Periodontology Flashcards
how is the 2017 disease classification graded?
1 - health
2 - plaque induced gingivitis (localised/ generlised)
3 - non plauqe induced gingival diseases nd conditions
4 - periodontitis
- periodontitis***
- localised (<= 30 teeth)
- molar incisor pattern>
5- necrotising perio diseases
6 - perio as a manifestation of systemic
7 - systemic disease or conditions affecting the periodontal tissues
8 - perio bscesses
9- perio-endo lesions
10- micogongival deformities and conditons
how is clinical gingival health characterised?
absence of bleeding on probing, erythema and edema, patient symptoms, and attachment and bone loss
what are the physiological bone levels range for clinical gingival health?
1.0 to 3.0 mm apical to the cemento-enamel junction
how is gingival health defined?
For an intact periodontium and a reduced and stable periodontium, gingival health is defined as < 10% bleeding sites with probing depths ≤3 mm
what is plaque induced gingivitis - intact periodontium?
BPEs 2 and no radiological bone loss and no interdental recession
what is bleeding on probing in relation to localised or generalised?
<30% - localised
>30% - generalised
what differentiates health and gingivitis
health <10% BOP
gingivitis >10% BOP
what are plaque induced gingivitis modifying factors?
A. associated with bacterial dental biofilm only
B. potential modifying factors of plaque induced gingivitis
1. systemic conditions
a) sex steroid hormones
1) puberty
2) Menstrual cycle
3) pregnancy
4) oral contraceptive
b) hyperglcemia
c) leukemia
d) smoking
e) malnutrition
2. oral factors enhancing plaque accumulation
a) prominent subgigival restoration margins
b) hyposalivation
C. drug-influenced gingival enlargements
what is plaque induced gingivitis - modified by puberty?
can be BPE 3s
no radiological bone loss
no interdental recession
types of plaque induced gingivitis?
modified by puberty
modified by poor restorative margins
drug influenced gingival enlargement
what are non plaque induced gingival diseases?
- Genetic/developmental e.g. hereditary gingival fibromatosis
- Specific infections e.g. herpetic gingival stomatitis, Candida albicans
- Inflammatory/immune conditions – e.g. lichen planus
- Inflammatory/immune conditions e.g. benign mucous membrane pemphigoid
- Nutritional deficiency e.g. vitamin C deficiency
what may occur in severely immune compromised nercotising periodontitis patients?
bone sequestrum
what are necrotising perio diseases?
- necrotising gingivitis
- necrotising periodontitis
what is a type of rare diseases that affect the course of periodontitis resulting in the early presentation of severe periodontitis.?
o Papillon Lefevre Syndrome
o leucocyte adhesion deficiency
o hypophosphatasia
o Down’s syndrome
o Ehlers-Danlos
what are Systemic Diseases or Conditions Affecting the Periodontal Tissues?
Mainly rare conditions affecting the periodontal supporting tissues independently of dental plaque biofilm‐induced inflammation. This is a more heterogeneous group of conditions which result in breakdown of periodontal tissues and some of which may mimic the clinical presentation of periodontitis
what are a more heterogeneous group of conditions which result in breakdown of periodontal tissues and some of which may mimic the clinical presentation of periodontitis.
o squamous cell carcinoma
o Langerhans cell histiocytosis
what is recession type 1 for gingival recession?
- Gingival recession with no loss of inter‐ proximal attachment.
- Interproximal CEJ is clinically not detect‐ able at both mesial and distal aspects of the tooth.
what is recession type 2 for gingival recession?
- Gingival recession associated with loss of interproximal attachment.
- The amount of interproximal attach‐ ment loss (measured from the interproximal CEJ to the depth of the interproximal sulcus/pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket).
what is recession type 3 for gingival recession?
- Gingival recession associated with loss of interproximal attachment.
- The amount of interproximal attach‐ ment loss (measured from the interproximal CEJ to the apical end of the sulcus/pocket) is greater than the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket)
what is step 1 for the BSP treatment of perio diseases?
building foundations for optimal treatment outcomes
I: explain disease, risk factors and tx alternatives, risk and benefits including no treatment
II: explain importance of OHI, encourage and support behaviour change for OH improvement
III: reduce risk factors including plaque retentive features , smoking cessation and diabetes control interventions
IV: provide individually tailored OH advice including interdental cleaning. +/- adjunctive efficacious toothpaste and mouthwash, +/- professional mechanical plaque removal (PMPR) including supra and subgingival scaling of clinical crown
V: select recall period following published guidance and considering risk factors such as smoking diabetes
VI: oral health educator (I,II), hygienist therapist (I-IV), dentist, practitioner accredited for level 2 and 3 care (I-V)
what do you do after step 1 for bsp guidelines of perio?
re-evaluate
non engaging patient repeat step 1
engaging patient move to step 2
consider referral
what is step 2 of bsp guidelines for perio?
subgingival instrumentation (root surface debridement/ PMPR on root)
I: reinforce OH, risk factor control, behaviour change
II: subgingival instrumentation, hand or powered (sonic/ ultrasonic) either alone or in combination
III: use of adjunctive systemic antimicrobials determined by practitioner accredited for level 2 and 3 care
what do you do after step 2 of bsp perio guidelines?
re-evaluate after 3 months
unstable -> step 3
stable -> step 4
if step unstable and you go to step 3 for bsp perio guidelines what do you do?
managing non-repsonding sites:
I: reinforce OH, risk factor control, behaviour chnage
II: moderate (4-5mm) residual pockets - re-preform subgingival instrumentation
III: deep residual pocketing (6>=mm) consider alternative causes
IV: consider referral for pocket management or regenerative surgery
V: if referral not possible, re-perform subgingival instrumentation (if all sites stable after step 3 proceed to step 40
if stable and you to step 4. what step 4 for the bsp perio guidelines?
maintenance
I: supportive periodontal care strongly recommended
II: Reinforce OH, risk factor control, behaviour change
III: regular targeted PMPR as required to loimit tooth loss
IV: consider evidence based adjunctive efficacious tooth paste and or mouthwash to control gingival inflammation
after step 4 of bsp perio guidelines?
maintenance recall individually tailored intervals from 3 -12 months
how do you define if a pt is engaging?
engaging - plaque levels <= 20 percent and bleeding levels <30 percent or 50 percent improvement
what to do for decision making at re-evaluation? If he has Poor OH, persistent inflammation
identify reason for poor OH, then supportive care or repeat cause-related therapy
what to do for decision making for this perio lecture? Good OH, inflammation resolved?
supportive care & proceed with treatment plan
what to do for decision making for this perio lecture? Good OH, persistent deep pockets with BOP?
consider surgical access or repeat RSD, then re-evaluate
what is the ideal endpoint?
No pockets > 4mm
No pockets = 4mm with BOP
BOP < 10%
Functional and comfortable dentition
Plaque scores < 20% (or target for patient)
But not all patients will reach these….but they can still maintain a functional dentition…
why supportive peridontal care?
Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis (e.g., increased pocket depth, bone loss, or tooth loss).
The more often patients present for recommended supportive periodontal treatment (SPT), the less likely they are to lose teeth.
Treated patients who do not return for regular recall are at 5.6 times greater risk for tooth loss than compliant patients.
Patients who are not maintained in a supervised recall program subsequent to active treatment show obvious signs of recurrent periodontitis (e.g., increased pocket depth, bone loss, or tooth loss).
The more often patients present for recommended supportive periodontal treatment (SPT), the less likely they are to lose teeth.
Treated patients who do not return for regular recall are at 5.6 times greater risk for tooth loss than compliant patients.
how is supportive periodontal car done?
3 separate parts.
Part I – exam
- MH changes
- oral pathologic examination oral hygiene status (plaque chart)-
- gingival changed
- pocket depth changes
- mobility changes
- occlusal changes
- dental caries
- restorative, prosthetic and implant status
Part II – treatment
- oral hygiene reinforcement
- supra gingival scaling
- root surface debridement
- polishing
Part III: report, cleanup and scheduling
- write report in chart
- discuss report with pt
- schedule next recall visit
- schedule further periodontal tx
- schedule or refer for restorative or prosthetic tx
what is part 1 exam of the supportive periodontal care?
- Similar to the initial evaluation of the patient
- Updating medical history
- Oral mucosa inspected for pathologic conditions
- Evaluation of restorations, caries, prostheses, occlusion, tooth mobility, bleeding on probing, and periodontal and periimplant probing depths
- Analysis of the current oral hygiene status of the patient is essential.
- The dentist primarily looks for changes that have occurred since the last evaluation
what is part II treatment of supportive periodontal care?
- Required scaling and root surface debridement (supra and subgingival PMPR) are performed, (based on pocket chart/plaque chart).
- Care must be taken not to instrument normal sites with shallow sulci (1 to 3 mm deep – that do NOT have any calculus) because studies have shown that repeated subgingival scaling in initially normal periodontal sites result in significant loss of attachment.
causes for recurrence of perio disease?
- Often can be traced to inadequate plaque control on the part of the patient or failure to comply with recommended SPT schedules.
- Inadequate or insufficient treatment that has failed to remove all the potential factors favoring plaque accumulation.
- Incomplete calculus removal in areas of difficult access.
- Inadequate restorations placed after the periodontal treatment was completed.
- Failure of the patient to return for periodic checkups. This may be a result of the patient’s conscious or unconscious decision not to continue treatment or the failure of the dentist and staff to emphasize the need for periodic examinations.
- Presence of some systemic diseases that may affect host resistance to previously acceptable levels of plaque.
characteristics of necrotising periodontal diseases?
The most severe inflammatory periodontal disorder caused by plaque bacteria
Rapidly destructive and debilitating
Due to shared predisposing factors in a population (e.g. students during a period of examinations, armed forces recruits) NPD are known to occur in epidemic-type patterns. This has led to the popular belief that NPD are contagious, but this is not the case.
The main features of the NPD are painful, bleeding gums and ulceration and necrosis of the interdental papilla - punched-out appearance
Opportunistic infection – caused by the bacteria inhabiting healthy oral cavity
what are the classification of necrotising periodontal diseases?
necrotizing gingivitis
necrotizing periodontitis
necrotizing stomatitis
what is necrotising ginigivits?
when only the gingival tissues are affected.
what is necrotising periodontitis?
when the necrosis progresses into the periodontal ligament and the alveolar bone, leading to attachment loss.
what is necrotising stomatitis?
when the necrosis progresses to deeper tissues beyond the mucogingival line, including the lip or cheek mucosa, the ton- gue, etc.
what does foetor ex ore mean?
halitosis - bad breath
what does halitosis mean?
bad breath
what are the first lesions that are seen in necrotising gingivitis?
interproximally in mandiular anterior region
what are necrotising periodonitis ulcers associated with?
deep pockets formation as gingival necrosis coincides with loss of crestal alveolar bone
