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BDS4 > Periodontology tutorials > Flashcards

Periodontology tutorials Flashcards

1
Q

What are the signs of periodontal stability?

A
  • BoP < 10%
  • PPD < 4mm
  • No bleeding on probing @ 4mm sites
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2
Q

What are the signs of patient engagement in perio treatment?

A
  • BoP < 30%
  • Plaque < 20%
    or > 50% improvement in both
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3
Q

What are 3 ideal outcomes of periodontal treatment?

A
  • Reduce inflammation and pocket depths
  • Regain attachment of long junctional epithelium
  • Reducing rate of progression of alveolar bone loss
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4
Q

Based on SDCEP criteria, What proportion of >5mm pocket depths would a patient have following successful periodontal treatment?

A

0

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5
Q

What is the difference in quality of debridement and efficacy between ultrasonic scalers and hand scalers?

A

If done with correct technique, there is no difference

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6
Q

What is the definition of a non responding site?

A

Pocketing that remains the same depth following non-surgical instrumentation

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7
Q

Give 4 treatment options for non responding sites

A
  • Continued non surgical instrumentation - re-attempt step 2
  • Surgical debridement through surgical access to pocket
  • Resective surgery
  • Regenerative surgery
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8
Q

What is periodontal access surgery ?

A

Surgical debridement of full depth of pocket which cannot be accessed with non-surgical instrumentation

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9
Q

What is resective surgery?

A

Removal of pocketing by changing archtecture of hard and soft tissues to achieve shallow probing depths

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10
Q

What is regenerative surgery?

A

Adding material into infrabony or furcation defects to regenerate attachment

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11
Q

What is the rationale behind step 3?

A

To treat non-responsive sites to step 2 with
* targeted repeated non surgical instrumentation
* To consider the use of invasive surgical techniques to gain access for subgingival PMPR in deep pockets
* Regenerate or resect areas

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12
Q

What is a residual pocket?

A
  • A deep pocket that persists after carrying out initial periodontal therapy ( step 1 and step 2)
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13
Q

What PPD is a deep residual pocket?

A

> 6mm

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14
Q

What PPD is moderately deep residual pocket?

A

4-5mm

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15
Q

In a stage III periodontitis patient with residual pockets after the first and second step of periodontal therapy, when is it recommended to take access flap surgery instead of repeated subgingival PMPR?

A

> 6mm

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16
Q

If referral/expertise is not an option, what is the minimum level of primary care required for management of residual pockets associated with/without infrabony defects or furcation involvement after completion of step 1 and step 2 of periodontal therapy? (2)

A
  • Repeated subgingival instrumentation ( with or without access flaps)
  • Regular supportive periodontal care than includes subgingival instrumentation
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17
Q

A patient with poor engagement with OHI wishes to undertake periodontal surgery. What is the recommendation for this?

A

This is a contraindication as surgical interventions need excellent OH compliance

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18
Q

What is the adequate management of residual deep pockets in Stage III after step 1 and step 2

A

Resective surgery

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19
Q

What is the adequate management for residual deep pockets associated with infrabony defects (>3mm) after step 1 and step 2 ?

A

Step 3 - targeted non surgical sub-gingival instrumentation / Refer to secondary care

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20
Q

Management of molars with Class 2 or 3 furcation involvement and residual pockets after step 1 and step 2 ?

A
  • Step 3 - targeted non surgical subgingival instrumentation / Refer to secondary care
  • Furcation involvement alone is not an indication for XLA
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21
Q

Management options for maxillary interdental class II furcation involvement after step 1 and step 2 ?

A
  • Step 3 involving non surgical instrumentation
    Refer for
  • regenerative surgery
  • root resection
  • access surgery
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22
Q

Management options for class III furcation involvement after step 1 and step 2?

A

Step 3
* non surgical instrumentation
* access surgery
* tunneling
* root resection

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23
Q

What is the choice of regenerative biomaterials for promoting healing of residual deep pockets associated with a deep infrabony defect? or class II molar buccal furcation involvement?

A

Regenerative surgery with
* barrier membranes (DBBM or collagen)
* enamel matrix derivative

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24
Q

What is gingivitis?

A

Presence of bleeding on probing, erythema and oedema, with no loss of attachment or bone loss

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25
Q

What is chronic periodontitis?

A

Loss of gingival and periodontal tissues from current or historic chronic inflammation of the periodontium

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26
Q

What is necrotising ulcerative gingivitis?

A

Immunosuppression resulting in oral commensal bacteria causing necrosis and ulceration of the gingival tissues with no bone loss

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27
Q

What is necrotising ulcerative periodontitis?

A

Immunosuppression resulting in oral commensal bacteria causing necrosis and ulceration of the gingival tissues with bone loss

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28
Q

What is a periapical abscess?

A

A periapical pathology with pus accumulation associated with an infected tooth

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29
Q

What os a periodontal abscess

A

A pathology associated with localised accumulation of non draining pus within the gingival wall of periodontal pocket associated with rapid tissue destruction

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30
Q

What is an endo-perio lesion?

A
  • Pathologic communication between pulpal and periodontal tissues
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31
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

Describe the clinical presentation?

A

Swelling of region associated with LL6, absence of erythema or bleeding on visual inspection

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32
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

Describe the radiographic presentation?

A

Deep pocketing associated distal root of 36, large >3mm infrabony defect distal of 36

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33
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

What special tests could you use to help diagnosis?

A
  • Mobility
  • Sensibility testing
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34
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

What may have caused the patient issue?

A

Previous PMPR resulted in reattachment of junctional epithelium which trapped bacteria deep in the pocket, long term proliferation of non-draining pus associated with periodontal infection causing significant localised bony destruction

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35
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

What are the underlying risk factors?

A
  • Deep pocketing
  • Periodontitis patient
  • Poor access to site for cleaning
  • Impaction of food
  • Diabetes
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36
Q

Using the appropriate classification, what is the differential diagnosis?

A

Periodontal abscess

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37
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

What initial treatment would you carry out?

A
  • Careful sub-gingival PMPR short of base of pocket
  • Drain abscess
  • Prescribe analgesia
  • AB if systemic involvement or spreading infection
  • CHX 0.2% rinse 2xD for 7 days for symptomatic relief
38
Q
  • Pt complaining of pain in URQ anteriorly
  • He had some dental work done on tooth in the quadrant a couple months ago, but since moving is unable to visit his dentist
  • You take clinical photographs and two radiographs of tooth 12

Describe the clinical presentation?

A

Sinus present at mid-apical level of tooth 12

39
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

Describe the radiographical presentation?

A
  • Post placement, radiopacity present on distal surface of the post , possibly perforation
40
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

What may have caused the patient issue?

A

Perforation during post placement

41
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

Using the appropriate classification what is the differetial diagnosis?

A

Endo-perio lesion

42
Q
  • Stage 4 grade C generalised periodontitis
  • complaining of pain in LLQ
  • History of deep pocketing in posterior quadrants
  • Multiple >6mm pockets in LLQ
  • You take clinical photographs and a PA of 36

What initial treatment would you carry out?

A
  • Refer for re-rct
43
Q

What is the diagnosis ? and describe 5 clinical presentations?

A

** Necrotising gingivitis/periodontitis **
* Severe gingival bleeding
* necrosis of interdental papilla
* Pseudomembrane formation
* lymphandenopathy
* possible associated bone loss

44
Q

What symptoms may the patient have?

A
  • Pain
  • Halitosis
  • foul taste
45
Q

Give 5 risk factors for this condition?

A
  • HIV/AIDS
  • immunosuppression
  • Stress
  • Fatigue
  • Malnourishment
  • alcohol/smoking
46
Q

A different patient presents with same presentation but have significant bone loss away from the periodontium, what is the diagnosis?

A

Necrotising stomatitis

47
Q

What initial treatment would you carry out?

A
  • Supragingival PMPR
  • CHX MW twice a day for 7 days
  • AB if systemic symptoms (metronidazole)
  • OHI
  • Return in 3 days for subgingival PMPR
  • Treat predisposing systemic factors
48
Q

At review visit the patient condition has stabilised, but there is evidence of gingival loss. Give a surgical option for the management of Superficial craters and Deep craters?

A
  • Superficial - gingivectomy / gingivoplasty
  • Deep craters - Periodontal flap surgery
49
Q

Describe the clinical presentation?

A

Erosion/atrophy of gingivae of tooth 22

50
Q

What symptoms may the patient have?

A
  • Pain / sensitivity to gums
51
Q

The patient mentions he had a restoration placed on that tooth a few days ago, what may have caused this lesion?

A

Acid-etch leaking into gingivae

52
Q

What initial treatment would you give this patient?

A

Desensitising agent , topical anaesthetic (lidocaine)

53
Q

Describe the clinical presentation?

A

Full thickness erythema of the gingivae

54
Q

What are your differential diagnosis? (4)

A
  • Bullous condition
  • Oral lichen planus
  • Systemic lupus erythmatous
  • Primary herpatic gingivostomatitis
55
Q

after further investigations, the condition turns out to be Primary Herpatic gingivostomatitis

Give 2 ways in which a sample may have been collected for lab testing?

A
  • Oral swab
  • Oral rinse
56
Q

What information is included on a virology request form? (6)

A
  • Patient information
  • Clinician information
  • Date and time sample was taken
  • Sample type
  • Test required
  • Brief clinical details of the presentation/differential diagnosis
57
Q

What treatment would you carry out?

A
  • Reassure and Educate patient about the condition
  • Soft diet and hydration
  • Rest and analgesia
  • If the patient is immunosuppressed = prescribe acyclovir
58
Q

Describe the clinical presentation?

A

Multiple unilaterally-resenting small ulcerations on left side of hard palate

59
Q

What is the most likely condition associated with this?

A

Shingles

60
Q

What 3 symptoms might the patient have?

A
  • Severe pain
  • Eating difficulties
  • Parasthesia
61
Q

What is the pathogenesis of this condition?

A

** Caused by Varicella-Zoster **
* Initially presents as chicken pox in childhood
* Retrograde transport to the trigeminal ganglion
* Triggers lead to anterograde transport leading to shingles

62
Q

What four things that may trigger this condition?

A
  • Immunosuppression
  • Ultraviolet light
  • Fever
  • Diabetes
63
Q

How can this be transmitted?

A
  • Direct contact
  • Air borne
  • Droplet
64
Q

What 4 complications associated with this condition?

A
  • Post herpetic neuralgia
  • Secondary bacterial infections
  • Ophthalmic zoster
  • Ramsay-hunt syndrome
65
Q

What treatment would you carry out ?

A
  • Prescribe aciclovir 800mg 5xD for 7 days
  • Preventative treatment
66
Q

What 3 preventative treatment would you carry out for this condition?

A
  • Early detection for prophylaxis 5% aciclovir topical cream
  • Manage triggers
  • HZV screening
67
Q

Describe the clinical presentation?

A

Gingival hyperplasia

68
Q

Give 3 drug types and conditions that may cause this?

A
  • Immunosuppressants - cyclosporine
  • Calcium channel blockers - amlodipine
  • Anticonvulsant - phenytoin
69
Q

What is the pathogenesis of this condition if induced by drugs?

A
  • Drug interacts with fibroblasts
  • Overstimulation leads to gingival overgrowth and false pocketing
70
Q

What are 4 risks associated with this condition?

A
  • Plaque accumulation
  • Difficulty fulfilling oral hygiene
  • Caries
  • Periodontal disease
71
Q

What is the rationale behind step 4?

A
  • Maintain stability of periodontal disease
  • Preventing relapse of periodontal disease based on risk-based recall a combination of step 1 and 2
72
Q

Following completion of active periodontal therapy, what are two diagnostic categories for step 4 patients?

A
  • Periodontitis patients with a healthy reduced periodontium
  • Periodontitis patients with gingival inflammation
73
Q

Give 5 preventative or therapeutic interventions used on step 4?

A
  • OHI Reinforcement TIPPS at recall appointments
  • Repeated targeted PMPR
  • Risk factor control and behavioral change
  • Use of adjuncts such as toothpastes and mouthwashed
  • Records keeping
74
Q

At what intervals should supportive periodontal care appointments be? and based on what?

A

3-12 months , based on risk and status of periodontal disease

75
Q

What is the recommended interdental cleaning method for SPC patients?

A

Interdental brushes

76
Q

What is the recommended adjunct that can be considered in specific SPC patients? and why?

A
  • Antiseptics = CHX
  • To control gingival inflammation
77
Q

What are the recommended 2 risk factors which should be controlled in SPC?

A
  • Smoking
  • Diabetes
78
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • Describe the patient oral hygiene?
A

** Poor oral hygiene **
* interdental and posterior plaque
* heavy calculus in lower anterior
* Caries posteriorly on radiograph

79
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • Describe the gingival condition?
A
  • Mild oedema and erythema especially on 12,22
  • Loss of interdental papillae
  • Recession on lower anteriors 41/31/32
80
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • Describe teeth and restorations?
A
  • Heavily restored posterior dentition
  • Mild staining in palatal pits upper 2s
81
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • What further investigations will you carry out?
A
  • Diet diary
  • Modifies plaque and bleeding scores
  • Full mouth six point pocket chart
  • Sensibility testing of 12
82
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • How does the radiographic appearance correspond with the clinical findings?
A
  • Horizontal bone loss relative to clinical gingival presentation
83
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • What is your periodontal diagnosis?
A
  • Generalised periodontitis, Stage 4 Grade ,C Risk factors non , currently unstable
84
Q
  • Mr floss is a new patient
  • C/O - bleeding on brushing , loose 22 getting worse
  • SH - 50 yrs old , non-smoker
  • O/E -
    12,21,22 - Grade III mobile
    25,37,45 - Grade II mobile
    11,24,36,46 ,47 - Grade I mobile

BPE 4/4/4
4/3/4

  • How would you describe the bone loss on distal of 36?
A
  • Angular bony defect
85
Q

Give the 4 classes of angular bony defects types

A
  • Class I = one walled
  • Class II = two walled
  • Class III = three walled
  • Class VI = combined osseous defects
86
Q

How do angular bony defects form?

A

They for due to plaque accumulation in a specific region causing scalloping , may be due to
* Endo-perio lesion
* Occlusal trauma
* Periodontal abscess

87
Q

How may angular bony defects affect the treatment of a periodontal patient? (3)

A
  • May respond poorly to non surgical instrumentation
  • May require treatment adjuncts such as CHX
  • May require surgical instrumentation or regenerative surgery
88
Q

Give 4 members of the team that take care of a periodontal patient?

A
  • General dental practitioner
  • Dental hygienist
  • Dental nurse
  • Oral health educator
  • Periodontal specialist
89
Q

When prescribing LA, What 4 details should be included in Patient specific directions?

A
  • Type of anaesthetic
  • Maximum does of anaesthetic
  • Frequency
  • Route of adminstration
90
Q

When should periodontitis patients be referred ?

A
  • Step 2 patients who have not responded to initial non-surgical therapy
  • Who show engagement with OHI and improvement in life style in risk factor management
  • Grade C patients after initial therapy
91
Q

What information should be included in a referral letter?

A
  • Referrer details
  • Patient details
  • Medical history
  • Social history
  • Clinical information
92
Q

When should a dentist prescribe LA to hygienist ?

A

As required

BDS4 (63 decks)

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