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ODDR > Periodontics > Flashcards

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

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2
Q

How does periodontist start

A

Health
Supragingival plaque
Crevice depends and plaque extends subgingivally (gingivitis)
Periodontitis loss of attachment irreversible

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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

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4
Q

Periodontitis key features

A

Loss of attachment
Apical migration of junction epithelium
Alveolar bone loss

(Heavy inflammatory filtrate ulcerated pocket)

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5
Q

Features of the biofilm

A

Complex community
Attached to pelicle
Organised into 3D structure
Enclosed in matrix of extra cellular material

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6
Q

What type of bacteria is found supragingivally

A

Airobes and gran positive cocci and rods with not loads of diversity

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7
Q

What bacteria is found subgingivally

A

Gram negative rods and spirochaetes

Highly anairobic and great diversity

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8
Q

What makes plaque pathogenic (virulence factors)

A 
Proteases 
Bone resorting factors 
Cytotoxic metabolites
Leukotoxin
Capsule 
Induction of the inflammatory response
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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

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10
Q

What is the host defences agains plaque

A 
Saliva 
Epithelium 
Inflammatory response 
Immune response 
Mediators
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11
Q

What is the order of conversation

A 
Presenting complaint 
History for presenting complaint 
Past dental history 
Social history 
Past medical history
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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.

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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
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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

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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

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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

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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

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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

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19
Q

What does BPE * mean

A

Furcation involvement

OHI RSD refer to specialist

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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

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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

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22
Q

How do you do BPE in kids.

A

Only use codes 0-2 in 7-11

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23
Q

What factors effect probing

A 
Inclination 
Angle 
Contour of tooth 
Probing force
Soze of probe
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24
Q

What happens when period stops

A

You get a stable periodontitis patient

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25
Q

What actually causes gingivitis

A

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

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26
Q

What is a false pocket

A

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

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27
Q

What drugs induce gingivitis

A

Phenytoin (epilepsy)
Ciclosporin (immunosuppressant Organ transplantation)
Calcium Ion blockers for (high blood pressure)
Oral contraceptive associated

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28
Q

What is gingival fibromatosis

A

Causes gingival overgrowth it’s hereditary

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29
Q

What is herpetic gingivostomatitis

A

This is gingivitis of viral origin comes with swollen lymph nodes and viral vesicles on gingiva

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30
Q

What is the progression of periodontitis

A

This can be continuous or in bursts
Multiple bursts in a patients life for specific period
Multiple bursts with no cause

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31
Q

What are the stages of perio (4)

A

Initial
Moderate
Sever (potential additional tooth loss)
Severe (potential loss of dentition)

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32
Q

How is perio extent classified

A

Localised
Generalised
Molar/incisor specific

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33
Q

What are the grades of perio progression

A

Slow
Moderate
Rapid

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34
Q

How is perio graded in numbers

A

Ratio of bone loss to age
A is less than 0.5
B is 0.5-1
C is more than 1

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35
Q

What’s necrotising periodontitis

A

Associated with HIV positive status
Ulceration and bleeding
Punched out papillae

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36
Q

How is recession measured

A

From CEJ to gingival margin

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37
Q

What does incipient perio mean

A

This is perio in adolescence meaning ‘in initial stage’ prevalent in indiopackistani

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38
Q

What are the main perio bacteria

What are features of agressive perio

A

A actinomycetemcomitans and some P. Gingivalis

Phagocyte abnormalities
Micro dial deposits inconsistent with destruction

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39
Q

What’s a cross sectional study

What’s a longitudinal study

A

A particular time

Over a period of time

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40
Q

What’s a descriptive test

Analytical?

A

Describes distribution of variables

Examine associations

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41
Q

Which is the most prevalent perio

A

Chronic

Aggressive is less prevalent

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42
Q

What are the perio indices used for in monitoring?

A

Making sure a patient is progressing in the direction you want

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43
Q

Screening?

A

To find cases of disease in a population

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44
Q

What is monitoring

A

Follow up progression after treatment

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45
Q

What is the order of treatment

A 
Screen 
Establish level of disease 
Reach diagnostic 
Monitor treatment response 
Establish need for further treatment
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46
Q

Why do we need plaque indices

A

Plaque is the main causes tube factor in gingivitis periodontitis and success failure if treatment

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47
Q

How is the plaque index recorded

A

6 point each tooth plaque present or not

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48
Q

What is the BOP index

A

Bleeding on probing 6 point test again

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49
Q

When do you use the bleeding index

A

For patients of BPE of 1 or 2

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50
Q

What are the periodontal Indices

A 
Bleeding on probing 
Probing pocket depths 
Attachment levels 
Mobility index 
Furcation indices 
Suppuration
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51
Q

How long after treatment do you do the perio indices again

A

6-8 weeks

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52
Q

There is a difference between bleeding on probing and marginal bleeding

A

-

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53
Q

What is the difference between gingivitis and perio in bleeding terms

A

Marginal bleeding gingivitis

Bleeding from pocket base perio

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54
Q

What is recession used for

A

Used to determine loss of bone and attachment

55
Q

What are the different mobility indexes

A

Grade 1: 1mm horizontal movement
Grade 2: more than 1mm horizontal movement
Grade 3 vertical movement too

56
Q

What is furcation

A

Loss of bone between multirooted teeth

57
Q

What are the furcation grades

A

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
Q

What are the three stages of periodontal therapy

A

Initial - get rid of plaque infections
Corrective - therapeutic measures
Supportive - stop reoccurrence

59
Q

What is the aim of initial therapy

A

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
Q

What stage is before initial therapy

A

Emergency phase to remove pain

61
Q

What I decided do you record if the BPE is 1 or 2

A

Marginal gingival bleeding free score

Plaque free

62
Q

What Indices do you record when BPE is 3 or 4 or *

A 
Depths 
Bleeding on probing 
Suppuration 
Furcation 
Recession 
Mobility
63
Q

What is the pocket depth receccion and attachment level all have in common

A

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
Q

What are essential oils good for m

A

These can actually be anti plaque

65
Q

What about if patients in responsive to treatment are smokers

A

Over 90% or patients that don’t respond to treatment well are smokers

66
Q

What should you do to a smoker

A

Explain the harms of smoking and record you have done this

67
Q

What is the difference between root planing and RSD

A

Root planning removes nercrotic cementum and is not currently advocated
RSD just removes plaque calculus etc no cementum

68
Q

What is the red sickle used for

A

Removal supra all teeth

69
Q

Grey curette

A

Incisors and canines Dee subgingival

70
Q

Orange curette

A

Deep subgingival molars premolars

71
Q

Blue curette

A

Distal molars and premolars subgingival

72
Q

Yellow curette

A

All sub and supra

73
Q

What has initial therapy been shown to cause

A

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
Q

What is the one thing you will not retake after treatment

A

Radiographs bone will not come back so this is an unnecessary exposure

75
Q

How do you give tooth brushing instruction

A 
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
Q

What is the target plaque free score

A

More than 70%

77
Q

What techniques best for brushing

A

Modified bass

78
Q

What are the main toothpaste ingredients

A 
Abrasives 
Humectants 
Water 
Foaming agent
Binding agent 
Flavouring 
Therapeutic agent 
Preservative
Fluoride agent
79
Q

What controls plaque in toothpaste

A

Stannous salts - agains caries

Triclosan - antibacterial

80
Q

What is the aim of corrective therapy

A

This is to restore the function and provide a stable occlusion for the patient to restore aesthetic and increase healing

81
Q

What may be done after perio scores have got much better

A

Restorations orthodontics prosthetics etc

82
Q

What is supportive therapy?

A

This is a phase of a patients treatment that is to prevent a relapse back to periodontitis

83
Q

What do study’s show about regular scale every two weeks 1975

A

No loss of attachment compared to the control group

84
Q

What is bad about traditional occasional dental care in the case of a patient with perio

A

Does not emphasise plaque control enough then standard treatment

85
Q

What was good about seeing a perio patient every 2 months

A

Little or not attachment loss

86
Q

What was the axelsson and lindhes study

A

This was the idea that the recall group had way better oral health than the nine recall group

87
Q

What is the problem with perio treatment

A

There is a significant difference in treatment response

88
Q

What’s a spy visit

A

This is an hour of examination and motivation and instrumentation

89
Q

What is successful treatment

A

Bleeding free scores more than 80 as well as plaque free scores
No furcation
No bop
PPD <5

90
Q

What is bad about lots of scaling

A

It can leave grooves making the issue worse

91
Q

What are the areas to identify progression

A

Patient
Tooth
Tooth site

92
Q

What does absence of bleeding show

A

Stability

93
Q

When does supportive therapy start.

A

After initial and corrective therapy

94
Q

What is a periodontal abscess

A

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
Q

What are the causes of abcesses

A

Periodontal disease
Pulp necrosis
Pericoronitis (inflamed tissue around wisdom teeth)
Trauma or surgery

96
Q

What bacteria are found in a periodontal abscess

A 
P. Gingivalis 
P. Intermedia
F. Nucleatum
C. Rectus 
Capnocytophaga spp
Tannerella forsythia 
Spirochaetes
97
Q

What is the occlusion pocket orifice hypotheses of perio abscess

A

Occlusion causes poor rinsing etc and food gets stuck hard to brush etc

98
Q

Other aetiologies factors causing abscess

A

Furcation (hard to clean)
Systemic antibiotic therapy (superinfection with opportunistic organisms)
Diabetics increased abscess susceptibility

99
Q

What are clinical features of a perio abscess

A 
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
Q

Management for non draining abscess

A

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
Q

What are systemic involvement symptoms

A 
Extra-oral swelling 
Lymphadenopathy (Swelling of the lymph nodes)
Cellulitis (rare)
Malaise (general unwell was feeling)
High temp
102
Q

How do you treat a systemically involved perio abscess

A

Same antibiotics as just to treats the acute abscess or 250mg metronidazole and amoxicillin 375mg for 7 days

103
Q

What else can be similar to a periodontal abscess

A

Perio-endo lesion
Periapical abscess
Gingival abscess (involves interdental papilla
Peri coronal abscess (involves tissue surrounding partially erupted tooth)

104
Q

endodontic and Periodontic lesions

A

Primary Periodontic secondary endodontic (necrotic pulp due to periodontal involvement)

Primary endodontic secondary periodontic is where nercrotic pulp causes abscess lesion

105
Q

What are the symptoms of a periapical abscess

A 
Pulp necrosis 
Non vital tooth 
Periapical tissues involved
Periodontal tissue involvement
Tooth tender to percussion
106
Q

What is necrotising periodontal disease

A

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
Q

What’s the management for NPD

A

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
Q

Gingivostomatisis

A 
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
Q

What does malocclusion cause

A

Can lead to perio making sites hard to clean causes recession

110
Q

What are the idiosyncrasy or morphology factors that lead to perio

A

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
Q

What does mouth breathing cause

A

Hyperplasia if gingival cells upper anterior problems

112
Q

How does smoking cause perio

A

Stop neutrophils from working reduce bleeding increased keratinisation

113
Q

What are introgenic factors

A

Factors we have caused leading to perio like poor restoration margins poor ortho etc

114
Q

What causes gingival hyperplasia

A

(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
Q

What’s pregnancy gingivitis

A

Increases till 8 months then resolved after birth. Not as sever and sex hormone (the pill) induced gingivitis

116
Q

What’s a pregnancy epulis

A

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
Q

What does diabetics do to the periodontium

A

Cause perio leading to recession because of higher metabolites for the bacteria and reduced immune response

118
Q

How does downs affect the mouth

A

Likely to get aggressive perio because decreases neutrophil chemotaxis
Mouth breathing and poor oral hygiene

119
Q

What is papillon Lefevre syndrome

A

Palma plantar keratosis more keratin in the palms of hand and feet
Defective neutrophil chemotaxis and phagocytosis
Rapid perio destruction

120
Q

What is hypophosphatasia

A

Low enzyme alkaline phosphorylase so defective cementum formation and therefore minimal attachment so teeth exfoliate.
Rickets like skeletal disease

121
Q

Ehlers Danlos syndrome

A

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
Q

What do vitamin C deficiency and protein deficiency cause

A

VC gem organic gingivitis

PD loss of supporting tissues

123
Q

What is chediak-hegashi syndrome ?

A

Defects of phagocyte chemotaxis degranulation sever gingivitis eventual adult dentition loss

124
Q

What are neutropenias

A

Cyclic - gingival ulceration rapid perio breakdown and luckocyte fluctuation
Familial benign neutropenia - dominant condition

125
Q

What does leukaemia do

A

Gingival ulceration excessive bleeding and gingival swelling (acute)

Chronic (gingival swelling)

126
Q

What are the 3 stages of gingivitis

A

Initial
Early
Established
(Difficult to distinguish clinically)

127
Q

When does initial inflammation occur

A

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
Q

What happens in early gingivitis

A

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
Q

What happens in established gingivitis.

A

Extensive subgingival plaque

10-30% plasma cell infiltrate. False pocket forms. No loss of bone yet. Lots of neutrophils

130
Q

What are the key features of perio

A

50% cells in filtrate are plasma
Filtrate extends apically
Bone loss

131
Q

How is tissue damaged in the epithelium

A

bacterial enzymes damage keratinocytes
Endotoxins damage fibroblasts reducing collagen
Compliment activation also damages fibroblasts
Capsules from A. actinomycetmcomitans

132
Q

What are the 3 key features of perio break down

A

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
Q

What is a Stephan curve

A

This is the curve the mouth pH follows after food

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