periodontal disease- diagnosis Flashcards
what are the symptoms of clinical gingival health?
- coral pink and firm gingivae
- ID papillae exactly fill interdental space
- no signs of inflammation- erythema/ oedema
- good OH
- less than 10% bop
- knife edge margins
- stippling of gingivae
- little inflammatory infiltrate- mainly neutrophils (normal immune surveillance)
- little GCF fluid
what are the symptoms of gingivitis?
INFLAMMATION OF GINGIVAL TISSUES:
- loss of stippling
- overfilled ID papillae
- rolled margins
- erythema
- oedema
- bop
- false pocketing
- plaque at gingival margins
- more inflammatory infiltrate
- increased GCF
- reduced no of fibroblasts
- reduced collagen
what are the clinical signs and symptoms of periodontitis?
- LOA (JE migrates apically)
- radiographic bone loss
- ID papillae recession
- bop
- increased pocketing- true pockets
- mobility
- furcation involvement
- tooth loss
what makes up
LOA?
Pocket?
Recession?
ACJ-base of pocket
GM- base of pocket
ACJ- GM
what happens when the periodontium breaks down?
- JE migrates apically due to underlying PDL and collagen destruction
- collagen breakdown and therefore breakdown of CT ECM, losing tissue support
- bone resorption due to osteoclastic activation due to immune cells such as cytokines and other cells such as fibroblasts, endothelium, osteoblasts releasing host resorption factors
- fibroblast damage and reduction needed for repair
what is the initiating factor for periodontal disease? and what causes the damage
plaque but it is the hosts response to plaque which causes 80% of the tissue damage to avoid bacteria entering deeper tissues
what do people have when they have an increased response to plaque which causes damage?
hyper-reactive immune response
what is the hyper-reactive immune response due to?
increased release of cytokine- IL1- which causes an excessive inflammatory response
discuss the meaning of susceptibility to periodontal disease
- measured by age and OH relative to periodontal destruction
- can be high
- can be low
- high susceptibility relates to genetic factors
can you predict periodontal disease?
no- but can assess susceptibility to understand how it may progress
thorough history should be carried out to assess risk
genetic testing to identify positive PAG- coding for IL1 which means the individual has a hyperactive IR to bacteria by high levels of IL1 which cause excessive inflammatory response
what are the theories of disease progression?
- continuous rate theory
- random burst theory
- multiple burst theory
what is the continuous rate theory?
suggests disease progression is slow and continuous- with affected sites showing constant progressive rates of periodontal destruction
what is random burst theory?
- sites can be active or inactive and undergo random short bursts of destruction at random sites followed by periods of no destruction
what is the multiple burst theory?
- multiple sites undergo destruction within a particular period of time such as during an illness and followed by long periods of no destruction
what are the conclusions from the burst theory ?
- gingivitis does not always progress to periodontal disease
- periodontal destruction does not occur in a gradually or continuously
- pattern of destruction varies between individuals and within the same person (diff sites/diff rates of progression)
what is RAL and Gal?
- rapid attachment loss
- gradual attachment loss
more susceptible individuals will have RAL and low susceptibility will have GAL but can have both occurring at different sites within the same individual e.g RAL in areas harder to clean e.g back of mouth,
how do you screen for periodontal disease?
- risk assessment with thorough history- DH, MH, SH, FM
- clinical assessment- BPE, 6PPC, R/Gs
what is a BPE used for?
screening tool to identify those who need more detailed periodontal assessment
what do you use for BPE?
who probe
what are the advantages of doing a BPE?
- quick and simple
- only 1 specific instrument needed
- recognised internationally
- summary of periodontal condition
- indicates potential tx required
what are the disadvantages of BPE?
- need specific specialised BPE probe
- does not specify sites affected
- lacks detail on BOP sites, mobility, and specific furcation sites
- no information on disease activity
- does not differentiate between false and true pocketing
- not used for under 7s
what sites are checked for 7-17 year olds?
ur6, ur1, ul6, ll6, ll1, lr6
only scores of 0,1,2 for 7-11 due to false pocketing
full bpe scores on those sites for 12-17
what are the BPE scores?
0- no ppd >3.5mm, no bop and no calculus/overhangs
1- no ppd >3.5mm, no overhangs/calculus- but BOP present
2- no ppd >3.5mm but calculus/overhangs present
3- ppd 3.5mm-5.5mm
4- ppd >5.5mm
*- furcation involvement
what is the treatment indicated by each BPE score?
0- no tx
1- OHI and PB charts
2- PB charts, OHI, removal of plaque retentive factors (supra/sub PMPR as required)
3- as for code 2 plus RSD if required- i.e initial therapy) or rsd if needed- review 12 weeks and 6ppc if score of 3 remains- consider radiographs
4- PB charts, OHI, 6ppc, radiographs, RSD, post op 6PPC- may refer
*- depends on score or if referral required
when should third molars be included in sextant?
if 6 and/or 7 missing
- must have 2 teeth in sextant
what force should be used with bpe?
20-25 g
should a bpe of implants be done?
no- detailed probing for implants should be carried out to identify deepest pocket of B, L/P, M, D, BOP present and suppuration present
when should you record a bpe?
- new patients
- at routine exam for 0,1,2 patients
when would a simple Periodontal review be used?
a more detailed screening tool for periodontal patients using cp12 probe
what does SPR assess?
- ppds
- BOP
- mobility
- furcation
- LOA- ACJ-base of pocket
what is false pocketing?
when ppd> actual loss of attachment due to inflammation of gingival tissues
what is the gold standard radiograph for assessing periodontal health?
parallelling peri-apicals giving non-distorted view- accurate and detailed assessment
what are the benefits of using paralleling peri-apicals?
- assess extent of bone loss against root length
- assess furcation suggestions
- assess prognosis of teeth
- identify possible endodontic problems
what other radiographs could be used to assess bone levels?
- vertical bitewings
- dpt
why would vertical bitewings be used?
- they give more information on bone levels than horizontal
- can be difficult to position in those with shallow palates
- may not show Periapical pathothology
why would you use dpt?
- if there are other concerns within the most
- not as detailed a view
- quicker
- more comfortable
- full mouth view- can find other pathologies
- distorted anteriors
what must be completed after taking radiographs?
radiographic report- which must be signed off by a dentistw
what should be included in a radiographic report?
- patient details
- extent, pattern and distrubution of bone loss
- calculus
- enamel caries
- dentine caries
- overhangs/ledges/defects
- furcation suggestion
- retained roots
- unerupted teeth
- Periapical pathology
- any other significant findings
what are the drawbacks of radiographs?
- superimposition for e.g bone on bone - underestimates bone loss
- no disease activity shown- snapshot of time
- furcation SUGGESTION
- no mobility shown
- no ppds/loa shown
what are supra bony pockets?
pockets which sit above bone- easier to clean with periodontal instruments as gingival tissue can be distorted
what are infra bony pockets?
vertical bone loss- making pockets more difficult to access and clean with periodontal instruments due to bone
what does ALARP mean?
as low as reasonably practicable
what is the legislation called for ionising radiation?
ionising radiation medical exposure regulations
IR(ME)R
what does a therapist act as when taking radiographs?
- referrer
- prescriber
- operator if trained
what is an intact periodontium?
non-perio patient with no recession involvement
what is a reduced perio patient?
non- perio with recession due to surgery such as crown lengthening surgery- no particular risk to future disease
perio-patient who is currently stable- risk of future disease
what does prognosis mean?
predicated outcome of a tooth
