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DMD3 > PERIODONTICS > Flashcards

PERIODONTICS Flashcards

1
Q

Briefly explain how cigarette smoking contributes to periodontitis.

A
  1. Impairment/destruction of vasculature → Decreased neutrophils to fight against infection and delayed healing
  2. Interference with collagen biosynthesis and maintenance
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2
Q

What are the 5A’s to address smoking cessation?

A

• Ask – interest in quitting
• Advise – effects of smoking
• Assess – interest and barriers
• Assist – refer to quitline
• Ask again – review smoking cessation progress

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3
Q

What are the three main medications that induce gingival enlargement?

A

Medications inducing GE
• Phenytoin – 50%
• Cyclosporine – 30%
• CCBs – Nefedipine and verapamil – 20%

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4
Q

Briefly explain HIV lifecycle

A
  1. Retrovirus binds to CD4+ t cell
  2. Fuses to enter the cell
  3. Utilises reverse transcriptase to convert HIV RNA to HIV DNA
  4. Integration of HIV DNA into host cell
  5. Replication of viral HIV proteins
  6. Assembly of HIV proteins and movement to cell surface
  7. Budding of immature HIV for inoculation of other CD4 cells
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5
Q

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?

A

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

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6
Q

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

A

C) Commonly has non-specific target which reduces development of resistance

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7
Q

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)

A

(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.

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8
Q

List three indications for adjuvant antibiotics.

A

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
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9
Q

What is the antibiotic(s) and dose recommended for adjuvant antibiotic therapy in periodontics (nil pencillin intolerance and in case of penicillin intolerance.

A

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

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10
Q

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

A

(D) Primary aim is for meticulous instrumentation but no attempt to reduce pocket depth - this may occur however during healing due to tissue shrinkage

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11
Q

What are the four stages of periodontal destructrion? Briefly epxlain timeline, clinical S+S and histopath.

A
  1. Initial lesion (2 weeks): Inflammation confined to sulcus, reversible - predominated by PMNs
  2. Early lesions (2-6wks): Increased plaque formation with deepened sulcus (pseudopocket due to inflammation), reversible - T lymphocytes predominate, formation of epithelial rete pegs
  3. Established lesion (6+ wks): Deep gingival pocket formation with loss of JE - B lymphocytes predominate, epithelial rete pegs
  4. Advanced lesion (time = ?): Real periodontal pocket formation, irreversible - Plasma cells predominate with large loss of CT
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12
Q

Name the vertical and horizontal subclass for furcation involvement

A

Vertical
- A = 0-3mm
- B = 3-6mm
- C = 7mm+

Horizontal
- I = 0-3mm
- II = >3mm
- III Through and through

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13
Q

What are predisposing and modifying factors in periodontal health?

A

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

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14
Q

What is the definition of periodontitis (diagnostic factor)

A

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

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15
Q

What is the bone loss for each stage of periodontitis?

A

Stage I: <15%
Stage II: 15-33%
Stage III and IV: >/=33%

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16
Q

What is classified as requiring complex rehabiliation (ie. Stage IV periodontitis)

A

> /=2 teeth with severe mobility, <10 opposing pairs, significant masticatory dysfunction, secondary occlusal trauma, drifting and flaring of teeth

17
Q

How does smoking act as a modifying factor on periodontal health?

A
  • Impairment/destruction of vasculature → Decreased neutrophils to fight against infection and delayed healing
  • Interference with collagen biosynthesis and maintenance
18
Q

What are some systemic illnesses that affect the periodontium?

A
  • Papillon Lefevre Syndrome
  • Down Syndrome
  • Severe neutropenia
  • HIV
  • Rheumatoid arthritis
19
Q

What are contraindications of powerdriven instruments?

A
  • 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
20
Q

What are special considerations and contraindications of air powder polishing?

A

• 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

21
Q

Distinguish antiseptics and antibiotics

A

Antiseptics = Broad spectrum (bacteria, fungi, virus), no specific target (no resistance)
Antibiotics = Specifically target bacteria, target specific aspects of bacteria (resistance)

22
Q

What is recommended dose of chx and duration of the treatment for mild gingivitis vs chronic/severe periodontitis/post-operative.

A

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

23
Q

What is the abx dose recommended for adjuvant perio therapeutics?

A

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

24
Q

When should periodontal surgery be considered?

A

After non response to one round of SRP and pockets of >6mm persist (more effective than SRP when PPD>6mm)

25
Q

List the virulence factors and their role for A.A and P.G

A

A.A
- Lipopolysaccharide (endotoxin) = Triggers immune response for inflammation and phagocytosis
- Leukotoxin → Pores in WBC
- Immune suppression factor → Inhibits important functions of lymphocytes
- Bacteriocine → Regulating intra and interspecific microbiota
- Adhesins = Bind to epithelial cells and collagen

General the above:
- Inhibits osteoblast, fibroblasts, endothelial and epithelial cells
- Degradation of Type I collagen
- Bone loss

P.G
- Trypsin like enzyme and strong proteolytic activities → Degrades plasma proteins
- Collagenase → Breaks down collagen
- Haemolysin → Breaks down haem
- Inhibits PMNs
- Toxins – hydrogen sulphide, ammonium compounds
- LPS = Triggers immune response for inflammation and phagocytosis
- Gingipains = Proteolytic enzyme that degrades C5 complements which allows pathogens to survive for continued inflammation

26
Q

What are the 6 options available for treatment of furcation involvement? Which class of furcation involvement are they indicated for?

A
  1. SRP –> I
  2. Furcationplasty –> I and II
  3. Tunnel preparation –> II and III
  4. Root resection –> II and III
  5. Tissue regeneration –> II only for mandibular molars
  6. Extraction –> II and III
27
Q

Name early colonisers, bridging and late colonisers

A
  1. Early = Streptococci and actinomycoses (gram + aerobic)
  2. Bridging = Fusobacterium
  3. P.gingivalis and AA (gram - anaerobic)
28
Q

What are the theories of periodontal disease

A
  1. Non specific plaque theory = Excess plaque that is beyond host response threshold results in periodontitis (no recognition of pathogen types and also clinically, patients presenting with minimal plaque but severe periodontitis)
  2. Selective plaque theory = Specific pathogens cause periodontitis (does not recognise early and late colonisers and certain pathogens identified also present in health)
  3. Ecological plaque theory = Periodontitis results when there is an imbalance in normal microbiota - caused by pathogens which influence local factors
  4. Keystone pathogen theory = Keystone pathogens cause periodontitis (even when available in small quantities) as they change the normal microbiota and host response
29
Q

Gingival vs periodontal abscess?

A

Gingival abscess = Localised accumulation of pus in gingiva (healthy tissue)
- Cause = Impacted foreign body or abnormal root morphology (e.g. root invagination)
- Clinical signs = PPD (pseudopocket), pain, swollen gingiva
- Tx: Incise, drain, remove cause

Periodontal abscess = Localised accumulation of pus in periodontal pocket (diseased tissue)
- Cause = Buildup of bacterial in perio pocket
- Clinical signs = PPD, pain, swollen gingiva, BOP, mobility, bone loss
- Tx: Incise, drain (abx only if difficult to drain), review in 48h and perio therapy

30
Q

Treatment of periocoronitis?

A

Irrigation with monojet and saline

Debridement of area

Advise patient to brush area and use of ChX – 10mL 0.2% 2x daily for 1 week

+ Abx (metronidazole or amoxicillin) → Only if facial swelling or risk of spreading odontogenic infection or patient immunocompromised
- Metronidazole 400mg BID + Amoxicillin 500mg TDS or Augmentin Duo Forte 875mg BID → 5 Days
- Hypersensitivity = Clindamycin 400mg TDS → 5 days
- If systemic involvement = Transfer to hospital for IV abx

Extraction of tooth in 1 week (consider difficulty in achieving anaesthesia when infected)

Considerations
- Adjustment of occlusion/considerations of extracting opposing tooth
- Operculectomy

31
Q

What are the three active ingredients with clinical evidence for dentine hypersentivity?

A

Arginine = Colgate sensitive pro relief
Strontium = Sensodyne rapid relief
Stannous fluoride = Oral B pro health

DMD3 (13 decks)

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