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BDS3 CDS > Paediatrics: Periodontology > Flashcards

Paediatrics: Periodontology Flashcards

1
Q

What are features of periodontal health in children?

A
  • absence of gum inflammation and calculus
  • no more than one sextant with plaque
  • gingival margin several mm coronal to the CEJ
  • gingival sulcus 0.5-3mm on a fully erupted tooth
  • in teenagers the alveolar crest is situated 0.4-1.9mm apical to CEJ
  • BOP <10%
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2
Q

What occurs to the gingivae during gingivitis?

A
  • plaque accumulates on teeth (large number of bacteria) and inflammatory cells accumulate
  • this causes inflammation of the gingivae and the junctional epithelium is disrupted
  • allows apical migration of plaque and an increase in gingival sulcus depth
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3
Q

When can gingivitis occur in a reduced periodontium patient?

A
  • successfully treated periodontitis patient
  • root lengthening
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4
Q

Name the sub-classifications of gingival diseases and conditions that are non-dental biofilm induced?

A

Genetic/Developmental disorders
Specific infections
Inflammatory and immune conditions and lesions
Reactive processes
Neoplasms
Endocrine
Nutritional and metabolic diseases
Traumatic lesions
Gingival pigmentation.

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5
Q

What is the microbial aetiology of necrotising gingivitis?

A

fusiform spirochaetal

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6
Q

What is the socioeconomic factors of necrotising gingivitis?

A

developing countries

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7
Q

what are the modifiable risk factors of necrotising gingivitis?

A
  • smoking
  • immunosuppression
  • stress
  • malnourishment
  • poor diet
  • diabetes
  • pharmaceutical drugs (cyclosporin, calcium channel blockers)
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8
Q

What are the local risk factors of necrotising gingivitis?

A
  • root proximity
  • tooth malposition
  • dental trauma
  • orthodontic appliances
  • overhangs
  • tooth anatomy
  • incompetent lip seal
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9
Q

What are the systemic non -modifiable risk factors of necrotising gingivitis?

A
  • HIV positive
  • underlying undiagnosed pathology in a immunosuppressed host
  • haematological conditions (leukaemia)
  • increase in sex steroids (period/pregnacy)
  • genetics, age
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10
Q

What are the features of necrotising gingivitis?

A
  • pain
  • punch out gingivae
  • ulceration
  • spontaneous bleeding
  • halitosis
  • pseudomembrane may be present
  • fever
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11
Q

What are the treatment options for gingival overgrowth?

A
  • rigorous home care
  • frequent appointments for professional mechanical plaque removal (PMPR)
  • +/- surgery, especially with drug-induced gingival overgrowth
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12
Q

If an extent of a patients condition is inconsistent with level of oral hygiene observed and have unexplained bleeding, gingival enlargement, inflammation and tooth mobility what should you do?

A

consider urgent referral to a physician and haematinic screening

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13
Q

What are the 4 main distinguishing features of periodontitis?

A
  • apical migration of the junctional epithelium
  • loss of attachment of PDL to bone
  • transformation of junctional epithelium to pocket epithelium
  • alveolar bone loss
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14
Q

What is early clinical signs of periodontitis in teenagers classified as?

A

1mm loss of attachment

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15
Q

What pathogens can be found in the subgingival flora of teenagers with periodontitis?

A
  • similar to adults
  • p. gingivalis, p. intermedia, T. forsythia
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16
Q

What do you need to consider when taking BPE around erupting permanent dentition?

A

false pocketing

17
Q

What are the features of molar-incisor periodontitis in adolescents?

A
  • rapid attachment loss and bone destruction
  • patient is otherwise healthy
  • onset at puberty
  • family history
  • Caucasians and African ancestry
18
Q

What teeth does localised molar-incisor periodontitis usually effect?

A

incisors and first permanent molars

19
Q

What teeth does generalised molar-incisor periodontitis usually effect

A
  • Traditionally > or = 3 permanent teeth other than the incisors and first molars
20
Q

What things are you looking for when assessing gingival condition?

A
  • contour
  • recession
  • bleeding
  • suppuration
  • swelling
  • gingival colour
  • inflammation
21
Q

How would you asses oral Hygiene status on a patient?

A
  • look for visible plaque or plaque on probing
  • score (modified plaque and bleeding chart)
22
Q

What 4 things would you look at when recording and diagnosing periodontal disease?

A
  1. gingival condition
  2. oral hygiene (plaque)
  3. calculus present
  4. local risk factors
23
Q

What type of tool is a BPE?

A

screening tool- helps to aid in diagnosis and any special test/further investigations needed

24
Q

What does a BPE not consider?

A
  • bone levels
  • historical attachment loss
25
Q

What age would you start doing a BPE on children and how would you do it?

A
  • all co-operative patients from 7-18 years
  • only use 6 teeth (all 6s and UR central and LL central)
  • insert parallel to the root surface and walk around margins
26
Q

What force should be applied when using a BPE probe?

A

20-25g

27
Q

What BPE codes would you use for 7-11 year olds?

A

0-2

28
Q

What BPE codes would you use for 12-18 year olds?

A

0-4*

29
Q

How would you carry out a plaque score on children according to the SDCEP guidelines?

A
  • record worst tooth in each sextant
  • run probe over crown of tooth
  • 10/10 no plaque
  • 8/10 cervical plaque
  • 6/10 a 1/3 of crown covered
  • 4/10 middle 1/3 of crown covered
30
Q

When would you next screen your patient if they scores BPE of 0 or 1?

A

1 year at next recall visit

31
Q

When would you next screen your patient if the scored a BPE of 2?

A

6 months

32
Q

When would you next screen your patient if the scored BPE of 3?

A

3 months

33
Q

What are 3 basic treatments you would give to your patient with BPE score 1-4?

A
  • preventative advice
  • health education
  • oral hygiene instruction
34
Q

What are the 4 steps in the treatment guidelines for periodontitis?

A

step 1 - Building foundations for optimal treatment outcomes
Step 2 - Cause related therapy
Step 3- Management of non responding sites (BoP >4mm or sites >6mm)
Step 4 - Supportive periodontal care (maintenance)

35
Q

What is the treatment in Step 1 of periodontitis?

A
  • OHI and DHE
  • control risk factors
  • PMPR (supragingival)
  • adjunctive therapies for gingival inflammation
36
Q

What is the treatment in Step 2 of periodontitis?

A
  • sub gingival PMPR
  • use of physical or chemical agents
37
Q

What is the treatment of periodontitis in Step 3 of the guidelines?

A

Aims to gain access to further subgingival instrumentation or to achieve regeneration or resection in lesions (infrabony or furcation) that increase complexity in managing periodontitis.

38
Q

What is the treatment of periodontitis in step 4 of the guidelines?

A

Aims to maintain periodontal stability in all treated periodontitis patients. Combines preventive/therapeutic interventions from Steps 1 and 2. Regular recall intervals are needed, tailored to patient’s individual needs. Recurrent disease to be managed with updated diagnosis and treatment plan. Compliance with OHI/ healthy lifestyle are integral.

39
Q

When would you refer a periodontitis patient to a specialist?

A
  • stage 2/3 perio not responding to treatment
  • Grade C or stage 4 perio
  • MH that significantly affects perio treatment or requiring multi disciplinary care
  • periodontitis as a direct manifestation of systemic disease
  • systemic/genetic disease that can effect periodontal supporting tissues
  • root morphology that adversely affecting prognosis on key teeth
  • non -plaque induced conditions requiring specialist care
  • cases requiring diagnosis/management or rare/complex clinical pathology
  • drug-induce gingival overgrowth requiring surgery
  • ## cases requiring evaluation for periodontal surgery

BDS3 CDS (6 decks)

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