Periodontology

Question 1

NUG/NUP

1. Define
2. 4 signs/symptoms
3. What is NUP
4. Associated bacteria
5. 3 risk factors
6. 4 treatment options
7. What antibiotics and when

Answer 1

1. Painful ulceration and blunting of interdental papilla, grey/yellow necrotic slough
2. Malodour/halitosis, inter proximal necrosis, gingivitis, pain, swelling, bleeding, metallic taste, bleeding
3. Reversible NUG + irreversible attachment loss. Occurs if NUG is recurrent or inadequately treated
4. Anaerobic fusospirochetael bacteria
5. Poor OH, immunocompromised, stress, smoking
6. Smoking cessation, OHI, mechanical debridement, MW (6% H2O2 or 0.2% CHX)
7. 400mg metronidazole (500mg amoxicillin as second choice) 3x day for 3 days
   If resistant/persistent/immunocompromised

Question 2

Abscess

1. Define
2. 4 signs/symptoms
3. 4 types
4. 2 general types and 3 features of each
5. Treatment
6. What antibiotics and when

Answer 2

1. Localised collection of dead and dying neutrophils
2. TTP in lateral direction, pain, swelling, redness, pus drainage (sinus tract), bleeding
3. Gingival, periodontal, pericoronal, periapical, perio-endo
4. Acute - rapid onset, symptomatic - pain, swelling
   Chronic - gradual onset, asymptomatic - sinus tract, intermittent pus discharge, PAP
5. Mechanical debridement short of base pocket, drain pus (through pocket/incision and drainage), irrigation, analgesia, CHX MW
6. 500mg amoxicillin (400mg metronidazole as second choice) 3x day for 3-5 days
   If spreading infection, systemic symptoms (fever, malaise, lymphadenopathy) or if immunocompromised

Question 3

Occlusal trauma

1. Effects on healthy periodontium
2. Response of health periodontium
3. Effects on healthy but reduced
4. Effects on diseased

Answer 3

1. Areas of intermittent pressure and tension, areas of widened PDL, hypermobility. In absence of plaque, gingival margin remains intact (no perio disease)
2. PDL width increases until forces adequately dissipated (increasing mobility). PDL width then stabilises and returns to normal if demand/forces reduced.
   If forces cannot be adequately dissipated/forces increase, PDL continues to widen until tooth lost (pathological failure of adaptation)
3. Previous LoA and bone resorption - tooth effectively on fulcrum
4. Zone of co-destruction (physiological and pathological). Occlusal forces cause PDL widening at base of pocket. and may cause CAL (pathological) or excessive bone loss (combined - pressure causes resorption, as does pathology)

Question 4

Mobility

1. 4 causes
2. When unacceptable (x2)
3. 3 ways to treat/reduce (describe one – what for, 2 disadvantages)
4. 2 reasons for migration and 2 treatments

Answer 4

1. PDL width, PDL height, presence of inflammation, shape/number/length of roots
2. Progressively increasing, symptomatic, associated with deep pockets
3. Treat perio disease/inflammation, correct occlusal relations (selective grinding), splinting
   Splinting - treatment of last resort. Used to stabilise teeth for debridement/if discomfort/chewing difficulties. May lead to OH difficulties and does not influence rate of disease (does not slow/stop/treat perio disease)
4. Unfavourable occlusal forces, unfavourable soft tissue profiles. Accept and stabilise, correct occlusal relations, orthodontics, treat perio disease

Question 5

Perio surgery

1. Purpose/function
2. 2 contraindications
3. One indication
4. Benefit of OFG
5. 2 pros of gingivectomy
6. 2 reasons for gingivectomy

Answer 5

1. Arrest disease by gaining access to complete RSD and regenerate lost perio tissues
2. Poor OH/plaque control, smoker
3. Post-CRT/NSPT, excellent OH, inflammation resolved, pockets 5+mm persist
4. Helps gain access to root surface in persisting pockets
5. Improves aesthetics, facilitates plaque control
6. Reduce overgrowth, pseudo pockets, areas with difficult access, gingival fibromatosis

Question 6

Antibiotics and antiseptics

1. Define substantivity (and what 2 things does it depend on)
2. One class of antiseptics (name, example, how it works, 3 things it’s used for, 3 cons)
3. 3 disadvantages of antibiotics/why they don’t work
4. 2 indications for antibiotics
5. 3 benefits of systemic
6. 3 benefits of local

Answer 6

1. Persistence of action (how long works/adheres for)
   Maintenance of antimicrobial activity and slow neutralisation of antimicrobial activity
2. Bisbiguanides, Chlorhexidine
   Dicationic action - one cation binds to pellicle-coated tooth, other cation sticks to negatively-charged bacterial membrane. In low concentration, causes increased permeability. In high concentrations causes cytoplasm precipitation leading to cell death
   Uses - endodontic irrigant, pre-/post-surgery MW, MW for immunocompromised/limited self-care, surgical scrub
   Cons - staining, minimal GI absorption, mucosal erosion, parotid swelling, bitter taste
3. Allergy, resistance, superinfection, cannot penetrate biofilms well, high concentration required to be effective, can be inactivated/degraded by non-target organisms
4. Immunocompromised, spreading facial infection,
5. Delivered via serum to tissues, reaches non-dental reservoirs, cheaper, less chairside time
6. Reaches site directly, adequately high drug concentration, low systemic effects, better compliance, high concentration in GCF

Question 7

Perio treatment

1. 3 aims
2. 3 side effects/cons
3. CAL/CAG post-treatment and why

Answer 7

1. Arrest disease, regenerate lost perio tissue, maintain LT perio health
2. Sensitivity, gingival recession, short-term bleeding
3. CAG - gingival recession + gain in attachment through long junctional epithelium

Question 8

Perio-endo

1. 3 perio-pulp communications
2. How primary endo involves perio and 2 features
3. How primary perio involves endo and 2 features
4. How true combined proceed
5. Perio-endo prognosis
6. Treatment

Answer 8

1. Apical foramen, lateral and furcal canals, #, perforations
2. Pulp infection travels down root canal to PA area, PAP/abscess, progresses coronally to gingival/avleolar bone margin.
   Localised perio disease, non-vital tooth
3. Pocket forms, progresses apically to accessory canal/apical foramen, bacterial ingress into canal, pulp inflammation.
   Generalised perio disease, tooth often not/minimally restored
4. Zone of co-destruction. Endo disease proliferates coronally and perio disease proliferates apically and they combine together into one lesion.
   Non-vital tooth, periodical and alveolar bone loss
5. Generally poor, worse if true combined. Mainly dependent on severity of perio disease and response of perio disease to treatment
6. Primary RCT, secondary NSPT. If unresolved, can perform perio surgery

Question 9

Drugs that cause gingival hyperplasia

Answer 9

Calcium-channel blockers (nifedipine)
Immunosuppressants (cyclosporine A)
Anticonvulsants (phenytoin)