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FINALS - Periodontology > Periodontal Treatment > Flashcards

Periodontal Treatment Flashcards

1
Q

What is excessive occlusal force?

A

Occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus. This can result in trauma or tooth wear.

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2
Q

What is occlusal trauma?

A

Injury to attachment apparatus, including bone, PDL, and cementum.

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3
Q

What factors impact tooth mobility?

A
  • Width of PDL
  • Height of PDL
  • Inflammation
  • Number, shape, and length of roots.
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4
Q

In what cases can tooth mobility NOT be accepted?

A
  • If it is progressive
  • It gives rise to symptoms
  • It creates difficulty with restorative treatment
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5
Q

What treatments are available to reduce tooth mobility?

A
  • Reduce plaque induced inflammation.
  • Correction of occlusal relations
  • Splinting
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6
Q

What is primary occlusal trauma?

A

Excessive force on a tooth with normal bone support, resulting in injury of tissue.

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7
Q

How is the PDL suited to handle occlusal forces?

A

It has the ability to increase its width so forces can be adequately dissipated, and can then return to normal width and stabilise the tooth.

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8
Q

What is secondary occlusal trauma?

A

Injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced support.

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9
Q

What is fremitus?

A

A palpable or visible movement of tooth when subjected to occlusal forces.

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10
Q

What may cause a tooth to migrate?

A
  • Loss of periodontal attachment
  • Unfavourable occlusal forces
  • Unfavourable soft tissue profile
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11
Q

How do you manage tooth migration?

A
  • Treat periodontitis
  • Correct occlusal relations
  • Accept position of teeth and stabilise
  • Consider orthodontic treatment
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12
Q

What impact does abnormal occlusal contact have on periodontal tissues?

A

Significantly deeper probing depths, and greater attachment loss - ultimately leading to less favourable tooth prognosis.

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13
Q

What is the benefit of occlusal therapy as part of periodontal disease treatment?

A
  • It can help in situations where abnormal occlusal load is being placed on teeth
  • It should not be used routinely
  • In cases where occlusal trauma is present, it may slow progression of periodontitis.
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14
Q

What is a gingival abcess?

A

An infection localised to the gingival margin.

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15
Q

What is a periodontal abscess?

A

A localised infection related to a pre-existing deep pocket, assosiated with food packing and tightening of gingival margin post HPT.

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16
Q

What is a pericoronal abcess?

A

Associated with partially erupted teeth and 8s.

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17
Q

What is an endodontic-periodontal lesion?

A

A pathological communication between the endodontic and periodontal tissues of a given tooth.

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18
Q

What is the guidance for treatment of acute periodontal abscess?

A
  • Careful PMPR under LA
  • Drain pocket via incision
  • Recommend optimal analgesia
  • Recommend 0.2% CHX mouthwash
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19
Q

When should antibiotics be given for periodontal abscess?

A
  • Pen V 250mg for 5 days
  • Amoxicillin 500mg 5 days
    -Metronidazole 400mg 5 days

Each have a TID dose.

20
Q

What are the signs/symptoms of a periodontal abscess?

A
  • Swelling
  • Pain
  • Tooth TTP
  • Bleeding
  • Enlarged lymph nodes
  • Fever
  • Tooth usually vital
  • Pre-existing PD
21
Q

What causes acute periodontal-endodontic lesions?

A

Trauma or perforation of canal

22
Q

What causes chronic periodontal-endodontic lesions?

A

Pre-existing periodontitis, and may not have evident symptoms.

23
Q

What are the signs and symptoms of a periodontal-endodontic lesion?

A
  • Deep pocketing, reaching apex
  • Negative response to vitality tests
  • Bone resorption at apex/furcation
  • Spontaneous pain
  • Pain on palpation/percussion
  • Tooth mobility
  • Sinus tract
24
Q

What are the possible routes of communication from periodontal/endodontic lesions?

A
  • Exposed dentinal tubules
  • Lateral/accessory canals
  • Furcal canals
25
Q

What percentage of teeth have lateral and accessory canals?

A

30-40% of all teeth, the majority are found near the apex of the tooth.

26
Q

What is the treatment for acute perio-endo lesions?

A
  • Carry out endo treatment
  • Recommend optimal analgesia
  • Do not prescribe ABs unless signs of systemic involvement
  • Recommend the use of 0.2% CHX mouthwash until acute symptoms subside
  • Carry out management of lesion, with PMPR and other perio management.
27
Q

What types of treatment are available for periodontal-endodontic lesions?

A
  • Primary endodontic therapy
  • Periodontal therapy (non-surgical likely to be unsuccessful)
  • Surgical investigation and treatment
  • Guided tissue regeneration
28
Q

What surgical treatment options could you take to manage a periodontal-endodontic lesion?

A

Open flap debridement

29
Q

Why is smoking a risk factor for periodontal disease?

A

It decreases the healing capacity, due to decreased blood flow from vasoconstrictive effects of nicotine. This can also mask symptoms such as gum bleeding.

30
Q

Why is poorly controlled diabetes a risk factor for periodontal disease?

A

Hyperglycemia may modulate the RANK/OPG ratio, contributing to alveolar bone destruction. Hyperglycemia production of AGE increases, which leads to productions of pro inflammatory cytokines and MMPs.

31
Q

Why can nutrition be a risk factor for periodontal disease?

A

Severe vit C deficiency can lead to scorbutic gingivitis (scurvy), and a general lack of nutrients suppresses immune response.

32
Q

Why can obesity be a risk factor for periodontal disease?

A
  • Phenytoin (anti-convulsant)
  • Cyclosporin (immunosupressant, transplant patients use)
  • Nifedipine/nifedipine (Ca channel blockers)
33
Q

What cardiovascular diseases can periodontal disease be a risk factor for?

A

Atherosclerosis and hypertension.

34
Q

What are the five steps of periodontal therapy?

A
  • Basis of therapy: Exam, assessment, diagnosis.
  • Step 1: Control of local/systemic risk factors. PMPR
  • Step 2: Step 1 + Subgingival instrumentation
  • Step 3: Periodontal surgery in certain patients
  • Step 4: Supportive periodontal therapy. Continuous monitoring. PMPR. Permanent SPT.
35
Q

What is involved in step 1 of the BSP clinical guidelines for treating periodontitis?

A
  1. Explain the disease
  2. Explain importance of OH
  3. Reduce risk factors
  4. Provide tailored advice
  5. Select recall period.

Re-evaluate. If patient engaging send to step to, if not repeat step 1. Consider referral if complicated case.

36
Q

How can success be defined for periodontal treatment?

A
  • Good OH
  • No BOP
  • No increasing pocket depth
  • No increasing tooth mobility
  • Functional and comfortable dentition.
37
Q

What is involved in step 2 of the BSP clinical guidelines for treating periodontitis?

A
  1. Reinforce OH, risk factor control, and behaviour change.
  2. Subgingival PMPR
  3. Adjunctive systemic anti-microbials
38
Q

What determines whether you escalate treatment to step 3, or step 4 after step 2 of the BSP tx plan is complete?

A

If stable, go to step 4
If unstable go to step 3

39
Q

What is involved in step 3 of the BSP clinical guidelines for treating periodontitis?

A
  1. Reinforce OH, risk factor control, and behaviour change.
  2. Subgingival PMPR
  3. Consider alternative reasons for pocketing
  4. Consider periodontal regenerative surgery
40
Q

What is involved in step 4 of the BSP clinical guidelines for treating periodontitis?

A
  1. Supportive periodontal care
  2. Reinforce OH, risk factor control, behaviour change.
  3. Regular targeted PMPR
  4. Consider evidence baste adjunctive efficacious toothpaste/mouthwash.
41
Q

How can you define an engaging patient?

A
  • > 50% improvement in MPBS
  • Plaque levels <20% and bleeding <30%
  • Patient has met specific targets
42
Q

What is the most effective form of interdental cleaning?

A

Interdental brushes.

43
Q

Why is it ideal to eliminate deep pockets?

A

Teeth with pockets >4mm are more likely to be lost in the future. The deeper the pocket, the more likely it is the tooth will be lost.

44
Q

What should be done with pockets of 4-5mm?

A

Repeated subgingival instrumentation.

45
Q

What should be done with pockets of >6mm?

A

Consider surgical approach.

FINALS - Periodontology (16 decks)

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