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Clinical knowledge II > Periodontal Disease > Flashcards

Periodontal Disease Flashcards

1
Q

What is the first bacteria to colonise a clean tooth surface?

A

Gram positive streptococci

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2
Q

What are the 4 stages of periodontal disease?

A

The initial lesion
The early lesion
The established lesion
The advaed lesion

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3
Q

What is the initial lesion in periodontal disease?

A

Develops after 2-4 days after the plaque accumulation.
Vasculitis of vessels below the JE
Presence of serum proteins.
Streptococci dominant and is STABLE.

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4
Q

What is the early lesion?

A

Develops after 7-10 days.
Increased fluid exudate.
Oedema and erythema is visible.
proliferation of basal cells at the JE
Anaerobic filamentous bacteria dominant.

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5
Q

What is the established lesion?

A

Develops after 21-28 days.
Gingival crevice deepens.
Increase of neutrophils.
Loss of collagen.
T cells > B cells
Breakdown of connective tissue.

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6
Q

What is the advanced lesion?

A

Epithelium migrates apically to form a pocket.
Endotoxins permeate the surface layer of the cementum.
Loss of collagen and bone.
B cells > T cells.
Lesion is unstable.

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7
Q

What is the function of saliva?

A

To wash the teeth
dilute substances
Allows for swallowing and mastication.

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8
Q

What are the two main categories of risk factors in periodontal disease?

A

Local risk factors.
Systemic risk factors.

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8
Q

What are some acquired local risk factors of periodontal disease?

A

Plaque
Calculus
BoP
PPD
Poorly contoured prosthesis.

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9
Q

What is the role of plaque in periodontal disease?

A

It instigates periodontal disease.
The biofilm creates an environments which makes a change in health.

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10
Q

With regards to iatrogenic aspects, what should any restoration or prosthesis do?

A

Minimise plaque accumulation
Avoid physical injury to the periodontium.

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11
Q

What can iatrogenic factors arise from?

A

Overhangs
Partial dentures
Bulbous emergence profile.
Restorations which impinge on biological width.

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12
Q

What are cervical enamel projections?

A

Located apically to the CEJ
Often in furcation areas
triangular

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13
Q

What are enamel pearls?

A

a Large spherical extension of the pulp.

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14
Q

What are systemic risk factors of periodontal disease?

A

Smoking
diabetes
medications
stress
nutrition
Genetics
Pregnancy
Hormonal changes
Immunodeficiency
Age

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15
Q

What are non-modifiable systemic risk factors of periodontal disease?

A

Genetic predispositions
Pregnancy
Hormonal changes
Immunodeficiency states
Age

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16
Q

Patients with poor OH and no periodontitis may have a genetic resistance, why is this?

A

Periodontitis is polygenetic
They are likely to be a result of polymorphisms that contribute to the immune response.

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17
Q

What should be taken in a full smoking history?

A

Type of tobacco
how many years
How many in a day
What time of day
Any attempts to quit

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18
Q

What are the effects of smoking on the periodontium?

A

Sites with deeper pockets
Greater attachment loss
Bone loss
Furcation involvement
Tooth loss
Accumulate plaque
Reduction in gingival vessels.
Poor healing response

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19
Q

What effect does smoking have on the gingival tissues?

A

Necrotising periodontal diseases.
Decreased bleeding
Decreased redness and inflammatory response.

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20
Q

How does smoking effect the neutrophils in the immune response?

A

Increased impaired neutrophil production

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21
Q

What effect does smoking have on the function of fibroblasts in the inflammatory response?

A

Inhibits fibroblast proliferation.
Fibroblast attachment is reduced.
Poor wound healing

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22
Q

What medications can cause gingival overgrowth?

A

Ca channel blockers
Anti-rejection immunosupressents
Anti-epileptic drugs

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23
Q

Why are women who are pregnant more likely to suffer from periodontitis?

A

Elevated levels of oestrogen and progesterone increase vascular permeability,
Plaque then promotes more inflammation.

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24
Pregnant women with existing periodontitis are more likely to have...
Pregnancy periodontitis Pregnancy epuli
25
What are the risk factors for pregnancy complications?
Young mothers Drug/alcohol use Stress Genetics GU infection Idiopathic Periodontal disease.
26
What are the oral complications of diabetes?
Xerostomia Infections Caries delayed wound healing Oral paraesthesia Altered taste sensation
27
Why do diabetics with poor glycaemic control have an increased risk of periodontitis?
Glycosylated haemoglobin gives an accurate indication of glycaemic control. Patients with diabetes have higher levels of HbAIc.
28
How do you manage a patient with periodontitis and diabetes?
Advise patients about the risks. Collect diabetic history. Review MH Maintain the periodontal health.
29
What can periodontal disease exacerbate?
Heart diseases.
30
How does periodontal disease exacerbate heart disease?
Leads to entry of bacteria into the blood stream. Bacteria activate the host inflammatory response. Atheroma formation, maturation and exacerbation.
31
How do you manage a patient with perio and a cardiovascular disease?
Stagger treatments Multiple visits for treatment Liase with cardiologist Cardiac review
32
What is supportive periodontal therapy?
It is directed towards limiting disease progression, identifying those sites that continue to break down and provide treatment when indicated.
33
What are the aims of supportive periodontal therapy?
To prevent perio progression Prevent tooth loss Increase the likelihood of detection of other oral diseases
34
When is supportive periodontal therapy useful?
Stable disease Compliant patient Good response to treatment Good prognosis Teeth are expected to be retained
35
How is supportive periodontal therapy achieved?
Regular clinical assessments Retreatment of certain sites Patit motivation
36
What are the stages of supportive periodontal therapy?
Review MH Review OH Clinical assessment Radiographs Diagnosis Discuss findings Treatment Reinforce advice Arrange recall.
37
Why may a patient have non-responding sites in perio?
Incorrect diagnosis Inadequate plaque control Inadequate sub-gingival debridement Smoking
38
Why may a patient not be compliant with periodontal therapy?
Time Cost Social issues Treatment complexity Treatment dissatisfaction
39
What are the systemic conditions that perio is related to?
Cardiovascular Diabetes Pregnancy Obesity Respiratory disease Chronic kidney disease Rheumatoid arthritis Cognitive impairment Metabolic syndrome Cancer
40
What are the anatomical risk factors of periodontitis?
Dental crowding Furcation Bone defects Mucosal defects Root grooves Cervical enamel projections Enamel pearls Canine fossa.
41
What do subgingival margins risk?
Plaque accumulation Marginal tissue regression
42
When can definitive restorations be placed in a patient with periodontal disease?
When a patient is engaging with periodontal advice.
43
What questions would you as someone who smokes?
Type of tobacco How many years they have been smoking. What time of day is their first cigarette Attempts to quit Interest in quitting.
44
What are the affects of smoking on the periodontium?
More sites with deeper pockets Greater attachment loss More teeth with furcation involvement. Increased tooth loss Accumulate more plaque. Reduction in gingival vessels. Poor healing response.
45
What affect does smoking have on the inflammatory response?
Increased number of neutrophils with impaired function. Inhibits fibroblast proliferation.
46
What drugs cause gingival overgrowth?
Ca channel blockers - Amlodipine, nifedipine, felodipine. immunosuppressants - ciclosporin. Anti-epileptic drugs - Phenytoin.
47
Why are pregnant women more likely to suffer with perio?
Due to the elevated oestrogen and progesterone vascular permeability is increased.
48
What is a pregnancy epulis?
A small non-cancerous growth on the gingiva.
49
How does an epulis form?
Inflammation from plaque formation.
50
What are the oral complications to diabetes?
Xerostomia Opportunistic infections (candida) Caries Delayed wound healing Periodontal disease Oral paraesthesia Altered taste sensation Glossodynia Sialosis Lichenoid drug reactions
51
What are diseases associated with diabetes?
Retinopathy Nephropathy Neuropathy Macro-vascular disease Impaired wound healing Periodontal disease.
52
Explain the relationship between diabetes and perio.
It is Bi-directional. Poor diabetic control is likely to have more rapidly progressing perio disease. Leads to immune dysfunction, cellular stress and cytokine imbalance. Enhanced tissue destruction and impaired tissue repair due to reduced collagen.
53
How would you mange a patient with cardiovascular disease and perio?
Should be informed of increased CVD risk. Should be informed of risk of cardiac event risk. Take careful history. Focus on prevention. Regular monitoring Be mindful of anti-platelet medications.
54
For patients who are likely to not retain teeth, what should you do?
Regular clinical assessment Retreatment Motivation Modify risk factors Discuss progression Manage symptoms If they are compliant why may the disease still be progressing.
55
When is SPT likely to be effective?
Good OH Healthy looking gingiva Shallow pockets Stable attachment levels Intact dentition Removal of deposits.
56
What is included in a periodontal assessment?
PPD Bleeding scores Plaque scores Recession Attachment loss Suppuration Mobility Furcation
57
Why may sites not be responding?
Incorrect diagnosis Inadequate plaque control Inadequate sub-gingival debridement Smoking Systemic/bacterial
58
What makes a patient stable?
BoP less than 10% PPD less than 4mm No BoP at sites of 4mm
59
What makes a patient in remission?
BoP more than 10% PPD less than 4mm No BoP at 4mm sites
60
What makes a patient unstable?
PPD mroe than 5mm or PPD 4mm with BoP
61
When are frequent recalls indicated?
Unstable disease Grade C disease Poor plaque control Deep pockets Poor response to treatment Guarded prognosis Risk factors Special care
62

Clinical knowledge II (17 decks)

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