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BDS4 PP > Perio > Flashcards

Perio Flashcards

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1
Q

extent

A

<30% localised
>30% generalised

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2
Q

stage

A

severity
1 - <2mm or 15% coronal
2 - coronal third
3 - mid third
4 - apical third

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3
Q

grade

A

progression
A - slow - <0.5
B - moderate - 0.5-1.0
C - rapid - >1.0

% bone loss / age

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4
Q

stability

A

stable; BoP <10%, PPD <=4mm

remission; BoP >=10%, PDD <=4mm

unstable; PDD >=5mm or >=4mm + BoP

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5
Q

investigations

A

diet diary
MPBS
6PPC
PA radiographs

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6
Q

further questions for pt

A

pt motivation
OH techniques
smoking
MH

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7
Q

why could non-surgical therapy fail to eliminate bacteria from perio pockets

A
  • deep/inaccessible pockets
  • furcation lesion
  • infra bony defect
  • presence of virulent resistant bacteria
  • poor pt compliance w OH
  • systemic/host factors impairing healing
  • smoking
  • poorly controlled DM
  • medication [phenytoin, ca channel blockers]
  • immunocompromised
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8
Q

problems that limit usefulness of oral abx in the tx of periodontitis

A
  • not bacterial infection but host mediated inflammatory
  • abx resistance
  • limited penetration of sub gingival biofilm
  • disruption of normal microflora
  • side effects
  • need mechanical disruption
    = compliance and OH needed
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9
Q

management of lateral periodontal abscess

A

reassure
incise and drain or through pocket w LA if needed
thorough supra+subgingival debridement, just short of length
occlusal adjustment if needed
analgesia

systemic PenV 2 tabs 4x day 5 days
amoxicillin 500mg tds 5 days

after acute phase - review and assess, continue pd tx

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10
Q

signs of improved health post periodontal abscess

A

reduced pocket depths
resolution of infection
decreased swelling/erythema
improved systemic conditions

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11
Q

bacteria involved in necrotising gingivitis

A

fusiform bacteria
spirochetes

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12
Q

clinical signs and symptoms

A

punched out papillae, ID, ulcers, swelling, pain
pseudomembrane formation, grey/white slough when wiped reveals bleeding underlying connective tissue
tissue destruction
halitosis

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13
Q

necrotising gingivitis risk factors

A

high stress
young
poor OH
smoking
immunocompromised
malnutrition
HIV/AIDs

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14
Q

outline management of necrotising gingivitis

A

reassure pt
superficial debridement w ultrasonic to remove soft and mineral deposits, gentle
increase depth each day 2-4
limit mechanical OH as may impair healing
chx 0.2% 2xday

abx if systemic or failing to resolve
metronidazole 400mg tds 3 days

close follow up, daily if possible
after acute phase - tx of existing condition, address risk factors

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15
Q

info for pt for informed consent

A

nature of procedure
risks vs benefits
alternatives
reason why needed
risks of nothing
costs
aftercare

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16
Q

crushing pain across chest and left arm

  • diagnosis
  • immediate management
A

myocardial infarcation

999
abc
oxygen 15l/min
300mg aspirin to chew
monitor vital signs, prepare for CPR

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17
Q

after open flap curettage

post-op instructions to minimise complications

A

analgesia
avoid brushing directly on area, soft brush, chx
avoid surgical site w tongue/fingers
care with hot as encourage bleeding
avoid spicy, salty, acidic
if bleeding, gentle pressure
ice to swelling
avoid strenuous activity
avoid smoking and alcohol
recognise complications and number to call back

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18
Q

post open flap curettage, you review at one week and all is good

when should you review next and why

A

4-6 weeks
healing at 1-2 weeks but takes weeks for full tissue regeneration and reattachment of PD fibres

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19
Q

clinical signs of improved health following non-surgical therapy

A

<20% plaque, <10% BoP
reduced inflammation, erythema
reduced pocket depths [ideally <=4mm]
epithelium reattachment [decreased probing depths due to long junctional epithelium]

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20
Q

what is SIRS
parameters

A

systemic inflammatory response syndrome

serious, exaggerated defence response form body causing severe inflammation throughout, due to infection/trauma/burns etc

temp <34 >36
pulse >90
resp >20
WCC <4 >12

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21
Q

what is a periodontal abscess

A

abscess from periodontal origin, usually existing pocket
accumulation of pus within gingival walls
destruction of collagen fibre attachment and alveolar bone

cause = disease exacerbation, complex morphology, changes in microbiota, increased bacterial virulence, reduced host response

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22
Q

signs + symptoms of periodontal abscess

A

ovoid elevation in gingiva along lateral root
pain, localised swelling, associated pus
bite may feel high
bleeding, tenderness of probing
increased mobility
TTP
suppuration through root spontaneous or w pressure

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23
Q

differentiate periodontal abscess and periapical abscess

A

sensibility =
PD normal, PA not respond as necrosis

probing =
PD deep pocket, PA normal

radiograph =
PD vertical bone loss, PA radiolucency/widened PDL

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24
Q

management of occlusal trauma in pt w periodontal disease

A

address perio - non-surgical

correct occlusal stability - smooth premature contacts, reduce high cusps, ortho, occlusal adjust to distribute forces more evenly

parafunctional habits - splint, relaxation, CBT etc

splinting - temp stabilise if excessively mobile, or for debridement
doesn’t affect rare of PD destruction, can worsen OH

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25
what factors influence localised mobility
periodontal - inflammation, attachment loss, height/width of PDL teeth - number, shape, length of roots PD abscess occlusal - trauma, bruxism, tooth migration endo - pathology, RR trauma iatrogenic - high rests causing excessive forces, ortho forces medications - bisphosphonates
26
when may splinting be advised
advanced mobility due to loss of attachment - discomfort, difficulty eating stabilisation for tx post-trauma
27
why is there a decrease in mobility post-perio tx
reduced inflammation improved attachment level reorganisation and reattachment of PDL improved occlusal stability bone healing long junctional epithelium
28
what could you do if PDL is still widened post perio tx in occlusal trauma pt
reassess perio health - plaque, bleeding, probing, occlusal trauma splinting management parafunction
29
what bacteria is implicated in periodontitis
P.gingivalis T.denticola T.forsythia
30
how is angular bone loss caused
vertical osseous defect, occurs when bone loss progresses down the root of the tooth bone destruction occurs at an angle, not uniformly around a tooth "V" shaped pattern
31
how do you classify angular defects/infrabony
based on number of walls remaining 1 wall 2 wall 3 wall
32
what is the limitation of treatment for angular bone loss
limited access of non-surgical therapy root surface debridement may not be successful and effectively access these deep defects
33
alternative tx for angular defects, beside non-surgical
periodontal surgery = access surgery/open flap debridement regenerative periodontal surgery = guided tissue regeneration, enamel matrix derivative
34
what is the difference between horizontal and angular bone loss
horizontal = more generalised, uniform loss of bone height across alveolar ridge, parallel plane angular = infrabony, localised bone loss non-uniformly, unevenly, creating a "V" shape
35
define localised and generalised bone loss
localised = <30% of teeth generalised = >30% of teeth
36
define mild, moderate and severe bone loss
mild = <15% or 2mm of root mod = coronal third severe = mid third very severe = apical third
37
how does healthy periodontium react to traumatic occlusion
PDL widening until forces adequately dissipated should then stabilise may cause mobility as a result RETURN TO NORMAL
38
how does healthy but reduced periodontium react to traumatic occlusion
PDL widening until forces adequately dissipated less resilient less able to adapt and recover tooth more vulnerable, increase mobility, further degradation of periodontal health
39
how does periodontitis respond to traumatic occlusion
worsening of periodontitis increased mobility progressive attachment loss increased bone loss exacerbation of inflammation gingival recession root resorption risk tooth loss
40
what is chlorhexidine
biguanide gluconate broad spectrum antimicrobial topical antiseptic
41
chlorhexidine mode of action
membrane disruption = disrupts cell membrane, binds and causes leakage of cell causing death bactericidal effect = bactericidal action against wide range bacteria inhibition of bacterial adhesion = prevents bacteria adhering to oral surfaces
42
define substantivity
ability of substance to bind to tissues/surfaces and maintain antimicrobial action over time
43
what is chlorhexidine substantivity
good remains active for several hours up to 12hrs of residual effect
44
give 2 common doses of chlorhexidine
0.12% - general oral hygiene, 10-15ml 30secs 2x day 0.2% - antibacterial purpose, tx, 10-15ml 30secs 2x day
45
side effects of chlorhexidine
staining taste alteration mucosal irritation xerostomia sore throat parotid gland swelling
46
uses of chlorhexidine
OH adjunct post-surgical care [xla, perio surgery] oral infections - necrotising, RAS peri-implantitis management pericoronitis denture stomatitis primary herpetic gingivostomatitis osteonecrosis
47
what is TIPPS
behavioural change theory, aim to make pt more confident in ability to perform effective plaque biofilm removal, plan how and when to look after oral TALK INSTRUCT PRACTICE PLAN SUPPORT
48
what 7 things are recorded on periodontal pocket chart
teeth present/not present pocket depths gingival margin clinical attachment level furcation mobility bleeding
49
disadvantages of pocket charting
time consuming uncomfortable for pt subjective based on operator technique doesn't give comprehensive view on bone loss limited predictive value
50
local factors for gingival recession
restoration overhangs poor IP contact points plaque/biofilm accumulation toothbrushing trauma poor OH traumatic incisor relationship abrasive TP frenum misaligned teeth ortho tx piercings
51
how can you measure gingival recession
CPITN probe relative to CEJ cairo classification
52
how is localised recession managed
record magnitude clinically/study models to monitor progression alter habits - TB, TP, single tuft improve OH remove plaque + retentive factors desensitising agents if bad gingival veneers crowns mucogingival surgery
53
tooth 15 has been root treated, has 9mm pocket and vertical body defect radiographically give 3 differential diagnosis what special investigations
endo-perio lesion, periodontal abscess, subgingival root fracture PA radiograph, percussion/palpation test, transillumination, BPE, 6PPC if indicated, sensibility tests
54
pt wants implant what would you look for?
good compliance good OH quality of remaining bone height/width of bone proximity to roots/anatomcial structures MH smoking status age gingival biotype
55
2 interventions for inadequate bone level pre-implant
autograft - same allograft - cadaver xenograft - animal alloplast - synthetic
56
indications for regenerative periodontal surgery
infrabony defects >=3mm class 2/3 furcation defect deep pockets >=6mm no medical contraindications reasonable tooth prognosis non-resolved pockets following good quality non-surgical tx
57
if regenerative periodontal surgery fails, how else can this root be managed
resective surgery root resection root separation xla
58
why is diabetes a risk factor in periodontal disease
impaired/altered immune response impaired wound healing overproduction of pro-inflammatory cytokines hyperglycaemia leads to AGE, which makes connective tissue more susceptible to destruction and damages collagen/connective tissue
59
tests for diabetes normal vs diabetic values
HbA1c = normal <42mmol/L, <5.7% diabetic >48mmol/L >6.5% random blood glucose= diabetic >11.1mmol/mol fasting blood sugar test = normal <99mg/dL diabetes >126mg/dL / >7mmol/mol glucose tolerance test = normal <140mg/dL diabetes >200mg/dL
60
how does smoking affect periodontal tissues
vasoconstriction increased keratinisation impaired antibody production decreased Th lymphocytes increased pro-inflammatory cytokines impaired wound healing
61
what is interleukin-1
cytokine involved in regulation of immune and inflammatory responses pro-inflammatory cytokine mediatior promotes tissue destruction via MMP induces bone resorption via activating osteoclasts
62
name 3 oral conditions associated with inflamed gingiva extending beyond mucogingival junction
periodontitis acute necrotising periodontitis desquamative gingivitis
63
medications associated with gingival hyperplasia
phenytoin cyclosporin amlodipine
64
how do you manage gingival hyperplasia
identify cause improve OH surgical management if needed - gingivectomy/gingivoplasty
65
describe BPE values
0 - <3.5mm, no calculus/BoP 1 - <3.5mm, BoP 2 - <3.5mm, calculus 3 - 3.5-5mm 4 - >5mm * - furcation
66
how is mobility graded
0 - 0.1-0.2mm 1 - 1mm 2 - >1mm 3 - horizontal + vertical movement
67
how is furcation graded
1 - <1/3 tooth width 2 - >1/3 tooth width 3 - through through

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