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BDS3 Paediatrics > Paediatric periodontology > Flashcards

Paediatric periodontology Flashcards

1
Q

What are the aims of 2021 guidelines for Periodontal screening and management of under 18years of age?

A
  • Outline method of screening under 18years for periodontal diseases during routine clinical dental examination in order to detect presence of gingivitis or periodontitis at earliest opportunity
  • Provide guidance on periodontal management and when it is appropriate to treat in practice or refer to specialist services, thus optimizing periodontal outcomes for children and young adolescents
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2
Q

What is the Mnemonic to remember the 2017 World Workshop classification for periodontal disease?

A

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

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3
Q

What are the categories for 2017 World Workshop Classification of periodontal disease?

A
  • Periodontal health (Intact or reduced periodontium)
  • Gingivitis - dental biofilm induced (intact or reduced periodontium)
  • Gingival diseases and conditions - non dental biofilm induced
  • Necrotising periodontal diseases
  • Periodontitis
  • Periodontitis as a manifestation of systemic disease
  • Systemic disease or conditions affecting periodontal supporting tissues
  • Periodontal abscesses and endodontic-periodontal lesions
  • Mucogingival deformities and conditions
  • Traumatic occlusal forces
  • Tooth and prosthesis related factors
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4
Q

What is periodontal health?

A
  • A state free from inflammatory periodontal disease
  • Allows an individual to function normally
  • Avoids physical and mental consequences due to current or past disease
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5
Q

What are features of healthy periodontium in children?

A
  • Gingival margin several mm coronal to cemento-enamel junction
  • Gingival sulcus 0.5mm-3mm deep on fully erupted tooth
  • In teenagers, alveolar crest situated between 0.4mm-1.9mm apical to CEJ
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6
Q

What can cause reduced periodontium in the 2017 classification?

A

In a non-periodontal patient
- Crown lengthening surgery
- Recession

In a periodontal patient
- Stable periodontitis

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7
Q

In regard to BPE what is the clinical presentation of periodontal health?

A
  • <10% Bleeding on probing is clinical periodontal health in either intact or reduced periodontium
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8
Q

What are the two types of gingival conditions?

A
  • Plaque biofilm-induced gingivitis with either intact or reduced periodontium
  • Non plaque biofilm-induced gingivitis/ gingival lesion
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9
Q

What is plaque biofilm-induced gingivitis?

A
  • Supragingival plaque accumulates on teeth
  • Inflammatory cell infiltrate develops in gingival connective tissue
  • Junctional epithelium becomes disrupted
  • Allows apical migration of plaque and increase in gingival sulcus depth
  • Gingival pocket/ false pocket/ pseudo pocket
  • Most apical extension of junctional epithelium is still CEJ
  • Process is reversible
  • No periodontal attachment loss
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10
Q

What can gingival diseases non-dental biofilm induced be?

A
  • Manifestations of systemic conditions
  • Pathologic changed limited to gingival tissues
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11
Q

What are the sub-classifications of Gingival diseases: non-dental biofilm induced?

A

1) Genetic/Developmental disorders
2) Specific infections
3) Inflammatory and immune conditions and lesions
4) Reactive processes
5) Neoplasms
6) Endocrine
7) Nutritional and metabolic diseases
8) Traumatic lesions
9) Gingival pigmentation

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12
Q

What genetic factors can cause gingival diseases and conditions: non-dental biofilm induced?

A
  • Phenotype
  • Hereditary fibromatosis (characterised by benign, non-haemorrhage, fibrous gingival overgrowth showing clinically pink gingiva with marked stippling and can prevent eruption)
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13
Q

What Infective factors can cause gingival diseases and conditions: non-dental biofilm induced?

A
  • Viral
  • Fungal
  • Bacterial
  • Deep mycoses (disease caused by fungi)
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14
Q

What Trauma factors can cause gingival diseases and conditions: non-dental biofilm induced?

A
  • Thermal/ chemical
  • Physical
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15
Q

What Drug induced factors can cause gingival diseases and conditions: non-dental biofilm induced?

A
  • Immune complex reactions
  • Anti-retro-viral
  • Immunosuppressants
  • Ca+ channel blockers
  • Anti- convulsant
  • Cytotoxic
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16
Q

What Manifestation of systemic disease factors can cause gingival diseases and conditions: non-dental biofilm induced?

A
  • Granulomatous inflammation
  • Immunological conditions
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17
Q

What are features of Necrotising gingivitis?

A
  • Pain
    – Necrosis of interdental papillae -“punched out” appearance
    – Ulceration
    – Spontaneous bleeding
    – Secondary foetor oris
    – Pseudomembrane may be present
    – +/- lymphadenopathy
    – Fever
    – May manifest in teenagers
    – May progress to necrotising periodontitis (NP)
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18
Q

What are risk factors of Necrotising gingivitis?

A
  • Smoking
  • Immunosuppression
  • Stress
  • Malnourishment
  • Poor diet
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19
Q

What is the aetiology of Necrotising gingivitis?

A
  • Fusiformspirochaetal microbial aetiology
  • Socioeconomic factors esp in developing countries
  • Local factors inc root proximity and tooth malposition
  • Systemic factors inc HIV positive status
  • Underlying undiagnosed pathology in immunosuppressed host
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20
Q

What are the modifying (systemic risk factors) factors for the other conditions affecting the periodontium?

A
  • Smoking tobacco
  • Metabolic factors (hyperglycaemia/ Diabetes type 1)
  • Pharmacological agents (cyclosporin)
  • Nutritional factors (Vit C deficiency)
  • Increase in sex steroids (puberty or pregnancy)
  • Haematological conditions (Leukaemia)
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21
Q

What are the predisposing (local risk factors) for other conditions affecting periodontium?

A

Malocclusion
- Instanding or rotating tooth
- Traumatic occlusion: Low frenal attachments

Traumatic dental injury
- Damage to PDL i.e. luxation/ intrusion/ avulsion

Dental plaque-biofilm retentive factors
- Tooth anatomy e.g. talon cusp, cingulum, enamel pearl, enamel defects like pits or grooves
- Restoration margins/ overhangs/ cavities
- Ortho/Prosthodontic appliances
- Incompetent lip seal lead to oral dryness as decrease saliva flow and decrease saliva quality

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22
Q

What is gingival overgrowth related to?

A
  • Systemic and metabolic diseases
  • Genetic factors like hereditary gingival fibromatosis
  • Local factors
  • Side effects by some medications e.g. cyclosporin, phenytoin and calcium channel blockers
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23
Q

How is gingival overgrowth treated?

A
  • Rigorous home care and OHI
  • Frequent appointments for professional mechanical plaque removal PMPR
  • surgery? esp with drug induced gingival overgrowth
24
Q

When to consider for referral to physician for haematinic screening?

A
  • In cases where extent of condition is inconsistent with level of oral hygiene observed
  • With unexplained gingival enlargement/ inflammation/ bleeding/ tooth mobility
25
Q

What is periodontitis?

A
  • A chronic multifactorial inflammatory disease
  • Associated with dysbiotic (microbial imbalance) plaque biofilms
  • Characterised by progressive destruction of the tooth-supporting apparatus.
  • Multifactoral disease influences:
    – dysbiotic microbiome changes ARE more likely for some patients than for others
    – May influence severity of disease
26
Q

What are the 4 main features of Periodontitis?

A
  • Apical migration of Junctional epithelium beyond CEJ
  • Loss of attachment of periodontal tissues to cementum
  • Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated)
  • Alveolar bone loss
27
Q

What pathogens can be found in subgingival microflora of teenagers with periodontitis?

A
  • Porphyromonas gingivalis
    – Prevotella intermedia
    – Aggregatibacter actinomycetemcomitans. (AA)
    – Tannerella forsythia (associated with subsequent
    clinical attachment loss in a 3- year longitudinal
    study in adolescents
28
Q

What is included in Diagnosis of Periodontitis?

A
  1. Staging
    - IP bone loss at worst site of bone loss due to periodontitis
    - Stage I/ Stage II/ Stage III/ Stage IV
  2. Grading
    - Rate of progression (diabetes glycaemic control vital for grading)
    - %bone loss/age
    - Grade A/ Grade B/ Grade C
  3. Assess current periodontal status
    - Currently stable/ in remission/ unstable
  4. Risk assessment
    - Smoking
    - Poorly controlled diabetes
29
Q

What are the features of Necrotising Periodontitis?

A
  • Necrosis/ulceration of the interdental papilla,
  • Bleeding of the gingival tissues
  • Periodontal ligament loss and rapid bone loss
  • Pseudomembrane formation
  • Lymphadenopathy
  • Fever
30
Q

What is Necrotising stomatitis?

A
  • Severe inflammatory condition
  • Necrosis extends beyond gingiva to soft tissues, leading to bone denudation (erosion)
  • Severely systemically compromised patients
31
Q

What to keep in mind about periodontitis in children?

A

Primary dentition - some evidence that bone loss can occur around primary teeth in some children and its not perio

Mixed dentition - False pocketing can be present around erupting dentition

32
Q

What are the features of Periodontitis Molar Incisor Pattern?

A
  • Present in small proportion of adolescents (uncommon)
  • Rapid attachment loss and bone destruction
    – Patient is otherwise healthy
    – Onset around puberty
    – Family history
    – 0.1% Caucasians and 2.6% African Ancestry
33
Q

What is localised Molar incisor pattern periodontitis?

A
  • Localised to incisors and first molars
34
Q

What is generalised Molar incisor pattern periodontitis?

A
  • > = 3 permanent teeth other than incisors and first molars
  • Onset usually older but sometimes under 30
  • Staging and grading essential for up-to-date diganosis
35
Q

What systemic diseases can paediatric patients have giving them periodontitis as a manifestation of systemic disease?

A

– Papillon – Lefevre syndrome (PLS)
– Neutropenias
– Chediak-Higashi syndrome
– Leucocyte adhesion deficiency syndrome (LAD)
– Ehlers – Danlos sydndrome
– Langerhans’ cell histiocytosis (LCH)
– Hypophosphatasia
– Down syndrome

36
Q

When looking at gingival condition during periodontal screening what should be recorded?

A
  • Gingival colour
  • Contour
  • Swelling
  • Recession
  • Suppuration
  • Inflammation (presence and location)
  • Consider use of marginal bleeding free chart
37
Q

What to record when assessing OH status during periodontal screening?

A
  • Description of plaque status
  • Describe surfaces covered by plaque
    – Is plaque easily visible?
    – Detectable only on probing?
    – Use of plaque-free scores (%)- motivational aid to patient

Assess if any calculus present and chart location

38
Q

What to record when assessing local risk factors during periodontal screening?

A

– Plaque retention factors.
– Low frenal attachments
– Malocclusion

Incompetent lip seal:
-Reduced upper lip coverage- labial and palatal gingivitis
- Increased lip separation

Mouth breathing:
- Palatal gingivitis

39
Q

What is a simplified BPE?

A
  • Screening tool to guide clinician to arrive at provisional diagnosis of periodontal health, gingivitis or periodontitis
  • Used in all co-operative children aged 7-18 years old
  • Uses only 6 teeth 16,11,26,36,31,46
  • Designed to be quick, easy, well tolerated and avoid false pocketing
40
Q

How to perform a simplified BPE?

A
  • Use WHO 621 probe
  • 20-25g force application same as adults
  • Inserted parallel to root surface and walked around gingival margin
  • Coronal to CEJ
  • 16,11,26,36,31,46
41
Q

What do the simplified BPE codes mean?

A

0 - Healthy
1 - Bleeding after gentle probing with black band fully visible
2 - Calculus or plaque retention factor with black band fully visible
3 - Pocketing 4mm-5mm with black band partly visible
4 - Pocketing >= 6mm with black band disappears
* - Furcation involvement

42
Q

What BPE codes can only be used between 7 and 11years old?

A

0, 1 and 2 used for 7-11years
1-4 used for 12-17years

43
Q

Why are plaque and bleeding scores useful?

A
  • Can be motivational for child so higher score reflects improvement
44
Q

What to do if BPE scores is code 3 or 4 for 12-17year old?

A
  • 6 Point pocket chart (localised to 3 BPE or full if 4)
  • Check alveolar bone level with bitewings for posterior and periapical for anteriors and OPG esp if part of orthodontic treatment
45
Q

Should BPE be carried out before or after orthodontic treatment?

A
  • Before
46
Q

What preventative oral health messages should you be delivering?

A
  • Plaque induced gingivitis / progression of early
    periodontal disease in children and adolescents can be prevented by affective toothbrushing (careful and
    regular removal of dental plaque biofilm)
    – systematically clean all surfaces
    – Hands on demonstration – supervised toothbrushing
    – Modified bass technique
    – Consider disclosing tablets

Standardised prevention with fluoride advice

Smoking cessation
– paramount importance in teenage years
– 11% of 15-year-olds reported being a current smoker and 29% reported having ever smoked cigarettes

Oral health measures

47
Q

What to do if BPE code 0?

A
  • No periodontal treatment
  • Screen at routine recall or within 1 year (whichever is sooner)
48
Q

What to do if BPE 1?

A
  • OHI
  • Screen at routine recall or within 1 year (whichever sooner)
49
Q

What to do if BPE 2?

A
  • OHI
  • Supragingival / subgingival professional mechanical plaque removal (PMPR)
  • Remove / manage plaque retention factors
  • Screen at routine recall or within 6months (which ever sooner)
50
Q

What to do if BPE 3?

A
  • OHI as for codes 1 and 2
  • Supragingival / subgingival PMPR in shallow 4 – 5mm pockets.
  • Remove / manage plaque retention factors
  • 3 months full periodontal assessment inc 6Point pocket probing depth (PPD) chart in affected sextants
51
Q

What to do if BPE 4 or *?

A
  • Unusual in young patients
  • Full periodontal assessment, including 6-point
    PPD chart, throughout entire dentition
  • Consider referral to a Specialist, while doing
    initial therapy (as per code 3)
52
Q

What is Step 1 Building Foundations for Optimal Treatment Outcomes in S3 Treatment Guidelines?

A
  • Focus on behaviour change/motivation to successfully control plaque biofilm (OHI)
  • Possible adjunctive therapies for gingival inflammation;
  • Supragingival Professional Mechanical Plaque Removal (PMPR) to remove supragingival plaque/calculus
  • Risk factor control.
53
Q

What is Step 2 Cause-related Therapy in S3 Treatment Guidelines?

A
  • Aims to control (reduce/eliminate) the subgingival plaque biofilm and calculus by subgingival instrumentation (subgingival PMPR).
  • May also involve use of: adjunctive physical or chemical agents; adjunctive local or systemic host modulating agents; adjunctive subgingival locally delivered antimicrobials; adjunctive systemic antimicrobials.
54
Q

What is Step 3 Management of Non-responding Sites (> 4mm with BOP or > 6 mm) in S3 Treatment Guidelines?

A
  • Aims to gain access to further subgingival instrumentation or to achieve regeneration or resection in lesions (infrabony or furcation)
    that increase complexity in managing periodontitis.
55
Q

What is Step 4 Supportive Periodontal Care (Maintenance) in S3 Treatment Guidelines?

A
  • Aims to maintain periodontal stability in all treated periodontitis patients.
  • Combines preventive/therapeutic interventions from Steps 1 and 2.
  • Regular recall intervals are needed, tailored to patient’s individual needs.
  • Recurrent disease to be managed with updated
    diagnosis and treatment plan.
  • Compliance with OHI/ healthy lifestyle are integral.
56
Q

If patient given diagnosis of generalised periodontitis, stage III, grade C , currently unstable no risk factor - what are following steps?

A
  • Systematic periodontal treatment needed initiated.
  • Outcome of treatment will not result in a change of the initial disease classification.
    -This patient will always be a periodontitis
    patient, with evidence of high disease susceptibility (as indicated by grade C), requiring careful and intensive periodontal maintenance, risk factor control and monitoring.
57
Q

When should a GDP consider referral to specialist service?

A
  • Stage II, III periodontitis not responding to treatment
  • Grade c or stage IV periodontitis
  • MH that sig affects periodontal treatment or requiring multi-disciplinary care
  • Periodontitis as direct manifestation of systemic disease
  • Systemic/genetic disease that can affect periodontal supporting tissues
  • Root morphology/furcation defects adversely affecting prognosis on key teeth
  • Non-plaque induced conditions requiring complex or specialist care
  • Cases requiring diagnosis/management of rare/complex clinical pathology
  • Drug induced gingival overgrowth needing surgery
  • Cases requiring evaluation for periodontal surgery

BDS3 Paediatrics (14 decks)

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