Restorative - Periodontology Flashcards
1
Q
What clinical and lab investigation can you do to help with periodontal diagnosis?
A
- history and exmaination
- 6PPC
- Full mouth OPT or PA
- Microbiological analysis of sample (swap of cervicular fluid)
2
Q
How would you decide on the prognosis of individual teeth that have periodontal disease
Do in systemical way like new patient assessment to make sure dont miss anything
A
- Facial swelling due to periodontal abscess
- Loss of attachment
- Tooth mobility
- furcation involvement
What you assess on 6PPC bascially
3
Q
- What bacteria are implicated in periodontal disease?
A
P.ginigvalis
AA aggregtibact actinomycomitans
4
Q
- 2 further investigations to be carried out for perio patients to aid diagnosis ? (2)
A
6PPC
MP&BS
5
Q
Give 4 reasons tooth may have a poor prognosis in a periodontal patient?
A
- LOA (less supporting structures)
- Mobility (loss of bone support)
- furcation involvement (difficult to keep clean for patient, increase risk of caries
- Non longer vital
6
Q
- What patient factors affect prognosis of teeth? (2)
A
- Smoking
- diabetes
- family history of periodontal disease
- Stress
- Levels of OH
- Immunosuppressed and pregnancy
7
Q
Risk Factors-
1. Why is diabetes a risk factor in periodontal disease?
A
- In patients with poorly controlled glucose levels there are increased advanced glycation end products (AGE) (due to reaction of glucose and other glycating compounds) which causes microvascular changes (including increased inflammatory cytokine release and chemotaxis such as TNF &interleukins, increased permeability and adhesion of endothelial cells and increased MMPS) this increases systemic inflammation therefore increasing risk of periodontal disease
- Also, implications of poor wound healing and immunosuppression (as a result of impaired neutrophil function) and alteration of collagen metabolism in poorly controlled diabetics
8
Q
What tests are carried out to tests for diabetics?
A
- Fasting plasma glucose
- Random plasma glucose
9
Q
- What is the normal value for this? Fasting and random plasma glucose.
A
- RPG- normal < 11.1mmol/L, diabetes > 11.1mmol/L on 2 separate occasions
- FPG- normal <7mmol/L, diabetes >7mmol/L on 2 separate occasions
10
Q
- Give 1 test for diabetic control?
A
- Hb1aC- glycated haemoglobin
11
Q
- What is it normal value for a Hb1aC in a patient who has well controlled diabetes.
A
- <7% (treatment aims for 6.5%)
12
Q
- How does smoking affect the periodontal tissues?
A
- Smoking impairs the vasculature of the gingival and periodontal tissues resulting in reduced blood flow (shown through less gingival erythema and bleeding on probing- masking effect on gingivitis and periodontitis)
- It also alters the recruitment (via chemotaxis) and function of various inflammatory cells including neutrophils
- Shifts the inflammatory balance towards tissue destruction through increased production and expression of pro-inflammatory mediators such as cytokines
- Can also result in impaired wound healing
13
Q
- What is interleukin 1 and what does it do?
A
- Pro-inflammatory cytokine which plays a role in the regulation of immune responses
- Produced by a range of cells including epithelial cells, macrophages, endothelial cell and B cells
- Stimulated the release of enzymes and osteoclasts causing increased tissue destruction
14
Q
- What do the values mean for BPE?
A
- 0- black band showing completely, no BoP or plaque retentive factors (no Tx, OHI)
- 1- black band visible, BoP, no plaque retentive factors (Tx- OHI)
- 2- black band visible, BoP, supra or sub-gingival calculus or plaque retentive factors (Tx- OHI, remove plaque retentive factors, supra-gingival scaling and RSI as required)
- 3- black band on partially visible pocket 3-5-5.5mm (Tx- OHI, remove plaque retentive factors, supra-gingival scaling and RSI as required, 6ppc at review)
- 4- black ban no longer visible pocket >5.5mm (Tx- OHI, remove plaque retentive factors, supra-gingival scaling and RSI as required, 6PPC full mouth)
- *- furcation involvement
15
Q
- How is mobility graded?
A
- 0- physiological movement 0-0.2mm
- 1= <1mm horizontal movement
- 2= 1-2mm horizontal movement
- 3= >2mm horizontal and vertical movement (rotations and depression)