle cells + Vascular endothelium–> collagen elastin, Upregulation of ICAM -1 and V CAM-1–> PMNs , macrophages and Foam cells—> Atheroma formation (Coronary vascular disease)

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32
Q

Increased CRP in the liver does what?

A

Binds to epitopes on lipid membranes of damaged cells leading to CRP– C’ activation leads to PMN chemotatix and phagocyte activation causing tissue damage

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33
Q

Increased SAA in the liver causes what ?

A

Promotes lipid deposition in atheroma –> Atheroma formation (coronary vascular disease)

34
Q

_________ + ___________ activates the C’ cascade via the classical pathway

A

CRP + C1 q

35
Q

Increased Fibrinogen in the liver in perio disease causes what?

A

Thrombus fomation–> Atheroma formation (coronary vascular disease)

36
Q

Hypertension is present in ________ american adults.
Systolic BP > or equal to _______ Hg
Diastolic BP > or equal to _______Hg

A

> 20%
140 mm Hg
90 mm Hg

37
Q

When measuring BP take _______ readings, _____ reading, ______ minutes apart at a min of ______ office visits

A

multiple
2
10
2

38
Q

Normal BP = _____

Pre-hypertention = _______

A
39
Q

What is stage 1 hypertension?

What should you do?

A
  • 140-159/ 90-99)
  • inform patent and routine medical consult
  • Monitor BP @ each appointment
  • Minimize stress
  • No changes in dental Tx
40
Q

What is stage 2 hypertension?

What should you do?

A

> or equal to 160/ > or equal to 100

  • inform patent and routine medical consult
  • Monitor BP @ each appointment
  • Minimize stress
  • Selective dental care when BP is or equal to 180 or diastolic > or equal to 100 IMMEDIATE MEDICAL ATTENTION ONLY DO EMERGENCY CARE
41
Q

What are the dental consideration or hypertension?

A

1) DONT treat if not under MD
2) Local anesthesia w/ epi 1: 100,000 or without
3) Ensure profound local anesthesia
4) review medication/drug interaction

42
Q

If you have unstable angina _______ treatment ONLY

A

Emergency

43
Q

If stable angina:
Pt brings _________
Local anesthesia w/ _________ for _____ patients
Carefully ____ during treatment

A

Nitroglycerin
Epi
Hypertensive
Monitor

44
Q

How long should patient wait after MI or STROKE to have TX?

A

6 MONTHS

Note: Then treat as stable angina & BEST to obtain medical consult prior to TX

45
Q

Congestive Heart Failure:
_________ problem- inadequate ____ to tissue
consult with _______________
Review _______________
Treat in ___________ postion
__________ appointments /_______ reduction

A 
Pump
O2
Physician
Medications/drug interaction
Upright 
Short
Stress
46
Q

All pacemakers places in the last _______ are shielded

A

10 yrs

47
Q

With defibrillators, patients may exhibit _________ movement.
Consider using a _______ during Tx

A

Sudden

Bite-block

48
Q

In Infectious (Bacterial endocarditis):

Microbes colonize ________ or _________
___________ strep is most common
Periodontal bugs involved are _______, _______ , and ______

A
  • Endocardium
  • heart valves
  • Alpha hemolytic
  • Eikenella corodens
  • A.a
  • Capnocytophaga spp
49
Q

How can a dental procedure lead to infectious endocarditis?

A

Dental procedure–> Bleeding–> Transient bacteremia–>Possible Infectious Endocarditis

50
Q

In Infectious (Bacterial endocarditis):

Identify level of patient _________
Provide oral hygiene __________
Educate patient about importance of ___________
Treatment should include__________, ____________, __________ , _____________

A
  • Risk
  • instructions
  • maintaining perio health w/ respect to transient bacteria
  • Pre- treatment with CHX
  • DECREASE # of visits
  • 7 + days between appoints (10-14 days)
  • Regular recall/perio maintenance
51
Q

MOST patients ________ antibiotics before dental procedures to prevent infective endocarditis (prophylaxis)

A

DO NOT NEED

52
Q

Which cases are worth the risks for dental prophylaxis?

A

1) artificial heart valve
2) history of having IE
3) certain specific, serious congenital heart conditions

53
Q

Which type of cases have taken prophylactic ABX in the past but NO LONGER need them?

A

1) Mitral valve prolapse
2) Rheumatic heart disease
3) bicuspid valve disease
4) calcified aortic stenosis
5) Congenital heart conditions (septal defect, atrial defect, hypertrophic cardiomyopathy)

54
Q

CVA =

Wait how long to do perio Tx?

A

Stroke

-6 months

55
Q

Ischemic =

A

Atherosclerosis

56
Q

Hemorrhagic =

A

Hypertension

57
Q

What are the TX considerations for Cerebrovascular Accident ?

A

1) Short appointments
2) Ensure profound anesthesia
3) concentration of epi in local anesthetic no greater than 1: 100,000
4) consider using light conscious sedation
5) Obtain MD consult (INR)
6) Monitor BP during TX

58
Q

What is the Pathobiology of Diabetes (Type I)

A

Depletion of Beta cells–> lack of insulin–>hyperglycemia–>cellular starvation–> (retinopathy, nephropathy, angiopathy, neuropathy, delayed wound healing, periodontitis)–> increased lipolysis–> increase in FFA–> Elevated Ketone levels–>KETOACIDOSIS–> DEATH or pathology

59
Q

What is the Pathobiology of Diabetes (Type II)

A

Diet & Obesity–> elevated FFA–> Lipocyte secretion of TNF alpha–> insulin resistance–> DIABETES –> (retinopathy, nephropathy, angiopathy, neuropathy, delayed wound healing, periodontitis)

60
Q

What can lead to ELEVATED synthesis of Inflammatory cytokines (TNF alpha, IL-1, IL 6 and PGE2)?
(keep in mind this later leads to chronic disease like diabetes)

A

1) Obesity

2) Periodontitis (bacterial factors)– can be genetic or environmental [smoking]

61
Q

BMI of _______ is overweight

BMI of _______ is obese

A

25-29.9

>30

62
Q

Obesity has been suggested to be associated with an INCREASED susceptibility to ____________

A

Bacterial infection (perio disease)

63
Q

Study that analyzed Body weight & perio infection suggested that response association of BMI with __________ in ___________

A
  • Increase

- Periodontal pockets

64
Q

Normal HbA1c assay _________
Good diabetes control _______
Moderate diabetes control_____
poor_________

A

4-6%

8%

65
Q

Diabetes Alert:

A

1) Family history
2) Age > 40
3) Classic symptoms (3 P’s)
4) Perio abscesses (multiple & recurrent)
5) Rapid alveolar bone loss
6) poor response to Tx

66
Q

Signs and symptoms of Diabetes

A

1) Xerostomia
2) burning of mouth
3) Perio abscesses
4) Dental caries
5) Candidiasis

67
Q

What are the periodontal considerations for diabetes?

A

1) Impaired wound healing
2) increased plaque activity (xerostomia)
3) Increased bone resorption
4) Altered PMN chemotaxis
5) Periodontal Abscesses

68
Q

What are the intrinsic changes of the aging periodontium?

A

1) DECREASED epithelial turnover rates with age
2) DECREASED progenitor cell reserves
3) Oral epithelium becomes thin
4) Reduced keratinization

69
Q

What are the Stochastic(RANDOM) changes of the aging periodontium?

A

1) Changes within cells result in morphologic and physiologic changes
2) Structures become stiffer
3) Loss of elasticity

70
Q

What are the Physiologic changes of the aging periodontium?

A

1) PDL LOSS of elasticity
2) DECREASED in vascularity
3) DECREASE in bone density
4) INCREASE in bone resorption
5) INCREASE in cementum thickness

71
Q

What are the Functional changes of the aging periodontium?

A

1) REDUCED mitotic activity
2) REDUCED metabolic rate
3) REDUCTION in healing capacity & rate
4) Inflammation develops more rapidly and more severely

72
Q

Risk factors for older adults and perio disease are the ________ for any age

A

Same

73
Q

The older adults and perio disease have ________ numbers with advanced disease

A

fewer (problem teeth removed?)

74
Q

When treatment planning for older adults what should we do?

A

1) Carefully review medical status
2) Assessment for PD, CAL, Mobility, radiographic bone loss of remaining teeth
3) Diagnosis
4) Initial Therapy- Non-surgical
5) Re-evaluation
6) Restorative/ implants OK
7) Maintenance

75
Q

Oral Bisphosphonates are used for the treatment of __________ and it is associated with _____________

A

-Bone cancer, other diseases
-Avascular bone necrosis of the jaws
(BIONJ) Biphospho induced osteonecrosis of the jaw

76
Q

Intravenous Bisphosphonates =

A

1) Aredia

2) Zometa

77
Q

Individual taking oral Bisphosphonates (Fosamax, Aconel and Boniva) for > 3 years may be at a __________ risk for loss of newly placed ____________ and ___________ following tooth ________ or periodontal surgery involving bone exposure.

A
  • GREATER
  • implants
  • BIONJ
  • Extractions
78
Q

What are the Treatments for Sjogrens syndrome and diabetes ?

A

1) Salivary substitues (Salivart)

2) Salivary Stimulation (Sugarless candy–lemon drop, Sugarless gum)

79
Q

In the Elderly patient what are the special considerations for root caries?

A

1) Susceptibility due to gingival recession

2) Recurrent carries around old restoration & crowns

80
Q

In the Elderly patient what are the special considerations ?

A

1) Mental capacity (Senile Dementia, Alzheimers)
2) Depression
3) Nutrition
4) Neuromuscular Control (Parkinsonian Tremor)

Periodontics D2 (12 decks)

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