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BDS3 PAEDIATRICS > PERIODONTAL SCREENING AND MANAGEMENT IN KIDS > Flashcards

PERIODONTAL SCREENING AND MANAGEMENT IN KIDS Flashcards

1
Q

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

A
  • periodontal health, gingival diseases and conditions
  • periodontitis
  • other conditions affecting the periodontium
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2
Q

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

A

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

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3
Q

What is the definition of periodontal health?

A

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

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4
Q

what are the features of healthy peridontium?

A
  • 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
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5
Q

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

A
  • crown lengthening surgery
  • recession
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6
Q

how much bleeding on probing would suggest periodontal health?

A

<10% BOP

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7
Q

what are the 2 overall types of gingivitis?

A
  1. plaque biofilm-induced gingivitis
  2. non plaque biofilm-induced gingivitis / gingival lesions
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8
Q

how does plaque biofilm-induced gingivitis occur?

A

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 !!!!

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9
Q

what can cause non-dental biofilm-induced gingivitis?

A
  • manifestations of systemic conditions
  • pathological conditions limited to gingival tissues
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10
Q

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

A

hereditary fibromatosis

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11
Q

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

A

granulomatous inflammation

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12
Q

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

A
  • anti-retro-viral meds
  • immunosuppressants
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13
Q

what are the features of necrotising gingivitis?

A
  • pain
  • necrosis of interdental papillae “punched out” appearance
  • ulceration
  • spontaneous bleeding
  • halitosis
  • lymphadenopathy (maybe)
  • fever (maybe)
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14
Q

what are the aetiological risk factors of necrotising gingivitis?

A
  • smoking
  • immunosuppression
  • stress
  • malnourishment
  • poor diet
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15
Q

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

A

developing country / poverty

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16
Q

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

A
  • unusual root proximity
  • tooth malposition
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17
Q

what systemic factor can cause necrotising gingivitis?

A

HIV positive status

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18
Q

what medications can cause gingival overgrowth?

A
  • cyclosporin
  • phenytoin
  • calcium channel blockers
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19
Q

what other things can gingival overgrowth be related to?

A
  • puberty (alongside dental plaque)
  • hereditary gingival fibromatosis
  • systemic and metabolic diseases
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20
Q

how is gingival overgrowth treated?

A
  • rigorous home care
  • frequent appointments for PMPR
  • may need surgery
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21
Q

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

A

urgent referral to physician for haematinic screening!

22
Q

what are the 4 main distinguishing features of periodontitis?

A
  • 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
23
Q

what is periodontitis?

A
  • a chronic multifactorial inflammatory disease
  • associated with dysbiotic plaque biofilms
  • characterised by progressive destruction of the tooth-supporting apparatus
24
Q

what is the early clinical sign of periodontitis in teenagers?

A

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

25
Q

what are the pathogens typically found in teenager periodontitis patients?

A
  • porphyromonas gingivalis
  • prevotella intermedia
  • aggregatibacter actinomycetemcomitans
26
Q

what are the features of necrotising periodontitis?

A
  • necrosis/ulceration of the interdental papilla
  • bleeding of the gingival tissues
  • periodontal ligament loss & rapid bone loss
  • pseudomembrane formation
  • lymphadenopathy
  • fever
27
Q

what is necrotising stomatitis?

A

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

28
Q

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

A

FALSE POCKETING occurs around erupting permanent dentition

29
Q

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

A
  • rapid attachment loss and bone destruction
  • patient is otherwise healthy
  • onset around puberty
  • family history related
30
Q

What systemic diseases may periodontitis be a manifestation of?

A
  • Papillon-Lefevre Syndrome (PLS)
  • Neutropenia’s
  • Down syndrome
  • Leucocyte adhesion deficiency syndrome (LAD)
31
Q

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

A
  • gingival colour
  • contour
  • swelling
  • recession
  • suppuration
  • inflammation (presence and location)
32
Q

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

A
  • Plaque status
  • Description of surfaces covered by plaque (easily visible? detectable only on probing?)
  • assess any calculus present
33
Q

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

A
  • plaque retention factors (misshaped teeth etc)
  • low frenal attachments
  • malocclusions
  • incompetent lip seal
  • mouth breathing
34
Q

how can an incompetent lip seal increase the periodontitis risk?

A
  1. Reduced upper lip coverage —> labial and palatal gingivitis
  2. Increased lip separation
35
Q

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

A

BPE (basic periodontal examination)

36
Q

when should a BPE be carried out in children?

A

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

37
Q

how is a simplified BPE carried out?

A
  • performed with a WHO 621 probe
  • carried out on 16, 11, 26, 36, 31, 46
  • 20-25g force application (same as adults)
38
Q

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

A

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

39
Q

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

A

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

40
Q

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

A
  • 10/10
  • 8/10
  • 6/10
  • 4/10
41
Q

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

A

perfectly clean tooth

42
Q

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

A

line of plaque around the cervical margin

43
Q

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

A

cervical 1/3rd of crown covered

44
Q

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

A

middle 1/3rd of crown covered

45
Q

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

A
  • 6 point pocket chart in that sextant
  • radiographs taken
46
Q

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

A
  • full mouth 6PPC
  • radiographs
47
Q

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

A
  • advice on affective toothbrushing
  • fluoride advice
  • smoking cessation advice PARAMOUNT in teenagers
48
Q

what is step one of the S3 treatment guidelines?

A

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

49
Q

what is step two of the S3 treatment guidelines?

A

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

50
Q

what is step three of the S3 treatment guidelines?

A

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

51
Q

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

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

BDS3 PAEDIATRICS (7 decks)

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