Periodontitis, Dental Caries and MRONJ ☺️

Question 1

Epidemiology

Etiology and pathophysiology of periodontitis

Answer 1

Increases with age

Inflammation of gums => gingivitis
Untreated gingivitis => periodontitis
Bacteria move under gum line, destroy soft tissue and bone

Question 2

Presentation

• gingivitis
• periodontitis

Answer 2

Receding, tender, swollen, red gums
Bleed easily

The above and loose teeth
Pain from chewing
Bad breath

Question 3

Risk factors for dental disease in older adults

Answer 3

Difficulties maintaining oral hygiene

• reduced manual dexterity
• lower tactile thresholds
• impaired vision
• cognitive impairment, depression
• poor carer knowledge and support in assisted brushing

Dry mouth

• SE of poly pharmacy
• SE of certain medical conditions

Diet
-high sugar intake (sugar covered meds, foods, drinks)

Lifestyle

• smoking
• chronic disease

Question 4

Prevention and management of gum disease

Answer 4

Brush gum line and each tooth daily - may exacerbate bleeding but will reduce with continued brushing

Medium electric toothbrush
Floss, interdental brush

Chlorhexidine mouthwash for patients with high risk of aspiration pneumonia

Sodium laureate free toothpaste for

Smoking cessation

Question 5

Adaptations for good gum care

Answer 5

Barman’s toothbrush

Assisted brushing with finger guards

Question 6

Dental caries

• Etiology
• pathophysiology
• presentation

Answer 6

Triad of high sugar, bacteria and teeth => demineralisation of tooth due to acidic pH

Toothache - continuous/occasional sharp pain
Sensitivity
Grey, brown, black spots on teeth
Bad breath
Unpleasant taste

Question 7

Dental caries

-management

Answer 7

Reducing sugary food intake frequency

High fluoride toothpaste and mouthwash

Optimise dosing regimen for sugar coated medications

Question 8

How would you detect MRONJ

How would you decrease the chances of developing MRONJ

Answer 8

Exposed bone Bone that can be probed through intraoral or extraoral fistula in maxillofacial region that has persisted for 2 months

Refer to dentist for dental assessment prior to starting bisphosphonates
Extract teeth of poor prognosis prior
Regular checkups and oral hygeine

Question 9

What is the link between periodontal disease and heart disease
-how would you avert this risk

Answer 9

Periodontal disease increases your risk of heart disease
-bacteremia from oral cavity to heart

Screen preoperatively for any oral infection and manage any infection first

Question 10

Causes of MRONJ

Answer 10

Bisphosphonates, denosumab and other antiangiogenic drugs

Dental

• dental extractions
• periodontal disease
• poorly fitting dentures
• infections

Medical

• cancer treatment
• concurrent steroids
• long use of oral bisphosphonates (5+ years)
• previous history