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BDS 3 Sem 2 > Perio > Flashcards

Perio Flashcards

1
Q

What are some of communication pathways between the pulp and periodontium?

A
  1. Apical foremen
  2. Dentinal tubules
  3. Accessory canals
  4. Lateral canals
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2
Q

What is the primary aetiology factors of endo-perio lesions?

A
  1. Endo or perio infection
  2. Trauma an/or iatriogenic trauma - like perforation during root canal treatment or root fracture or crack post RCT or root resorption
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3
Q

What is an endo-perio lesion?

A

An EPL (endo-perio lesion) is a pathological communication between the pulpal and periodontal tissues at a given tooth accompanied by a deep periodontal pocket and altered pulp sensitivity test that may occur in (symptomatic) acute or chronic (asymptomatic) form.

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4
Q

What is the endo-perio aetiology?

A
  1. Primary endo infection - carious lesions affect the pulp and secondarily affect the periodontium
  • Inflamed pulp exerts little or no effect on the periodontium
  • Necrotic pulp cause bone resorption
  • Sinus tract drain through PDL into gingival sulcus
  • Isolated periodontal defect
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5
Q

What are some of the diagnostic hints that might lead us to see that the lesion is a primary endo secondary perio lesion?

A
  1. Pulp test negative
  2. Compromised coronal integrity
  3. Isolated deep narrow peridontal pocket - might need to use a guttapercha and take a PA
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6
Q

What is the treatment of primary endo secondary perio lesion?

A
  1. RCT
  2. No immediate scaling and root instrumentation - please await healing first - 3-6 months should be enough for healing and reassessment
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7
Q

What are some of the diagnostic hints that might lead us to see that the lesion is a primary perio secondary endo lesion?

A
  1. Sever periodontitis
  2. Pathological changes occur in pulp
  3. Retrograde pulpitis - acute pain for long duration
  4. Pulp test incoclusive
  5. Coronal integrity intact
  6. Deep periodontal pockets around the tooth
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8
Q

What is the treatment of primary perio secondary endo lesion?

A
  1. Scaling and root instrumentation needs to be done together with the root canal treatment

or

  1. Extraction depending on prognosis
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9
Q

What is the diagnostic clues of a combination endo-perio lesion?

A
  1. Pup test is negative
  2. Deep peridotnal pockets on multiple sites
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10
Q

What is the treatment for a combination endo-perio lesion?

A
  1. Scaling and root instrumentation needs to be done together with the root canal treatment
  2. Possible resective surgery
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11
Q

What is the treatment of fractures teeth?

A
  1. Do nothing
  2. Extraction
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12
Q

What is usually associated with hopeless prognosis of EPL?

A

EPLs that are related to aitriogenic damage.

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13
Q

How to write a diagnostic statement for a endo-perio lesion?

A
  1. Write that it is a endo perio lesiom
  2. Root damage extent
  3. Perio status of the patient
  4. Grade of the problem
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14
Q

What are the classifications of periodontal pockets associated with an endo-perio lesion associated with periodontitis patients?

A

Grade 1 - narrow and deep periodontal pocket in 1 tooth surface

Grade 2 - wide deep periodontal pocket in 1 tooth surface

Grade 3 - wide deep periodontal pocket in more than 1 tooth surface

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15
Q

What are the classifications of periodontal pockets associated with an endo-perio lesion associated with non-periodontitis patients?

A

Grade 1 - narrow deep periodontal pocket in 1 tooth surface

Grade 2 - wide deep periodontal pocket in 1 tooth surface

Grade 3 - deep periodontal pockets in more than 1 tooth surface

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16
Q

What are the difference between the periodontium in children comparing to adults?

A
  1. Gingival colour more reddish because of the thinness
  2. Rounded gingval margins
  3. Looser consistency
  4. Smoother surface
  5. Increase in attached gingiva
  6. Sulcus depth shallower
  7. Wider PDL space
  8. Prominent lamina dura
  9. Distance between CEJ to alveolar crest is less
17
Q

What decreases the susceptibility to gingivitis in children?

A
  1. Thicker junctional epithelium
  2. T-cell dominated response
  3. Few B lymphocytes
  4. Less calculus build up thus less niches for bacteria to propagate
18
Q

Why is there around 100% occurrence rate of gingivitis in kids going through puberty?

A

There is a theory that during puberty when tooth exfoliation occurs, due to some discomfort that may occure during the process - the brushing habit worsen in kids thus resulting in gingivitis.

Also fixed and removable orthodontic appliances contirute to this.

19
Q

What are some of the other systemic factors that may contribute to development of gingivitis in young patients?

A
  1. Smoking
  2. Hyperglycemia
  3. Nutritional factors
  4. Pharmacological factors
  5. Sex steroid hormones
  6. Hematological factors like leukemia
20
Q

How do we treat primary herpetic gingivostomatitis?

A

Primary herpetic gingivostomatitis is a disease that occurs after primary infection with herpes simplex virus

Treatment:

10-14 day duration

Control fever, pain and hydration

DO NOT TOUCH THE ULCERS

21
Q

What do we classify any fast-progression periodontitis in young patients?

A

Grade C and we look at the underlying systemic conditions or genetic factors.

22
Q

What is the BPE and how do we use it for paediatric patients?

A

BPE stands for basic periodontal examination and we use it as a code system similar to PSI!

Children with codes 0,1,2 should just have routine exams

While children with codes 3 & 4 should be undergoing consistent periodontal care to improve their condition

Note that some times Code 3 in a mixed dentition could be just erupting teeth so please be considerate.

23
Q

What caution should we have in terms of perio and orthodontics?

A

The actual orthodontic process do not cause attachment loss but:
There needs to be cautious approach for patient with with thin periodontium phenotype as labial orthodontic movement in thin periodontal phenotype may result in bone dehiscence.

And presents of gingival inflammation or trauma may result in CAL.

24
Q

What is pathological tooth migration (PTM)?

A

In significant periodontitis, the arch integrity may be compromised due to destruction of Sharpay fibres thus resulting in migration of the teeth.

The symptoms may be increase diastemas, drifting of teeth or collapsing of occlusal vertical dimension

25
Q

What is the treatment of pathological tooth migration?

A
  1. Periodontal therapy - treating of Stage 4 perio is successful
  2. During ortho therapy - after periodontal stabilityis achieved - patient periodontal status needs to be closely managed by a periodontist - maintenance and interruption of ortho treatment is possible
  3. Life long orthodontic and periodontic care needs to be provided for the patient
26
Q

What kind of instrument could you use of disturbing the biofilm in a patient with orthodontic appliances?

A
  1. Airflow instrument
  2. Different ultrasonic scalers
  3. Hand instruments - use appropriate size because it is generally difficult to debride
27
Q

What is the supracrestal attached tissues?

A

It is the combination of junctional epithelium width and connective tissue attachment width

28
Q

What happens when you place the restoration subgingivally inappropriately?

A

It results in violation of supracrestal attached tissues resulting in chronic inflammation and bone loss because the body ants to maint that SAT at around 2mm

29
Q

How do we assess the SAT violations?

A
  1. Radiographic findings
  2. Clinical assessment - beeding on probing int he area, clinical attachment loss and pocket formation - debridement does not help the lesion
  3. Bone sounding - pass through the attached tissues witha
    sterile probe should be around 3mm from gingival margin - if the margin of the restoration and the alveolar crest have a distance of less than 2mm it is considered as a SAT violation - note that this is a guide, healthy alveolar crest could be upto 3mm below CEJ
30
Q

What are the treatments of SAT violations?

A
  1. Consider restoring appropriately - please do not damage the tissues, remove the cement properly
  2. Re-establish SAT width by surgical crown lengthening or orthodontic extrusion
31
Q

What are the steps to make a gingiva friendly temporary crown?

A
  1. Mark cervical margin and contact point
  2. Polish it
  3. Consider interdental papilla
  4. Polish it
32
Q

How should you design a pontic?

A

It need to be hygienic in order to be cleaned.

Tell your patient to use super floss to clean under the bridge

33
Q
A

BDS 3 Sem 2 (16 decks)

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