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Periodontology Flashcards

1
Q

What is the diagnosis for patient who has generalised bone loss on full mouth periapicals?

A

Generalised Periodontitis (include stage and grade)

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2
Q

What clinical and lab investigations can be done for Periodontal disease?

A

Thorough History (SH/FH)

6PPC

Mobility

Furcation involvement

BPE

MPBS

Microbiological analysis of crevicular fluid swab

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3
Q

What are the factors to consider when deciding on prognosis of individual teeth in periodontal disease?

A

Loss of attachment

Mobility

Furcation involvement

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4
Q

What are the reasons for PMPR being unsuccessful?

A

Patient does not comply with OH regime

Inadequate PMPR by dentist

Difficulty in accessing deep pockets and furcations

Patient is immunocompromised/has systemic disease

Poor restoration causing plaque trap

Dentist fails to motivate patient

Patient continues smoking

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5
Q

What are the reasons for antibiotics not being effective in treating perio?

A

Biofilm must be disrupted to allow for efficacy

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6
Q

How would you manage a periodontal abscess with systemic involvement?

A

Subgingival PMPR- short of base of pocket

If pus- incision and dilation of pocket

Recommend analgesia

0.2% CHX until symptoms subside

Prescribe Pen V 250mg for 5 days

When free of pain- recall for PMPR

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7
Q

What would be the signs of improved health following a periodontal treatment? (engaging patient)

A

Probing depths- <4mm

BOP- less than or equal to 30% (aiming for <10%)

Plaque scores- less than equal to 20% (aiming for 15% overall)

** or 50% reduction

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8
Q

What investigations would you do for patient with space between 13 and 14?

A

BPE- screening tool for periodontal health

MBPS- assess OH

6PPC- to assess periodontal disease

PA radiogaphs- to assess bone levels, prognosis

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9
Q

What are the issues with placing implants in patients with periodontal disease?

A

Risk of future peri-implantitis

Inadequate space

Inadequate bone levels

Soft tissue defects

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10
Q

What bacteria are involved in ANUG?

A

P.Intermedia

Fusobacterium

Treponema

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11
Q

What are the signs and symptoms of ANUG?

A

Pain

Bad breath

Sloughthing of gingival tissue

Loss of papillae- punched out appearance

Bleeding

Lymphadenopathy

Pseudomembrane formation

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12
Q

What are the risk factors for ANUG?

A

Stress

HIV

Sleep deprivation

Young age

Poor OH

Smoking

Leukaemia

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13
Q

How do you manage ANUG?

A

Ultrasonic PMPR
CHX 0.2% x 2 daily
Ibruprofen if fever
Diet advice and supplements
AB- 400mg metronizadole TID for 3 days (no alcohol)

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14
Q

What information would you provide to a patient when consenting them for Periodontal surgery?

A

Risks:
Gingival recession
Infection
Surgical complications- pain, bleeding, bruising, swelling, need for suturing

Benefits:
More effective removal of calculus and biofilm as you have direct vision

Other options:
Repeat PMPR

RISKS OF NO TX:
Increased pocket depth, mobility, likelihood of tooth loss

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15
Q

After treatment, patient complains of central crushing pain across chest and down left arm. What is the likely diagnosis and immediate management? (pt is conscious)

A

MI
-> Give oxygen- 15L per min
-> Chew 1 aspirin tablet 300mg or crush and place under tongue in edentulous patients
-> Send to jubilee if STEMI/ Royal infirmary if NSTEMI

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16
Q

What information is given to patients after periodontal surgery?

A
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17
Q

How long after suture removal in perio surgery do you schedule a review?

A
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18
Q

What are the causes of AB not being effective for periodontal disease?

A

Lack of mechanical disruption of biofilm

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19
Q

What is a periodontal abscess?

A

Acute exacerbation of an existing periodontal pocket
-> associated with food packing and tightening post-HPT

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20
Q

What are the signs and symptoms of perio abscess?

A

Swelling
Pain
TTP in lateral direction
Bleeding
Suppuration
Lymphadenopathy
Fever

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21
Q

How can periodontal abscess be differentiated from Periapical?

A

Periodontal abscesses tend to be more acute

Lack of PA pathology radiographically

Tooth tends to be vital in Perio abscess

Perio tends to have narrow bone loss on one side

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22
Q

How do you manage occlusal trauma in a patient with periodontal disease?

A

Splint teeth

Fix occlusal relation - remove high restorations

Control plaque induced inflammation with PMPR

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23
Q

What factors can influence mobility in teeth?

A

Short roots

Widened PDL

Shorter PDL

Inflamamtion

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24
Q

When is splinting advised for patients with occlusal trauma?

A

If mobility is advanced

If it is causing issues eating

If teeth need to be stabilised for PMPR

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25
Why is there a decrease in mobility after periodontal treatment?
As treatment can facilitate gain in attachment -> long junctional epithelium formation -> Improved tissue tone- inflammatory infiltrate is replaced with collagen
26
What may you do if the PDL is still widened after successful treatment?
Look at the occlusion for any potentially traumatic areas and adjust
27
How is localised and generalised periodontitis differentiated?
Localised- <30% of teeth affected Generalised- >30% * Molar-incisor pattern also seen
28
What bacteria is implicated in Periodontitis?
A.a P.gingivalis T.Forsythia T. Denticola
29
How is aggressive periodontitis managed?
30
What are the features of teeth with poor periodontal prognosis?
Mobility- loss of bone support Furcation involvemet- difficult to clean Lack of vitality LOA- less soft tissue support
31
If only a pocket chart is given, what information would be required before determining final prognosis and diagnosis?
Smoking status Drug history Systemic disease Radiographs
32
What are the causes of a patient discomfort in case of mobile 21 and severe recession?
Sensitivity due to exposed root dentine Traumatic occlusion
33
What investigations can be done for patient who present with periodontal disease?
6PPC MPBS Periapical radiographs Smoking status
34
What are the diseases in 2017 periodontal classification?
1. Health- intact or reduced periodontium 2. Plaque induced gingivitis 3. Non-plaque induced gingival conditions- L/G 4. Periodontitis- L/G/MI 5. Necrotising Periodontal diseases 6. Periodontitis as manifestation of systemic disease 7. Systemic diseases affecting perio tissues 8. Perio abscesses 9. Perio-endo lesions 10. Mucogingival deformities and abnormalities
35
What are clinical signs of healing in periodontal disease?
Gingival recession- presence of black triangles Reduced BOP Clinical attachment gain- reduced probing depth
36
What is the difference between vertical and horizontal bone loss?
Vertical (angular occurs in thicker parts of bone)- zones of destruction destroy some of the septum between teeth but part remains Thinner areas of bone are subjected to horizontal where the septum is lost totally
37
How does a healthy peridontium react to traumatic occlusion?
PDL width increases until force from occlusion can be dissipated and then stabilises -> Will return to normal after demand is reduced No LOA or inflammation **IF healthy but reduced- more mobility IF perio- LOA may be faster
38
What is CHX?
Biguanide antiseptic
39
What is the mode of action of CHX?
Dicationic -> 1 cation adheres to pellicle and 1 disrupts bacterial membrane Effective against Gram+/- bacteria, fungi and viruses
40
What is the substantivity of CHX?
12 hours
41
What are the side effects of CHX?
Staining Anaphylaxis Taste disturbance Salivary gland enlargement
42
What are the uses of CHX in dentistry?
ANUG/P Denture stomatitis OH in patients who are struggling to brush To treat oral ulceration Denture stomatitis As Endodontics irrigant To test dam in Endo To irrigate under operculum in periocoronitis If high caries risk
43
What does TIPPS stand for? (periodontal OHI)
Talk Instruct Practice Plan Support
44
What is recorded on periodontal pocket chart?
Gingival margin level Pocket depth LOA Bleeding Mobility Furcation Involvement Teeth missing
45
What are the disadvantages of pocket charts?
Probing depth may vary between operators (subjective?) If done prematurely it can disrupt healing socket Cannot be done in children- immature, false pocketing common Asumes all patients have same root length
46
What are the causes of gingival recession?
Periodontal disese PMPR Traumatic toothbrushing Traumatic OB Ortho Poor margins on indirect restorations
47
How can recession classified?
Recession Index: Type 1- no loss of interproximal attachment -> CEJ is not visible medially and distally Type 2- associated with loss of attachment -> attachment loss inter proximally is less than buccal attachment loss Type3- inter proximal attachment loss is greater than buccal attachment loss
48
How can recession be managed?
Treat sensitivity Atraumatic brushing technique Monitor Grafting Gingival veneer
49
How can recession be measure?
Photos Studymodels 6PPC
50
What are the differential diagnoses for root treated tooth with 9mm pocket and vertical bony defect?
Perio-endo lesion Endo-perio lesion True combined lesion
51
What special investigations would you carry out for endo-perio/perio-end lesions?
PGI 6PPC Sensibility testing PA radiograph
52
What is the initial treatment for a previously treated tooth with perio-endo lesion?
ReRCT
53
If patient wants implants what factors are we looking to consider?
Bone quantity and quality OH Smoking Patient motivation Cost MH- bisphosponates
54
What interventions can be carried out in patient who have inadequate bone levels?
Bone graft Sinus lift Guided tissue regeneration Emdogain
55
How is vertical bone loss classified?
56
What are the indications for regenerative periodontal surgery?
57
What are the options if regenerative perio surgery fails?
58
What are the causes for lack of success in non-surgical perio therapy?
Lack of motivation on patient Patient does not comply with dentist advice Inadequate PMPR by dentist Difficult access to certain pockets Patient unable to stop smoking Systemic disease Inadequate restoration placed- plaque trap
59
What makes diabetes a risk factor for periodontal disease?
Hyperglycaemia can modulate RANKL (Over OPG -> encouraging bone destruction Production of Advanced Glycation End products in hyperglycaemia -> increased production of pro-inflammatory cytokines and MMPS Poorer wound healing Impaired immune system
60
What tests are available for diabetes?
Fasting plasma glucose: <6.1mmol/l- normal 6.1-7.0- impaired >7.0- diabetes Glucose tolerance Test: <7.8- normal 7.8-11.1- impaired >11.1- diabetes
61
What test is used to indicate diabetic control?
Glycated Haemoglobin- Hb1Ac -> <6.5% is the aim (48mmol/mol)
62
What are the effects of smoking on periodontal tissues?
Reduced blood flow- impaired healing Increased activation of immune system Anaerobes favoured
63
What is the role of interleukin 1?
Pro-inflammatory cytokine- stimulates enzymes and osteoclasts to cause tissue destruction
64
What medications are associated with gingival hyperplasia?
Phenytoin Ca channel blockers- nifidipine Cyclosporin
65
How is drug induced gingival hyperplasia managed?
Control plaque- OHI, PMPR If no improvement and good OH- liaise with GP to discuss changing medications Consider gingival reduction surgery
66
What do the different values for BPE mean?
0- PPD <3.5mm, no BOP, no PRF 1- PPD <3.5mm, BOP, no PRF (plaque can be present) 2- PPD <3.5, BOP, plaque retentive factors (calculus and overhangs) 3- PPD between 3.5-5.5mm 4- >5.5mm *- furcation involvement
67
What is the treatment for different BPE values?
0 = none 1 = OHI and plaque and gingivitis charts 2 = OHI, plaque and gingivitis charts and removal of PRF via PMPR or remove overhangs 3 = OHI, plaque and gingivitis charts, PMPR, 6ppc of the sextants with 3 either just after or before and after treatment and radiographs 4 = OHI, plaque and gingivitis charts, PMPR, 6PPC of whole mouth either just after or before and after treatment (B&A = SDCEP) , radiographs and possible referral * = as for the score and possible specialist referral
68
How is mobility graded?
0 = physiological movement 1 = up to 1mm movement 2 = 1-2mm movement 3 = severe movement that impacts function, rotational and vertical (>2mm)
69
How are furcations graded?
1 = < 1/3rd (<3mm) 2 = > 1/3rd but not all the way through (>3mm) 3 = through and through

BDS Exam style questions (15 decks)

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