Perio Flashcards
(153 cards)
1
Q
What BPE score is the following?
- pockets < 3.5mm
- no calculus/overhangs, no bleeding on probing (black band entirely visible)
A
grade 0
2
Q
What BPE score is the following?
- pockets < 3.5mm
- no calculus/overhangs, bleeding on probing (black band entirely visible)
A
grade 1
3
Q
What BPE score is the following?
- pockets < 3.5mm
- supra or sub gingival calculus/overhangs (black band entirely visible)
A
grade 2
4
Q
What BPE score is the following?
- probing depth 3.5-5.5mm
- black band partially visible, indicating pocket of 4-5mm)
A
grade 3
5
Q
What BPE score is the following?
- probing depth >5.5mm
- black band disappears, indicating pocket of 6mm or more
A
grade 4
6
Q
What BPE score is the following?
- furcation involvement
A
*
7
Q
What is the BPE score indicating the following treatment?
- no need for periodontal treatment
A
grade 0
8
Q
What is the BPE score indicating the following treatment?
- oral hygiene instruction
A
grade 1
9
Q
What is the BPE score indicating the following treatment?
- as for code 1, plus removal of PRFs, including all supra and sub gingival calculus
A
grade 2
10
Q
What is the BPE score indicating the following treatment?
- as for code 2 and RSD if required and review in 3 months with localised 6ppc in involved sextants
- radiographs
A
grade 3
11
Q
What is the BPE score indicating the following treatment?
- OHI, RSD, assess the need for complex treatment, referral to a specialist may be indicated
- rads and 6ppc
A
grade 4
12
Q
What is the BPE score indicating the following treatment?
- treat according to BPE code (0-4)
- assess the need for more complex treatment, referral to a specialist may be indicated
A
*
13
Q
What would be the diagnosis for BPE code 0/1/2 and < 10% bleeding on probing?
A
clinical gingival health
14
Q
What would be the diagnosis for BPE code 0/1/2 and 10-30% bleeding on probing?
A
localised gingivitis
15
Q
What would be the diagnosis for BPE code 0/1/2 and > 30% bleeding on probing?
A
generalised gingivitis
16
Q
What would be the diagnosis for BPE code 4 and pocketing molar-incisor pattern?
A
periodontitis molar-incisor pattern
17
Q
What would be the diagnosis for BPE code 4 and pocketing < 30% of teeth?
A
localised periodontitis
18
Q
What would be the diagnosis for BPE code 4 and pocketing > 30% of teeth?
A
generalised periodontitis
19
Q
What is meant by intact periodontium?
A
no bone loss
20
Q
What is meant by reduced periodontium?
A
bone loss not caused by periodontitis
21
Q
What is meant by staging?
A
severity of disease
22
Q
What is meant by grading?
A
rate of disease progression
23
Q
How is the staging of periodontal disease measured?
A
interproximal bone loss (using worst site of bone loss due to perio)
24
Q
What staging is given to <15% bone loss (or <2mm attachment loss from CEJ)?
A
stage 1 (early/mild)
25
What staging is given to bone loss to coronal third of root?
stage 2 (moderate)
26
What staging is given to bone loss to mid third of root?
stage 3 (severe)
27
What staging is given to bone loss to apical third of root?
stage 4 (very severe)
28
How is grading calculated?
% bone loss divided by patient age
29
What is meant by grading of < 0.5?
grade A (slow rate of progression)
30
What is meant by grading of 0.5-1.0?
grade B (moderate rate of progression)
31
What is meant by grading of > 1.0?
grade C (rapid rate of progression)
32
What assessment would be given of current periodontitis status?
- BoP < 10%
- PPD 4mm or less
- no BoP at 4mm sites
currently stable
33
What assessment would be given of current periodontitis status?
- BoP 10% or more
- PPD 4mm or less
- no BoP at 4mm sites
currently in remission
34
What assessment would be given of current periodontitis status?
- PPD 5mm or more or PPD 4mm or more and BoP
currently unstable
35
What grade for mobility is the following?
- normal movement (up to 0.2mm)
grade 0
36
What grade for mobility is the following?
- < 1mm horizontal
grade 1
37
What grade for mobility is the following?
- > 1mm horizontal
grade 2
38
What grade for mobility is the following?
- horizontal and vertical
grade 3
39
What grade for furcation is the following?
- 1/3 of the furcation width
grade 1
40
What grade for furcation is the following?
- 1/3 of the furcation width but not through and through
grade 2
41
What grade for furcation is the following?
- through and through
grade 3
42
What is the difference between marginal bleeding and bleeding on probing?
marginal bleeding is where you sweep the probe along the gingival sulcus no more than 3mm
BoP is bleeding from base of the pocket
43
What are 2 aims of PMPR?
- reduce bacterial load
- removal of plaque retentive factors
44
What is the definition of risk factors?
a factor that increases the probability of a disease developing in a given individual
45
What are the 2 main categories of types of risk factors?
- local risk factors
- systemic risk factors
46
Which type of risk factors is the following?
- those which are confined to the oral cavity
- can be divided into 2 parts: acquired and anatomical/development
local risk factors
47
What are 5 examples of acquired local risk factors?
- plaque/calculus
- bleeding on marginal probing
- probing pocket depth - pockets 5mm or more are at an increased risk of attachment loss
- poorly controlled/defective restorations
- poor prosthesis
48
Explain how plaque is an acquired local risk factor for periodontal diseases?
- instigator of periodontal disease
- biofilm creates environment which can initiate change in health
- soft - easily removed by patient with OH measures
- removal of plaque retentive factors can help with plaque control
49
Explain 6 reasons restorations or prosthetic are an acquired local risk factor for periodontal disease?
- overhangs and deficiencies
- partial dentures can trap plaque
- restorations with bulbous emergence profile
- restorations which impinge on the biological width
- inadequate contact points
- subgingival margins
50
What are 8 examples of anatomical risk factors for periodontal disease?
- dental crowding
- furcations
- bone defects (presence of a dehiscence and/or fenestration)
- mucosal defects (a high frenal attachment)
- root grooves/concavities
- cervical enamel projections
- enamel pearls
- canine fossa
51
What type of root anomaly is the following?
- located apically to the CEJ
- often found in furcation areas
- triangular, tapering apically and flat
cervical enamel projections
52
Which type of root anomaly is the following?
- usually larger than enamel projections and more spherical
- often found apical to the CEJ
- care must be taken when removing or sub-scaling as often contain extension of the pulp
enamel pearls
53
What are 5 examples of modifiable systemic risk factors for perio?
- smoking
- diabetes
- medications
- stress
- nutrition
54
What are 5 examples of non-modifiable systemic risk factors for perio?
- genetic predispositions (family history of perio)
- pregnancy
- hormonal changes
- immunodeficiency states
- age
55
Mutations of which genotype contribute to the immune inflammatory response for periodontal disease?
IL-1 genotype
56
Which condition has the following underlying defect of periodontal relevance?
- defects of PMNL chemotaxis, killing and phagocytosis
- depressed T-cell antigen induced killing
down syndrome
57
Which condition has the following underlying defect of periodontal relevance?
- failure of the 'respiratory burst' in phagocytes
- oxygen radicals are not produced and bacteria survive
chronic granulomatous disease
58
Which condition has the following underlying defect of periodontal relevance?
- hyperglycaemic state reduces PMNL function
- monocytes are hyper-reactive and excess IL-1B, PGE2, TNFa and oxygen radicals are produced
- effects also on collagen and vascularity reduce healing
insulin-dependent juvenile diabetes
59
Which condition has the following underlying defect of periodontal relevance?
- low levels of the enzyme alkaline phosphatase (ALP) result in poor mineralisation/formation of cementum and teeth exfoliate
hypophosphatasia
60
Which condition has the following underlying defect of periodontal relevance?
- defects of PMNL chemotaxis and phagocytosis
- gene mapped to PMNL enzyme (Cathepsin-C) gene locus on chromosome 11
papillion-lefevre syndrome
61
Which condition has the following underlying defect of periodontal relevance?
- defects of collagen synthesis -type VIII is associated with severe periodontal destruction
Ehlers danlos syndrome
62
Which condition has the following underlying defect of periodontal relevance?
- defects of the phagocyte chemotaxis, degranulation and membrane fusion leads to total loss of the adult dentition
chediak-higashi syndrome
63
Which condition has the following underlying defect of periodontal relevance?
- excessive IgE and histamine release by mast cells and IgE immune complex formation
jobs syndrome
64
What are 5 effects of smoking on the periodontium?
- poorer healing response
- more teeth with furcation involvement
- reduction in gingival vessels
- greater attachment loss
- more sites with deeper pockets
65
What are the effects of smoking on gingival tissues?
- links between smoking and necrotising periodontal diseases are well established
- decreased gingival bleeding
- decreased gingival redness and GCF volume in smokers suggests decreased inflammation response to plaque
66
What are 4 roles of neutrophils in the inflammatory immune response and healing response of smokers?
- increase in the number of neutrophils in the systemic circulation
- impaired neutrophil function
- increased proteolytic activity
- smoking affects the respiratory burst of neutrophils
67
What are 5 roles of fibroblasts in the inflammatory immune response and healing response of smokers?
- nicotine inhibits gingival fibroblast proliferation
- decreased production of type 1 collagen and fibronectin
- increased collagenase activity
- PDL fibroblast attachment is significant decreased on root surfaces from heavy smokers
- poor wound healing
68
Which 3 drug groups are known to cause gingival overgrowth?
- calcium channel blockers eg. amlodipine, nifedipine, felodipine
- anti-rejection immunosuppressants eg. ciclosporin
- anti-epileptic drugs eg. phenytoin
69
Medication induced gingival overgrowth usually affects the anterior region with onset usually less than?
3 months
70
What is the first bacteria to colonise a clean tooth surface?
- supragingivally
- some of them secrete endotoxins
- does not trigger an immune response
streptococci (gram positive)
71
What is the next stage of plaque formation following initial colonisers?
- if not removed within 2 days, gram negative bacteria appear in the biofilm subgingivally
- gram negative have both exotoxins and endotoxins
- the gingiva will become inflamed
72
What are the 4 stages of periodontal disease?
- the initial lesion
- the early lesion
- the established lesion
- the advanced lesion
73
Which stage of periodontal disease is the following?
- develops 2-4 days after plaque accumulation
- vasculitis of vessels below junctional epithelium
- increased leukocyte migration into junctional epithelium
- extravascular presence of serum proteins
- localised collagen destruction
- mainly gram positive bacteria - streptococci dominate
- stable condition - not visible clinically
initial lesion (healthy gingiva)
74
Which stage of periodontal disease is the following?
- develops 7-10 days after plaque accumulation
- increased fluid exudate
- increase in PMNLs
- swelling and redness visible
- proliferation of basal cells at the junctional epithelium
- anaerobic filamentous bacteria dominate
early lesion (early gingivitis)
75
Which stage of periodontal disease is the following?
- develops 21-28 days after plaque accumulation
- further proliferation of the junctional epithelium
- gingival crevice deepens
- increased neutrophils
- continuing loss of collagen
- T cells > B cells
- breakdown of connective tissue but no bone loss
established lesion (established gingivitis)
76
Which stage of periodontal disease is the following?
- epithelium migrates apically forming a pocket
- plaque and endotoxins permeate the surface layer of the cementum
- loss of collagen and bone
- B cells > T cells
- only develops in 10-15% of patients and not always in all sites
- the lesion is unstable
advanced lesion (periodontitis)
77
What are the 2 types of responses from the immune system?
- the innate response
- the adaptive/acquired response
78
What are 4 roles of the junctional epithelium?
- innate response starts with the junctional epithelium, epithelial cells release cell signalling molecules which initiate inflammation
- allow bacterial products to go in
- allow GCF and neutrophils to go out
- becomes more permeable in disease
79
Which fluid is the following?
- washes and dilutes
- allows vehicle for swallowing bacteria
- contains antibacterial enzymes
saliva
80
Which 2 bacterial enzymes does saliva contain?
- lysozyme
- immunoglobulins (IgA and IgG)
81
Which fluid is the following?
- carries all components of serum including complement and immunoglobulins
- increased flow during inflammation
GCF
82
Which type of molecule does the following?
- stimulate cells to release other molecules
cytokines
- cytokines and lymphokines can stimulate cells to perform other functions
83
Which type of molecule does the following?
- attract cells to areas of infection
chemokines
84
What is the most important cell signalling molecule as it is a powerful pro-inflammatory and causes bone resorption?
IL-1
85
Which cytokine has the following effects?
- activates osteoclasts
- increases PMNL margination
- increases PGE2 production
- increases TNF-alpha production
- causes bone resorption
IL-1
86
Which cytokine has the following effects?
- increases IL-1 production
- increases PGE2 production
TNF-a (tumour necrosis factor alpha)
87
Which cytokine has the following effects?
- stimulates bone resorption
PGE2 (prostaglandin E2)
88
What are 4 cells of origin of IL-1?
- macrophages
- fibroblasts
- monocytes stimulated by endo/exotoxins
- epithelial cells
89
What are 3 cells of origin of TNF-a?
- activated macrophages
- monocytes
- epithelial cells
90
What are 5 cells of origin of PGE2?
- activates macrophages
- monocytes
- PMNLs
- mast cells
- epithelial cells
91
Histamine (vasoactive peptide) is stimulated by which complements of the complement cascade?
C3a and C5a
92
Which cell type is histamine released?
mast cells
93
What is the role of adhesion molecules and what is the most important one?
- used to stick to each other or to components of intercellular matrix
- ICAM-1
94
What are 2 roles of vasoactive peptides?
- vasodilation, more blood cells and plasma proteins, slows blood flow allowing PMNLs to touch vessel walls
- increases vessel permeability
95
What are the 4 main components of PMNLs?
- receptors - pathogen recognition, opsonisation
- cytoskeleton - movement, actin muscle fibres
- lysosomes - destroy bacterial strictures
- oxygen radicals - super-oxides, destroy bacterial structures
96
Which cell type is the following?
- develop from monocytes in the blood
- emigrate to inflamed gingival tissue
- scavengers of dead cells
- bridge between innate and acquired immunity
macrophages
97
Which macrophage allow recognition between host and foreign tissue?
MHC-class II
98
What are the 3 main roles of the complement cascade?
- recruit phagocytes
- aid phagocytosis - opsonisation
- kill bacteria - formation of membrane attack complex leading to cell lysis
99
What are the 2 pathways for complement activation?
- alternative pathway - activated by bacterial endotoxin (LPS) mainly
- classical pathway - only activated by the antigen-antibody complexes (the adaptive/acquired response)
100
Alternative and classical pathways of the complement cascade activate which complement component?
C3
101
Summarise the complement cascade?
- classical and alternative activate C3
- C3 activates C5
- cascade amplifies
- MAC formed (membrane attack complex)
- cell lysis occurs
- bacteria dies
102
What does the membrane attack complex lead to?
cell lysis
103
What effect does C3a of the complement cascade have?
chemotaxis of phagocytes
104
What 3 effects does C3b of the complement cascade have?
- cytokine production
- macrophage secretion
- opsonisation
105
What effect does C5a of the complement cascade have?
- leukocytes stick to vessel walls
- neutrophils release enzymes and oxygen radicals (degranulation)
106
What effect does C3a and C5a of the complement cascade have?
- increased vascular permeability due to histamine release from mast cell degranulation
107
What effect does C3b and C5a of the complement cascade have?
production of oxygen radicals
108
What effect does C5a and C567 complex of the complement cascade have?
leukocyte chemotaxis
109
What effect does C5b, C6, C7, C8 and C9 of the complement cascade have?
bacterial cell lysis
110
Which 3 things does the acquired response involve?
- T lymphocytes - cell mediated response
- B lymphocytes - humoral response
- immunoglobulins
111
Which immunoglobulin is the first one produced?
IgM
112
Which immunoglobulin are the most important in periodontal disease?
IgG and IgA
113
Which immunoglobulin is the following?
- from GCF
- small molecular weight
- originates from blood plasma
IgG
114
Which immunoglobulin is the following?
- from saliva
- dimer
IgA
115
Which cells are the first to arrive in gingivitis?
T-lymphocytes
116
Which immune response is the following?
- constantly in function
- rapid response
- usually involved in early gingival inflammation
- T cells > B cells
innate response
117
Which immune response is the following?
- specific cell-cell interactions
- slower response
- usually involved in moderate gingivitis and periodontitis
- B cells > T cells
adaptive response
118
What are bacterial factors contributing to perio?
- increased number
- specific pathogens
- direct tissue invasion
119
What are host factors contributing to perio?
- reduced effectiveness of host defences
- increased damage in response to microbial changes
120
What are 3 conditions with a strong evidence base link to periodontal disease?
- cardiovascular disease
- diabetes
- adverse pregnancy outcomes
121
Explain why pregnancy has a strong link to periodontal disease?
- hormonal changes during pregnancy, elevated oestrogen and progesterone increase vascular permeability
- plaque alongside this will promote inflammation, worse in women with existing periodontitis
122
What are 5 risk factors for pregnancy complications?
- young mothers <18 years old
- drug or alcohol use
- maternal stress
- genetics
- periodontal disease
123
What are 3 complications which can be seen in pregnancy associated with periodontitis?
- low birth weight
- preterm birth
- pre-eclampsia
124
What are 5 disease processes associated with chronic hyperglycaemia?
- retinopathy
- nephropathy
- neuropathy
- micro and macrovascular disease
- periodontal disease
125
Explain how PMNL function contribute to perio risk in diabetic patients?
- impaired chemotaxis, phagocytosis and adherence
- PMNL defects may be inherited or secondary to hyperglycaemia
126
Explain how collagen metabolism contribute to perio risk in diabetic patients?
- diabetic synthesise less collagen
- diabetics have higher levels of PMNL collagenase
127
Explain how advanced glycation end-products (AGE) contribute to perio risk in diabetic patients?
- hyperglycaemic environment = AGE formation increased
- AGE products cause increased collagen cross-linking and so reduced turnover/stability
- monocytes/macrophages have AGE receptors (RAGE) which when bound by AGE products, cause release of pro inflammatory cytokines
128
Perio patients have a higher chance of developing which?
- pre diabetes
- type 2 diabetes
129
What is the mechanism of the link between perio and cardiovascular diseases?
- perio leads to entry of bacteria (or their products) into the blood stream
- bacteria activate the host inflammatory response by multiple mechanisms
- the host immune response favours atheroma formation, maturation and exacerbation
130
How should patients who have had recent adverse CVD event diagnosed with perio be managed?
- treatment should be staggered
- multiple visits advised as periodontal treatment associated with transient impairment of endothelial function for a week after
- patient with perio and other known risk factors (smoking, obesity, hypertension) who have not seen their GP for over a year should be advised to have a cardiac review
- focus on preventative advice
- CVD patients should have thorough periodontal assessment- - regular periodontal monitoring for those with CVD but no perio - at least every 12 months
131
Improved oral hygiene has an important role in the prevention of what?
hospital acquired pneumonia (especially patients on ventilators)
132
What are 3 aims of supportive periodontal therapy?
- prevent or minimise periodontal disease recurrence or progression
- prevent or reduce incidence of tooth loss
- increase the likelihood of detecting and treating other oral conditions
133
Which study aimed to look at periodontal disease in Sri Lankan tea workers?
loe et al 1986
134
What did the Loe et al study 1986 conclude?
- all had similar high plaque and calculus levels
- a small group showed rapidly progressing disease, some showed no progression
- this suggests a possible genetic component influencing disease progression
135
How is the supportive therapy phase utilised for patients with stable disease, good compliance, good response to treatment and prognosis?
- phase is vital to ensure stability
- implementing regular clinical assessment
- retreatment of certain sites
- patient motivation
136
How is the supportive therapy phase utilised for patients with unstable disease, rapidly progressing disease, uncompliant patient, poor prognosis and tooth loss expected?
- regular clinical assessment
- retreatment of certain sites
- motivation
- modify risk factors: smoking cessation
- discuss progression
137
In what circumstances is supportive periodontal therapy likely to be effective?
- good OH (reinforce)
- healthy looking gingiva
- shallow pockets
- stable attachment levels
- intact dentition (no tooth loss or increasing mobility)
- removal of deposits
138
In what circumstances is supportive periodontal therapy likely to be ineffective?
- marked gingivitis
- deepening pocket depths
- loss of attachment
- tooth loss
- evidence of ineffective debridement
139
What are the 9 stages of supportive therapy?
1. review history: medical, dental, social
2. review OH
3. clinical assessment and periodontal review
4. radiographic assessment (if indicated)
5. diagnosis
6. discuss findings
7. treatment
8. reinforce advice
9. arrange recall/review
140
Radiographs can be justified when what 3 deteriorations are suspected?
- deepening pockets
- increased attachment loss/mobility/furcation involvement
- suppuration or abscess
141
When discussing findings, what should the patient be informed of?
- their current condition
- any non-responsive sites
- reasons why sites have not responded (if known)
- any sites being missed during plaque control
- changes in prognosis
- recommended options (risks and benefits)
142
What are 5 potential reasons for non-responding sites?
- incorrect diagnosis
- inadequate plaque control
- inadequate sub-gingival debridement
- smoking
- other (systemic, bacterial)
143
What are 5 potential reasons for non-compliance?
- time
- cost
- personal views of disease (don't think its an issue/part of ageing process)
- social issues
- treatment complexity
144
What is the treatment for responding sites 4mm and no bleeding?
maintenance: reinforce OH, regular targeted PMPR
145
What is the treatment for residual sites 4mm or more +/- bleeding?
sub gingival PMPR
146
What is the treatment for residual sites 6mm or more?
refer to specialist for possible surgical options
147
What are 5 indications of when frequent recalls are indicated?
- unstable disease, risk factors
- grade C disease (rapidly progressing)
- poor plaque control
- deep pockets
- poor response to treatment
148
What are 5 indications of when less frequent recalls are indicated?
- stable disease
- grade A disease
- good plaque control
- shallow pockets
- good response to treatment
149
Evidence base shows microbial plaque tend to grow back to pre-cleaning levels during what time period post debridement?
3-4 months
150
Professional support is recommended to prevent the initial onset of periodontitis every?
3-4 months
151
What is the healing phase of the long junctional epithelium?
3+ months
avoid probing for this period as to not disrupt healing process
152
What is the healing phase of the surrounding gingival and connective tissues?
6-9 months
153
What are 5 reasons why recall periods are important?
- helps to review the clinical condition to maintain stability
- assess changes which may affect stability
- identify problems early and manage them appropriately
- keep the patient informed about their disease status
- avoid medico-legal issues
