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Dentistry in a Nutshell > perio - tutorials > Flashcards

perio - tutorials Flashcards

1
Q

ideal outcomes of perio tx according to SDCEP (4)

A
  1. high levels of plaque control
  2. bleeding <10% and plaque <15%
  3. PPD <4mm throughout mouth
  4. absence of bleeding at 4mm sites
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2
Q

what does healing depend on

A
  • anatomy of pocket
  • immune system
  • local risk factors
  • anatomy of teeth at which site of pocket is
    if >50% pockets healing tx is working so if less then there is an issue with instrumentation
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3
Q

‘engaging’ patient according to BSP

A

plaque levels <20% and marginal bleeding <30%
OR
>50% reduction in plaque & marginal bleeding from baseline recordings

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4
Q

what is a ‘non responding’ site

A

> 10% sites with PPD >4mm and BoP at >20% sites 1 year after active treatment

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5
Q

pocket depth v clinical attachment loss

A

pocket depth = inflammation
clinical attachment loss = bone loss

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6
Q

factors influencing decision for referral for perio surgery (8)

A
  1. smoking
  2. compliance
  3. OH
  4. systemic disease
  5. suitability of sites i.e. access soft & hard tissue factors
  6. prognosis of tooth / important of tooth
  7. availability of specialist tx
  8. pt preference
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7
Q

4 types of perio surgery

A
  1. access
  2. resective
  3. regenerative
  4. mucoginigval
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8
Q

access perio surgery

A

to gain more access to root surface in persisting pockets; inc raising full thickness mucoperiosteal flap & removal of granulose tissue
aim = improved visibility & accessibility for subgingival instrumentation of both hard & soft root surface deposits which have not been removed by non surgical means

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9
Q

resective perio surgery

A

to remove infected soft tissue of gingivae & infected bone
gingivectomy = during crown lengthening before prosthetic tx
reduction of gingival excess facilitates plaque control, restorative dentistry & improves appearance

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10
Q

regenerative perio surgery

A

indications -
1. 2 and 3 walled bony defects
2. grade II mandibular furcation defects
3. grade II buccal maxillary furcation defects

aim is to increase periodontal attachment of severely compromised teeth, a decrease in deep pockets so more maintainable range & reduction in vertical & horizontal component of furcation defects

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11
Q

mucogingival therapy

A

gingival augmentation, root coverage, gingival preservation at ectopic tooth eruption, preservation of ridge collapse associated with tooth xla

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12
Q

symptoms of periodontal emergency

A

pain
localised swelling
increased bleeding
increased mobility
ulceration
halitosis
bad taste in mouth
signs of systemic involvement i.e. fever, malaise
signs of spreading infection i.e. cellulitis, lymph node involvement

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13
Q

what will help diagnose perio emergency

A

radiographs i.e. PA
vitality testing
clinical exam
pain hx i.e. SOCRATES
location of swelling i.e. how far up root
perio exam - check pocketing in area, are they are perio pt or not
vertical bone loss more likely to be abscess in area or furcation and pocket in furcation

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14
Q

perio abscess v periapical abscess

A

for perio abscess there must be clinical attachment loss
for periapical abscess the infection has began in the pulp chamber / root canal and spread out through apices of tooth
note - the 2 can occur simultaneously in endo-perio lesion

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15
Q

endo perio lesion classification

A
  1. with root damage
    - root # or cracking
    - root canal or pulp chamber perforation
    - external root resorption
  2. without root damage
    - perio pt
    - non perio pt
    grade 1 - narrow deep pocket in 1 tooth surface
    grade 2 - wide deep pocket in 1 tooth surface
    grade 3 - deep perio pocket in >1 tooth surface
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16
Q

sdcep mx of endo perio lesions

A
  1. consider overall prognosis of tooth & assess whether retention is possible or desirable
  2. if to be retained carry out endo tx of affected tooth
  3. following endo tx mx of perio tissues as indicated non surgically or surgically
  4. do not prescribe ABs unless there are signs of spreading infection or systemic involvement
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17
Q

when could a periodontal abscess occur

A

following subgingival PMPR when not all of debris is removed from base of pocket & there is healing at coronal part but not apical part so pt will present 2-3 days later with abscess

18
Q

step by step of mx of perio abscess

A
  • careful subgingival instrumentation short of base of pocket to avoid iatrogenic damage (LA likely to be required)
  • if pus present in perio abscess drain by incision or through pocket
  • recommend optimal analgesia i.e. paracetamol / NSAIDs
  • do not prescribe ABS unless signs of spreading infection or systemic involvement
  • recommend use of 10ml x2 daily 0.2% CHX MW until acute symptoms reside // H2O2 6% 15ml diluted x 3 daily
  • following acute mx r/v in 10 days and carry out definitive perio instrumentation & arrange appropriate recall
19
Q

if endo perio with root damage due to perforation

A

sectional CBCT for that area if suspecting perforation / # of roots
could:
- lift flat find perforation & treat
- xla
- refer to specialist
if no apical area no need to re endo
mta used to restore perforation
if remove post warn pt of risk of # and risk increases with increasing length of post

20
Q

what ABs to use

A

pen V 500mg x 4 daily for 5 days
metronidazole 400mg TID for 5 days
MUST be used in conjunction with mechanical therapy to reduce bacterial load and disrupt the biofilm

21
Q

NG/NP symptoms

A

severe pain
punched out papilla (can end up with a lot of recession following tx)
yellow / grey sloughing
halitosis
bleeding readily provoked

22
Q

risk factors of NG/NP

A

stress (suppresses immune system)
smoking
immunocompromised
severe malnutrition

23
Q

key factor about NG/NP

A

OPPORTUNISTIC INFECTION - bacteria already there but they thrive in this environment

24
Q

tx of NG/NP

A

1st visit - LA as very painful, supra gingival debridement to encourage healing, prescribe CHX MW / H2O2 MW, identify & address risk factors

2nd visit (3-5 days later) - r/v, subgingival debridement
if continuation of symptoms consider referral to specialist in primary or secondary care

if systemic involvement / spreading infection prescribe 400mg metronidazole TID for 3 days

25
Q

chemical burn symptoms

A

pain, TTP, bad taste

26
Q

tx chemical burn

A

not much tx
avoid brushing that specific area for a few days to allow to heal
antimicrobial MW
likely to have gingival recession so cover it

27
Q

PHG presentation & tx

A

presentation - severe red & inflamed gingiva, vesicles that rupture and can form ulcers on gingiva, buccal, palatal, labial mucosa
cause - HSV1
tx - self limiting, lasts 10-14 days, analgesia & fluids
if severe / immunocompromised pt then aciclovir 200mg x 5 daily for 5 days

28
Q

recurrent 2ndary herpes

A

redness, swelling, heat, pain itching, fluid filled blisters
water, analgesia, more local and therefore painful
analgesia & wait for it to resolve by itself, can prescribe CHX MW as pt will not want to brush area & we don’t want accumulation of plaque
usually lips / palate

29
Q

leukaemia

A

infiltration of lymphocytes, OH compromised due to gingival appearance, swollen, spontaneous bleeding & palor?
urgent referral to GMP
in meantime regular fluid intake & analgesia

30
Q

how often 6PPC in supportive care

A

x1 yearly

31
Q

why is 4mm threshold

A

pt has influence on environment of pocket via home methods in pockets up to 4mm but anything >4mm is impossible for pt to reach and maintain

32
Q

why HbA1c

A

interested in glycation because of advanced glycation end products which trigger inflammation in the body i.e. vessel causing microangiopathy & neuropathy leading to CV disease & leading to diabetic outflow
measure HbA1c as it measures process of glycation over 3mths (lifespan of RBC)

33
Q

intervals in step 4

A

tailored to patient !
shortest recall is 3/12
key to this is risk factors i.e. behavioural / lifestyle / systemic / local plaque retentive factors / root grooves / furcation / crowding / overhanging restorations

34
Q

what can be an adjunct to determine periodontal risk

A

online tools such as periodontal risk assessment (spider diagram)

35
Q

members of the team that can take care of pt who requires periodontal tx

A

GDP
hygiene therapist
perio specialist
dental students in secondary care

36
Q

hygienist & local anaesthetic

A

following PGD directive so can give anaesthetic but needs to be under prescription from dentist
same with radiographs; hygienist can take radiographs but dentist must report them

37
Q

how to prescribe LA

A

type of anaesthesia
max dosage
frequency
route of administration i.e. via injection

38
Q

when should periodontitis pts be referred

A

level 2 complexity (stage II/III/IV & residual true pocketing 6mm+) after initial non surgical tx step 1 and 2 accepted in specific situations

level 3 complexity (grade C or stage IV & true pocketing of 6mm+) should be referred once lifestyle / behavioural factors have been addressed & appropriate non surgical step 1 and 2 are undertaken in general practice

39
Q

what is involved in step 4 tx

A

continuous visits ongoing for life
OH / risk factors at every appt
supra & sub gingival PMPR if residual pockets
prescription will need reviewed yearly
can use perio tools to decide recall interval as this must be tailored to pt
(furcation / risk factors / residual pocketing will all decrease recall period)
6PPC should be carried out yearly (modified pocket chart just for r/v)

40
Q

what should be contained on referral letter

A

referrer details
address of referring practice
email address of referring practive
date
telephone no
pt details i.e. address, DoB, CHI, contact details
GMP details - address, telephone, email
MH - current meds
SH - smoking, family hx of perio
clinical indo
diagnosis and classification
reason for referral
details of prev perio tx carried out inc OH demonstration & PMPR
relevant radiographs & perio charts
clinical images if available

Dentistry in a Nutshell (30 decks)

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