Periodontics Flashcards
What is the definition of a periodontal abscess?
Localised, acute exacerbation of a pre-existing pocket
What is the definition of a periapical abscess?
Localised collection of pus around apex of a non-vital tooth due to pulp necrosis
How does a periodontal abscess present?
Usually vital
Pain on lateral movements
Usually mobile
Loss of alveolar crest
Associated with generalised horizontal bone loss
How does a periapical abscess present?
Non-vital
TTP vertical
May be mobile
Loss of lamina dura
What is the definition of occlusal trauma?
Tooth mobility which is progressively increasing or tooth mobility with symptoms and radiographic evidence of increased pdl width
What is the definition of periapical periodontitis?
Periodontal disease that has reached the apex of the tooth
How does periapical periodontitis present?
Resorption of alveolar bone
Loss of attachment
How does chronic gingivitis present?
Bleeding on probing
Gingival inflammation
False pockets due to oedema
What are the contraindications for periodontal surgery?
Poor OH/plaque control
Smoker
What is the purpose of periodontal surgery?
Arrest disease by gaining access to complete RSD and regenerate lost periodontal tissues
What are the indications for periodontal surgery?
Post non-surgical periodontal treatment
Excellent OH
Inflammation resolved
Pockets >5mm persist
What are the benefits of open flap for periodontal surgery?
Helps gain access to root surface in persistent pockets
What are the benefits of a gingivectomy?
Improves aesthetics
Facilitates plaque control
What are the reasons for a gingivectomy?
Reduces overgrowth
Pseudopockets
Areas with difficult access
Gingival fibrzomatosis
What is the rate of chronic periodontitis?
10-15%
What is the clinical presentation of gingival health?
Knife-edge scalloped gingival margin
Stippled gingiva
Pink
What is the diagnostic definition of gingival health?
Absence of bleeding on probing
Absence of erythema (redness) and oedema (swelling)
Absence of patient symptoms, attachment and bone loss
What are the bone levels in gingival health?
1.0-3.0 apical to the CEJ
What is the definition of gingival health in regard to bleeding and probing depths?
<10% bleeding sites
<= 3mm proving depths
What are examples of local plaque retentive factors?
Calculus
Restoration overhangs
Crowding
Mouth breathing
What are systemic modifying factors associated with increased periodontal disease risk?
Sex hormones (puberty, pregnancy, contraception)
Medication
Smoking
Hyperglycaemia
Malnutrition
What is the minimal annual bone loss for periodontitis?
0.05-1.0mm
What is the role of MMPs in periodontitis?
Responsible for matrix degradation
What is the role of osteoclasts in periodontitis?
Immune activation of osteoclasts via RANK/RANKL causes connective tissue matrix degradation
What are anatomical periodontitis risk factors?
Enamel pearls/projections
Grooves
Furcations
Gingival recession
What are tooth position associated periodontitis risk factors?
Malalignment
Crowding
Tipping
Migration
Occlusal forces
What are iatrogenic risk factors for periodontitis?
Restoration overhangs
Defective crown margins
Poorly designed rpds
Orthodontic appliances
What are behavioural risk factors for periodontitis?
Smoking- vasoconstriction, impaired antibody production
What are genetic risk factors for periodontitis?
Twin studies showed 50% association
What are environmental risk factors for periodontitis?
Local risk factors
Local microbiome
Stress
What does the stage mean in a periodontal diagnosis?
Severity
What is stage 1 periodontitis?
Mild
<15mm/2mm
What is stage 2 periodontitis?
Moderate
Coronal 1/3 root
What is stage 3 periodontitis?
Severe
Mid 1/3 root
What is stage 4 periodontitis?
Very severe
Apical 1/3 root
What does grade mean in a periodontal diagnosis?
Susceptibility
What is the calculation for grading periodontal disease?
Bone loss/ age
What is grade A periodontitis?
Slow
<0.5
What is grade B periodontitis?
Moderate
0.5-1.0
What is grade C periodontitis?
Rapid
>1.0
What does extent mean in a periodontitis diagnosis?
Distribution
What does localised mean?
<30%
What does generalised mean?
> 30%
What does molar incisor mean?
Affects molars and incisors primarily
What are the 5 components of a periodontitis diagnosis?
Extent
Severity
Susceptibility
Stability
Risk factors
What provides a currently stable diagnosis?
No BoP at 4mm
BoP <10%
PPD <=4mm
What provides a currently in remission diagnosis?
No BoP at 4mm
BoP >=10%
PPD <= 4mm
What provides a currently unstable diagnosis?
PPD >= 5mm
BoP at 4mm
What is a BPE of 0?
Pockets <3.5mm
No BoP
No calculus/overhangs
What is a BPE of 1?
Pockets <3.5mm
BoP
No calculus/overhangs
What is a BPE of 2?
Pockets <3.5mm
Calculus/Overhangs
What is a BPE of 3?
Pockets 3.5-5.5mm
What is a BPE of 4?
Pockets >5.5mm
What is * in a BPE?
Furcation involvement
What should be done when a patient has a BPE 3?
Radiographs
Initial therapy
then 6ppc of that sextant (BSP)
6ppc before and after treatment (SDCEP)
What should be done when a patient has a BPE 4?
Radiographs
6ppc of full dentition
What is the force on the probe during a BPE exam?
20-25g
What are the sextants for BPE?
17-14 | 13-23 | 24-27
47-44 | 43-33 | 34-37
What is plaque?
Sticky colourless biofilm deposit
What is is calculus?
Calcified deposits of plaque attached to tooth surface
Can be covered in biofilm (plaque), sub or supra gingival, detected by vision, probing or radiographs
What is the manifestation of plaque induced gingivitis?
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
What are the clinical manifestations of periodontitis?
Loss of attachment
Gingival sulcus >3mm
Alveolar bone loss
What is step 1 of periodontal treatment?
Control of local and systemic risk factors (diabetes, smoking, medication, diet)
Oral hygiene instruction (OHI)
Professional mechanical plaque removal (PMPR)
What is step 2 of periodontal treatment?
Step 1 and
Subgingival instrumentation +/- adjunctive measures
What is step 3 of periodontal treatment?
Repeated sub gingival instrumentation
Periodontal surgery: access flap, resective, regenerative
What is step 4 of periodontal treatment?
Supportive periodontal therapy
Risk adaptive intervals ( 3-12 months)
Continuous monitoring of local and systemic risk factors
What are the further investigations radiographs?
Aids diagnosis
Aids prognosis
Assess morphology of affected teeth
Pattern and degree of alveolar bone loss
Monitoring disease stability
What are the benefits of horizontal bitewings in periodontics?
Can show early, localised bone loss
What are the benefit of vertical bitewings in periodontics?
Difficult to position, provides good visualisation of bone loss
What is the gold standard of radiographs for periodontal disease?
Periapical
What are the benefits of periodicals in periodontics?
Shows bone levels, root length, furcation involvement and possible endodontic complications