periodontology Flashcards
A 29-year-old female, non-smoker, who is fit and well, presents to your practice complaining of extremely painful gums in the anterior mandible, and bad breath. On examination you note no extraoral abnormality. Intraorally, you notice marked redness of the gingivae around the lower anterior teeth and a ‘punched-out’ appearance of the interdental papilla, with yellow ulcers on several papillae. You suspect a necrotising periodontal disease.
a) What further investigations would you carry out (1 mark)
microbial analysis
identify specific bacteria (spirochetes and fusobacterias)
b) List 3 predisposing factors could contribute to this disease? (3 marks)
stress
sleep deprivation
poor OH
smoking and vaping
immunosuppression (HIV and leukemia)
malnutrition
c) The patient is anxious and reluctant to have any dental treatment. What risks of no treatment do you explain to the patient? (1 mark)
it can progress to destruct PDL
more pain = difficult to eat, speak and do daily activities
infection can spread and cause systemic health complications
halitosis
d) The patient agrees to treatment. What treatment do you provide today?
(3 marks)
superficial debridement daily using ultrasonic - possibly use LA
chlorehexidine daily (0.12-0.2%) twice daily
3% hydrogen peroxide diluted 1:1 in warm water
e) Ms. White returns for another emergency appointment 2 days later. She feels the gums are still very painful and is now complaining of fever and feeling generally tired and unwell. Of the additional treatment options listed below, select two you would provide by placing a cross or a tick the box beside the options. (2 marks)
Prescribe amoxicillin 500 mg three times per day for 5 days
Prescribe amoxicillin 250 mg three times per day for 5 days
Prescribe Metronidazole 200 mg three times per day for 5 days
Prescribe Metronidazole 400 mg three times per day for 5 days
Prescribe Metronidazole 200 mg three times per day for 3 days
Prescribe Metronidazole 400 mg three times per day for 3 days
Prescribe phenoxymethylpenicillin 250mg, 2 tablets, four times per day for 5 days.
Arrange to review the patient in 6 months
Arrange to review the patient in 8-12 weeks
Arrange to review the patient in 1-2 weeks
Offer the patient reassurance that no further treatment is needed
Prescribe Metronidazole 400 mg three times per day for 3 days
Arrange to review the patient in 1-2 weeks
a) 4 factors which can result in tooth mobility? (4 marks)
Width of PDL, Height of PDL, Inflammation, Number, length and
shape of roots
Periodontal Disease, Periapical Abscess, Trauma, External
Inflammatory resorption
b) When would you intervene to stop tooth mobility? (2 marks)
If it is progressively increasing
If it gives rise to symptoms
If it creates difficulty with restorative treatment
c) Would you expect tooth mobility to increase or decrease in a patient with
moderate to advanced periodontal disease, following HPT? Explain why?
(2 marks)
Expect it to decrease as you expect for clinical reattachment via long
junctional epithelium
d) A patient has mobile lower incisors and refuses XLA, what would you
advise him and what are the disadvantages of this? (2 marks)
Splinting may be appropriate when there is tooth mobility caused by advanced
LOA/if tooth mobility is causing discomfort or difficulty in chewing.
However, splinting does not influence the rate of periodontal destruction and
it may create hygiene difficulties.
It is a Tx of last resort
a) 3 reasons for non surgical before surgical (3 marks)
Allows evaluation of patients motivation and plaque control
Improves soft tissue consistency for easier surgical management
Some deep pockets may heal following non-surgical therapy
b) 2 indications for surgical at reevaluation (2 marks)
Pockets of 5mm or greater persist despite improvement in oral hygiene
Furcation
c) when to reevaluate non surgical (1 mark)
4-6 weeks after non-surgical therapy
d) aim of surgical treatment (1 mark)
To arrest the disease by gaining access to complete root surface debridement
To regenerate lost periodontal tissue
e) 3 supportive role of gdp after surgical carried out by specialist (3 marks)
Periodontal Pocket chart annually & carry out oral exam including plaque and bleeding levels
Review oral hygiene and use oral hygiene TIPPS
Remove Supragingival and sub gingival plaque and calculus deposits
Carry out Root surface debridement
Re-appraise mechanical plaque control
a. list three potential pathways of communication between the pulp space
and the periodontal ligament
- apical foramen
- accessory canals
- fractures
- dentine tubules
- perforations
