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Dentistry BDS4 > Periodontology > Flashcards

Periodontology Flashcards

1
Q

define resorption

A

loss of dental hard tissues due to clastic activities

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2
Q

classification of resorption

A

internal (inflammatory/replacement)

external (surface, inflammatory, replacement, cervical)

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3
Q

what stimulates or inhibits osteoclasts?

A

parathyroid hormone,
osteoprotegrin (stops osteoclast activity)
RANKL - stimulated blastic activty

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4
Q

Internal resorption classification

A

originates and affects root canal wall

inflammatory or replacement

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5
Q

What is root resorption

A

alteration or damage to protective layer of precementum or predentine
inflammation must occur to the unprotective root surface

directly - trauma
indirectly - inflammatory response after injury

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6
Q

What is the destructive phase of RR?

A

short lived destruction - continues if stimulus is present

if long lived destruction - continues until enough root is resorbed or is resorbed completely

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7
Q

what is the inflammatory response of RR?

A

the healing phase, cementoblasts causing cemental healing if small lesions
least favourable is bone cells - get ankylosis (replacement resorption)
occurs if diffuse injury (>20%)

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8
Q

aetiology of IIRR

A

outer odontoblast and predentine layer damaged - underlying mineralised dentine exposed to odontoclasts
trauma, caries, perio infections, heat, pulpotomy, ortho etc
need blood supply

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9
Q

clinical presentation of IIRR

A

+ve vitality test, asymptomatic, might have active pulpitis, sinus tract in late stage, pink spot possible

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10
Q

radiographic presentation of IIRR

A

might be chance finding.
uniform radiolucent enlargement of pulp canal, outline of canal is distorted, no adjacent bony defect, continuous periphery of lesions with canal

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11
Q

IIRR treatment

A

if salvageable - RCT
need ultrasonic irrigation with NaOCl to get into shape
cant mechanically debride
CaOH intracanal medicament
obturate with thermoplastic GP (can use master apical point for apex)

if perforated - XLA

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12
Q

What is external inflammatory RR

A

precementum layer gets thinner as you go apically

shallow resorption of cementum often with involvement of small amount of underlying dentine

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13
Q

aetiology of EIRR

A

prolonged stimuli to area (infection), trauma, pressure, endodontic stimulus

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14
Q

How to diagnose EIRR

A

Sub clinical issue, might cause mobility,
pressure = radiographic shortening and blunting of root apices. tooth still vital.
trauma causes more extensive loss, might lose vitality

if infection then might have lateral canal

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15
Q

Treatment of EIRR

A

orthograde RVCT, reduce ortho pressure, remove impacted tooth, halt infective stimulus

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16
Q

What is external replacement resorption (ankylosis)

A

bony trabecluae develop in PDL space and fuse to root surface
replacement of root surface with bone, AKA ankylosis
may be transient or self limiting

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17
Q

How to diagnose ankylosis?

A

often sub clinical, only when 10-20% surface affected, might get infra occlusion, lack of mobility, change in percussive sound

radiogrpahically - moth eaten look, loss of PDL space
CBCT, PA, upper standard occlusal

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18
Q

Management of ankylosis

A

once established - no effective Tx. camouflage
monitor - may infraocclude.
XLA and implants

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19
Q

What is external cervical resorption and what are predisposing factors?

A

localised resorptive lesion of the cervical area of the root below epithelial attachment. usually on traumatised tooth, internal/external bleaching, ortho, oral surgery

classified by heithersays classification (1-4, least to most severe)

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20
Q

what are the clinical signs of ECR?

A

often asymptomatic, might have pink spot lesion, BOP, loss of PDL support and attachment, granulation tissue perforate at gingival margin (looks like gingivitis)

eventually causes pulp necrosis

radiographically
asymmetric radiolucency, still have tramlines of canal, corresponding loss of alveolar bone, multilocular and superimposed on pulp
need parallax

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21
Q

What are the management options of ECR?

A

Refer
raise flap, curette granulation tissue, treat with TCA (tricholoroacetic acid) to cause coagultion necrosis of resorptive tissues without PDL damage
remove undermined enamel and dentine
restore with GI or comp

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22
Q

How to aid diagnosis of resorption?

A

Good Hx ( trauma, ortho, crowns, pulpotomy, internal bleaching, impacted teeth, perio disease and Tx, contact with cats, pagets disease, papillo le fevre)
Exam (tooth colour, restoration, percussion, mobility, LOA, EPT/ethylCl)
Imaging (multiple PAs, CBCT)

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23
Q

What are the classifications of periodontal disease?

A
  1. Gingival diseases
  2. chronic periodontitis
    localised or generalised
  3. aggressive periodontitis
    localised or generalised
  4. periodontitis as a manafestation of systemic disease
  5. necrotising periodontal disease
    (ANUG/ANUP)
  6. abscesses of the periodontium
  7. periodontitis associated with endodontic lesions
  8. developmental or acquired deformities and conditions
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24
Q

What are the BPE scores?

A

0 - healthy ginigval tissues. no BOP
1 - BOP, pockets <3mm, no plaque retention factors
2 - pockets <3mm, plaque retention factors
3 - pockets 3.5-5.5mm in deepest area
4 - pockets >5.5mm
* - furcation involvement

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25
Q

What are the treatment options for the BPE scores?

A 
0 - OHI
1 - OHI
2 - OHI and removal of PRF
3 - OHI, scaling and root planing
4 - OHI, scaling, root planing (surgical or non surgical)
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26
Q

what are risk factors for periodontal disease?

A

smoking, poorly controlled diabetes

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27
Q

What are features of a periodontal abscess?

A

tooth is usually vital
pain on lateral movements
tooth usually mobile
loss of alveolar crest on x-ray

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28
Q

What are features of a periapical abscess?

A

tooth is usually non-vital
TTP vertically
tooth may be mobile
loss of lamina dura on x-ray

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29
Q

What comes under the banner non-surgical treatment planning?

A

Oral hygiene instruction, mechanical plaque control (tooth brushing and interdental cleaning), chemical plaque control
scaling and root surface debridement

30
Q

What are contraindications to periodontal surgery?

A

poor plaque control
systemic diseases
smoking
teeth with poor long term prognosis

31
Q

Types of surgical periodontal intervention?

A

apically repositioned flap, osseous surgery (osteoplasty, ostectomy), furcationplasty, tunnel preparations, root resection, hemisection, extraction, gingivectomy guided tissue regeneration (bone grafts, enamel matrix derivatives), mucogingival surgery (free grafts or pedicle grafts)

32
Q

What is supportive periodontal therapy?

A

success of treatment is characterised by reduction in BOP, reduction in pocket depth and change of gingival contour.
need constant monitoring of BOP and pocket depths and plaque levels and radiographs
6ppc 8-12 weeks after treatment

33
Q

What is Millers classification of ginigval recession?

A

Class I - recession does not extend past MGJ, no interdental bone loss
Class II - recession just beyond MGJ, no bone loss
Class III - recession to or beyond MGJ, some interdental bone loss, no movement of teeth
Class IV - recession to or beyong MGJ, interdental bone loss, malpositioned teeth

34
Q

Who gets periodontal support care and what is included

A

anyone who has had perio treatment. if pts arent given supportive therapy they are 6x more likely to lose teeth

3month intervals for sub and supragingival plaque removal. OHI. 6PPC every 12 months (SDCEP guidelines)

35
Q

What is included in supportive periodontal care?

A
  1. examination - looking for anything that can affect their plaque retention factors and what factors have changed since last evaluation
  2. treatment options - scaling and RSD - but not <3mm sulci
  3. reporting, cleaning, scheduling for further treatment - motivation, check reason for recurrence
36
Q

What are reasons for perio disease recurrence after successful treatment?

A
  • 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.
37
Q

What are treatment options for pockets of 6mm?

A
  • root surface debridement
  • cause related therapy
  • nothing
  • open flap curattage
38
Q

How would you consent a patient for treatment?

A 
explain risks
explain benefits
explain what happens if no treatment
likely chance of success
other possible treatment options
explains the cost
39
Q

When you are treating a paitent, they complain of central crushing pain in their chest. what is the most likely diagnosis and what is your management?

A
  • MI or angina
  • ask pt if they have had this before
  • ABCDE
  • give O2 - 15L/min with non rebreather mask
  • sublingual GTN 2x400ug actuations (repeat after 3 mins)
  • call ambulance
  • give 300mg crushed asprin
40
Q

When do you review treatment in a perio patient and why?

A

need to wait at least 6 weeks, best 8 to assess whether junctional epithelium has reattached, but not too long as can get re-colinisation and calculus preventing healing and need to re-treat

41
Q

What findings would suggest that perio treatment has been successful?

A 
no BOP
reduction in pocket depts to <4mm
increased tone of ep
reduction in gingivitis and inflammation
reduction in plaque and calculus levels
42
Q

If a perio patient has a traumatic occlusion, how would you proceed?

A

HPT
correct any premature contact areas
dahl appliance if severe
BRA at night

43
Q

what are local causes of tooth mobility?

A 
attachment loss
widening of PDL
morphology
roots
length of roots
inflammation
PA lesions
trauma
44
Q

Patient attends your clinic with a periodontal abscess - outline your treatment

A 
Hx of the infection
Rx of infection
administer LA
establish drainage - through pocket or incise the heaviest part of abscess
gentle sub gingival debridement
HSMW
if systemic - metronidazole 400mg TID 5 days
HPT and maintenance
45
Q

How would you treat a perio-endo lesion?

A

These need treatment of the perio condition - so sub gingival RSD and RCT to treat endo

46
Q

When would you perform a 6PPC?

A

on any sextant scoring 3
whole mouth if any sextant scores 4
before and after treatment (SDCEP_)
after treatment only (BSP)

47
Q

What information can you gain from a 6PPC?

A 
mobility
pocket depth
LOA
BOP
teeth present
furcal involvement
sites with LOA
48
Q

What are problems of the 6PPC

A 
assumes average root lengths
probing force/angulation
calculus
inflammation
cooperation
49
Q

What are treatment options for a tooth with furcation involvement (score 3)

A 
furcationoplasty
sectioning the tooth after RCT
guided tissue regenetation
expose more of the furcation to ease cleaning
XLA
50
Q

why is there a difference between vertical and horizontal bone loss?

A 
occlusal trauma (glickmans theory)
zone of destruction from plaque and thickness of cortical bone (waerhaugs theory)
plaque traps
51
Q

what different factors are considered when diagnosing aggressive or chronic periodontitis?

A 
rate of destruction
age of patient
medical history
family history
sites affected
degree of bone loss
general OH
52
Q

How do you treat ANUG?

A

ultrasonic debridement
hydrogen peroxide MW/CHX
OHI
metronidazole 400mg TID 3 days

53
Q

What are indications for the use of CHX?

A 
post oral surgery
post periodontal surgery
full mouth disinfection
where OH is difficult
root canal irrigant
RAS
chemotherapy pts to maintain OH
ANUG
candidal infection
if at risk of secondary infection with PHG
54
Q

how does biofilm develop?

A 
adhesion
colonisation
accumulation
develop complex community
disperse
55
Q

give virulence factors for p ging

A 
biofilm formation
LPS endotoxin
production
fimbrae for adhesion and invasion
proteases
complex plysaccharide production
56
Q

What are some different constituents of saliva?

A 
immunoglobulins
lipase
lysozyme
mucins
lactoperoxidase
lactoferrin
amylase
57
Q

What are oral signs of anaemia?

A 
beefy tongue
RAS
gingivitis
burning mouth/dysasthetia
glossitis
angular cheilitis
58
Q

What are oral signs of leukaemina?

A 
gingival hyperplasia
bleeding
petechiae
ulceration
swellings
predisposition to infections
59
Q

List reasons a patient could be taking warfarin

A

heart valve replacement
atrial fibrillation
thrombophilia
ischaemic stroke

60
Q

What can you do for a patient with haemophilia?

A 
check with their consultant
infiltrations, not blocks
simple treatments not disrupting the gingivae
supragingival scaling
restorations
61
Q

what are the types of vertical bony defects?

A

infrabony - one wall, two wall, three wall. interproximal crater

62
Q

What is a periodontal abscess and how is it managed?

A

acute exacerbation of existing perio disease (from trauma or blockage)
LA, incise, drain, gentle pocket debridement short of base - stops spreading infection.
OHI, CHX, HSWM, XLA is possible. ABs if systemic/immunocompromised. HPT and review

63
Q

what is the difference between generalised and localised aggressive perio?

A

generalised = 3 tteh other than 6s and 1s
localised - patient is generally healthy, rapid loss off bone, familial aggregation, low levels of plaque, around 30s onset

If there is a cause - then it is not aggressive perio - it is perio secondary to the cause

64
Q

how do you treat aggressive perio?

A

daily removal of plaque and modify behaviours

65
Q

What are the bactieral virulence factors causing perio?

A

leukotoxin, endotoxin, collagenases, fibroblast inhibitory factor, soluble heat labile factor

66
Q

What are risk factors for causing Ag perio?

A

smoking
genetics
inherited diesases
papillon lefevre syndrome

67
Q

how can you detect for the CAL to be below furcation?

A

probe - can use neighbour probe for finding furcation

radiographically

68
Q

What are the grades of furcation involvement?

A

I - up to 3mm horiztontal attachment loss
II - >3mm horizontal attachment loss, not through and through
III - through and through

69
Q

What are the different treatment options for furcation involvement?

A

repair - NST, ST
regenerate - GTR, graft
eliminate - tunnel, root resection, hemisection, XLA
palliate - supportive care

NST is best for grade I

70
Q

What are aetiological factors for gingival recession?

A 
iatrogenic
toothbrushing
traumatic occlusion
trauma
fraenal attachments - high or aberrant
71
Q

What are some surgical procedures to treat gingival recession?

A

free soft tissue (free ginigval, connective tissue)

pedicle soft tissue (rotational, laterally positioned, transpositional)

advanced flap (coronally/semilunar coronally positioned)

Dentistry BDS4 (20 decks)

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