Gingival Recession and Dentine Hypersensitivity Flashcards
(91 cards)
1
Q
What is gingival recession
A
A situation where you can see the CEJ and underlying gingival margin
2
Q
Where does the gingival margin lie on a tooth with gingival recession?
A
Gingival margin lies apical to the cemento enamel junction
Root surface may be exposed
3
Q
Name the 3 sections of the new classification scheme for periodontal and peri implant diseases and conditions(2018)
A
- Periodontal health, gingival diseases and conditions
- Periodontitis
- Other conditions affecting the periodontium
4
Q
Under the new classification scheme for periodontal diseases and conditions (2018) in which section does gingival recession fall in?
A
Other conditions affecting the periodontium
5
Q
What can the “other conditions affecting the periodontium” be split into?
A
- Systemic diseases or conditions affecting the periodontal supporting tissues
- Periodontal abscesses and Endodontic-Periodontal lesions
- Mucogingival Deformities and Conditions
- Traumatic Occlusal Forces
- Tooth and prosthesis related factors
6
Q
“other conditions affecting the periodontium” which category des gingival recession fall under?
A
Mucogingival Deformities and Conditions
7
Q
Name the conditions the fall under Mucogingival Deformities and Conditions
A
- Gingival phenotype
- Gingival / soft tissue recession
- Lack of gingiva
- Decreased vestibular depth
- Aberrant frenum / muscle position
- Gingival exces
7 Abnormal colour - Condition of the exposed root surface
8
Q
How many adults age 30 + suffer from recession of 1mm or more?
A
58%
9
Q
Describe generally the distribution of gingival recession
A
Maxillary 1st molars and mandibular centralnfanies
10
Q
Patients with gingival recession on their buccal surfaces have god or bad oral hygiene?
A
Good oral hygiene
11
Q
Patients who have gingival recession associated with the lingual surfaces of they lower anteriors have god or bad oral hygiene?
A
Poor
12
Q
What is the aetiology of gingival recession?
A
- Normal sulcus and undiseased interdental crystal bone
OR - In periodontal disease
13
Q
Aside from periodontal disease why might a patient suffer from gingiva recession?
A
- Trauma
- Post treatment
- Smoking
14
Q
Give some examples of trauma that may lead to gingival recession
A
- Foreign bodies
- Finger nail picking
- Toothbrushing (eg brushing too hard etc)
- Chemical trauma from topical cocaine
- Partial dentures that are poorly designed or painted
- Poor oral hygiene
15
Q
What type of tooth brushing technique is most likely to lead to gingival recession?
A
Scrubbing instead of using a more rounded technique
16
Q
What do we mean by the keratinised tissue?
A
Tissue above the mucogingival junction is keratinised
17
Q
What happens to keratinised tissue I a person suffering from gingival recession ?
A
It becomes reduced
18
Q
What do we mean by gingival biotype?
A
The thickness of tissue
19
Q
The talking about the gingival biotype are we talking about the height o thickness of keratinised tissue?
A
Thickness
20
Q
Is recession more likely in thin or thick tissue?
A
Thin
21
Q
Is there a minimum width you need to have to reduce your chances of getting gingival recession? If so what is it?
A
no theres not a minimum width
22
Q
Describe gingival hat inmost likely to suffer from gingival recession?
A
Thin fragile tissue is predisposed to recession in the precesence of plaque induced inflammation or trauma
23
Q
Give examples of some local plaque retention factors that relined to gingival recession
A
- High muscle attachment of the lip
- Frenal pull
- Restorative dentistry
- Calculus
24
Q
Is the frenum keratinised tissue?
A
No it is oft
25
Why can a feral pull become a plaque retentive factor ?
As bushing the anteriors may resulting you talking your frenum which will then become are and resulting the patient avoiding their anterior teeth when brushing
26
How can restorative dentistry become a plaque retentive factor that may lead to gingival recession?
Subgingival margins on restorations may increase plaque retention
27
Why does periodontal disease sometimes lead to gingival recession?
As patients will get bone loss and theres apical migration f the soft tissue
28
How can a patient get recession post treatment?
If we scale enthusiastically gums may become inflammation and one the inflammation dies down patient may have recession
29
Where can inhaled tobacco pool in the mouth?
Palatal side of the central incisors
| not every smoker will have this
30
What are the possible consequences of gingival recession?
1. Fear of tooth loss
2. Plaque retention/ bleeding gingivae
3. Aesthetics
4. Root caries
5. Abrasion
6. pain due to dentine hypersensitivity
31
How is dentine hypersensitivity characterised?
Characterised by short, sharp pain
32
What causes the short sharp pain patients experience when they have dentine hypersensitivity?
Due to exposed dentine which becomes sensitive in response to a certain stimuli
33
What can dentine hypersensitivity manifest as?
May manifest as a dull ache beyond the duration of the stimulus, possibly as an altered plural response
34
In what age does dentine hypersensitive peak?
20-40 year olds
35
Is there a gender bias to dentine hypersensitivity? If so to which gender?
YES there is more female are seen to get it than males
36
What is a suggested reason why more females get hypersensitivity than men?
Could be due to better oral hygiene and some attend to use dental services more so their dentine hypersensitive would be diagnosed
37
On which SURFACES of the teeth is dentine hypersensitivity more frequent?
The buccal/ labial cervical areas of the teeth
38
List, from most to least, which teeth are affected by dentine hypersensitivity?
1. First molars
2. Canines
3. Incisors
4. Second premolars
5. Molars
39
What does the distribution of dentine correspond to?
1. Areas of gingival recession
2. Areas of thinning enamel
3. Areas of cementum loss
40
Does every area of gingival recession have dentine hypersensitivity?
NO but every case of dentine hypersensitivity usually stems from gingival recession
41
What are the 3 key factors that lead to a hypersensitive lesion?
1. Dentine exposure (lesions localisation)
2. Tubules made patent/open (lesion initiation)
3. STIMULUS
42
Is the pulp vital or non vital in a patent suffering from detente hypersensitivity?
Pulp will be vital
43
Give example of stimuli that can trigger a dentine hypersensitivity response
1. Thermal (Hot or cold)
2. Osmotic hypertonic solutions (Sweet, spicy or acidic)
3. Desiccation (drying of lesions may stimulate pain)
4. Electrical (galvanic reactions and EPT)
5. Tactile (touching probing or tooth brushing)
44
Name the 3 proposed mechanisms of sensitivity conduction
1. Odontoblast as receptors
2. Nerves in dentine
3. Hydrodynamic mechanism
45
Which of the 3 mechanism is the currently accepted one?
Hydrodynamic theory
46
What has research shown about dentine having nerves and that causing sensitivity/
Only seen in 1% of tubules in the cervical margin, however electrical Curren and cold stimulate nerves directly
47
Explain Brännströms hydrodynamic hypothesis
1. Dentine hypersensitivity is caused by the movement of dentinal tubule contents
2. Increased outward fluid low causes a pressure change across the dentine
3. Distortion of A- delta fibre causes pain
48
Where are the A delta fibres found?
Near the pulp
49
Give the steps in the hydrodynamic mechanism of pulp nerve activation
1. Stimulus
2. Causes fluid flow
3. Distorts and stimulates fibres
50
What affects the severity of pain a dentine hypersensitivity patient may feel in response to a stimulus?
Width of the tubules
51
What does the rate of fluid flow depend on?
Depends o the 4th power of the radius
| So if a tubule is twice the width fluid flow is 16 times greater
52
Does dentine hypersensitivity increase or decrease with age? Why?
Decreases as the size of the tubules decreases
53
What does a slide of sensitive dentine show under a microscope?
1. A distrusted smear layer
2. Many more dentinal tubules at the surface
3. Tubules not occluded by deposits
4. Tubule diameter is wider
54
What debates are going on surrounding the affect of the pulp in a patent with dentine hypersensitivity
1. Does the pulp react to modify the sensitivity over time ?
| 2. With resolution of pulpal inflammation is there regression of sensitivity?
55
What does dentine exposure result from?
Results from loss of enamel
56
What can cause enamel loss?
1. Removal of enamel by restorative treatment
2. Attrition
3. Abrasion
4. Erosion
5. Combined erosion and abrasion
57
Does tooth brushing alone have a significant effect on hard tissues?
no
58
How can toothbrushing slightly affect the teeth?
Toothpaste has the potential to abrade dentine considerably
| Toothbrush bristles may indirectly contribute to abrasion
59
How can tooth paste cause abrasion?
1. Abrasive particles might remove the smear layer and open tubules
2. Detergents might help to remove the smear layer
3. Tubulents could be occluded with particulate matter from the paste
60
What causes erosion?
Intrinsic or extrinsic sources of acid
61
What is erosion?
It is the loss of enamel and dentine which can lead to surface softening
62
How is tooth surface lost increased?
By toothpaste abrasion if the intra oral environment is acidic
63
What factors affect erosion?
1. pH of the acid
2. Type of acid
3. Chemical strength
4. Exposure time and frequency
64
If a patient comes to you complaining of short sharp pains when they eat anything hot/cold/sugary what might they suffer from?
Dentine hypersensitivity BUT it could be other things too
65
Give some differential diagnosis for dentine hypersensitivity
1. Cracked tooth syndrome
2. Incorrect placement of dentine bonding agents
3. Fractured restorations
4. Pulpal response to caries and restorative treatment
5. Restoration left high in occlusion
6. Palatogingival groove
7. Chipped tooth
8. Vital bleaching
66
When carrying out the history, exam and diagnosis phase what must you note down?
1. Record extent of recession
2. Description of the mouth
3. Record periodontal indexes
4. Identify aetiological factors
67
Do you need to record every mm of recession you see in your patients mouth?
No as a rule of thumb record any pockets/ recession over 3mm
68
How is dentine hypersensitivity characterised?
Sharp pain that lasts as long as the stimulus is present
69
What should your treatment plan be when you have a patient with dentine hypersensitivity
1. Pain management
2, Prevent progression
3. Periodontal screening and early treatment
70
Give the two ways we can manage dentine hypersensitivity
1. Tubule occlusion
| 2. Blocking pulpal nerve response
71
What does blocking tubule occlusion do?
It promotes the formation of new tissues (eg smear layer, intratubular dentine etc ) in response to a stimulus or trauma
72
How can we block tubule occlusion?
By applying a artificial barrier eg a varnish, dentine bonding agents, composite resin, GIC and toothpaste
73
out of the 2 methods of reducing hypersensitivity which one is more commonly carried out?
Tubule occlusion
74
Why is blocking pulpal nerve response not a common way to treat dentine hypersensitivity?
As it is unproven in humans
| Clinically it is unlikely that ions will diffuse into tubules against the flow of dentinal fluid
75
List some ideal qualities of barrier materials for blocking tubule occlusion?
1. Retentive
2. Insoluble
3. Penetrate tubules
4. Form mechanical tags from tubules
5. Must seal the tubules
76
Give some home use products that can be used by patients to manage hypersensitivity
toothpastes, gels ad mouthwashes that contain potassium, strontium, oxalate and fluoride salts
77
What must you tell patients when you recommend to them a home use product?
It requires long term use before results are apparent
78
Why is it hard to evaluate the efficacy of dentine hypersensitivity products
1. Pain perception is subjective and open to individual interpretation
2. Psychological, medical, gender and cultural issues abound
3. Stimulus varies
4. The response is often complex
5. We are unable to examine effects o subjects tissues
6. Placebo effect
79
What is percentage of the placebo effect on some of the toothpastes used to treat hypersensitivity?
40%
80
What is good about strontium acetate ?
It withstands immersion in acid well
81
Give examples of some in surgery products that are used to manage hypersensitivity
1. Varnish
2. 1-3 layers of adhesive resin bonding system
3. Desensitising polishing paste
4. Reinforced GIC where there is a cavity progression
82
Give examples of varnish we use in surgery to manage hypersensitivity
1. Duraphat
| 2. Clinpro
83
What is duraphat made up of?
5% NaF
84
What is clinpro made up of?
5% NaF and tricalcium phosphate
85
Give examples of resin bonding systems we use in surgery to manage hypersensitivity
1. Seal and protect
2. Optibond solo
3. Scothbond
86
What do desensitising polishing pastes we use in surgery to manage hypersensitivity contain?
Calcium carbonate and arginine
87
Describe the efficacy of fluoride varnish
Reasonable efficacy but dissolution over time
88
Describe the efficacy of resins
Good if film thickness is adequate
89
Describe the efficacy of GIC
Good at occlusion tubules where indicated for use
90
Give some preventative advice can give to patients
1. Change from damaging brushing techniques to modified bass technique or using an electric toothbrush
2. Smoking cessation
3. Try and eliminate traumatic habits
4. Reduce risk factors associated with diet
91
Why might we treat gingival recession surgically?
1. Aesthetics
2. Hypersensitivity
3. Shallow root caries and abrasions
