4. Comprehensive Periodontal Disease Flashcards by J L

Goals

Collect as much ____ as possible
• Clinical signs & symptoms
Risk factors: systemic, local Dental history
Clinical examination

Establish a ____
Disease classification
Etiology

Give a ____ to the patient
Tooth by tooth
Will vary with patient acceptance of treatment and type of treatment

information
diagnosis
prognosis

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Patient Information Collection

____, ____ model, and an ____ picture

x-ray
study
intraoral

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Basic Evaluation of a Dental Patient
✦ \_\_\_\_ history
✦ \_\_\_\_ history
✦ \_\_\_\_ examination
✦ \_\_\_\_ examination

medical
dental
radiographic
clinical

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Basic Evaluation of a Dental Patient

- Medical History
• \_\_\_\_  Classification
• Systemic diseases
• \_\_\_\_ 
• Allergies
• \_\_\_\_ 
• Family history

Last week, we talked about ASA Classification. This is the ____ evaluation you should make of the patient.

You have to ask the patient of their systemic disease. For example, diabetes, smoking, and high blood
pressure are all things you need to be aware of before you begin examining the patient.

For medication, if a patient has high blood pressure, maybe they are taking a ____ blocker that can cause gingiva hyperplasia. Gingiva hyperplasia can also result from a patient taking ____ for seizures.
Organ transplant patients take ____ . These 3 kinds of drugs are closely related to perio, so it is
important to understand the patient’s medication.

Also, it is important to check a patient’s allergies, particularly antibiotics, in case you need to pre-medicate with antibiotics.

Smoking is very related to perio, it has been shown in many studies.

Family history is also very important. Some cases of high ____ or diabetes are related to family history; it is important to ask them if there is any history of gum disease in their family. For example, ____ is very related to family history.

ASA
medication
smoking

first
calcium channel
dilantin
cyclosporin

blood pressure
aggressive periodontitis

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ASA Classification

1 A normal healthy patient
2 A patient with ____ systemic disease
3 A patient with ____ systemic disease
4 A patient with severe systemic disease that is constant threat to ____
5 A moribund patient who is not expected to survive without the ____
6 A declared ____ patient whose organs are being removed for donor purposes

• Treating only ASA \_\_\_\_

mild
systemic
life
operation
brain-dead

I-III

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Basic Evaluation of a Dental Patient

Dental history

____
Dental restoration
____ treatment
Dental visit habit
____ habits

trauma
orthodontics
oral hygiene

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Basic Evaluation of a Dental Patient

• Panoramic
	○ Not clear, but provides an overall view
	○ Can visualize the whole jaw and \_\_\_\_
	○ \_\_\_\_ extracted - it's better to have a pan
• Full mouth x-ray
	○ PA and bite-wings
	○ \_\_\_\_ PA and \_\_\_\_ posterior bite-wing
		§ BW: better angulation, better \_\_\_\_ level, and easier to assess \_\_\_\_ caries
	○ If bone levels are low: \_\_\_\_ bite-wing

TMJ
impaction

14
4
bone
IP
vertical

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Basic Evaluation of a Dental Patient

Clinical examination

____ examination
____ examination
- Examination of the ____
- Examination of the ____

extraoral
intraoral
teeth
periodontium

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Examination of the Teeth

Wasting Disease of the Teeth
any gradual loss of tooth substance

Formation of Smooth, Polished Surfaces without Regard to the Possible Mechanism of this Loss

____
____
____
____

erosion
abrasion
attrition
abfraction

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Erosion (Corrosion)

Sharply Defined Wedge-shaped depression in the ____ area of the ____ tooth

Generally affects a ____ of teeth

Enamel > Dentin, Cementum

Etiology
Decalcification by ____ (1949, McCay CM, Wills L) or ____ in combination with the effect of acid salivary secretion are suggested causes

* Adjacent teeth end up having similar lesions
* Begins at \_\_\_\_ and extends into \_\_\_\_

cervical
facial
group
acidic beverages
citrus fruits

enamel
dentin/cementum

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Abrasion

Loss of tooth substance that is induced
by ____ wear other than that of ____

____-shaped or ____-shaped indentations with a ____, shiny surface

____ > dentin of root

Etiology
____ with an abrasive dentifrice and the action of ____ are frequently mentioned, but aggressive tooth-brushing is the most common cause
Horizontal brushing at ____ angles to the vertical axis of the teeth

* Abrasion is observed more often than \_\_\_\_
* Usually combined with gingival \_\_\_\_

mechanical
mastication
saucer
wedge
smooth

cementum

toothbrushing
clasps
right
erosion
recession

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Attrition

Occlusal wear that results from functional contacts with ____ teeth

Occlusal or incisal surfaces worn by attrition are called ____

Etiology
A certain amount of tooth wear is ____, but accelerated wear may occur when abnormal ____ or unusual functional factors are present

opposing
facets
physiologic
anatomic

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Attrition

The ____ of the facet on the tooth surface is potentially significant to the periodontium

____ forces on the vertical axis of the tooth to which the periodontium can adapt most effectively

____ facets direct occlusal forces laterally and increase the risk of periodontal damage

angle
direct
angular

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Abfraction

Etiology
Result from ____ loading surfaces causing tooth flexure and mechanical ____ and tooth substance loss in the ____ area

• Presence of microfractures
• Lesions are \_\_\_\_ and \_\_\_\_ than abrasion
	○ More \_\_\_\_ (rather than U-shaped)

occlusal
microfractures
cervical

deeper
sharper
V-shaped

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Dental Stains
____ deposits
- Origin

Hypersensitivity - ____ exposed by gingival recession
• Root surfaces exposed by gingival recession may be hypersensitive to ____ changes or ____ stimulation. Patients often direct the clinician to the sensitive areas. These may be located by ____ exploration with a probe or cold air.

Proximal Contact Relations

Open contacts allow for ____ impaction
Checked by means of clinical observation and with dental floss
Abnormal contact relationships may also initiate occlusal changes. Ex: Shift in ____, Teeth opposite an edentulous site may ____. thereby opening the proximal contacts.

pigmented
root
thermal
tactile
gentle

food
midline
supererupt

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Basic Periodontal Evaluation

Evaluation of ____
Evaluation of ____
____ charting
Evaluation of ____ and interdental ____
Evaluation of ____

oral hygiene
soft tissues
periodontal
occlusion
relationships
radiographs

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Evaluation of Oral Hygiene

Presence or absence of ____, plaque, and/or calculus
____ index
Evidence of ____ brushing and/or flossing• Posterior teeth (upper right)
○ Opening of ____ gland

food debris
plaque
traumatic
parotid

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Silness & Loe’s Plaque Index (PI)

Score 0: No ____ in gingival area

Score 1: No plaque visible by the unaided ____, but plaque is made visible on the point of the ____ after it has been moved across surface at entrance of gingival crevice

Score 2: Gingival area is covered with a ____ to ____ thick layer of plaque; deposit is visible to the naked ____

Score 3: Heavy accumulation of soft matter, the thickness of which fills out niche produced by ____ and ____; ____ area is stuffed with soft debris

plaque
eye
probe
thin
moderately
eye

gingival margin
tooth surface
interdental

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Evaluation of Soft Tissue

____
Contour
____
Texture

color

consistency

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Evaluation of Soft Tissue

• Color
In health ____
In acute inflammation ____
In chronic inflammation deep ____ to ____ or ____

coral pink
red
deep pink
blue
bluish-red

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Evaluation of Soft Tissue

•Contour
In health gingival margins are ____ edged, papillae are ____, triangular and completely fill the ____

In disease the margins become thickened or ____, papillae may become ____ and bulbous, tips may be ____

knife
flat
embrasure

“rolled”
swollen
blunted

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Evaluation of Soft Tissue
- Consistency

In health the gingiva is ____ and ____

In disease might become ____ or ____ and ____

firm
resilient

spongy
firm
fibrotic

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Evaluation of Soft Tissue
- Texture

In health ____ may be present

In disease ____ may disappear and gingiva appears “____ and ____”

stippling
stiplling
smooth
shiny

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Silness & Loe’s Gingival Index (GI)

Score 0: Normal ____
Score 1: ____ inflammation. Slight change in ____, slight edema, no ____
Score 2: ____ inflammation. Redness, edema and glazing, ____
Score 3: ____ inflammation. Marked redness and edema, ____, tendency toward ____

Study These Flashcards

gingiva
mild
color
BOP
moderate
BOP
severe
ulcerations
spontaneous bleeding

Periodontal Charting ``` ____ Recession (REC) ____ Keratinized gingiva (KG) ____ Mobility ____ ```

probing depth (PD) clinical attachment level (CAL) bleeding on probing (BOP) furcation involvement

What Dose a Complete Perio Exam Kit Contains? • ____ probes to probe implants

Plastic

University of North Carolina UNC 15 probe ``` ____ with tapered end ____mm probe ____mm markings Color coded bands ____, 9-10,____mm ____ to read ``` • Bottom of color band is ____, top of color band is ____

``` round 15 1 4-5 14-15 easy ``` 4 5

Nabers 2N probe ``` ____ with tapered end Curved to access ____ 3-6-9-12 mm markings Color coded bands ____, 9-12 mm Used for the clinical diagnosis of ____ involvement ```

round furcations 3-6 furcation

Normal Periodontium • ____mm below the CEJ - this is considered as normal ○ CEJ to alveolar bone

Four Stage of Passive Eruption • Active eruption - tooth erupts from alveolar floor to occlusal plane • Tooth approached occlusal plane - passive eruption • Young ○ JE is at ____ • As time goes on, it moves down but still remains at ____ • Argument that this is a ____ process • However, stage IV: ____ - pathologic

enamel enamel pathologic recession

What are we probing for? - Healthy: ____mm • Pocket is the pathologic deepening of the ____

0-3 | sulcus

Pocket Depth • ____ term • Distance between the ____ and the base of the ____ (most coronal cells of the junctional epithelium) * Base of pocket = top of ____ * Probe accurately - probe should be at top of JE

histologic gingival margin base of the pocket JE

``` Probing Depth • ____ term • Distance to which a probe penetrates into the pocket • Within the ____ in the absence of inflammation ``` * Probing depth is usually a little bit ____ * Can potentially drop into the ____

clinical junctional epithelium deeper CT

What Is Important When Probing? Probing ____ Probing ____ Probing ____ • Record the deepest pocket in each area

position angulation force

Facial & Lingual Probing ✓ ____ to Vertical Axis ✓ ____ the probe

parallel | walking

Interproximal Probing ✓ To detect deepest point of interdental crater ✓ Probe should be placed ____ * Most important picture in this lecture * Craters are normally present in ____ teeth * Coronal part of probe should be as close to ____ as possible, and the tip should be ____

obliquely posterior contact angulated

Probing Force * 25gm (____N) * Depress ____ pad ____mm = 0.75N

0.75 thumb 1-2

Gingival Recession • Location of the ____ apical to the ____

gingival margin | cementoenamel junction

Miller’s Classification of Recession Class I: Marginal soft tissue recession not extending to the ____ with no loss of ____ or soft tissue Class II: Marginal soft tissue recession extending ____ or ____ the MGJ with no ____ of interdental bone or soft tissue Class III: Marginal soft tissue recession extends ____ or ____ the MGJ with ____ loss of bone or soft tissue, apical to the ____ but ____ to the level of soft tissue recession Class IV: Marginal soft tissue recession extends ____ or ____ the MGJ with ____ of interdental bone or soft tissue ____ to the level of the recession defect

MGJ interdental bone to beyond loss ``` to beyond interdental CEJ coronal ``` to beyond loss apical

What Is Clinical Attachment Level (CAL)? CAL: distance between the ____ and the tip of the ____ (base of the sulcus/ pocket)

cemento-enamel junction (CEJ) | periodontal probe

Clinical Attachment Level in Health ____ term CEJ- base of the sulcus/ pocket

clinical mild moderate severe

Clinical Attachment Level Attachment loss measurements are the best assessment of how much damage has occurred to the ____ * Pocket depth represents your attachment loss * 1-2 = ____ perio * 3-4 = ____ perio * >=5 = ____ perio

periodontal apparatus mild moderate severe

Masticatory Mucosa Attached v.s. unattached gingiva ____ gingiva MGJ (Muco-gingival junction): Demarcates ____ and ____ Another method that can be used to demarcate the mucogingival line is pushing the lip or cheek ____ • Marginal groove (free gingival groove) ○ Projection inside is the base of the ____ • Free gingival groove to sulcus = free gingiva ○ Not ____ • From groove to MGJ = ____ gingiva ○ Pink • Alveolar mucosa is not ____ ○ Red • Keratinized includes ____ and ____ gingiva

keratinized keratinized gingiva nonkeratinized mucosa coronally ``` sulcus attached attached attached free attached ```

Lack of Keratinized Gingiva * Lang & Loe, 1972 : minimum of ____ mm keratinized gingiva is necessary * Kennedy, 1985 : No sig diff found in ability to control plaque & gingival inflammation irrespective of presence/ absence of ____

2 | attached gingiva

Bleeding on Probing * Gingiva is ____ * Pocket epithelium is ____ or ulcerated * ____ after the removal of the probe or be ____ for a few seconds -> recheck for bleeding ____ to ____ seconds after probing

``` inflamed atrophic immediately delayed 30 60 ```

Mobility All teeth have a slight degree of ____ mobility

physiologic

Miller’s Classification of Mobility (1938) Class 1 The ____ distinguishable sign of movement greater than normal Class 2 Movement of the crown as much as ____mm from normal position in any direction Class 3 Movement of crown > ____mm in any direction and /or ____ depression / ____ of the tooth

``` first 1 1 vertical rotation ```

Furcation Involvement * Evaluating ____ bone loss * Using a ____ probe • Easier to catch furcation from ____ side

horizontal naber's palatal

Hamp Classification of Furcation Involvement (1975) Degree I. - horizontal loss of periodontal tissue support that is less than ____ mm Degree II. - horizontal loss of periodontal tissue support that is greater than ____ mm but does not encompass the ____ of the furcation(Cul-de-sac) Degree III. - horizontal destruction of periodontium that is ____

3 3 width through and through

Line between adjacent at CEJ level Parallel Bone level ____ Represents the cortical bone lining the tooth socket • Oblique ○ Interdental bone crest is ____ to CEJ ○ Normal bone level • Lamina dura

lamina dura | parallel

Radiographic Techniques Long-cone paralleling technique - ____ beam Bite-wing technique - ____ beam * Taking a BW shows a more accurate ____ to CEJ level * when you see a bone lesion it is better to assess from the BW * If the pt has sever periodontitis (shown below) a ____ will be better

angled perpindicular bone vertical

Radiographic Appearance of Periodontal Disease Fuzziness & Disruption of ____ • ____ and ____ is key to periodontitis *Once the pt has attachment loss and bone loss it is no longer considered gingivitis, it is now ____* If you see bone loss w/ a funnel shape and have disruption of lamina dura that is a sign of ____ periodontitis.

lamina dura attachment loss bone loss periodontitis chronic

Radiographic Appearance of Periodontal Disease ____ or ____ has been partially or completely destroyed * Best way to assess bony structure is from ____ * Bone sampling Usually these kind of teeth will have a little bit of ____. You can see in this view where the oblique line here (circled in green) you may consider that bone loss but *remember* it is a 2D image you can't know exactly how the bony structure is. The best way to asses the bony structure is a 3D image, CBCT.

labial lingual bony plate CBCT (3D) mobility

Pattern of Bone Destruction Horizontal bone loss Vertical bone loss This is horizontal and vertical bone loss. You can see the bone drops and follows the CEJ line. This isn't the best picture b/c they have the restorations and you can't see the CEJ. But here you can roughly follow the CEJ line. In green circled area the CEJ line is totally different, so we know here we have vertical bone loss = ____.

angular defect

Radiographic Appearance of Periodontal Disease Furcation involvement Definitive diagnosis of furcation involvement is made by ____ examination, which includes careful probing with a specially designed probe (e.g., ____) Same area, different angulation. Radiographs should be taken at different ____ to reduce the risk of missing furcation involvement

clinical | nabers

Radiographic Appearance of Periodontal Disease Furcation involvement • Furcation arrow ○ ____ ○ ____, not very reliable

reference | subjective

Radiographic Appearance of Periodontal Disease Calculus ``` This is seen a lot in clinical cases. When the plaque got calcified, it becomes ____, you can see tons of calculus in the X-rays for some pt. After the procedure you can use another X-ray to double check if you got all of the calculus out (this isn't done ____) ```

calculus | routinely

Advanced Imaging Modalities CBCT This is seen in a CBCT. It has been used more in ____ and ____ dentistry. The 3D image will help you see exactly how ____ your bone is to determine if you need ____ procedure before placing the an implant. But you can also use it to evaluate your ____. Not used on every pt.

``` endo implant thick bone graft bony defect ```

Conclusion Take Home Message Periapical ____ examination should be part of each patient’s periodontal evaluation and should be coupled with other records Radiographic evaluation should be updated every ____ years Periapical radiographs often ____ the amount of periodontal bone loss, and ____ changes are usually not detected

radiographic 2 underestimate early

4. Comprehensive Periodontal Disease Flashcards

(59 cards)