Perio Final Flashcards
(117 cards)
1
Q
What are the four components of P I C O
A
P = problem or population, I = intervention (what are you going to do), C = compassion = comparing two or more approaches to the problem, O = outcome (see results)
2
Q
EB DM is used to sub what kind of problem
A
Clinical
3
Q
What kind of study offers the highest quality research
A
Systemic reviews of random controlled studies
4
Q
Systemic review
A
Focused question Search method stated Studies selected by criteria rigorous appraisal database conclusion, may include meta analysis
5
Q
Traditional (narrative) review
A
Question broad in scope search method not stated no key criteria selected variable critical appraisal opinion based conclusion
6
Q
What is the purpose of oral irrigation
A
An adjunct of method for the arrest and control of gingival infections as it targets the loosely attached bacterial plaque and lowers the bacterial level in the oral cavity through disrupting microbial colonization.
Modes are both power driven and manual (water piks, ultrasonics, and manuals syringes with cannula)
7
Q
Characteristics of an effective mouth rinse
A
Non-toxic or toxicity (will not damage tissue)
None or limited absorption (absorbed through G.I. tract; confined to oral cavity)
Substantivity (Peridex, CHX), (ability to bind to the pellicle and tooth surface and be released over a period of time)
Bacterial specificity or high potency
Low induced drug resistance
8
Q
Definition of controlled drug release agents
A
Intercrevicular medication that is professionally placed and provides delivery of a drug over a substained period of time
9
Q
What is the advantage of controlled drug release agents
A
Drug delivers 1000 times the concentration of GCF but only 1/100 of this is systemic dose reaches the rest of the body
10
Q
What are the bacteria associated with periodontal disease
A
Read complex bacteria (most periodontal pathogenic bacteria I gram-negative, non-motile and anaerobic)
11
Q
What are the three major organisms found in 98% of periodontal diseases
A
- Actinobacillus actinomycetemcomitans (Aa)
- Porphyromanas gingivalis (Pg)
- Prevotella intermedia (Pi)
Others are: camplylobacter recta eikenella corrodens, fusobacterium nucliatum, spirochetes, bacteroikes forsynthus
12
Q
What are the dental hygienist role?
A
Recognize, record, referred
13
Q
Orthofunction (physiologic occlusion)
A
Health and comfort, no pathologic changes in the oral tissues
14
Q
Dysfunction (morphofunctional disharmony)
A
Often a result of para functional activities = grinding, clenching, activities which stress the system
15
Q
What is the range of morphofunctional harmony to disharmony
A
Dependent on the adaptive capabilities of the individuals oral system. When the para functional activities exceed what the system can sustain, dysfunctional results
16
Q
Traumatic occlusion
A
Occlusion which has caused injury to the teeth, muscles or TMJ
17
Q
Primary dramatic inclusion
A
Heavy occlusal forces exceed the adaptive range in normal periodontium, causing injury to the tissues and bone. The bite causes the injury
18
Q
Secondary traumatic occlusion
A
Normal occlusal forces exceeded the capability of a periodontium already affected by disease. (The bite alters tissues already compromised.)
19
Q
What does EBDM stand for
A
Evidence-based decision-making
20
Q
What are the Primary Signs and Symptoms of TMJ Disorders?
A
- pain in muscles (myalgia)most common
- pain in TMJ (arthralgia)
- painful clicking of the joint in function (crepitus)
- limited range of motion (incoordination of joint)
21
Q
Additional symptoms of TMJ include?
A
- uncomfortable bite
- incoordination of the jaw (dyskinesia)
- ringing in the ears
- muscles swelling
- clinical signs of tooth wear, mobility and pulpitis
22
Q
TMJ disorders
A
Musculoskeletal conditions that produce pain and or dysfunction of the masticatory system.
- Extracapsular- involves muscle not joint
- Intracapsular- occuring in the TMJ
23
Q
If you have one or more symptoms of TMJ does not indicate a?
A
Positive diagnosis
24
Q
Oral habits
A
repetitive masticatory activities. tooth-to-tooth or tooth-to-object. Wear faucets
25
Tobacco Cessation Statistics
- chief avoidable (preventable) cause of illness and death in the USA
- contributing factor in many medical conditions such as cancer, cardiovascular, respiratory, and reproductive, in addition to an increased risk of perio disease
- contains nicotine which is a highly addictive drug
- itself is not a carcinogen but it is the chemical that causes addiction
- smokeless contains more nicotine than cigarettes
- is harmful
- on a milligram to milligram basis, nicotine is 10x more addictive than heroin or cocaine and 6-8x more addictive than alcohol
- the extent of periodontitis is directly related to the number of cigarettes smoked and the number of years of smoking
26
Tobacco clinical clues
-normal clinical signs of diseased are masked: gingival inflammation and bleeding are often reduced or absent in smokers.
-the lack of bleeding on probing does NOT indicated healthy tissue as with a nonsmoker
-gingival recession and decay of exposed root surface adjacent to site of placement of smokeless tobacco
-white patches or red sores on buccal mucosa
nicotine stomatitis on maxillary palate
27
How Nicotine Affects the Body
manufacturers are able to control the level of free nicotine found in their product by controlling the PH levels.
-Free nicotine is ionized nicotine that passes rapidly through the oral mucosa into the bloodstream and into the brain. The more alkaline the product the faster the uptake into the bloodstream
28
Tobacco role of the dental hygienist
Ask
Advise
Assess
29
On a milligram to milligram basis, nicotine is __ times more addictive than heroin or cocaine and ___ times more addictive than alcohol
10
| 6-8
30
The more alkaline the product the ____ the uptake into the bloodstream
Faster
31
Ask
- important to identify tobacco users
| - most often done through health history form
32
Advise
Important to relate tobacco use to protecting current and future health
33
Assess
- readiness to quit-open ended question
| - States of change theory
34
How many stages of stage theory are there?
5
35
What are the 5 stages of change theory?
Stage 1: Pre-contemplation - no thought of quitting
Stage 2: Contemplation - thinking about quitting "someday"
Stage 3: Preparation- ready to quit and willing to set a "quit" date
Stage 4: Action-stopped their tobacco use for less than 6 months
Stage 5: Maintenance-stopped tobacco use for more than 6 months
36
Periodontal Abscesses
Inflammation of bacterial origin that is associated with exudates. The abscess is often caused by microbiota that has become established in the tissue as a result of trauma, advancing perio disease, or incomplete S/RP. the abscesses may be acute or chr
37
Acute
pre-existing periodontal disease. Inflammatory reaction occurs when the periodontal pocket becomes occluded. Often a result of a foreign object (such as residual calculus)
38
Chronic
Result of an overgrowth of pathogenic organisms in a periodontal pocket than drains the exudate. Often painless because of this drainage
39
Tobacco Information Patients should know
- nicotine withdrawal lasts 2-4 weeks and is the brains way of healing
- medications can minimize discomfort of nicotine withdrawal and cravings.
- untreated nicotine withdrawal symptoms may include craving, irritability, frustration, anger, anxiety, difficulty concentrating, weight gain, insomnia, and gastrointestinal problems.
- strategies that combine behavioral and FDA - approved adjunctive phamacologic support achieve the best outcomes for nicotine-dependent patients.
- stages of readiness to quit are progressive levels of mental readiness. Not everyone moves through the steps a the same speed.
- the type of assistance we provide or promote is determined by the patients readiness to quit.
40
Necrotizing Ulcerative Gingivitis (NUG)
- Vincents Disease
- associated with stress, lifestyle and chronic illness and conditions
- spirochetes and gram-negative organisms
- pseudomembrane on tissue
- crated interdental papillae
- severe halitosis
- painful
41
Nectrotizing Ulcerative Periodontitis (NUP)
NUG like symptoms with attachment loss
42
Acute Herpetic Gingivostomatitis
- herpes simplex virus 1
- child, adolescence, young adults, most prevalent group
- limit dental care with infected patients
- after initial infection virus remains dormant in nerve ganglion until re-stimulated
- oral lesions small yellow filled vesicles that will get larger with bright red boarders
- painful
- can have fever, malaise, irritability
- herpetic whilow
43
Facts about Lasers
- produce light energy absorbed by targeted tissues. Absorption dependent on wave length.
- absorption causes thermal reaction within the tissue
- can be used on wide range of population including children and pregnant women
- unlike medications there are no allergic reactions, bacterial resistance or untoward side effects.
- lasers disinfect and detoxify periodontal tissues
- still controversial-not enough current studies to prove advantageous to initial periodontal therapy (Phase 1)
44
Healing 3 ways
1. Primary intention - healing does not involve granulation tissue
2. Secondary intention - heals with granulation tissue
3. Tertiary intention- healing with granulation tissue and loss of surrounding tissue. Ex. infections, large excisional areas
45
Bone loss
Biological width: 1-2 mm of connective tissue attachment between the base of the sulcus or pocket and the alveolar bone. This 1-2 mm is the combined height of the gingival connective tissue and the junctional epithelium.
46
Periodontal surgeries
- allow a minimum of 4 weeks after phase 1 treatment before recommending Phase II
- most successful in 5-9mm pockets
- disease must have progressed by a 2mm increase in probing depths (bone loss)
47
Incisional procedure
Flap
48
Excisional procedure
gingivectomy and gingivoplasty. Procedure used to remove excess tissue from the wall of perio pocket. Useful for the rapid reduction of periodontal pockets.
49
Full thickness flap
also called a mucoperiosteal flap, the gingiva, alveolar mucosaa nd periosteum are reflected from the root and underlying bone (exposed bone)
50
Partial thickness flap
also called a split-thickness flap, the periosteum and some connective tissue are left attached to the bone and not included in the flap procedure (no bone exposure)
51
Most common flap
Modified Widman and apically positioned
52
based on the final positioning of the flap....
They may be classified as replaced or repositioned (ex. Modified Widman), apically positioned, coronally positioned and laterally positioned
53
3 main components of implants
- Body - implant fixture (replaces the root)
- Abutment - extends from the implant through the soft tissue (transmucossal)
- Restoration or prosthesis - attaches to the abutment
54
Osseointegration
contact established between normal and remodeled bone and the implant surface without connective tissue interaction. An implant is never 100% osseointegrated.
55
Osseointegration
contact established between normal and remodeled bone and the implant surface without connective tissue interaction. An implant is never 100% osseointegrated.
56
Titanium
most common metal used for implants since it is biocompatible and 45% lighter than steel
57
Contraindications for implant surgery
- uncontrolled diabetes
- heavy smokers
- bisphosphonate therapy
- refusal for oral health compliance
58
Implant loading
placement of restoration on the implants
| -no fixed time period-normal recommendation is 3 months mandibular and 6 months maxillary
59
Two stage
-submerged protocol -restorative procedures usually begin 3-5 weeks after tissue healing
60
One stage
-nonsubmerged protocol - similar to two stage except tissues are closed around the specially designed transmucosal portion of the implant. This eliminates need for second step.
61
Most successful region of the mouth for implants
Posterior molars and pre-molars
62
Least successful region of the mouth for implants
Anteriors - bone density is major contributing factor. Maxillary Anterior bone is the least dense.
63
Criteria for successful implants
- no peri-implant radiolucency
- absence of mobility
- bone loss not greater than 1/3 of implant
- functional service for 5 years
- absence of persistent pain, infection, paresthesia
- bone loss less than 0.2mm annually after first year
- allows satisfactory restoration option
- absence of soft tissue complications
- probing depths less than 4-5mm, bone loss less than 4mm
- no mechanical failure
64
What are the types of abcesses
- Periodontal
- Endodontic abscess and periapical abscess
- gingival abscess
- pericoronal
65
Types of lasers
- Erbium
- Carbon Dioxide
- Diode
66
Common bone grafts
- Graft
- Autograft
- Allograft
- Alloplasty
- Xenograft
67
Graft
Source
68
Autograft
Own body
69
Allograft
Cadaver of bone bank
70
Alloplasty
biocompatible, inorganic synthetic materials (hydroxyapatite, calcium sulfates, and tricalcium phosphates)
71
Xenograft
another species (usually cow)
72
Ostecomy
removal of supporting bone to obtain optimal contours
73
Osteoplasty
recontouring nonsupporting bone to obtain physiologic contour
74
Guided Tissue Regeneration (GTR)
Prevent gingival tissue from establishing contact with the root surface, creating space for the formation of a new attachment and new bone.
75
Active ingredient in arestin
1 mg Minocycline hydrochloride
76
active ingredient in Perio Chip
2.5 mg chlorhexidine gluconate
77
Active ingredient in Actisite First used historically
Tetracycline
78
Active ingredient in Atridox First resorbable
10% doxycycline hyclate
79
How many levels of implant quality scale are there?
4
80
Implant Quality Scale Level I Success
- no pain, mobility or exudate history
| - less than 2mm bone loss from initial surgery
81
Implant Quality Scale Level II Satisfactory Survival
- no pain, mobility or exudate history
| - 2-4 mm bone loss form initial surger
82
Implant Quality Scale
| Level III Compromised Surviva
- may have slight pain, and exudate history
- no mobility
- >4 mm bone loss, shows radiographically less than 1/2 the implant length
- probing depths >7mm
83
Implant Quality Scale Level VI Failure
- pain on function
- mobility
- bone loss of more than 1/2 the implant length. Show radiographically.
- uncontrolled exudate
84
Gingivoplasty
surgical reshaping of the tissue
85
Gingivectomy
deep pockets with fibrous tissue as with drug induced gingival hyperpl
86
Free gingival graft
donor site away from graft site. Most common area is palate
87
Laterally positioned flap or pedicle graft
move gingiva from an adjacent tooth or edentulous area
88
apically positioned flap
may be full or partial thickness. main objective is to surgically reduce deep pockets
89
modified widman (repositioned flap)
gain access to root surfaces and reduce periodontal pockets
90
Endosseous "in bone"
implant is placed directly into a socket. most conventional length is 8-14mm and diameter is 3-6 mm
91
Subperiosteal "on bone"
custom-fabricated framework of metal that is supralveolar (on top of the bone) but beneath the oral tissues. 4 posts protrude through tissues to provide anchor for final bridge or denture
92
Transperiosteal "through bone
penetrates entire mandibular jaw, 5-7 pegs protrude through tissue to provide anchor. used for atrophic mandible
93
Biologic Environments Natural Tooth
gingival sulcus depth - shallow
PDL - perpendicular connective tissue inserts into cementum
gingival fibers -transseptal/circular
location of crestal bone - 1-2mm from CEJ
Cementum - cementum
Mobility - slight mobility - physiologic function of PDL
Plaque - more localized inflammation
Inflammation - inflammation not found in bone marrow
Proprioception - receptors within the PDL
94
Biologic Environments Implant
gingival sulcus depth - dependent on type of implant and prosthetic component length
PDL - no PDL
gingival fibers -no limiting fibers; only circular or parallel
location of crestal bone -dependent on implant type; range 0.5-2.5 from implant shoulder to first thread
Cementum - No cementum
Mobility - mobility indicates implant failure
Plaque - more wide spread inflammation
Inflammation - inflammation into bone marrow
Proprioception - no receptors within interface
95
What type of laser is a hard tissue laser?
Erbium
Don't do often
96
What type of laser(s) is/are soft tissue lasers?
Carbon Dioxide, Diode, and erbium
97
Oral rinses
```
Bis-biguanides
Phenolic Compounds
Quaternary Ammonium Compounds
Sanguinarine extracts (Herbal)
2nd generation antimictobial (CPC) 0.07%
Fluoride rinses
Oxygenating
Self made
```
98
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Oral Rinse
Self Made (salt rinse) active ingredient
```
Iodine
99
Oral Rinse Oxygenating (Gly-oxide amosan) active ingredient
Hydrogen peroxide
100
```
Oral Rinse
Fluoride rinses (Gel-Kam rinse and Stanimax) active ingredient
```
Stannous SnF2
101
Oral Rinse 2nd Generation antimicrobial (CPC) 0.07% (Crest Pro-health) active ingredient
Cetylpyridium chloride a cationic quaternary ammonium compound (+ charge)
102
Oral rinse Sanguinarine extracts (Herbal) (Viadent) active ingredient
alcohol extract from roots and herbs
103
Oral rinse quaternary ammonium compounds (Scope, Cepacol) active ingredient
Cetylpyridinium chloride 0.045-0.05%) Domiphen bromide and benzthonium chloride
104
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Oral Rinse
Phenolic Compounds (Listerine) active ingredient
```
Alcohol and Essential oils; thymol, eucalyptol, menthole, and methyl-salicylate
105
Oral Rinse
| Bis-biguanides (Peridex, Perio Guard) Active ingredient
Chlorhexine gluconate
106
Active ingredient in a perio chip
Chlorhexidine
107
Disease progression is determined by how many millimeters
2 mm increase in probing depths over a period of time
108
Surgery is most successful in treating what millimeter pockets
5-9 mm
109
What is the most critical factor in determining surgery
The mound of attachment loss. Clinical attachment laws is more accurate than probing depths, tooth mobility and presence of furcation involvement
110
Biologic width
1-2mm area of connective tissue attachment covered by epithelium between the probing depths and alveolar bone
111
Suprabony/horizontal boneloss
Olness parallels the CEJ of adjacent teeth. Normally generalized around several teeth. Bone destruction is not intra-osseous. Pocket base is coronal to the crest of the bow
112
Types of suprabony pockets
Gingival pocket/pseudo-pocket
| Periodontal pocket
113
Vertical/infrabony boneloss
Bone loss not parallel with the CEJ and found around isolated
114
How are osseous defects classified
By the number of walls remaining
115
How do you determine the number of walls remaining
Through exploratory surgery. Radiographs Will not show the number of walls remaining
116
What are the two critical factors in determining the prognosis of a tooth
Mobility and attachment loss. Attachment loss is the most critical
117
How many wall defects yields the greatest success
A narrow three wall defect
