PERIODONTICS Flashcards
Briefly explain how cigarette smoking contributes to periodontitis.
- Impairment/destruction of vasculature → Decreased neutrophils to fight against infection and delayed healing
- Interference with collagen biosynthesis and maintenance
What are the 5A’s to address smoking cessation?
• Ask – interest in quitting
• Advise – effects of smoking
• Assess – interest and barriers
• Assist – refer to quitline
• Ask again – review smoking cessation progress
What are the three main medications that induce gingival enlargement?
Medications inducing GE
• Phenytoin – 50%
• Cyclosporine – 30%
• CCBs – Nefedipine and verapamil – 20%
Briefly explain HIV lifecycle
- Retrovirus binds to CD4+ t cell
- Fuses to enter the cell
- Utilises reverse transcriptase to convert HIV RNA to HIV DNA
- Integration of HIV DNA into host cell
- Replication of viral HIV proteins
- Assembly of HIV proteins and movement to cell surface
- Budding of immature HIV for inoculation of other CD4 cells
A patient presents to your clinic with the following:
- CAL = 4mm
- PPD = 5mm
- Nil furcation involvement
- Teeth loss due to perio = 2
- Horizontal bone loss only ~ 30%
- Non smoker
- Diabetes - Hb1ac = 5%
- Age = 29
What is the staging and grading of this periodontitis case?
Periodontitis Stage 3, Grade C
CAL and PPD = Stage 2
Nil furcation = Stage 1 or 2
Tooth loss =/< 4 = Stage 3
Horizontal bone loss at 30% = Stage 2
Non smoker = A
Diabetes Hb1Ac <7% = B
Bone loss%/Age >1 = C
Which of the following is false regarding antiseptics and antibiotics?
(A) Antiseptics are broad spectrum compared to antibiotics
(B) Antibiotics are narrow spectrum compared to antiseptics
(C) Antiseptics commonly have a specific target which reduces development of resistance
(D) Antibiotics may be bacteriostatic or bactericidal
C) Commonly has non-specific target which reduces development of resistance
This mouthrinse has an efficacy of 4hrs and primarily effective against G+ bacteria through disruption of cell membrane function and reduction in biofilm formation.
(A) Chlorhexidine
(B) Citrox
(C) Essential Oils
(D) Cetylpyridiniumchloride (CPC)
(D)
(A) Efficacy of 8-12hrs
(B) Efficacy not stipulated in lectures but is a broad spectrum antibacterial with primary purpose of supporting wound healing and stimulating host immune response
(C) EO has efficacy of <6hrs but braod spectrum - gram+, gram-, fungi and some viruses.
List three indications for adjuvant antibiotics.
Stage III & IV, Grade C Periodontitis→ Unnecessary if patient responds well to SRP
Periodontal abscess with tendency to extend in critical areas (fever and/or lymphadenitis) Severe generalised periodontitis in patients with severe systemic diseases (e.g. dysfunction PMNs, Diabetes, HIV with CD4 < 200/mm3) Prevention infective endocarditis prophylaxis
What is the antibiotic(s) and dose recommended for adjuvant antibiotic therapy in periodontics (nil pencillin intolerance and in case of penicillin intolerance.
Metronidazole 400mg BID 7 days + Amoxicillin 500mg TDS 7 days
Pencilin intolerance:
- Metronidazole 400mg BID 7 days + Ciprofloxacin 250mg BID 7 days OR
- Clindamycin 300mg QID 7 days
Which of the following is false regarding periodontal surgery?
(A) Benefits of surgical therapy is primarily only evident for initial PPD >6mm
(B) Resective surgery aims to eliminate existence of the pocket
(C) Surgical therapy should only be considered after at least one round of SRP
(D) Access flap surgery facilitates better instrumentation and reduce pocket depth
(D) Primary aim is for meticulous instrumentation but no attempt to reduce pocket depth - this may occur however during healing due to tissue shrinkage
What are the four stages of periodontal destructrion? Briefly epxlain timeline, clinical S+S and histopath.
- Initial lesion (2 weeks): Inflammation confined to sulcus, reversible - predominated by PMNs
- Early lesions (2-6wks): Increased plaque formation with deepened sulcus (pseudopocket due to inflammation), reversible - T lymphocytes predominate, formation of epithelial rete pegs
- Established lesion (6+ wks): Deep gingival pocket formation with loss of JE - B lymphocytes predominate, epithelial rete pegs
- Advanced lesion (time = ?): Real periodontal pocket formation, irreversible - Plasma cells predominate with large loss of CT
Name the vertical and horizontal subclass for furcation involvement
Vertical
- A = 0-3mm
- B = 3-6mm
- C = 7mm+
Horizontal
- I = 0-3mm
- II = >3mm
- III Through and through
What are predisposing and modifying factors in periodontal health?
Predisposing = Factors that increase risk of plaque accumulation and therefore periodontitis –> Tooth morphology, restorations
Modifying factors = Factors that accelerate alter the way in which an individual responds to plaque accumulation –> Smoking, systemic health, medications
What is the definition of periodontitis (diagnostic factor)
o Interdental CAL is detectable at ≥2 of non-adjacent teeth or
o Buccal or oral CAL ≥ 3mm with pocketing >3mm is detectable at ≥2 teeth
What is the bone loss for each stage of periodontitis?
Stage I: <15%
Stage II: 15-33%
Stage III and IV: >/=33%
What is classified as requiring complex rehabiliation (ie. Stage IV periodontitis)
> /=2 teeth with severe mobility, <10 opposing pairs, significant masticatory dysfunction, secondary occlusal trauma, drifting and flaring of teeth
How does smoking act as a modifying factor on periodontal health?
- Impairment/destruction of vasculature → Decreased neutrophils to fight against infection and delayed healing
- Interference with collagen biosynthesis and maintenance
What are some systemic illnesses that affect the periodontium?
- Papillon Lefevre Syndrome
- Down Syndrome
- Severe neutropenia
- HIV
- Rheumatoid arthritis
What are contraindications of powerdriven instruments?
- Patients with predisposition to infection (e.g. leukaemia, post organ transplant)
- Patients with infectious diseases → Aerosol spread
- Patients with respiratory diseases (e.g. severe asthma) → Difficulty breathing
- Patients with unshielded pacemaker (magnetostrictive)
- May require consultation for patients who are pregnant
- Areas of demineralisation/recession/sensitivity
- Around titanium implants → use plastic/tefloncoated tip
- Children: Primary/newly erupted teeth
What are special considerations and contraindications of air powder polishing?
• Contraindications of air power polishing:
o Patients with upper respiratory tract infections
o Always take a physician’s consent for medically compromised patients (e.g. bleeding disorders, diabetic patients)
o Patients following a no salt diet should be treated only with glycine or erythritol
• Special considerations:
o Sensitive teeth
o Exposed cementum/dentine
o Inflamed gingiva
o Areas of demineralisation
o Newly erupted teeth
o Implant abutments
o Restored tooth surfaces
Distinguish antiseptics and antibiotics
Antiseptics = Broad spectrum (bacteria, fungi, virus), no specific target (no resistance)
Antibiotics = Specifically target bacteria, target specific aspects of bacteria (resistance)
What is recommended dose of chx and duration of the treatment for mild gingivitis vs chronic/severe periodontitis/post-operative.
Recommended dosage – anti-plaque and anti-inflammatory with bactericidal action:
- 20mg Chx twice daily up to 60s → Provides 24hr bacterial suppression
- 10 ml of 0.2% CHXmouthwash (20mg)
- 15 ml of 0.12% CHXmouthwash (18mg)
- NB: Low concentrations = 0.05, 0.06 and 0.09% → Antiplaque properties only and bacteriostatic
Duration CHX treatment
- Prevention/mild gingivitis / minor problems: 2 weeks
- Chronic/more severe disease, post-operative: 4 weeks
What is the abx dose recommended for adjuvant perio therapeutics?
1, Metronidazole 400mg TDS + Amoxicillin 500mg TDS - 7 days
2. Metronidazole 500mg BID + Ciprofloxacin 250mg BID - 7 days
3. Clindamycin 300mg QID - 7 days
4. Metronidazole 400mg TDS
When should periodontal surgery be considered?
After non response to one round of SRP and pockets of >6mm persist (more effective than SRP when PPD>6mm)
