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Module 3 Revision > Periodontology > Flashcards

Periodontology Flashcards

1
Q

In what situation would mouthwash be recommended for use?

A

When a patient cannot effectively clean mechanically

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2
Q

Name all seven components of toothpaste

A
  1. Abrasives
  2. Detergent
  3. Binding agents
  4. Thickeners
  5. Humectants
  6. Preservatives
  7. Flavours and sweeteners
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3
Q

What toothpaste component is used to aid plaque/stain removal?

A

Abrasives

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4
Q

What component of toothpaste causes it to foam?

A

Detergent

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5
Q

What is the role of binding agents as a toothpaste component?

A

Prevent separation of liquid and solid phases of paste during storage

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6
Q

What is the role of thickeners as a toothpaste component?

A

They give consistency

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7
Q

What toothpaste component conserves moisture?

A

Humectants

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8
Q

What is the role of preservatives as a toothpaste component?

A

Prevent bacterial growth

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9
Q

What is the most likely toothpaste component that patients can be allergic to?

A

Flavourings

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10
Q

What toothpaste is advised for use when a patient presents with large calculus build-up?

A

Triclazan

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11
Q

What is the effect of calculus build-up on plaque?

A

It causes plaque to accumulate

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12
Q

What mouthwash can increase calculus formation as well as staining?

A

Chlorohexidine

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13
Q

What is staining, induced by chlorohexidine, causd by?

A

CHX binding tannins

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14
Q

Can mouthwash penetrate the biofilm?

A

No

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15
Q

What does PMPR stand for?

A

Professional mechanical plaque removal

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16
Q

What are the aims of non-surgical periodontal debridement? ( i.e. hand instrumentation and ultrasonics)

A

To remove supra- and subgingival calculus deposits from the tooth surface, as well as disrupting pathogenic subgingival plaque biofilm

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17
Q

If calculus is essentially an inert mineralised deposit, why is it necessary to remove it?

A

Because calculus acts as a plaque trap, promoting further build up of plaque. Removal of calculus also makes maintaining OH easier for patients

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18
Q

What two key health instructions could be given to patient to prevent future build-up of calculus?

A

Oral hygiene instruction and smoking cessation

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19
Q

Why do we get less BOP in smokers?

A

Mainly due to the ‘masking effect’ which means there are reduced levels of periodontal inflammation and gingival vascularity.

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20
Q

What is important to warn smoking patients about for if they stop smoking and their OH improves?

A

That their gums may BOP

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21
Q

Why is sub-gingival PMPR usually carried out with LA?

A

Because patients may experience pain during subgingival PMPR due to the nerve supply from the periodontal soft tissues and the root dentine

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22
Q

What is the recommended time before a pocket should be re-probed following subgingival PMPR?

A

10-12 weeks

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23
Q

Ideally, when should you see a pateint post subgingival PMPR, only to check OH is being maintained?

A

4-6 weeks

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24
Q

What are the four stages of periodontal wound healing?

A
  • haemostasis
  • inflammation
  • proliferation
    -remodelling
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25
Q

Angiogenesis is an essential phase in the proliferation stage of wound healing. Define angiogenesis.

A

New blood vessels form from pre-existing vessels

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26
Q

At what depth are perio pockets when periodontitis status is at ‘currently stable’?

A

4mm or less

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27
Q

Why is there usually more recession following non-surgical periodontal treatment?

A

Reduction in inflammatory swelling results tissue shrinkage (more recession)

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28
Q

If a perio patient has to move from a small tepe brush for interproximal cleaning to a large tepe brush is this good or bad, and why?

A

A good thing, shows that there has been shrinkage in tissue due to reduced inflammation

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29
Q

What are the two phases of perio healing?

A
  • reattachment
  • new attachment
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30
Q

Re-union of tissue with a root which has been pathologically exposed due to periodontitis, is known as?

A

New attachment

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31
Q

What structures make up the periodontium?

A
  • PDL
  • root cementum
  • alveolar bone
  • gingival tissues ( gingival epithelium and connective tissue)
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32
Q

what does regeneration of the periodontium mean?

A

Returning the periodontium to normal as if disease never happened

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33
Q

what four tissues can be involved in periodontal pocket healing?

A
  • gingival epithelial cells
  • gingival connective tissue cells
  • bone ells
  • periodontal ligament cells
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34
Q

Which tissue, involved in perio pocket healing, is the fastest cell type to develop following perio treatment?

A

Gingival epithelium

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35
Q

What is the negative impact of fast growing gingival epithelium cells?

A

They can block the growth of other cell types involved in perio pocket healing, preventing regeneration of perio tissues

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36
Q

What type of epithelium do fast growing gingival epithelial tissues form?

A

Long junctional epithelium by new attachment

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37
Q

What are the three reasons for reduced probing depth following successful perio treatment?

A
  • reduction in inflammatory swelling
  • improved tissue resistance to probing
  • formation of the long junctional epithelium
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38
Q

What type of patients tend to have worse treatment outcomes, with less successful pocket depth reduction.

A

Smokers

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39
Q

In what situation would 4mm perio pockets be deemed ‘currently stable’?

A

If there is no BOP

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40
Q

What are the key features of periodontal treatment success?

A
  • pateint is comfortable
  • all pockets are 4mm or less
  • consistently low BOP below 10%
  • adequate plaque control
  • cleansable restorations
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41
Q

what would be the next step for a patient with successful non-surgical perio treatment?

A

Move patient onto maintenance/ supportive periodontal therapy (SDL)

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42
Q

If a perio patient is young and very susceptible to periodontal disease, how long between maintenance appointments should be left?

A

3 months

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43
Q

What are key features of perio treatment failure?

A
  • discomfort of patient
  • deep persistent pockets that aren’t maintainable by OH at home measures
  • persistent BOP
  • persistent suppuration
  • increasing LOA
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44
Q

What are the five main causes of periodontal treatment failure?

A
  • inadequate plaque control
  • original assessment/diagnosis incorrect
  • inadequate debridement
  • patient is a poor responder to treatment ( possible underlying medical condition)
  • inadequate maintenance/SPT
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45
Q

What is the most common cause of periodontal treatment failure?

A

Inadequate plaque control

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46
Q

What perio patient may require palliative care?

A

Patients who refuse to take responsibility for condition and treatment plans (OH), also those who have failed non-surgical perio treatment for other reasons.

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47
Q

What is palliative care?

A

Form of medical care that relives symptoms without dealing with the cause of the condition

48
Q

To decide whether to provide perio treatment after failure, ask yourself what three questions?

A
  1. Are you sure diagnosis of failure is correct?
  2. Why has the treatment failed?
  3. Can this be corrected?
49
Q

What are the three aims of periodontal palliative care?

A

Keep patient:
1. comfortable
2. Functioning
And
3. Slow the progression of periodontal disease

50
Q

What are the required pocket depths for Jon-surgical perio treatment to be effective?

A

6mm or less

51
Q

If a pateint has perio pockets that are 6mm or more, what should be done?

A

Refer to a specialist

52
Q

What society have guidance on referrals to specialists?

A

The British society of Periodontology (BSP)

53
Q

The ability of an organism to maintain the internal environment of the body within limits that allow it to survive, is known as?

A

Homeostasis

54
Q

What protein is most important in homeostasis of the oral cavity and turnover in the PDL?

A

Collagen

55
Q

The movement of something into, through and out. The rate at which something is depleted and replaced. This is known as?

A

Turnover

56
Q

What does BPE stand for?

A

Basic periodontal examination

57
Q

What is a screening system used to identify individuals who require a more detailed periodontal examination?

A

BPE

58
Q

What patients require a BPE?

A
  • new patients
  • recall patients who haven’t has a perio examination in a year
59
Q

What teeth are generally not included in BPE charting?

A

3rd molars

60
Q

What should your probing pressure be when carrying out a BPE?

A

20-25g

61
Q

What code would be given for:

  • pockets < 3.5mm
  • no calculus/overhangs
  • no BOP
  • first black band on who probe completely visible
A

CODE 0

62
Q

What code would be given for:

  • pockets < 3.5mm
  • supra or sub gingival calculus/overhangs
  • first black band on who probe completely visible
A

CODE 2

63
Q

What code would be given for:

  • pockets < 3.5mm
  • no calculus/overhangs
  • BOP
  • first black band on who probe completely visible
A

CODE 1

64
Q

What code would be given for:

  • pockets 3.5mm - 5.5mm
  • first black band on who probe partially visible
A

CODE 3

65
Q

What code would be given for:

  • pockets >5.5mm
  • first black band on who probe completely in pocket
A

CODE 4

66
Q

What does a BPE code of 4 indicate about pocket depth?

A

That pocket depth is 6mm or more

67
Q

What are the disadvantages of BPE?

A
  • no indication of which teeth are affected/specific site
  • BPE alone doesn’t account for bone loss
    -can’t be used to monitor disease
68
Q

What are the three stages that BSP guidelines advise on BPE?

A
  1. Carry out a patient history
  2. Examine intra and extra orally
  3. Screen for periodontal disease (BPE)
69
Q

What are the two types of intra-oral radiographs commonly taken on clinic?

A
  • bitewing
  • periapical
70
Q

What are the two types of bitewing radiographs?

A

Horizontal bitewing and vertical bitewing

71
Q

What is the radiograph called that gives an entire view of the dentition?

A

DPT

72
Q

When would use of a DPT be required in replacement to intra-oral radiographs?

A

If a patient gags and cannot tolerate the film sitting in their mouth

73
Q

What are the four key disadvantage of radiographs?

A
  • superimposition of structures
  • radiation exposure
  • does not show disease activity
  • underestimates bone loss
74
Q

What 3 ways can extent of bone loss in periodontitis be described?

A
  1. Distribution (localised or generalised)
  2. Pattern ( horizontal or vertical on radiograph)
  3. Severity ( bone loss expressed in % proportion to tooth length)
75
Q

How many stages of bone loss are there?

A

4

76
Q

Bone loss of <15% would be described as incipient. What stage of bone loss is this?

A

Stage 1

77
Q

What stage describes bone loss of the mid 1/3 of the tooth root (33-50% bone loss)?

A

Stage 3

78
Q

What stage describes bone loss in the coronal 1/3 of the tooth root (15-33%)?

A

Stage 2

79
Q

What stage describes bone loss in the apical 1/3 of tooth root (>50%)?

A

Stage 4

80
Q

How is grade of disease calculated?

A

% bone loss /patient age

81
Q

How is severity of bone loss calculated?

A

(Measurement of ACJ to bone crest/ measurement of ACJ to root apex) x100

82
Q

What is a medico-legal requirement to carry out in order to take periodontal treatment plan forward?

A

A radiographic report

83
Q

What was the main focus of the 2017 world workshop on periodontitis?

A
  • periodontal health and gingival disease/ conditions on an intact and reduced Periodontium
  • the biological features of disease and risk factors
84
Q

What are the three types of periodontal disease according to new classifications?

A
  1. Necrotising periodontal disease
  2. Periodontitis
  3. Periodontitis as a manifestation of systemic disease
85
Q

What guide should be used to diagnose the stage and grade of periodontal disease?

A

Extent- periodontitis- stage- grade- stability -risk

86
Q

What can the extent of periodontitis be?

A
  • molar-incisal
  • localised
  • generalised
87
Q

Why should periodontitis be graded?

A

To estimate the risk of progression of periodontitis and to guide recall

88
Q

If the % bone loss/age is less than half the pateints age (<0.5) what grade of periodontitis is this?

A

Grade A

89
Q

If the % bone loss/age is half the pateints age (0.5-1) what grade of periodontitis is this?

A

Grade B

90
Q

If the % bone loss/age is more than half the pateints age (>1) what grade of periodontitis is this?

A

Grade C

91
Q

What is Grade A periodontitis normally driven by?

A

High plaque levels

92
Q

What is grade B periodontitis normally driven by?

A

High plaque levels and additional risk factors

93
Q

Which grade of periodontitis has the highest risk of relapse?

A

Grade C

94
Q

What would be the recall time for a grade A periodontal patient?

A

After about 1 year

95
Q

What would be the recall time for a grade B periodontal patient?

A

3-6 months

96
Q

Which grade of periodontitis requires a discussion to be had with the patient about the genetic risk of other family members to periodontitis?

A

Grade C

97
Q

Would periodontitis be described as stable, in remission, or unstable if:

BOP <10%, pocket depth is <4mm

A

Stable

98
Q

Would periodontitis be described as stable, in remission, or unstable if:

pocket depth is >5mm or 4mm pockets BOP

A

Unstable

99
Q

Would periodontitis be described as stable, in remission, or unstable if:

BOP >10%, pocket depth is <4mm, no BOP at 4mm pockets

A

In remission

100
Q

What are the top three risk factors for periodontitis that need to be controlled in order for treatment to be successful?

A
  • Plaque control
  • smoking
  • diabetes
101
Q

Fill the gap.
The most severe periodontitis patients have a _____________ immune system.

A

Hyper- responsive

102
Q

What stages of periodontitis are treatable by GDP?

A

Stages 1-3

103
Q

What stage of periodontitis should be treated by a specialist?

A

Stage 4

104
Q

What are S3 guidelines?

A

The highest level of evidence-based guidelines

105
Q

What is the BSP recommended four step approach to structure periodontal treatment planning?

A
  1. Risk factor management including OHI and supra-gingival PMPR
  2. Subgingival PMPR
  3. Reassessment
  4. Maintenance/ supportive periodontal treatment
106
Q

What is the most fundamental factor to perio treatment success?

A

Individualised oral hygiene instruction

107
Q

What approach of PMPR is not recommend for patients with systemic disease (e.g. cardiovascular disease) and why?

A

Full mouth approach where PMPR is carried out over one or two appointments all typically within 24 hours.
Due to risk of increased systemic inflammation

108
Q

For patients who initially had BPE scores of 3 or 4, when should they be reassessed?

A

After 3 months

109
Q

Why should caution be taken when putting patients on palliative care?

A

There is a risk of accusation of supervised neglect

110
Q

What are features of a healthy Periodontium?

A
  • pink/racial pigmentation
  • stippled
  • knife-edge margins
  • papillae fill interdental space
  • no BOP
111
Q

What are features of an unhealthy Periodontium?

A
  • red, swollen/ inflamed gingiva
  • loss of knife-edged margins
  • papillae over or under fill interdental spaces
  • loss of stippling
  • BOP
112
Q

What is the primary cause of gingivitis and periodontitis?

A

Plaque-induced inflammation

113
Q

LOA is associated with gingivitis. True or false?

A

False. No associated LOA with gingivitis. There is only LOA associated with periodontitis

114
Q

What epithelium in the gingival sulcus is the weak point in the gingival barrier against invading plaque bacteria?

A

Junctional epithelium

115
Q

If inflammatory reactions are higher, what’s happens to the levels of gingival crevicular fluid?

A

Increases

116
Q

What pieces of information do we need to formulate a periodontal treatment plan?

A
  • patient history
  • periodontal examination
  • further/special investigations

Module 3 Revision (20 decks)

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