4th year Flashcards
(243 cards)
1
Q
4 components of a full periodontal charting
A
Periodontal pocket depths
Bleeding on probing
Plaque index
Mobility
2
Q
2 uses of the WHO-621 periodontal probe
A
Record BPE
Assess root surfaces for presence of subgingival deposits of calculus
3
Q
Define BPE and describe how it is conducted
A
Screening tool for periodontal disease
Conducted by using light probing force (20-25grams) WHO-621 probe (‘ball end’ 0.5mm and a black band 3.5 -5.5mm) to assess pocket depths in sextants
4
Q
Define periodontal health
A
Clinical gingival health on an intact or reduced periodontium
5
Q
Define periodontitis
A
Chronic inflammation of the supporting tissues around the teeth
6
Q
6 clinical symptoms of periodontitis reported by patients
A
Bleeding on toothbrushing
Spacing/drifting of teeth
Mobility
Gingival recession
Sensitivity
Halitosis
7
Q
6 investigations to stage periodontal disease
A
Assessment of greatest site of clinical attachment loss
Assessment of radiographic bone loss
Assessment of tooth loss due to periodontitis
Maximum pocket depth
Furcation involvement
Occlusal trauma
8
Q
4 step approach to periodontal treatment
A
Step 0: Prerequisite to therapy
Step 1: Risk factor control
Step 2: Intervene
Step 3: Check/review
Step 4: Exit, plan longer-term care
9
Q
Describe the 3 components of step 0 in the S3 treatment guidelines for periodontitis
A
Diagnose
Risk assess
Plan
10
Q
Describe the 3 components of step 1 in the S3 treatment guidelines for periodontitis
A
Risk factor control
OHI
Supra-gingival scaling
11
Q
Describe the 2 components of step 2 in the S3 treatment guidelines for periodontitis
A
Sub-gingival scaling under LA: root surface debridement, calculus removal
Adjunct therapy
12
Q
Describe the 2 components of step 3 in the S3 treatment guidelines for periodontitis
A
Full periodontal chart
Re-treatment of non-responder sites
13
Q
Pocket depth reduction expected following non-surgical periodontal therapy in initial PPD <3mm
A
No change
14
Q
Pocket depth reduction expected following non-surgical periodontal therapy in initial PPD 4-6mm
A
1-2mm reduction in ppd
15
Q
Pocket depth reduction expected following non-surgical periodontal therapy in initial PPD ≥7mm
A
2-3 mm reduction in ppd
16
Q
3 reasons some sites do not respond
successfully to non-surgical therapy
A
Poor plaque control (>20%)
Root surfaces not adequately debrided
Due to associated risk factors
17
Q
4 potential re-treatments following initial non-surgical periodontal treatment
A
Re-instrument root surfaces
Re-instrument plus local delivery antimicrobial
Periodontal surgery
Extraction
18
Q
Describe 1 component of step 4 in the S3 treatment guidelines for periodontitis
A
Plan longer-term, supportive care
19
Q
Define an engaging patient
A
Favourable improvement in OH
Reduce plaque and bleeding scores by 50%
Plaque scores ≤ 20% and bleeding scores ≤ 30%
Progresses to step 2
20
Q
Describe the management of a non-engaging patient
A
Remain in step 1 until engaged
21
Q
Describe 2 features of the rationale for non-surgical periodontal therapy
A
Removal of the plaque bacteria and their products
Removal of plaque retentive factors to leave a smooth root surface, clear of chronic inflammatory tissue, for the reattachment of the junctional epithelium
22
Q
Describe the evidence-based recommendations for the choice of toothbrush
A
The use of a powered toothbrush may be considered as an alternative to manual tooth brushing for patients in supportive periodontal care
23
Q
Describe the evidence-based recommendations for interdental cleaning
A
Recommend that tooth brushing should be supplemented by the use of interdental brushes (where anatomically possible) for patients in supportive periodontal care
24
Q
Describe the evidence-based recommendations for the use of floss
A
Do not suggest the use of floss as the first-choice method of interdental cleaning for patients in supportive periodontal care
25
Describe the evidence-based recommendations for the use of other interdental cleaning devices
Suggest the use of other interdental cleaning devices in interdental areas, not reachable by interdental brushes, for patients in supportive periodontal care
26
Describe the evidence-based recommendations for the use of adjunctive locally administered antiseptics
Locally administered sustained-release chlorhexidine may be considered as an adjunct to sub-gingival instrumentation in patients with periodontitis
27
Describe the evidence-based recommendations for the timing of delivery of sub-gingival root
instrumentation
Supportive periodontal care should be scheduled for intervals of 3 to a maximum of 12 months, with the frequency determined by the patient's risk profile and periodontal status after active therapy
28
Epidemiology of periodontitis
8-12% of population
29
1 mechanisms behind why Down syndrome increases risk of periodontal disease
Underlying neutrophil disorder
30
1 mechanisms behind why Papillon-Lefevre syndrome increases risk of periodontal disease
Mutation in cathepsin C gene and enzyme required for activation of LL-37 neutrophil-derived antimicrobial peptide
31
6 effects of smoking on periodontal status
Increases risk of developing periodontal disease
Greater frequency of diseased sites
Greater reduction of periodontal bone height
Poorer response to periodontal therapy
Increased risk of continuing loss of attachment
More prone to gingival recession/furcation defects
32
4 mechanisms behind why smoking increases risk of periodontal disease
Impaired PMN function
Reduced gingival blood flow
Impaired healing
Affects plaque microbial flora
33
Effect of age on periodontal status
Prevalence of periodontitis increases with age
34
Effect of diabetes on periodontal status
Increases risk of developing periodontal disease
35
3 mechanisms behind why diabetes increases risk of periodontal disease
Dysregulation of PMNs function
Altered collagen metabolism
Micro vascular damage
36
Describe the relationship between periodontal disease and diabetic control
Significant periodontal disease increases risk of worsening glycaemic control
37
Effect of psychological stress on periodontal status
Increases risk of developing periodontal disease
38
Effect of scurvy on periodontal status
Increases gingivitis and loss of attachment leading to tooth loss
39
1 mechanism behind why scurvy increases risk of periodontal disease
Lack of vitamin C affects formation of collagen fibres
40
Effect of pregnancy on periodontal status
Increased gingival inflammation progressively during pregnancy
41
Effect of IL-1 gene polymorphisms on periodontal status
Associated with advanced periodontal disease
42
3 drugs associated with drug induced gingival overgrowth
Phenytoin
Cyclosporin
Amlodipine
43
Describe a risk assessment tool for periodontal disease
PreViser uses smoking history, diabetic status and clinical findings to assess a patients risk of developing periodontal disease
44
3 properties of chlorhexidine
Anti-plaque
Anti-microbial
Substantivity
45
Mode of action of chlorhexidine
Highly cationic, binds to bacterial cell membranes, induces pore formation and cell death
46
Describe the substantivity property of chlorhexidine
Ability to bind to soft and hard tissues, increasing working time
47
Concentration of standard chlorhexidine mouthwash UK
0.2% chlorhexidine gluconate, 10ml rinse (20mg)
48
Concentration of chlorhexidine and fluoride in Corsodyl Daily Defence mouthwash
0.06% chlorhexidine digluconate, 250ppm sodium fluoride
49
3 indications for the use of chlorhexidine mouthwash
Post-scaling and root instrumentation
Post periodontal surgery
Acute gingival infections
50
4 disadvantages of chlorhexidine mouthwash
Interacts with sodium lauryl sulphate in toothpaste decreasing chlorohexidine activity
Brown/black staining of teeth
Altered taste sensation
Potential to cause parotid swelling
51
2 features of advice relating to the use of chlorhexidine mouthwash
Use at least 1-2 hours before/after toothbrushing;
Avoid longterm usage – advise use 1-2 times per day for 7-10 days during treatment
52
Indication for use of Corsodyl Daily Defence mouthwash
Part of a maintenance programme to limit staining
53
Indication for use of chlorhexidine gel
Patients with localised gingivitis associated with mouthbreathing
54
1 reason antibiotics are used in periodontal therapy
Facilitate removal of sub-gingival bacteria
55
4 reasons against of the use of antibiotics in periodontal therapy
No penetration of antibiotics without mechanical disruption of the plaque biofilm
Potential systemic upset
Potential bacterial resistance
Non-surgical periodontal therapy is successful without antibiotics
56
3 topical antimicrobials
Dentomycin
Atridox
Periochip
57
4 advantages of topical antimicrobials
Direct to site of action
Low dosage required
No systemic upset
Reduced risk of resistance
58
5 indications for the use of topical antimicrobials
Localised disease
Sites showing poor response to mechanical treatment in otherwise stable patients
Localised molar/incisor periodontitis
Chronic, recurrent periodontal abscesses
Adjunctive to debridement in deep or recurrent periodontal sites
59
Describe Periochip
Slow release 2.5mg chlorhexidine from bovine gelatin carrier
Designed to be used in periodontal pockets ≥5mm
60
3 indications for the use of systemic antimicrobials
Treatment of generalised, advanced periodontitis (Stage IV Grade C)
Necrotising gingivitis/periodontitis
Acute periodontal abscess with systemic involvement
61
4 properties of Periochip
Delivers peak concentration at 2 hours
Continued release over 7-9 days
Self-retentive in pocket
No bacterial resistance
62
6 stages in the treatment of generalised periodontitis in young adults
OHI/smoking cessation
Extract hopeless teeth
NSPT
Systemic antibiotics Amoxycillin 250mg tid + Metronidazole 200mg tid 7 days
Periodontal surgery
Maintenance, regular follow-up
63
Describe Periostat
Low-dose doxycycline used as part of maintenance programme for patients with generalised, aggressive periodontitis
64
4 features of Periostat
Sub-MIC levels
Anti-collagenase effect
Single dose daily over 9 months (compliance issues)
No bacterial resistance problems
65
4 features of localised molar-incisor periodontitis in young adults
Affects younger age group (<35 years)
Rapid attachment loss and bone destruction
Patients otherwise healthy
Microbial and plaque deposits inconsistent with levels of destruction
66
1 risk determinant for periodontitis in young adults
Family history
67
1 causative bacteria linked to periodontitis in young adults
Aggregatibacter actinomycetemcomitans
68
5 mechanisms of Aggregatibacter actinomycetemcomitans leading to periodontitis in young adults
Releases lethal leucotoxin directed against neutrophils and monocytes
LPS induces bone resorption
Produces enzymes such as collagenase
Chemotactic inhibition factors
Resists phagocytosis
69
5 stages in the treatment of localised molar/incisor periodontitis in young adults
OHI/smoking cessation advice
NSPT
Local delivery of Dentomycin (14 days), Atridox (7 days), Periochip
Periodontal surgery
Maintenance, follow-up
70
Describe dentomycin
2% minocycline hydrochloride local anti-microbial with anti-collagenase activity
71
Describe atridox
10% doxycycline hyclate local anti-microbial with anti-collagenase activity
Liquid polymer, hardens on contact with fluid
72
4 acute gingival conditions
Periodontal abscesses
Necrotising gingivitis
Necrotising periodontitis
Acute herpetic gingivostomatitis
73
Define acute periodontal abscesses
Sudden build up of pus within a pocket that will track until it is able to drain either through pocket or gingival tissues
74
4 signs of an acute periodontal abscess
Well localised pain to a vital tooth
Tooth ’elevated’ in its socket
Redness / swelling around gingiva
Pointing on gingiva
75
Management of an acute periodontal abscess
Drainage through the pocket by thorough subgingival debridement with LA or lanced with a scalpel to allow pus drainage
Antibiotics if evidence of spreading infection: Amoxycillin 500mg tid or Metronidazole 400mg tid 5-7 days
Follow-up
76
Antibiotic prescriptions for periodontal abscess with evidence of spreading local spread or systemic symptoms
Amoxycillin 500mg tid or Metronidazole 400mg tid 5-7 days
77
Define chronic periodontal abscesses
Long-standing suppurating pocket
78
3 potential causes of traumatic gingival lesions
Toothbrushing
Flossing
Toothpicks
79
1 sign of trauma from toothbrushing
Elongated superficial lesions predominantly found buccally
80
1 sign of trauma from flossing
Interdental lesion with linear cleft on buccal or lingual gingiva
81
Management of traumatic gingival lesions
Removal of the offending agent and symptomatic therapy
82
Define necrotising gingivitis
Opportunistic infection commonly affecting interdental papillae
83
3 predisposing factors to necrotising gingivitis
Smoking
Stress
Immuno-compromised
84
3 bacteria linked to necrotising gingivitis
Anaerobic bacteria
Gram -ve motile rods
Spirochaetes
85
4 signs of necrotising gingivitis
Acute pain in gingivae
Punched out ulceration of tips of interdental papillae
Gingival ulcers bleed spontaneously/readily
Foetor oris
86
Define necrotising periodontitis
Infection characterised by necrosis of gingival tissues, PDL and alveolar bone
87
2 signs of necrotising periodontitis
Deep interproximal craters with denudation of alveolar bone
Sequestration of interdental or buccal/lingual bone
88
6 features of the management of necrotising gingivitis and periodontitis
OHI/soft brush
Gentle debridement under LA
Prescribe chlorhexidine mouthwash
Severe cases 200mg metronidazole tid for 5 days
Analgesia
Follow-up at 1 week for NSPT
89
Define acute herpetic gingivostomatitis
Infection of the oral cavity which is caused by the herpes simplex virus (HSV)
90
2 signs of acute herpetic gingivostomatitis
Multiple lesions which rupture to form ulcers (<5mm) over gingivae and oral mucosa with erythematous margin
Swollen gingiva
91
Management of acute herpetic gingivostomatitis
Supportive and symptomatic management as condition is self-limiting over 7 days
92
Define gingival recession
Apical migration of the gingival margin below the cement-enamel junction leading to exposure of the root surface accompanied with osseous/bone recessions
93
Prevelance of gingival recession
20-60% of the population
94
4 anatomical predispositions to gingival recession
Bone dehiscence
Bone fenestration
Thin gingival biotype
High frenal attachment
95
Define bone dehiscence
Defect that results in lowering of the crestal bone margin to expose the root surface
96
2 common sites of bone dehiscence
Buccal aspect of maxillary canines and mandibular anterior teeth
97
Define bone fenestration
Window of bone loss on the lingual/buccal aspect of a tooth that exposes root surface
98
Describe the assessment of periodontal phenotype
Periodontal probe inserted into the sulcus:
Probe visible: thin, ≤1 mm
Probe not visible: thick, >1 mm
99
Describe the relationship between high frenal attachment and gingival recession
High frenal attachment can cause an apical pull of gingival tissues and gingival recession
100
5 acquired factors linked to gingival recession
Aggressive toothbrushing
Occlusion, parafunctional habits
Orthodontic treatment
Trauma
Restorations impinging on the biologic width
101
Describe the relationship between occlusion and parafunctional habits and gingival recession
Repeated gingival trauma due to occlusion or parafunctional activity may lead to gingival recession
102
Describe the relationship between orthodontic treatment and gingival recession
Tooth/root movements through bony envelope may lead to dehiscence and risk of recession
103
Define biological width
The distance from the junctional epithelium and connective tissue attachment to the root surface of a tooth (2mm)
104
4 consequences of crown margin impinging on biologic width
Gingival inflammation
Pain
Gingival recession
Underlying bone resorption
105
3 aquired pathological factors linked to gingival recession
Periodontal disease
Periodontal treatment
Factitious trauma
106
Describe the relationship between periodontal treatment and gingival recession
Treatment may induce gingival recession as healthy gingival tissues migrate to sit 2-3mm above bone or recession becomes more noticeable as gingival swelling decreases
107
Describe the relationship between factitious trauma and gingival recession
Self-induced injury of the periodontal tissues as a result of repeated voluntary trauma to localised areas may lead to gingival recession
108
Describe Miller’s classification of gingival recession
Presence of interdental papilla is the most important factor for determining root coverage
109
Define Miller’s I classification
Recession short of muco-gingival junction, normal papillary height, no periodontal bone loss in the interdental area, 100% root coverage
110
Define Miller’s II classification
Recession at or apical to mucogingival junction, normal papillary height, no periodontal loss in the interdental area, 100% root coverage
111
Define Miller’s III classification
Recession at or apical to mucogingival junction, some reduction in papillary height, bone or soft tissue loss in the interdental area or malpositioning of the teeth preventing 100% root coverage
112
Define Miller’s IV classification
Recession at or apical to mucogingival junction; significant loss of papillary height to a level apical to marginal soft tissue recession
113
4 consequences of gingival recession
Root caries
Abrasion cavities
Dental hypersensitivity
Poor aesthetics
114
Describe level 1 management of gingival recession
Prevention: OHI, atraumatic toothbrushing technique, scaling and root debridement
115
Describe level 2 management of gingival recession
Surgical correction if indicated
116
Describe level 3 management of gingival recession
Maintenance and monitoring
117
6 factors improving success of surgical treatment
Gingival margin is on the CEJ (class I,II)
PPD<3mm
No BOP
Highly motivated patients with excellent plaque control
Adequate width of attached gingiva
Thick gingival biotype
118
4 treatment options for gingival recession
NSPT
Composite additions to teeth
Gingival veneer
Mucogingival surgery
119
Describe 3 features of free gingival graft tissue
Generally from firm keratinised tissue of the palate
Includes epithelium and underlying connective tissue lamina propria
Should be 1-2mm thick
120
Describe 3 features of a connective tissue graft
Underlying connective tissue lamina propria only
Healing is improved, heals by primary intention
Improved aesthetic outcome
121
Describe 3 features of a coronal advancement flap
One surgical site
Improved vascularisation and colour match
Predictable only in shallow recessions
122
Describe 4 features of periodontal surgery with repositioning
Flap surgery with apically repositioned flap
Allows access for bone removal
Preserves keratinised gingival tissue
Heals more rapidly than Gingivectomy
123
Give an alternative to grafts
Synthetic materials
124
3 examples of synthetic materials
Mucograft
Mucoderm
Aloederm
125
2 features of synthetic materials
Increase thickness of keratinised tissue
Can be used where there is no suitable donor site to harvest material
126
Describe Brannstrom’s theory of dentine sensitivity
Fluid movement in dentinal tubules stimulates nerve endings and causes short, sharp pain which resolves immediately on removal of stimulus
Level of sensitivity related to number of exposed dentinal tubules
127
3 symptomatic treatments for dentine hypersensitivity
Topical fluoride
Unfilled resin eg Seal and Protect
Restoration with GI or composite
128
5 indications for flap surgery
Access for root surface instrumentation
Modification of osseous furcation defects
Apical repositioning of gingival tissues/crown lengthening
Periodontal regeneration
Root resection/hemisection
129
3 indications for excisional surgery
Management of drug-induced gingival overgrowth
Tissue biopsy
Crown lengthening
130
1 indication for mucogingival surgery
Management of gingival recession
131
3 indications for crown lengthing
Aesthetic reasons
Complications with existing restorative work
Toothwear
132
4 features to consider when selecting patients suitable for periodontal flap surgery
Good compliance and response but some residual pockets ≥5mm and bleeding
Re-instrumentation unsuccessful
Bleeding on probing (from bottom of pockets)
Non-smoker
133
4 stages of the surgical flap procedure
Crevicular incision that splits periosteum using firm pressure from scalpel
Careful mucoperiosteal flap elevation
Scaling and root planning
Interrupted suturing
134
2 important features in surgical flap design
Ensure broad base of flap so as to allow good vascular supply to tissue
Include papilla in flap
135
2 options for surgical flap design
Envelope flap
Relieving incisions
136
3 features of post-operative care after periodontal flap surgery
Chlorhexidine mouthwash start next day
Use soft brush
Review in 1 week for suture removal
137
3 potential responses to periodontal flap surgery
Gingival recession
Exposed root surface
Minimal residual pocketing
138
Describe 3 stages of Modified Widman approach internal bevel incision
Initial incision splits the periosteum
Crevicular incision
Incision to remove wedge of gingival tissue
139
2 types of resective gingival surgery
Gingivectomy
Gingivoplasty
140
Define gingivectomy
Surgical excision of gingival tissue, removal of true
periodontal pockets
141
Define gingivoplasty
Surgical re-contouring or reshaping of gingival tissue, removal of excess gingival tissues/false pockets
142
Describe 2 stages of external bevel incision
Blade at 45 degree angle to gingival tissue, use Blake’s or Kirkland scapel
Recontour the gum or to excise areas of gingival overgrowth
143
Describe 1 feature of healing following excisional surgery
Leaves a broad wound which requires a dressing to allow healing by primary intention
144
4 indications for resective gingival surgery (gingivectomy or gingivoplasty)
Eliminate supra bony pockets after completion of non surgical treatment
Improve aesthetics
Crown lengthening to facilitate restorative procedures
Management of drug-induced gingival overgrowth
145
1 feature of post-operative care after resective gingival surgery
Coe-pak for 5 days following surgery
146
Define occlusal trauma
Injury to the periodontium occurring as a result of occlusal forces in excess of the reparative or adaptive capacity of periodontium
147
Does occlusal trauma commonly occur with or independently of periodontal disease
Commonly with periodontal disease
148
Define primary occlusal trauma
Due to excessive occlusal forces applied to teeth with normal periodontal support, periodontally healthy teeth
149
Define secondary occlusal trauma
Due to normal or excessive forces applied to teeth with reduced periodontal support
150
Define grade I mobility
Tooth movement less than 1mm in buccal-lingual direction
151
Define grade II mobility
Tooth movement greater than 1mm in buccal-lingual direction
152
Define grade III mobility
Tooth movement greater than 1mm in buccal-lingual direction and can be depressed in the socket
153
Give a primary indicator of occlusal trauma
Tooth mobility
154
Describe the relationship between secondary occlusal trauma and tooth mobility
In secondary occlusal trauma a smaller non-axial force causes the same horizontal movement because the position of fulcrum is lower due to reduced supporting bone
155
4 stages in pathogenesis of occlusal trauma
Increased occlusal forces overwhelm the physical limitations of the PDL
PDL vessels undergo haemorrhage, thrombosis oedema and increased vascular permeability
Periodontal fibres become disorganised and collagen destruction follows
Increased osteoclastic activity and cemental resorption leads to bone resorption in pressure zones
156
Define fremitus
Tooth displacement caused by the patients own occlusal forces
157
Describe how to assess fremitus
Place a finger on the buccal aspect of the maxillary teeth
Ask the patient to tap the teeth together in inter-cuspal position and lateral and protrusive contacts
Palpate and visualise for displacement
158
Describe 3 common clinical signs of traumatic occlusion
Class II incisor relationships and with deep overbites
Stripping of upper incisor palatal gingiva or lower incisor buccal gingiva
Increased probing depths on the palatal aspect of upper incisors
159
Describe 4 common radiographic signs of traumatic occlusion
Alveolar bone loss due to periodontitis
Widening of PDL
Funneling of periodontal ligament
Reduced crown - root ratio
160
Describe the relationship between stress and periodontal disease
Increased risk for progressive periodontitis in adults with psychological traits of stress
161
Describe the relationship between stress and occlusal trauma
Increased stress is associated with clenching/grinding causing increased occlusal load and subsequent PDL widening
162
3 managements of occlusal trauma
Grind teeth out of occlusion
Splint if mobility persists despite resolution of pocketing
Restore missing posterior support with RPD to reduce occlusal load
163
Describe a Twistflex wire splint
Passive wire splint cemented in place with flowable composite
164
Describe a fibre splint
Fibre mesh placed on teeth and cemented with composite
165
Describe a composite only splint
Composite flowed around teeth, rigid splint
166
2 disadvantages of a composite only splint
Bulky and interferes with cleaning
Rigid, high chance of fracture
167
Describe a cast metal resin-retained splint
Specific lab made metal splint
168
1 disadvantages of cast metal resin-retained splint
Rigid, very high chance of debond
169
4 considerations for splinting
Must provide with an occlusal splint
Preferable for splint to incorporate stable canines
Must be sufficient enamel for etching, crowns not suitable
Not suitable for teeth with Class III mobility
170
Define natural pontics
Use crown of compromised tooth as bridge pontic
171
Indication for natural pontics
Technique used for mobile teeth with very poor prognosis
172
5 stages of natural pontic provision
Compromised tooth extracted and root sectioned off at previous level of gingiva + 2mm
Extirpate pulp through apical foramen and clean pulp chamber with sodium hypochlorite
Seal apical portion of crown with composite
Splint cemented onto remaining teeth
Crown of extracted tooth cemented onto splint
173
Define desquamative gingivitis
Erythema, desquamation and/or erosion of the buccal aspect of attached gingiva
174
4 possible causes of desquamative gingivitis
Lichen planus/lichenoid reaction
Mucous membrane pemphigoid
Pemphigus vulgaris
Lupus
175
5 methods of diagnosing desquamative gingivitis
Clinical history of preceding blisters (bullae)
Clinical evidence of lichen planus
Biopsy and histopathology
Patch testing of possible allergen
Blood tests: occasional iron deficiency in lichen planus
176
Define lichen planus
Reticular, papular, atrophic, ulcerative and bullous lesions that affect skin and mucous membranes including oral cavity
177
3 epidemiological features of lichen planus
Relatively common
Age of onset 40-70 yrs
More common in females
178
Define mucous membrane pemphigoid
Autoimmune disorder that manifests in the oral mucosa as sub-epithelial bullae which rupture to leave ulcerated areas
179
2 epidemiological features of mucous membrane pemphigoid
Age of onset 50 or older
More common in females
180
Define pemphigus vulgaris
Autoimmune, vesiculobullous disorder that manifests as oral lesions preceded by small-large blisters and causes epithelium to lift off underlying connective tissue (Nikolsky sign positive)
181
3 histological features of lichen planus
Saw-tooth rete pegs
Dense band-like infiltration of lymphocytes in lamina propria
Liquefaction degeneration of basal layer
182
3 histological features of mucous membrane pemphigoid
Subepithelial cleft
All epithelial layers remain intact and split from the underlying connective tissue
Direct immunofluoresence shows linear deposits of IgG along basement membrane
183
4 histological features of pemphigus vulgaris
Intra-epithelial clefting
Basal layers of epithelium remain attached to basement membrane
Moderate chronic inflammatory cell infiltrate
Direct immunofluoresence shows intraepithelial deposition of IgG
184
2 epidemiological features of pemphigus vulgaris
Primarily seen over 40 years old
More common in females
185
1 feature of the sequelae of pemphigus vulgaris
Potentially lethal (10% mortality rate)
186
5 managements of desquamative gingivitis
OHI/soft brush/SLS-free toothpaste/alcohol-free mouthwash
Difflam
Tacrolimus mouthwash
Steroids: Beta-methasone mouthwash,
Synalar gel
Triple therapy mouthwash
187
4 topical medicaments for desquamative gingivitis
Difflam
Beta-methasone steroid mouthwash
Synalar steroid gel
Tacrolimus mouthwash
188
Define orofacial granulomatosis
Condition characterised by lip swelling, vertical lip fissures, lower facial swelling and angular chelitis
189
What condition is orofacial granulomatosis associated with
Crohn’s disease
190
Define supportive periodontal therapy
A tailor-made individualised programme of periodontal maintenance based on patient risk assessment
191
3 features of re-assessment after non surgical treatment
4 - 6 weeks after initial treatment
Evaluate compliance
Repeat probing depths, bleeding indices and plaque score to assess stability
192
2 options for future care following re-assessment after non surgical treatment
Active periodontal care
Maintenance periodontal care
193
Describe the 3 frequencies of recall visits following risk assessment after non surgical treatment
Moderate to high risk periodontal disease patients: 3 month recall
Lower risk periodontal disease patients: 6 months recall
Low risk chronic gingivitis or mild periodontitis: 1 year recall
194
2 advantages of maintenance periodontal therapy
Early detection of periodontal breakdown and institution of treatment when required
Prevents the recurrence of periodontal disease
195
Define a dental implant
A prosthetic device which is implanted into the oral tissues beneath the mucosa and within the bone to provide retention and support for a fixed or removable dental prosthesis
196
Aim of dental implant implantation
Osseointegration, a direct functional and structural connection between living bone and the surface of a load carrying implant
197
Define peri-implant disease
Presence of inflammation in the tissues surrounding the implant
198
2 categories of peri-implant disease
Peri‐implant mucositis
Peri‐implantitis
199
Describe 2 features of peri‐implant mucositis
Bleeding on probing and visual signs of inflammation around an implant
Can be reversed with measures aimed at eliminating the plaque
200
Prevalence of peri-implant mucositis
43%
201
Describe 2 features of peri‐implantitis
Inflammation of the peri‐implant mucosa and subsequent progressive loss of supporting bone
In the absence of treatment, progresses in a non‐linear and accelerating pattern
202
Prevalence of peri-implantitis
22%
203
Frequency of radiographs for assessment of peri-implant disease
Time of implant placement
6 month follow-up radiograph
1-2 year follow-up if no complications are detected
204
3 indicators of peri-implant conditions
Pocket depths >4mm
Suppuration
Bleeding on probing
205
3 managements of peri-implant mucositis
OHI
Non-surgical therapy
Prosthesis modification of required
206
3 managements of peri-implantitis
OHI
Surgical therapy + prosthesis modification if required
Maintanence
207
3 surgical therapies for management of peri-implantitis
Open flap access surgery
Resective surgery with or without implant surface modification (implanto-plasty)
Regenerative: use of grafting materials
208
Describe the difficulties in establishing a relationship between periodontal disease and systemic conditions
Often association complicated as periodontal disease and systemic diseases share risk factors such as smoking, stress, low socio-economic status
209
Describe the relationship between periodontal disease and cardiovascular disease
Periodontitis leads to bacteraemia, activating the host inflammatory response and cytokines which favours atheroma formation
210
Describe the relationship between periodontal disease and diabetes
Moderate/severe periodontitis is associated with an increased HbA1c levels
211
Describe the relationship between periodontal disease and respiratory disease
Patients with poor oral hygiene levels had an increased risk of developing COPD and pneumonia
212
Define a furcation defect
Bone loss, usually a result of periodontal disease, affecting the bifurcation or trifurcation of a tooth where roots meet
213
3 causes of furcation defects
Defective restoration margins impinging on biologic width
Root anatomy causing difficulty in maintaining oral hygiene
Periodontal disease causing progressive loss of attachment
214
3 classifications of furcation defects
Class I: horizontal attachment loss < 3 mm
Class II: horizontal attachment loss > 3mm not encompassing the total width of the furcation area
Class III: horizontal through-and-through destruction of the periodontal tissue in the furcation area
215
Probe for measuring furcation defects
Nabers probe
216
Management of Class I furcation defects
Non-surgical therapy
217
3 managements of Class II furcation defects
Flap surgery for visual access might be indicated for surgical debridement
Root resection/hemisection
Tunnel preparation of class II to create class III
218
2 difficulties in managing Class II furcation defects
Access to furcation for instrumentation
Access to furcation for brushing and cleaning by patient
219
Management of Class III furcation defects
Extraction of affected tooth
220
Define root hemi-section
Resection of root and coronal aspect of the tooth
221
Define root resection
Resection of root leaving remaining coronal aspect of the tooth intact
222
Define perio-endodontic lesions
Endodontic lesions caused by pathological communication between the periodontal and pulpal tissues
223
Management of perio-endodontic lesions in restorable teeth
RCT followed by NSPT or surgical flap debridement
224
Define periodontal regeneration
Biological process by which the architecture and function of the lost tissue is completely restored
225
5 features of the normal healing process following periodontal treatment
Fibrin clot formation
Reduced inflammation
Granulation tissue formation
Epithelial proliferation
Repair by long junctional epithelium
226
4 indications for periodontal regenerative techniques
Good response to non surgical therapy
Localised site: 2- or 3-walled bony defect
Class II furcations
Infrabony defects
227
3 periodontal regeneration techniques
Guided tissue regeneration
Bone or synthetic grafts
Growth factors
228
Describe guided tissue regeneration technique
Mucoperiosteal flap raised with cumine scaler, root surface cleaned, defect debrided of chronic inflammatory tissue then membrane is placed and sutured in place
229
3 features of non-resorbable barrier membranes for guided tissue regeneration
Difficult technique
Second stage surgery necessary to remove membrane
Can become colonised
230
3 features of resorbable barrier membranes for guided tissue regeneration
Easier technique
No second stage surgery required
Less likely to be colonised
231
3 features of autogenous bone grafts
Gold standard
Excellent osteoinductivity and osteoconductivity
Requires 2nd surgical site
232
3 features of allografts
Demineralised, freeze-dried human bone
Osteoconductive
Doesn’t require 2nd surgical site
233
2 features of xenografts
Bovine bone grafts
Osteoconductive
234
2 features of perioglas (Bioglass)
Synthetic bone graft particulate
Osteoinductive
235
2 features of Emdogain periodontal regeneration growth factor
Porcine derived enamel matrix proteins
Topically applied gel
236
Mechanism of enamel matrix proteins in periodontal regeneration
Exposure of the cells of dental follicle to amelogenins result in cementogenesis and oestogenesis
237
Describe which Graceys currettes are used at each site in the mouth
1, 2: all surfaces of anterior teeth
5, 6: all surfaces of anterior teeth
11, 12: buccal, lingual, mesial surfaces of posterior teeth
13, 14: distal surface of posterior teeth
238
Additional clinical information that should be recorded following BPE code 3
Record plaque, bleeding and pocket depth in sextant after treatment
239
Additional clinical information that should be recorded following BPE code 4
Record full periodontal charting in all sextants (periodontal pocket depths, bleeding on probing, plaque index, mobility)
240
Strategy for giving smoking cessation advice
Ask for information regarding patients smoking
Assess if patient would be willing to quit
Advise on the benefits of stopping smoking
Assist by providing information on stop smoking products
Arrange a referral to GP/follow-up with you
241
5 risks of orthodontic treatment for the periodontal patient
Worsening of periodontal disease
Root resorption
Gingival recession
Tooth mobility or loss
Increased plaque retention due to appliances
242
4 ways to minimise the risks of orthodontic treatment for the periodontal patient
Ensure periodontal disease is controlled before starting orthodontic treatment
Use light, controlled forces
Avoid intrusive, tipping or excessive movement in compromised areas
Frequent professional cleanings and monitoring
243
6 features of teeth that lead to a hopeless prognosis
>75% bone loss
Non-maintainable areas
Grade III furcation
Grade 3 mobility
Recurrent abscesses
Uncontrolled risk factors
