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SDCEP Guidelines > Prevention and txt of Periodontal disease in primary care > Flashcards

Prevention and txt of Periodontal disease in primary care Flashcards

1
Q

What is the key recommendation for assessment of perio pts?

A
  • Assess and explain risk factors for perio disease
  • Screen all pt for perio disease at every routine management
  • Carry out full perio exam for pts with BPE 3, 4 and *
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2
Q

What is gingivitis?

A
  • Plaque-induced inflammation of the gingivae characterised by red, swollen
    tissues which bleed on brushing or probing
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3
Q

What is Chronic periodontitis?

A
  • Characterised by the destruction of the junctional epithelium and connective
    tissue attachment of the tooth, together with bone destruction and formation of periodontal pockets.
  • The disease progresses slowly and the
    amount of bone loss tends to reflect the age of the patient over time
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4
Q

What is aggresive periodontitis?

A
  • A severe condition usually found in a younger cohort of patients, which
    may be associated with a familial history of aggressive periodontitis.
  • Disease
    progression is rapid and the degree of destruction of the connective tissue
    attachment and bone is severe, considering the age of the patient.
  • Plaque
    levels may be inconsistent with the level of disease seen
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5
Q

What is necrotising ulcerative gingivitis? NUG and NUP

A
  • Painful ulceration of the tips of the interdental papillae.
  • Grey necrotic tissue
    is visible and there is an associated halitosis.

The condition
is termed necrotising ulcerative periodontitis (NUP) in the presence of
connective tissue attachment loss and bone destruction.

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6
Q

What is periodontal abscess?

A
  • Infection in a periodontal pocket which can be acute or chronic and
    asymptomatic if freely draining
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7
Q

What are perio-endo lesions?

A
  • Lesions may be independent or coalescing and the bacterial source originates
    either in the periodontium or the root canal system
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8
Q

What is gingival enlargement?

A
  • Thickening of the gingivae which can occur as a response to irritation caused
    by plaque or calculus, repeated friction or trauma, fluctuations in hormone
    levels or the use of some medications
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9
Q

What are the main risk factors for periodontal disease?

A
  • Smoking
  • Poorly controlled diabetes
  • Poor controlled cardiovascular disease
  • Family history
  • Meds such as calcium channel blockers, phenytoin , ciclosporin = gingival enlargement (hyperplasia)
  • Hormonal changes in adolescents and pregnancy
  • Local risk factors like calculus , malpositioned teeth, overhanging rest, partial dentures
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10
Q

Why is smoking a risk factor of perio disease?

A
  • Reduces gingival blood flow (thereby supresses signs and symptoms of gingivitis)
  • Impair wound healinig
  • Increases production of inflammation mediating cytokines
  • Don’t respond as well as non smokers and increased risk of losing teeth
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11
Q

Why is poorly controlled diabetes risk of periodontsl disease?

A
  • Enhances signs and symptoms of gingivitis and periodontitis
  • Adverse affect on wound healing, making txt more difficult
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12
Q

What is the probing force of BPE screening?

A
  • 25g
  • Equivalent to force required to blanch a fingernail
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13
Q

Why does BOP occur?

A
  • Inflammation of periodontal tissues in response to presence of dental plaque and microorganisms leading to bleeding
  • Absence suggest periodontal health
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14
Q

Why do smokers not BOP?

A
  • Suppressed inflammatory response
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15
Q

What is a BPE? How is it done?

A
  • Screening tool for assessment of dentate adult pts
  • modified used for children and adolescents
  • Indicates what further assessment and perio txt is needed
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16
Q

How is a BPE done?

A
  • WHO CPITN probe (with 0.5mm diameter ball end) walked around gingival margin at pressure of 25g
  • Divide into 6 sextants (must include at least 2 teeth, if only one include in neighbouring sextant)
  • Record highest score for each sextant including any furcation involvement
  • Consider recording plaque scores for pts with sig plaque levels
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17
Q

What are the BPE scoring codes?

A
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18
Q

How do you screen children and adolescents <18yrs?

A
  • Modified BPE to avoid problem of false pocketing
  • Explain reason for exam
  • Using WHO CPITN probe with light 25g probing force examine 16, 11, 26, 36, 31, 46
  • BPE codes 0-2 used for 7 to 11 (mixed dentition) to screen for bleeding and presence of local plaque retentive factors
  • BPE codes normal for 12-17yrs olds (perm teeth erupted)
  • Refer any child immediately with evidence of perio or unexplained gingival enlargement to consultant paed dentistry, consultant restorative or specialist perio
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19
Q

What is the guidance for further assessment and txt based on BPE score?

A
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20
Q

What does a full periodontal examination involve?

A
  • Charting gingival margins (recssion)
  • Porbing depths
  • BOP
  • Moibility
  • Furcation involvement
  • Measured at 6 sites on each tooth
  • Using PCP 12mm probe walked around the gingival margin
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21
Q

Where does the normal gingival position lie? Why might it be coronal? Why might it be apical>

A

_ Normal lies at cementoenamel junction
- If swollen may be coronal to CEJ
- Apical in cases of gingival recession

22
Q

Why might pts be concerned of their ‘receding gums’?

A
  • Aestehtic concerns
  • Exposed root surfaces may be sensitive
23
Q

What is meant by probing depth? What might a change in this show?

A
  • Distance form gingival margin to base of the pocket
  • A decrease in probing depth can give good indication of response to perio txt in short term but cannot be recommended for assessment over long time
24
Q

What is the clinical attachment level (CAL)?

A
  • measured form fixed point usually the CEJ to base of periodontal pocket
  • Best measure of changes in remaining periodontal support over time
25
Q

What might bleeding from gingival margin/ base of pocket indicate?

A
  • Presence of gingivitis
  • Active disease
26
Q

What is the grading system of furcation involvement in full periodontal examination?

A
27
Q

How is tooth mobility assessed in full periodontal examination?

A
  • Horizontally by applying gentle pressure in buccal lingual direction using index finger and instrument of mirror on either side of tooth and assess level of displacement
  • Vertically by applying gentle pressure on the crown of tooth with rigid instrument handle in vertical direction
28
Q

What is the mobility grading scores?

A
29
Q

What is a useful way to motivate and monitor pts oral hygiene control?

A
  • Use mod plaque and scores giving a percentage score for each quadrant
  • Plaque disclosing tablets or solutions can also aid detection of plaque and be helpful for visual demonstartion
30
Q

What other diagnostic tools are helpful for periodontitis pts?

A
  • Study models to monitor gingival recession
  • Clinical photographs calibrated by inclusion of probe also to monitor gingival recession
  • radiographs for diagnosis, treatment planning
31
Q

What do radiographs allow the practitioner to assess?

A
  • Level of alveolar bone
  • Periodontal ligament space
  • Periapical region
  • Identify subgingival calculus
  • Defective restorations
  • Root length and morphology
  • Remaining bone support of periodontal involved teeth inc assessment of furcation involvement
32
Q

Describe what you see in these parallax periapical radiographs

A

A
- Horizontal bone loss up to 50% of root length
- Calculus on root surfaces 17D, 18M
- Inadequate root canal treatment 15

B
- Horizontal bone loss 26D/ 27M of 15% root length
- Overhanging restorations 26M, 26D, 27M
- Fractured restoration / secondary caries 27D

33
Q

For uniform probing depths of >=4 and <6mm and little or no recession what radiographs would you take?

A
  • Horizontal bitewings
  • if anterior teeth take intra oral PA
34
Q

For probing depth >=6mm what radiograph would you take?

A
  • Intra oral PA of all affected teeth
35
Q

What do you need to include in radiographic periodontal assessment?

A
  • Degree of bone loss as a percentage if root apex visible
  • Type of bone loss (horizontal or angular infrabony defects)
  • Furcation’s defects
  • Subgingival calculus
  • Perio-endo lesions, widened PDL, abnormal root length or morphology, overhanging and defective rest, caries
36
Q

What are the ORAL TIPPS for goals of intervention?

A
  • Talk with pt about cases and discuss barriers to effective plaque removal
  • Instruct pt on best to perform effective plaque removal
  • Ask to practise cleaning teeth and use interdental cleaning aids whilst in the surgery
  • Put in place a plan how they can incorporate into daily life
  • Provide support at following visits
37
Q

How can smoking cessation be incorporated into visit?

A
  • Ask if they do and record in notes
  • If stopped congratulate
  • If not ask if they want help and remind services available
  • remind about stopping improves not only overall health, but mouth health too, reduces oral cancer risk
38
Q

Other than oral hygiene what is good advice to give pt in regard to healthy lifesyle?

A
  • Smoking cessation
  • Alcohol consumption (men <21units per week no more than 4 in a day and women <14units nor more than 3 in a day)
  • Regular exercise
  • Healthy diet low in sugar, salt and fat, high in veg fruit and starchy foods
  • Drink enough water
39
Q

What can odeoma and hyperplasia result in (in regard to gum health)?

A
  • False pocketing
40
Q

What medications and their disease can result in drug induced gingival enlargement?

A
  • Calcium channel blockers for hypertension
  • Phenytoin for epilepsy
  • Ciclosporin for anti-rejection drug or some autoimmune conditions
41
Q

What is the treatment for drug induced gingival enlargement?

A
  • Condition may respond to non surgical txt
  • More severe cases may need to alter drug regime with consult with pts physician
  • Periodontal surgery may also be required ot reduce and recontour the gingiva
42
Q

What is the management of pregnancy associated gingivitis?

A
  • Adequate oral hygiene usually enough but if gingival enlargement then may require further care
  • most resole after delivery of baby but caution breastfeeding can extend condition
43
Q

What condition can unexplained gingivitis and gingival enlargement be associated with?

A
  • Unexplained, gingival enlargement, inflammation and bleeding can be sign of undiagnosed leukaemia in children and adults
44
Q

What si the goal pf non surgical periodontal treatment?

A
  • Signs of periodontal stability which are easy to sustain
  • Plaque scores below 15%
  • Bleeding scores below 10%
  • Probing depth <4mm

But this is not the same for everyone, if pts have sig improved oral hygiene, reduced BOP and reduction in probing depth from baseline then considered responded well to treatment and may progress to supportive perio therapy

45
Q

What is the role of the clinician in non surgical periodontal therapy?

A
  • Explain to pt potential benefits of successful txt including stabilisation of disease and reduced risk of tooth loss
  • Explain pts role and make clear it is chronic condition that needs to be managed
  • Emphasises management is partnership between clinician and pt and requires life long commitment
  • Oral Hygiene TIPPS
  • Smoking cessation
  • remove supra gingival plaque , calculus and stain with approp method
  • Correct local plaque retentive factors
  • Root surface instrumentation at sites >=4mm probing depth where sub gingival deposits or BOP
  • May exp discomfort and sensitivity following txt and expect some gingival recession as result of healing
  • Full perio exam min 8 weeks after txt
46
Q

How to use the sonic instruments?

A
  • Use only sides of working tip for debridment without applying lateral pressure
  • Overlapping stroked to affect surface
47
Q

Give some examples of local plaque retentive factors

A
  • Mal positioned teeth
  • Overhanging restorations
  • Crown and bridgework
  • Partial dentures
  • Fixed and removable ortho appliances
48
Q

Pts may complain of sensitivity following therapy. How can this be managed?

A
  • Consent prior to therapy that this may occur
  • Oral hygiene TIPPS
  • Desensitising toothpastes useful to place small amount in that area (need plaque free dentine for this to work)
  • High fluoride toothpaste can be prescribed or fluoride varnish or dentine bonding agent
49
Q

What bacteria is associated with NUG ?

A
  • Anaerobic fusospirochaetal bacteria
50
Q

What are risk factors for NUG?

A
  • Stress
  • Smoke
  • Immunosuppressed
  • poor oral hygiene
51
Q

What is the management of NUG?

A
  • Excellent OHI
  • Smoking cessation
  • Remove supra gingival plaque, calculus and stain and sub gingival using sonic or hand (LA may be needed)
  • 6% hydrogen peroxide or 0.2% chlorhexidine mouthwash until acut symptoms subside
  • If evidence of spreading infection or systemic involvement consider metronidazole 400mg 3/3
  • review in 10 days and caryr out further supra and sub gingival instrumentation as required and arrange appropriate recal
  • If no resolution signs and symptoms occur review pts general health and consider referral to specialist
52
Q
A

SDCEP Guidelines (5 decks)

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