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periodontal diagnosis Flashcards

1
Q

what is needed to make a periodontal diagnosis?

A
  • thorough history
  • risk assessment
  • clinical exam- bpe
  • radiographic exam
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2
Q

what is BOP?

A

risk marker- best form of indicator of disease- however only 30% of sites go on to develop LOA- so essentially we are overtreating patients as we cannot determine which sites will progress and which sites wont.

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3
Q

what does BPE stand for?

A

basic periodontal examination

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4
Q

what is the purpose of bpe?

A

a screening tool used to identify those who require more detailed perio exam and give a brief indication of treatment required

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5
Q

when should bpe be carried out?

A
  • all new patients
  • routine appointments
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6
Q

what probe do you use for bpe and what force do you use?

A

who probe
20-25g

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7
Q

what are the advantages of using BPE?

A
  • only 1 piece of equipment needed
  • quick and simple
  • indicates treatment required
  • recognised internationally
  • indicate furcation involvement
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8
Q

what are the disadvantages of using bpe?

A
  • need specialised probe
  • not used for under 7s
  • lacks detail on specific teeth or disease activity
  • does not differentiate between false and true pocketing
  • not for implants
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9
Q

what teeth are examined in 7-16 yo?

A

ur6, ur1, ul6, ll1, ll6, lr6
for 7-12- 0,1,2
>12-17- full bpe score

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10
Q

how do you carry out a bpe?

A
  • let the pt know the process and gain consent
  • walk the probe round the tooth and mark down the worst site within each sextant- must have at least 2 teeth in each sextant- if only 1 move to adjacent sextant
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11
Q

meaning of bpe score 0

A
  • black band fully visible
  • no ppds >3.5mm
  • no calculus or overhangs
  • no bop
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12
Q

treatment for bpe score 0

A

nil

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13
Q

meaning of bpe score 1

A
  • black band fully visible
  • no calculus/overhangs
  • no ppds >3.5mm
  • WITH bop
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14
Q

treatment of bpe score 1

A

OHI

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15
Q

meaning of bpe score 2

A
  • black band fully visible
  • no ppd >3.5mm
  • calculus and/or overhangs presentt
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16
Q

treatment of bpe score 2

A
  • OHI
  • removal of plaque retentive factors
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17
Q

meaning of bpe score 3?

A
  • black band partially visible
  • ppd between 3.5 and 5.5mm
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18
Q

treatment of bpe score 3?

A
  • ohi
  • plaque and bleeding charts
  • radiographic assessment
  • initial therapy (supra/sub ging PMPR and OHI)
  • review in 3 months with localised 6ppcs in involved sextants
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19
Q

what is code 4?

A
  • blank band no longer visible
  • ppd >5.5mm
20
Q

treatment for code 4

A

OHI
plaque and bleeding charts
6 point pocket charts
radiographs
RSD of sites greater than or equal to 4mm with bop or sites greater than 5mm
- review in 3 months with post op 6ppcs

21
Q

what does * mean

A

furcation involvement

22
Q

what is treatment for *

A

as for code 4

23
Q

what are the purpose of plaque and bleeding charts?

A
  • helps clinician and patient see where they are not cleaning well
  • can be used as a motivational tool
  • at review appointment new b and p charts can be used as comparison to assess if improvement or deterioration in OH.
24
Q

what do 6ppc tell us?

A
  • bop
  • ppds
  • FI
  • mobility
25
what are the purpose of 6ppc ?
- more detailed periodontal charts - indicate treatment required - motivational tool for patients - can be used to assess improvement or deterioration after treatment
26
explain code 0,1,2 on british society of periodontology flow chat
- <10% bop - CGH - 10-30% bop - localised ging - > 30% generalised gingivits
27
what does code 3 pathway indicate?
no evidence of ID recession - may require radiographic assessment - initial therapy (PMPR and OHI) if pockets less than 4mm and no radiographic bone loss- follow 0,1,2 - if pockets greater than or equal to 4mm and/or radiographic ev of bone loss- code 4 pathway
28
code 4 pathway- pattern of disease always 4 if radiographs and or ID recession
molar incisior pattern affects <30% teeth- localised affects >30% teeth- generalised
29
staging of code 4
severity of disease- worst site of bone loss stage 1- mild- less than 15% bone loss stage 2- moderate- bone in the coronal 3rd of root stage 3- severe- bone loss in the mid 3rd of root stage 4- very severe- bones loss in the apical third of root
30
grading code 4?
progression of disease A- slowly progressing- <0.5 B- moderate progression- 0.5-1 C- rapid- >1 % bone loss/age
31
assessment of periodontal status code 4-
stable- <10% bop, ppd < or equal to 4, no bleeding at sites of 4 in remission (partially responsive)- >10% BOP "" unstable- bop at sites equal or greater than 4mm, sites >5mm
32
what else is included in a periodontal diagnosis?
risk factors
33
what is the gold standard RG for perio?
PA
34
what other radiographs can be used?
vertical bws and DPT
35
why are radiographs useful for periodontal diagnosis?
- can assess extent of bone loss- pattern and amount - determine if theres interproximal calculus deposits - determine if there are overhangs or restoration deficiencies. - - determine if there is suggestion of furcations
36
how do you assess mobility and what is its relevance?
using your finger and end of mirror or using 2 ends of mirrors - can affect the prognosis of the tooth and affect function of the dentition.
37
how do we measure mobility?
millers mobility index
38
what does grade 0 mean for mobility?
movement of up to 0.2mm which is normal physiological movement
39
what does grade 1 mean for mobility?
horizontal movement of more than 0.2mm but less than 1mm
40
what does grade 2 mean for mobility?
horizontal movement of more than 1mm
41
what does grade 3 mean for mobility ?
more than 1mm of horizontal movement or any vertical movement
42
how do we measure furcation?
using hamps furcation classification and a periodontal or explorer probe
43
explain hamps grading system?
grade 1- probe goes less than 1/3rd of the way through the furcation grade 2- probe goes more than 1/3rd of the way through the furcation grade 3- through-through- probe goes all the way through the furcation
44
why is furcation involvement of relevance?
FI can affect the prognosis of the tooth: furcation areas can have accessory canals meaning bacteria can enter the pulp via these canals- may lead to loss of vitality of the tooth furcations are stagnation areas and are hard to maintain with at home oral hygiene practices and for the clinician to gain access and clean- controlling disease is made more difficult
45
how can we treat furcations?
OHI- single tufted toothbrushes can be used for easier cleaning of these areas furcationplasty tunnel prep both are used to widen the furcations in order for the patient to clean the area more effectively.
46
what must you do for furcation involvment?
regrade- every 6 months vitality test- every 1 year

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