Paediatric Periodontology Flashcards
(97 cards)
1
Q
What are the 2 aims of the 2012 guidelines (children)?
A
- To outline a method of screening children and adolescents for periodontal diseases during the routine clinical dental examination in order to detect the presence of gingivitis or periodontitis at the earliest opportunity
- To provide guidance on when it is appropriate to treat in practice or refer to specialist services, thus optimising periodontal outcomes for children and young adolescents
2
Q
What is included in the old classifications of periodontal disease (2011)? (8)
A
- Periodontitis associated with endodontic lesions
- Developmental or acquired deformities and conditions
- Gingival diseases
- Chronic periodontitis
- Aggressive periodontitis
- Periodontitis as a manifestation of systemic disease
- Necrotising periodontitis
- Abscesses
3
Q
What is included in the newer classification of periodontal conditions (2017)? (6)
A
- Periodontal health (intact periodontium or reduced periodontium)
- Gingivitis: dental biofilm induced (intact periodontium or reduced periodontium)
- Gingival diseases and conditions: non-dental biofilm induced
Periodontitis:
- Necrotising periodontal diseases
- Periodontitis
- Periodontitis as a manifestation of systemic disease
(There is another area for other conditions affecting the periodontium)
4
Q
What is included in the section ‘other conditions affecting the periodontium’ in the 2017 classification of periodontal conditions? (5)
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
5
Q
What does the mnemonic ‘Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight’ stand for?
A
- Periodontal health
- Gingivitis: dental biofilm induced
- Gingival diseases and conditions: non-dental biofilm induced
- Necrotising periodontal diseases
- Periodontitis
- Periodontitis as a manifestation of systemic disease
- Systemic disease 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
What is ‘staging’ in the classification of periodontitis?
A
- Interproximal bone loss at the worst site of bone loss (due to periodontitis)
- Stage I, II, III or IV
7
Q
What is ‘grading’ in the classification of periodontitis?
A
- Rate of progression
- % bone loss/age
- Grade A, Grade B, Grade C
8
Q
What are the categories for assessing the current periodontal status of a periodontitis patient? (3)
A
- Currently stable
- Currently in remission
- Currently unstable
9
Q
What are the 4 things you would include in a periodontitis diagnosis of a patient?
A
- Stage
- Grade
- Current periodontal status (stability)
- Risk assessment/factors
10
Q
What would we expect in a patient with a healthy periodontium? (3)
A
- Gingival margin may be several millimetres coronal to the CEJ
- Gingival sulcus may be 0.5-3mm deep
- Alveolar crest 0.4-1.9mm apical to the CEJ (teenagers)
11
Q
What is the biological width of the tooth?
A
- This is the distance between the CEJ and the alveolar bone crest
12
Q
For a patient with periodontal health, what would we expect to get from the BPE in relation to BOP?
A
<10% for clinical periodontal health (intact or reduced periodontium)
13
Q
What is gingivitis?
A
Inflammation of the gingivae
14
Q
The 2003 child dental health survey showed that plaque and gingival inflammation were present in…? (3)
A
- Two third of 8 and 12 year olds
- One third of 5 year olds
- Half of 15 year olds in the UK
15
Q
What are the 2 types of gingivitis?
A
- Dental biofilm induced
- Gingival diseases and conditions: non-dental biofilm-induced
16
Q
What are the 2 types of dental biofilm induced gingivitis?
A
- Localised
- Generalised
17
Q
Explain dental biofilm gingivitis and how this occurs? (4)
A
- As supra-gingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
- The junctional epithelium becomes disrupted
- This allows apical migration of plaque and an increase in the gingival sulcus depth
- This results in gingival pockets/false pockets/ pseudo pockets
18
Q
What are 2 other names for false pockets?
A
- Gingival pockets
- Pseudo pockets
19
Q
What is important about dental biofilm induced gingivitis?
A
- The process is reversible
20
Q
What happens if there is severe inflammation in dental biofilm induced gingivitis?
A
- Gingival swelling increases
- Get even deeper false gingival pockets
21
Q
In dental biofilm induced gingivitis, where is the most apical extension of the junctional epithelium?
A
- This is still the CEJ
- There has been no periodontal loss of attachment (this is why it is called false pocketing)
22
Q
Why is classification of periodontitis an important component of diagnosis?
A
because diagnosis informs prognosis and treatment plan
23
Q
How would we split gingivitis into localised and generalised?
A
BOP:
- 10-30% = localised gingivitis
- > 30% = generalised gingivitis
- Plaque retentive factors e.g. overhangs often present
24
Q
What is the appearance of necrotising ulcerative gingivitis? (4)
A
- Blunted papillae
- Malodour
- Painful gingivae
- No attachment loss
25
What is the aetiology of necrotising ulcerative gingivitis? (2)
Bacteria:
- Fusiform
- Spirochete
26
What are risk factors for necrotising ulcerative gingivitis? (7)
- Smoking, stress, immunosuppression, poor diet
- HIV + status or other underlying conditions
- Common in developing countries
- Trench mouth
27
What is pubertal gingivitis?
- Increased inflammatory response to plaque
28
What is pubertal gingivitis mediated by?
Hormonal changes
29
In teenagers, what can gingivitis progress into?
- Early periodontitis
30
Give examples of factors that can influence the progression of pubertal gingivitis? (5)
Local
- Plaque
- Braces
- Overhangs
and systemic factors can influence progression
31
Non-dental biofilm induced gingival diseases can be caused by an 'infective' reason. Give examples of these? (3)
- Viral
- Fungal
- Deep mycoses
32
Non-dental biofilm induced gingival diseases can be caused by an 'genetic' reason. Give examples of these? (2)
- Phenotype
| - Hereditary fibromatosis
33
Non-dental biofilm induced gingival diseases can be caused by a 'Trauma' reason. Give examples of these? (2)
- Thermal/chemical
| - Physical
34
Non-dental biofilm induced gingival diseases can be caused by a 'manifestation of systemic disease' reason. Give examples of these? (3)
- Haematology: benign/malignant
- Immunological conditions
- Granulomatous inflammation
35
Non-dental biofilm induced gingival diseases can be caused by a 'drug induced' reason. Give examples of these? (6)
- Anti-retro-viral
- Immunosuppressants
- Ca+ channel blockers
- Anti-convulsants
- Cytotoxic
- Immune complex reactions
36
Look at slide on drug induced aetiologies
Has pictures
37
One example of a haematological disease which can lead to gingivitis is Agranulocytosis. What is this?
- Acute condition. Low white-blood cell count
38
One example of a haematological disease which can lead to gingivitis is Cyclic neutropenia. What is this?
- Low neutrophil count. Occurs every 3 weeks and lasts 4-6 days
39
Give examples of granulomatous inflammations that can lead to gingivitis? (3)
- Crohn's disease
- Sarcoidosis
- Granulomatosis
40
One example of a granulomatous inflammation which can lead to gingivitis is Granulomatosis. What is this?
- Autoimmune vasculitis. Affects multiple systems. Most commonly mouth, URT and kidneys
41
Gingival overgrowth beyond biofilm induction can relate to what? (4)
- Systemic and metabolic disease
- Genetic factors, local factors
- Side effects of some medications (Cyclosporin, Nifedipine, Phenytoin)
- Greater incidence seen in puberty
42
What are the treatments of gingivitis? (3)
- Rigorous oral hygiene/home care
- Frequent scaling
- Surgery may be necessary (esp with drug-induced) -> refer to specialist
43
What are the 4 main distinguishable featured of periodontitis?
- Apical migration of junctional epithelium beyond CEJ
- Loss of attachment of periodontal tissues to cementum
- Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated)
- Alveolar bone loss
44
Early clinical signs of periodontitis can be seen in a substantial proportion of teenagers. What is this classified as?
- Classified as >1mm loss of attachment (of cementum to PDL)
45
Similar pathogens to adults with periodontitis can be found in subgingival microflora of teenagers with periodontitis. What are they? (3)
- Porphyromonas gingivalis
- Prevotella intermedia
- Aggregatibacter actinomycetemcomitans (AA)
46
Periodontitis may be present in a small proportion of adolescents. What dot he features include? (5)
- Rapid attachment loss and bone destruction
- Patient is otherwise healthy
- Onset around puberty
- Family history
- 0.1% Caucasians and 2.6% African ancestry
47
Where is localised periodontitis in adolescents usually found?
- Traditionally localised to incisors and first molars
48
Where is generalised periodontitis usually found and who does this usually affect?
- Traditionally > or equal to 3 permanent teeth other then incisors and first molars
- Onset is usually older but sometimes under 30 years
(now based on number of sites as per new classification)
49
What is essential for an up to date diagnosis of periodontitis?
Staging and grading
50
What would stage 1 periodontitis be?
- (early/mild)
- Interproximal bone loss = <15% or <2mm
(measurement in mm from CEJ if only bitewing radiograph available or no radiographs clinically justified)
51
What would stage 2 periodontitis be?
- Moderate
| - Interproximal bone loss = coronal third of root
52
What would stage 3 periodontitis be?
- Severe
| - Interproximal bone loss = Mid third of root
53
What would stage 4 periodontitis be?
- Very severe
| - Apical third of root
54
How do we describe the extent of periodontitis?
- Localised (up to 30% of teeth), generalised (more than 30% of teeth), molar/incisor pattern
55
What would grade A of periodontitis be?
- Slow progression
| - % bone loss/age = <0.5
56
What would grade B periodontitis be?
- Moderate progression
| - % bone loss/age = 0.5-1.0
57
What would grade C periodontitis be?
- Rapid progression
| - % bone loss/age = >1%
58
Can periodontitis occur in the primary dentition?
- Some evidence that bone loss can occur around primary teeth in some children
59
Can periodontitis occur in the mixed dentition?
- Be aware of false pocketing around erupting permanent dentition
60
Periodontal screening should be a routine and essential part of history and clinical examination. When looking at gingival condition what should we look at/for? (7)
- Gingival colour
- Contour
- Swelling
- Recession
- Suppuration
- inflammation (presence and location)
- Consider use of marginal bleeding free chart
61
Periodontal screening should be a routine and essential part of history and clinical examination. Part of this is to assess OH status. What would we include in this? (5)
Description of plaque status
Describe surfaces covered by plaque:
- Is plaque easily visible?
- Detectable only on probing?
- Use of plaque free scores (%) - motivational aid to patient
62
Periodontal screening should be a routine and essential part of history and clinical examination. How would we asses if any calculus is present?
- Chart the location of calculus if found
63
Periodontal screening should be a routine and essential part of history and clinical examination. Part of this is to asses local risk factors. What are examples of these that we would look for? (5)
- Plaque retention factors
- Low frenal attachments
- Malocclusions
- Incompetent lip seal: (reduced upper lip coverage - labial and palatal gingivitis or increased lip separation)
- Mouth breathing (palatal gingivitis)
64
When we are assessing local risk factors for periodontal disease we may find a patient with a complete overbite. Why could this be a problem?
- Biting down on gingival margin of lower incisors so could end up with chronic continuous trauma to the area and could end up with recession and other problems
65
When we are assessing local risk factors for periodontal disease we may find a patient with a malocclusion. Why could this be a problem?
- This can make brushing more difficult and so could have poorer OH
66
When we are assessing local risk factors for periodontal disease we may find a patient with an incompetent lip seal at rest. Why could this be a problem?
- This may contribute to drying of their intra-oral mucosa and potentially gingivitis can occur
67
What is a BPE used as?
- A screening tool
| - Rapidly guides clinicians to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis
68
What information does a BPE not consider? (2)
- Historical attachment loss
| - Bone loss (staging and grading not done)
69
When in children would we use a BPE?
In children aged 12-17 years old
70
When would we used a simplified BPE in children?
- In all co-operative children aged 7-11 years old
71
which probe would we use for a BPE?
WHO CPITN probe (is this out of date?)
72
How much force should we apply when doing a BPE?
20-25g of force application (for both adults and children)
73
Where should a BPE probe be used?
- Inserted parallel to the root surface and walked around the gingival margin
- Should be coronal to the CEJ
74
Why do we use the simplified BPE for children?
Because it has been modified for paediatrics to be:
- Quick
- Easy
- Well tolerated
- Avoid false pocketing
75
Which teeth are a simplified BPE carried out on? (6)
16, 11, 26, 36, 31, 46
76
At what age would you begin to take simplified BPE's from a child?
- Start at 7 years (permanent teeth only)
77
What does the simplified BPE identify in children?
- Identifies patients who would benefit from further investigation
78
Do we often find periodontal disease where there is primary teeth?
- Periodontal disease rare
| - Mobility or gingival suppuration -> refer to a specialist
79
Which BPE codes should we use for patients aged 7-11?
0-2
80
Which BPE codes should we use for patients aged 12-17?
All BPE codes should be used
| - 0-4 and *
81
What does a plaque score of 10/10 mean?
- Perfectly clean tooth
82
What does a plaque score of 8/10 mean?
- Line of plaque around the cervical margin
83
What does a plaque score of 6/10 mean?
- Cervical 1/3 of crown covered
84
What does a plaque score of 4/10 mean?
- Middle 1/3 of crown covered
85
In 12-17 year olds where they are getting BPE scores of codes 3 or 4 what sound be done? (3)
- 6PPC (localised to 3 BPE, or full if 4)
- Check alveolar bone levels (BW's for posteriors, periapicals for anterior's, OPT
- BPE should always be carried out prior to orthodontic treatment
86
In adolescents when should a BPE always be carried out prior to?
- Prior to orthodontic treatment
87
How can plaque induced gingivitis be treated in children and adolescents?
- Can be managed by good toothbrushing
- Emphasise the need to systematically clean all surfaces
- Standard toothbrushing and fluoride advice should be given to all patients
- Supervised/assisted brushing (up to about 7 years old)
- Disclosing tablets helpful
- Fluoride mouthwash (225ppm) should be recommended for patients undergoing fixed appliance therapy
88
What treatment should we give to a child with a BPE score of 0?
- None
89
How frequently should we see a child with a BPE score of 0?
- Screen again at routine recall or within 1 year
90
What treatment should we give a child with a BPE score of 1?
- OHI and prevention
| - Can do bleeding/plaque charts
91
How frequently should we see a child with a BPE score of 1?
- Screen again at routine recall or after 6 months
92
What treatment should we give a child with a BPE score of 2?
OHI, prevention, scaling, removal of plaque retention factors
- Can do bleeding/plaque charts
93
How frequently should we see a child with a BPE score of 2?
- Screen again at routine recall or after 6 months
94
What treatment should we give a child with a BPE score of 3, 4 or *?
- Full periodontal assessment, radiographs, to establish whether false pocketing or true pocket
- Scaling, RSD, OHI + prevention
- Scores of 4 or * - consider referral to specialised periodontologist or paediatric dentist
95
How frequently should we see a child with a BPE score of 3, 4 or *?
Treat and review after 3 months
96
What in relation to periodontal diseases is important for optimum treatment outcome?
- Early detection
97
What in children can make periodontal diagnosis more challenging in the mixed permanent dentition?
- False pocketing
