PERIODONTOLOGY ODTP Flashcards
Patient has throbbing pain. PA of Q3 given.
a. 4 Pathological findings from the x-ray
Don’t even understand this drawing
External Root Resorption
Horizontal bone loss
Vertical bone loss
Patient has throbbing pain. PA of Q3 given.
b. Diagnosis of 36
- Irreversible Pulpitis with furcation involvement
- Why?
- Seems like patient is having throbbing pain so irreversible pulpitis.
- Why?
Patient has throbbing pain. PA of Q3 given.
c. Factors to consider when determining the prognosis of 36
Anatomical anomalies that may prove different for periodontal treatment to treat
Furcational involvement of the tooth
Any presence of calculus
Bone loss level
Any systemic diseases like diabetes and osteoporosis
Patient has throbbing pain. PA of Q3 given.
d. Two Tx options for Quadrant 3 i. Tx1:
ii. Tx2:
e. Risk of Tx
No answers given
a. What is your most likely periodontal diagnosis? (1)
Aggressive periodontitis
b. From the radiograph, what problem is affecting tooth 35?
How would this problem affect the treatment of periodontal disease using scaling and root surface debridement? (4)
- Problem of tooth 35
- Bone level loss till apex of the tooth and grade 4 furcation
- Presence of enamel pearls or cervical enamel projections
- How does this affect treatment outcome?
- This is a periodontal risk which may affect the prognosis of the tooth
- The enamel pearls or cervical enamel projections may affect the treatment outcome because it may proof difficult to remove plaque from there.
a. List 4 periodontal findings (4)
Gingival Swelling and Redness
Generalized Horizontal Bone Loss
Deep periodontal pockets in sextant 6 and 8
Mobility
Generalized Recession
Furcation Involvement
b. What is your diagnosis (1)
Generalized Aggressive Periodontitis Stage 3 or 4 Grade C
Stage 3 or 4 because of the bone level
Grade C because familial aspects and bone level to age ratio.
c. Suggest the plan of management/therapy (3)
d. What are the possible positive treatment outcome in response to your therapy plan (3)
a. List out the local modifiable risk factors based on the information given
b. Base on the x-ray explain why the prognosis of 17 is poor
Vertical bone loss, severe horizontal bone loss, incomplete separation of root difficult for RSD, convergent root less retention -> higher mobility
c. You have performed scaling and root debridement for the px and he came back one month later as shown in the lower photograph. You would like the dental hygienist to perform some tasks. Write a prescription for the hygienist (7)
Dear (Name of Dental Hygienist),
The patient, (Name), MH: smoker, alcoholic, DM, hypertension, down syndrome, cancer, low IQ syndrome
Would perform OHI: ID brush, tooth brush, dietary analysis
Supragingival scaling on xxx
Discharge the patient after finish perio treatment, thank you
a. List four abnormality found in OPG
b. A nonvital upper incisor with an isolated 10 mm pocket on the palatal side, no caries and no recent trauma, 3 possible causes
Palato-Radicular Groove
Perio-Endo Lesion
Vertical Root Fracture
a. 4 modifiable risk factors for periodontitis (4m)
Modifiable risk factors
Smoking, DM, oral hygiene, plaque retentive factors
Non-modifiable risk factors
Genetic risk, immune compromised, tooth anatomy
b. Describe Xray findings
NA
a. Describe the clinical photo (4)
Swollen and red gingiva
Generalized gingival reccession
Increased ID space
Poor OH with plaque and calculus
Anterior crossbite
b. Describe the periodontal condition from the radiographs. (6)
Generalized horizontal bone loss up to one-third of teeth
Localized angular bone loss
Multiple teeth with vertical bone loss up to apex
Furcation involvement for most of the molars
PA: bone loss up to apex of buccal roots → Severe generalized periodontitis (not the real dx? because it’s aggressive) (this q is just asking to describe the condition, no need the dx xd)
c. What is the general approach for non-surgical periodontal therapy? (4)
OHI
Supragingival scaling → review gingival response for 2weeks → RSD → evaluate periodontal conditions after 6-8 weeks with OHI reinforcement and evaluation in between → if satisfactory, continue review regularly; if unsatisfactory, re-do RSD or reinforce OHI or consider surgical therapy
for gingivitis, it is to remove the causative agent → OHI + supragingival scaling
for periodontitis, it is to arrest progression of disease and regenerate damaged structure → systemic phase, preventive phase - OHI + RSD
d. What is the likely diagnosis? And would you modify the treatment plan and how?(4)
Aggressive Periodontitis
Do Scaling and RSD asap within 2 days (Dr Lai’s ppt - within 7 to 14 days)
Adjunctive antibiotic therapy: amoxicillin 500mg + metronidazole 200mg, TID, 3/7
e. You have to let your patient sign some consent form related to the risks/sequelae/consequences of non-surgical periodontal therapy. What are the 3 main points to be highlighted? (3)
Increased recession (esthetics problems)
Dentinal hypersensitivity
Transient increased mobility of teeth
Tenderness of soft tissue due to trauma from instrumentation
f. What are the diagnosis and prognosis of 16 and 17? What would you do to relieve the acute symptoms of the teeth? (2)
Severe periodontitis, perio endo lesion (should be primary periodontal, secondary endodontic lesion causing pulpitis)
Prognosis is poor. Bone is unlikely to regenerate. (prognosis is poor because of severe bone loss to apex of buccal roots, patient’s family history, and mobility of the teeth)
Xn/emergency RCT or extirpate pulp/analgesics
g. What is the mechanism of tooth drifting for this px?(2)
Reduced periodontal support due to reduced height of alveolar bone, weakened transseptal fibers and swollen ginigva.
Bone remodelling
a. Describe the clinical photo(3 marks)
Recession?
Dark triangles?
Gingival condition: Swollen? Inflamed? Redness? Presence of Plaque and Calculus?
Bite?
b. What is the likely diagnosis and prognosis of 47? Please give your justification and what treatment will you suggest?(5 marks)
- Poor prognosis because bone level till apex and furcation involvement
- Treatment
- Periodontal surgery
- Bone grafting
- Or Root resection
c. What is the likely diagnosis and prognosis of 17? Please give your justification and what treatment will you suggest? (5 marks)
Can’t answer
d. What is the V-shaped radiolucency shown in the panoramic radiograph?
Furcation?
e. What is the structure marked in the periapical radiograph of 17?
Can’t answer
f. State the initial periodontal treatment (3 marks)
OHI
Supragingival scaling → review gingival response for 2weeks → RSD → evaluate periodontal
conditions after 6-8 weeks with OHI reinforcement and evaluation in between → if satisfactory,
continue review regularly; if unsatisfactory, re-do RSD or reinforce OHI or consider surgical therapy
for gingivitis, it is to remove the causative agent → OHI + supragingival scaling
for periodontitis, it is to arrest progression of disease and regenerate damaged structure → systemic phase, preventive phase - OHI + RSD
g. From the photos and radiographs, what is the condition of the periodontal health
Poor?
- C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on
brushing for years. Given: PAN. (Summative, 2005)
a. Write down five clinical findings.
b. What is the likely diagnosis for the patient’s complaint?
Generalized chronic periodontitis / gingivitis
Irreversible pulpitis (assume not apical periodontitis due to insufficient info)
- C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on
brushing for years. Given: PAN. (Summative, 2005)
c. What is the mechanism of development of the above problem?
- Dull pain in irreversible pulpitis
- Untreated caries / recurrent caries in 46 invade into pulp through dentinal tubules
- Bacterial toxin stimulate pulpal inflammation
- Presence of inflammatory mediators lower pain threshold, allowing endotoxin stimulate the C fiber (located more center in pulp) to initiate dull pain sensation
- Acute apical periodontitis
- Continuous bacterial irritants together with inflammatory mediators cause the pulp severely inflamed and fail to heal and eventually become non vital
- Inflammation cease and infection no longer be confined and spread apically eventually
- Toxin and irritants from necrotic pulp cause periradicular tissue inflammation
- Bone destruction occur due to osteoclastic activity initiated by bacterial toxin and host mediators
- Bleeding in chronic periodontitis / gingivitis
- Bacterial lipopolysaccharide from dental plaque activate a series of pro inflammatory cytokines and inflammatory mediators from macrophag e , PMN and fibroblasts that mediate periodontal inflammation and subsequent tissue destruction
- Migration and infiltration of PMNs and macrophages to the sulcus
- Cytokines induce vasodilation and increase permeability of vessel to allow further migration of inflammatory cells→swelling
- Enzymes like MMP, collagenase secreted by both host and bacteria cause epithelial and connective tissue breakdown
- Highly inflamed status easily cause bleeding by external stimulation like brushing
- C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on
brushing for years. Given: PAN.
d. What disease could have caused the gum swelling and bleeding? What are three risk factors for the disease?
Gingivitis and periodontitis
Systemic: DM / medication causing gingival enlargement / immunocompromised / hormonal change
Behavioral: smoking / poor OH habit / stress
Genetic: IL 1 polymorphism
Local: iatrogenic treatment, overhang restoration, denture, furcation
- C/O: Spontaneous intense pain on upper left back teeth; gum swelling and bleeding on
brushing for years. Given: PAN.
e. Briefly outline the treatment plan for this patient.
Emergency: RCT of 27
Hygienic: OHI
Scaling
Review
Crown 27
a. What are the findings in the information provided that you need to take into account for making your diagnosis?
b. What is the prognosis of 36? What treatment options may you provide? (5)
- Clinical factors
- Deepest probing depth / extent and distribution of attachment loss / furcation involvement / mobility
- Radiographic factors
- Root length / shape / furcation morphology / remaining bone support
- Other factors
- Restorative & endodontic status / functional value (as abutment) / position in the arch
- OHI, scaling, root debridement
- Odontoplasty, open debridement, surface demineralization, root resection (amputation, hemisection), GTR, bone graft, tunnel preparation
- Extraction with or without prosthetic replacement
Information Given:
72 year-old female
C/O: Pain of upper left molar region. Pain on biting.
HPC: Swollen gum 2 months ago. Spontaneous pain. Visited dentist and subsized 1 month after. DH: The dentist she visited performed “a cut” to relieve her symptoms.
MH: unremakable
I/O: Pain of percussion //Peri showing 25 – 28
a. You are going to perform periodontal therapy for the patient. Before that, you would like to send her to the auxillary staff to prepare the patient for your treatment. What will you write on the prescription? (5)
- Would dental hygienist please kindly provide following preventive treatment to this patient:
- OHI for brushing and interdental cleaning
- Diet analysis
- Fluoride varnish
- Supragingival gross scaling
- Periodontology (Formative, 2014)
a. Describe what you can see in the photo provided. (5)
Multiple missing teeth / Calculus in lower anterior region / Plaque accumulation / Tooth drifting / Abrasion
- Periodontology (Formative, 2014)
b. Treatment plan for this patient and justifications
Systemic phase > emergency phase > preventive phase > corrective phase > re-evaluation phase > maintenance phase
a. What is BPE? (1)
BPE is a simple and rapid screening tool that is used to indicate the level of examination needed and to provide basic guidance on treatment needed
Neither monitoring periodontal process nor linking to diagnosis
b. What does the code “4*” mean? (2)
4 = Color band of WHO probe completely inserted into the pocket, i.e. pocket > 5.5 mm
* = Furcation involvement, (or pocket plus recession greater than 7 mm)
c. What is your diagnosis? What is the diagnostic criteria for the condition? (5)
d. What further information do you need to assess the condition of the teeth? (2)
Mobility, vitality, alveolar bone loss
e. What is informed consent? What should be included in the informed consent in this case? (5)
f. How to conduct the debridement in order to maximize the adjunctive effect of anti- microbial medicament? (1)
Finish root debridement as fast as possible (e.g. within 2 weeks) and immediately prescribe antibiotics just after the last debridement
g. Write the prescription for analgesic and antimicrobial medication for this case (6)
Antimicrobial: amoxicillin 500 mg and metronidazole 200 mg, both TID and 7 days
Analgesic: ibuprofen 200 - 400 mg TID 7 days ?, paracetamol 500 - 1000 mg QID prn
