W13 Perio classification Flashcards
What are factors in determining prognosis?
Compliance Plaque control Caries Anatomy of tooth eg; root concavities, development grooves. Smoking Diabetes
What will determine prognosis?
Frequency of appointments is related to risk. Related to compliance, consider history in planning. Explain and document options you have told patient. Prognisis risk for each of the options. Also do nothing is an option but has poor prognosis
What is the Preliminary phase and Phase 1?
Resolve acute problems, stabilise active disease and phase 1 aetiological factors. Sequence by priority: Stablising periodontal health Stabilizing caries Mouth guards Eg. sequencing by quadrants Phase 1: Diet assessment/ counciling Identifying pt education and self care awareness implications/positives Smoking/ceasation Fluoride theraphy Sealants Debridements Hard tissue desenitisating (careis, frac, attr, erosion) Staining Behavioural management, GP (uncontrolled diabetes) Occulsal assessement
Explain Phase 1: Non surgical phase
Patients general health Teeth present Amount of calculus Pocket depths and CAL Furcation involvement Alignment of teeth Margins or restorations Developmental anomalies Pt cooperation and compliance Sequencing appointments is important, based on severity, use critical things for optimal tx. Eg do debridement before filling due to gingival health and or bleeding
Explain the re-evaluation phase
The tissues are re-examined to determine the need for further therapy , REVIEW success of treatment, done between every phase of the tx plan. (gingiva takes 4-8 weeks to heal) . re-examin via perio charts, charts, what needs further therapy, compliance and motivation. 1. Re-evaluation of the results of initial therapy (pocket depths, CAL) 2. Re-evaluation of OH status, affirm OH instruct 3. Measuring BOP & Plaque score; checking for improvement
When ins the appropriate time for re-evaluation?
Do no re-evaluation before 2 weeks, as junctional epithelium is re-establishing. Takes approx 4-8 weeks Why? - Subgingival microbial repopulation occurs within a few months, - Longer than 2 months may be too long for re-evaluation - Can review Oh after a few days, and it tends to relapse if not constantly reviewed during maintenance. - The re-evaluation of tooth mobility after occlusal therapy 6-12 months
When to refer to a periodontist??
May need to refer immediately, depending on patients medical history and disease presentation. 5mm CAL (w addition to 2mm from CEJ). Consider: - extent of disease - Root length - hypermobility - difficult access - need for extensive restorative care - pt age.
What is the purpose of the maintenance phase?
Establish oral enviroment conducive to perio health. - disruption of plaque biofilm - support and reinforce optimal OH behaviours Early diagnosis and tx of new disease, or reoccurrence Decrease risk of systemic disease of periodontium
Define the maintenance phase
Continuing care provided by the dental team at selected intervals to assist the peridontal pt in maintainng health following the completion of nonsurgical and/or surgical therapy
What is involved in the maintenance phase?
Update history - extra oral and intra oral exam - periodontal evaluation - radiographic evaluation - removal of calculus, selective root debridement - removal of other local contributing factors - selective polishing - review OH
What is stage III (Restorative therapy)
Restroration of defects with fixed or removable prosthodontics, periodontal prosthesis or other kinds of restoration are done.
Why does tooth color change?
- COlour gradient changes from gingival margin to insical edge. 2. Gingival margin appears darker because of the close approximation of dentine below the enamel 3. In most cases canines are darker, younger primary dentition is lighter.
What are the classifications of staining & location?
Extrinsic; occurs on externalsurface of the tooth, Maybe associated with occupational exposure to metallic salts / medication. Intrinsic; incorportated within the tooth. Structure may be related to the period of tooth development
Define exogenous
Stains orginate from sources outside the tooth. Can stay on outside of tooth or become intrinsic
Define endogenous
These stains originate from within the tooth, always intrinsic. ( Can be caused by mother taking tetracycline as it can affect foetal teeth development)
What does the colour yellow refer to in staining?
Discolouration of biofilm, very common. Due to suboptimal OH care, must differentiate that the ‘yellowish’ the pt is referring to is not the cementum/dentine of exposed roots etc
What does the green stain refer too?
Chromogenic bacteria/fungi decomposed hemoglobin and inrorganic elements. Frequently superimposed by soft yellow or grey food debris. Enamel under stand is sometimes demineralised as a result of cariogenic biofilm. NOTE: must differentiate from stain cause by copper in workers in contact with metal in industrial circumstances. (Sx)
What does black staining refer to?
Highly retentive black or dark brown calculus-like stain, forms along gingival third (gingival margin). Mostly found on lingual and proximal areas of maxillary posterior teeth, - Can be associated with food soy products, tea/coffee, green tea
Metallic staining + from medications
Industrial workers inhald dust, bringing metallic substance in the contact with teeth, it imparts on biofilm. May penetrate tooth surface and become exogenous intrinsic stain, seen mostly on anterior teeth. Medications: enters biofilm substance, and imparts on calculus
Brown staining causes
Smoking, beta nut chewing, tobacco chewing, food and beverage (tea/coffee), medicaments. Chlorhexidine >2 weeks use Stannous fluoride: caused by reaction of the tin ion in fluoride compound after extended use - Dental caries - extrinsic staining diffused into irregularities - pulp necrosis, RBS lysis - pulpal necrosis (decomposed hemoglobin and pulp tissues that penetrate dentinal tubules)
Orange staining causes
Due to chromogenic bacteria.
White (endogenous) staining causes
Enamel hypoplasia, fluorosis, amelogenesis imperfecta, enamel opacities, demineralisation, hypo mineralisation
What is this condition?
Enamel hypoplasia/ hypomineralisation. Caused by disturbances in mineralisation and form (soft and porous). Enamel appears more opaque than normal, may appear extra wite through creamy yellow brown.
What is this condition
Fluorosis. Caused by excessive systemic intake of fluoride during tooth development. Mostly at (2). Scattered white flecks, occasional white spots, frosty edges
What is this condition?
Ameologenesis imperfecta. Developmental, often inherited disorder, affecting enamel. Predominate clinical manifestations of affected indivduals are enamel hypoplasia + hypomineralisation or a combined phenotype
What is this condition?
Enamel opacity. Defined in shape, well differentiated from surrounding enamel, randly distributed, may be associated with history of trauma.
What is this condition/event?
Demineralisation. Process of enamel lossing its minerals, risk of cavitating. Appears white, frosty, around gingival margins and smooth surfaces
What is this condition?
Tetracycline staining, diffusion of drugs cross placenta and enter fetal circulation. Discolouration of childs teeth due to moths use of antibiotics during 3rd trimester
Describe Dentiongensis Imperfecta
It is hereditary. Clinically discoloured most often a blue/gray or yellow/brown colour and translucent. Hypoplastic/hypocalcified enamel defects in 1/3rd & breaks away from underlying defective dentin. (Exposed dentine may undergo severe and rapid attrition. Radiographically bulbus crowns with constricted roots
What is this condition?
Exogenous Intrinsic stain.Stains from the outside source not from within the tooth. Etrinsic stains from tobacco or green stains can become intrinsic. Restorative material cause staining of teeth
What are possible treatment options for discoloured teeth?
- Selective prophlaxis - Air abrasion - Acid/pumice abrasion or microabrasion - vital bleaching - non vital bleaching - direct/indirect restorative tx
