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3. Paediatrics > Periodontal Screening and Management of Perio Conditions in Children > Flashcards

Periodontal Screening and Management of Perio Conditions in Children Flashcards

1
Q

What is the 2017 Perio guidelines mnemonic?

A

Please give greg nine Percy pigs straight past meal time tonight

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2
Q

What is included in the 2017 perio guidelines?

A

Perio health, gingival diseases and conditions:

Periodontal health
Gingivits
Gingival diseases and conditions

Periodontitis:

Necrotising perio disease
periodontitis
periodontitis as a manifestation of pts underlying systemic disease

Other conditions affecting periodontium:

Systemic diseases that affect perio supporting tissues
Perio abscesses and ends perio lesions 
Mucogingival deformities and conditions 
Traumatic occlusal forces
Tooth and prosthesis related factors
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3
Q

What are the types of perio health, gingival diseases and conditions? (3)

A

Periodontal health

Gingivitis - dental biofilm induced

Gingival diseases and conditions that are non dental biofilm induced

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4
Q

What are the two types of perio health?

A

Intact periodontium

Reduced periodontium - caused by things other than periodontitis such as ortho tx, crown lengthening surgery

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5
Q

Why may a pt have perio health with a reduced periodontium?

A

If had ortho tx or crown

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6
Q

What are the types of periodontium in gingivitis?

A

Intact or reduced

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7
Q

How do we diagnose periodontitis?

A

Stage

Grade

Current status

Risk Assessment

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8
Q

What is staging in perio dx?

A

Staging is when we look at interproximal bone loss at worst site of bone loss due to periodontitis

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9
Q

What are stages 1-4 in period dx?

A

1 - early/mild

2 - moderate

3 - severe

4 - very severe

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10
Q

Describe interproximal bone loss in early/mild stage of the disease

A

bone loss <15% or 2mm

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11
Q

Describe interproxial bone loss in moderate stage of disease?

A

Coronal third of root

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12
Q

Describe interproximal bone loss in severe stage of disease?

A

Middle third of root

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13
Q

Describe interproximal bone loss in very severe stage of disease?

A

Apical third of root

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14
Q

What is grading in perio dx?

A

This is grade A B C

and it is based on the worst site of bone loss and we assign a percentage as to how much bone loss there is compared to the patients age

Ie - if pt has bone loss in apical third then more than 60-70% and if pt is 70 then = 1 so grade C

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15
Q

Describe the grading system in perio dx

A

Grade A - slow progressing (<0.5)

Grade B - moderate progression (0.5-1)

Grade C - rapid progression (>1)

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16
Q

What is the extent of perio disease?

A

Generalised >30%

localised <30%

Molar incisor pattern

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17
Q

What might the gingival margin be?

A

Several mm coronal to ACJ

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18
Q

How deep may the sulucus be in perio health?

A

0.5-3mm deep

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19
Q

Where is the alveolar crest in relation to the CEJ in teens?

A

0.4-1.9mm apical

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20
Q

What is supracrestal attachment?

A

This is junctional epithelium + supracrestal connective tissue attachment (it is around 2mm) and then coronal to JE is the gingival sulcus which is 0.5-1mm

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21
Q

How do we diagnose periodontal health?

A

Intact or reduced periodontium

must have <10% BOP

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22
Q

What if gingivitis?

A

This is inflammation of the gingivae it can be biofilm related or non biofilm related

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23
Q

What are the types of gingivitis?

A

Dental biofilm induced

Non dental biofilm induced

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24
Q

What are the types of dental biofilm induced gingivitis?

A

Localised

Generalised

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25
Q

How do we diagnose localised biofilm induced gingivitis?

A

Localised - 10-30% BoP

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26
Q

How do we dx generalised biofilm induced gingivitis?

A

> 30% BoP

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27
Q

What are some plaque retentive factors?

A

overhanging restoration margins

prostheses

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28
Q

What is dental biofilm induced gingivitis?

A

This is when supra gingival plaque accumulates on teeth and an inflammatory cell infiltrate develops in gingival connective tissue disrupting the junctional epithelium which allows plaque to migrate apically in the increasing depth of gingival sulcus

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29
Q

What does biofilm induced gingivitis give rise to?

A

gingival pocket

false pocket

pseudo pocket

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30
Q

Is gingivitis reversible?

A

Yes with inc OH, brushing 2x daily with f toothpaste, flossing

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31
Q

What happens if gingival swelling increases?

A

Then there will be an even deeper false gingival pocket

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32
Q

Descrie false pocketing

A

This is when deepest part of pocket is still at the CEJ so there is no loss of periodontal attachment - the distance has increased due to swelling rather than loss of attachment of soft tissue

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33
Q

What are the clinical signs of gingivitis?

A

Redness

puffy swollen gums

loss of knife edge margin

Presence of calculus and plaque

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34
Q

When a patient progresses to periodontitis what are the three options?

A

Stable (bop <10%, PPD<4mm and no bop at 4mm sites)

Remission (bop>10%, PPD<4mm, no bop at 4mm sites)

Unstable (ppd>5mm, bleeding at >4mm and bop)

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35
Q

What is necrotising ulcerative gingivitis?

A

This is when the papillae is blunted with a bad smell, painful gums and no attachment loss

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36
Q

What can necrotising ulcerative gingivitis be caused by?

A

Anaerobic fusiform bacteria and spirochaetes are implicated,

predisposing factors including poor oral hygiene, smoking, malnutrition and immune defects

Stress

HIV + status

ALSO KNOWN AS TRENCH MOUTH

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37
Q

What is pubertal gingivitis?

A

uberty gingivitis is usually caused by a combination of poor oral hygiene habits and diet, combined with the elevated hormone levels during puberty (which increase the sensitivity of the gums to accumulated dental plaque).

This combination of factors makes gingivitis more of a risk for young people going through puberty than it would be at other times in their lives.

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38
Q

What is increased in pubertal gingivitis?

A

Response to plaque due to hormonal changes that occur in puberty

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39
Q

What can influence progression of pubertal gingivitis?

A

Plaque, braces, overhanging restorations and systemic factors

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40
Q

What is non biofilm induced gingivitis?

A

This is when the main cause is not plaque

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41
Q

What are some of the main causes of non dental biofilm induced gingivitis?

A

Drug induced

Trauma

Genetics

Infective

Manifestation of systemic disease

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42
Q

What drugs can induce non dental biofilm gingivitis?

A

Anti-convulsant drugs - for epilepsy

Ca channel blockers

Immunosupressants

Cytotoxic drugs

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43
Q

What can non biofilm induced gingivitis be manifestations of?

A

Haematology - such as leukaemia

Immunological conditions

44
Q

What is cyclosporin?

A

Cyclosporin is a calcineurin inhibitor, used as an immunosuppressant medication.

It is taken by mouth or by injection into a vein for rheumatoid arthritis, psoriasis, Crohn’s disease, nephrotic syndrome, and in organ transplants to prevent rejection.

45
Q

What can cyclosporin cause?

A

drug induced non biofilm gingivitis

46
Q

What is phenytoin?

A

Anti-convulsant medication

It is useful for the prevention of tonic-clonic seizures and focal seizures, but not absence seizures.

works by decreasing electrical activity in the brain

47
Q

What can phenytoin cause?

A

Non dental biofilm induce gingivitis

48
Q

What can OFG present as?

A

full thickness gingivitis

49
Q

What can leukaemia present as?

A

gingivitis however this is rare

50
Q

What is agranulocytosis?

A

is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood.

51
Q

What can agranulocytosis lead to?

A

gingivitis

52
Q

What is cyclic neutropenia?

A

rare blood disorder characterized by recurrent episodes of abnormally low levels of neutrophils (a type of white blood cell ) in the body. Neutrophils are instrumental in fighting off infection by surrounding and destroying bacteria that enter the body.

53
Q

What can cyclic neutropenia cause?

A

Gingivitis

54
Q

What is Crohns disease?

A

type of inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition. Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people.

can cause gingivitis

55
Q

What is nifedipine?

A

Nifedipine, sold under the brand name Adalat among others, is a calcium channel blocker medication used to manage angina, high blood pressure, Raynaud’s phenomenon, and premature labor.

56
Q

How do we treat gingivitis?

A

Rigorous OHI and home care

freq scaling

if pt has hypertrophy we may need to consider surgical tx

57
Q

What happens in periodontitis?

A

there is apical migration of JE beyond the CEJ and loss off attachment of periodontal tissues to cementum, there will also lead to alveolar bone loss

58
Q

What are early clinical signs of perio in teens?

A

1mm loss of attachment of cementum to PDL

59
Q

What are the pathogens for perio?

A

p gingivitis

prevotella intermedia

60
Q

What are features of perio?

A

Rapid LOA and bone destruction

FH

61
Q

How do we stage periodontal disease?

A

we stage it 1-4

1 - mild - 2mm or <15%

2 - moderate - coronal third

3- severe - middle third

4 - very severe - apical third

62
Q

How do we grade periodontal disease?

A

we grade it ABC

A - slow - <0.5

B - moderate 0.5-1

C - rapid >1

The grade is based on extend of bone loss at worst site/age

63
Q

How do we describe extent of perio?

A

Localised

Gneralised

MI Pattern

64
Q

What must we be aware of in the mixed dentition?

A

False pocketing around erupting permanent dentition

65
Q

What do we look at in terms of gingival condition?

A

Gingival colour

Contour

Swelling?

Any recession?

Any suppuration?

Any inflammation? - if so where

66
Q

How do we define pts OH status?

A

Plaque status - where is the plaque - we can use plaque scores as motivation for pt

67
Q

What do we do if there is calculus present?

A

Chart the location

68
Q

What are some local risk factors for perio?

A

Plaque retentive factors

low feral attachments

malocclusion

incompetent lip seal - reduced upper lip coverage and inc lip separation

mouth breathing - palatal gingivitis

69
Q

Why can overbite lead to recession?

A

biting down on gingival margin of lower incisors which can cause chronic continuous trauma which leads to recession and other issues

70
Q

Why can an incompetent lip seal at rest lead to oral problems?

A

Drying of intra oral mucosa and potential gingivitis

71
Q

What exam do we undertake in children aged 12-17?

A

FULL BPE - screening tool for perio disease that rapidly guides us to arrive at provisional diagnosis of perio health, gingivitis or periodontitis

72
Q

What does the BPE not consider?

A

Historical attachment loss

bone loss - no staging or grading is done

73
Q

What exam do we carry to in those aged 7-11?

A

Simplified BPE

74
Q

What is the simplified BPE?

A

This is a quick, easy, well tolerated modified bpe that is used in children aged 7-11 on permanent teeth only on certain teeth using codes 0-2

75
Q

What do we use to carry out bpe?

A

who CITPN probe

76
Q

What type of force do we use for BPE?

A

20-25g of force - enough to blanch nail beds

77
Q

Where do we insert instrument when doing a bpe?

A

We insert parallel to root surface of tooth in question and walk around the gingival margin, coronally to ACJ

78
Q

What teeth do we asses in SIMPLIFIED BPE?

A

UR6 UR1 UL6 LL6 LL1 LR6

79
Q

What BPE codes do we use for those aged 7-11?

A

0-2

0 - no plaque, no bop, black band fully visible

1 - bleeding on probing

2 - calculus or plaque retentive factors

80
Q

What BPE codes do we use on those aged 12-17?

A

0-4*
0-2

0 - no plaque, no bop, black band fully visible

1 - bleeding on probing

2 - calculus or plaque retentive factors

3 - pocketing 4-5mm (black band partially visible)

4 - black band no longer visible

    • furcation involvement
81
Q

What would a diagnosis of clinical gingival health signify?

A

Code 0/1/2

<10% bleeding on probing

82
Q

What would a diagnosis of localised gingivitis signify?

A

code 0/1/2

10-30% bop

83
Q

What would a diagnosis of generalised gingivitis signify?

A

code 0/1/2

> 30% bop

84
Q

If pt has a code 3 with no obvious evidence of internal recession what do we do?

A

Take radiographs then initiate perio therapy and review in 3 months with localised 6ppc

85
Q

After a code 3 and after 6pppc when would we continue with code 0/1/2 pathway?

A

If no pockets >4mm and no radiographic evidence of bone loss due to perio

86
Q

After a code 3 and after 6pppc when would we continue with code 4 pathway?

A

If pockets >4mm and or radiographic evidence of bone loss due to perio

87
Q

What do we do if pt is code 4 and or has evidence of internal recession?

A

Radiographs

full perio assessment - 6PPC

88
Q

What are the diff types of periodontitis?

A

Localised

generalised

molar incisor pattern

89
Q

What must we do if pt has perio?

A

Stage, grade, current disease status, risk factor assessment in notes (DIAGNOSTIC STATEMENT)

90
Q

What are plaque free and marginal bleeding charts?

A

These are good for pts motivation and track pts plaque and bleeding scores at each visit which can be compared

higher the score –> better the teeth

91
Q

What are plaque levels?

A

These are scores that indicate brushing habits and we can monitor them over time

92
Q

What are the different plaque scores?

A

10/10 - perfectly clean

8-10 - plaque around cervicle margin

6/10 - cervicle 1/3rd crown covered

4/10 - middle 1/3rd of crown covered

93
Q

In 12-17yr olds if they score a bpe of 3 or 4 what do we do?

A

6PPC - if in 3 just 6ppc OF THAT AREA BUT IF 4 THEN FULL MOUTH

CHECK ALVEOLAR BONE LEVELS

94
Q

What would <15% or 2mm bone loss indicate?

A

stage 1 - early/mild

95
Q

What would coronal 1/3rd bone loss indicate?

A

Stage 2 - moderate

96
Q

What would middle 1/3rd bone loss indicate?

A

stage 3 - severe

97
Q

What would apical 1/3rd bone loss indicate?

A

stage 4 - very severe

98
Q

What would <0.5 grading indicate?

A

Grade A - slow progressing bone loss

99
Q

What would 0.5-1 grading indicate?

A

Grade B - moderate progression bone loss

100
Q

What would >1 grading indicate?

A

Grade C - RAPID progression

101
Q

What are some risk factor assessments?

A

Smoking

sub optimal controlled diabetes

102
Q

How do we manage plaque induced gingivitis in kids?

A

Good brushing - OHI, brush all surfaces, demo, dj brush app, supervised brushing unit they can tie their own laces

disclosing tablets

fluoride mouthwash

103
Q

What can be useful for pts undergoing fixed ortho?

A

225ppm fluoride mouthwash

104
Q

If the code is 0 in kids BPE what tx do we do and at what frequency?

A

No tx, screen again in a year

105
Q

If code 1 in kids bpe what tx do we do and what frequency?

A

OHI and prevention

bleeding and plaque charts

recall every 6 months (or yearly)

106
Q

In code 2 what tx do we do and what freq?

A

OHI
Diet
Prevention
Scaling and removal of plaque retentive factors

6 months recall

107
Q

What tx and review do we do in code 3 and 4?

A

full perio assessment, radiographs, scaling, RSD, OHI, diet advice

tx and review after 3 months

3. Paediatrics (10 decks)

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