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Periodontics Flashcards

1
Q

What is the definition of a periodontal abscess?

A

Localised, acute exacerbation of a pre-existing pocket

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2
Q

What is the definition of a periapical abscess?

A

Localised collection of pus around apex of a non-vital tooth due to pulp necrosis

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3
Q

How does a periodontal abscess present?

A

Usually vital
Pain on lateral movements
Usually mobile
Loss of alveolar crest
Associated with generalised horizontal bone loss

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4
Q

How does a periapical abscess present?

A

Non-vital
TTP vertical
May be mobile
Loss of lamina dura

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5
Q

What is the definition of occlusal trauma?

A

Tooth mobility which is progressively increasing or tooth mobility with symptoms and radiographic evidence of increased pdl width

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6
Q

What is the definition of periapical periodontitis?

A

Periodontal disease that has reached the apex of the tooth

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7
Q

How does periapical periodontitis present?

A

Resorption of alveolar bone
Loss of attachment

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8
Q

How does chronic gingivitis present?

A

Bleeding on probing
Gingival inflammation
False pockets due to oedema

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9
Q

What are the contraindications for periodontal surgery?

A

Poor OH/plaque control
Smoker

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10
Q

What is the purpose of periodontal surgery?

A

Arrest disease by gaining access to complete RSD and regenerate lost periodontal tissues

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11
Q

What are the indications for periodontal surgery?

A

Post non-surgical periodontal treatment
Excellent OH
Inflammation resolved
Pockets >5mm persist

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12
Q

What are the benefits of open flap for periodontal surgery?

A

Helps gain access to root surface in persistent pockets

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13
Q

What are the benefits of a gingivectomy?

A

Improves aesthetics
Facilitates plaque control

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14
Q

What are the reasons for a gingivectomy?

A

Reduces overgrowth
Pseudopockets
Areas with difficult access
Gingival fibrzomatosis

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15
Q

What is the rate of chronic periodontitis?

A

10-15%

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16
Q

What is the clinical presentation of gingival health?

A

Knife-edge scalloped gingival margin
Stippled gingiva
Pink

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17
Q

What is the diagnostic definition of gingival health?

A

Absence of bleeding on probing
Absence of erythema (redness) and oedema (swelling)
Absence of patient symptoms, attachment and bone loss

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18
Q

What are the bone levels in gingival health?

A

1.0-3.0 apical to the CEJ

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19
Q

What is the definition of gingival health in regard to bleeding and probing depths?

A

<10% bleeding sites
<= 3mm proving depths

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20
Q

What are examples of local plaque retentive factors?

A

Calculus
Restoration overhangs
Crowding
Mouth breathing

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21
Q

What are systemic modifying factors associated with increased periodontal disease risk?

A

Sex hormones (puberty, pregnancy, contraception)
Medication
Smoking
Hyperglycaemia
Malnutrition

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22
Q

What is the minimal annual bone loss for periodontitis?

A

0.05-1.0mm

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23
Q

What is the role of MMPs in periodontitis?

A

Responsible for matrix degradation

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24
Q

What is the role of osteoclasts in periodontitis?

A

Immune activation of osteoclasts via RANK/RANKL causes connective tissue matrix degradation

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25
Q

What are anatomical periodontitis risk factors?

A

Enamel pearls/projections
Grooves
Furcations
Gingival recession

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26
Q

What are tooth position associated periodontitis risk factors?

A

Malalignment
Crowding
Tipping
Migration
Occlusal forces

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27
Q

What are iatrogenic risk factors for periodontitis?

A

Restoration overhangs
Defective crown margins
Poorly designed rpds
Orthodontic appliances

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28
Q

What are behavioural risk factors for periodontitis?

A

Smoking- vasoconstriction, impaired antibody production

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29
Q

What are genetic risk factors for periodontitis?

A

Twin studies showed 50% association

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30
Q

What are environmental risk factors for periodontitis?

A

Local risk factors
Local microbiome
Stress

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31
Q

What does the stage mean in a periodontal diagnosis?

A

Severity

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32
Q

What is stage 1 periodontitis?

A

Mild
<15mm/2mm

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33
Q

What is stage 2 periodontitis?

A

Moderate
Coronal 1/3 root

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34
Q

What is stage 3 periodontitis?

A

Severe
Mid 1/3 root

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35
Q

What is stage 4 periodontitis?

A

Very severe
Apical 1/3 root

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36
Q

What does grade mean in a periodontal diagnosis?

A

Susceptibility

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37
Q

What is the calculation for grading periodontal disease?

A

Bone loss/ age

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38
Q

What is grade A periodontitis?

A

Slow
<0.5

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39
Q

What is grade B periodontitis?

A

Moderate
0.5-1.0

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40
Q

What is grade C periodontitis?

A

Rapid
>1.0

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41
Q

What does extent mean in a periodontitis diagnosis?

A

Distribution

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42
Q

What does localised mean?

A

<30%

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43
Q

What does generalised mean?

A

> 30%

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44
Q

What does molar incisor mean?

A

Affects molars and incisors primarily

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45
Q

What are the 5 components of a periodontitis diagnosis?

A

Extent
Severity
Susceptibility
Stability
Risk factors

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46
Q

What provides a currently stable diagnosis?

A

No BoP at 4mm
BoP <10%
PPD <=4mm

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47
Q

What provides a currently in remission diagnosis?

A

No BoP at 4mm
BoP >=10%
PPD <= 4mm

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48
Q

What provides a currently unstable diagnosis?

A

PPD >= 5mm
BoP at 4mm

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49
Q

What is a BPE of 0?

A

Pockets <3.5mm
No BoP
No calculus/overhangs

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50
Q

What is a BPE of 1?

A

Pockets <3.5mm
BoP
No calculus/overhangs

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51
Q

What is a BPE of 2?

A

Pockets <3.5mm
Calculus/Overhangs

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52
Q

What is a BPE of 3?

A

Pockets 3.5-5.5mm

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53
Q

What is a BPE of 4?

A

Pockets >5.5mm

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54
Q

What is * in a BPE?

A

Furcation involvement

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55
Q

What should be done when a patient has a BPE 3?

A

Radiographs
Initial therapy
then 6ppc of that sextant (BSP)
6ppc before and after treatment (SDCEP)

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56
Q

What should be done when a patient has a BPE 4?

A

Radiographs
6ppc of full dentition

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57
Q

What is the force on the probe during a BPE exam?

A

20-25g

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58
Q

What are the sextants for BPE?

A

17-14 | 13-23 | 24-27
47-44 | 43-33 | 34-37

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59
Q

What is plaque?

A

Sticky colourless biofilm deposit

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60
Q

What is is calculus?

A

Calcified deposits of plaque attached to tooth surface
Can be covered in biofilm (plaque), sub or supra gingival, detected by vision, probing or radiographs

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61
Q

What is the manifestation of plaque induced gingivitis?

A

Change in gingiva colour
Marginal gingival swelling
Loss of contour of the dental papilla (blunting)
BoP
Plaque at gingival margin
No clinical attachment loss/ bone loss
Gingival sulcus <= 3mm

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62
Q

What are the clinical manifestations of periodontitis?

A

Loss of attachment
Gingival sulcus >3mm
Alveolar bone loss

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63
Q

What is step 1 of periodontal treatment?

A

Control of local and systemic risk factors (diabetes, smoking, medication, diet)
Oral hygiene instruction (OHI)
Professional mechanical plaque removal (PMPR)

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64
Q

What is step 2 of periodontal treatment?

A

Step 1 and
Subgingival instrumentation +/- adjunctive measures

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65
Q

What is step 3 of periodontal treatment?

A

Repeated sub gingival instrumentation
Periodontal surgery: access flap, resective, regenerative

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66
Q

What is step 4 of periodontal treatment?

A

Supportive periodontal therapy
Risk adaptive intervals ( 3-12 months)
Continuous monitoring of local and systemic risk factors

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67
Q

What are the further investigations radiographs?

A

Aids diagnosis
Aids prognosis
Assess morphology of affected teeth
Pattern and degree of alveolar bone loss
Monitoring disease stability

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68
Q

What are the benefits of horizontal bitewings in periodontics?

A

Can show early, localised bone loss

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69
Q

What are the benefit of vertical bitewings in periodontics?

A

Difficult to position, provides good visualisation of bone loss

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70
Q

What is the gold standard of radiographs for periodontal disease?

A

Periapical

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71
Q

What are the benefits of periodicals in periodontics?

A

Shows bone levels, root length, furcation involvement and possible endodontic complications

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72
Q

What are the benefits of panoramic in periodontics?

A

More comfortable, but supplementation often needed

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73
Q

What do plaque and bleeding scores assess?

A

Oral hygiene and patient compliance

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74
Q

What are the Ramfjord teeth?

A

16 21 24
44 41 36

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75
Q

What surfaces are included in the modified plaque score?

A

Interproximal
Buccal
Palatal

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76
Q

What are the scores for a modified plaque score?

A

0: no visible
1: no visible but seen with probe
2: visible

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77
Q

What surfaces are included in the modified bleeding score?

A

Mesial
Distal
Buccal
Palatal

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78
Q

What are the scores for a modified bleeding score?

A

0: no
1; yes

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79
Q

What is the maximum score for a modified plaque score?

A

36

80
Q

What is the maximum score for a modified bleeding score?

A

24

81
Q

When is the code N used in a modified plaque and bleeding score?

A

Tooth is missing and there is no suitable replacement

82
Q

How is the probe ran when carrying out a modified bleeding score?

A

Probe ran 45 degrees to the sulcus and bleeding checked after 3o seconds

83
Q

What are the three considerations when measuring patient engagement?

A

<35% bleeding score and <30% plaque score
Greater than 50% improvement in both
Patient meets target agreed by patient and clinician

84
Q

What happens to non-engaged patients?

A

Subgingival PMPR is delayed
Patient is informed
Barriers identified
Continue with oral health education, motivation and behaviour change

85
Q

What does probing depth indicate?

A

Difficulty of treatment and likelihood of reoccurrence

86
Q

What do attachment levels indicate?

A

Measure of tissue destruction and extent of repair

87
Q

What are the scores for furcation involvement?

A

1: <3mm (<1/3 tooth)
2: >3mm (>1/3 tooth)
3: through and through

88
Q

What probe is used to measure furcations?

A

Nabers

89
Q

Where are the black bands on Nabers probes?

A

3-6mm
9-12mm

90
Q

What are the scores for tooth mobility?

A

0: physiological (0.1-0.2mm)
1: <1mm
2: 1-2mm
3: >2mm and horizontal/rotational depression

91
Q

What is included in the patient education phase of periodontal treatment?

A

Explain disease
Modifiable risk factors
Plaque control
Behavioural change: risk factor management, effective plaque control

92
Q

What does the patient information leaflet for periodontal disease include?

A

Patient agreement form and treatment consent form

93
Q

What does SOLER stand for?

A

Square on to patient
Open posture
Lean forward
Eye contact
Relaxed demeanor

94
Q

What can you use to aid communication with patient when discussing periodontal diagnosis?

A

Pictures and diagrams
Radiographs
Disclosing tablets
Sites of inflammation
See and modify tooth brushing
Check patients understanding

95
Q

What is the Modified Bass technique?

A

Brush at 45 degrees to gingival sulcus
Short back and forth vibrating motions
Medium soft brits
Wait 30 minutes before eating

96
Q

What does TIPPS stand for?

A

Talk
Instruct
Practice
Plan
Support

97
Q

What is Step 1 of perio treatment?

A

Risk Factor Modification
OHI
PMPR: removal of supra and sub gingival plaque and calculus deposits, powered and hand instruments can be used
MP+BS can be carried out to assess patient engagement

98
Q

When should a patient be moved onto stage 2 of perio treatment?

A

If they stage 1 is completed and they are engaged

99
Q

What is Step 2 of perio treatment?

A

Risk factor modification
OHI
PMPR: subgingival instrumentation on root surface
Optional adjuvant therapy: chlorhexidine

100
Q

What are the features of the mini sickle?

A

Double ended
Single blade on each end
Point scaler

101
Q

What colour is the mini sickle?

A

Red

102
Q

Where is the mini sickle used?

A

Supra gingival
Buccal and lingual embrasures
Limited used in pockets

103
Q

What are the features of the universal (Columbia 4L-4R) scaler?

A

Double ended
Two bladed on each end

104
Q

What colour is the universal (Columbia 4L-4R) scaler?

A

Red

105
Q

Where is the universal (Columbia 4L-4R) scaler used?

A

Subgingival
Anywhere in mouth

106
Q

What are the features of the Gracey curettes?

A

Double ended
One blade on each end (70 degree angle to shank)
Triangular cross section

107
Q

What are the gracey curettes used for?

A

Subgingival fine scaling

108
Q

What colour is the gracey 1-2?

A

Grey

109
Q

Where is the gracey 1-2 used?

A

Anterior teeth

110
Q

What colour is the gracey 7-8?

A

Green

111
Q

Where is the gracey 7-8 used?

A

Buccal/Lingual of posteriors

112
Q

What colour is the gracey 11-12?

A

Orange

113
Q

Where is the gracey 11-12 used?

A

Mesial of posteriors

114
Q

What colour is the gracey 13-14?

A

Blue

115
Q

Where is the gracey 13-14 used?

A

Distal of posteriors

116
Q

What are the features of the Hoe scalers?

A

Double ended
Single blade on each end

117
Q

What are the Hoe scalers used for?

A

Gross sub and subragingival deposits

118
Q

What colour is the Hoe 134-135?

A

Orange

119
Q

Where is the Hoe 134-135 used?

A

Buccal/Lingual

120
Q

What colour is the Hoe 156-157?

A

Red

121
Q

Where is the Hoe 156-157 used?

A

Mesial/Distal

122
Q

What angle is the sickle scalers shank to the blade?

A

90 degrees

123
Q

What angle is the face of the graceys offset to the lower shank?

A

100 degrees

124
Q

What is the blade of the hoe scaler to the shank?

A

100 degrees

125
Q

What is the cutting edge of the hoe bevelled at?

A

45 degrees

126
Q

What is the cutting edge of the hoe angulated at?

A

90 degrees

127
Q

What is the risk if the hoe scaler is not properly angled?

A

Root surface damage

128
Q

What angle should the universal curette be to the teeth?

A

90 degrees

129
Q

What are the differences between powered and hand instruments?

A

Powered may leave a rougher surface
Powered may produce aerosols
Powered may have better furcation access
Powered may have less unwanted tooth tissue removal
Powered causes less fatigue

130
Q

What is the effect of supra and subginigival PMPR on the microflora?

A

Reduces levels and prevalence of pathogens

131
Q

What is the effect of supra and sub gingival PMPR on the tissues?

A

Decreases gingival inflammation
Shrinkage of tissues leading to recession
Increase in collagen fibres in connection tissue
Formation of long junctional epithelium attachment
Decreased pocket depth and increased attachments

132
Q

What are the ideal outcomes of periodontal treatment?

A

Plaque scores <15%
Bleeding on probing <10%
No pockets >4mm

133
Q

When should you move onto step 3 of perio treatment?

A

When step 2 is completed and the patient is unstable

134
Q

When should you move onto step 4 of perio treatment?

A

When step 2 is completed and the patient is stable

135
Q

What is step 3 of perio treatment?

A

Reinforce OHI
Subgingival instrumentation
Consider referral to surgery

136
Q

What is step 4 of perio treatment?

A

Supportive care
OHI, risk factor control, behavioural change

137
Q

What triggers the oral microbiome to cause inflammation?

A

Poor oral hygiene
Accumulation of plaque bacteria

138
Q

What is gingival crevicular fluid?

A

Fluid found within the gingival sulcus and periodontal pockets

139
Q

What does gingival crevixular fluid contain?

A

AMPs (antimicrobial peptides)
Cytokines
Chemokines
Lactoferrin
IgG (immunoglobin G)

140
Q

What is the role of antimicrobial peptides (AMPs)?

A

Eliminate pathogenic microorganisms

141
Q

What is the role of cytokines?

A

Signalling molecules

142
Q

What is the role of chemokines?

A

Specific cytokines that make immune cells move to a target

143
Q

What is lactoferrin?

A

Iron-binding molecule

144
Q

What is the role of IgG?

A

High levels indicate infection?disease

145
Q

What is the role of the oral mucosa during periodontal disease?

A

Express TLR which detect MAMPS/PAMPs which cause the release of AMPS, cytokines and chemokines

146
Q

What does saliva contain?

A

S-IgA
Lysozyme
Peroxidase
Lactoferrin
Mucin
Agglutinins
Cystatins
Histatins

147
Q

What is the role of S-IgA?

A

High levels indicate activated immune response

148
Q

What is the role of lysozyme?

A

Antimicrobial enzyme that cleaves bacteria

149
Q

What is the role of peroxidase?

A

Enzyme that catalyses oxidative reactions involving H2O2

150
Q

What are the red complexed for periodontal disease?

A

P gingivalis
T denticola
T forsythia

151
Q

What is the immunological cause of periodontal disease?

A

Polymicrobial dysbiosis

152
Q

What are the virulence factors of p gingivitis?

A

Inflammophillic (inflammation leaded to virulence)
Atypical liposaccharide

153
Q

What are some example causes of dysbiosis?

A

Smoking
Oral hygiene
Disease
Diet
Antibiotics
Genetics
Salivary proteins
Salivary flow
Innate/adaptive factors

154
Q

What is the aetiology of periodontal disease?

A

Plaque bacteria accumulates
Periodontal pathogen presence
Polymicrobial dysbiosis

155
Q

What are the hallmarks of periodontitis?

A

Attachment loss
Alveolar bone loss

156
Q

What is the immunological development of periodontitis?

A

TLR stimulation
Increased pro-inflammatory mediators
Acute inflammatory response

157
Q

What are examples of pro-inflammatory mediators?

A

Neutrophils
Monocytes
Lymphocytes

158
Q

What are the features of an acute inflammatory response?

A

Increased vasodilation
Increased redness, swelling, bleeding
Increased immune cell migration

159
Q

What is the role of neutrophils in the periodontium?

A

Maintain a healthy periodontium
Release degenerative enzymes like MMPs that contribute to attachment loss

160
Q

What does leukocyte adhesion deficiency lead to?

A

Neutrophils cannot leave the blood to enter tissues

161
Q

What is periodontal health dependant on a balance of?

A

OPG and RANKL

162
Q

What is the role of osteoblasts?

A

Synthesise and secrete bone matrix

163
Q

What is the role of osteoclasts?

A

Resorbs bone
Macrophage lineage

164
Q

What are the immunological stages of periodontitis development?

A
  1. Bacterial products bind TLRs on epithelium (cytokine, chemokine and AMP secretion)
  2. Vasodilation and selective leukocyte recruitment (neutrophils, monocytes and lymphocytes)
  3. Bacteria activates neutrophils (further pro-inflammatory mediator release)
  4. Activated lymphocytes lead to RANKL/OPG balance destruction (increase RANKL, decrease OPG)
  5. RANKL binds RANK on monocytes leading to osteoclast differentiation and alveolar bone resorption
  6. Pro-inflammatory cytokines contribute to bone resorption: IL-1, IL-6, IL-17, TNF-alpha
  7. Elevated MMP activation leads to connective tissue destruction
165
Q

How does periodontal bone loss occur in regard to the adaptive immune response?

A

B and T cells secrete RANKL
RANKL binds RANK (osteoclast differentiation)
OPG prevents RANKL binding RANK (inhibits osteoclast differentiation
Inflammation leads to an increase in RANKL, decrease in OPG and increased monocyte recruitment

166
Q

What are examples of conditions linked to periodontitis?

A

Cardiovascular disease
Alzheimer’s disease
Rheumatoid arthritis
Pregnancy complications
Diabetes

167
Q

What are the assocaitions between periodontitis and type 2 diabetes?

A

Periodontitis is associated with higher HbA1c fasting blood glucose levels
Severe periodontitis is associated with increased diabetes risk

168
Q

What is the increased risk of periodontitis in patients with diabetes?

A

2-3x more likely

169
Q

What is the associated risk of periodontitis on a diabetic?

A

Increased HbA1c levels
Worse complications

170
Q

What is the diabetes threshold for improved response to Perio tx?

A

HbA1c reductions of 3-4mmol/mol (0.3-0.4%) in 3-4 months post treatment

171
Q

What guidelines recognised periodontitis as a complication of diabetes?

A

NICE

172
Q

What is the dentally relevant guideline that discusses the negative impact of diabetes on periodontitis?

A

SDCEP Prevention and Treatment of Periodontal Diseases in Primary Care- 2024

173
Q

What questions should you ask a patient with diabetes in regard to Perio?

A

Is it controlled?
What was your last HbA1c reading and when was it measured?
How often does your doctor check your diabetes control?
Do you have any complications of diabetes?

174
Q

What HbA1c levels indicated good control of diabetes?

A

48-58mmol/mol (6.5-7.5%)

175
Q

What is a HbA1c >58 associated with?

A

Increased risk of diabetes related complications

176
Q

How is untreated periodontitis associated with increased diabetes complications?

A

Untreated periodontitis —> Circulating bacteria and bacterial antigens —> Elevated circulating levels IL-6, TNF-alpha, CRP, oxygen radicals —> Systematic inflammatory state, impaired insulin signalling and resistance —> Elevated HbA1c levels, exacerbation of diabetes

177
Q

What is PISA?

A

Periodontal inflammed surface area

178
Q

What is PISA?

A

Periodontal inflammed surface area

179
Q

What are the aims of periodontal therapy?

A

To arrest the disease process
To regenerate lost tissue
To maintain periodontal health long term

180
Q

What is the role of periodontal therapy as an aid to restorative dentistry?

A

Improves soft tissue management
Establishes stable gingival margin position
Contributes to aesthetics
Reduces tooth mobility
Informs prognosis

181
Q

What is the effect of an inflamed gingival margin in regards to restorative treatment?

A

Bleeds during operative procedures
Unstable in its apico-coronal location
Makes effective restorative dentistry impossible

182
Q

When will the position of the gingival margin be stable?

A

When it is healthy

183
Q

How should you manage gingival margins in regards to restorative treatment?

A

Monitor gingival margin for 3-6 months after completion of periodontal treatment to check that it is stable.
Once stable- place restorations

184
Q

What are the prosthodontics options for the partially dentate?

A

FPD with natural abutments
RPD with natural abutments
Implant supported prosthesis
Combination of the above

185
Q

What are the damages associated with crowns and bridges?

A

Plaque retention- location and fit of restoration margins, contour of retainers and pontics
Unfavourable transmission of occlusal forces
Pulp damage

186
Q

What are the risks of damage with RPDs?

A

Plaque retention- gingival margin coverage
Direct trauma from components
Unfavourable transmission of forces- occlusal, insertion and removal

187
Q

What are the supracrestal attached tissues?

A

Histologically composed of the junctional epithelium and supracrestal connective tissue attachment.

Term replaces biological width

188
Q

What is the outcome of restoration margins that encroach on the supracrestal attachment?

A

Persistent inflammation
Loss of attachment- pocketing, recession

189
Q

What are the effects of overhanging restorations?

A

Associated with more inflammation and bone loss than non-restored sites
The larger the overhang the greater the bone loss
Development of pathogenic flora

190
Q

What is the ideal shape for restorations?

A

The same shape as the teeth

191
Q

What does inadequate tooth preparation lead to?

A

Overcontoured crowns

192
Q

What are the keys to periodontally successful indirect restorations?

A

Start with healthy tissue
Adequate tooth preparation
Precise margin location
Excellent provisional restorations
Careful tissue handling and impression technique

193
Q

What is Ante’s Law?

A

The combined periodontal area of the abutment teeth should be equal to or greater than the periodontal area of the tooth or teeth to be replaced

194
Q

What happens to abutments which are periodontlaly compromised?

A

They will be overloaded

195
Q

What are the factors of soft tissue harmony?

A

Gingival health
Gingival display
General gingival inclination
Gingival outline and symmetry

Finals (20 decks)

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