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Flashcards in Perio III Deck (95):
1

There are more bacteria than cells in a human body by a factor of _____

20

2

Undisturbed oral biofilm grows at ____to _____ micrometers/day

82 - 200

3

T/F
CHX can affect plaque that's been in place from 24-48 hours.

T/F
CHX can affect 6 hour plaque

False

True

4

If PD is over 7mm, what is the average reduction in PD after Scaling and Root Planing?

2.16 mm

5

If PD is over 7mm, what is the average reduction CAL after Scaling and Root Planing?

1.19 mm

6

What is the main function of Scaling/Root Planing?

Decreases surface area

7

What is the deepest Scaling and Root Planing generally goes on the root?

5 mm

*even if PD much bigger than 5 mm

8

6 problems of Restricted Access when Scaling/Root planing

PD

Furcations

Root Proximity

Root Flutings

CEJ relationships

Restorations

9

Periodontal _____ lesions can limit soft tissue management

Infrabony

10

Perio OHI clinical protocol:

(3 items)

Electric toothbrush

Waterpik (or floss)

CHX 2x/day

11

SRP is part of Perio clinical protocol and is done with ______

local anesthesia

12

What low dose antibiotic is preferred?

What is the dose?

Doxycycline

20 mg

13

When is the re-eval post-SRP?

4-6 weeks

14

At 4-6 weeks SRP, what sites are re-treated after re-eval?

In what 2 ways?

greater than 5 mm

SRP, Site-specific drugs

15

When are surgical treatments considered in the Perio Clinical Protocols?

Post re-eval, after second SRP, site specific drugs, etc if response not achieved

16

Low Dose Doxycycline (originally Periostat) is 20 mg doxy, _____ tabs, every ____ hours

180 tabs

12 hours

17

20 mg concentration of doxy has no bacterial effect, but does chelate metals (Ca, Zn, Mg) and inactivates ________

Matrix metalloproteinases

18

The matrix metalloproteinases inactivated by low dose Doxy are what 2 specific products?

Produced by what 2 specific cells?

Gelatinases, Collegenases

PMN's, Macrophage


*so low-dose Doxy fights our own immune system and its degrading factors

19

When is it appropriate to use SRP + Local delivery?

Post re-eval

20

6 conditions SRP + local delivery can be used:

Pockets greater than 5mm

Maintenance PD 5-6mm

Early perio abscess

PD distofacial 2M's for 3M extraction

Ailing implants

Furcations

21

3 locally delivered Antimicrobials (brand names)

PerioChip

Atradox

Arestin

22

What is in PerioChip:

Atradox:

Arestin:

CHX

Doxycycline (gel)

1 mg minocycline (powder)

23

T/F
In terms of reaching the disease site, achieving adequate concentration and duration, killing the target microbe, and not harming the patient, Locally Delivered antimicrobials are the best

(when compared to mouth rinse, subgingival irrigation, and systemic antibiotics)

True

24

Arestin is __mg of _____ in powder

1 mg

minocycline

25

GCF concentration minocycline after Arestin therapy:

3 days out:

14 days:

28 days:

90,000 ug/ml

3250 ug/ml

340 ug/ml

10-20 ug/ml

26

5 bacteria that are susceptible to minocycline (Arestin) concentrations at 2-8 ug/ml

P. gingivalis

P. intermedia

F. nucleatum

E. corrodens

A.a.

27

Low dose doxy targets cytokines, prostanoids, MMP's and therefore inhibits _____ and _____ metabolism

CT

bone

28

T/F
Local antimicrobial + Low Dose Doxy goes after both microbial challenge and CT/Bone metabolism

True

29

It is possible to get a pocket reduction of 3mm, but more realistically it will be ____mm.

Pocket reduction of ___mm is not realistic

2mm

4mm

30

Open Flap Debride can get a Pocket Reduction of ___mm

3.00

31

SRP + Arestin reduction in PD:

SRP + Atridox:

SRP + PerioChip:

1.65 mm

1.2 mm

0.9 mm

(bout half mm less reduction in CAL)

32

What systemic antibiotic is the drug of choice in treatment of Agressive Perio?

Amoxicillin

33

Other than Amoxicillin, name 6 drugs prescribed for Aggressive Perio:

Metronidazole (NOT w/ EtOH)

Tetracycline (photosentitive)

Doxy

Clindamycin

Amoxicillin + Clavulanic Acid (Augmentin)

Azithromycin (Z-pak not used much any more)

34

T/F
The advantages of systemic antibiotics is wide dispersement, reduction of chair time to treat pts, and a wide range of drugs to choose from.

True

35

What is the primary disadvantage to systemic antibiotic use for chronic perio?

pt compliance

36

Aside from compliance, allergy, GI problems, DDI's, cost and the inability to penetrate intact ______ are disadvantages for systemic antibiotic use for chronic perio.

biofilm

37

T/F
Frequency (of taking drug) and compliance are inversly related

True

38

GI, nausea, photosensitivity, bacterial resistance, _____, and ______, are common side effects of systemic antibiotics.

Esophagitis

Candidiasis

39

Name 4 antibiotics commonly prescribed for systemic use in perio

Tetracycline

Doxycycline

Minocycline

Amoxicillin

40

Systemic antibiotics has a positive effect on ____

CAL

41

What antibiotic combination has the greatest effect on CAL?

This reduces CAL by ___mm

Best results are obtained when prescribed for ____ days

Amoxicillin + Metronidazole

0.4 mm

7

*either aggressive or chronic

42

T/F
Systemic antibiotics should be used in most pts with periodontitis

False

43

Systemic antibiotics should be used in conjunction with _____ treatment over a period of 7 days

SRP

44

SRP + Arestin decreases ______ and _______

hsCRP

IL-6

45

SRP + low dose Doxy degreases what 4 things?

MMP's

hsCRP

HDL

apolipoprotein-A

46

Most changes in a perio Tx plan occur when?

Re-evaluation

47

After all non-surgical therapy is considered in the Re-Evaluation, what are the 3 options?

Control Etiology (or modifying factors)

Surgical Therapy (phase II)

Compromised maintenance therapy

48

When should the pt proceed to a Maintenance Phase?

When Stable

49

If the pt is not stable upon re-evaluation, then proceed to...

Personalized re-treatment

50

What are the 3 options in Personalized Re-treatment?

Antimicrobial therapy

Surgery

Combination

51

What is the most critical phase of successful periodontal therapy?

Maintenance

52

Maintenance visit: If PD is stable with no BOP, then Tx is routine - review OHI with same recall interval. If PD same but BOP is present, what is the Tx course?

OHI

SRP on bleeding sites

Consider - local antimicrobials

Consider - shortening recall intervals

53

Maintenance visit: PD and BOP increase

(4 things)

OHI

SRP

Adjuctive therapy (local/systemic antibiotics)

***Refer to Periodontist

54

Why is Perio maintenance interval 3 months?

Re-infections of pockets happens around 3 months

(60+ days)

*referrals tend to alternate GP/Periodontist

55

The only exception to initiating Tx without a Tx Plan:

Emergencies

56

A Tx Plan is a working ______

Document

57

An emergency begins a Treatment Plan at the _____ phase

Urgent

58

After the Urgent Phase is the ______ Phase

Control

59

Emergency therapy

Initial therapy

Determine Response:

Corrective:

Regular re-care examinations (reassessments):

Urgent Phase

Control Phase

Re-evaluation Phase

Definitive Phase

Maintenance Phase

60

What is the Initial Therapy (Phase I) for Gingivitis?

Med consult (if needed)

OHI

scale and polish

re-eval 4-6 wks

phrophylaxis every 6 months if disease resolved

61

Mild Chronic Periodontitis has Inflammation extending to the ______.

Attachment loss ____mm from CEJ

PD ____mm

Radiographic bone loss less than ____%

furcation:

bone

1-2mm

3-4mm

20%

Class I or no furcation involvement

62

Initial (phase I) therapy for Mild Chronic Periodontitis:

Med consult (if needed)

OHI

SRP w/ anesthesia

2-4 appointments

Re-eval 4-6 weeks

3-4 month maintenance interval (depending on OH)

63

Moderat Chronic Periodontitis has inflammation extending to the _____.

Attachment loss ___mm from CEJ

PD ___ mm

Radiographic bone loss ___% to ___%

Furcation involvement

Mobility:

bone

3-4 mm

5-6 mm

20%-40%

Class I or II furcations

Class I and II mobility

64

Moderate Chronic Periodontitis Initial Therapy (Phase I):

Med consult if indicated

OHI

SRP

2-4 appointments

Re-eval 4-6 weeks

Locally delivered antimicrobials in 5-6mm pockets

Periodontist referral

65

Advanced Chronic Periodontitis has inflammation extending to the bone, bleeding on provocation, attachment loss greater than ___ mm from CEJ

PD greater than ___mm

Radiographic bone loss greater than ___%

furcation

mobility

5 mm

7 mm

40%

Class I, II, or III furcation

Class I, II, or III mobility

66

Advanced Chronic Periodontitis: Med consult if needed, OHI, SRP, 2-4 appointments, Re-eval in 4-6 weeks, locally delivered antimicrobials in ___mm residual pockets, and referral to periodontist

***this is exactly the same treatment as Moderate Chronic Periodontitis

5-6 mm

67

What is prognosis without treatment?

What type of prognosis takes into account what effect the periodontal treatment will have on the course of the disease?

Diagnostic prognosis

Therapeutic prognosis

68

What type of prognosis anticipates the results of perio treatment and forecasts for the success of a prosthetic restoration?

What prognosis is given prior to the initial phase of Treatment and may change according to the patient/tooth response?

Prosthetic prognosis

Provisional prognosis

69

Prognosis is divided into:

Overall prognosis

Individual tooth

70

What is the single most important factor in the Overall Prognosis/Systemic Background?

Smoking

71

Cigaretts smokers are __-___ times more likely than non-smokers to develop severe periodontitis

5 to 8 times

72

What 3 positive effects does 20 Minutes smoking cessation have?

BP drops to normal

Pulse rate drops to normal

Peripheral body temp increases to normal

73

What positive effect does smoking cessation have at 8 hours?

At 24 hours?

CO drops to normal

Chance of heart attack decreases

74

What positive benefit is seen related to smoking cessation at 2 weeks - 3 months?

At 1 to 9 months?

Circulation improves, lung function increases 30%

Coughing, sinus probs, breathing improve and Cilia Re-Grow

75

What positive benefit is seen by smoking cessation at 1 year?

5 years?

Heart disease reduced 50%

Lung, oral, pharynx, esophageal cancer decreased 50%

*stroke reduced to non-smoker in 5-15 year range

76

What positive benefit is seen by smoking cessation at 10-15 years

Lung cancer similar to nonsmoker

heart disease like nonsmoker

77

What bacteria is increased by Type I diabetes?

What bacteria is increased by Type II diabetes?

Captocytophaga spp.

P. gingivalis

78

What 2 consequences does diabetes have in the GCF?

Decreased PMN function

Increase glc

79

What vascular changes are seen in diabetes?

Increased thickness

*decreases oxygen diffusion and waste elimination

80

How does diabetes impair wound healing?

Stimulates collegenase and alters collagen metabolism

Also limits production of Growth Factors

81

Untreated moderate/advanced periodontitis pt loses ___ teeth/yr

Treated w/ no maintenance loses ___ teeth/yr

Treated w/ maintenance loses ___ teeth/yr

0.36

0.22

0.11

82

Perio treatment is ___x as effective as no treatment

3.5x

83

T/F
The level of oral hygiene at 1st treatment isn't as important as the level of OH at completion of initial phase of Tx (Phase I)

True

84

T/F
An inflammatory response and plaque calculus suggests a better prognosis

True

85

What has a better prognosis, chronic infection or perio abscess?

Abscess

86

In SRP, what is the instrumentation limit?

Curette efficiency:

5.52 mm *most of time calculus over 5 mm remains

3.73 mm

87

T/F
PD is more important than CAL when determining prognosis

False

*invert - prognosis based on CAL

88

The ratio for a tooth with an average root length (13mm) is:

1:2

89

Individual tooth Prognosis Class I:

Class II:

Class III/IV:

Fair

Questionable

Poor/Hopeless

90

Prognosis based on tooth mobility
Class I:

Class II:

Class III:

fair (slight mobility)

questionable

hopeless (severe mobility + depressive)

91

What's worse, a single rooted mobile tooth or multi rooted mobile tooth?

Multi-rooted tooth is worse

92

T/F
Prognosis can be Good, Fair, Poor Questionable, and Hopeless

True

93

T/F
Maxillary molars are lost more frequently than mandibular molars

True

94

The average tooth loss with furcations over a 20 year period is what?

35.7%

95

What is the Periodontal Treatment plan for someone that had PD of 3 mm?

Fluoride

*no SRP

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