Primary Care Flashcards
What percentage of the adult population is affected by periodontitis, severe periodontitis, and how common is the disease in the world ?
50%
11%
6 th most common
What is the prevalence of peri implant mucositis and peri implantitis ?
Mucositis is 43%
Implantitis is 22%
What factor causes progression of periodontitis ?
Sub gingival bacteria which are derived from supra gingival plaque
What is a predictor of tooth loss ?
Continued gingivitis
What is the best method for treating and preventing gingivitis and peri implant mucositis ?
Mechanical plaque control
What does mechanical plaque control involve ?
Self care
Professional mechanical plaque removal
What does chemical plaque control involve ?
Self care
Professional
How many hours does it take to produce gingival inflammation ?
48
What level of mechanical plaque control is sufficient to maintain gingival health ?
Tooth brushing and interdental cleaning once daily
What interventions are effective in improving oral hygiene behaviour in patients with periodontal disease ?
Goal setting , self monitoring, planning, understanding seriousness of disease
How effective is a manual toothbrush at plaque removal ?
Ineffective 42%
What force should be exerted on a mainsail toothbrush ?
Up to 4 N
What is the plaque score reduction for a toothbrush with flat trim, multi level and crisscross bristles ?
Flat trim is 24-47%
Multi level is 35-54%
Crisscross is 39-61%
How effective are electric toothbrushes at plaque removal ?
Effective 46%
In which area of the tooth surface are electric toothbrushes shown to be superior ?
Approximal surfaces
By how much do electric toothbrushes reduce plaque and gingivitis compared to Manual brushes ?
Plaque 11-21%
Gingivitis 6-11%
By how much does interproximal cleaning reduce plaque on the approximal surfaces ?
50%
Where should pmpr be concentrated ?
Tooth surfaces normally neglected by the patient ie Buccaneers lingual and interproximal
How long should be spent on each tooth surface when polishing ?
3-7 seconds, complete plaque removal takes 5 minutes using rubber cup and pumice
What effect does frequent pmpr have on diseased periodontal pockets ?
Quantitative reduction of sub gingival micro flora and qualitative shift to less pathogenic micro organisms
What is the standard care for peri implant mucositis ?
Professionally and patient administered plaque control
What evidence is there that tooth paste reduces gingivitis ?
Standouts fluoride
Triclosan/ copolymer
Chlorhexidine
What a evidence is there that mouthwash reduces gingivitis ?
Amine fluoride
Cpc
Essential oils
Chlorhexidine
What percentage of a population suffers from severe periodontitis ?
5-20%
Why may treatment of control of periodontal disease be deferred or declined ?
Poor general health
Lack of compliance
Patients or operators own choice
First what purpose were indicies first developed ?
Epidemiology studies
What factors do indicies reflect?
The pattern of aetiology, pathogens is and treatment concepts
What categories are periodontal index systems classified into ?
Inflammatory changes Loss of periodontal tissues Oral hygiene Bone loss / mobility Treatment needs
What so the definition of an index ?
A numerical value describing the relative status of a population on a a scale with an upper and lower level
What are the qualities of a good index ?
Reliable and valid
Allows comparison of disease severity between groups
Subject to examiner variability depending on training and experience
Why should caution be taken when interpreting data from clinical indicies ?
Most indices follow an ordinal scale eg turesky
But most subsequent analyses are non parametric
Describe a nominal measurement scale
Lowest statistical power
No ranking or structure
Describe an ordinal measurement scale
Describes difference of gross order but not differences in degree of order
Describe an interval scale
Eg pain scale
Why is a ratio the highest power of measurement ?
There is a true 0 eg measurement of pocket depth
What determines the development of a classification system ?
Consensus if international group of experts
What type of inflammation is seen in most periodontal diseases ?
Chronic
What is chronic periodontal disease and what is it characterised by ?
Plaque related periodontal disease characterised by extent and severity in relation to the patients age
How is the extent of chronic periodontal disease measured ?
Extent is number of sites involved :
Localised up to 30% of sites affected
Generalised more than 30% of sites affected
How is the severity of chronic periodontal disease classified ?
According to clinical attachment loss
Mild 1-2 mm cal with 0-25% bone loss
Moderate 3-4 mm cal with 25-50% bone loss
Severe 5 or more mm cal with more than 50% bone loss
What is the aim of periodontal therapy ?
To achieve a pocket depth of 3 mm or less
What is the significance of bop for disease ?
Presence is 30 % predictor for disease
Absence in 98% indicator of periodontal a stability
How is clinical attachment loss measured ?
From amelo cemental junction to base of pocket
What is cal a measure of ?
Sum of total periodontal destruction since eruption
What is used to diagnose periodontal disease ?
1999 classification of periodontal disease
What are the additional signs of gingivitis ?
Bad or metallic taste
Halitosis
False pocketing
Fibrous tissue reaction
Describe the Loe and Silness 1963 gingival index
Subjective assessment of gingivitis based on colour consistency and bleeding
0 is normal
1 is mild colour change, slight inflammation, oedema, no bleeding
2 is moderate inflammation, redness, oedema, bleeds on probing
3 is severe inflammation, very red, ulceration, spontaneous bleeding
4 sites on each tooth examined and divided by number of sites to give average
Which systemic factors can modify plaque induced gingival disease ?
Diabetes, puberty, pregnancy, menstrual cycle (endocrine)
Leukaemia ( blood dyscrasias)
What can cause non plaque induced gingival lesions ?
Bacteria eg neisseria gonorrhea Fungi eg candida viral eg herpes Genetic Trauma Foreign body reactions Systemic conditions eg mucocutabeous disorder, allergy
What bacteria are associated with necrotising ulcerative gingivitis?
Spirochaetes and fusiform
What systemic factors contribute to necrotising ulcerative gingivitis?
Smoking Severe malnutrition Stress Compromised immune system hiv or aids Blood dyscrasias eg acute leukaemia
Describe the histology of nug
Necrotic surface epithelium and underlying connective tissue
Dense acute inflammatory infiltration
Increased plasma cells lymphocytes and macrophages
What is the most common site of ulceration in nug?
Interdental papilla
Describe the character of the ulcers in nug
Crater like, pseudomembranous, covered by yellow or white or grey Slough
What a re the symptoms of nug?
Slight fever, malaise, painful gums, dead feeling teeth, swollen submandibular and cervical lymph nodes
How is the acute phase of nug managed ?
Irrigate with ultrasonic
Use oxygen releasing mouthwash
Metronidazole is antibiotic of choice
Chlorhexidien mouthwash
How is nug managed following initial treatment ?
Supra and sub gingival debridement
Remove local predisposing factors
If cause unexplained consider medical examination and blood screening
What is cancrum oris ?
Associated with poverty, immunosuppressive therapy
What diseases commonly precede noma cancrum oris ?
Measles , malaria , severe diarrhoea, nug
What are the early features of cancrum oris ?m
Soreness of mouth, pronounced halitosis, foetid taste, blue black discolouration of skin
How is acute noma managed ?
Correct dehydration and electrolyte balance
Nutritional rehabilitation
Treat predisposing disease
Antibiotics
Antiseptic
Physiotherapy to reduce fibrous scarring
Serological test for HIV
How is a peri apical abscess diagnosed ?
No pupal response
Apical lesion on radiograph
No increased probing depth
How is a peri coronal abscess diagnosed ?
Partially erupted tooth
Adjacent vital teeth with no increased pocket depths
Describe the classification of combined perio endo lesions
Class 1 - primary endodontic lesion draining through pdl
Class 2 - primary endodontic lesion with secondary periodontal involvement
Class 3 - primary periodontal lesion
Class 4 - primary periodontal lesion with secondary endodontic involvement
What are the treatment options for a combined perio endo lesion ?
If class 1 endodontic treatment and reassessment
If class 3 periodontal treatment and reassessment
Root resection
Extraction
