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DEN1SKB > week 6 > Flashcards

week 6 Flashcards

1
Q

What is the examination sequence?

A

1 - Patient History
2 - Extra oral examination
3 - Intraoral examination
4 - Perio Chart
5 - Radiographic Examination
6 - Special tests

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2
Q

What are the 8 aims of perio assessment?

A

1 - Identify pathology
2 - Identofy risk factors
3 - Collect relevant data to establish a diagnosis
4 - develop short medium and long term prognosis
5- Formulate treatment plan
6 - establish baseline data for follow up assessment
7 - Communicate with patient
8 - Satisfy professional dentolegal requirements

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3
Q

What are the aspects of Patient History?

A

1 - Presenting complaint
2 - Dental History
3 - Medical History
4 - social history
5 - diet
6 - Oral Hygeine

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4
Q

What does SOCRATES stand for in determining the characteristics of a patients presenting complaint?

A

Site
Onset
Character (what does it feel like)
Radiation
Associated factors
Timing
Exacerbations (what makes it worse)
Severity

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5
Q

What do we gather during dental history

A

Oral hygeine habits
Dental Visits
Previous conditions
current concerns
History of dental attendance

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6
Q

3 reasons for taking medical history

A

1 - To identify medications and conditions (may affect treatment and presentation of periodontitis)
2 - To identify systemic conditions (require special precautions)
3 - To identify transmissible diseases (present hazard to clinician)

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7
Q

What are examples of allergies?

A

Penicillin
sulphar containing antibiotics
Certain spices eg mint (irritating for some mucousal diseases - oral lichen planus)

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8
Q

Management of Allergies

A

double check with patient even if its ticked no

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9
Q

Examples of anticoagulants and bleeding dyscrasias

A

Apixaban
Warfarin
Haemophillia A

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10
Q

Management of risk of prolonged bleeding

A

Consult with patients medical practitioner - temporarily taken off anticoagulant - consider referal

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11
Q

Antibiotic propylaxis/ cover

A
  • Antibiotics taken 1 hour before invasive dental procedure for patients at risk of infective endocarditis
  • Optimise patients oral hygiene to reduce risk of bacteraemia (bacteria in blood) from daily oral hygiene and mastication
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12
Q

Procedures with high risk of bacteraemia

A

Sub gingival root debridement
Dental Extractions
Periodontal Surgery

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13
Q

Examples of steroid cover

A

Long term Prednisolone

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14
Q

Management of steroid cover

A
  • Consider amount of stress induced by dental procedures and need for increase dose of corticosteroid
  • Consider steroid dose and duration
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15
Q

Risk of medication - related osteonecrosis of the jaw (MRONJ) examples

A

Prolia (denosumnab)
Bisphosphonates

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16
Q

Management of MRONJ

A
  • Increased risk for MRONJ if patient on medications for more than 3 years
  • Refer to OMFS for extractions and surgery
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17
Q

Examples of Immunosuppression

A

Chemotherapy
Methotrexate

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18
Q

Management of Immunosuppression

A

Consider antibiotic cover or delaying treatment

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19
Q

Examples and comments for Osteoradionecrosis

A
  • Head and neck therapy
  • History pf radiotherapy to the head and neck
  • Non healing extraction sockets
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20
Q

Management of Osteoradionecrosis

A

Dental Fitness prior to radiotherapy
Referral to OMFS/dental unit

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21
Q

Management of Coronary ischaemic syndrome

A

Defer elective dental procedures for 6 months following myocardial infarction, stent placement, coronary artery bypass

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22
Q

Examples of cardiac pacemakers

A

pacemakers/defibrillators
New units shielded from EMFs generated by ultrasonics

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23
Q

Management of Cardiac Pacemakers

A

Old units may not be shielded - avoid ultrasonic scalers

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24
Q

Uncontrolled diabetes involvement in wound healing

A

Poor wound healing and resistance to bacteria

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25
Q

Uncontrolled diabetes management

A

Consider antibiotic cover or delaying treatment

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26
Q

Examples of Systemic conditions (8)

A
  • smoking
  • diabetes
  • Cardiovascular disease
  • pregnancy/hormonal fluctuations
  • Immunosuppressed states
  • drug induced gingival overgrowth
  • Stress
  • Genetics
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27
Q

What is in Social History

A
  • Family responsibilities
  • Language Barriers
  • Sources of stress
  • Ethnicity
  • Occupation
  • Socioeconomic status and education levels
  • Family History of periodontitis and hereditable diseases
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28
Q

relevant information when investigating oral hygiene habits

A

Erosive and cariogenic elements in patients diet
Alcohol consumption
Frequency
Parent/carer education levels
Supervised brushing for children

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29
Q

What factors can you visually assess involving periodontal tissue

A
  • Changes in size (recession vs gingival hyplasia)
  • Colour (pink, red, cyanotic (purple))
  • Contour (Pointed = healthy, blunted papilla and bulbous = inflammed)
    Tone (firm = healthy, spongey and retractable = loss of tissue tone)
  • Thickness
  • Consistency
  • Texture
  • Position
  • Location of inflammation
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30
Q

How much attached gingiva is required for health?

A

2mm

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31
Q

Amount of keratinised gingiva on thick (flat) phenotype?

A

Broad Zone

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32
Q

Amount of keratinised gingiva on thin (scalloped) phenotype?

A

Narrow zone

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33
Q

Tooth shape of thick phenotype

A

Square with large contact area and short papilla

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34
Q

Tooth shape of thin phenotype

A

elongated and triangular

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35
Q

Does thin phenotype have recession after treatment?

A

yes - needs to be maintained

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36
Q

Does thick phenotype have recession after treatment?

A

no - resists recession

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37
Q

How do we assess plaque and calculus deposits?

A

Plaque Index - O’leary Index

38
Q

What is Plaque Index - O’leary Index

A
  • Records presence of plaque on individual tooth surfaces (4 per tooth)
  • Expressed as a whole k=mouth percentage
  • Can utilise plaque disclosing solution
  • record presence of plaque at dentogingival level
  • Can be used as motivating tool
39
Q

What is a frenum

A

Thin fold of mucosa enclosing muscle fibres which attaches to the lip mucosa, underlying periosteum and bone

40
Q

Where do u see frenae

A

Maxillary arch - Facial midline stablising lips
Mandibular arch - facial midline (stabilising lips), ligual frenum (stabilising tongue)

41
Q

What dental factors are important to identify as they can impact on periodontal health and disease? (12)

A

Caries
fractures
Stains
Calculus
Hypersesitivity
Mobility
Missing teeth
Diastemas
Open contacts
Crowding/rotation
supraeruptions
Restorations

42
Q

what are the 7 probe based tests?

A

Probing Depth
Recession
Pseudopockets
Clinical Attachment loss
Bleeding on probing Suppuration on probing
Furcation involvement

43
Q

what is the healthy probing depth

A

1-3mm

44
Q

how is cal calculated

A

adding recession to proving depth

45
Q

what is suppuration

A

pus- neutrophil rich exudate
seen in poorly controlled diabetics

46
Q

what is a grade 1 furcation

A

less than 1/3 of the root trunk

47
Q

what is a grade 2 furcation

A

more than 1/3 of the root trunk but not all the way through

48
Q

what is a grade 3 furcation

A

through and through

49
Q

what are the 4 common probing errors

A
  • Incorrect angualtion
  • Probe stopped by restorations
  • use of probe in different diameters and markings
  • using high force greater than 25 Ncm
50
Q

what is a furcation

A

exposed area of where the root divides

51
Q

why does a site bleed on probing

A

presence of inflammation within a pocket
presence of bacteria

52
Q

what does measuring the whole mouth percentage bop indicate?

A

how much is affected
severity

53
Q

what is the main limitation of all periodontal tests including radiographs

A

only show bone loss that has occured within the buccal and lingual plate

54
Q

what are the 6 advantages of using radiographs

A
  • Relatively non invasive
  • inexpensive
  • Quick to produce
  • provides significant diagnostic
    -information in one image
  • can be stored and reassed at anytime
  • Can estimate disease activity overtime by comparing radiographs
55
Q

what are the 6 disadvantages of radiographs

A
  • exposes patient to xray radiation
  • insensitive to small changes
  • retrospective - no current info on disease activity
  • Cannot detect pocketing
  • Anatomical structures may overlie lesions in trabecular bone
  • To detect cancellous bone loss, the cortical bone must be involved
56
Q

Are cone beam CT scans indicated for periodontal diagnosis

A

no - need a specific reason eg implants

57
Q

horizontal bone loss

A

flat - easy to debride

58
Q

vertical bone loss

A

difficult to debride

59
Q

what are the two anatomical features of a tooth that are used for the calculation of radiographic bone loss

A

root apex
CEJ

60
Q

what is the threshold for severe bone loss on an xray

A

more than 50%

61
Q

what are the 4 special tests in periodontics

A

pulp testing
use a frac finder or tooth sleuth to find cracked cusps
Microbiological tests
Genetic tests

62
Q

what is frequency of disease: prevelance

A

Number of disease cases at a given point in time

63
Q

what is frequency of disease: incidence

A

number of cases appearing over a defined period of time

64
Q

what is senstivity

A

number of diseased patients who are correctly identified as having disease - that is the diagnostic marker leads to a minimum number of false negative diagnosis

65
Q

What is specificity

A

the number of healthy persons who are correctly determined to not have the disease - that is the diagnostic marker leads to a minimum number of false positive diagnosis

66
Q

who does periodontitis risk increase in

A

Males
smokers
increases with age

67
Q

how is plaque index measured

A

assesses the presence or absense of plaque deposits at gingival margin as y/n

68
Q

how is gingival index measured

A

scores severity of gingival inflammation 1-4

average core/tooth = GI tooth
Average score/dentition = GI Dentition

69
Q

how is BOP measured

A

assessed by absence or presence
y/n
expressed as a whole mouth percentage

70
Q

what are indicies

A

numerical expressions representing a defined set of disease criterea - summarise and characterise the disease state of a patient

71
Q

what are the four limitations of periodontal indicies

A

no assessment of past periodontal disease
no record of alveolar bone loss or recession
record of calculus assumes bop has occured even if it hasnt (overestimates bop)
presence of deeper pockets persisting after treatment assumes presence of calculus and bop as they are in the same code

72
Q

what does BPE stand for

A

basic periodontal examination

73
Q

what does PSR stand for

A

periodontal screening and recording

74
Q

what does CPITN stand for

A

community index of periodontal treatment needs

75
Q

what does code 0 indicate for periodontal indices

A

nothing - preventative care

76
Q

what does code 1 indicate for periodontal indices

A

BOP for BPE, PSR and CPITN

77
Q

what are the treatment recommendations for code 1

A

oral hygiene instructions and plaque and stain removal

78
Q

what does code 2 indicate for periodontal indices

A

BOP, calculus, overhangs/defective resto margins for BPE, PSR and CPITN

79
Q

what are the treatment recommendations for code 2

A

OHI
plaque and calculus and stain removal
remove overhangs

80
Q

what does code 3 indicate for periodontal indices

A

3.5-5.5mm pockets for BPE, PSR and CPITN

81
Q

what are the treatment recommendations for code 3

A

radiographs, subgingival debridement
OHI
possible referal

82
Q

what does code 4 indicate for periodontal indices

A

greater than 5.5mm pockets for BPE, PSR and CPITN

83
Q

what are the treatment recommendations for code 4

A

full perio chart
complex treatment including surgery
referal to specialist

84
Q

what does code * indicate for periodontal indices in BPE

A

furcation involvement of CAL greater or equal to 7mm

85
Q

what does code * indicate for periodontal indices in PSR

A

furcation involvement, abnormal tooth mobility, mucogingival problems or significant gingival recession

86
Q

what does code * indicate for periodontal indices in CPITN

A

furcation involvement

87
Q

what are the treatment recommendations for code *

A

full perio chart

88
Q

what does code X indicate for periodontal indices

A

PSR - Sextant absent or fewer than 2 teeth in a sextant

89
Q

what recordings are CPITN, BPE and PSR

A

sextant

90
Q

what codes require perio charting

A

3 and 4

DEN1SKB (12 decks)

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