PERIODONTAL SCREENING AND MANAGEMENT IN KIDS

Question 1

What is the 2017 World Workshop classification (of paediatrics) divided into?

Answer 1

• periodontal health, gingival diseases and conditions
• periodontitis
• other conditions affecting the periodontium

Question 2

what is the mnemonic for remembering the classification of periodontal conditions 2017?

Answer 2

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

Question 3

What is the definition of periodontal health?

Answer 3

A state:
- free from inflammatory periodontal disease
- that allows an individual to function normally
- that avoids physical or mental consequences due to current or past disease

Question 4

what are the features of healthy peridontium?

Answer 4

• gingival margin several mm coronal to the CEJ
• gingival sulcus 0.5mm-3mm deep on fully erupted tooth
• in teenagers = alveolar crest is situated between 0.4mm-1.9mm apical to CEJ

Question 5

what can cause a reduced periodontium in a non-periodontal patient?

Answer 5

• crown lengthening surgery
• recession

Question 6

how much bleeding on probing would suggest periodontal health?

Answer 6

<10% BOP

Question 7

what are the 2 overall types of gingivitis?

Answer 7

1. plaque biofilm-induced gingivitis
2. non plaque biofilm-induced gingivitis / gingival lesions

Question 8

how does plaque biofilm-induced gingivitis occur?

Answer 8

supragingival plaque accumulates on teeth:
- an inflammatory cell infiltrate develops in gingival connective tissue
- junctional epithelium becomes disrupted
- allows apical migration of plaque and increase in gingival sulcus depth

** false pocketing in gingivitis !!!!

Question 9

what can cause non-dental biofilm-induced gingivitis?

Answer 9

• manifestations of systemic conditions
• pathological conditions limited to gingival tissues

Question 10

what is an example of genetic disorders that predispose a patient to non-dental biofilm-induced gingivitis?

Answer 10

hereditary fibromatosis

Question 11

what is an example of manifestations of systemic disease disorders that predispose a patient to non-dental biofilm-induced gingivitis?

Answer 11

granulomatous inflammation

Question 12

what is an example of drugs that predispose a patient to non-dental biofilm-induced gingivitis?

Answer 12

• anti-retro-viral meds
• immunosuppressants

Question 13

what are the features of necrotising gingivitis?

Answer 13

• pain
• necrosis of interdental papillae “punched out” appearance
• ulceration
• spontaneous bleeding
• halitosis
• lymphadenopathy (maybe)
• fever (maybe)

Question 14

what are the aetiological risk factors of necrotising gingivitis?

Answer 14

• smoking
• immunosuppression
• stress
• malnourishment
• poor diet

Question 15

what socioeconomic factor can contribute to the likelihood of developing necrotising gingivitis?

Answer 15

developing country / poverty

Question 16

what local factors can contribute to development of necrotising gingivitis? (aetiology)

Answer 16

• unusual root proximity
• tooth malposition

Question 17

what systemic factor can cause necrotising gingivitis?

Answer 17

HIV positive status

Question 18

what medications can cause gingival overgrowth?

Answer 18

• cyclosporin
• phenytoin
• calcium channel blockers

Question 19

what other things can gingival overgrowth be related to?

Answer 19

• puberty (alongside dental plaque)
• hereditary gingival fibromatosis
• systemic and metabolic diseases

Question 20

how is gingival overgrowth treated?

Answer 20

• rigorous home care
• frequent appointments for PMPR
• may need surgery

Question 21

if a condition is inconsistent with level of oral hygiene observed, what would you do?

Answer 21

urgent referral to physician for haematinic screening!

Question 22

what are the 4 main distinguishing features of periodontitis?

Answer 22

• APICAL MIGRATION of junctional epithelium beyond CEJ
• LOSS OF ATTACHMENT of periodontal tissues to cementum
• transformation of JUNCTIONAL EPITHELIUM -> POCKET EPITHELIUM (thin and ulcerated)
• ALVEOLAR BONE LOSS

Question 23

what is periodontitis?

Answer 23

• a chronic multifactorial inflammatory disease
• associated with dysbiotic plaque biofilms
• characterised by progressive destruction of the tooth-supporting apparatus

Question 24

what is the early clinical sign of periodontitis in teenagers?

Answer 24

> 1mm loss of attachment (of cementum to PDL)

Question 25

what are the pathogens typically found in teenager periodontitis patients?

Answer 25

- porphyromonas gingivalis - prevotella intermedia - aggregatibacter actinomycetemcomitans

Question 26

what are the features of necrotising periodontitis?

Answer 26

- necrosis/ulceration of the interdental papilla - bleeding of the gingival tissues - periodontal ligament loss & rapid bone loss - pseudomembrane formation - lymphadenopathy - fever

Question 27

what is necrotising stomatitis?

Answer 27

a sever inflammatory condition - necrosis extends beyond gingiva to soft tissues leading to bone denudation (erosion) - seen in severely systemically compromised patients

Question 28

what should you be aware of when assessing the periodontal health of a child in the mixed dentition stage?

Answer 28

FALSE POCKETING occurs around erupting permanent dentition

Question 29

what are the features of molar incisor pattern periodontitis in adolescents?

Answer 29

- rapid attachment loss and bone destruction - patient is otherwise healthy - onset around puberty - family history related

Question 30

What systemic diseases may periodontitis be a manifestation of?

Answer 30

- Papillon-Lefevre Syndrome (PLS) - Neutropenia’s - Down syndrome - Leucocyte adhesion deficiency syndrome (LAD)

Question 31

When considering a patients gingival condition, what things will you assess?

Answer 31

- gingival colour - contour - swelling - recession - suppuration - inflammation (presence and location)

Question 32

When assessing the oral hygiene status of a paediatric patient, what would you note?

Answer 32

- Plaque status - Description of surfaces covered by plaque (easily visible? detectable only on probing?) - assess any calculus present

Question 33

What local risk factors may play a part in paediatric periodontal disease?

Answer 33

- plaque retention factors (misshaped teeth etc) - low frenal attachments - malocclusions - incompetent lip seal - mouth breathing

Question 34

how can an incompetent lip seal increase the periodontitis risk?

Answer 34

1. Reduced upper lip coverage —> labial and palatal gingivitis 2. Increased lip separation

Question 35

what screening tool aids in the provisional diagnosis of periodontal health. gingivitis or periodontitis?

Answer 35

BPE (basic periodontal examination)

Question 36

when should a BPE be carried out in children?

Answer 36

A simplified BPE should be carried out in all co-operative children aged 7-18 years old - only on 6 teeth!!

Question 37

how is a simplified BPE carried out?

Answer 37

- performed with a WHO 621 probe - carried out on 16, 11, 26, 36, 31, 46 - 20-25g force application (same as adults)

Question 38

what are the BPE codes possible for children ages 7-11?

Answer 38

0 = healthy 1 = bleeding after gentle probing (black band visible) 2 = calculus or plaque retention factor

Question 39

what BPE codes are possible for kids aged 12-17?

Answer 39

0 = healthy 1 = BOP & black band visible 2 = calculus or plaque retention factor & black band visible 3 = pocketing 4mm-5mm (black band partially visible) 4 = pocketing >6mm (black band disappears) * = furcation involvement

Question 40

what are the different SDCEP plaque scores used in paediatric dentistry?

Answer 40

- 10/10 - 8/10 - 6/10 - 4/10

Question 41

what would a plaque score of 10/10 indicate in paediatric dentistry?

Answer 41

perfectly clean tooth

Question 42

what would a plaque score of 8/10 indicate in paediatric dentistry?

Answer 42

line of plaque around the cervical margin

Question 43

what would a plaque score of 6/10 indicate in paediatric dentistry?

Answer 43

cervical 1/3rd of crown covered

Question 44

what would a plaque score of 4/10 indicate in paediatric dentistry?

Answer 44

middle 1/3rd of crown covered

Question 45

if a patient has a BPE score of 3 what are the following steps?

Answer 45

- 6 point pocket chart in that sextant - radiographs taken

Question 46

if a patient has a BPE score of 4 what are the following steps?

Answer 46

- full mouth 6PPC - radiographs

Question 47

what oral health messages should be delivered to paediatric patients to ensure good prevention?

Answer 47

- advice on affective toothbrushing - fluoride advice - smoking cessation advice PARAMOUNT in teenagers

Question 48

what is step one of the S3 treatment guidelines?

Answer 48

building foundations for optimal treatment outcomes - focuses on behaviour change/motivation to control plaque - PMPR - risk factor control

Question 49

what is step two of the S3 treatment guidelines?

Answer 49

Cause-related Therapy - aims to control the subgingival plaque biofilm & calculus by subgingival PMPR

Question 50

what is step three of the S3 treatment guidelines?

Answer 50

Management of non-responding sites (>4mm with BOP or >6mm) - aim to gain access to further subgingival instrumentation

Question 51

give examples of when you should refer a paediatric perio patient?

Answer 51

- Grace C or Stage IV periodontitis - Periodontal disease as a direct manifestation of systemic disease - Extensive medical history that will affect treatment