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BDS3 CDS > periodontology > Flashcards

periodontology Flashcards

1
Q

step 1 of perio treatment

A

explain disease - risks and benefits of treatment/no treatment

OHI

risk factor control

PMPR

extract hopeless teeth - grade 3 mobility

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2
Q

step 2 perio treatment

A

assess engagement - if non-engaging return to step 1

reinforce risk factor, OHI and behaviour change

sub gingival PMPR for >4mm pockets

revaluate 3 months

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3
Q

step 3 of perio treatment

A

skip if stable

management of non-responding sites

repeat sub gingival instrumentation on pockets >4mm

may need surgery >6mm pockets

referral

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4
Q

step 4 perio treatment

A

supportive periodontal therapy

reinforce OHI risk factor control and behaviour change

regular targeted PMPR - individually tailored intervals 3-12 months

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5
Q

what is involved in revaluation at each step of perio treatment

A

OHI
BOP
attachment levels
tooth mobility
risk factor control and behaviour change

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6
Q

signs of successful perio treatment

A

no BOP or <10%
no pockets >4mm
plaque score <20%
no increased tooth mobility

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7
Q

aim of SPT supportive periodontal therapy

A

maintain periodontal health
detect and treat recurrence
maintain accepted level of disease
manage tooth loss

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8
Q

treatment given for SPT

A

OHI
supra gingival scaling - careful at 1-3mm pockets as can cause loss of attachment
RSD
polishing

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9
Q

reasons for recurrence of periodontitis

A

inadequate plaque control
failure to comply with SPT
inadequate treatment to remove all plaque retentive factors
failure to return to check ups
presence of systemic disease - host plaque resistance affected

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10
Q

how many teeth are affected in localised periodontal disease

A

<30%

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11
Q

how many teeth are affected in generalised periodontal disease

A

> 30% teeth

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12
Q

3 classifications of periodontal disease

A

localised
generalised
Molar incisor pattern

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13
Q

why classify disease

A

to properly diagnose and treat
for scientists to investigate aetiology, pathogenesis
capture severity and current state

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14
Q

what are the 10 2017 periodontal disease classifications

A

gingival health

plaque induced gingivitis

non-plaque induced gingivitis

periodontitis

necrotising periodontal disease

periodontitis as manifestation of systemic disease

systemic diseases affecting periodontal tissues

periodontal abscess

perio-endo lesions

mucogingival deformities and conditions

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15
Q

what is gingival health according to 2017 classification of perio disease - 4

A

absence of BOP or <10% for intact peridontium and reduced and stable peridontium
no erythema or oedema
physiological bone levels 1-3mm of ECJ
probing depth less than or equal to 3mm

Patients with an intact periodontium
Patients with a reduced periodontium due to causes other than periodontitis
Patients with reduced periodontium due to periodontitis

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16
Q

what is plaque induced gingivitis according to 2017 classification of perio disease - 4

A

associated with biofilm alone
BOP <30% localised or >30% generalised
no bone loss
BPE2

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17
Q

modifying factors of plaque induced gingivitis

A

smoking
pregnancy
drugs causing gingival enlargement
puberty

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18
Q

causes of non plaque induced gingivitis

A

hereditary gingival fibromatosis
herpetic gingival stomatitis
lichen Planus
nutrition deficiency - vit C

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19
Q

what does perio stage measure

A

severity

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20
Q

what does perio grade measure

A

susceptibility

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21
Q

how do you stage periodontitis

A

use bone loss at worst site
<15% early
coronal third of root - moderate
mid third - severe
apical third - very severe

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22
Q

how do you grade periodontitis

A

percentage bone loss at worst site/age

A - slow rate of progression <0.5
B - moderate 0.5-1
C - rapid >1

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23
Q

when is periodontitis stable - 3

A

BOP <10%
PPD </=4mm
no BOP at 4mm sites

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24
Q

when us periodontitis in remission

A

BOP<10%
PPD </= 4 mm
no BOP at 4mm sites

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25
Q

when is periodontitis unstable

A

PPD >/=5mm
OR
>/=4mm with BOP

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26
Q

what is included in diagnostic statement of periodontitis

A

extent
stage
grade
stability
risk factors

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27
Q

BSP BPE 3 sextant guidelines

A

review after initial treatment and 6PPC completed for this sextant only and only after treatment

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28
Q

what are the characteristics of NG

A

necrosis and ulcer of interdental papilla
punched out appearance
pseudo membrane formation along gingival margin
halitosis
gingival bleeding - readily
severe pain
fever and lymphadenopathy

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29
Q

3 necrotising periodontal diseases

A

necrotising gingivitis
necrotising periodontitis
necrotising stomatitis

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30
Q

how does NP differ to NG

A

same signs and symptoms as NG, additionally there is periodontal attachment loss and bone destruction

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31
Q

what is necrotising stomatitis

A

progression of NP - necrosis progressed to deeper tissues beyond mucogingival line - lip, cheek mucosa, tongue etc

can lead to denudation of bone - osteitis and OAF

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32
Q

what exacerbates NPD

A

immunocompromised patients
HIV
malnourishment
stress
smokers

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33
Q

who is susceptible to NS

A

compromised patients
HIV
stress
smokers
NP
NG

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34
Q

which diseases and condition can lead to early presentation of severe periodontitis

A

papillon lefevre syndrome

downs syndrome

leucocyte adhesion deficiency

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35
Q

systemic diseases or conditions that affect periodontal tissues

A

squamous cell carcinoma
uncontrolled diabetes mellitus

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36
Q

causes of periodontal abscess in non-perio patients

A

impaction
harmful habits
gingival overgrowth

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37
Q

causes of periodontal abscess in perio patient

A

acute exacerbation - untreated periodontitis, SPT
post scaling
medication e.g. nifedipine

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38
Q

3 examples of mucogingival deformities and conditions

A

lack of keratinised gingiva
abnormal renal attachment
recession

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39
Q

describe type 1 recession

A

no loss of inter proximal attachment
CEJ not detectable at distal and mesial

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40
Q

describe type 2 recession

A

loss of inter proximal attachment
inter proximal attachment loss less than or equal to buccal attachment loss
gums look normal but more apical

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41
Q

describe type 3 recession

A

low of inter proximal attachment
inter proximal attachment loss greater than buccal attachment loss
gums look straight across

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42
Q

where is attachment loss measured from and to

A

from CEJ to apical depth of pocket

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43
Q

two subdivisions of perio endo lesions

A

with or without root damage

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44
Q

In developed countries, NPD occurs mostly in young adults with predisposing factors. what are these predisposing factors

A

stress
sleep deprivation
poor OH
smoking
immunosuppression (HIV)
malnutrition

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45
Q

In cases that show unsatisfactory response to debridement or show systemic effects, what should you consider prescribing

A

400mg metronidazole TID

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46
Q

aesthetic consequence of NP

A

gingival creators

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47
Q

2 genetic conditions associated with periodontitis due to impairment of immune system

A

papillon lefevre syndrome
downs syndrome

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48
Q

3 diseases/conditions that lead to impairment of immune system and therefore periodontitis

A

leukaemia
neutropenia
HIV infection

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49
Q

give 3 local acquired risk factors of perio

A

overhangs
calculus
ortho appliance

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50
Q

give 3 local anatomical risk factors of periodontitis

A

malpositioned teeth
root grooves
enamel pearls

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51
Q

3 modifiable systemic risk factors of periodontitis

A

smoking
poor controlled diabetes
stress

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52
Q

3 non-modifiable systemic risk factors of periodontitis

A

age
genetic disorders
gender - males higher risk

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53
Q

why is smoking a risk factor of periodontitis

A

poor healing capacity - reduced blood flow
chemicals in smoke activate immune cells

54
Q

what effect does suboptimal diabetes control have on periodontitis development - 3

A

in hyperglycaemia production of advanced glycation end products (AGE) increases

leads to exacerbation of inflammation - production of pro inflammatory cytokines and destructive metalloproteinases

RANKL:OPG ratio is altered leading to alveolar bone destruction

55
Q

cause of scorbutic gingivitis

A

severe vit C deficiency - scurvy

56
Q

2 drugs that are a risk factor for periodontitis

A

phenytoin - anticonvulsant
cyclosporin - immunosuppressant

57
Q

what is neutropenia

A

reduced number and function of neutrophils
and macrophages
increasing risk of NUG and periodontitis

58
Q

what is leukaemia

A

reduced number and function of neutrophils and macrophages
increasing risk of NUG and periodontitis

59
Q

modifiable systemic risk factors of periodontitis

A

smoking
poor controlled diabetes
stress
osteoporosis
HIV

60
Q

why is stress a risk factor for periodontal disease

A

secretion of cortisol stimulates immune system and ANS
leading to secretion of catecholamine and substance P
regulates immune inflammatory response
affects bacterial adherence and growth

can cause suppression of the immune system which tips
host-bacterial interaction in favour of bacteria

61
Q

what health issues is periodontitis a risk factor of

A

CV disease - atherosclerosis and hypertension
preeclampsia

62
Q

how does diabetes contribute to increased inflammation in periodontitis

A

increased production of AGEs (advanced glycation end products) which leads to activation of local immune and inflammatory responses

results in periodontal tissue damage and resorption of bone

63
Q

how does periodontitis impact diabetes

A

circulating bacteria causes inflammatory state and elevates HbA1c and causes impaired insulin signalling and resistance

64
Q

what step of perio is controlling risk factors part of

A

step 1

65
Q

function of periodontum

A

to attach teeth to jaws
to dissipate occlusal forces

66
Q

define excessive occlusal force

A

occlusal force that exceeds reparative capacity of periodontal attachment apparatus -> occlusal trauma and tooth wear

67
Q

tooth mobility can be accepted unless - 3

A

progressively increasing
gives rise to symptoms
creates difficulty with restorative treatment

68
Q

how can you correct occlusal relations

A

adjust occlusal surfaces - grinfing
restorations
orthodontics

69
Q

how can you reduce tooth mobility

A

splint
correct occlusal relations
control plaque induced inflammation

70
Q

what is primary occlusal trauma

A

Injury resulting in tissue changes from excessive occlusal forces appliedto a tooth or teeth with normal periodontal support.

normal attachment levels, normal bone levels, and excessive occlusal force(s).

71
Q

how does healthy periodontium respond to occlusal trauma

A

PDL width increases
tooth mobility increases as result
this is regarded physiological and successful adaptation

72
Q

how does healthy periodontium respond to excessive occlusal trauma

A

PDL width continues to increase
PDL width and tooth mobility do not stabilise
failure to adaptation - pathological

73
Q

what is secondary occlusal trauma

A

injury resulting in tissue changes from normalor excessive occlusalforces applied to a tooth or teeth with reducedperiodontal support.

occurs in presence of attachment loss, bone loss and normal or excessive forces

74
Q

what is fremitus

A

palpable or visible movement of a tooth when subjected to occlusal forces

75
Q

what is bruxism

A

habit of grinding clenching or clamping teeth
force may damage tooth and attachment apparatus

76
Q

what is the effect on attachment loss where there is plaque induced inflammation in addition to trauma induced inflammation

A

greater attachment loss

77
Q

what causes tooth migration

A

loss of periodontal attachment
unfavourable occlusal forces and soft tissue profile

78
Q

when is splinting appropriate

A

last resort treatment

appropriate if mobility is caused by advanced loss of attachment
causing discomfort and difficulty eating
needs stabilised for debridement

79
Q

what is a gingival abscess

A

abscess localised to gingival margin

80
Q

signs and symptoms of periodontal abscess

A

swelling
pain and bleeding
TTP laterally
suppuration fever
enlarged lymph nodes

81
Q

what is a periodontal abscess

A

abscess within periodontal pocket
acute chronic or free draining (asymptomatic)
rapid destruction of periodontal tissues
associated rated with food packing and tightening of gingival margin after HPT

82
Q

what is a pericoronal abscess

A

associated with partially erupted tooth

83
Q

treatment of periodontal abscess

A

sub gingival instrumentation of pocket
Drain pus through pocket or incision
0.2% chlorhexadine

84
Q

when would you prescribe antibiotics to a pt with periodontal abscess and what would you prescribe

A

signs of spread of infection
systemic effects
symptoms don’t resolve

250mg penicillin or
400mg metronidazole or
500mg amoxicillin
for 5 days

85
Q

4 components of periodontium

A

gum or gingiva
periodontal ligament
cementum
alveolar bone

86
Q

which of these is not an acute cause of periapical periodontitis

trauma
periodontitis
perforation

A

periodontitis

87
Q

signs and symptoms of perioapical infection

A

deep pockets
bone resorption apical or furcation
spontaneous pain
TTP

88
Q

what result would you expect from pulp vitality test on tooth with apical infection

A

negative or altered

89
Q

how does infection spread to the apex of tooth

A

through PDL
through apex of root canal with necrotic pulp
through furcal
through lateral and accessory canals

90
Q

role of apical foramen in periodical infection

A

main route of communication between pulp and periodontist

microbial and inflammatory bi products can exit apical foramen, or enter to affect pulp where there are deep pockets

91
Q

what is perforation of root canal and give 3 causes

A

communication between root canal and either peri-radicular tissues, PDL or oral cavity

extensive caries
resorption
operator error

92
Q

classification of perioendo lesion

A

by a carious lesion that affects the pulp and, secondarily, affects the periodontium.

by periodontal destruction that secondarily affects the root canal

93
Q

grade 1, grade 2 and grade 3 endo-periodontal lesions

A

grade 1 - narrow deep periodontal pocket in 1 tooth surface
grade 2 - wide deep periodontal pocket in 1 tooth surface
grade 3 - deep perio pocket in more than one tooth surface

94
Q

how can pathogenic invasion and secondary inflammation and necrosis of the pulp result from scaling?

A

accessory canals severed and opened to oral environment

95
Q

treatment of perio-endo lesion

A

primary endo therapy
analgesia and 0.2% chlorhexadine mouth wash
periodontal therapy - supra and sub gingival instrumentation
review within 10 days

96
Q

how can developmental grooves/invaginitation lead to deep pockets

A

if epithelial attachment is breached, groove becomes contaminated and pocket forms along its entire length

97
Q

what is an S3 guideline

A

evidence and consensus based guideline

98
Q

step one of perio treatment and when to progress to step 2

A

control risk factors

OHI and education of disease

PMPR

proceed when engaging and if PPD >3mm
if non engaging repeat step 1

99
Q

step 2 of perio treatment and when to progress step 3 or 4

A

step 1 plus

sub gingival instrumentation of pockets >4mm

step 3 if residual pockets >4mm

step 4 if no residual pockets

100
Q

step 3 of perio treatment and when to proceed to step 4

A

reinforce OHI, RFC and behaviour change

repeated sub-gingival instrumentation on >4mm pockets

consider referring for periodontal surgery in residual pockets

proceed when PPD less than or equal to 4 with no BOP

101
Q

step 4 perio treatment

A

SPT

reinforce OHU, RFC and behaviour change

3-12 months - individually tailored

continuous monitoring

regular targeted PMPR

102
Q

factors that influence the decision of periodontal surgery

A

smoking
compliance
OH
systemic disease
suitability of site - access, prognosis

103
Q

define an engaging patient according to bop

A

favourable improvement of OH
50% or more improvement in plaque and marginal bleeding scores
OR
plaque levels </=20% and bleeding </=30%
OR
pt met targets in personal care plan with dentist

104
Q

define non-engaging pt according to BSP

A

insufficient improvement in OH
less than 50% improvement in plaque
OR
plaque >20% bleeding >30%
IR pt states preference to palliative approach

105
Q

indicators of successful perio treatment

A

good OH
no BOP or <10%
plaque scores < 20%
no pockets > 4mm
no increasing mobility
functional and comfortable dentition

106
Q

what does a re-evaluation perio exam includee

A

OH
BOP
pocket depth
attachment levels
tooth mobility

107
Q

treatment of residual pocked depths >/=6mm

A

surgical approach

108
Q

treatment of residual pocket depths 4-5mm

A

repeated sub gingival instrumentation

109
Q

aim of SPT

A

maintain perio health
detect and treat recurrence
maintain accepted level of disease
manage tooth loss

110
Q

why give SPT

A

patients who are not recalled subsequent to active treatment show signs of recurrent periodontitis

more often patients get SPT - less likely to lose teeth

111
Q

how often is patient recalled for SPT

A

individually assessed 3-12 months

112
Q

steps of SPT

A

examination - look for changes since last recall

treatment - PMPR, care to avoid 1-3mm normal sites as can cause loss of attachment

113
Q

why do patients experience bleeeding from gingivae when they quit smoking

A

smoking causes vasoconstriction so quitting increases vascularisation in gingivae as it returns to normal

114
Q

how to calculate pack years

A

multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked

(packets are 20)

115
Q

minimum teeth required for a sextant to qualify in BPE

A

2

116
Q

probing force for BPE

A

20-25g

117
Q

BPE 0

A

healthy tissues
no bleeding or calculus

118
Q

BPE 1 meaning and management

A

bleeding
<3.5mm probing

plaque and bleeding scores
OHI

119
Q

BPE 2 meaning and management

A

calculus or plaque retentive factor
<3.5mm probing

plaque and bleeding scores
OHI
remove plaque retentive factors

120
Q

BPE 3

A

3.5-5.5mm probing

121
Q

BPE 4

A

> 5.5mm probing

122
Q

6 index teeth for simplified BPE - children and adolescents

A

UR6 UL6 LR6 LL6
UR1
LL1

123
Q

best probe for BPE

A

BPE probe (WHO probe)
OR
WHO 621

124
Q

best probe for sBPE and why

A

WHO 621 - second black band useful if false pocketing

125
Q

BPE codes used for 7-11 year old

A

0-2

126
Q

BPE codes for 12+

A

all codes

127
Q

why not use BPE on implants

A

no PDL - les resistance to probe in healthy sites

128
Q

management of BPE 3

A

OHI, risk factor control, RSD

6ppc after initial treatment, in code 3 sextant only

plaque and bleeding scores

radiographs to monitor alveolar bone levels

129
Q

management of BPE 4

A

6ppc for full dentition before and after treatment

OHI, RSD, plaque and bleeding scores

radiographs to monitor alveolar bone levels

130
Q

gold standard radiograph for periapical assessment

A

periapical using long-cone paralleling technique

131
Q

what is TIPPS and what does it stand for

A

aim is to make patients feel more confident in their ability to perform OH and to help them plan
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