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BDS2 CDS ALL > Periodontology > Flashcards

Periodontology Flashcards

1
Q

Aetiology and Pathogenesis

Healthy gingiva appearance characterised by:

A
  • knife edge, scalloped gingival margin
  • pink colour
  • stippling in about 30% (collagen fibres)
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2
Q

Aetiology and Pathogenesis

Clinical ginigval health characterised by:

A
  • absence of bleeding on probing (<10% bleeding sites with probing depth </= 3mm)
  • erythema and edema
  • patient symptoms
  • attachment and bone loss (physiological bone levels range 1.0mm - 3.0mm apical to cemento-enamel junction)
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3
Q

Aetiology and Pathogenesis

Give examples of local plaque retentive factors that may lead to gingivitis

A
  • calculus
  • restoration margins
  • crowding
  • mouth breathing
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4
Q

Aetiology and Pathogenesis

Give examples of systemic modifying factors that may lead to gingivitis

A
  • sex hormones
  • medication
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5
Q

Aetiology and Pathogenesis

What is the difference between a True Pocket and a False Pocket?

A

False Pocket: Gingiva still attached to cervical portion of tooth
True pocket: Loss of attachment (normal bone levels measured from ACJ)

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6
Q

Aetiology and Pathogenesis

What is classified as Rapid progression of periodontitis?

A

more than or equal to 2mm of attachment loss over 5yrs

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7
Q

Aetiology and Pathogenesis

What is dysbiosis?

A

Causes an imbalance (change in behaviour) in the community associated with a disease which may alter immune response

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8
Q

Aetiology and Pathogenesis

Give an example of dysbiosis in periodontal health

A

Commensal bacteria (good bacteria) at the gingival margin may begin to cause problems via keystone pathogens whihc will cahnge the behaviour of the commensal bacteria

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9
Q

Aetiology and Pathogenesis

Briefly describe connective tissue matrix degradation within periodontitis

A
  1. matrix metalloproteinases are a family of Zn and Ca dependent proteolytic enzymes, which include collagenases
  2. matrix degradation largely a result of MMP’s secreted by host inflammatory cells
  3. immune cell activation of osetoclasts via RANK/RANKL/other cytokines
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10
Q

Aetiology and Pathogenesis

What is involved in the host immune response (responisble for 80% of damage) to the development of periodontitis?

A

Saliva
Epithelium
- physical barrier
- shedding of cells
- production of inflammatory mediators
GCF
Inflammatory and immune response

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11
Q

Aetiology and Pathogenesis

What is LAD?

A

Leukocyte Adhesion Deficiency
- neutrophils can’t work and spread to site of infection

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12
Q

Aetiology and Pathogenesis

What are the 4 categories of risk factors for periodontitis?

A
  1. Local
  2. Behavioural
  3. Genetic
  4. Environmental
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13
Q

Aetiology and Pathogenesis

Give examples of local risk factors

A

Anatomical
- enamel projections
- grooves
- furcations
- gingival recession

Tooth Position
- malalignment
- crowding
- tippling
- migration
- occlusal factors

Latrogenic
- restorative overhangs
- defective crown margins
- poorly designed PDs
- orthodontic appliances

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14
Q

Aetiology and Pathogenesis

Give an example of a behavioural risk factors

A

Smoking
- vasconstiction of ginigval vessels and increases gingival keratinisation
- impaired antibody production
- decreased number of Th lymphocytes
- impairesed PMN (polymorphonucleur neutrophils) function
- increased production of pro-inflammatory cytokines

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15
Q

Aetiology and Pathogenesis

Which risk factor is approximately the cause of 50% PD cases?

A

Genetic
- some gene variants predisposed to periodontitis

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16
Q

Aetiology and Pathogenesis

Give examples of environemental risk factors

A
  • local risk factors
  • local microbiome
  • stress
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17
Q

Aetiology and Pathogenesis

What is the epidemiology of PD?

A
  • Across all age groups: ~50% of pop. have PD, ~10% of pop. have severe P.D
  • Periodontitis prevalence increases with age
  • more common in people who smoke (but common in those who don’t/never have)
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18
Q

Classification

What are the aims of the current 2017 periodontal disease classification system?

A
  • capture extent: amount of periodontal tissue loss
  • patient susceptibility: estimated by historical rate of progression
  • current periodontal state: pocket depth/bleeding on probing
  • a system that can be future proofed for update with new biomarker info
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19
Q

Classification

What is the classification of plauqe induced gingivitis?

A
  • associated with dental biofilm only
  • intact periodontium (no radiological bone loss)
  • reduced periodontium (no interdental recession)
  • associated with dental biofilm
  • mediated by systemic or local risk factors
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20
Q

Classification

What are the modifying factors of plaque indced gingivitis?

A
  1. Systemic conditions
    sex steroid hormones
    - puberty
    - menstrual cycle
    - pregnancy
    - oral contraceptives
    hyperglycemia
    leukemia
    smoking
    malnutrition
  2. Oral factors enhancing plaque accumulation
    - prominent subgingival restoration margins
    - hyposalivation
  3. Drug-influenced gingival enlargements
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21
Q

Classification

What determines whether plaqe indduced gingivtis is localised or generalised?

A

Bleeding on probing
Localised: <30%
Generalised: >30%

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22
Q

Classification

BPE Score 0

A
  • Pockets >3.5mm
  • black band visible
  • no calculus overhangs
  • no bleeding on probing
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23
Q

Classification

BPE Score 1

A
  • Pockets <3.5mm
  • black band visible
  • No calculus/overhangs
  • bleeding on probing
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24
Q

Classification

BPE Score 2

A
  • Pockets <3.5mm
  • black band visible
  • supra/subgingival calclus/overhangs (plaque retentive factors)
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25
Q

Classification

BPE Score 3

A
  • Probing depth 3.5-5.5mm
  • black band paritally visible
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26
Q

Classification

BPE Score 4

A
  • Probing depth >5.5mm
  • black band disappears
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27
Q

Classification

BPE Score with *

A

Furcation involvement

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28
Q

Classification

BPE Score 0 Recommended Treatment

A

No need for periodontal treatment

29
Q

Classification

BPE Score 1 Recommended Treatment

A

OHI

30
Q

Classification

BPE Score 2 Recommended Treatment

A
  • OHI
  • PMPR (removal of plaque retentive factors)
31
Q
A
32
Q

Classification

BPE Score 3 Recommended Treatment

A
  • OHI
  • PMPR
  • RSD (root surface debridement) if required
  • Six point pocket chart (in that sextant only)
33
Q

Classification

BPE Score 4 Recommended Treatment

A
  • OHI
  • PMPR
  • RSD
  • 6PPC (entire dentition)
  • Assess need for more complex treatment
34
Q

Classification

What is Staging based on?

A

severity of disease

35
Q

Classification

What is grading based on?

A

disease susceptibility

36
Q

Classification

Stage 1

A

Severity
Early/Mild

IP bone loss (worst site)
<15% or 2mm

37
Q

Classification

Stage 2

A

Severity
Moderate

IP bone loss (at worst site)
coronal 1/3 of root

38
Q

Classification

Stage 3

A

Severity
Severe (potential for additional tooth loss)

IP bone loss (at worst site)
mid 1/3 of root

39
Q

Classification

Grade A

A

Slow progression

Bone loss <50% of patients age

40
Q

Classification

Stage 4

A

Severity
Very severe (potential for loss of dentition)

IP bone loss at worst site
apical 1/3 of root

41
Q

Classification

Grade B

A

Moderate progression

Bone loss 50 - 100% of patient’s age

42
Q

Classification

Grade C

A

Rapid Progression

Max. bone loss >100% of patient’s age

43
Q

Classification

Extent of periodontal disease
Localised

A

<30% of teeth

44
Q

Classification

Extent of Periodontal Disease
Generalised

A

> 30% of teeth

45
Q

Classification

Which population if the molar inscisor pattern most prevalent in?

Extent

A

Younger people

46
Q

Classification

What should the final diagnosis of Periodontal Disease include

A
  1. What disease does the patient have?
  2. How extensive? (localised or generalised)
  3. How severe? (Staging)
  4. Is it controlled? (Assess current PD state - stable or unstable)
  5. What is the patients risk profile? (Risk factors)
  6. What is the rate and risk of disease progression (grading)
47
Q

Instrumentation

Which probe is used for a BPE?

A

WHO Probe

48
Q

Instrumentation

WHO Probe features

A
  • Ball end 0.5mm diameter
  • 1st black band 3.5 - 5.5mm
  • 2nd black band 8.5 - 11.5mm
49
Q

Instrumentation

UNC 15 Probe

A

Grade at every mm

50
Q

Instrumentation

Which instrument can be only used to remove supragingival plaque?

A

Mini sickle or point scaler

51
Q

Instrumentation

What are the characteristics/uses of a Mini Sickle or Point Scaler?

A
  • curved blade triangualr cross section
  • double ended and 2 cutting edges
  • for buccal/lingual embrasure supragingival or just into gingival margin
52
Q

Instrumentation

Why is a mini sickle/point scaler not used for subgingival plaque removal?

A
  1. sharp point can groove/damage root surface
  2. pocket wall could be damaged
53
Q

Instrumentation

Which instruments can be used for Supra gingival PMPR ONLY?

A

Mini Sickle or Point Scaler

54
Q

Instrumentation

Which instruments can be used for both sub/supragingival PMPR?

A

Hoe Scalers x2 (single cutting edge - double ended)
- Red: mesial and distal surfaces
- Yellow: buccal and lingual surfaces

Gracery Curettes x4 (double ended)
- Grey 1-2: anterior sextant
- Green 7-8: buccal/lingual posterior sextant
- Orange 11-12: mesial posteriors sextants
- Blue 13-14: distal posterior sextants

55
Q

Instrumentation

What does a finger rest provide?

A
  • support/stability
  • control
  • safety to prevent injury
  • patient comfort
56
Q

Instrumentation

What is the ideal finger rest?

A
  1. Use tooth as close to tooth treating
  2. prevents injury if patient moved suddenly or instrument slips
  3. Stable tooth rather than soft tissues which can move/slide around
  4. May need to use a rest further away in difficult access
57
Q

Instrumentation

Why may a hand instrument for PMPR be used instead of USS?

A
  1. Systemic health conditions
    - tuberculosis, coronovirus: diesease where aerosal may increase risk of infection
    - Parkinsons, MS, severe gag reflex: difficulty swallowing lots of water from from USS
    - Cardiac pacemaker (check make and model before using USS)
    - Access to certain areas of tooth can be difficult
  2. Oral Conditions
    - Demineralised areas: remineralisation may be affected by powerful USS
    - Sensitivity: exposed dentinal tubules, recession, children with large pulp horns
    - Children may be less tolerable due to dental anxiety
    - Restorations: porcelain/composite can be marked by USS
    - Titanium implants: use implant inserts on USS tips (may not be available)
58
Q

Instrumentation

Sharpening of hand instruments

A

Improve calculus/biofilm removal
Less force and time required
Check sharpness with acrylic test stick

Methods
- Arkansas hand stone: natural stone from aluminium oxide with oil for steel instruments
- hoe require diamond abraive wihtout oil as they have tungsten carbide
- Sharpening machines quicker
- May have sharpening service

59
Q

Instrumentation

What are the tip diameter options for an USS?

A
  1. Standard
  2. Slim
  3. Thin
60
Q

Instrumentation

Which USS tips are used for supragingival PMPR only?

A

1000 and #3 design

61
Q

Instrumentation

Which USS tips are used for BOTH supra/subgingival PMPR?

A

10 and #100

62
Q

Instrumentation

What may cause breakage of insert of USS?

A
  • incorrect power setting
  • insert does not match application
  • improper sterilisation maintenance
63
Q

Instrumentation

What may cause overheating of insert of USS?

A
  • improperly adjusted water
  • not filling handpiece with water prior to insert insertion
  • use of unserviceable insert
  • adequate water pressure
64
Q

Step 1 Treatment

Give a general summary of what should be carried out in step 1 of periodontits treatment according to BSP guidelines

A
  1. Educate patient of PD
  2. Control risk factors
  3. OHI
  4. PMPR (supra/subgingival)
  5. Removal of plaque retentive factors
65
Q

Step 2 Treatment

What is “full mouth debridement”?

A
  • All the sites with pockets >3mm are instrumented
  • Either 1 or 2 visits within 24hrs
66
Q

Step 2 Treatment

What is “Full mouth disinfection”?

A
  • all sites with pockets >3mm are instrumented
  • either at 1 or 2 visits within 24hrs
  • pockets are irrigated with 0.2% Chlorhexidine (CHX)
  • patient uses CHX spray and mouthwash for 1-2 weeks
67
Q

Step 2 Treatment

What is “Full mouth disinfection/ or Full mouth debridement with systemic antibiotics” ?

A
  • Full mouth disinfection
  • Patient takes antibiotics for 7 days
  • Only carried out for a small minority of patients, and in specialist care
68
Q

Step 2 Treatment

What is the objective of full mouth treatment?

A

to prevent treated pockets being recolonised by intra-oral translocation of bacteria

69
Q
A

BDS2 CDS ALL (3 decks)

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