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Perio > Second half > Flashcards

Second half Flashcards

1
Q

CAL

A

Measured pocket (probe depth) + visible recession below CEJ

(In this image the CAL= 8mm)

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2
Q

Plaque disclosing agents

A

-Fuchsia-colored erythrosine sodium solution

-Visual aid for patients to see plaque build up

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3
Q

What drugs are associated with gingival enlargements (hyperplasia)?

A
  1. Calcium channel blackers (Nifedipine & Diltazem)
  2. Anticonvulsants (phenytoin)
  3. Immunosuppressants (cyclosporin)
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4
Q

A tooth brush should have a ______ head (about ________ in size).
It should have ____, _______, ________ bristles, usually in ____ rows.

A

-relatively small head

-1-1.25 inches for adults

-soft nylon
-multitufted
-polished

-3

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5
Q

The force of which bristles are applied to the tooth should not exceed

A

300-400g

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6
Q

Modified Bass technique

A

Effective toothbrush technique, ESPECIALLY for patients with ginigivitis & periodontitis.

Bristles at 45 degree angle, small vibratory/circular motions (known as sulcular brushing).

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7
Q

Natural vs. Synthetic toothbrush bristles

A

Natural bristles contain gaps that bacteria can colonize.

They don’t have rounded ends, which can cause lesions to the gingiva.

Synthetic bristles have end-round filaments that reduce the damage to gingiva.

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8
Q

Modified Stillman method

A

-Vertical, Rotary brushing

-a series of brush movements repeated 5-10 times in the same area

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9
Q

When is vertical brushing indicated?

A

-Overlapped teeth
-Open interproximal areas
-areas of recession

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10
Q

Fones method of brushing

A

Max teeth closed, circular motion from max gingiva to mand gingiva

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11
Q

Where is toothbrush trauma most frequently seen?

A

The facial surfaces of canines & premolars

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12
Q

What is the purpose of interdental care?

A

Disease originates in the interproximal areas.

The purpose is to remove plaque, NOT food debris.

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13
Q

What dictates the effectiveness of dental floss?

A

The anatomy of the tooth (areas might be missed due to shape of the tooth)

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14
Q

Pre-Armitage classification of gingival diseases

A

-Older classification system of gingivitis vs. periodontits based on probing depth (NOT attachment loss)

-Didn’t account for many systemic health considerations

-Had the term “refractory periodontitis”

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15
Q

Armitage classification of gingival diseases

A

-Gingival disease classification system that is based primarily on attachment level/loss

-Didn’t account for many systemic health considerations

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16
Q

Current classification of gingival diseases

A

-Oncology model

-Has stage and grade

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17
Q

In the new periodonal classification system, does the stage or grade improve with periodontal treatments?

A

The grade can improve with treatment and better oral hygiene, but the stage will never improve (can get worse).

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18
Q

Classifies severity and extent of disease based off measurable data, helps assess complexity.

A

Periodontal Staging

4 stages (see attached picture)

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19
Q

Used to indicate the rate of periodontitis progression, responsiveness to therapy, and potential impact on systemic health.

A

Periodontal Grading

3 Grades (A-C; see chart)

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20
Q

Intitial examination determines:

A

-Diagnosis

-Tx plan

-Prognosis

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21
Q

What is included in the exam/data collection of the initial exam?(6)

A
  1. Medical hx
  2. Chief complaint
  3. Dental hx
  4. Radiographs
  5. Extra-oral exam
  6. Intra-oral exam
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22
Q

What % of patients at dental schools require medical consultation?

A

25%

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23
Q

What are the 4 categories of periodontal health?

A
  1. Pristine periodontal health
  2. Clinical periodontal health
  3. Periodontal disease stability
  4. Periodontal disease remission/control
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24
Q

Clinical Periodontal health

A

-absence/minimal levels of clinical inflammation

-normal osseous support

-CAL exists, but due to predisposting factors (recession, fenestrations, toothbrush abrasion)

-NOT due to active periodontal disease activity

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25
Q

Periodontal disease stability

A

-absence of inflammation & infection (reduction in predisposing factors and control of modifying factors)

-reduced periodontium

-the goal of perio patients

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26
Q

Periodontal disease remission/control

A

-Cannot fully control modifying/predisposing factors

-decreased inflammation

-improved clinical parameters

-stabilization of disease progression to low disease activity

-an acceptable alternative threapeuting goal in long-standing perio disease patients

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27
Q

Health vs. Stability

A

Health= minimal recession w/out pre-existing active perio disease

Stability= healthy state of a patient with previous perio disease (has attachment loss)

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28
Q

Pristine clinical health

A

Absence of :

-attachment loss

-BOP

-Clinical erythma, edema, & pus

-pocket depths greater than 3mm

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29
Q

What cells are increased in the initial lesion of healthy gingiva (clinically)?

A

Neutrophils

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30
Q

What cells are increased in early lesions of clinically evident early gingivitis?

A

T lymphocytes

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31
Q

What cells are increased in established lesions of established chronic gingivitis?

A

Plasma cells

note, NO appreciable bone loss

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32
Q

What cells are increased in advanced lesions (the transition from gingivitis to periodontitis)?

A

Cytopathically altered plasma cells

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33
Q

Gingivitis is associated with ___________.
It is mediated by _______ or ______ factors.
What external factor can influence gingival hypertrophy?

A

-dental biofilm

-systemic

-local

-medications

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34
Q

Plaque-induced gingivitis is exacerbated by ______

A

sex steroid hormones (puberty, menstrual cycle, pregnancy, oral contraceptives)

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35
Q

Pyogenic granuloma

A

-Vascular epulis (tumor)

-almost exclusively in pregnant women

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36
Q

Granuloma

A

A tiny cluster of WBCs and other tissue.

Non-cancerous.

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37
Q

Pre-malignant neoplasms

A
  1. Leukoplakia (often associated w/tobacco use)
  2. Erythroplakia
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38
Q

Malignant neoplasms

A
  1. Squameous cell carcinoma
  2. Leukemic cell infiltration
  3. Lymphoma (Hodgkins & Non-Hodgkins)
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39
Q

When probing, when the gingival margin appears at a level between prob marks, do you read the higher or the lower mark as the measurement?

A

The higher mark

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40
Q

When charting in axium, if the pocket depth is 3mm and there is no sign of attachment loss, what value should you enter for the gingival margin?

A

-3 (put the negative value of the pocket depth)

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41
Q

When charting in axium, if the pocket depth is 5mm but the gingiva is inflamed and the gingival margin is above the CEJ (toward the crown), what value should you enter for the gingival margin?

A

Assume -2mm so that the pocket depth is at 3mm

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42
Q

When charting in axium, if the pocket depth is 4mm and the gingiva is located at the CEJ (can see black triangles), what value should you enter for the gingival margin?

A

0mm (reflects 4mm of attachement loss)

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43
Q

Scaling

A

The instrumentation of the crown & root surfaces to remove plaque, calculus, & stains w/out removing tooth substance

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44
Q

Root planing

A

The removal of cementum & surface dentin that’s impregnated w/calculus.

Objective= produce a smooth, hard, clean surface.

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45
Q

Why is root planing necessary?

A

Calculus becomes embeded in the irregularities of the cementum, thus it needs to be removed & a smooth surface established

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46
Q

Indications for SRPs

A

-inflamed/bleeding/edematous gingival tissues

-Gingival hyperplasia

-4mm+ pockets

-plaque, calculus, diseased cementum, endotoxins

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47
Q

SRP results (5)

A

-decreased inflammation & edema

-decreased pocket depth

-improved tissue tone

-smoother root surface

-decreased bacteria, plaque, and calculus

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48
Q

Subgingival calculus vs. Supragingival calculus

A

Subgingival is harder & more tenacious than supragingival calculus.

Subgingival calculus can be removed in an open or closed surgical procedure.

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49
Q

Does gingival curettage add any benefit to healing from SRPs?

A

No

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50
Q

For pocket depths >5mm, what is the success in total removal of calculus?

A

Failure of total removal of calculus dominates

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51
Q

What is one of the side effects of SRPs?

A

It exposed the dentinal tubules, which exposes the dentin to irritants that can cause pain.

Increases sensitivity to air, tactile, and thermal stimuli.

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52
Q

How long should you wait before scheduling a re-evaluation for SRP patients?

A

4-6 weeks

53
Q

Healing after SRPs:

What happens immediately after (2-8 hrs) root planing?

A

-Blood clot fills the gingival sulcus

-Hemorrhagine w/in tissue

-Appearance of PMNs leukocytes on the wound surface

54
Q

Healing after SRPs:

8-24 hours after, what is the clinical appearance?

A

Gingiva appears hemorrhagic & bright red

55
Q

Healing after SRPs:

2-7 days after what occurs?

A

Restoration & epithelialization of the sulcus (note, this is keratinized epithelium).

Reduction in the height of the gingival margin.

Gingiva is slightly redder than normal, but less so than the previous days.

56
Q

Healing after SRPs:

After 2 weeks:

A

-Gingiva regains normal color, consistency, surface texture, and contour

-Gingival margin is well adapted to the tooth

-Appearance of immature collagen

57
Q

Healing from SRPs results in the formation of a

A

long junctional epithelium

(sometimes the long JE is interrupted by islands of CT attachment)

58
Q

Chlorhexidine/Peridex

A

Antiseptic mouthwash that kills germs & destroys their protective coverings.

Can be used to prevent plaque.

Use prior to using a Cavitron.

59
Q

Side effects of Chlorhexidine/Peridex

A

-increased calculus formation

-staining

-altered taste

60
Q

Chlorhexidine/Peridex works due to

A

Substantivity (it remains on the pellicle & works for an extended period of time).

61
Q

When is periodontal surgical intervention indicated after SRPs?

A

-Consistantly acceptable levels of oral hygiene

-A number of gingival sites are still bleeding upon probing

-Significant reduction in probing depths has NOT been achieved

62
Q

When should a patient NOT be considered an acceptable candidate for periodontal surgery after SRPs?

A

-Poor oral hygiene

-Lack of motivation/ability to exercise proper home care

63
Q

When is a does a patient NOT require further perio treatment (other than routine maintenance)?

A

-Acceptable oral hygiene

-No gingival inflammation or BOP

-Probing depths significantly reduced

-Clinical attachment levels have improved

64
Q

Any patient with probing depths of ______ or greater should be referred to a periodontist

A

6mm

65
Q

In private practice, Stage ____ or _____ and Grade ___ perio patients should be IMMEDIATELY referred to a periodontitis.

A

-III
-IV
-C

66
Q

Phase I therapy

A

-AKA Hygienic Phase

-Elimination of active disease

-Goal is to reduce gingival inflammation and reduction of pocket depth through reduction of swelling

67
Q

What is included under Phase I therapy?

A

-OH instructions

-Prophy or SRP

-Antimicrobial agents

-Extraction of hopeless teeth

-Caries control

-Endo tx

68
Q

Ideal goal of treatment of periodontitis

A

periodontitis

-form new attachment

-regeneration of lost structures (alveolar bone, PDL, cementum, surrounding tissues)

note that there isn’t “regeneration” after an SRP, but there is healing with the long junction epithelium

69
Q

Repair vs. Regeneration

A

Repair: healing of a wound by tissue that does not fully restore architecture or function of the part

Regeneration: reproduction or reconstitution of lost or injured part

70
Q

New attachment

A

The union of CT and epithelium w/root surface that was deprived of its original attachment.

71
Q

Reattachment

A

To attach again.

Reunion of epithelium w/root surface & bone after incision/injury.

72
Q

What types of instruments are used for SRPs?

A

-Hand instruments

-Ultrasonic instruments

73
Q

What are the actions of ultrasonic scalers? (4)

A
  1. Allows for rapid removal of calculus
  2. Mechanical
  3. Cavitation (formation & collapse of bubbles by high-frequency waves surrounding ultrasonic tip)
  4. Irrigation (therapeutic washing of the pocket & root surface)
74
Q

________ are released from Gram negative bacterial cell walls and is toxic to humans. Release from bacteria covering the cementum triggers the _______. ______ penetrated deeply into the cementum and are held w/in calculus not removed during instrumentation.

A

-Lipopolysaccharides

-immune response

-Endotoxins

75
Q

Prior to instrumentation of subgingival area, what microorganisms dominate?

What microorganisms dominate after SRPs?

A

-Anaerobic, gram negative, motile bacteria

-Aerobic, gram positive, non-motile bacteria

76
Q

Why are perio maintenance recall exams every 3-4 months?

A

Anaerobic bacteria will become more active and need to be removed

77
Q

Contraindications of Ultrasonic instruments (10 points)

A
  1. Certain pacemakers
  2. Communicable diseases
  3. Medically compromised patients
  4. Patients at respiratory risk
  5. Patients with swallowing difficulty
  6. Titanium implants
  7. Some restorative materials (porcelain, composite, laminate veneers)
  8. Areas of demineralization
  9. Hypersensitive teeth
  10. Kids w/mixed dentition
78
Q

Universal (Straight) tip for ultrasonic scalers

A

-reaches all accessible surfaces

-MOST effective on buccal & lingual surfaces of all teeth and interproximal surfaces of anteriors

79
Q

Curved tips for ultrasonic scalers

A

Used for:

-interproximal surfaces of posteriors
-Furcations
-Mispositioned molars
-Concave surfaces

80
Q

Instrumentation fundamentals

A

-Use light lateral pressure

-Keep tip moving at all times

-Let the tip do the work

81
Q

If there’s a 1mm loss of an instruments tip, what % efficiency is lost? If there’s 2mm loss?

A

-25%

-50%

82
Q

Manual curette vs. Sonic/Ultrasonic

A

Manual is more efficient but requires increased time, effort, and expertise.

Ultrasonic insert designs are an adjunct to hand instrumentation.

The difference is clinically insignificant as long as you have achieved your goal of total debridement

Best results usually from starting with sonic/ultrasonic instruments followed by hand scaling

83
Q

Terminal shank

A

From the end of the working end to the first bend.

84
Q

Functional shank

A

From the working end to the handle

85
Q

Universal curette

A

Hand instrument used to treat subgingival surfaces; it has a blade with an unbroken cutting edge that curves around the toe and a flat face set at a 90-degree angle to the lower shank.

86
Q

Gracey curette

A

Curette with one cutting edge, “area specific”; it is designed to adapt to specific tooth surfaces (mesial or distal).

87
Q

curved sickle scaler

A

to remove large amounts of deposits from supragingival surfaces

88
Q

Straight sickle scaler

A

to remove large amounts of deposits from supragingival surfaces

89
Q

Overjet

A

-Excessive protrusion of the maxillary incisors

-Horizontal overlap

90
Q

Open bite

A

Open bite

No incisal contact; posterior teeth in normal occlusion

91
Q

Underjet

A

Maxillary teeth are lingual to mandibular teeth.

92
Q

Edge-to-Edge

A

Incisal edge to incisal edge of anterior teeth

93
Q

Anterior crossbite

A

maxillary incisors are lingual to the mandibular incisors

94
Q

Deep (severe) anterior overbite

A

Incisal edge of maxillary tooth is at the level of the cervical third of the facial surface of the mandibular anterior tooth

95
Q

Pathologic alteration/adaptive changes which develop in the periodontium as a result of undue force.

A

Trauma from occlusion

(Excessive occlusal force may cause TMJ, injury to masticatory muscles or pulp tissue.)

96
Q

Traumatizing forces may act on an individual tooth or groups of teeth in premature contact. This can occur in conjugation with ______ or ______.

A

-parafunctional habits
(clenching/bruxing)

-loss/migration of premolars/molars

97
Q

A reaction that’s elicited around a tooth w/normal height of the periodontium

A

Primary trauma from occlusion

98
Q

Occlusal forces cause injury in a periodontium of reduced height

A

Secondary trauma from occlusion

99
Q

Regardless of primary or secondary trauma from occlusion, the alterations which occur in the periodontium as a consequence of trauma from occlusion are __________.

Subjective symptoms of trauma from occlusion may develop only in situation when ___________ elicited by occlusion is so high that the periodontium around the exposed tooth cannot __________ with unalter position & stability of the tooth involved.

A

-similar & independent of the height of the periodontium

-magnitude of the load

-properly withstand & distribute the resulting force

100
Q

Causes of primary occlusal trauma

A
  1. High fillings
  2. Prosthetic replacements that create excessive forces on abutments and antagonistic teeth
  3. Drifting/extrusion of teeth into space created by unreplaced teeth
  4. Ortho movement into fx unacceptable positions
101
Q

Effect of occlusal forces on the periodontium is influenced by

A

-Magnitude
-Direction
-Duration
-Frequency

102
Q

Tissue responses to increased occlusal forces (3 stages)

A

Stage I= Tissue Injury (produced by excessive occlusal forces)

Stage II= Repair

Stage III= Adaptive remodeling of the periodontium

103
Q

Stage II of tissue responses to increased occlusal forces

A

Repair.

Damaged tissues removed, new CT & fibers, bone, & cementum formed in attempt to restore the injured periodontium.

Force remain traumatic ONLY as long as the damage produced exceeds the reparative capacity of the tissue.

104
Q

Stage III of tissue responses to increased occlusal forces (4)

A

Adaptive remodeling of the periodontium.

Results in thickened PDL.

Involved teeth can become loose.

NO ATTACHMENT LOSS

105
Q

Radiographic signs of occlusal trauma (3)

A

-Wide PDL w/thick lamina dura

-Vertical appearance of destruction

-Root resorption?

106
Q

T/F- Trauma from occlusion is reversible when the traumatic force is removed

A

True

107
Q

Result of periodontal infection; tooth moves up and down w/in socket

A

Pathological migration of teeth

108
Q

What happens with increasing the magnitude of occlusal forces?

A

The PDL thickens (increase in # and width of fibers)

109
Q

What happens with changing the direction of occlusal forces?

A

Reorientation of the stresses & strains.

Note that principal fibers of the PDL are arranged to accommodated forces along the long axis of the tooth.

Lateral & rotational forces can injure the periodontium.

110
Q

Duration of occlusal forces

A

Constant pressure on the bone is more injurious than intermittent forces

111
Q

Frequency of occlusal forces

A

The more frequent the application of an intermittent force, the more injurious the force is to the periodontium

112
Q

Tooth Mobility= 0

A

Within physiological limits

113
Q

Tooth Mobility= 1

A

less than 1mm movement in a BL/MD direction

114
Q

Tooth Mobility= 2

A

1mm + movement in a BL/MD direction

115
Q

Tooth Mobility= 3

A

exceeds 1mm movement in a BL/MD direction AND depressible occluso-apical direction

116
Q

Tipping movements occur when there are excessive force directed _______.

______ and _______ zones will develop within the _____ and _____ parts of the periodontium.

_______ alterations occur within theses zones, allowing the tooth to tilt in the direction of the force.

When the tooth has escaped the trauma, __________ of the periodontial tissues takes place.

In the absence of inflammation, there is NO apical down-growth of the _____.

A

-horizontally

-Pressure
-Tension
-marginal
-apical

-Tissue

-complete regeneration

-JE

117
Q

Movement of the tooth due to pressure & tension over the entire tooth surface.

A

Bodily movement

No inflammatory rx in gingiva of down-growth of JE (in the absence of inflammation)

118
Q

Buttressing bone

A

-the bone formation that occurs to repair trauma from occlusion

-attempt to reinforce weakened trabeculae

-may produce a bulbous/ridge-like distortion (lamellar bone with osteoclasts & osteoblasts)

119
Q

T/F- Trauma from occlusion, without inflammation, can induce periodontal tissue breakdown

A

False

120
Q

Which tooth has the worst prognosis in the mouth?

A

Maxillary 2nd molar

121
Q

What bacterium can be found in hidden pockets of localized aggressive periodontitis?

A

Actinobacillus actinomycetemcomitans

122
Q

D1110

A

Prophylaxis

(for healthy/gingivitis patients; 6mo recall)

123
Q

D4910

A

Periodontal maintenance (STP)

For patients who have completed SRPs; 3 month recall

124
Q

T/F- Metal instrumentation is used for calculus removal on implants

A

False; plastic instruments ONLY

125
Q

T/F- Acidic fluoride prophylactic agents are avoided for patients with implants

A

True; acidity damages the titanium abutments

126
Q

Peri-implant mucositis

A

Gingivitis around implant

127
Q

Per-implantitis

A

Periodontal disease around implants

128
Q

How do you calculate the attachment loss with both pocket depth and external measurements of the gingiva?

A

Measurement of mucogingival junction to gingival margin - pocket depth= remaining attachment

Perio (2 decks)

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