Periodontology in Paediatrics Flashcards

1
Q

Describe the mnemonic

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

A

P - periodontal health
intact periodontium or reduced periodontium

G - Gingivitis: dental biofilm induced
intact periodontium
reduced periodontium

G - Gingival diseases and conditions that are not biofilm induced

N - Necrotising periodontal diseases

P - periodontitis

P - Periodontitis as a manifestation of systemic disease

S - systemic diseases or conditions that affect the periodontal supporting tissues

P - periodontal accesses and endodontic periodontal lesions

M - mucogingival deformities and conditions

T - traumatic occlusal forces

T - tooth and prosthesis related factors

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2
Q

Describe a healthy periodontium

A
  • gingival margin may be several millimetres coronal to the CEJ
  • gingival sulcus may be 0.5-3mm deep
  • alveolar crest is 0.4-1.9mm apical to the CEJ in teenagers
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3
Q

What is the biologic width

A

the area/distance between the CEJ and the alveolar bone crest

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4
Q

What are the potential diagnosis of a healthy periodontium

A

intact periodontium or reduced periodontium

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5
Q

What to we need in order to diagnose periodontal health

A
  • do a BPE

- <10% bleeding on probing

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6
Q

What are the types of gingivitis

A
  1. dental biofilm - induced (localised or generalised)

2. Non-dental biofilm induced

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7
Q

Outline the steps of gingivitis caused by the dental biofilm

A
  • As supra-gingival plaque accumulates on the teeth, an inflammatory cell infiltrate develops in gingival connective tissue
  • This causes the junctional epithelium to become disrupted
  • This allows apical migration of plaque and an increase in the gingival sulcus depth
  • This gives rise to a gingival pocket, also called a false pocked or pseudo pocket
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8
Q

is there loss of attachment in gingivitis

A

there is no periodontal loss of attachment

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9
Q

what is the diagnosis of 10-30% bleeding on probing

A

localised gingivitis

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10
Q

what is the diagnosis of over 30% bleeding on probing

A

generalised gingivitis

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11
Q

describe the appearance, aetiology and risk factors of Necrotising Ulcerative Gingivitis

A

appearance

  • blunted papillae
  • malodour
  • painful gingivae
  • no attachment loss

Aetiology
- Fusiform and spirochete bacteria

Risk factors

  • smoking, stress, immunosuppression, poor diet
  • HIV positive
  • common in developing countries
  • trench mouth
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12
Q

Describe pubertal gingivitis

A
  • increased inflammatory response to plaque mediated by hormonal changes during puberty
  • can progress to early periodontitis
  • local and systemic factors and influence progression
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13
Q

when do you diagnose non-dental biofilm-induced gingivitis

A

when the main etiological agent for gingivitis is not plaque

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14
Q

Describe two drugs which can cause drug induced gingivitis

A

cyclosporin
- immunosuppressant used in patients with underlying immune conditions, such as crohn’s, or post organ transplants

Phenytoin
- anti epileptic medicine used in children with epilepsy

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15
Q

What systemic diseases can lead to gingivitis

A
  • agranulocytosis
  • cyclic neutropenia
  • crohn’s
  • Sarcoidosis
  • Granulomatosis
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16
Q

What are examples of non biofilm induced gingivitis

A
infective 
genetic 
trauma 
systemic manifestations 
drug induced
17
Q

what is the treatment of gingivitis

A
  • rigorous oral hygiene/home care
  • frequent scaling
  • surgery may be necessary if drug induced (refer to a specialist)
18
Q

What are the 4 main distinguishing features of periodontitis?

A
  1. Apical migration of junctional epithelium beyond the CEJ
  2. Loss of attachment of periodontal tissues to cementum
  3. Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated)
  4. Alveolar bone loss
19
Q

What pathogens can cause periodontitis

A
  • porphyromonas gingivalis
  • prevotella intermedia
  • aggregatibacter actinomycetemcomitans (AA)
20
Q

What should you look for when accessing the gingival condition

A
  • gingival colour
  • contour
  • swelling
  • recession
  • suppuration
  • inflammation (presence and location)
21
Q

what are some local risk factors for periodontal disease in children

A
  • plaque retention factors
  • low feral attachments
  • malocclusion
  • incompetent lip seal
  • mouth breathing
22
Q

what age do you use a simplified BPE

A

all co-operative children aged 7 - 11 years old

23
Q

what probe do you use for a simplified BPE and how much pressure

A

WHO CPITN probe
(community periodontal index of treatment needs)

20-25g force

24
Q

what teeth do we carry out a simplified BPE on

A

16, 11, 26, 36, 31, 46

25
Q

what codes can be used for children aged 7- 11

A

codes 0, 1 and 2

26
Q

when do you do a full BPE on children

A

any patient 12 years and older

27
Q

what do you do if there are scores of 3 or 4 in BPE

A

6 point pocket chart (localised if 3, full if 4)

check alveolar bone level (BW’s for posteriors, periodicals for anteriors

28
Q

what should you encourage in patients with periodontal disease

A
  • good toothbrushing
  • emphasis the need to clean all surfaced (brush Dj app is good)
    Standard toothbrushing and fluoride advice given to all patients
  • supervised/ assisted brushing up to 7 years old
  • disclosing tablets can be helpful
  • fluoride mouthwash of 225ppm should be recommended for patients undergoing appliance therapy