4. Comprehensive Periodontal Disease Flashcards
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
Patient Information Collection
____, ____ model, and an ____ picture
x-ray
study
intraoral
Basic Evaluation of a Dental Patient ✦ \_\_\_\_ history ✦ \_\_\_\_ history ✦ \_\_\_\_ examination ✦ \_\_\_\_ examination
medical
dental
radiographic
clinical
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
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
Basic Evaluation of a Dental Patient
Dental history
- ____
- Dental restoration
- ____ treatment
- Dental visit habit
- ____ habits
trauma
orthodontics
oral hygiene
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
Basic Evaluation of a Dental Patient
Clinical examination
- ____ examination
- ____ examination
- Examination of the ____
- Examination of the ____
extraoral
intraoral
teeth
periodontium
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
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
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
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
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
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
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
Basic Periodontal Evaluation
- Evaluation of ____
- Evaluation of ____
- ____ charting
- Evaluation of ____ and interdental ____
- Evaluation of ____
oral hygiene soft tissues periodontal occlusion relationships radiographs
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
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
Evaluation of Soft Tissue
____
Contour
____
Texture
color
consistency
Evaluation of Soft Tissue
• Color
In health ____
In acute inflammation ____
In chronic inflammation deep ____ to ____ or ____
coral pink red deep pink blue bluish-red
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
Evaluation of Soft Tissue
- Consistency
In health the gingiva is ____ and ____
In disease might become ____ or ____ and ____
firm
resilient
spongy
firm
fibrotic
Evaluation of Soft Tissue
- Texture
In health ____ may be present
In disease ____ may disappear and gingiva appears “____ and ____”
stippling
stiplling
smooth
shiny
