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FINALS > Periodontics > Flashcards

Periodontics Flashcards

1
Q

give a definition of gingival health (3 points)

A

knife edges scalloped gingival margin
pink
absence of BOP

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2
Q

give four examples of local plaque retentive factors

A

calculus
restorative margin
crowding
mouth breathing

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3
Q

give two examples of systemic modifying factors that increases plaque retention

A

sex hormones
medication

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4
Q

what is a false pocket

A

proliferation of sulcular epithelium and enlargement of gingivae with no clinical LOA

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5
Q

what is a true pocket

A

apical migration of sulcular epithelium and plaque accumulation on root surface which perpetuates inflammation and continued apical migration of epithelium

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6
Q

how far away from the ACJ does alveolar bone usually sit

A

1-2 mm

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7
Q

what is the keystone pathogen of periodontal disease

A

P. gingivalis

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8
Q

what aspects of immune response protects against plaque

A

saliva
epithelium (physical)
GCF which has antimicrobial properties and antibiotics

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9
Q

what are MMPs

A

matrix metalloproteinases which are degradative enzymes secreted by inflammatory cells causing tissue destruction

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10
Q

in periodontitis what cells secrete MMPs

A

host cells

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11
Q

name three effects smoking has on the gingiva

A

increased gingival keratinisation
vasoconstriction of gingival tissues
impaired antibody function

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12
Q

name the two types of BPE probes

A

WHO probe
UNC 15 probe

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13
Q

what is the WHO probe

A

0.5mm ball
black band at 3.5mm-5.5mm
black band 8.5mm-11.5mm

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14
Q

what is a requirement for BPE

A

must be at least 2 teeth in the sextant

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15
Q

what is the treatment if the highest BPE score is a 1

A

OHI

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16
Q

what is the treatment if the highest BPE score is a 2

A

PMPR and OHI

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17
Q

what is the treatment if the highest BPE score is a 3

A

OHI and RSD

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18
Q

what is the treatment if the highest BPE score is a 4

A

OHI RSD and assess for more complex

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19
Q

what is the treatment plan for a BPE of 3

A

radiographs
initiate periodontal therapy (PMPR) and 6PPC after 3 months

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20
Q

what is the treatment plan for BPE of 4

A

radiographs and full perio assessment (6PPC)

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21
Q

what are the six Ramfjord’s teeth

A

16, 21, 24, 36, 41, 44

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22
Q

what modified plaque and bleeding scores would you find in an engaged patient

A

less than 35% bleeding
less than 30% plaque
more than 50% reduction in BOTH

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23
Q

what is a grade 0 tooth mobility score

A

tooth moves around 0.1-0.2mm in horizontal direction

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24
Q

what is grade 1 tooth mobility score

A

tooth moves 1mm in horizontal direction

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25
Q

what is grade 2 tooth mobility

A

tooth moves more than 1mm in horizontal direction

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26
Q

what is grade 3 tooth mobility

A

tooth moves in horizontal and vertical direction

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27
Q

when might single tufted brushes be used

A

clean malaligned teeth
clean distal surfaces of last molar teeth
clean teeth affected by localised gingival recession

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28
Q

give three advantageous properties of chlorhexidine mouthwash

A

long substantivity
broad antimicrobial spectrum
adsorption to oral surfaces - including enamel

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29
Q

give two disadvantages of chlorhexidine mouthwash

A

interferes with taste
stains teeth

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30
Q

according to SDCEP guidelines when is the only time anti-plaque mouthwash should be prescribed

A

when pain limits patient’s ability to perform mechanical plaque removal

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31
Q

what is the TIPPS acronym

A

talk
instruct
practice
plan
support

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32
Q

what three things should be on the patient agreement form

A

diagnosis
self care plan
agreement statement

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33
Q

name the desired outcome of scaling and RSD

A

create a root surface compatible with biological reattachment

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34
Q

what effect does PMPR have on the microflora

A

significantly reduces levels of pathogenic species - p.gingivalis and t.denticola

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35
Q

what 3 effects does PMPR have on the soft tissues

A

decrease in gingival inflammation
recession of gingival tissues due to shrinkage
increase in collagen fibres in connective tissue

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36
Q

what is gain in attachment following RSD attributed to

A

long junctional epithelium formation and replacement of inflammatory infiltrate by collagen

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37
Q

when is greatest change seen in tissues after RSD

A

4-6 weeks after therapy

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38
Q

give three reasons why periodontal treatment may fail

A

inadequate patient plaque control
residual subgingival deposits
systemic risk factors

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39
Q

what is marginal bleeding

A

bleeding from gingival margin when gingivae have been gently touched - indicator of self-performed plaque control

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40
Q

what is bleeding on probing

A

bleeding from base of the pocket which indicates presence of inflammation - does not mean there is active disease

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41
Q

what is the name of the probe used for furcation assessment

A

Naber’s probe

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42
Q

give three components of gingival crevicular fluid

A

AMPs
cytokines
IgG

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43
Q

give four virulence factors of P.gingivalis

A

asaccharolytic
gingipains
atypical LPS
inflammophilic

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44
Q

what does asaccharolytic mean

A

displays nutrients from breakdown of proteins and peptides

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45
Q

how does the host detect bacteria on gingival epithelial cells

A

via TLRs

46
Q

what does TLR activation lead to

A

production of pro-inflammatory mediators which trigger the acute inflammatory response

47
Q

what does the TLR activation of the chemokine/ cytokine gradient lead to

A

monocytes and lymphocytes follow the gradient into the gingival tissue

48
Q

what are the purpose of the monocytes and lymphocytes in gingivitis

A

they phagocytose invading bacteria
release degradative enzymes into GCF

49
Q

what is the role of neutrophils in the periodontal tissues

A

to ensure health
they release their contents in GCF

50
Q

what is the result of excessive neutrophils in a dysbiotic environment

A

leads to chronic inflammation and contributes to periodontal destruction

51
Q

what is the role of MMPs in periodontitis

A

remove damaged tissue, degrade it and allow for regeneration of tissue
however chronic recruitment leads to bone destruction

52
Q

what are osteoclasts derived from

A

immune cell - monocytes

53
Q

How are osteoclasts made

A

activated T/B cells release RANKL into the perio lesion
RANKL binds to RANK receptor on pre-osteoclast
when it binds - causes differentiation into osteoclast

54
Q

what is the role of OPG

A

to inhibit RANKL binding to RANK and inhibiting bone resorption

55
Q

how does OPG work

A

binds to RANK receptor on pre-osteoclast
RANKL cannot bind
results in less bone resorption

56
Q

what is inflammation in relation to OPG and RANKL

A

high RANKL and low OPG levels

57
Q

what is the function of a mini sickle

A

removes supragingival calculus from buccal and lingual
triangular in cross section
sharp pointed - not to be used below gingival margin

58
Q

what is the function of a columbia curette

A

semi circular cross section
used for supra and subgingival scaling throughout the whole mouth

59
Q

what is the function of the yellow hoe scaler

A

buccal and lingual sub-gingival scaling

60
Q

what is the function of the red hoe scaler

A

mesial and distal surface sub-gingival scaling

61
Q

what is the function of the grey gracey curette

A

subgingival scaling of upper and lower anterior teeth

62
Q

what is the function of the orange gracey curette

A

mesial scaling of posterior teeth

63
Q

what is the function of the green gracey curette

A

buccal and lingual scaling of posterior teeth

64
Q

what is the function of the blue gracey curette

A

distal surfaces of posterior teeth

65
Q

what is the first step in the bsp periodontal treatment

A

building foundations for optimal treatment outcomes - eg explaining risk factors, control plaque and bleeding through OHI
removing plaque retentive factors

66
Q

when should you reevaluate a patient after BSP step 1 periodontal treatment

A

after 6-8 weeks

67
Q

if 6 weeks after step 1 the patient is seen to be non-engaging, what would be the next step

A

repeat step 1

68
Q

if 6 weeks after step 1 the patient is seen to be engaging, what is the next step

A

step 2 - subgingival instrumentation

69
Q

what is involved in S3 step 2 periodontitis treatment

A

reinforce OHI
subgingival instrumentation
use systemic antimicrobials if required

70
Q
A

name the structures blanked out by the navy squares

71
Q

name the five cardinal signs of inflammation

A

pain
heat
redness
swelling
loss of function

72
Q

what is biofilm

A

aggregate of microorganisms that adhere to each other on a surface - these cells are embedded within a self produced matrix

73
Q

what is the keystone pathogen in periodontal disease

A

porphyromonas gingivalis

74
Q

name four ways that P gingivalis can evade the host immune system

A

gingipains
adhesions
fimbriae
capsular polysaccharide

75
Q

what is a periodontal emergency

A

gum swelling, mouth pain, difficulty brushing/ eating due to pain, unexplained bleeding and loose teeth

76
Q

how should acute periodontal emergencies be managed in the first instance

A

with local measures - do not prescribe abx unless systemically unwell or signs of spreading infection

77
Q

what is a perio-endo lesion

A

a pathological communication between endodontic and periodontal tissues of a given tooth

78
Q

how is a periodontal abscess differentiated from a periapical abscess

A

if the tooth is non-vital or not
if non-vital = periapical

79
Q

name the four components of the periodontium

A

gingiva, periodontal ligament, cementum, alveolar bone

80
Q

how do endo-perio lesions present on radiographs

A

as a J-shaped lesion - with radiolucencies around the roots of the teeth only

81
Q

what are treatment options for a tooth with an endo-perio lesion

A

XLA
pulp extirpation
abx if systemic involvement
subgingival instrumentation after endo treatment or XLA

82
Q

what are the two forms of internal root resorption

A

inflammatory
replacement

83
Q

what is internal inflammatory resorption

A

caused by trauma or damage to predentine
root canal coronal to lesion is necrotic but apically is vital
appears as round radiolucency of root canal

84
Q

what is treatment for internal inflammatory resorption

A

orthograde endodontics, intervisit medicament and thermal GP obturation

85
Q

what is internal replacement resorption

A

uncommon, associated with previous trauma, caries or periodontal infection affecting pulp
tooth root as cloudy appearance and outline of canal appears wider

86
Q

what is the treatment for internal replacement resorption

A

orthograde endodontics and obturation with thermoplastic GP

87
Q

what are the four types of external root resorption

A

cervical
inflammatory
replacement
surface

88
Q

what is external surface root resorption

A

pressure induced resorption which stops progressing once pressure removed
root apices appear blunt or shorter than unaffected teeth - PDL intact

89
Q

what is the treatment for external surface resorption

A

remove source of pressure

90
Q

what is external inflammatory resorption

A

pulp is necrotic - triggered by damage to root surface and periodontium
roots appear short and ragged root ends with a periapical radiolucency

91
Q

what is the treatment for external inflammatory resorption

A

endodontic treatment

92
Q

what is external cervical resorption

A

tooth has pink spot at cervical aspect
causes - damage to subepithelial cementum, infection, orthodontics, non-vital tooth whitening

93
Q

what is the treatment for external cervical resorption

A

monitor
XLA and prosthetic replacement
surgical repair and endodontics

94
Q

how is external cervical root resorption classified

A

1 - affects crestal area
2 - affects coronal 1/3
3 - affects mid 1/3
4 - affects apical 1/3

95
Q

what is external replacement resorption

A

caused by severe luxation or avulsion injury
the PDL is crushed and degenerates - osteoclasts come and remove degenerated PDL but also some cementum
osteoblasts lay down alveolar bone - tooth becomes ankylosed and infra-occluded
clinically has high pitched percussion note

96
Q

what is the treatment for external replacement resorption

A

monitor (if non-growing patient)
decoronate
allow for healing (rare)

97
Q

what are the aims of step 3 periodontal treatment

A

treat non-responding sites
consider referral for non-responding pockets more than 6mm
adjunct options

98
Q

name examples of treatment adjuncts for step 3 periodontal treatment

A

local antimicrobials (chlorhexidine or tetracyclines)
periochip
dentomycin periodontal gel

99
Q

what is periochip

A

biodegradeable gelatin matrix
2.5mg chlorhexidine digluconate
inserted into pocket following PMPR
releases slowly over 7 days

100
Q

what is dentomycsin periodontal gel

A

2% mincocycline gel
syringed into pocket after PMPR
3-4 applications every 2 weeks
reduces pathogenic load in pocket

101
Q

when are systemic antimicrobials considered for perio patients

A

in young patients with rapidly progressing disease (C)
only delivered by specialists
full mouth PMPR in 24 hour period with 400mg metronidazole TID for 7 days

102
Q

what is periostat

A

use of drugs to modify host inflammatory system
sub antimicrobial dose doxycycline

103
Q

when is periodontal surgery considered

A

stage III
residual pockets of 6mm or more
quality non-surgical periodontal treatment has not resolved pocketing

104
Q

what patient factors must be considered for periodontal surgery

A

compliance
good plaque control and little bleeding
cost and patient acceptance

105
Q

what tooth factors must be considered for periodontal surgery

A

tooth position
anatomy of tooth
shape of defect
access to non-responding sites

106
Q

what systemic factors must be considered before periodontal surgery

A

smoking
poorly controlled diabetes
unstable angina or stroke or MI within 6 months
immunosuppression
anticoagulants

107
Q

why are monofilament sutures used after periodontal surgery

A

to prevent plaque adhering to it

108
Q

what are the three most common mucogingival surgeries

A

free gingival graft
pedicle graft
connective tissue graft

109
Q

what are three aetiological aspects of gingival recession

A

local - excessive toothbrushing, traumatic incisor relationship, chewing habits
generalised - periodontal disease
local or generalised - complication of ortho treatment

110
Q

what is the classification for gingival recession

A

1 - no interproximal tissue loss
2 - interproximal tissue loss not as significant as mid-buccal
3 - interproximal tissue loss worse than buccal loss

111
Q

name three treatment options for gingival recession

A

eliminate habits and remove piercings
oral hygiene instruction
topical desensitising agents
gingival veneer
mucogingival surgery

112
Q
A

FINALS (25 decks)

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