Study Guide Flashcards
NUG
Necrotizing ulcerative gingivitis
Symptoms of NUG
Painful interdental papilla and severe inflammation of the gingiva
Ehlers Danlos syndrome
Heritable disorder of connective tissue
Symptoms of ehlers danlos syndrome
Easy bruising
Joint hyper mobility
Skin laxity
Weakness of tissue
Most significant oral manifestation of ehlers danlos syndrome
Weekly onset generalized periodontitis
Can lead to premature loss of deciduous and permanent teeth
NPD
Necrotizing periodontal disease- an inflammatory destructive infection of periodontal tissues that involve tissue necrosis.
Includes NUG AND NUP
NUP AND NUG
Painful infections with ulcerations, swellings and sloughing of dead epithelial tissue.
NUG
Tissue necrosis limited to gingival tissue
NUP
Tissue necrosis of gingival tissue combined with loss of attachment and alveolar bone
Symptoms of NUP
Extremely rapid bone loss.
Loss of periodontal attachment within days
NPD (necrotizing periodontal disease) will look like what clinically
Punched out or cratered papilla
Ulcerated margin bounded by red halo
Do periodontal pathogens cause periodontal disease?
Not alone—- there must be a host response to cause the loss of attachment and alveolar bone
Secondary occlusal trauma
An unjust as a result of occlusal forces on a tooth or teeth that have previously attachment and/or bone loss
—the periodontitis was unhealthy BEFORE experiencing excessive occlusal forces
What may result as from secondary occlusal traumas
Rapid bone loss and pocket formation
Papillon- lefevre syndrome
Inherited disorder of defective leukocyte chemotaxis.
— is rare.
Symptoms of papillon-lefevre syndrome
Recurrent bacterial and fungal infections
Impaired pus formation
Delayed wound healing
Perio disease begins upon eruption of primary teeth with rapid attachment loss and early tooth loss.
Guidelines for fundamental decision making
- ) does the clinical assessment indicate healthy or inflammatory disease?
- ) If inflammatory disease is present is it gingivitis or periodontitis?
- ) If gingivitis, what type? (Aggressive, localized, etc.)
- if periodontitis, what type?
Master TX plan
Sequential outline of measures to be carried out by dentist, dental hygienist, or patient to eliminate disease and restore a healthy periodontal environment
The master TX plan can be used to
Coordinate and sequence ALL TX and educational measures employed
The master TX plan may not include
TX by the dental hygienist directly, but hygienist must understand how all TX phases contribute to goal
When diagnosing periodontal disease the dental team must document:
- ) diagnostic term (aggressive, chronic perio)
- ) disease severity (slight,moderate, severe)
- ) disease extent
NSP therapy (non surgical periodontal therapy) includes
All non surgical measures used to control gingivitis and periodontitis
-including measures to eliminate local contributing factors
NSP therapy includes all of these
Pt self care education Nutritional counseling Smoking cessation counseling Periodontal debridement Antimicrobial therapy Correction of local risk factors Fluoride therapy Caries control and temp. Restorations Occlusal therapy Minor ortho TX Re-evil of phase 1 therapy
NSP therapy is also referred to as
Initial periodontal therapy
Phase 1 therapy
Bacterial control
Anti infective therapy
During NSP the hygienist must make sure
That the pt understand all TX options
Informed consent
A patients voluntary agreement to proposed TX
Pt can only give informed consent after:
The pt understands the relevant facts, benefits and risks involved
The dental professional must inform the patient of these things before they can make an informed consent
1.) recommended TX
2.) alternative TX
3.) the likely consequences of refusing TX.
—in a language the patient understands
surgical phase of periodontal therapy includes:
Any needed periodontal surgery and placement of dental implants
—by needed for all pt’s
Surgical therapy is also called
Phase 2.
Periodontal maintenance phase includes
All measures used by dental team and patients to keep periodontitis from recurring once the inflammatory disease is under control
The point of periodontal maintenance phase is to:
Maintain functioning teeth throughout life and may be needed for there rest of a pts life
Difference in periodontitis and gingivitis
Clinical loss of attachment (in periodontitis)
Signs of periodontal disease:
Can be observed and are measurable by the clinician
Symptoms of periodontal disease:
Features noticed by the patient
Hidden signs of inflammation:
Signs that are not visible just by looking in the patients mouth.
Hidden signs of inflammation include:
- ) bone loss
- ) purulence (exudate)
- ) bleeding on probing
Informed refusal:
A pt has the right to refuse all TX or a portion of the proposed TX
—pt always has the right to refuse proposed periodontal care.
Questions hygienist can ask to make patients ask more about their care.
Open ended exchange of info and non direct questions (not just yes or no)
- ) what more would you like to know?
- ) what are your concerns?
- ) what is your next question?
Chediak-higashi syndrome:
Inherited disorder of immune and nervous systems.
—rare
Symptoms of chediak-higashi syndrome
Pale colored hair,eyes and skin
Prone to severe periodontitis
Familial and cyclic neutropenia
Hereditary and congenital disorder affecting bone marrow
Symptoms of familial and cyclic syndrome
Severe periodontal destruction at a young age
Abnormally low levels of neutrophils.
Down syndrome:
Caused by error in cell destruction w: additional 3rd chromosome.
1 in 691 children born with DS.
Mild/moderate cognitive effects
Most common genetic condition
Down syndrome
Symptoms of Down syndrome
Early onset periodontal disease
Substantial plaque biofilm formation
Deep perio pockets
Extensive gingival inflammation
Periodontal disease strongly associated with HIV infection
Classified as linear gingival erythema (LGE) but used to be known as HIV associated gingivitis
symptoms of LGE
- 2-3 mm band of intense erythema in the free gingiva
- May extend into attached gingiva and alveolar mucosa.
- may be localized to 1-2 teeth but it’s more common to be generalized.
Cytokines
Recruit PMN’s and macrophages to infection site and increase vascular permeability
-have potential to initiate tissue destruction and bone loss.
Cytokines are associated with
Interleukin 1,6,8 and tumor necrosis factor beta.
Prostaglandins
Increase permeability leading to redness and edema of connective tissue.
—can trigger osteoclasts
What initiates most of alveolar bone destruction
Prostaglandins
MMP’s (matrix metalloprotenases)
—In absence of disease: facilitate normal turnover of periodontal connective tissue matrix
—in presence of chronic bacterial infection: large amounts released to kill invading bacteria, resulting in enhanced breakdown of connective tissue and periodontium.
Increased levels of MMP’s will cause
Extensive collagen destruction
Bacterial accumulation: initial lesion
2-4 days after plaque biofilm accumulation.
Gingiva appears healthy clinically
Early gingivitis: early lesion
4-7 days after plaque biofilm accumulation.
Edema and redness of gingival marginal tissues can be seen clinically
Established gingivitis: established lesion
21 days after plaque biofilm formation.
All clinical feature of gingivitis can be observed clinically
Periodontitis: advances lesion
Perio pockets formed Bleeding on probing Alveolar bone loss Furcation involvement Tooth mobility Can all be seen clinically
Phases of management of pts with periodontal disease:
- assessment phase and preliminary therapy
- nonsurgucal periodontal therapy
- surgical therapy
- restorative therapy
- periodontal maintenance
Assessment phase
Health hx Comp. exam Assessment data collection Radiographs Diagnosis of oral conditions TX of urgent conditions Planning of NSP therapy Referral for care of medical conditions Extraction of hopeless teeth
Surgical therapy
Periodontal surgery
Endodontic surgery
Dental implant placement
Restorative therapy
Dental restorations
Fixed and removable prosthesis
Re evaluation of overall response to TX
Periodontal maintenance
Ongoing care at specified intervals
