Periodontics Flashcards
1
Q
What are the features of healthy gingiva
A
Pink, firm, scalloped, knife edged papillae, 1-2mm cuff, mucoperiosteum bound to bone splits at mucogingival junction
2
Q
How does periodontist start
A
Health
Supragingival plaque
Crevice depends and plaque extends subgingivally (gingivitis)
Periodontitis loss of attachment irreversible
3
Q
What are clinical features of plaque induced gingivitis
A
Red swollen bleeding gingiva, blunt papillae with a loss of contour. Reversible with the removal of etiological agent. False pocket not associated with bone loss.
Actinomyces israelii, A. naeslundii, A.odontolyticus, veilonella parvula, campylobacter app
4
Q
Periodontitis key features
A
Loss of attachment
Apical migration of junction epithelium
Alveolar bone loss
(Heavy inflammatory filtrate ulcerated pocket)
5
Q
Features of the biofilm
A
Complex community
Attached to pelicle
Organised into 3D structure
Enclosed in matrix of extra cellular material
6
Q
What type of bacteria is found supragingivally
A
Airobes and gran positive cocci and rods with not loads of diversity
7
Q
What bacteria is found subgingivally
A
Gram negative rods and spirochaetes
Highly anairobic and great diversity
8
Q
What makes plaque pathogenic (virulence factors)
A
Proteases Bone resorting factors Cytotoxic metabolites Leukotoxin Capsule Induction of the inflammatory response
9
Q
Supragingival Calculus
Subgingival calculus
A
Plaque that has calcified its creamy yellow in appearance
Subgingival is dark brown/black due to mineral salts from GCF
10
Q
What is the host defences agains plaque
A
Saliva Epithelium Inflammatory response Immune response Mediators
11
Q
What is the order of conversation
A
Presenting complaint History for presenting complaint Past dental history Social history Past medical history
12
Q
What is INR
A
This is a clotting score for patients on anticoagulants. The threshold for treatment is less than 4. Some nurses can do an INR test on clinic.
13
Q
What are the different positions in the BPE chart
A
Upper right post Upper ant Upper left post Lower right post Lower Ant Lower left post
14
Q
What does BPE 0 mean
A
Pockets less than 3.5mm (black band fully visible) no calculus or overhangs and no bleeding on probing
No need for perio treatment
15
Q
What does BPE 1 mean
A
Pockets less than 3.5 (all black band visible) no calculus or overhangs and some bleeding on probing
OHI
16
Q
What does BPE 2 mean
A
Pockets less than 3.5 (whole black band visible) with calculus/overhangs sub or supra gingivaly
OHI and scale and polish
17
Q
What does BPE 3 mean
A
Pocket between 3.5 and 5.5 black band partially visible
OHI scale and polish and RSD if required
Radiographs recommenced
Should only have 6 point pocket check after initial therapy and only sites of 4 and above should be recorded
18
Q
What does BPE 4 mean
A
Probing depth greater than 5.5 no black band visible
OHI RSD, asses the need for more complex treatment/referral
Radiographs recommenced
19
Q
What does BPE * mean
A
Furcation involvement
OHI RSD refer to specialist
20
Q
What are the increments in a BPE probe
A
Spherical ball end 0.5
Black band 3.5-5.5
8.5
11.5
21
Q
How do you do do sextants
A
Record worst level for each sextant if the code is 4 examine all sites in sextants
2 teeth per sextant minimum
22
Q
How do you do BPE in kids.
A
Only use codes 0-2 in 7-11
23
Q
What factors effect probing
A
Inclination Angle Contour of tooth Probing force Soze of probe
24
Q
What happens when period stops
A
You get a stable periodontitis patient
25
What actually causes gingivitis
Biofilm induces inflammation
There can be non biofilm induced such as genetic or immune condition incompetent etc
Can be pregnancy (progesterone) toward end or puberty induced
Diabetics
26
What is a false pocket
This is where the gingiva is way higher than the CEJ for different reasons but there is no actual bone los even tho there is a pocket
27
What drugs induce gingivitis
Phenytoin (epilepsy)
Ciclosporin (immunosuppressant Organ transplantation)
Calcium Ion blockers for (high blood pressure)
Oral contraceptive associated
28
What is gingival fibromatosis
Causes gingival overgrowth it’s hereditary
29
What is herpetic gingivostomatitis
This is gingivitis of viral origin comes with swollen lymph nodes and viral vesicles on gingiva
30
What is the progression of periodontitis
This can be continuous or in bursts
Multiple bursts in a patients life for specific period
Multiple bursts with no cause
31
What are the stages of perio (4)
Initial
Moderate
Sever (potential additional tooth loss)
Severe (potential loss of dentition)
32
How is perio extent classified
Localised
Generalised
Molar/incisor specific
33
What are the grades of perio progression
Slow
Moderate
Rapid
34
How is perio graded in numbers
Ratio of bone loss to age
A is less than 0.5
B is 0.5-1
C is more than 1
35
What’s necrotising periodontitis
Associated with HIV positive status
Ulceration and bleeding
Punched out papillae
36
How is recession measured
From CEJ to gingival margin
37
What does incipient perio mean
This is perio in adolescence meaning ‘in initial stage’ prevalent in indiopackistani
38
What are the main perio bacteria
| What are features of agressive perio
A actinomycetemcomitans and some P. Gingivalis
Phagocyte abnormalities
Micro dial deposits inconsistent with destruction
39
What’s a cross sectional study
| What’s a longitudinal study
A particular time
| Over a period of time
40
What’s a descriptive test
| Analytical?
Describes distribution of variables
| Examine associations
41
Which is the most prevalent perio
Chronic
| Aggressive is less prevalent
42
What are the perio indices used for in monitoring?
Making sure a patient is progressing in the direction you want
43
Screening?
To find cases of disease in a population
44
What is monitoring
Follow up progression after treatment
45
What is the order of treatment
```
Screen
Establish level of disease
Reach diagnostic
Monitor treatment response
Establish need for further treatment
```
46
Why do we need plaque indices
Plaque is the main causes tube factor in gingivitis periodontitis and success failure if treatment
47
How is the plaque index recorded
6 point each tooth plaque present or not
48
What is the BOP index
Bleeding on probing 6 point test again
49
When do you use the bleeding index
For patients of BPE of 1 or 2
50
What are the periodontal Indices
```
Bleeding on probing
Probing pocket depths
Attachment levels
Mobility index
Furcation indices
Suppuration
```
51
How long after treatment do you do the perio indices again
6-8 weeks
52
There is a difference between bleeding on probing and marginal bleeding
-
53
What is the difference between gingivitis and perio in bleeding terms
Marginal bleeding gingivitis
| Bleeding from pocket base perio
54
What is recession used for
Used to determine loss of bone and attachment
55
What are the different mobility indexes
Grade 1: 1mm horizontal movement
Grade 2: more than 1mm horizontal movement
Grade 3 vertical movement too
56
What is furcation
Loss of bone between multirooted teeth
57
What are the furcation grades
1 loss is less than 1/3 the width of the tooth
2 is more than 1/3 but not through and through
3 through and through
58
What are the three stages of periodontal therapy
Initial - get rid of plaque infections
Corrective - therapeutic measures
Supportive - stop reoccurrence
59
What is the aim of initial therapy
To eliminate the infectious and inflammatory process
Bring oral cavity to a state of health by endo extraction etc
Root surface debridement etc
OHI
correction
Antimicrobial therapy
60
What stage is before initial therapy
Emergency phase to remove pain
61
What I decided do you record if the BPE is 1 or 2
Marginal gingival bleeding free score
| Plaque free
62
What Indices do you record when BPE is 3 or 4 or *
```
Depths
Bleeding on probing
Suppuration
Furcation
Recession
Mobility
```
63
What is the pocket depth receccion and attachment level all have in common
They are all the same thing pocket depths turn into attachment levels when attachment is lost then into recession levels when lots of attachment is lost
64
What are essential oils good for m
These can actually be anti plaque
65
What about if patients in responsive to treatment are smokers
Over 90% or patients that don’t respond to treatment well are smokers
66
What should you do to a smoker
Explain the harms of smoking and record you have done this
67
What is the difference between root planing and RSD
Root planning removes nercrotic cementum and is not currently advocated
RSD just removes plaque calculus etc no cementum
68
What is the red sickle used for
Removal supra all teeth
69
Grey curette
Incisors and canines Dee subgingival
70
Orange curette
Deep subgingival molars premolars
71
Blue curette
Distal molars and premolars subgingival
72
Yellow curette
All sub and supra
73
What has initial therapy been shown to cause
Gain in attachment in deep sites
Loss of attachment in shallow sites (must be carefull)
Healing after 3 mints
Bleeding decreased to 14-20%
74
What is the one thing you will not retake after treatment
Radiographs bone will not come back so this is an unnecessary exposure
75
How do you give tooth brushing instruction
```
Disclose
Records free score
Show patient in mirror
Let patient brush with own toothbrush
Modify technique
Let patient try new techniques
```
Set and agree targets
76
What is the target plaque free score
More than 70%
77
What techniques best for brushing
Modified bass
78
What are the main toothpaste ingredients
```
Abrasives
Humectants
Water
Foaming agent
Binding agent
Flavouring
Therapeutic agent
Preservative
Fluoride agent
```
79
What controls plaque in toothpaste
Stannous salts - agains caries
| Triclosan - antibacterial
80
What is the aim of corrective therapy
This is to restore the function and provide a stable occlusion for the patient to restore aesthetic and increase healing
81
What may be done after perio scores have got much better
Restorations orthodontics prosthetics etc
82
What is supportive therapy?
This is a phase of a patients treatment that is to prevent a relapse back to periodontitis
83
What do study’s show about regular scale every two weeks 1975
No loss of attachment compared to the control group
84
What is bad about traditional occasional dental care in the case of a patient with perio
Does not emphasise plaque control enough then standard treatment
85
What was good about seeing a perio patient every 2 months
Little or not attachment loss
86
What was the axelsson and lindhes study
This was the idea that the recall group had way better oral health than the nine recall group
87
What is the problem with perio treatment
There is a significant difference in treatment response
88
What’s a spy visit
This is an hour of examination and motivation and instrumentation
89
What is successful treatment
Bleeding free scores more than 80 as well as plaque free scores
No furcation
No bop
PPD <5
90
What is bad about lots of scaling
It can leave grooves making the issue worse
91
What are the areas to identify progression
Patient
Tooth
Tooth site
92
What does absence of bleeding show
Stability
93
When does supportive therapy start.
After initial and corrective therapy
94
What is a periodontal abscess
This is a lesion, an infection in the tissues adjacent to the periodontal pocket which may cause break down of the periodontal ligament and alveolar bone
95
What are the causes of abcesses
Periodontal disease
Pulp necrosis
Pericoronitis (inflamed tissue around wisdom teeth)
Trauma or surgery
96
What bacteria are found in a periodontal abscess
```
P. Gingivalis
P. Intermedia
F. Nucleatum
C. Rectus
Capnocytophaga spp
Tannerella forsythia
Spirochaetes
```
97
What is the occlusion pocket orifice hypotheses of perio abscess
Occlusion causes poor rinsing etc and food gets stuck hard to brush etc
98
Other aetiologies factors causing abscess
Furcation (hard to clean)
Systemic antibiotic therapy (superinfection with opportunistic organisms)
Diabetics increased abscess susceptibility
99
What are clinical features of a perio abscess
```
Deep pockets and attachment loss
Suppuration from pocket
Chronic
May be systemic involvement
Mobile tooth
Painful to bite on
May want to grind tooth
Could become chronic
```
Acute presentation - redness puss not draining
You can’t see a perio abscess on a radiograph
100
Management for non draining abscess
Remove impacted material
Hot salt water rinses
Lots of pain killers
If drainage dose not occur three systemic antibiotics required such as
Metronidazole 200mg 3 times a day for 5 to 7 days
Penicillin 250mg 4 times a day for 5 to 7 days
May have to instrumentally drain
101
What are systemic involvement symptoms
```
Extra-oral swelling
Lymphadenopathy (Swelling of the lymph nodes)
Cellulitis (rare)
Malaise (general unwell was feeling)
High temp
```
102
How do you treat a systemically involved perio abscess
Same antibiotics as just to treats the acute abscess or 250mg metronidazole and amoxicillin 375mg for 7 days
103
What else can be similar to a periodontal abscess
Perio-endo lesion
Periapical abscess
Gingival abscess (involves interdental papilla
Peri coronal abscess (involves tissue surrounding partially erupted tooth)
104
endodontic and Periodontic lesions
Primary Periodontic secondary endodontic (necrotic pulp due to periodontal involvement)
Primary endodontic secondary periodontic is where nercrotic pulp causes abscess lesion
105
What are the symptoms of a periapical abscess
```
Pulp necrosis
Non vital tooth
Periapical tissues involved
Periodontal tissue involvement
Tooth tender to percussion
```
106
What is necrotising periodontal disease
Rapid onset painful bleeding punched out papillae ulcers maybe lymph node involvement 4 zones bacterial zone neutraphill zone necrotic zone spirocheatal zone
In people in early 20s immune suppression poor diet malnutrition etc
107
What’s the management for NPD
Remove gross deposits
Oxidising mouthwash (hydrogen peroxide)
Clorohexadine rinse
Maybe antibiotics
Then periodontal therapy
NPD can be reoccurring
Necrotising stomatitis is even worse version of this it’s below the mucogingival junction
108
Gingivostomatisis
```
Caused by herpes simplex virus 1
Causes fever
Gingivae very red and swollen
Makes small vesicles
Treated with antibody rinse
Runs its course in 7-18 days
Plenty of fluids
Analgesics
Clorohexadine
Very infectious be carefully aided herpatic whitlow sore fingers
```
109
What does malocclusion cause
Can lead to perio making sites hard to clean causes recession
110
What are the idiosyncrasy or morphology factors that lead to perio
Enamel pearls - apical to enamel and cause attachment loss
Root grove - located palatally and extend 5mm these cause plaque retention and attachment loss
Cemental tears - separation along cemetodentinal junction causing rapid attachment loss
111
What does mouth breathing cause
Hyperplasia if gingival cells upper anterior problems
112
How does smoking cause perio
Stop neutrophils from working reduce bleeding increased keratinisation
113
What are introgenic factors
Factors we have caused leading to perio like poor restoration margins poor ortho etc
114
What causes gingival hyperplasia
(Hyperplastic) This is overgrowth causes by drugs or hormones there is no attachment loss just overgrowth
Causes (phenytoin(epilepsy), cyclosporin (immunosuppressant), calcium channel blockers).
115
What’s pregnancy gingivitis
Increases till 8 months then resolved after birth. Not as sever and sex hormone (the pill) induced gingivitis
116
What’s a pregnancy epulis
This is a swelling of the interdental papilla and all of the vasocture. This will be removed after pregnancy once it shrinks because bleeding would be hard to stop otherwise
117
What does diabetics do to the periodontium
Cause perio leading to recession because of higher metabolites for the bacteria and reduced immune response
118
How does downs affect the mouth
Likely to get aggressive perio because decreases neutrophil chemotaxis
Mouth breathing and poor oral hygiene
119
What is papillon Lefevre syndrome
Palma plantar keratosis more keratin in the palms of hand and feet
Defective neutrophil chemotaxis and phagocytosis
Rapid perio destruction
120
What is hypophosphatasia
Low enzyme alkaline phosphorylase so defective cementum formation and therefore minimal attachment so teeth exfoliate.
Rickets like skeletal disease
121
Ehlers Danlos syndrome
Poor collagen formation only type 8 is associated with sever perio destruction.
They are easily bruised very stretchy skin and they will probs loose all teeth by 30
122
What do vitamin C deficiency and protein deficiency cause
VC gem organic gingivitis
| PD loss of supporting tissues
123
What is chediak-hegashi syndrome ?
Defects of phagocyte chemotaxis degranulation sever gingivitis eventual adult dentition loss
124
What are neutropenias
Cyclic - gingival ulceration rapid perio breakdown and luckocyte fluctuation
Familial benign neutropenia - dominant condition
125
What does leukaemia do
Gingival ulceration excessive bleeding and gingival swelling (acute)
Chronic (gingival swelling)
126
What are the 3 stages of gingivitis
Initial
Early
Established
(Difficult to distinguish clinically)
127
When does initial inflammation occur
24-48 hours after plaque accumulation which increases vasodilation then the inflammatory filtrate increases immune cells migrate to plaque clinically wont look much different
128
What happens in early gingivitis
More neutrophils greater plaque and fibroblasts exhibit signs of cell damage
1 week after we see early lesions gingival loss of collagen swelling and deepening of gingival crevis
129
What happens in established gingivitis.
Extensive subgingival plaque
| 10-30% plasma cell infiltrate. False pocket forms. No loss of bone yet. Lots of neutrophils
130
What are the key features of perio
50% cells in filtrate are plasma
Filtrate extends apically
Bone loss
131
How is tissue damaged in the epithelium
bacterial enzymes damage keratinocytes
Endotoxins damage fibroblasts reducing collagen
Compliment activation also damages fibroblasts
Capsules from A. actinomycetmcomitans
132
What are the 3 key features of perio break down
Apical migration caused by connective tissue damage
Breakdown of the PDL caused by host factors causing connective tissue damage or bacterial factors causing damage
Bone resorption caused by host of bacterial factors causing osteoclasts resorption
133
What is a Stephan curve
This is the curve the mouth pH follows after food
