Periodontology Flashcards
what extent can periodontitis be classified
localised - less than 30%
generalised - more than 30%
molar incisor pattern
what stages are used in classification
maximum bone loss in the worst area on radiograph
1 - early/mild - less than 15%, or 1-2mm
2 - moderate - coronal third, 3-4mm
3 - severe - mid-third, more than 5mm
4 - very severe - apical third, more than 5mm
what grades are used in classification
% bone loss over age, rate of destruction
a - slow - less than 0.5
b - moderate - 0.5-1.0
c - rapid - more than 1.0
what systemic risk factors are present in periodontitis
diabetes, smoking, obesity, stress, alcohol consumption
what defines stable periodontitis
bleeding on probing less than 10%
pocket depth less than or = to 4mm
no bleeding at 4mm sites
what defines periodontitis in remission
bleeding on probing greater than 10%
pocket depth less than or = to 4mm
no bleeding at 4mm sites
what defines unstable periodontitis
pocket depth more than or = to 5mm
bleeding at 4mm pockets
why is the 4mm pocket depth important
patients cannot clean pockets greater than 4mm themselves, if a pocket is 4mm and is bleeding, it is unable to heal and needs further RSD
what defines a healthy periodontium
absence of bleeding on probing, erythema, oedema, pocket depth 1-3mm, no radiographic bone loss or interdental recession
what defines plaque induced gingivitis
bleeding on probing greater than 10%, no radiographic bone loss, no recession, pockets no greater than 4mm
give 3 uses of chlorhexidine
necrotising ulcerative gingivitis - after debridement, too painful for patients to brush, instead use chlorhexidine mouthwash 2 times a day
periodontal patients - respond well to hygiene phase therapy but some persistent pockets of 5mm or more - can be put in these pockets when carrying out RSD
trauma patients - should use mouthwash for a week after trauma
what is the advantages and disadvantages of local microbials
advantages - not systemic, higher concentration, no drug interactions, no patient compliance, can use chlorhexidine
disadvantages - expensive, still require disruption of biofilm
why are antibiotics not first line use for periodontitis patients
bacteria in perio is in a biofilm, surrounded by extra cellular matrix, antibiotics cannot penetrate through the layers of this, so need mechancial disruption of biofilm, bacteria is then vulnerable and can use antibiotics after this - only in patients with rapid disease - grade b or c
what cohort of patients is necrotising gingivitis/periodontitis in
malnourished children or immunosuppresed - HIV positive
give clinical signs of necrotising gingivitis
painful bleeding gums, ulceration and necrosis of interdental papilla, rapidly destructive, halliotosis, yellowish white plaque (Slime)
what treatment would be given to patients with NUG
ultrasonic debridement of necrotic tissue, painful to brush teeth so need chlorhexidine mouthwash - 0.1% 10ml twice a day
what kind of antiboitic is given to patients with NUG and when is it given
200mg metronidazole 3 times a day for 3 days (TID - 3 times daily)
how does chlorhexidine work
group of biguanides one cation invades the cell and the other alters the cell wall, this increases permeability leading to precipitation of cytoplasm and cell death
what is the relationship between smoking and periodontitis
smoking alters the microbiome - more pathogenic and destructive as it reduces the level of oxygen in the mouth. Therefore more anaerobic bacteria survive - P. gingivalis, A.A, more destructive. it also alters the immune system to increase pro-inflammatory cytokines. additionally, it is a vasoconstrictor which reduces blood flow and reduces healing capacity
what is the relationship between diabetes and periodontitis
sub-optimally controlled diabetes results in hyperglycaemia. Increase in glycotoxin, which increases the level of proinflammatory mediators such as IL. This alters the ratio between OPG and RANKL - resulting in more alveolar bone loss. Also, increases advanced glycation end products which increases pro-inflammatory cytokines and desctructive inflammatory mediators. Results in more inflammation which is destructive to the periodontium
what is medication is linked with risk of periodontitis
anti-convulsants - phenytoin
immuno-suppressants - cyclosporin
calcium channel blockers - nifidepine
what other systemic diseases are linked with periodontitis
an increase in chronic inflammation has an effect on the overall wellbeing of the patient. Increase systemic inflammation, by inflammatory mediators.
cardiovascular disease - hypertension and artherosclerosis
rheumatoid arthritis
alzheimer’s dementia
who requires supportive periodontal care
every periodontal patient, for the rest of their life. Always at risk of disease recurring.
when should supportive periodontal care be carried out.
Depends on every individual patient. Need to risk assess to see how likely they are for disease recurring, therefore, how often they should be seen and supported to prevent this happening. Risk assessment dependant on - bleeding on probing, probing depth, bone levels per age, tooth loss, systemic disease and environmental factors (e.g. smoking)
what is done in supportive periodontal care
part 1 - examination. Need to check medical history, plaque and bleeding scores, probing depth, can use this to inform oral hygiene and motivation levels. evaluation of caries, restoration, prosthesis. compare this to last visit
part 2 - treatment, depending on what is found. remove any supra gingival plaque and calculus, want to provide patient with a polished surface easy to clean. If any pockets larger than 4mm - RSD. pockets 1-3mm - unless there is visible calculus, no subgingival scaling - can effect attachment, and cause attachment loss.
