periodontics Flashcards
1
Q
2 types of acute gingivitis
A
ANUG
primary herpetic gingivostomatitis
2
Q
why is GCF increased in gingivitis/PD?
A
delivers humoral + cellular defence factors to combat microbial insult
3
Q
which bacteria dominates in health?
A
streptococci
4
Q
which bacteria dominates in gingival disease?
A
anaerobic gram-negative bacteria - red
5
Q
how does bone loss occur?
A
inflammation spreads to bone, bone resorbed by osteoclasts to create room for host defence cells
6
Q
what epithelium is attached to tooth surface?
A
junctional
7
Q
how many days for an established periodontal lesion to form?
A
21days+
8
Q
3 clinical presentations of ANUG
A
- painful
- sloughing of gingival margin
- ulceration
9
Q
causes of ANUG
A
poor OH
often immunocompromised
poor diet + general health
smoking
10
Q
bacteria associated with ANUG
A
fuso-spirochaetal bacteria
11
Q
treatment of ANUG
A
- OHI
- remove deposits
- if spreading infection - metronidazole (2nd line amoxicillin)
12
Q
5 dermatological disease causing non-plaque induced gingivits
A
- lichen Planus
- pemphigoid
- pemphigus
- erythema multiforme
- lupus erythematous
13
Q
4 main groups in 2017 classification of periodontal disease
A
- gingival health + gingivitis
- periodontitis
- other conditions affecting periodontist
- peri-implantitis
14
Q
what is necrotising stomatitis
A
severe inflammation extending through peridontium + oral cavity - past gingiva
15
Q
difference between localised + generalised gingivitis.PD
A
> 30% generalised
16
Q
3 classifications our periodontal status of implants
A
- peri-implant health
- peri-implant mucositis
- peri-implantitis
17
Q
how is a pocket created in periodontal disease?
A
junctional ep migrates apically to try and maintain ep barrier - anaerobic bacteria flourish
18
Q
how to proceed if NPE code 4s or evidence of interdental recession?
A
radiographic assessment
full PPDs
19
Q
how to proceed if any code 3 with no obvious sign of interdental recession?
A
radiographic assessment
initial therapy - OHI, risk factors, suprascale
localised PPDs in 3 months to review
20
Q
grades of tooth mobility
A
0 = physiological <0.2mm 1 = 0.2 - 1mm horizontal mouvement 2 = >1mm horizontal but not vertical 3 = horizontal + vertical
21
Q
classification of furcations
A
1 = <3mm deep 2 = >3mm deep but not through 3 = through and through
22
Q
how to measure recession + clinical attachment loss
A
recession = CEJ to gingival margin
clinical attachment loss = CEJ to base of pocket
23
Q
what tooth brushing technique is used for spaces between teeth?
A
charter
24
Q
how does chlorhexidine mouth was work?
A
bactericidal
disrupt negatively charged cell walls, disrupts osmotic barrier
25
disadvantages of chlorhexidine
taste disturbance + brown stain
26
difference between RSD + root planing?
RSD = no intentional removal of cementum
27
what is curettage?
instrumentation to remove soft tissue lining of periodontal socket
28
expected probing depth reduction + attachment gain following RSD if initial probing depth 4-6mm?
expected probing reduction = 1-1.5mm
| expected attachment gain = 0-0.5mm
29
expected probing depth reduction + attachment gain following RSD if initial probing depth 7+mm?
expected probing reduction = 2-3mm
| expected attachment gain = 1-2mm
30
why do probing depths reduce after RSD?
decreased gingival swelling, increase resisitance
| formation of LJE
31
negatives of RSD
gingival recession
root sensitivity
aesthetic - black triangles
32
recall frequency for SPT?
2-4months
indices annually
33
healing after RSD within a few hours
acute inflammatory reaction in pocket wall
34
healing after RSD within 1-2days
epithelisation of pocket wall
35
healing after RSD 1-2weeks
epithelial reattachment at base of pocket, gingival recession
36
healing after RSD 3-6 weeks
formation of functionally oriented collagen replacing granulation tissue
37
adjunctive treatments to RSD
local = periochip
chlorhexidine
antibiotics
38
what is a periochip
2.5mg chlorhexidine in biosorbale gel - does not need to be removed
effective 7-10days
39
2 bacterias typically associated with aggressive forms of PD
aggregatibacter actinomycemecomitans
| porphyromonas ginigvalis infection
40
what is rapidly progressing PD?
tissue destruction inconsistent with local + systemic factors
antibiotics may be indicated
41
host response modulator used to treat PD?
doxycycline (periostat - 20mg twice daily)
inhibits MMP (colleganase) activity in periodontal tissue
42
classification for traumatic incisor relationship?
akerly class II +III
43
radiographic evidence of primary occlusal trauma
widened PMS but no loss in bone height
44
difference between primary + secondary occlusal trauma
primary = excessive force to tooth/teeth with normal supporting structures
secondary = normal occlusal force becomes excessive because loss of attachment
45
3 groups of acute gingival conditions
1. infective
2. traumatic
3. systemic
46
what is primary herpetic gingivostomatits
recurrent oral herpes effecting gingiva HSV1
47
blood dycrasias causing acute gingivitis
leukaemia associated - acute myeloid leukaemia
neutropenia
48
clinical appearance of ANUG
'punched out' ulcers covered with yellow/grey pseudomembranous slough
tips of interdental papilla affected first
```
linear erythema
bleeding
pain
halitosis
lymphadenitis, fever, malaise
```
49
clinical features of primary herpetic gingivostomatitis
fever, headaches, malaise, dysphagia, lymphadenopathy
aggressive marginal gingivitis
fluid filled vesicle tongue, palate, buccal, lips
burst to leave painful yellowf-grey ulcers, red inflamed margins
ulcers heal without scarring ~14 days
50
7 riks factors for PD
1. smoking
2. diabetes
3. genetics
4, medications
5. hormones + pregnancy
6. Stress
7. obesity
51
how does diabetes effect PD
microvascular damage - affecting leukocyte/nutrient delivery
altered collagen turnover, increase PD breakdown, decreased PD healing
PMN dysfunction
more inflammatory mediators - more inflammation
52
histology of drug induced gingival overgrowth
fibrous tissue forms bulk - proliferation of fibroblasts + increased collage content
highly vascularised tissue, increased inflammatory cells
53
why is PD common in Ehlers dances
collagen deficient
54
how does leukaemia cause gingival swelling
infiltration of gingiva with leukemic cells
55
how does leukaemia cause gingival bleeding
thrombocytopenia
56
oral manifestation of papillon lefevre syndrome
severe generalised periodontitis
57
5 indications ofr periodontal surgery
1. improved access for RSI
2. excision of gingival hyperplasia
3. correction of gingival recession
4. access sub gingival caries
5. increase sub gingival tissue for restorative procedures
58
indications for open flap debridement
residual pockets of 5mm+
to response to convention management
motivated + optimised OH
accept risk of recession, sensitivity, aesthetics
59
most common open flap debridement technique
modified Widman flap
60
4 steps to flap debridement surgery
1. raise buccal flap to visualise root surface/granulation tissue/calculus
2. raise palatal flap
3. debride + curettage of granulation tissue
4. flap closure + apical repositioning for direct pocket reduction
61
what is guided tissue regeneration
regenerate lost peridontium in localised vertical/infrabony defects
62
4 steps of GTR
1. direct vision - open surgically
2. placement of stable biomaterial int well-constrained defect
3. coverage with membrane - prevents ingrowth of ep
4. primary closure
63
2 options for healing of open flap debridemen?
new long junctional epithelium attachment
GTR
64
what forms PDL in GTR
undifferentiated stem cells
65
2 examples of GTR biomaterial
emdogain
bio-oss
66
what dressing is used to promote secondary intention healing after gingivectomy
coe-pak
67
miller classification of recession
1 = not extending beyond mucogingival junction + no loss of interdental soft tissue + bone
2 = extending beyond mucoginigval junction + no loss of interdental soft tissue + bone
3. extending beyond mucoginigval junction + loss of interdental soft tissue + bone apical to CEJ but not coronal
4. extending beyond mucogingival junction + loss of interdental soft tissue + bone apical + coronal
68
cairo classification of recession
RT1 = no inter proximal tissue loss
RT2 = interproximal tissue loss not as significant as mid buccal
RT3 = interproximal tissue loss worse than mid buccal
69
surgical options for gingival recession
soft tissue grafting - free gingival graft, connective tissue craft
if interproximal tissue lost = full root coverage not possible
70
aim of gingival recession surgery
increase keratinised tissue or achieve root coverage
71
where is free gingival graft taken from
palate
72
treatment indicated in extensive recession
not surgery- root coverage not possible
gingival veneer +/- composte augmentation
73
3 indication for crown lengthening
1. access subgingival caries
2. increase surface area for restoration
3. improve aesthetic - gummy/uneven
74
how clear of alveolar crest must restorations be
3mm
prevent recession/bone loss by inflammatory response if encroaches on biologic width
75
3 steps for crown lengthening surgery
1. raise flap
2. remove bone
3. wait 3-6months for healing
76
furcation surgery aim + disadvantages
improve OH - loss of tissue risking sensitivity/loss of vitality
77
2 parts of furcationplasty in class 1 + 2 furcations
odontoplasty + osseoplasty
78
treatment for class 3 furcations
tunnel preparation
