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Pedo 1 > Perio > Flashcards

Perio Flashcards

1
Q

True or false.. gingival related oral pathology is rare in children

A

False. It is relatively common

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2
Q

Periodontal disease, most of the time, conditions are ___ with palliative care

A

Self-limiting

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3
Q

What is the most difficult step in treating perio problems in pedo pts?

A

Management of the parent

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4
Q

What does this pt likely have?

Mom calls with report that 2 yo has been irritable, not eating, not sleeping well and slightly febrile. Gums have been red and swollen. Breath is terrible. Brushing has been exceptionally difficult last couple of days.

A

Primary hermetic gingivostomatitis

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5
Q

Primary herpetic gingivostomatitis is caused by ____. It occurs in children younger than ___. It is transmitted via ___. Primary infection is usually ___.

A

Herpes simplex virus type 1

6

Direct contact

Asymptomatic

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6
Q

What does primary herpetic gingivostomatitis look like?

A

Discrete spherical gray vesicles

Hard palate, attached gingiva and oral mucosa

Blisters outside of lip, excoriation, bleeding

Generalized soreness and gingival erythema

Ruptured vesicles - focal site of pain

Irritability, generalized malaise

Pain upon swallowing. Refusal to eat

Fever

Cervical lymphadenopathy

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7
Q

How long does primary herpetic gingivostomatitis typically last?

A

7-10 days

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8
Q

How do you treat primary herpetic gingivostomatitis?

A

Treatment is symptomatic and supportive

Bed rest, soft diet

Hydration is important

In severe cases, use systemic acyclovir (200mg for 5 days).

Remember that course is self limited to 7-10 days

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9
Q

What does this pt likely have?

Mom calls with report that 4yo has not been eating well. Mom cannot look in the mouth very well without it hurting. No reports of fever or swelling. Brushing has been exceptionally difficult last couple of days.

A

Recurrent apthous ulcer

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10
Q

What things may cause a recurrent apthous ulcer?

A

Genetic predisposition

Systemic disease

Stress

Mechanical injuries

Hormones

Micro element deficiencies

Viral and bacterial infections

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11
Q

True or false.. RAUs are typically asymptomatic

A

False they are typically very painful

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12
Q

Where do RAUs occur? What do they look like?

A

Buccal and labial mucosa and tongue and gingiva are commonly involved.

Discrete conquest lesions
Round to oval craterform base, raised and reddened margins.

Begin as single or multiple superficial erosion covered by grey membrane, surrounded by localized areas of erythema

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13
Q

What is the treatment of a RAU?

A

Symptomatic and supportive

Use topical corticosteroid trimcinolone four times a day if severe

Nutritional diet

Maintenance of oral hygiene

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14
Q

What is a specially common location of RAUs in kids?

A

Buccal mucosa adjacent to lower molars

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15
Q

What does this pt likely have?

Mom calls with report that 2 month old has white and red ares inside mouth. Mom thought it was just milk residue but when removed, it appeared reddish underneath. No reports of fever or swelling.

A

Acute candidiasis (oral thrush) (Candida albicans)

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16
Q

What are some things that can cause oral candidiasis?

A

Illness

Corticosteroids

Stress

Antibiotics

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17
Q

What are two different types of acute candidiasis?

A

Pseudomembranous

Erythematous

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18
Q

What does acute candidiasis look like?

A

Pearly white or bluish white plaque present on oral mucosa which may extend to circumoral tissues

Painless and noticed on careful evaluation

May be removed with little difficulty

Pt may complain of burning sensation

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19
Q

True or false… acute candidiasis is painful

A

False

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20
Q

What is the treatment for acute candidiasis?

A

Nystatin - 1ml dropped into mouth for local action four times a day for infants and very young children

Clotrimazole lozenge (this works really well when the kids get older)

Systemic fluconazole suspension

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21
Q

What does this pt likely have?

Mom calls with report that 14 month old is fussy and will not eat normally. Brushing has been difficult last couple of days. No swelling or fever reported. Mom wonders if teeth are coming in.

A

Eruption gingivitis

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22
Q

True or false… the erupting tooth causes gingivitis directly

A

False. Tooth eruption does not cause gingivitis, however there can be inflammation with plaque accumulation in the area

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23
Q

Should the pt stop brushing if it is painful in eruption gingivitis?

A

No. Although eruption gingivitis causes secondary discomfort and inflammation caused by brushing friable areas, they shouldnt stop

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24
Q

What is the treatment for eruption gingivitis?

A

Time

Improved oral hygiene

Chlorhexidine rinses in older kids

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25
Q

What does this pt likely have?

Mom calls with report that 8yo is fussy and experiences pain in the gums when eating or brushing. Child is sensitive when brushing in UL quad and bleeding noticed. The gums are swollen in sensitive area.

A

Acute inflammatory gingival enlargement. Could be tooth related, infection, or just gingiva related. Rule out trauma, caries, etc.

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26
Q

What is the clinical appearance of acute inflammatory gingival enlargement?

A

Localized, painful rapidly expanding lesion that is usually of sudden onset.

Red swelling with smooth shiny surface becoming fluctuations

Removal of substance and possible incision and drainage

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27
Q

What are some likely causes of acute inflammatory gingival enlargement?

A

Irritation from foreign substance embedded into gingiva

Limited to the marginal gingiva or interdental papillae

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28
Q

Although most periodontal diseases peak in their destructive stages during ___, many of them have their inception during ___.

A

Middl age

Childhood

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29
Q

True or false… the early detection and early treatment are important because the prevention of most periodontal diseases are relatively simple and very effective, providing lifetime benefits.

A

True

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30
Q

True or false.. plaque is necessary for bone loss.

A

True?

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31
Q

Describe the progression to periodontitis.

A

Periodontal health

Accumulation of supragingival plaque

Gingivitis

Pocket formation and accumulation of sub-gingival plaque

Periodontitis

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32
Q

The clinical and radiographic images of gingiva and periodontium in children and adolescents differ from those seen in adults because of..

A

The significant changes taking place during growth and development. The periodontium during childhood and puberty is in constant state of change owing to the exfoliation and eruption of teeth. This makes a general description of the normal periodontium difficult because it varies with age and patient.

33
Q

How does the interdental area look in children and adults?

A

Children: saddle shaped

Adults: papillary

34
Q

What is the appearance of the gingival sulcus in children vs adults?

A

Children: newly erupted tooth sulcus depth is greater than deciduous predecessor

Adults: 1-2mm

35
Q

What is the difference in the appearance of attached gingiva in children vs adults?

A

Children: width increases with age with concomitant decrease in sulcus depth

Adults: greater in adults

36
Q

What is the difference of color of gingiva in children vs. adults?

A

Children: more reddish

Adults: coral pink

37
Q

What is the difference of contour of gingiva in children vs adults?

A

Children: rounded margin

Adults: knife edge margin

38
Q

What is the difference in consistency of gingiva in children vs. adults?

A

Children: flabby due to less CT density and lack of organized collagen fiber bundles

Adults: firm and resilient

39
Q

What is the difference in surface texture in children vs. adults?

A

Children: stippling absent until age 6

Adults: stippling present

40
Q

True or false.. dental plaque induced gingival diseases are rare in children

A

False they are very common

41
Q

Dental plaque-induced gingival disease have increased subgingival levels of what bacterial species?

A

Actinomyces

Capnocytophaga

Leptotrichia

Selenomonas

42
Q

Normal and abnormal fluctuation of hormone levels, including changes in ___ during ___, can modify the gingival inflammatory response to ___

A

Gonadotrophic hormone levels

Onset of puberty

Dental plaque

43
Q

True or false.. alterations in insulin levels in patients with diabetes can affect gingival health

A

True

44
Q

True or false… topical antibacterial agents can be useful for control of subgingval plaque

A

False. Supragingival plaque

Consider systemic disease if no resolution despite efforts

45
Q

____ medicaments have been given the ADA seal of acceptance for the control of gingivitis. The active ingredients of one product (listenine) are ___, ___, __, and ___. Active ingredients in the other two are ____, ___, and ___.

A

Three

Thymol, menthol, eucalyptol, methyl salicylate

Chlorhexidine*** , digluconate, triclosan

46
Q

Aggressive periodontitis is more common in ___ than ___

A

Children

Adolescents

47
Q

The primary features of aggressive periodontitis include a history of ___ and ___ with ___. Secondary features include ___ abnormalities and ___ phenotype.

A

Rapid attachment and bone loss with familial aggregation

Phagocyte
Hyper-responsive macrophage

48
Q

In young individuals, the onset of aggressive periodontitis is often ___. Aggressive periodontitis can be __ or ___.

A

Circumpubertal

Localized or generalized

49
Q

Localized aggressive periodontitis pts have ___ attachment loss on at least _______, with attachment loss on no more than ____ other than ___ and ___

A

Two permanent first molars and incisors

Two teeth other than first molars and incisors

50
Q

Bone loss around the ___ can be an early finding of localized aggressive periodontitis. It is possibly ____ but evidence is inconsistent. Occurs in children and adolescents without clinical evidence of ___.

A

Primary teeth

Self-limiting

Systemic disease

51
Q

What is the prevalence of localized aggressive periodontitis. In which race is it markedly greater in?

A

0.2%

African American populations (2.5%)

52
Q

True or false… the supragingival dental plaque of calculus can be variable in localized aggressive periodontitis.

A

True

53
Q

Bacteria of probable etiologic importance of localized aggressive periodontitis includes highly virulent strains of ____ in combination with ___. In some populations, ___ have been associated with the presence of LAGP. To date, however, no single species is found in all cases of LAGP.

A

Actinobacillus actinomycetemcomitans

Bacteroides-like species

Eubacterium

54
Q

What is the single species found in all cases of LAGP?

A

There is none

55
Q

In localized aggressive periodontitis, a variety of functional defects have been reported in ___ form pts with LAGP.

A

Neutrophils

56
Q

Generalized aggressive periodontitis (GAgP) pts exhibit generalized interporximal attachment loss including at least ___ that are not ___.

A

At least three teeth that are not first molars and incisors

57
Q

GAgP is considered to be a disease of ___.

A

Adolescents and young adults.

However, it can begin at any age and often affects the entire dentition

58
Q

GAgP is typically found with marked periodontal inflammation with __ accumulations of plaque and calculus

A

Heavy

59
Q

___ from pts with GAgP frequently exhibit suppressed __ as observed in LAGP, which suggests a relationship between the two variants of aggressive periodontitis.

A

Neutrophils

Chemotaxis

60
Q

What are some things common between LAgP and GAgP?

A

Lack of chemotaxis in neutrophils

Alterations in immunologic factors such as immunoglobulins

Protective antibody response is altered by genetics, environment (smoking, bacterial infection)

61
Q

What is the treatment of aggressive periodontitis?

A

Early diagnosis

Directing therapy against the infecting microorganisms

Providing an environment for healing that is free of infection

Possible combination of surgical and non-surgical root debridement in conjunction with antimicrobial therapy

Effective antibiotics

62
Q

What are some effective antibiotics used to treat aggressive periodontitis?

A

Tetracycline

Metronidazole

Amoxicillin

63
Q

Chronic periodontitis is most prevalent in __ but can also occur in ___

A

Adults

Children/adolescents

64
Q

What is the difference between localized chronic periodontitis and generalized chronic periodontitis?

A

Localized = <30% of dentition

Generalized = >30% of dentition

65
Q

Chronic periodontitis has a ___ rate of progression that may include periods of ___

A

Slow to moderate

Rapid destruction

66
Q

Severity of disease of chronic periodontitis can be mild (CAL = ___), moderate (CAL = ___), or severe (CAL = ___)

A

1-2mm

3-4mm

> 5mm

67
Q

What can cause early loss of intact teeth?

A

Hypophosphatasia

68
Q

What medications can cause gingival hyperplasia?

A

Anti-seizure drugs (phenytoin)

Calcium channel blockers (nifedipine)

Cyclosporine

69
Q

What are common associated systemic diseases with periodontitis

A

Papillon lefevre syndrome

Cyclic neutropenia

Agranulocytosis

Down syndrome

Hypophosphatasia

Leukocyte adherence deficiency

Drug induced gingival enlargement

70
Q

____ is a specific form of periodontitis associated with systemic disease. In type __ diabetics, 11 -18 years of age, ___% were found to have overt periodontitis often localized to first molars and incisors.

A

Diabetes-associated periodontitis

1

10%

71
Q

Defects in ___ and ___ function associated with systemic increase the susceptibility to periodontitis and other infections.

A

Neutrophils

Immune cell

72
Q

In the ___ form of periodontitis, affected sites exhibit rapid bone loss and minimal gingival inflammation

In the __ form, there is rapid bone loss around nearly all teeth and marked gingival inflammation

A

Localized

Generalized

73
Q

Describe the growth involved in drug induced gingival enlargement.

A

Growth starts as a painless, beadlike enlargement of the interdental papilla and extends to the facial and lingual margins.

May interfere with occlusion

74
Q

Describe the difference between mild, moderate, and severe drug induced gingival enlargement.

A

Mild = <1/3 clinical crown

Moderate = 1/3-2/3 clinical crown

Severe = >2/3 clinical crown (may need to do surgical correction if doesn’t respond to other therapy)

75
Q

Necrotizing periodontal disease is rare (less than 1 percent), but is seen in greater frequency (2-5%) in what populations?

A

Children and adolescents from developing areas of Africa, Asia, South America

76
Q

What are the significant findings of necrotizing periodontal disease?

A

Punched out, crater like interproximal necrotic ulcersations

Rapid onset of gingival pain and sometimes fever, sloughing of gingival tissue

77
Q

What are the predisposing conditions for necrotizing periodontal disease?

A

Poor oral hygiene

Viral infections (HIV)

Nutrition deficiencies (vit B and C)

Emotional stress

Lack of sleep

Variety of systemic diseases

78
Q

What is the treatment of necrotizing periodontal disase?

A

Mechanical debridement (ultrasonic) with local anesthesia, oral hygiene instruction, careful follow-up

If pt is febrile, antibiotics may be important adjunct to therapy.

79
Q

What are the antibiotics of choice for treating necrotizing periodontal disease if pt is febrile?

A

Metronidazole

Penicillin

Pedo 1 (14 decks)

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