Periodontal Treatment Flashcards
What is excessive occlusal force?
Occlusal force that exceeds the reparative capacity of the periodontal attachment apparatus. This can result in trauma or tooth wear.
What is occlusal trauma?
Injury to attachment apparatus, including bone, PDL, and cementum.
What factors impact tooth mobility?
- Width of PDL
- Height of PDL
- Inflammation
- Number, shape, and length of roots.
In what cases can tooth mobility NOT be accepted?
- If it is progressive
- It gives rise to symptoms
- It creates difficulty with restorative treatment
What treatments are available to reduce tooth mobility?
- Reduce plaque induced inflammation.
- Correction of occlusal relations
- Splinting
What is primary occlusal trauma?
Excessive force on a tooth with normal bone support, resulting in injury of tissue.
How is the PDL suited to handle occlusal forces?
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.
What is secondary occlusal trauma?
Injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced support.
What is fremitus?
A palpable or visible movement of tooth when subjected to occlusal forces.
What may cause a tooth to migrate?
- Loss of periodontal attachment
- Unfavourable occlusal forces
- Unfavourable soft tissue profile
How do you manage tooth migration?
- Treat periodontitis
- Correct occlusal relations
- Accept position of teeth and stabilise
- Consider orthodontic treatment
What impact does abnormal occlusal contact have on periodontal tissues?
Significantly deeper probing depths, and greater attachment loss - ultimately leading to less favourable tooth prognosis.
What is the benefit of occlusal therapy as part of periodontal disease treatment?
- 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.
What is a gingival abcess?
An infection localised to the gingival margin.
What is a periodontal abscess?
A localised infection related to a pre-existing deep pocket, assosiated with food packing and tightening of gingival margin post HPT.
What is a pericoronal abcess?
Associated with partially erupted teeth and 8s.
What is an endodontic-periodontal lesion?
A pathological communication between the endodontic and periodontal tissues of a given tooth.
What is the guidance for treatment of acute periodontal abscess?
- Careful PMPR under LA
- Drain pocket via incision
- Recommend optimal analgesia
- Recommend 0.2% CHX mouthwash
When should antibiotics be given for periodontal abscess?
- Pen V 250mg for 5 days
- Amoxicillin 500mg 5 days
-Metronidazole 400mg 5 days
Each have a TID dose.
What are the signs/symptoms of a periodontal abscess?
- Swelling
- Pain
- Tooth TTP
- Bleeding
- Enlarged lymph nodes
- Fever
- Tooth usually vital
- Pre-existing PD
What causes acute periodontal-endodontic lesions?
Trauma or perforation of canal
What causes chronic periodontal-endodontic lesions?
Pre-existing periodontitis, and may not have evident symptoms.
What are the signs and symptoms of a periodontal-endodontic lesion?
- Deep pocketing, reaching apex
- Negative response to vitality tests
- Bone resorption at apex/furcation
- Spontaneous pain
- Pain on palpation/percussion
- Tooth mobility
- Sinus tract
What are the possible routes of communication from periodontal/endodontic lesions?
- Exposed dentinal tubules
- Lateral/accessory canals
- Furcal canals
What percentage of teeth have lateral and accessory canals?
30-40% of all teeth, the majority are found near the apex of the tooth.
What is the treatment for acute perio-endo lesions?
- 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.
What types of treatment are available for periodontal-endodontic lesions?
- Primary endodontic therapy
- Periodontal therapy (non-surgical likely to be unsuccessful)
- Surgical investigation and treatment
- Guided tissue regeneration
What surgical treatment options could you take to manage a periodontal-endodontic lesion?
Open flap debridement
Why is smoking a risk factor for periodontal disease?
It decreases the healing capacity, due to decreased blood flow from vasoconstrictive effects of nicotine. This can also mask symptoms such as gum bleeding.
Why is poorly controlled diabetes a risk factor for periodontal disease?
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.
Why can nutrition be a risk factor for periodontal disease?
Severe vit C deficiency can lead to scorbutic gingivitis (scurvy), and a general lack of nutrients suppresses immune response.
Why can obesity be a risk factor for periodontal disease?
- Phenytoin (anti-convulsant)
- Cyclosporin (immunosupressant, transplant patients use)
- Nifedipine/nifedipine (Ca channel blockers)
What cardiovascular diseases can periodontal disease be a risk factor for?
Atherosclerosis and hypertension.
What are the five steps of periodontal therapy?
- 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.
What is involved in step 1 of the BSP clinical guidelines for treating periodontitis?
- Explain the disease
- Explain importance of OH
- Reduce risk factors
- Provide tailored advice
- Select recall period.
Re-evaluate. If patient engaging send to step to, if not repeat step 1. Consider referral if complicated case.
How can success be defined for periodontal treatment?
- Good OH
- No BOP
- No increasing pocket depth
- No increasing tooth mobility
- Functional and comfortable dentition.
What is involved in step 2 of the BSP clinical guidelines for treating periodontitis?
- Reinforce OH, risk factor control, and behaviour change.
- Subgingival PMPR
- Adjunctive systemic anti-microbials
What determines whether you escalate treatment to step 3, or step 4 after step 2 of the BSP tx plan is complete?
If stable, go to step 4
If unstable go to step 3
What is involved in step 3 of the BSP clinical guidelines for treating periodontitis?
- Reinforce OH, risk factor control, and behaviour change.
- Subgingival PMPR
- Consider alternative reasons for pocketing
- Consider periodontal regenerative surgery
What is involved in step 4 of the BSP clinical guidelines for treating periodontitis?
- Supportive periodontal care
- Reinforce OH, risk factor control, behaviour change.
- Regular targeted PMPR
- Consider evidence baste adjunctive efficacious toothpaste/mouthwash.
How can you define an engaging patient?
- > 50% improvement in MPBS
- Plaque levels <20% and bleeding <30%
- Patient has met specific targets
What is the most effective form of interdental cleaning?
Interdental brushes.
Why is it ideal to eliminate deep pockets?
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.
What should be done with pockets of 4-5mm?
Repeated subgingival instrumentation.
What should be done with pockets of >6mm?
Consider surgical approach.
