Periodontal Screening and Management of Perio Conditions in Children Flashcards
What is the 2017 Perio guidelines mnemonic?
Please give greg nine Percy pigs straight past meal time tonight
What is included in the 2017 perio guidelines?
Perio health, gingival diseases and conditions:
Periodontal health
Gingivits
Gingival diseases and conditions
Periodontitis:
Necrotising perio disease
periodontitis
periodontitis as a manifestation of pts underlying systemic disease
Other conditions affecting periodontium:
Systemic diseases that affect perio supporting tissues Perio abscesses and ends perio lesions Mucogingival deformities and conditions Traumatic occlusal forces Tooth and prosthesis related factors
What are the types of perio health, gingival diseases and conditions? (3)
Periodontal health
Gingivitis - dental biofilm induced
Gingival diseases and conditions that are non dental biofilm induced
What are the two types of perio health?
Intact periodontium
Reduced periodontium - caused by things other than periodontitis such as ortho tx, crown lengthening surgery
Why may a pt have perio health with a reduced periodontium?
If had ortho tx or crown
What are the types of periodontium in gingivitis?
Intact or reduced
How do we diagnose periodontitis?
Stage
Grade
Current status
Risk Assessment
What is staging in perio dx?
Staging is when we look at interproximal bone loss at worst site of bone loss due to periodontitis
What are stages 1-4 in period dx?
1 - early/mild
2 - moderate
3 - severe
4 - very severe
Describe interproximal bone loss in early/mild stage of the disease
bone loss <15% or 2mm
Describe interproxial bone loss in moderate stage of disease?
Coronal third of root
Describe interproximal bone loss in severe stage of disease?
Middle third of root
Describe interproximal bone loss in very severe stage of disease?
Apical third of root
What is grading in perio dx?
This is grade A B C
and it is based on the worst site of bone loss and we assign a percentage as to how much bone loss there is compared to the patients age
Ie - if pt has bone loss in apical third then more than 60-70% and if pt is 70 then = 1 so grade C
Describe the grading system in perio dx
Grade A - slow progressing (<0.5)
Grade B - moderate progression (0.5-1)
Grade C - rapid progression (>1)
What is the extent of perio disease?
Generalised >30%
localised <30%
Molar incisor pattern
What might the gingival margin be?
Several mm coronal to ACJ
How deep may the sulucus be in perio health?
0.5-3mm deep
Where is the alveolar crest in relation to the CEJ in teens?
0.4-1.9mm apical
What is supracrestal attachment?
This is junctional epithelium + supracrestal connective tissue attachment (it is around 2mm) and then coronal to JE is the gingival sulcus which is 0.5-1mm
How do we diagnose periodontal health?
Intact or reduced periodontium
must have <10% BOP
What if gingivitis?
This is inflammation of the gingivae it can be biofilm related or non biofilm related
What are the types of gingivitis?
Dental biofilm induced
Non dental biofilm induced
What are the types of dental biofilm induced gingivitis?
Localised
Generalised
How do we diagnose localised biofilm induced gingivitis?
Localised - 10-30% BoP
How do we dx generalised biofilm induced gingivitis?
> 30% BoP
What are some plaque retentive factors?
overhanging restoration margins
prostheses
What is dental biofilm induced gingivitis?
This is when supra gingival plaque accumulates on teeth and an inflammatory cell infiltrate develops in gingival connective tissue disrupting the junctional epithelium which allows plaque to migrate apically in the increasing depth of gingival sulcus
What does biofilm induced gingivitis give rise to?
gingival pocket
false pocket
pseudo pocket
Is gingivitis reversible?
Yes with inc OH, brushing 2x daily with f toothpaste, flossing
What happens if gingival swelling increases?
Then there will be an even deeper false gingival pocket
Descrie false pocketing
This is when deepest part of pocket is still at the CEJ so there is no loss of periodontal attachment - the distance has increased due to swelling rather than loss of attachment of soft tissue
What are the clinical signs of gingivitis?
Redness
puffy swollen gums
loss of knife edge margin
Presence of calculus and plaque
When a patient progresses to periodontitis what are the three options?
Stable (bop <10%, PPD<4mm and no bop at 4mm sites)
Remission (bop>10%, PPD<4mm, no bop at 4mm sites)
Unstable (ppd>5mm, bleeding at >4mm and bop)
What is necrotising ulcerative gingivitis?
This is when the papillae is blunted with a bad smell, painful gums and no attachment loss
What can necrotising ulcerative gingivitis be caused by?
Anaerobic fusiform bacteria and spirochaetes are implicated,
predisposing factors including poor oral hygiene, smoking, malnutrition and immune defects
Stress
HIV + status
ALSO KNOWN AS TRENCH MOUTH
What is pubertal gingivitis?
uberty gingivitis is usually caused by a combination of poor oral hygiene habits and diet, combined with the elevated hormone levels during puberty (which increase the sensitivity of the gums to accumulated dental plaque).
This combination of factors makes gingivitis more of a risk for young people going through puberty than it would be at other times in their lives.
What is increased in pubertal gingivitis?
Response to plaque due to hormonal changes that occur in puberty
What can influence progression of pubertal gingivitis?
Plaque, braces, overhanging restorations and systemic factors
What is non biofilm induced gingivitis?
This is when the main cause is not plaque
What are some of the main causes of non dental biofilm induced gingivitis?
Drug induced
Trauma
Genetics
Infective
Manifestation of systemic disease
What drugs can induce non dental biofilm gingivitis?
Anti-convulsant drugs - for epilepsy
Ca channel blockers
Immunosupressants
Cytotoxic drugs
What can non biofilm induced gingivitis be manifestations of?
Haematology - such as leukaemia
Immunological conditions
What is cyclosporin?
Cyclosporin is a calcineurin inhibitor, used as an immunosuppressant medication.
It is taken by mouth or by injection into a vein for rheumatoid arthritis, psoriasis, Crohn’s disease, nephrotic syndrome, and in organ transplants to prevent rejection.
What can cyclosporin cause?
drug induced non biofilm gingivitis
What is phenytoin?
Anti-convulsant medication
It is useful for the prevention of tonic-clonic seizures and focal seizures, but not absence seizures.
works by decreasing electrical activity in the brain
What can phenytoin cause?
Non dental biofilm induce gingivitis
What can OFG present as?
full thickness gingivitis
What can leukaemia present as?
gingivitis however this is rare
What is agranulocytosis?
is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood.
What can agranulocytosis lead to?
gingivitis
What is cyclic neutropenia?
rare blood disorder characterized by recurrent episodes of abnormally low levels of neutrophils (a type of white blood cell ) in the body. Neutrophils are instrumental in fighting off infection by surrounding and destroying bacteria that enter the body.
What can cyclic neutropenia cause?
Gingivitis
What is Crohns disease?
type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people.
can cause gingivitis
What is nifedipine?
Nifedipine, sold under the brand name Adalat among others, is a calcium channel blocker medication used to manage angina, high blood pressure, Raynaud’s phenomenon, and premature labor.
How do we treat gingivitis?
Rigorous OHI and home care
freq scaling
if pt has hypertrophy we may need to consider surgical tx
What happens in periodontitis?
there is apical migration of JE beyond the CEJ and loss off attachment of periodontal tissues to cementum, there will also lead to alveolar bone loss
What are early clinical signs of perio in teens?
1mm loss of attachment of cementum to PDL
What are the pathogens for perio?
p gingivitis
prevotella intermedia
What are features of perio?
Rapid LOA and bone destruction
FH
How do we stage periodontal disease?
we stage it 1-4
1 - mild - 2mm or <15%
2 - moderate - coronal third
3- severe - middle third
4 - very severe - apical third
How do we grade periodontal disease?
we grade it ABC
A - slow - <0.5
B - moderate 0.5-1
C - rapid >1
The grade is based on extend of bone loss at worst site/age
How do we describe extent of perio?
Localised
Gneralised
MI Pattern
What must we be aware of in the mixed dentition?
False pocketing around erupting permanent dentition
What do we look at in terms of gingival condition?
Gingival colour
Contour
Swelling?
Any recession?
Any suppuration?
Any inflammation? - if so where
How do we define pts OH status?
Plaque status - where is the plaque - we can use plaque scores as motivation for pt
What do we do if there is calculus present?
Chart the location
What are some local risk factors for perio?
Plaque retentive factors
low feral attachments
malocclusion
incompetent lip seal - reduced upper lip coverage and inc lip separation
mouth breathing - palatal gingivitis
Why can overbite lead to recession?
biting down on gingival margin of lower incisors which can cause chronic continuous trauma which leads to recession and other issues
Why can an incompetent lip seal at rest lead to oral problems?
Drying of intra oral mucosa and potential gingivitis
What exam do we undertake in children aged 12-17?
FULL BPE - screening tool for perio disease that rapidly guides us to arrive at provisional diagnosis of perio health, gingivitis or periodontitis
What does the BPE not consider?
Historical attachment loss
bone loss - no staging or grading is done
What exam do we carry to in those aged 7-11?
Simplified BPE
What is the simplified BPE?
This is a quick, easy, well tolerated modified bpe that is used in children aged 7-11 on permanent teeth only on certain teeth using codes 0-2
What do we use to carry out bpe?
who CITPN probe
What type of force do we use for BPE?
20-25g of force - enough to blanch nail beds
Where do we insert instrument when doing a bpe?
We insert parallel to root surface of tooth in question and walk around the gingival margin, coronally to ACJ
What teeth do we asses in SIMPLIFIED BPE?
UR6 UR1 UL6 LL6 LL1 LR6
What BPE codes do we use for those aged 7-11?
0-2
0 - no plaque, no bop, black band fully visible
1 - bleeding on probing
2 - calculus or plaque retentive factors
What BPE codes do we use on those aged 12-17?
0-4*
0-2
0 - no plaque, no bop, black band fully visible
1 - bleeding on probing
2 - calculus or plaque retentive factors
3 - pocketing 4-5mm (black band partially visible)
4 - black band no longer visible
- furcation involvement
What would a diagnosis of clinical gingival health signify?
Code 0/1/2
<10% bleeding on probing
What would a diagnosis of localised gingivitis signify?
code 0/1/2
10-30% bop
What would a diagnosis of generalised gingivitis signify?
code 0/1/2
> 30% bop
If pt has a code 3 with no obvious evidence of internal recession what do we do?
Take radiographs then initiate perio therapy and review in 3 months with localised 6ppc
After a code 3 and after 6pppc when would we continue with code 0/1/2 pathway?
If no pockets >4mm and no radiographic evidence of bone loss due to perio
After a code 3 and after 6pppc when would we continue with code 4 pathway?
If pockets >4mm and or radiographic evidence of bone loss due to perio
What do we do if pt is code 4 and or has evidence of internal recession?
Radiographs
full perio assessment - 6PPC
What are the diff types of periodontitis?
Localised
generalised
molar incisor pattern
What must we do if pt has perio?
Stage, grade, current disease status, risk factor assessment in notes (DIAGNOSTIC STATEMENT)
What are plaque free and marginal bleeding charts?
These are good for pts motivation and track pts plaque and bleeding scores at each visit which can be compared
higher the score –> better the teeth
What are plaque levels?
These are scores that indicate brushing habits and we can monitor them over time
What are the different plaque scores?
10/10 - perfectly clean
8-10 - plaque around cervicle margin
6/10 - cervicle 1/3rd crown covered
4/10 - middle 1/3rd of crown covered
In 12-17yr olds if they score a bpe of 3 or 4 what do we do?
6PPC - if in 3 just 6ppc OF THAT AREA BUT IF 4 THEN FULL MOUTH
CHECK ALVEOLAR BONE LEVELS
What would <15% or 2mm bone loss indicate?
stage 1 - early/mild
What would coronal 1/3rd bone loss indicate?
Stage 2 - moderate
What would middle 1/3rd bone loss indicate?
stage 3 - severe
What would apical 1/3rd bone loss indicate?
stage 4 - very severe
What would <0.5 grading indicate?
Grade A - slow progressing bone loss
What would 0.5-1 grading indicate?
Grade B - moderate progression bone loss
What would >1 grading indicate?
Grade C - RAPID progression
What are some risk factor assessments?
Smoking
sub optimal controlled diabetes
How do we manage plaque induced gingivitis in kids?
Good brushing - OHI, brush all surfaces, demo, dj brush app, supervised brushing unit they can tie their own laces
disclosing tablets
fluoride mouthwash
What can be useful for pts undergoing fixed ortho?
225ppm fluoride mouthwash
If the code is 0 in kids BPE what tx do we do and at what frequency?
No tx, screen again in a year
If code 1 in kids bpe what tx do we do and what frequency?
OHI and prevention
bleeding and plaque charts
recall every 6 months (or yearly)
In code 2 what tx do we do and what freq?
OHI
Diet
Prevention
Scaling and removal of plaque retentive factors
6 months recall
What tx and review do we do in code 3 and 4?
full perio assessment, radiographs, scaling, RSD, OHI, diet advice
tx and review after 3 months
