Perio Exam 1 Flashcards
(45 cards)
1) What legal ethical requirements are we obligated to provide. (4)
- Must diagnose disease 2. Must inform patient of existing disease
- Must offer appropriate treatment or refer
for treatment - Must treat to the standard of care
2) Know the variables associated with probing. (5)
Variables
- Inflammation
- Probe Diameter
- Tapered vs. Parallel
- Force (0.15 N to 0.75 N)
- Band Width (0.7 mm to 1.0 mm)
3) Localized vs. Generalized Chronic Periodontitis
Localized Chronic Periodontitis: ≤ 30% of teeth involved Slight Moderate Severe Generalized Chronic Periodontitis: > 30% of teeth involved Slight Moderate Severe
4) Know the initial, early, established, advanced lesions of gingivitis and periodontitis. When do things occur
A. Normal=Healthy B1. Initial Lesion=Gingivitis B2. Early Lesion=Gingivitis B3. Established Lesion=Gingivitis C. Advanced Lesion=Periodontitis
5) You will be asked to calculate clinical attachment loss, based on the data provided.
GM= Gingival Margin PD= Probing Depth CAL= Clinical Attachment Loss GM + PD = CAL ex. GM=CEJ, 3 mm coronal, 3 mm apical PD= 6mm, 9mm, 3mm CAL= 6mm, 6mm, 6mm
6) Know about probing, how to do it and factors involved, when is it worse, when is it less, when do we exaggerate it, etc.
Always check interproximal/interdental crater clinically. X-ray may not show bone loss well enough.
7) Know about biological width.
Junctional Epithelium + Connective Tissue Attachment = Biological Width.
CEJ to Crest of Alveolar Bone = 1.5-2mm (biological width)
8) Know about mobility. How do we detect it, what is class 1, what is class 2.
Detect Mobility using two instruments, never fingers.
Average width of PDL in adults is: 0.17mm Class I > 0.2 mm but < 1 mm Class II > 1 mm Class III > 1 mm + Axial Displacement
9) Important concept, commonly confused.
When we record data every time and over time it shows disease progression or disease stability. This is an important concept. Probing depth, one day tells you what it is today, but over the year it gives an indication of the patient’s disease. Bleeding on probing indicates disease activity for that day
10) Know the normal distance between CEJ and alveolar bone.
CEJ to Crest of Alveolar Bone = 1.5-2mm (biological width)
11) The average width of the PDL
0.17
13) When we measure furcations we use a particular type of probe and that probe measures??.
Cowhorn or Nabors Furca Probes for Horizontal Bone Loss.
14) Know the difference between gingivitis and periodontitis.
GINGIVITIS
Gingivitis:
- Plaque-Induced
- Gingival Diseases Modified by Systemic Factors
ex. puberty, pregnancy, diabetes, leukemia. - Gingival Diseases Modified by Med’s
ex. dilantin, ca channel blockers, cyclosporine ask zak
15) Know the clinical presentation of gingivitis versus periodontitis.
Everybody develops gingivitis but only susceptible patients will develop periodontitis. Therefore, patient’s immunology is extremely important in the pathogenesis of periodontal disease
16) What are the characteristics of clinically healthy gingiva? (5)
- Some neutrophils and macrophages present
- A few neutrophils migrating through the JE
- No collagen destruction
- Intact epithelial barrier
- Gingival crevicular fluid present
18) Know the data that we collect to diagnose.
- Probing Depth
- Bleeding on Probing
- Clinical Attachment Levels
- Width of Attached Gingiva
- Gingival Recession
- Furcation Involvements
- Tooth Mobility
- Radiographic Evidence of Bone Loss
- Plaque and Calculus
*****19) Know about chronic periodontitis. What does it look like clinically, what are the manifestations, is it associated with pain, etc.
Chronic Perio
Slight: 1-2mm CAL
Moderate: 3-4mm
Advanced: >5mm
20) Highlighted a few slides by Dr.Loe and Dr.Cobb that have some research data on them, those are important to know.
Loe: The average rate of clinical attachment loss
in patients with untreated chronic periodontitis
ranges from 0.1 to 0.3 mm per year for facial
and lingual surfaces and 0.3 mm per year for
interproximal areas.
Cobb: During the same time period, untreated periodontal patients will lose 3.5 times more teeth than will those patients who receive treatment.
OR
In a ten year period, untreated periodontal patients will lose 3.5 – 4.0 teeth while those patients who receive treatment will lose 1 tooth.
21) You will be asked about periodontal progression (4), the asynchronous burst model. (4)
- Plaque-induced
- susceptible host is required (immune system).
- Only a small % of the population experiences advanced destruction.
- The progression of the disease is probably
an asynchronous multiple burst model - Several sites have one or more bursts of activity
- Prolonged period of inactivity
- Cumulative extent of destruction varies among
sites - Some sites don’t develop attachment loss
22) Know how we diagnose.
Meaning slight, moderate, severe, how much clinical attachment loss for each. Is it localized or is it generalized. How do you know based on how many percentages of sites, know the numbers and the know how to come up with a diagnosis.
23) Different types of walls of a defect, definition of them, prognosis of them.
Intrabony Pockets (Vertical Bone Loss)
1 wall (worst prognosis)
2 wall
3 wall-best prognosis (most remaining walls)
circumferential
interdental: 35% max intrabony defects & 63% of mand. intrabony defects
24) There will be a drawing of the wall defect.
slide 13 chronic perio slide
25) You will be asked about diabetes in terms of periodontal disease, multiple abscesses, treatment of, and their response to treatment. A well-controlled diabetic responds just as well as a non-diabetic treatment.
Diabetes Causes: xerostomia obesity (increases susceptibility to bacterial infection- aka perio disease) Periodontal abscesses Rapid alveolar bone loss increased bone resorption increased plaque activity impaired wound healing altered pmn chemotaxis
26) The pyogenic granuloma associated with pregnancy comes from what bacteria?
what is p. intermedia because it’s tissue invasive and associated with gingival inflammation and pyogenic granuloma.
