LO 2 - Part 2 Flashcards
1
Q
What can radiographs tell us about the periodontium
A
- Approximate bone levels
- Clinical crown to root ratio and root morphology
- Rads cannot diagnose perio but, they can be a ‘piece of the puzzle’
2
Q
List the limitation of radiographs
A
- Only 2 dimensional
- Only hard tissue is visible
- Under-estimates bone loss!!!
- DOES NOT show disease activity or inactivity
3
Q
Describe how alveolar bone appears on radiographs
A
- Alveolar Crest of Bone - in health located approximately 2mm below the CEJ
- Contour follows CEJs (scalloped)
- Alveolar bone proper shows as a thin white line - lamina dura (must be ‘intact’ at crest)
- Anterior teeth – crest is thin and pointed
- Posterior teeth – crest is wider and flat or rounded.
4
Q
What can be seen on radiographs?
A
- Bone loss - always under-represented on rads - By the time bone loss becomes detectable on a rad it has usually progressed beyond earliest stages of disease
- Cl II - Cl IV Furcation involvement - also underestimated in rads
- Overhanging Restorations
- IP Calculus
- Widened PDL space
5
Q
What are early radiographic signs of periodontitis
A
- Crestal Irregularities - appear as breaks or fuzziness instead of clean line of alveolar crest
- Triangulation - Widening of PDL caused by resorption on M or D bone
- Interseptal bone changes - Finger-like lines = reduction of mineralized bone adjacent to blood vessel channels
6
Q
Describe the types of bone loss
A
- Determined by comparing CEJ heights of adjacent teeth
- if loss of bone height is parallel to CEJ = Horizontal bone loss - most common
- if not parallel = Vertical bone loss
7
Q
How can radiographic quality impact how we view the periodontium
A
- poor technique can obscure bone loss
- PA’s with excessive vertical angulation may over or underestimate actual outline of bone
- Paralleling technique (BWs or PAs) should be used to assess bone height
8
Q
Describe the possible levels of the free gingival margin
A
- FGM significantly coronal to CEJ
- FGM near CEJ
- FGM apical to CEJ = recession of gingival margin
9
Q
Describe recession of the gingival margin
A
- Displacement of gingival soft tissue margin apical to CEJ that results in exposure of root surface
- Common clinical condition
- Shown to increase with age
- Multifactorial etiology
- Severity classified with Miller classification system
10
Q
How do you locate the CEJ?
A
- See a color difference
- Feel a groove, & feel a texture difference
- Use surrounding teeth as a guide
- Must estimate in cases of crowns or Class V fillings
11
Q
List the possible causes of recession
A
- Faulty toothbrushing technique or mod – firm bristles
- Tooth malposition
- Gingival inflammation/periodontitis
- Abnormal frenum attachments
- Iatrogenic dentistry
- Orthodontic movement
- Possible link to smoking
- Habits
- Increases with age
12
Q
In the Cairo classification system, describe recession type 1
A
- Interproximal CEJ is not visible (i.e. no recession there)
- Buccal or lingual recession is present
13
Q
In the Cairo classification system, describe recession type 2
A
There is some interproximal loss, but it is less than or equal to buccal attachment loss
14
Q
In the Cairo classification system, describe recession type 3
A
IP attachment loss is greater than buccal attachment loss
15
Q
Describe clinical attachment level
A
- Clinical measurement of true periodontal support around tooth as measured with periodontal probe
- Preferred over probing depth as indicator of periodontal support
- True attachment level measurement of healthy, intact site that has not previously lost attachment
16
Q
What is the difference between probing depths and CAL?
A
- Probing depths - measured from FGM to base of sulcus or periodontal pocket
- Clinical Attachment Level (CAL) - more accurate indicator of support around a tooth, measured from fixed point (CEJ)
- Clinical Attachment Loss (CAL) - measured the same as Level - called LOSS when attachment is lost
- PD are not as accurate as the FGM changes in response to risk factors - CAL (level or loss) is measured from the CEJ – which doesn’t move
17
Q
What is the significance of clinical attachment levels?
A
- More accurate indicator of periodontal support around tooth than probing depth measurement
- Presence of loss of attachment is critical factor in distinguishing between gingivitis and periodontitis - Inflammation without attachment loss: gingivitis; Inflammation with attachment loss: periodontitis
18
Q
How is the gingival margin recorded on a periodontal chart?
A
- Zero (0) - Indicates free gingival margin slightly coronal to CEJ
- Negative number (–) for negative recession - Free gingival margin significantly covers CEJ
- Positive number (+) for positive recession - Free gingival margin apical to CEJ
19
Q
What is the periodontal screening and recording (PSR) examination
A
- Rapid, inexpensive screening process
- Helps separate patients into three broad categories - Periodontal health, gingivitis, or periodontitis
- If periodontal health or gingivitis, no further clinical periodontal assessment may be needed
20
Q
How is the periodontal screening and recording (PSR) examination performed?
A
- World Health Organization (WHO) probe used
- Observe position of reference mark in relation to gingival margin and other clinical features
- Each sextant examined as separate unit
- Only one PSR code recorded for each sextant
- “X” recorded instead of PSR code if sextant edentulous
- Probing technique - “Walk” probe circumferentially around each tooth in sextant; Monitor reference mark continuously; At each site, reference mark will be completely visible, partially visible, or not visible at all
21
Q
Describe PSR codes
A
- code assigned to each sextant represents most advanced periodontal finding on any tooth in sextant
- Code 0 - Marker is completely visible; no calculus; no bleeding
- Code 1 - Marker is completely visible; no calculus; bleeding
- Code 2 - Marker is completely visible;
Calculus; defective margins - Code 3 - Marker is partially visible
- Code 4 - Marker is not visible
22
Q
What does it mean if a client receives low PSR scores in all sextants?
A
- Considered periodontally healthy
- No need for further periodontal assessment
23
Q
When is a complete periodontal assessment indicated?
A
When clients have two code 3 scores or one code 4 score in PSR
24
Q
When is PSR done at CNIH?
A
- PSR is done for clients who only want a Whitening Tray
- Before you can take impressions & deliver a WT - Status of oral health must be determined!; Must still do complete oral assessment – EXCEPT – instead of full Perio exam - PSR; hard tissue assessment must show no carious lesions
25
What are the cautions for interpreting PSR codes
1. Can be misleading
2. Must be alert for teeth with gingival enlargement or gingival recession
3. Partial recording approach may grossly underestimate severity of periodontal destruction
26
Describe supplemental diagnostic tests
Used for patients with refractory forms of periodontitis
3 general types:
1. Tests related to bacteria
2. Tests that analyze gingival crevicular fluid content
3. Tests for genetic susceptibility to periodontal disease
*No gold standard; should not be routinely ordered
27
Describe the phase contrast microscope patient education tool
1. Enables patients to view motion of live motile microorganisms
2. Limited diagnostic capabilities - Cannot discriminate different microorganisms
28
What tests analyze gingival crevicular fluid
1. Gingival crevicular fluid - Flows into sulcus from adjacent gingival connective tissue; May contain markers for periodontal disease progression
2. May be prohibitive to observe at all sites
3. Contents that have been studied - Collagenase and prostaglandin E2
29
Describe tests genetic susceptibility to PD
1. Genetic makeup affects susceptibility to diseases
2. Tests for interleukin-1 - PST Genetic Susceptibility Test; Interleukin’s PerioPredict Genetic Risk Test
3. High levels of interleukin-1 - Predispose patients to more inflammation in periodontium; Associated with increased risk for periodontal disease
30
What would the ideal diagnostic test for periodontal disease look like?
1. Reliably predict which individuals are susceptible for future periodontal breakdown
2. Have capability to quickly and accurately monitor current status of disease activity
3. More practical, reliable, accurate tests likely in future
31
List the periodontal phenotypes/biotypes
1. Thin Scalloped
2. Thick Scalloped
3. Thick Flat
32
Describe the thin scalloped biotype
1. Slender triangular teeth
2. Contact area close to incisal edge
3. scalloped & delicate soft tissue…You can see through it
4. Narrow zone of attached gingiva
5. Thin alveolar bone…Resorbs easily
33
Describe the Thick Flat Biotype
1. Square shaped teeth
2. Thick, dense tissue
3. Margins are slightly scalloped
4. Large amounts of attached tissue
5. Large interproximal contact
6. Thick underlying bone – resilient to trauma
34
Describe the Thick Scalloped Biotype
1. Thick, dense tissue
2. Pronounced gingival scalloping
3. Slender teeth
4. Narrow zone of keratinized tissue
