Periodontal Disease Flashcards
What is the epidemiology of periodontitis?
Effects 37% of uk population moderately (pocketing 4-5mm)
Effects 8% ok uk population severely (pocketing >6)
Effects 11% of worlds population
What is periodontitis?
An inflammatory process that affects the periodontal supporting structures ( gingiva, periodontal ligament, cementum and alveolar bone)
Causes by host/ parasite interactions leads to loss of connective tissue (PDL) and can also be resorption of alveolar bone
Forms pockets and teeth can become mobile
What are clinical features of periodontitis?
- colour change and inflammation at gingival margins
- bleeding on probing
- recession of gingival margin
- loss of alveolar bone
- root Furcation
- mobility of teeth
What is a basic periodontal exam (PBE)
A screening tool used to indicate the level of further examination needed and treatment guidance, it is not a diagnostic tool
What is looked out for in a BPE?
Screening involves assessing bleeding, presence of plaque or calculus and the depth of periodontal pockets which may be present
How are BEP scores recorded for adults?
- Only done for anterior 3 and posterior 4-7 (8 are never included due to not always being present)
- Split the mouth into sextants (6ths and must have at least 2 teeth) and all teeth are examined
- Probe is gently walked around gingival sulcus/pocket (20-25g of pressure)
- Highest score is taken at each sextant
How instrument is used for a BPE screening? And what makes it special?
WHO probe
- has a rounded ball end with a 0.5 diameter
- a black band which around 3.5-5.5mm and one at 8.5-11.5mm to measure pockets
Use around 20-25g of pressure when probing
What is a BPE code 0?
- No calculus or plaque
- No bleeding
- black band entirely visible
Pocket <3.5mm
What is a BPE code 1?
- No calculus or plaque
- Bleeding on probing
- Black band visible
Pocket <3.5mm
What is a BPE code 2?
- Has calculus or overhangs (supra or sublingual)
- Bleeding on probing
- black band still visible
Pocket <3.5mm
What is a BPE code 3?
- Has calculus/ overhangs
- Bleeding on probing
- Black band partially visible
Pocket depth 4mm-5.5mm
What is a BPE code 4?
- Calculus/ overhangs
- Bleeding on probing
- Black band no longer visible
Pocket depth >5.5mm
What does a * BPE code mean?
This mean there is Furcation involvement
- between 2 roots effects 4,6,7,8 (multi roots )
How to code a Furcation
Must always be another number alongside Furcation e.g. 0* or 3*
What are the uses of a BPE check?
- Allows for quick assessment of periodontal disease
- Allows clinician to differentiate simple and complex cases
On at risk patient should be done once a year
What is a DPC?
Detailed periodontal charting
A 6 point check is done, placing a probe on the long axis of the tooth going straight down recording scores at each site
1. Mesio-buccal
2. Buccal
3. Disto buccal
4. Mesio lingual
5. Lingual
6. Distolingual
What is used to do a DPE?
- A UNC 15 - has marking at 1mm increments for 15mm
- Can also use a:
Williams probe - curved so easier for posterior teeth ( 1mm increments for 10mm)
What is Furcation involvement?
Only applies to multi-rooted teeth
- Mandibular molar have 2 roots so 2 Furcation entrances ( buccal and lingual)
- Maxillary molars have 3 roots so 3 Furcation entrances ( buccal mesial and distal
How is Furcation checked? And why?
Nabers Furcation probe
Is curved so can check roots and also have coloured bands
1. Between 3mm-6mm
2. Between 9mm-12mm
How is Furcation involvement graded?
Hamp’s classification
What is a grade 1 on the Hamp’s classification?
- Initial Furcation and opening can be felt on probing
- Involvement < 1/3 of tooth
What is a grade 2 on the Hamp’s classification?
- Partial Furcation involvement
- Loss of support exceeds 1/3
>1/3
What is a grade 3 on the Hamp’s classification?
- Involvement all the way through, probe passes all the way through
100%
What is recession?
Pocket depth is normally from the CEJ to the base of the pocket
- with recession this pocket depth increases due to an increased pocket size therefore it’s adding on the probing depth
What is tooth mobility? What causes it?
Cause by alveolar bone loss and tooth may feel lose
1. Horizontal mobility - measured with genital pressure in buccal-lingual surfaces using rigid instruments
2. Verticals mobility - measured by applied genital pressure to crown with ridge instrument to see movement
How is tooth mobility graded?
Millers classification
What is a 0 on the millers classification?
Very little tooth movement 0.1-0.2mm (within normal rage )
What is a 1on the millers classification?
Increased mobility of crown on the horizontal direction up to 1mm
What is a 2 on the millers classification?
Visually increased mobility of crowns in horizontal direction exceeding 1mm
What is a 3 on the millers classification?
Sever mobility of the crown in both horizontal and vertical direction impinging on other teeth function
What are risk factors for Perio disease?
- Tobacco - increases risk of periodontal disease and reduces benefits if treatment and increases chance of losing teeth
- Diabetes - must maintain good control as they have greater risk of developing serious periodontal disease and get less benefit from perio-treatment
What advice can be given to prevent periodontitis?
- Remove plaque using method the dental teams shows this reduces risk of periodontal disease, daily effective brushing is important for Perio health more than scaling occasionally
- Toothbrushing - must clean at the gum line twice a day especially at night using a manual or electric toothbrush
Use a soft-medium brush with a small brush head - Toothpaste - must contain fluoride
How to talking to patients about quitting smoking?
Must be very brief so it doesn’t sound like we are judging or lecturing
- Ask - establish record or smoking and frequency
- Advice - talk about the negative impacts it has to oral health and benefits of stopping
- Act - offer help to stop
What treatment will be done for a patient with BOE codes 1-2?
They need to have normal appointments and give then advice on how to brush a little more effectively and other oral health tips
- Next check up in a year
What treatment will be done for a patient with BOE codes 3-4?
They need a detailed periodontal charting (DPC)
What are the differences in treatment between a code 3 and code 4 BPE patient?
Code 3 - Has a DPC (6 point check) only in the affected sextant
Code 4 - Has a DPC (6 point check( in the whole mouth all sextants
Both patient receive initial treatment, removal of plaque and scaling also told about mitigating risk factors e.g. smoking or diabetes
