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BDS3 paeds > Perio in Paeds > Flashcards

Perio in Paeds Flashcards

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1
Q

who produceed Guidelines for periodontal screening and management of children and adolescents under 18 years of age

A

BSP and BSPD

(British Society of Periodontology and British Society of Paedriatric Dentistry)

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2
Q

aims of 2012 guideline (children)

A
  • Classification of periodontal conditions: 2011 and 2017
    • Periodontal health
    • Gingivitis
    • Periodontitis
  • Early recognition of gingival and periodontal conditions
  • Recording and diagnosis of periodontal conditions
  • A practical guide for primary care
  • Simplified BPE
  • Management of treatment
    • Appropriate treatment and early referral to paediatric or periodontal specialist services
    • Early OHI to encourage good dental habits for life
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3
Q

2 key roles/aims of 2012 guidances

A
  1. ‘ to outline a method of screening children and adolescents for periodontal diseases during the routine clinical dental examination in order to detect the presence of gingivitis or periodontitis at the earliest opportunity’
  2. To provide guidance on when it is appropriate to treat in practice or refer to specialist services, thus optimising periodontal outcomes for children and young adults
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4
Q

classification of periodontal conditions 2017

A
  • Periodontal health, gingival diseases and conditions:
    • Periodontal health
      • Intact periodontium
      • Reduced periodontium
        • Due to causes other than periodontitis e.g. orthodontic treatment, crown lengthening surgery
    • Gingivitis – dental biofilm induced
      • Intact periodontium
      • Reduced periodontium
        • Due to causes other than periodontitis e.g. orthodontic treatment, crown lengthening surgery
    • Gingival diseases and conditions – non dental biofilm induced
  • Periodontitis
    • Necrotising periodontal diseases
    • Periodontitis
      • All patients with evidence of historical or current periodontists should be staged and graded at initial consultation
    • Periodontitis as a manifestation of systemic disease
  • Other conditions affecting the periodontium
    • Systemic diseases or conditions affecting the periodontal supporting tissues
    • Periodontal abscesses and endodontic-periodontal lesions
    • Mucogingival deformities and conditions
    • Traumatic occlusal forces
    • Tooth and prosthesis related factors
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5
Q

mneumonic for remembering classification of periodontal diseases 2017

A

Please Give Greg Nine Percy Pigs Straight Past Meal Time Tonight

  • Periodontal health, gingival diseases and conditions:
    • Periodontal health
    • Gingivitis – dental biofilm induced
    • Gingival diseases and conditions – non dental biofilm induced
  • Periodontitis
    • Necrotising periodontal diseases
    • Periodontitis
    • Periodontitis as a manifestation of systemic disease
  • Other conditions affecting the periodontium
    • Systemic diseases or conditions affecting the periodontal supporting tissues
    • Periodontal abscesses and endodontic-periodontal lesions
    • Mucogingival deformities and conditions
    • Traumatic occlusal forces
    • Tooth and prosthesis related factors
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6
Q

4 aspects of diagnoisis of periodontitis

A
  1. Staging
    • Interproximal bone loss at the worst site of bone loss (due to periodontitis)
    • Stage I, Stage II, Stage III, Stage IV
  2. Grading
    • Rate of progression
    • % bone loss / age
    • Grade A, Grade B, Grade C
  3. Assess current periodontal status
    • Currently stable
    • Currently in remission
    • Currently unstable
  4. Risk assessment
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7
Q

a healthy periodontium

A
  • Gingival margin may be several millimetres coronal to the CEJ
  • Gingival sulcus may be 0.5-3mm deep
  • Alveolar crest 0.4-1.9mm apical to the CEJ (teenagers)
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8
Q

biologic width

A

Distance between CEJ and alveolar bone crest (filled with acellular extrinsic fibrillar cementum)

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9
Q

conditions for diagnosis of periodontal health

A

BPE Screening (Basic Periodontal Examination)

  • Bleeding on Probing
    • <10% for clinical periodontal health
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10
Q

2 states of periodontal health

A
  • Periodontal health – intact or reduced periodontium
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11
Q

gingivitis

A

inflammation of the gingiva

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12
Q

prevalence of gingivitis in children

A

2003 Child Dental Health Survey (White et al 2006) showed that plaque and gingival inflammation were present in: (england, wales and NI - not scotland)

  • 2/3 of 8- and 12- year olds
  • 1/3 of 5 year olds
  • Half of 15- year olds in UK

Slight decrease in 2013 survey – marginal improvements

  • Still issue
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13
Q

2 types of gingivitis

A
  1. Dental biofilm induced
    • Localised
    • Generalised
  2. Gingival diseases and conditions – non dental biofilm induced
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14
Q

dental biofilm gingivitis

A
  • As supra-gingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
  • The junctional epithelium becomes disrupted
  • This allows apical migration of plaque and an increase in gingival sulcus depth

= gingival pocket/ false pocket/ pseudo pocket

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15
Q

process of dental biofilm gingivitis

A

Severe Inflammation -> Gingival Swelling increases -> even deeper false gingival pocket

Process is reversible

The most apical extension of the junctional epithelium is still the CEJ

  • NO periodontal loss of attachment
    • Hence false pocket – distance increase due to swelling not bone loss/ loss of tissue
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16
Q

difference between gingivitis and periodontitis

A

The most apical extension of the junctional epithelium is still the CEJ

  • NO periodontal loss of attachment

Hence false pocket – distance increase due to swelling not bone loss/ loss of tissue

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17
Q

characteristic marginal gingivitis

A

puffy swollen interproximal areas

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18
Q

localised region gingivitis

A

due to anatomical difference – buccally placed canine, pt may not be brushing gingival margin (only tooth surface)

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19
Q

cause of gingivitis here

A

Long standing plaque caused local irritation and inflammation all the way round gingival margins

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20
Q

different steps between health -> gingivits -> periodontitis (in its different states)

A

Diagnosis needs to include current health/disease status

Aids Tx planning and prognosis of pts

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21
Q

BPE in gingivitis

A
  • Bleeding on probing
    • 10-30% Localised Gingivitis
    • >30% generalised Gingivitis
    • Plaque retentive factors – overhangs of restorations, prosthesis
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22
Q

necrotising ulcerative gingivitis

appearance

A
  • Blunted papillae
  • Malodour
  • Painful gingivae
  • No attachment loss
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23
Q

necrotising ulcerative gingivitis

aetiology

A
  • Fusiform and Spirochete
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24
Q

necrotising ulcerative gingivitis

patient risk factors

A
  • Smoking, stress, immunosuppression, poor diet
  • HIV + status or other underlying condition
  • Common in developing countries
  • ‘trench mouth’
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25
pubertal gingivits
* Increased inflammatory response to plaque * Mediated by hormonal changes * In teenagers, gingivitis can progress to early periodontitis – if left unmanaged * Local (plaque/ braces/ overhanging restorations) and systemic factors can influence progression
26
what is non-dental biofilm gingivitis
* When main aetiological agents for gingivitis is not plaque Use diagnostic sieve for non-dental biofilm induced gingivitis
27
possible causes of non-dental biofilm gingivitis
use diagnostic sieve * infective * genetic * traumatic * manifestations of systemic disease * drug induced
28
infective causes of non-dental biofilm gingivitis
* fungal * viral * deep mycoses
29
genetic causes of non-dental biofilm gingivitis
* phenotype * heriditary fibromatosis
30
trauma causes of non dental biofilm gingivitis
* thermal/chemical * physical
31
manifestations of systemic disease that can cause non-dental biofilm gingivitis
* Haematology e.g. leukaemia * Benign * Malignant * Immunological conditions * Granulomatous inflammation
32
drug induced causes of non-dental biofilm gingivitis
* Anti-retro viral * Immunosuppressants * Ca+ channel blockers * Anti-convulsants – *epilepsy drugs can cause gingival hypertrophy* * Cytotoxic * Immune complex reactions
33
what causes this gingivitis
cyclosporin * Immunosuppressant * Used in pts with underlying immunological conditions (crohn’s) or organ transplant
34
what caused this gingivitis
phenytoin * Anti convulsant * Exuberate gingivitis anteriorly and inflamed interproximal papillae * Tender and red
35
what caused this gingivitis
* Characteristic full thickness * Often seen in OFG (orofacial granulomatosis)
36
what caused this gingivitis
gingivitos in leukaemia * Rare * Known to be initial presentation
37
haemtological systemic diseases that can cause gingivitis
* Agranulocytosis * Acute condition * Low white blood cell count * Cyclic neutropenia * Low neutrophil count * Occurs every 3 weeks, lasts 4-6 days
38
granulomatous inflammation that can cause gingivits
* Crohn’s disease * Sarcoidosis * Granulomatosis * Autoimmune vasculitis * Affects multiple systems * Most commonly mouth, URT, kidneys
39
gingivitis - summary
* Gingival overgrowth beyond biofilm induction can relate to: * Systemic and metabolic diseases * Genetic factors, local factors * Side effects of some medications * Cyclosporin, nifedipine, phenytoin * Greater incidence seen in puberty
40
gingivitis treatment
* Rigorous oral hygiene/ home care * Frequent scaling * Surgery may be necessary (esp with drug induced)  refer to specialist (persistent and hypertrophic)
41
4 main distinguishing features of periodontitis
* Apical migration of junctional epithelium beyond the CEJ * Loss of attachment of periodontal tissues to cementum * Transformation of junctional epithelium to pocket epithelium (often thin and ulcerated) * Alveolar bone loss
42
what early clinical sign of periodontitis can be seen in a substantial number of teenagers?
* Classified as \>1mm loss of attachment (of cementum to PDL) Clerehugh (1990) longitudinal study on 167 teenagers (attachment loss in at least 1 tooth) * 3% of AL at 14 years * 37% of AL at 16 years * 77% of AL at 19 years *Progress rapidly*
43
what common pathogens can be found in subgingival microflora of adult and child periodontitis
* *Porphyromonas gingivalis* * *Prevotella Intermedia* * *Aggregatibacter actinomycetemcomitans (AA)* *Clerehugh 1997*
44
old name for periodontitis in children
aggressive periodontitis
45
featurs of periodontitis in children
May be present in a small proportion of adolescents * Features include * Rapid attachment loss and bone destruction * Patients otherwise healthy * Onset around puberty * Family history * 0.1% Caucasians and 2.6% African Ancestry * Uncommon no longer localised or generalised (old classification) now based on number of sites as per new classification * **Staging and grading essential for up-to-date diagnosis**
46
stage I periodontitis
early/mild \<15% or \<2mm interproximal bone loss
47
Stage II periodontitis
moderate coronal third of root interproximal bone loss
48
stage III
severe mid third of root interproximal bone loss
49
stage IV periodontitis
very severe apical third of root interproximal bone loss
50
extent classes of periodontitis
* localised - up to 30% of teeth * generalised - more than 30% * molar incisor
51
grading of periodontitis based on
% bone loss/ age
52
Grade A periodontitis
slow \<0.5
53
Grade B periodontitis
moderate 0.5-1.0
54
grade C periodontitis
rapid \>1.0
55
interproximal bone loss
is measurement (mm) from CEJ
56
caution in periodontits in children
* Primary dentition * Some evidence that bone loss can occur around primary teeth in some children * Mixed dentition * Be aware of false pocketing around erupting permanent dentition
57
when should periodontal screening occur
should be a routine and essential part of history and clinical examination
58
7 things to assess in gingival condition
* Gingival colour * Contour * Swelling * Recession * Suppuration * Inflammation (presence and location) * Consider use of marginal bleeding free chart
59
how to assess OH status
* Description of plaque status * Describe surfaces covered by plaque * Is plaque easily visible? * Detectable only on probing * Use of plaque-free scores (%) – motivational aid to pt
60
how to assess calculus
if present - chart location
61
5 local risk factors to assess in periodontal screening
* Plaque retention factors * Low frenal attachments * Malocclusion * _Incompetent lip seal_ * Reduced upper lip coverage – labial and palatal gingivitis * Increased lip separation * _Mouth breathing_ * Palatal gingivitis ![]()
62
4 components periodontal assessment
1. Gingival condition 2. assess OH status 3. assess calculus 4. assess local risk factors
63
issue here
* complete overbite * Biting on gingival margin lower incisors thus cause chronic continuous trauma  recession and other issues
64
issue here
* Ortho tx * Malocclusion * Make OH harder – already poor and further complicated
65
issue here
significant calculus and staining to lingual lower incisors and soft tissues
66
issue here
* Incompetent lip seal at rest  drying of intraoral mucosa and potentially gingivitis
67
full BPE
* Screening tool * Rapidly guides clinicians to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis * Does not consider: * Historical attachment loss * Bone loss (staging and grading not done) * Children 12-17
68
simplified BPE
* In all co-operative children aged 7-11 years (permanent teeth only) * 0-2 BPE scores * Carried out on (16, 11, 26, 36, 31, 46) * one reference tooth per sextant * Identifies patients who would benefit from further investigation
69
probe used in BPE
Basic Periodontal Examination (BPE) performed with a WHO CPITN probe * The community periodontal index of treatment need Black band 3.5-5.5 mm and 8.5-11.5mm 0.5mm ball end 20-25g force – blanch nail bed * Parallel to root surface * Walked around gingival margin
70
benefits of modified BPE
* Quick * Easy * Well tolerated * Avoid false pocketing
71
teeth assessed in simplified BPE
* Carried out on (16, 11, 26, 36, 31, 46)
72
when to refer to specialist if detect perio issues in primary teeth
* Mobility or gingival suppuration  refer to specialist
73
BPE scores
74
plaque free and marginal bleeding free charts
aim for 100% plaque free/not bleeding motivational tool
75
how to record plaque in a way child understands
out of 10 * 10/10 - perferctly clean * 8/10 - line of plaque around cervcical margin * 6/10 - cervical 1/3 of crown covered * 4/10 middle 1/3 of crown covered
76
when get BPE code 3 or 4 (12+) action
* 6PPC (localised to 3 BPE, or full mouth if 4) * Check alveolar bone levels * BWs for posterior * Periapicals for anteriors * OPG * BPE should be carried out prior to any ortho Tx
77
treatment to aid OH
* Plaque induced gingivitis in children and adolescents can be managed by good toothbrushing * Emphasise the need to systematically clean all surfaces * Aids - Brush DJ App * Child and parent * Standard tooth brushing and fluoride advice should be given to all patients * Supervised/ assisted brushing (up to around 7 years old) * In general – can they tie their own shoelaces? * Disclosing tablets useful (plaque creamy coloured and can be hard to see) * Fluoride mouthwash (225ppm) should be recommended for pts undergoing fixed appliance therapy
78
treatment levels according to BPE scores in children
79
following steps after generalised periodontitis, stage II, grade C, currently unstable Dx in 19yo f
* Systematic periodontal treatment needed initiated * Outcome of Tx will not result in a change of the initial disease classification * This pt will always be a periodontitis pt with evidence of high disease susceptibility (indicated by grade C) * Requiring * careful and intensive periodontal maintenance * risk factor control * monitoring Any sibling? (do they need reviewed so not similarly affected)
80
what is imp for optimum treatment outcome in
early detection of perio diseases
81
periodontal diseases in young (below 7)
rare - require onward referral

BDS3 paeds (15 decks)

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