Perio/DMS Flashcards
(110 cards)
1
Q
What is periodontology?
A
The study of the periodontal tissues (gingiva, periodontal ligament, root cementum and alveolar bone) in health and disease, including causes prevention and treatment of diseases
2
Q
What are the periodontal tissues?
A
Gingiva
Periodontal ligament
Root cementum
Alveolar bone
3
Q
What causes stippling of the gingiva?
A
Connective tissue projections within the tissue.
4
Q
What is the cementoenamel junction?
A
AKA amelocemental junction
Place where cementum covering the root and enamel covering the anatomical crown meet.
5
Q
What is the free gingiva?
A
The free gingiva forms one of the walls of the gingival sulcus and is separated from the attached gingival by a groove called free gingival groove
6
Q
What is attached gingiva?
A
It is the continuation of the free gingival and extends up to the alveolar mucosa.
Attached gingival is separated from the alveolar mucosa by a muco-gingival sulcus
7
Q
What are the three types of gingival fibres?
A
Dentogingival
Alveologingival
Circular - fibres are unique in that they exist entirely within gingiva and don’t contact tooth
8
Q
What is periodontal disease?
A
A group of diseases affecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque
9
Q
What are possible plaque retention factors?
A
Calculus Dental restorations Carious cavities Partial dentures Orthodontic appliances Mal-positioned teeth
10
Q
What is inflammation?
A
The response of living tissue to injury
Dilation of blood vessels
Increased permeability of vessel walls
Inflammatory exudate
Emigration of white blood cells from blood vessels into connective tissue (diapedesis)
11
Q
What are they symptoms of gingivitis?
A
Erythema (redness)
Swelling
Bleeding on gentle probing
12
Q
What is the difference between gingivitis and periodontitis?
A
For gingivitis inflammation confined to the gingiva involving no loss of connective tissue attachment
In periodontitis, apical extension of the gingival inflammation resulting in destruction of the connective tissue attachment, apical migration of the junctional epithelium, bone loss and true pocket formation
13
Q
What is false and true pockets?
A
False pocket - gingival swelling
True pocket - loss of attachment
14
Q
What are the signs of periodontitis?
A
True pocket formation
Bone loss
Tooth mobility (looseness)
15
Q
Peridontitis may progress at different rates at different sites in the mouth and in different people, why?
A
Peridontitis is caused by microbial plaque but may be more or less destructive depending upon the susceptibility of the host
16
Q
What are the risk factors for periodontitis?
A
Smoking
Diabetes
Stress
Genetic
17
Q
What treatment can be used to treat periodontal disease?
A
Plaque control
Removal of plaque retention factors
18
Q
What is subgingival debridement?
A
Subgingival debridement is the part of nonsurgical therapy which aims to remove the biofilm without intentionally removing the cementum or subgingival calculus
19
Q
What are the different ways of plaque control?
A
- Oral hygeine (tooth brushing technique)
- Supragingival plaque control (scraping)
- Subgingival debridement
20
Q
What do the material characteristics of dental materials determine?
A
Selection - most suitable
Preparation/placement method
Dentists/patients expectation
Performance (longevity)
21
Q
What are the different material types?
A
Restorative
Impression
Dentures
Metals and alloys
22
Q
What are the different types of restorative materials?
A
Amalgam
Composite resin
Glass ionomer cement
23
Q
What is creep?
A
The deformation of a material over time
Amalgam creep may result in cuspal fracture as it protrudes around the margins and is thought to be a cause of failure of marginal ridges
24
Q
How does composite resin bind to a tooth?
A
Acid etch technique
30% phosphoric acid for 20 seconds
Acid etching is the use of an acidic substance to prepare the tooth’s natural enamel for the application of an adhesive. The acid roughens the surface microscopically, increasing retention of resin sealant.
25
What is shear strength?
Amount of stress a material is able to withstand when subjected to a tangential force or twisting motion
26
Properties of glass ionomer cement
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Bonds to enamel
Fluoride released (1ppm per day)
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27
How do you test the robustness of composite resins?
Shear strength
28
How is composite resin applied?
Mechanical interlocking between adhesive resin and etched enamel
Composite resin bonds to the unfilled resin
29
What is an alternative strength test other than shear strength?
Compressive strength
Amalgam beats composite resin
30
What is thermal expansion?
Restorative material should expand and contract as the tooth does otherwise microleakage occurs
31
What is microleakage?
The seepage of MOs, debris, fluid and breakdown products along the junction of restorations and the cavity preparation.
32
What is viscosity?
Ability to flow
33
In impression taking what is the low viscosity/high viscosity materials used for?
Low - most accurate detail of tooth surface e.g.
High - most dimensionally stable after setting and removing e.g Polyether
34
What does it mean if a material is elastic?
Full recovery of shape
If non-elastic there is permanent deformation
Elastic recovery should occur in impression material
35
What type of denture bases are available?
Acrylic resin
| Metals and alloys
36
What are metals and alloys used for?
Partial denture frameworks
Orthodontic wires
Denture bases
37
What are different type of interventive treatment for dental caries?
Ranges from
- Simple restoration
- Replacement restoration
- Root canal therapy
- Extraction
38
What does interventive treatment depend on for caries?
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Signs/symptoms
Cost
Time
Patient preference
Damage done
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39
What 4 causes induce caries?
Susceptible tooth surface
Bacteria
Substrate
Time
40
Where does plaque form?
- Pits and fissures
- Interproximal
- Smooth surfaces
- Root surface
41
What can we do to combat caries?
Reduce intake of sugar
Remove plaque, regularly
Increase exposure to fluoride
Tip balance towards remineralisation
42
What are primary caries?
Unrestored tooth
43
What are secondary caries?
Previous restoration
44
How can caries be detected?
Visual detection of coronal caries - enamel discolouration +/- surface destruction
Radiographs - conventional or digital
45
What is the difference between detection and diagnosis?
Both determine presence or absence of disease
Diagnosis is knowing whether or not disease is active or arrested to plan treatment and also identifying cause of disease
46
What is non-operative management of dental caries?
Dietary analysis - reduce sugars
Oral hygeine instructions - to remove plaque regularly
Increase fluoride exposure - to tip balance towards remineralisation
47
What should be reviewed when preparing a tooth for a restoration?
Position of the caries
Extent of the caries
Shape of the prepared cavity
Final restorative material
48
What positions could the caries be in?
Pits and fissure
Approximal - anterior/posterior
Smooth surface
Root
49
What is the difference between a symptom and a sign?
Symptom - what patient complains of
Sign - what trained observer sees
50
What is the usual procedure with a patient?
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History
Examination
Provisional diagnosis
Special investigations
Definitive diagnosis
Treatment plan
Recall
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51
How can history be further categorised?
C/O - complaining of - symptoms of disease
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HPC - history of present complaint
PMH - Past medical history
PDH - Past dental history
SH - Social history
FH - Family history
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52
What does the extraoral 'examination' category of a diagnosis involve?
Extraoral examination as soon as patient walks in
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Muscles
Joints
Nodes
Symmetry
Aesthetics
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53
What does the intraoral examination involve?
Identify signs of disease or complicating factors for treatment
Look - Soft tissues, hard tissues
Listen - percussion
Feel - Mobility or tenderness
54
What are the clinical examinations you can perform in intraoral examination?
Probing
- Pocket depth
- Bleeding on probing
- Subgingival calculus
- Plaque retention factors
55
What are common dental diagnoses?
```
Caries
Gingivitis
Pulpitis
Periodontitis
Recurrent Oral Ulceration (ROU)
Toothwear
Failure of restoration(s)
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56
What is the point in diagnosis?
```
Allows us to:
Direct management
Give indication of prognosis
Communicate with patients and other professionals
Record in notes
Screening a population of patients
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57
What are examples of special investigations?
```
Sensitivity/vitality test - dental pulp
Mobility tests
Radiographs
Plaque score
Biopsy - taking small sample of tissue to examine microscopically
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58
Which radiographs are for intraoral use?
Bitewings - side view, usually no overlap of teeth
Periapicals -zoom image
Occlusals - in occlusal plane
59
What radiographs is used extraorally?
Panoramic - wide angle
60
What is the curve of spee?
Curvature of the mandibular occlusal plane
61
How do you wiple scaling instruments?
Narrow bone aspirator tip to suction debris away
62
What is neoplasm?
Lesion arising from a proliferation of cell which is autonomous and persists after the initiating stimulus has been removed
63
What is the TNM system?
Most widely used cancer staging systems.
Size/extent of primary tumour (T)
Amount of spread to nearby lymph nodes (N)
Presence of metastasis (M)
64
In periodontitis, how is the extent measured as a percentage?
Periodontitis is considered localised if there is <30% teeth affected or generalised if >30% teeth affected
65
Apart from localised or generalised periodontitis, howe else can it be classified?
After a 6PPC
Can be classified as "Periodontitis molar-incisor pattern" if a molar incisor pattern is identified
Staging, grading, current disease status and risk factor assessment must then be conducted to produce a diagnosis statement
66
How do you compose a periodontal diagnostic statement?
Diagnostic statement: Extent - Periodontitis - Stage - Grade - Stability - Risk factors
67
What is "Staging" in relation to a periodontitis diagnosis?
Stage is the severity of interproximal bone loss
You use your radiographic assessment (periapicals or OPG) and choose the worst site
Stage I - <15% (or >2mm AL from CEJ) - Mild/early
Stage II - Coronal third of root - Moderate
Stage III - Mid third of root - Severe
Stage IV - Apical third of root - V Severe
68
What should you do to determine the stage of periodontitis if there are no periapical or OPG radiographs?
Use CAL or bone loss from CEJ
69
What is "Grading" in relation to a periodontitis diagnosis?
Grade is the susceptibility to bone loss, using periapicals or OPG choose the worst site to determine slow/moderate/rapid rate of progression
This is worked out as (% bone loss)/(patient age)
Grade A - <0.5 - Slow
Grade B - 0.5-1 - Moderate
Grade C - >1 - Rapid
70
How do you determine current disease status in relation to periodontitis?
What are the different statuses?
You look at
- % of BoP
- Probing pocket depth
- BoP at 4mm sites
Stable - BoP <10%, PPD <4mm, No BoP sites of 4mm
Remission - BoP >10%, PPD <4mm, No BoP sites of 4mm
Unstable - PPD >5mm OR PPD >4mm & BoP
71
In the 2017 Classification of Periodontal Diseases how do you use a BPE assessment Code 0/1/2 to form a diagnosis?
<10% BoP - Clinical gingival health
10-30% - Localised gingivitis
>30% - Generalised gingivitis
Diagnosis should also include a comment on plaque retentive features where a BPE code 2 is present
72
In the 2017 Classification of Periodontal diseases how do you use a BPE assessment Code 3 to form a diagnosis?
Use appropriate radiographic assessment to aid diagnosis (periapicals or OPG)
Conduct initial periodontal therapy and review in 3 months with localised 6PPC in involved sextants
- If no pockets >4mm and no bone loss due to periodontitis evident on radiograph then use code 0/1/2 pathway
- If pockets >4mm remain and/or radiographic evidence of bone loss due to periodontitis then use code 4 pathway
73
In the 2017 Classification of Periodontal diseases how do you use a BPE assessment Code 4 to form a diagnosis?
Use appropriate radiographic assessment (periapicals or OPG)
Full periodontal assessment
If <30% teeth affected - Localised periodontitis
>30% - Generalised periodontitis
Also look for molar incisor pattern
To form a diagnostic statement - staging, grading, current disease status and risk factor assessment need to be conducted
74
If a 0 is scored in the BPE, what is the appropriate treatment according to the guidelines?
No need for periodontal treatment
75
If a 1 is scored in the BPE, what is the appropriate treatment according to the guidelines?
OHI
76
If a 2 is scored in the BPE, what is the appropriate treatment according to the guidelines?
OHI and removal of all plaque retentive factors which may involve supra and sub gingival scaling to remove calculus
77
If a 3 is scored in the BPE, what is the appropriate treatment according to the guidelines?
OHI and Root Surface Debridement
As a general rule, radiographs to assess alveolar bone levels should be obtained for teeth or sextants
where BPE codes 3 or 4 are found.
78
What is Root Surface Debridement?
Scaling is when your dentist removes all the plaque and tartar (hardened plaque) above and below the gumline, making sure to clean all the way down to the bottom of the pocket. Your dentist will then begin root planing, smoothing out your teeth roots to help your gums reattach to your teeth.
79
If a 4 is scored in the BPE, what is the appropriate treatment according to the guidelines?
OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated
As a general rule, radiographs to assess alveolar bone levels should be obtained for teeth or sextants
where BPE codes 3 or 4 are found.
80
What is the treatment for gingivitis or gingival enlargement?
- Explain to the patient that untreated gingivitis is a risk factor for periodontitis, which can lead to tooth loss, but he/she can reduce this risk with OH
- Use TIPPS method to highlight how importance of effective plaque removal and show pt how they can achieve this
- Remove supra-gingival calculus/plaque/stain and sub-gingival deposits using appropriate method. Highlight to the patient areas where supra-gingival deposits are detected
- Ensure local plaque retentive factors are corrected, e.g. remove overhanging restorations or alter denture design
- Re-assess at a future visit to determine whether the gingivitis has resolved
81
What is TIPPS and how does it relate to the patients OH?
TALK - About causes of periodontal disease/any barriers for effective plaque removal
INSTRUCT - pt on best ways for plaque removal
PRACTICE - Ask pt to practice cleaning method and interdental cleaning whilst in dental setting, correct pts technique if necessary
PLAN - Make plan how pt will incorporate OH into daily routine
SUPPORT - Follow up at next visits
82
What commonly prescribed drugs for hypertension, epilepsy and autoimmune disorders can cause gingival enlargement?
Calcium channel blockers - Hypertension
Phenytoin - Epilepsy
Ciclosporin - Anti-rejection drug used for Autoimmune disorders
83
What is the treatment for drug-induced gingivitis?
- Ensure you have an up-to-date medical history
- Use TIPPS method to highlight how importance of effective plaque removal and show pt how they can achieve this, smoking cessation where needed
- Remove supra-gingival calculus/plaque/stain and sub-gingival deposits using appropriate method. Highlight to the patient areas where supra-gingival deposits are detected
- Ensure local plaque retentive factors are corrected, e.g. remove overhanging restorations or alter denture design
- Where the gingival enlargement hinders adequate plaque removal or interferes with the
normal function of the oral cavity, consider consulting the patient’s physician or referring for
specialist periodontal care.
- Re-assess at further visit to determine whether the gingival enlargement has been resolved
84
Briefly how does pregnancy associated gingivitis occur?
Due to the change in hormone levels and due to the immune response associated with pregnancy
85
What is the treatment for pregnancy associated gingivitis?
- Where the condition is mild, use the Oral Hygiene TIPPS behaviour change strategy to highlight the importance of effective plaque removal and to show the patient how she can achieve this. Where applicable, give smoking cessation advice
- Where the condition is severe, give oral hygiene and smoking cessation advice as detailed above. Remove supra-gingival plaque, calculus and stain and sub-gingival deposits using an appropriate method. Highlight to the patient areas where supragingival deposits are detected. These patients may require more frequent recall visits during pregnancy and additional care.
- Ensure that local plaque retentive factors are corrected - for example, remove overhanging restorations or alter denture design.
- Explain to the patient that the condition is likely to resolve once her baby is born or following the cessation of breastfeeding, assuming her oral hygiene is adequate.
- Re-assess at a future visit to determine whether the gingivitis has resolved.
86
Briefly how does puberty associated gingival enlargement occur?
Gingivitis is commonly observed in pre-teens and young teenagers where the increased inflammatory
response to plaque is thought to be aggravated by the hormonal changes associated with puberty.
87
What is the treatment for puberty associated gingival enlargement?
- In cases of puberty gingivitis and mild gingival enlargement associated with puberty, use
the Oral Hygiene TIPPS behaviour change strategy to highlight the importance of effective
plaque removal and to show the patient how he/she can achieve this. Where applicable, give smoking cessation advice.
- Remove supra-gingival plaque, calculus and stain and sub-gingival deposits using an appropriate method Highlight to the patient areas where supra-gingival
deposits are detected.
- Ensure that local plaque retentive factors which may hinder oral hygiene efforts, such as overhanging restorations, are corrected. Ensure patients are able to clean effectively around fixed orthodontic appliances.
- Where the gingival enlargement hinders adequate oral hygiene or interferes with the normal function of the oral cavity, consider referring to a consultant in paediatric dentistry, consultant in restorative dentistry or specialist periodontist.
- Re-assess at a future visit to determine whether the gingivitis or gingival enlargement has resolved.
88
What does unexplained gingivitis/gingival enlargement usually indicate?
Unexplained gingival enlargement, inflammation and bleeding can be a sign of undiagnosed leukaemia
in both children and adults.
89
What is the goal of non-surgical periodontal treatment?
To achieve signs of periodontal stability.
Optimal outcomes are plaque scores of >15%, Bleeding scores <10%, and probing depths >4mm
Patients with significantly improved oral hygiene,
reduced bleeding on probing and a considerable reduction in probing depths from baseline can be
considered to have responded successfully to treatment and may progress to supportive periodontal
therapy.
90
What is the treatment for periodontitis?
- Remove supra-gingival plaque, calculus and stain. Highlight to the patient areas where supra-gingival deposits are detected. Carry out root surface
instrumentation (RSI) at sites of ≥4 mm probing depth where sub-gingival deposits are present or which bleed on probing. Local anaesthesia may be required.
- Advise the patient that he/she may experience some discomfort and sensitivity following treatment and to expect some gingival recession as a result of healing.
• Proprietary desensitising toothpastes or mouthwashes can be used to treat particular areas of dentine sensitivity following RSI.
- Carry out a full periodontal examination a minimum of 8 weeks post treatment.
91
How do you treat acute conditions in relation to periodontitis?
- Manage acute conditions using local measures in the first instance.
- Do not prescribe antibiotics unless there is evidence of spreading infection or systemic involvement.
- Recommend the use of 0.2% chlorhexidine mouthwash (or 6% hydrogen peroxide for NUG and NUP) until the acute symptoms subside.
- Recommend optimal analgesia.
- Following acute management, review within ten days and carry out further supra- and sub-gingival instrumentation as required and arrange an appropriate recall interval.
92
What is the acute management of a perio-endo lesion?
Carry out RCT of affected tooth
93
What is the acute management of a periodontal abcess?
Carry out careful sub-gingival debridement short of the base of the peridontal pocket, LA may be required.
If pus is present, drain by an incision or through the periodontal pocket.
94
What is the acute management of necrotising ulcerative gingivitis and periodontitis?
Use oral hygeine TIPPS to address inadequate plaque removal, smoking cessation if needed.
Remove as much supra-gingival plaque, calculus and stain and sub-gingival deposits as can be tolerated by the patient; local anaesthesia may be required.
If there is evidence of spreading infection or systemic involvement, consider prescribing metronidazole.
If no resolution of signs and symptoms occurs, review the patient’s general health and consider referral.
95
What is the supportive periodontal therapy for patients with a history of periodontitis?
- Ensure that full mouth periodontal charting is performed annually in patients who scored BPE 4 in any sextant at baseline and in patients who scored 3 in more than one sextant at baseline.
• Where the patient scored BPE 3 in only one sextant, carry out full periodontal charting of that sextant.
- Remove supra-gingival plaque, calculus and stain using an appropriate method. Carry out RSD at sites of ≥4 mm probing depth where sub-gingival deposits are present or which bleed on probing. Local anaesthesia may be
required.
96
How do you manage patients with dental implants?
- Ensure that a baseline periapical radiograph of the implant is taken one year after superstructure connection to facilitate long term maintenance
- Assess level of oral hygeine, if necessary utilise TIPPS to encourage adequate plaque removal, smoking cessation if necessary
- Examine peri-implant tissue for signs of inflammation and bleeding on probing, and/or suppuration (pus discharge). Probe gently around the superstructure to feel for excess cement and sub-mucosal plaque and calculus. Measure probing depths using fixed landmarks. BPE not appropriate for dental implants.
- Remove supra-mucosal and sub-mucosal plaque and calculus deposits using an appropriate method. Remove sub-mucosal excess residual cement if this is detected. Local anaesthesia may be required.
- Assign a risk level and schedule recall appointments accordingly.
97
What is peri-implant mucositis and how is it managed?
Peri-implant mucositis is an inflammatory lesion of the soft tissues surrounding an endosseous implant in the absence of loss of supporting bone or continuing marginal bone loss.
- Ensure it is peri-implant mucositis and not peri-implantitis by carrying out a radiographic examination to assess peri-implant bone levels compared with the baseline
- Remove supra-mucosal and sub-mucosal plaque and calculus deposits using an appropriate method. Remove sub-mucosal excess residual cement if this is detected. Local anaesthesia may be required.
- Re-assess at a future visit to ensure that the inflammation has settled and a stable situation has been achieved.
98
What is peri-implantitis and how is it managed?
Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone.
- Carry out a radiographic examination to evaluate peri-implant bone levels compared with the baseline radiograph.
- If clinically significant progressing crestal bone loss is detected, refer back to the clinician who placed the implant. If this is not possible, treat by removal of supra-mucosal and sub-mucosal plaque and calculus deposits using an appropriate method. Remove sub-mucosal excess residual cement if this is detected. Local anaesthesia may be required. Plus:
* Arrange a follow-up appointment after 1-2 months to assess the outcome of treatment. Where there is no improvement, seek advice from secondary care.
* If the inflammation has settled and a stable situation has been achieved, arrange radiographic follow-up in 6-12 months.
99
What is hygiene phase therapy?
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Dental education
Oral Hygeine Instructions
Scaling and RSD
Removal of other plaque-retentive factors
Re-evaluation
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100
What are the pros and cons of using ultrasonic vs hand instruments?
- Ultrasonic tips may allow better access to furcations
- Powered instrumentations may be faster and less demanding on operator
- May result in less unwanted tooth tissue removal
- Powered instruments cause aerosols
- May leave a rougher surface
101
How is tooth mobility measured and classified?
Move it bucco-lingually, using an index finger on one side of the tooth and an instrument handle on the other. The amplitude of movement of the crown, from its most extreme buccal to its most extreme lingual position is scored as follows:
Grade 1 - <1mm
Grade 2 - 1-2mm
Grade 3 - >2mm or rotation/depression
Grade 3 mobility teeth have poor prognosis.
102
How do you identify a mini sickle and what is it used for?
A double-ended point scaler with two cutting edges on each blade for buccal and lingual embrasure surfaces supra-gingivally and within the pocket orifice.
103
How do you identify a mini sickle and what is it used for?
Red
A double-ended point scaler with two cutting edges on each blade for buccal and lingual embrasure surfaces supra-gingivally and within the pocket orifice.
104
How do you identify a Columbia Curette 4R-4L and what is it used for?
Red
A double-ended universal curette with 2 cutting edges on each blade for sub-gingival scaling anywhere in the mouth but with limited access to deep pockets.
105
How do you identify a Gracey Curette 1-2 and what is it used for?
Grey
A double-ended curette, each blade having a single cutting edge. Designed specifically for fine/deep sub-gingival scaling of upper and lower anterior teeth.
106
How do you identify a Gracey Curette 7-8 and what is it used for?
Green
A double-ended curette, each blade having a single cutting edge. Specifically designed for fine/deep sub-gingival scaling of buccal/lingual surfaces of posterior teeth.
107
How do you identify a Gracey Curette 11-12 and what is it used for?
Orange
A double-ended curette, each blade having a single cutting edge. Specifically designed for fine/deep sub-gingival scaling of mesial surfaces of posterior teeth.
108
How do you identify a Gracey Curette 13-14 and what is it used for?
Blue
A double-ended curette, each blade having a single cutting edge. Specifically designed for fine/deep sub-gingival scaling of the distal surfaces of posterior teeth.
109
How do you identify a Hoe Scaler 134-135 and what is it used for?
Yellow
| A double-ended instrument for gross supra- and sub-gingival scaling mainly on buccal and lingual surfaces.
110
How do you identify a Hoe Scaler 156-157 and what is it used for?
Red
| A double-ended instrument for gross supra- and sub-gingival scaling mainly on mesial and distal surfaces.
