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DCP2 > Case Conference Q’s > Flashcards

Case Conference Q’s Flashcards

(41 cards)

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1
Q

What are some challenges in treatment

A

Identifying RF

Pt concerns / compliance

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2
Q

Benefits of LA

A

Pt / operator comfort

Pt conscious and alert

Analgesic use of vasoconstrictor
- decrease haemorrhaging/bleeding
- extended duration of pulpal analgesia
- more effective / deeper analgesia level
- decrease systemic toxicity

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3
Q

How do you explain periodontal disease / pocketing to pt?

A

If bacteria sits on gums for toot long enough= irritation
Gums start to pull away from tooth

Pocketing = plaque accumulation beneath gums = hard to clean = plaque mineralisation = tartare /calculus

Increases disease process = deeper pocketing = bone dissolving = irreversible bone loss = mobility = tooth loss

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4
Q

Evidence of gum disease

A

Pocket > 4mm

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5
Q

Healthy gums

A

1-3mm pocketing + no BOP

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6
Q

Why is it important to explain why perio needed tx

A

Can be controlled however disease can relapse

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7
Q

What should we notice clinically as well as record when a pt smokes

A

How many for how long

Characteristics clinically
- fibrotic, tight gingiva
- decreased BOP
- xerostomia (challacombe scale)
- staining / tartare

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8
Q

What are pack years

A

Describes how may cigs smoked in lifetime

A pack has 20

Multiply number of packs smoked per day by number of years they’ve smoked

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9
Q

How can polypharmacy affect pt lifestyle

A
  1. Xerostomia
    - increased acidity in mouth (less saliva) = increased caries
    - acidity - tooth surface loss - erosion
    - fungal infections
    - less saliva = inc decay
  2. Anticoagulants
    - inc risk of bleeding (blood thinner eg, warfarin)
    - risk for LA
  3. Statins
    - for high cholesterol
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10
Q

How to manage NCTTL

A

Tooth surface loss due to process other than caries

Caused by attrition , erosion, abrasion

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11
Q

Define attrition

A

Flattening of occlusal surfaces

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12
Q

Do you agree with the diagnosi? Why ?

A
  1. Extent (assess by radiographs) + pattern of bone loss
    Generalised / localised / MIP
  2. Staging (use bone loss at worst site) to determine SEVERITY of disease
  3. Grading
    (% bone loss / pt age) = rate of progression of disease
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13
Q

How do radiographs assist in treatment plan / diagnosis?

A
  1. Horizontal bone loss
    - Loss of buccal / lingual cortices
    - Loss of intervening trabecular bone
  2. Vertical bone loss
    - Discrepancy in degree of bone loss at 2 adjacent sites
    - may indicate rapid bone loss
    - angular bony defects
  3. Furcation involvement
    - local PRF
    - radiolucency shows furcation

Therefore allowing you to stage and grade
+ identify extent
- can see calculus, PRF, occlusal trauma, sclerosis

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14
Q

Anatomy and chemistry of the tooth

Critical ph of dentine?

A

6.2-6.4

Root dentine vulnerable to acidic dissolution

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15
Q

Anatomy and chemistry of the tooth

Critical ph of enamel

A

5.5

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16
Q

Enamel structure

A

Highly organised, acellular tissue

  • 95% inorganic material impure calcium HAP
  • 5% fluid and organic protein
  • mineral crystals organised into prisms / rods
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17
Q

Mineral crystals in enamel made up of

Study These Flashcards
A
  1. Inorganic salt (calcium phosphate salt)
  2. Hydroxyapatite
18
Q

What is the plaque biofilm? Why disrupt?

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A

Community of ,microorganisms - spatial organisation into a 3D structure, enclosed in a matrix of extracellular material

Remove plaque before 48hrs when it hardens to tartare / calculus

Disrupt biofilm by mechanical TB - stop colonies

19
Q

Periodontal indicies
Pocket probing depths

What do we use
Where do we probe

Study These Flashcards
A

Pcp10 probe
6 point around each tooth

If lots of supra gingival calc present, periodontal charting should be postponed until after supra gingival scaling

20
Q

What is true probing attachment level and why is it important

Study These Flashcards
A

Probing depth measured from CEJ / other fixed point

Allows us to monitor periodontal progression

21
Q

If considerable gingival hyperplasia, pocketing may be …, but attachment loss may be …

Study These Flashcards
A

If considerable gingival hyperplasia, pocketing may be deep 5-7mm, but attachment loss may be small

22
Q

In order to interpret pocket measurement, note…

Study These Flashcards
A
  1. Position of gingival margin on tooth surface
  2. Position of the alveolar crest as seen on radiograph
  3. Factors affecting accuracy of periodontal probing
23
Q

Why is it important to measure gingival recession?

Study These Flashcards
A

So the total amount of measured attachment loss can be meaningfully compared with bone levels on radiographs

24
Q

Periodontal screening - why is it important

Study These Flashcards
A
  • to detect disease so tx can be carried out (Screening BPE) - helps detect who would benefit for further perio indicies
  • to diagnose
  • to educate pt
25
Limitation of periodontal screening
1. Not a replacement for perio indicies 2. Not able to show extent of periodontal involvement 3. Doesn’t not record plaque levels, attachment loss, recession 4. Not suitable to monitor perio status / response to tx
26
Systemic risk factors / risk factors for periodontal disease
Smoking Diabetes mellitus Race / genetics / gender Polymorphonuclear functional abnormalities PMN’s Acquired systemic infections eg HIV
27
Mechanisms by which systemic risk factors apeoar to be operating
1. Smoking - increase inflammatory response - direct toxic / thermal effects to cells - increased staining / calculus - decrease bone levels 2. Diabetes - increased infections - impairs immune response - interferes with wound healing - induces hyper inflammatory state (activated protein kinase C + advanced glycation of proteins) - = increased tissue destruction / infection 3. Obesity - adverse effects associated with adipokines and cytokines by macrophages in adipose tissue (pro inflammatory mol) - = hyper inflamed state = periodontal tissue destruction - inflammatory mediators produced by adipose tissue (TNF-a) = insulin resistance = diabates = increased risk of periodontal disease 4. Stress - chronic stress / increased allostatic load = - suppression of immune response - increased susceptibility to infections
28
Periodontitis and diabetes What’s usually happens to control BG
Bifunctional relationship General inflammatory response triggered by perio also affects regulation of blood sugar/glucose Usually… Increased sugar = increased insulin = decreased BG In the presence of gen inflammation, substances are formed that interfere with this mechanisms - inhibit binding of insulin - decreased glucose uptake from blood by cells - BG remains elevated In severe perio, BG elevated even in absence of diabetes = insulin resistance
29
Insulin mode of action
Insulin binds to membrane bound insulin receptors which activates glucose transporters Therefore glucose in cells Glucose is absorbed from blood by cells = BG levels decreased
30
Diabetes and periodontitis - bifunctional relationship
1. Glucose in blood binds to haem in RBC. 2. If BG levels remain high, other proteins will bind to excess glucose = AGE’s 3. AGE’s increase inflammation - they crosslink fibres in connective tissue - therefore interfering with wound healing in the oral cavity - WBC recognise AGE’s = increased inflammation = increased inflammatory cells, decrease healing = periodontal destruction
31
Accumulation of AGE’s causes…
- forms cross links in collages = production of bad collagen - bad collagen is easily broken down + poor healing - alters immuno-inflammatory response - receptor on monocytes / macrophages for AGE’s - increase WBC / inflammation - increased free radical species - increased pro inflammatory cytokines ===== periodontal disease Chronic inflammation = insulin resistance Insulin resistance = hard for cells to uptake glucose = elevated BG levels
32
What is the effect of persistent chronic inflammation
Increased cytokines in saliva and GCF (in diabetics) Dysregulated inflammatory environment Increased insulin resistance
33
Why does poorly controlled diabates affect how perio tissues respond to local factors like plaque
1. Neutrophils (first line of defence) - defective chemotaxis by chemokines (inflammatory mediators that help neutrophil to site) - therefore decrease phagocytosis - therefore microorg can survive and proliferate = periodontal breakdown 2. Monocytes macrophages release pro inflammatory cytokines but in diabetics.. - pro inflammatory cytokines in EXCESS = hyperactive cytokine release = perio breakdown
34
How are AGE’s produced
Glycation —> sugar molecules + protein mol = AGE’s
35
Periodontal tissues responses to healing and monitoring
1. Acute inflammation 24-48hrs 2. Decreased vasodilation / GCF / inflammatory cells 3. Pocket ulceration heals
36
Periodontal tissues responses to healing and monitoring \ How does pocket ulceration heals
1. Fibroblast proliferation = maturation of connective tissue - collagen fibres - ground substance 2. Formation of long junctional epithelium - attaches gingiva to clean root surface 3. Bony remodelling (alveolar bone reattaches)
37
Response to tx - what is affected?
1. Bacterial flora - decrease in total amount of microorganisms in perio pockets - residual microorganisms shifts from gram - anaerobes to gram + aerobes (associated with perio health) - decreased plaque = increased oxygen in residual plaque 2. Periodontal tissue - perio tissue heals (may show recession) - decrease in pocket depths - decreased inflammation / redness / BOP / suppuration - increased pink / firm tissue / fibrous - ging cuff tightens as collagen fibre bundles reform - attachment may occur at base of pocket
38
Monitoring - assessing to response to therapy
Post tx indicies - healing indicted by decreased pockets / BOP - pt ability to remove plaque at home by PFS - decrease mobility / furcation maybe - may increase recession
39
Why should probing be avoided in the first 6 weeks after treatment
Allows early healing / tissue maturation
40
When shoukd post tx indicies be done
8-12 weeks after tx
41
How do we know if tx is successful
Post tx indicies Have probing pockets of 3mm or less with no BOP been achieved If yes - supportive therapy If no - corrective therapy

DCP2 (5 decks)

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