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DMD2 > PERIODONTICS > Flashcards

PERIODONTICS Flashcards

1
Q

On true lingual surface of tooth 41, PPD measures 7mm and gingival margin is in normal position. What is CAL?
A) 7mm
B) 4mm
C) 3mm
D) 2mm

A

B) CAL = 4mm (Normal gingival overgrowth above CEJ is 3mm, therefore CAL = 7mm - 3mm)
*Question and answer taken from canvas quiz

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2
Q

When using a Nabers probe to detect furcation involvement, which of the following most accurately describes a CL2 furcation involved tooth/
A) First silver band of probe in furcation <3mm
B) Second black band of probe in furcation > 9mm
C) Second silver band of probe is in furcation >6mm
D) First black band of probe partially inside furcation >3mm less than 6mm

A

D)
*Question and answer taken from canvas quiz

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3
Q

Explain the horizontal and vertical classification of furcation involvement.

A

Vertical:
Subclass A = 0-3mm
Subclass B = 4-6mm
Subclass C = 7mm and above

Horizontal
Class I = 0-3mm
Class 2 = >3mm
Class 3 = Through and through

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4
Q

Name the current periodontal disease classification being used worldwide
A) SBI
B) PSR
C) Classification of periodontal and peri-implant diseases and conditions 1999
D) Classification of periodontal and peri-implant disease and conditions 2017

A

D)
*Question and answer taken from canvas quiz

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5
Q

According to 2017 classifcation of periodontal and peri-implant diseases and conditions, the two main categories of gingivitis?
A) Non biofilm induced gingivitis and necrotising gingivitis
B) Gingival enlargement caused by medications and dental biofilm induced gingivitis
C) Dental biofilm induced gingivitis and non biofilm induced gingivitis
D) Necrotising gingivitis and biofilm induced gingivitis

A

C)
*Question and answer taken from canvas quiz

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6
Q

What is the definition of a periodontitis case?

A

Interdental CAL >/=2mm in >/= 2 non-adjacent teeth OR buccal/oral CAL >/= 3mm with PPD >3mm in >/= 2 teeth

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7
Q

Periodontitis is classified as stage 1 when the following is recorded:
A) CAL 3-4mm, bone loss 15-30%, PPD =5mm, no tooth loss due to perio, horizontal bone loss pattern, no furcations
B) CAL >/=5mm, bone loss >/=33%, PPD >6mm, 3 teeth loss due to periodontitis, bone loss pattern vertical, class 2/3 furcations
C) CAL 1-2mmm, bone loss <15%, PPDF <4mm, no tooth loss due to perio, horizontal bone loss pattern, no furcations
D) CAL >5mm, bone loss >/=33%, PPDF <6mm, 4 teeth loss due to perio, bone loss patterns <3mm vertical, class 2/3 furcations

A

C)
*Question and answer (small variations) taken from canvas quiz

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8
Q

A patient presents with clear medical history excluding smoking 2 cigs/day. After full mouth perio chart and panoramic radiograph, the following parameters noted: average probing depth is 6mm in over 30% of teeth present, two vertical bone loss lesions visible, site with greatest CAL measures 6mm, one tooth lost due to perio, two class 2 furcations. There has been no change in these parameters over the past 5 years when reviewing period radiographs and perio chart. Which is the full perio diagnosis you would assign?
A) Localised stage 2, grade A
B) Localised stage 1, grade B
C) Generalised stage 4, grade C
D) Generalised stage 3, grade B

A

D)
*Question and answer taken from canvas quiz

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9
Q

What are primary goals of staging per the 2017 periodontal classifcations?
A) Staging refers to severity of disease at presentation and rate of progression
B) All answers are correct
C) Staging refers to biological features and complexity of disease management
D) Staging refers to severity of disease at presentation and complexity of disease management

A

D)
*Question and answer taken from canvas quiz

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10
Q

Distinguish staging and grading.

A

Staging:
- Classify severity and extent of current situation
- Assess complexity of long-term management

Grading:
- Estimates future risk of periodontitis progression and responsiveness to standard therapy
- Estimates potential health impact of periodontitis on systemic diseases and the reverse

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11
Q

Distinguish localised vs generalised periodontitis.

A

Localised = <30% teeth involved
Generalised = >30% teeth involved
Should be specified when staging

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12
Q

What are we aiming to remove when undertaking subgingival debridement?
A) Subgingival biofilm/necrotic cementum and granulation tissue
B) Subgingival biofilm/necrotic cementum and junctional epithelium
C) Subgingival biofilm/calculus and granulation tissue
D) Subgingival biofilm/calculus/necrotic cementum

A

C)
*Question and answer taken from canvas quiz

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13
Q

What does supportive periodontal therapy/maintenance involve?
A) Removal of hopeless prognosis teeth, prophylaxis/clinical and radiographic reassessment (if necessary), subgingival debridement (if necessary)
B) OHI remotivation, prophylaxis/clinical and radiographic reassessment (if necessary), surgical therapy (if necessary)
C) Full treatment planning, clinical and radiographic reassessment (if necessary), subgingival debridement (if necessary)
D) OHI remotivation, prophylaxis/clinical and radiographic assessment (if necessary), subgingival debridement (if necessary)

A

D)
*Question and answer taken from canvas quiz

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14
Q

What makes the PSR system unique?
A) The way the probe is marked and read
B) Its intended use on patients
C) The way the probe is inserted into the sulcus
D) Its adoption by the ADA and AAp

A

A)
*Question and answer taken from canvas quiz

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15
Q

The correct patient management for PSR code 1 is:
A) A comprehensive full mouth perio examination/charting must be carried out
B) Individualised OHI should be reinforced and supragingival plaque removal
C) A comprehensive full mouth perio examination/charting followed directly be subgingival debridement
D) Individualised OHI and removal of subgingival plaque, removal of calculus and plaque-retentive margins and restorations

A

B)
*Question and answer taken from canvas quiz

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16
Q

Which of the following is correct about the universal curette?
A) There is only one cutting edge
B) It is used for subgingival debridement only
C) The face is perpendicular to the terminal shank
D) It has a pointed toe and rounded back

A

C)

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17
Q

Briefly explain the design of the gracey curette in terms of number of cutting edges, cross section of the toe and the angle between face and terminal shank.

A
  • One cutting edge
  • Semicircular cross section
  • Rounded toe and back
  • Face at 70 degrees to the terminal shank
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18
Q

What is the correct recommendation for use of chlorhexidine?
A) Rinse 10mL 0.2% twice daily
B) Rinse 10mL 0.12% once daily
C) Rinse 15mL 0.2% twice daily
D Rinse 15mL 0.12% once daily

A

A)
15mL of 0.12% Chx twice daily can also be used

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19
Q

Explain the three categories of periodontitis under the new classification.

A
  • Necrotising periodontal diseases
  • Periodontitis
  • Periodontitis as a manifestation of systemic diseases
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20
Q

What are the three categories of tooth mobility?

A

Class 1 = B/L movement =1mm
Class 2 = B/L movement > 1mm
Class 3 = B/L movement > 1mm AND vertical displacement

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21
Q

What are the predominant microorganisms in necrotising periodontal diseases?

A

Trepenema, Provetella, Fusobacterium

22
Q

Briefly explain the steps involved in periodontal treatment.

A
  1. PSR/SBI/API
  2. Initial prophylaxis I:
    - Educate patient, OHI, discuss habits (e.g. smoking cesssation)
    - Supragingival scaling
  3. Periodontal assessment:
    - PSR/SBI/API
    - +/- Extractions for hopeless teeth
    - Only proceed to next stage if SBI and API are within acceptable limits
  4. Initial prophylaxis II:
    - Periodontal charting - 6 point parameters
    - Diagnosis and treatment plan
    - Subgingival scaling
  5. Reevaluation (3 - 12 weeks after):
    - Periodontal chart - 6 point parameters
    - API/SBI
    - +/- Extractions for hopeless teeth
    - +/- Periodontal surgery or microbial diagnosistics if required
  6. Supportive periodontal therapy:
    - Periodontal status is under control
    - Remotivate patient
    - Professional prophylaxis and supragingival debridement
    - Subgingival debridement and clinical/radiographic reassessment if required
23
Q

Distinguish magnetostrictive and piezoelectric ultrasonic scalers.

A

Ultrasonic scaler – Magnetostrictive:
- Stack of flat metal strips or rod of ferromagnetical material (capable of being magnetised) as transducer
- Transducer attached with working tip
- Coil within housing generate magnetic field = Influences the tip and causes it to move
- Tip moves in an elliptical or circular manner
- Type of motion allows the use of all sides (360°) of the working tip

Ultrasonic scaler – Piezoelectric
- Transducer completely contained within the handpiece and not connected to working tip
- Tip movement primarily linear / linear motion only the lateral (two) sides of the working tip are activated

24
Q

Which of the following is false regarding ultrasonic scalers?
A) Ultrasonic scalers contraindicated in patients with respiratory diseases
B) Caution should be taken when using on primary/newly erupted permanent teeth
C) Piezoelectric contraindicated in patients with unshielded pacemaker
D) Ultrasonic scalers contraindicated ion areas of demineralisation of recession

A

C) - False as referring to magnetostrictive

25
Q

Explain whether supra/subgingival use, grain size and suitability for low salt diet patients for the following:
- Sodium bicarbonate
- Calcium carbonate
- Glycine
- Erythritol

A
  • Sodium bicarbonate: Supragingival, 65 -250 μm, not suitable for low salt diet
  • Calcium carbonate: Supragingival, 54 μm, suitable for low salt diet
  • Glycine: Subgingival, 25 μm, suitable for low salt diet
  • Erythritol: Subgingival ad supragingival, 14 μm, suitable for low salt diet
26
Q

Which of the following is true regarding airpolishing?
A) Standard tip is used for removal in pockets up to 5mm
B) Air polishing is efficient in removal of calculus
C) Subgingival air polishing should not be used immediately after subgingival debridement
D) Circular motions are used for 8s on each surface

A

C) is true

A) Standard tip should be used for up to 4mm. Subgingival tip used for pockets 5 - 10mm
B) Does not remove calculus
D) Should not air polish on an area for > 5 seconds

27
Q

Which is FALSE regarding mouth rinses?
A) Chlorhexidine primarily active against G+ bacteria
B) Essential oils recommended as a monotherapy
C) Citrox reduces adverse effects associated with high concentrations of chlorhexidine
D) CPC primarily active against G+ bacteria

A

B) It is only recommended as an adjunctive therapy

28
Q

Briefly explain the adverse effects of chlorhexidine use.

A
  • Extrinsic yellow/brown discolouration of teeth and oral mucosa (removed with AP)
  • Increased in presence of biofilm and diet – iron supplements, wine, tea/coffee
  • Decreased risk with decreased concentration
  • Interference with taste bud activity → Food tastes bland
  • Temporary burning sensation and dry oral mucosa
  • Desquamative lesions and oral mucosa
  • Hypersensitivity reaction
    NB: Generally high risk of adverse effects if used for >2 times/day
29
Q

Explain the spectrum for the following:
- Chlorhexidine
- Essential oils
- CPC

A

Chlorhexidine
- Gram +
- Less active against gram -

Essential oils
- G+ and G -
- Fungi
- Some viruses

CPC
- Gram + and yeasts

30
Q

Which of the following is correct for the diagnosis for plaque induced gingivitis in a reduced periodontium (no Hx of perio) patient?

A. NO attachment loss, NO radiographic bone loss, =3mm PPD, <10% bleeding
B. Attachement loss, possible radiographic bone loss, =3mm PPD, <10% bleeding
C. Attachement loss, possible radiographic bone loss, =3mm PPD, >10% bleeding
D. Attachement loss, radiographic bone loss, =4mm PPD, <10% bleeding

A

C is correct

A - this is the classification for health in the intact periodontium
B - this is the classification for health in a reduced periodontium (w/out perio)
D - this is the classification for health in a reduced periodontium & Hx of perio

31
Q

In what order do your perform your initial periodontal screening exam

A

SAP

SBI –> API –> PSR

32
Q

Which handpiece would you use for prohpylaxis and what speed are you aiming for?

A

Green banded slow speed hand piece –> runs at 5500rpm
When performing prophylaxis you want to remain <3000rpm

33
Q

Describe the WHO probe

A

Screening probe with measurements –> 0.5mm (ball)
then increments of 3, 2, 3, 3

OR

0.5mm (ball), 3.5, 5.5, 8.5, 11.5

34
Q

What amount of pressure would you apply in PSR

A

25-50g of pressure
20g when probing an implant

35
Q

Would you include the wisdom teeth and midlines in;

PSR?
API?
SBI?

A

PSR - yes

API/SBI - no

36
Q

Which teeth are screened in a mixed dentition?

A

16, 11, 26, 36, 31, 46

37
Q

Explain a code 0-4 in PSR

A

0 - black mark visible, no bleeding, no calculus
1 - black mark visible, bleeding, no calculus
2 - black mark visible, bleeding, calculus and/or defective restoration margins
3- black mark partly visible, bleeding possible, calculus and/or defective restoration margins possible
4 - black mark no longer visible, bleeding possible, calculus and/or defective restoration margins possible

38
Q

In regards to a code 3 what is the difference in treatment for;

  1. A code 3 in one sextant
  2. A code 3 in 2+ sextants
A
  1. The code 3 sextant requires comprehensive perio charting
  2. Full-mouth comprehensive perio charting
39
Q

Discuss the GC tri-colour gel

A

The tri-colour gel allows the plaque on teeth to be visdualised. the gel contains a red pigment, blue pigment and sucrose

Three colours indicate different levels of the plaque

Pink - indicates plaque that has been present for <24 hours. The plaque is not thick enough to retain the blue pigment once rinsed

Purple/dark blue - indicated older plaque >48hrs. The plaque here is mature/structured anmd hence retains both the pink and blue pigments even after rinsing

Blue/light blue - indicated a high risk cariogenic plaque. In this plaque the sucrose is metabolised by acidogenic bacteria –> this leads to acid production (<4.5pH) which breaks down the red pigment leaving only the blue

40
Q

What is the critial oral pH and at what pH does the GC tri-colour gel appear light blue

A

Critical pH - 5.5
Light blue Tri-colour Gel - 4.5

41
Q

What is a healthy range for API and SBI

A

SBI - 15-25%
API - 25-35%

42
Q

You have 60% SBI but only 15% API
What could be happening here?

A

Underlying bleeding risk/systemic bleeding condition
Diabetes mellitus
Vitamin C deficiency
Medications that increase bleeding (warfarin, heparin)
Pregnancy

43
Q

You have an API of 80% but an SBI of 20%
What could be happening here?

A

Smoker

44
Q

When would you use an end-tuft brush?

A

Areas of recession
Misaligned teeth
Distal surfaces of distal most molars
Partially erupted teeth

45
Q

Explain modified bass technique

A

Brush is held at a 45 degree angle towards the gingiva so the brush is 1/2 on tooth and 1/2 on the gums - this allows the bristles to enter and clean the gingival sulcus. Gentle pressure is applied and using 10 small circular/vibrating motions each tooth is cleaned one at a time

46
Q

A patient has had recent gum surgery and/or they have orthodontic brackets what brushing technique could be applied here?

A

Charters
TB is placed at a 90 degree angle to the long axis of the tooth, pressure applied so the brush is averted from the gingiva.

47
Q

What is the recomended dose of CHX, when is its use indicated and what are some of it’s ADR’s?

A

Dosage:
15ml of 0.12% - twice daily
10ml of 0.2% - twice daily
Mild issue, prevention - 2 weeks use
Chronic issue, post-op, severe disease - 4 weeks use

Indications:
- Adjunct to brushing and flossing for those who are impaired –> decreased saliva, decreased motivation, decreadsed mobility/function
- Alternative to brushing after surgery or when there is an acute infection that causes ginvial pain –> affecting mechanical brushing
- Prevention/management of candida infections
- Halitosis

ADR:
Yellow/brown discolouration of teeth, tongue, restorations
Dysgeusia
Burning mouth
Desquamative lesions
Parotid swelling
Hypersensitivity (rarer but on the rise)

48
Q

You are about to do API in Q3 what surface are you applying the gel?

You are going to do SBI in Q1, whichh surface do you start on?

A

Lingual

Buccal

49
Q

Calculate your reading points for the following patient

14 & 15 missing - bridge from 13-16
21 missing
24 missing - gap has been closed by orthodontics
28 missing
34-36 missing - gap remains open
43-45 missing - replaced with implants

A

24 Reading points

14 and 15 - lose one reading point
21/28 - irrelevant
24 gap closure - lose one reading point
34-36 - losing two reading points
43-45 all replaced with implants - reading points retained

50
Q

A patient has 24 reading points, their API is 12 and their SBI is 18.

What are the percentages?
Is this good or bad?
What is your first line of tx?

A

API - 50% SBI - 75%

This is not good, patient needs education on brushing and cleaning techniques. IDT and initial therapy I

51
Q

What active ingredients have been shown to treat dentine hypersentivity?

A

o Active ingredients with clinical evidence
 Arginine
• Works with calcium carbonate to create dentine-like material to occlude tubules
• Colgate sensitive pro relief toothpaste
 Strontium
• Equivalent to arginine
• Sensodyne rapid relief
• Sensodyne original (red packaging)
 Stannous fluoride
• Superior to arginine
• Forms calcified barrier on dentin surface to occlude tubules
• Oral B Pro Health

52
Q

Distinguish gingival and periodontal abscess?

A

Gingival abscess = Pus in gingiva, occurs due in healthy gingiva due to foreign body impaction or root morphology (e.g. root invagination) –> Swelling of gingiva with pain and pus, pseudpocket
Treamtnet = Incision and drainage, removal of cause, NO abx

Periodontal abscess = Pus in periodontal pocket, occurs in perio involved gingiva –> Swelling of pocket with pain and pus, PPD, bone loss, mobility of tooth
Treatment = Incision and drainage with review in 48hrs (abx if drainage is difficult), periodontal therapy

DMD2 (13 decks)

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