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Paediatrics > Perio Screening + Management of Perio Conditions in Children > Flashcards

Perio Screening + Management of Perio Conditions in Children Flashcards

(61 cards)

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1
Q

What other treatments can cause perio problems?

A

Ortho

Crown lengthening surgery

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2
Q

Pnemonic for classification of perio conditions 2017

A

Please - periodontal health

Give - gingivitis (biofilm)

Greg - gingival disease (non biofilm)

Nine - necrotising perio disease

Percy - periodontitis

Pigs - perio as a manifestation of systemic disease

Straight - systemic disease or conditions affecting perio supporting tissues

Past - perio abscess+- endo perio lesions

Meal - mucogingival deformities

Time - traumatic occlusal forces

Tonight - tooth + prosthesis related factors

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3
Q

How is perio disease diagnosed? (4)

A
  1. Staging
    - Interprox bone loss at worst site of bone loss (due to perio)
    - Stage 1-4
  2. Grading
    - Rate of progression
    - Take a % of bone loss/age
    - Grade A,B,C
3. Assess current periodontal status
Is it:
- Currently stable
- Currently in remission
- Currently unstable
  1. Risk assessment
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4
Q

How deep is a healthy gingival sulcus?

A

0.5-3mm deep

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5
Q

How deep is a healthy alveolar crest in teens?

A

0.4-1.9mm apical to the CEJ

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6
Q

What is the biological width?

A

CEJ + alveolar bone crest

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7
Q

What is the BPE?

A

Basic Perio Exam

BPE - screening

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8
Q

BOP % for clinical periodontal health (intact or reduce periodontium)

A

<10%

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9
Q

Whats the different types of gingivitis (2)

A
  1. Dental biofilm - induced
    - Localised
    - Generalised
  2. Gingival diseases + conditions
    - Non dental biofilm induced
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10
Q

How does dental biofilm gingivitis occur? (4)

A
  1. As supragingival plaque accumulates on teeth, an inflammatory cell infiltrate develops in gingival connective tissue
  2. JE becomes disrupted as a result
  3. Apical migration of plaque and an increase in the gingival sulcus depth (gingival swelling increases)
  4. Leads to deeper Gingival pocket / false pocket / pseudo pocket
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11
Q

What type of gingivitis is reversible?

A

Dental biofilm induced

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12
Q

Does dental biofilm induced gingivitis have any periodontal loss of attachment?

A

No

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13
Q

How does dental biofilm induced gingivitis present? (2)

A
  • Puffy red interproximal areas

- Long standing plaque causing local irritation and inflammation all around the gingival margins

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14
Q

Name a plaque retentive factors

A

Overhangs

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15
Q

How does necrotising ulcerative gingivitis present?

A
  1. Blunted papillae
  2. Malodour
  3. Painful + tender gingivae
  4. No attachment loss
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16
Q

Patient risk factors for necrotising ulcerative gingivitis (5)

A
  1. Smoking
  2. Stress
  3. Immunosuppression (HIV/other)
  4. Poor diet (lacking vits+minerals)
  5. Common in developing countries
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17
Q

What is pubertal gingivitis?

A
  1. Increased inflammatory response to plaque

2. Influenced by hormonal changes around puberty

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18
Q

What are some local factors that can cause pubertal gingivitis? (2)

A
  1. Braces

2. Overhanging restorations

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19
Q

How does non dental biofilm induced periodontitis differ from biofilm induced?

A

Main aetiological agent for gingivitis is not plaque

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20
Q

What can cause non-dental biofim induced gingivitis? (5)

A
  1. Infective
    - Viral
    - Fungal
  2. Drug induced
    - CytotOXIC
    - Anti-convulstants
    - Immunosuppressants
  3. Genetic
    - Phenotype
  4. Trauma
    - Thermal/chemical
    - Physical
  5. Manifestation of systemic disease
    - Immunological conditions
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21
Q

Name an example of an immunosuppressant that can cause drug induced gingivitis

A

Cyclosporin

- Crohns disease

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22
Q

Name an example of an anticonvulsant that can cause drug induced gingivitis

A

Phenytoin

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23
Q

How does phentyoin induced gingivitis present clinically?

A

Very inflamed interprox papillae

Tender and red

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24
Q

What kind of gingivitis does OFG cause?

A

Full thickness gingivitis

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25
List some haematological diseases that can lead to gingivitis (2)
1. Agranulocytosis - Low WBC 2. Cyclic neutropenia - Low neutrophil count
26
List some granulomatous inflammations that can lead to gingivitis (3)
1. Crohns disease 2. Sarcoidosis 3. Granulomatosis
27
Tx for gingivitis
1. Rigorous OH 2. Frequent scaling 3. Surgery may necessary
28
List key features of periodontitis (4)
1. Apical migration of junctional epithelium beyond CEJ 2. Loss of attachment of periodontal tissues to cementum 3. Transformation of JE to pocket epithelium 4. Alveolar bone loss
29
Pathogen for periodontitis
P gingivalis
30
Features of periodontitis
Rapid attachment loss + bone destruction
31
What makes up the staging and grading grid?
STAGING 1. Interproximal bone loss 2. Extent GRADING Grade A-C
32
What should be checked as part of recording and diagnosis for periodontal screening?
1. Gingival condition 2. Assess OH status 3. Assess if any calculus present 4. Assess local risk factors
33
What should we look out for in gingival condition? (6)
1. Gingival colour 2. Contour 3. Swelling 4. Recession 5. Suppuration 6. Inflammation
34
How do we assess OH status?
1. Description of plaque status - Describe surfaces covered by plaque - Is plaque easily visible - Detectable only on probing - Use of plaque free scores
35
How do we assess calculus presence/
Chart location
36
How do we assess local risk factors? (3)
1. Plaque retention factors - Low frenal attachments - Malocclusion 2. Incompetent lip seal - If pt has reduced upper lip coverage (labial + palatal gingivitis) - Increased lip separation 3. Mouthbreathing - Palatal gingivitis
37
What can an incompetent lip seal cause?
May contribute to drying or intraoral mucosa and potentially gingivitis
38
Disadvantages of a BPE exam
Doesn't consider: 1. Historical attachment loss 2. Bone loss
39
When can a simplified BPE be carried out?
In all co-operative children ages 7-11years
40
What probe is used for a BPE
WHO CPITN probe
41
Describe the WHO CPITN probe (2)
1. 0.5mm ball end 2. 2 black bands up length of probe - 3.5-5.5mm - 8.5-11.5mm
42
Application of force for simplified BPE for adults + children
20-25g of force
43
Why is there a simplified BPE?
Quick Easy Well tolerated Avoids false pocketing
44
What teeth are included in the modified BPE?
16 11 26 | 46 31, 36
45
When is a simplified BPE carried out?
Starts at 7 years (permanent teeth only)
46
Why is a simplified BPE not carried out in primary teeth?
Periodontal disease is rare
47
Different codes for simplified BPE (4)
0 - Healthy 1 - Bleeding on gentle probing 2 - Calculus or plaque retention factor 3. Pocketing 4mm-5mm (black band visible but partially obscured) 4 - Pocketing > or equal to 6mm (black band obscured) * - Furcation involvement
48
What % of BOP indicates clinical gingival health
<10%
49
What % of BOP indicates localised gingivitis
10-30%
50
What % of BOP indicates generalised gingivitis
>30%
51
When using a simplified BPE what codes should we use up to?
Code 0, 1 or 2
52
Course of action if code 3
1. Radiograph | 2. Interdental perio therapy + review in 3 months with localised 6PPC
53
Course of action if code 4
1. Radiograph | 2. Full perio assessment (including 6PPC)
54
How are plaque scores noted for a child? (4)
- 10/10 perfect clean tooth - 8/10 line of plaque around cervical margin - 6/10 cervical third of crown covered - 4/10 middle 3rd of crown covered
55
What is a Grade A bone value?
<0.5
56
What is a Grade B bone loss value?
0.5-1
57
What is a Grade C bone loss value?
>1
58
Code 0 tx
None | Screen at routine recall or within year
59
Code 1 tx
OHI + Prevention | Screen at routine recall or after 6mths
60
Code 2 tx
OHI Prevention Scaling Removal of plaque retention factors Screen again at routine recall or after 6 mths
61
Code 3,4 * tx
- Full perio assessment - Radiographs to establish whether false or true pocket - Scaling, RSD, OHI + prevention - Scores 4 or * require referral Tx and review after 3mths

Paediatrics (12 decks)

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