Outcome 1 - Periodontics

Question 1

What is Periodontics?

Answer 1

Periodontics is the area of dentistry that deals with the cause, prevention, and treatment of disease of supporting structures and tissues. This includes the alveolar bone, periodontal ligament, cementum, attachment epithelium, and gingiva.

Question 2

What is Periodontal Disease?

Answer 2

Occurs when the inflammation process extends beyond the gingiva and affects the supporting structures of the teeth. It is typified by destruction of the attachment of the epithelium and alveolar bone supporting the teeth.

Question 3

Symptoms of periodontal disease can include:

Answer 3

-red, swollen, sensitive gingiva
-bleeding while brushing and flossing
-loose or separating teeth
-pain or pressure when eating
-pus present around the teeth or gingival tissues

Question 4

Factors contributing to the progession of periodontal disease:

Answer 4

-smoking
-diabetes mellitus
-poor oral hygiene
-osteoporosis
-HIV/AIDS
-Stress
-medication
-local factors (malocclusion, over hanging restorations, removable partial dentures)

Question 5

Systemic diseases linked to periodontal disease:

Answer 5

coronary artery disease, diabetes, stroke, respiratory disease, and delivery of low-birth-weight infants.

These are considered a risk factor and chronic inflammation is recognized to do harm to the entire body.

Question 6

2 Irritants that are significant causes of periodontal disease:

Answer 6

-Plaque (biofilm)
-Calculus (supragingival and subgingival)

Question 7

Types of Periodontal Disease:

Answer 7

Gingivitis
Periodontitis

Question 8

What is Gingivitis?

Answer 8

Is the inflammation of gingival tissue. The gingiva may have areas of redness and swelling and tend to bleed easily. There is no tissue recession or loss of bone associated with gingivitis.

Question 9

What is Periodontitis?

Answer 9

The inflammation of the supporting tissues around the teeth where connective tissue attachment at the base of the periodontal pocket is destroyed as the disease progresses. Bone loss from slight to major may be present and tooth mobility visible.

Question 10

The periodontal examination includes the following:

Answer 10

-Medical/Dental History
-Clinical Examination
-Mobility
-Oral tissues and supporting structures
-Periodontal probing
-Bleeding index
-Occlusal adjustment
-Radiographic Analysis

Question 11

Periodontal Examination: Medical/Dental History

Answer 11

The medical history is reviewed to determine if there are any systemic conditions that may influence periodontal treatment. The dental history gathers information regarding oral conditions that could increase bacterial plaque levels and therefore influence periodontal disease progression.

Question 12

Periodontal Examination: Clinical Examination

Answer 12

The dental examination will include checking the teeth for sensitivity, pathological migration, bruxism, defective restorations or bridgework, and mobility of the teeth. The periodontal examination assesses the amount of plaque and calculus, changes in gingiva, signs of bleeding, periodontal probing (presence of perio pockets where a 6 point depth probing of all teeth is taken) and improper occlusion.

Question 13

Periodontal Examination: Mobility

Answer 13

Healthy teeth have a slight amount of mobility. Mobillity will be recored on a scale of 0-3.

Question 14

Tooth Mobility Scale Readings

Answer 14

0 - Normal Mobility
1 - Slight Mobility
2 - Moderate Mobility
3 - Extreme Mobility

Question 15

Periodontal Examination: Oral Tissues and supporting structures

Answer 15

Amount of plaque, calculus, level of bone, bleeding and changes to gingival health and prescence of periodontal pockets will be assessed.

Question 16

Periodontal Examination: Periodontal probing

Answer 16

The depth of the normal sulcus is 3mm or less. The depth is measured by a perio probe and six measurements are taken for each tooth. The deepest measurement on each surface is recorded. The amount of bleeding observed during perio probing is also measured. This is recording is called the bleeding index.

Question 17

Periodontal Examination: Bleeding Index

Answer 17

During perio probing, the amount of bleeding will be observed and noted. Several systems are available in dentistry; all systems are based on a single principle that healthy gingiva does not bleed.

Question 18

Periodontal Examination: Occlusal adjustment

Answer 18

The dentist will utilize methods of indicating occlusal forces on the teeth during mastication and lateral excursions. Extensive pressure from certain types of contact in occlusion can contribute to bone loss around the tooth. The periodontist may choose to perform an occlusal equilibration, which alters the occlusal force to reduce pressure on affected teeth.

Question 19

Periodontal Examination: Radiographic Analysis

Answer 19

X-rays can help in diagnosing bone loss. Vertical bitewings are often used to view bone height along the root surface. It is critical for the dental assistant to take accurate x-rays to facilitate a proper diagnosis.

Question 20

How many mm can non-surgical periodontal treatment reduce pocket depth by?

Answer 20

1-2 mm of pocket depth can be completed by eliminating inflammation and returning gingiva to a healthy state

Question 21

Non-Surgical Periodontal Treatment & Procedures

Answer 21

Dental Prophylaxis
Scaling and Root Planning
Antibiotics and Antimicrobial Agents
Gingival Curettege

Question 22

What is Scaling?

Answer 22

Is performed to remove supragingival (above gumline) and subgingival (below gumline) deposits on teeth

Question 23

What is Root Planning?

Answer 23

Is performed after scaling is completed. Root Planning will remove any particles of calculus and necrotic cementum on the root surface.

Question 24

Systemic Antibiotic Therapy (Non-Surgical Periodontal Treatment)

Answer 24

When general bacterial levels remain high in the mouth, systemic antibiotic therapy may be used (Tetracylcline or Penicillin) to enable the tissue to heal properly after root planning.

Question 25

Antibiotics for Localized Bacterial Problems (Non-Surgical Peridontal Treatment)

Answer 25

For localized bacterial problems, antibiotics delivered directly into the periodontal pockets are preferable to generalized agents. A gel material containing tetracycline antibiotics can be injected into the peridontal pocket, where it will release over a period of time to eliminate the disease-causing bacteria.

Question 26

Antimicrobial Agents (Non-Surgical Periodontal Treatment)

Answer 26

The dentist may also have the patient use anti-microbial mouth rinses to reduce the bacterial levels for either a short or prolonged period of time, depending on the situation. Chlorhexidine is the most commonly used anti-microbial agent in mouth rinses.

Question 27

What is a side effect of Chlrohexidine (Anti-microbial) mouth rinse?

Answer 27

The side effect of this therapy is light brown stanining of teeth, tongue and composite restorations.

Question 28

2 Types of Surgical Periodontal Treatments & Procedures

Answer 28

Excisional Periodontal Surgery Incisional Surgery

Question 29

2 Types of Excisional Periodontal Surgery

Answer 29

Gingivectomy Gingivoplasty

Question 30

What is Gingivectomy?

Answer 30

Gingivectomy is the surgical removal / surgical excision of diseased gingiva in order to reduce the pocket/sulcus depth to 3 mm or less. This leaves the healed sulcus at a health, manageable depth for home care procedures.

Question 31

What is Gingivoplasty?

Answer 31

Gingivoplasty is the surgical reshaping of gingival tissue. Gingivectomy and gingivoplasty are often done simultaenously. Gingivoplasty does not reduce the depth of the gingival sulcus, but rather recontours defects and eliminates thickening of the gingival tissues.

Question 32

Types of Incisional Periodontal Surgery

Answer 32

-Periodontal Flap Surgery -Osseous Surgery -Crown Lengthening -Soft Tissue Grafting -Pedicle Graft -Free Gingival Soft Tissue Graft

Question 33

What is Periodontal Flap Surgery?

Answer 33

Flap surgery is performed when excisional surgery is not indicated. The tissues are elevated away from the underlying roots and alveolar bone. The flap is then lifted up and the dentist has the access to perform surgery required.

Question 34

What is Osseous Surgery?

Answer 34

There are two types: Ostectomy - When bone is removed to restore health and normal contour Osteoplasty - when bone or bone subsitute is added to fill in a defect

Question 35

What is Crown Lengthening?

Answer 35

This surgical procedure will expose more tooth structure when placement of a restoration such as veneers may be required. This procedure may involve removal of soft tissue and/or alveolar bone.

Question 36

What is Soft Tissue Grafting?

Answer 36

A tissue graft is the moving of tissue from one area to another. When root surfaces are exposed, a graft may be done to increase attached gingiva.

Question 37

What are 2 common types of Soft Tissue Grafting?

Answer 37

Pedicle Graft Free Gingival Soft Tissue Graft

Question 38

What is Pedicle Graft?

Answer 38

It is a type of procedure in which a piece of skin from a near area stays attached at one of the corners while the other part of it is re-attached over the area that needs coverage.

Question 39

What is Free Gingival Soft Tissue Graft?

Answer 39

It is a type of procedure in which a piece of skin from a near area is not attached but has a donor site that is located away from the sugical site, often palate will be used as a donor site.

Question 40

What is Intra-Oral Imaging?

Answer 40

The wand-like intra-oral camera is used to take still or video images of the oral mucosa. The patient can then view the images on a computer monitor. Magnification can be up to 36 times. Patients may be more likely to accept treatment and be motivated to follow oral hygiene education instructions if they can see their areas of disease and comparisons to healthy areas.

Question 41

What is Automated Dental Occlusion Recording Methods?

Answer 41

Extensive pressure from certain types of contact in occlusion can contribute to bone loss around the teeth. With the automated recording method, the patient bites on a preformed bite sheet slowly and firmly. It must be held in position for a short time. Sensors relay the occlusal loads of various teeth to the computer, which interprets the data and displays/prints the results on an anatomical chart. The periodontist may choose to alter the occlusal loads to reduce pressure on affected teeth.

Question 42

What is an Automated Dental Probing System?

Answer 42

This probing system provides highly accurate and repeatable periodontal measurements by using a sensorized probe with repeated, constant pressure at all sites. The probe registers the sulcus depth to a computer and records, stores and prints the examination results automatically.

Question 43

What is Voice-Activated Dental Recording Systems?

Answer 43

The dentist wears a headset and speaks his or her findings into a microphone while performing the examination. The computer registers various coded commands and periodontal probing depths. The results are stored in the patient’s electronic chart, which can be printed if desired.

Question 44

What is a Dental Perioscope?

Answer 44

The dentist can use a miniscule endoscope to see into a periodontal pocket by projecting the image onto a chair-side computer screen. This may be used for diagnosis and during treatment.