Periodontal Screening and Management of Perio Conditions in Children Flashcards
(107 cards)
1
Q
What is the 2017 Perio guidelines mnemonic?
A
Please give greg nine Percy pigs straight past meal time tonight
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
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
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
5
Q
Why may a pt have perio health with a reduced periodontium?
A
If had ortho tx or crown
6
Q
What are the types of periodontium in gingivitis?
A
Intact or reduced
7
Q
How do we diagnose periodontitis?
A
Stage
Grade
Current status
Risk Assessment
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
9
Q
What are stages 1-4 in period dx?
A
1 - early/mild
2 - moderate
3 - severe
4 - very severe
10
Q
Describe interproximal bone loss in early/mild stage of the disease
A
bone loss <15% or 2mm
11
Q
Describe interproxial bone loss in moderate stage of disease?
A
Coronal third of root
12
Q
Describe interproximal bone loss in severe stage of disease?
A
Middle third of root
13
Q
Describe interproximal bone loss in very severe stage of disease?
A
Apical third of root
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
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)
16
Q
What is the extent of perio disease?
A
Generalised >30%
localised <30%
Molar incisor pattern
17
Q
What might the gingival margin be?
A
Several mm coronal to ACJ
18
Q
How deep may the sulucus be in perio health?
A
0.5-3mm deep
19
Q
Where is the alveolar crest in relation to the CEJ in teens?
A
0.4-1.9mm apical
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
21
Q
How do we diagnose periodontal health?
A
Intact or reduced periodontium
must have <10% BOP
22
Q
What if gingivitis?
A
This is inflammation of the gingivae it can be biofilm related or non biofilm related
23
Q
What are the types of gingivitis?
A
Dental biofilm induced
Non dental biofilm induced
24
Q
What are the types of dental biofilm induced gingivitis?
A
Localised
Generalised
25
How do we diagnose localised biofilm induced gingivitis?
Localised - 10-30% BoP
26
How do we dx generalised biofilm induced gingivitis?
>30% BoP
27
What are some plaque retentive factors?
overhanging restoration margins
prostheses
28
What is dental biofilm induced gingivitis?
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
29
What does biofilm induced gingivitis give rise to?
gingival pocket
false pocket
pseudo pocket
30
Is gingivitis reversible?
Yes with inc OH, brushing 2x daily with f toothpaste, flossing
31
What happens if gingival swelling increases?
Then there will be an even deeper false gingival pocket
32
Descrie false pocketing
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
33
What are the clinical signs of gingivitis?
Redness
puffy swollen gums
loss of knife edge margin
Presence of calculus and plaque
34
When a patient progresses to periodontitis what are the three options?
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)
35
What is necrotising ulcerative gingivitis?
This is when the papillae is blunted with a bad smell, painful gums and no attachment loss
36
What can necrotising ulcerative gingivitis be caused by?
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
37
What is pubertal gingivitis?
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.
38
What is increased in pubertal gingivitis?
Response to plaque due to hormonal changes that occur in puberty
39
What can influence progression of pubertal gingivitis?
Plaque, braces, overhanging restorations and systemic factors
40
What is non biofilm induced gingivitis?
This is when the main cause is not plaque
41
What are some of the main causes of non dental biofilm induced gingivitis?
Drug induced
Trauma
Genetics
Infective
Manifestation of systemic disease
42
What drugs can induce non dental biofilm gingivitis?
Anti-convulsant drugs - for epilepsy
Ca channel blockers
Immunosupressants
Cytotoxic drugs
43
What can non biofilm induced gingivitis be manifestations of?
Haematology - such as leukaemia
Immunological conditions
44
What is cyclosporin?
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
What can cyclosporin cause?
drug induced non biofilm gingivitis
46
What is phenytoin?
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
What can phenytoin cause?
Non dental biofilm induce gingivitis
48
What can OFG present as?
full thickness gingivitis
49
What can leukaemia present as?
gingivitis however this is rare
50
What is agranulocytosis?
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
What can agranulocytosis lead to?
gingivitis
52
What is cyclic neutropenia?
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
What can cyclic neutropenia cause?
Gingivitis
54
What is Crohns disease?
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
What is nifedipine?
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
How do we treat gingivitis?
Rigorous OHI and home care
freq scaling
if pt has hypertrophy we may need to consider surgical tx
57
What happens in periodontitis?
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
What are early clinical signs of perio in teens?
1mm loss of attachment of cementum to PDL
59
What are the pathogens for perio?
p gingivitis
prevotella intermedia
60
What are features of perio?
Rapid LOA and bone destruction
FH
61
How do we stage periodontal disease?
we stage it 1-4
1 - mild - 2mm or <15%
2 - moderate - coronal third
3- severe - middle third
4 - very severe - apical third
62
How do we grade periodontal disease?
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
How do we describe extent of perio?
Localised
Gneralised
MI Pattern
64
What must we be aware of in the mixed dentition?
False pocketing around erupting permanent dentition
65
What do we look at in terms of gingival condition?
Gingival colour
Contour
Swelling?
Any recession?
Any suppuration?
Any inflammation? - if so where
66
How do we define pts OH status?
Plaque status - where is the plaque - we can use plaque scores as motivation for pt
67
What do we do if there is calculus present?
Chart the location
68
What are some local risk factors for perio?
Plaque retentive factors
low feral attachments
malocclusion
incompetent lip seal - reduced upper lip coverage and inc lip separation
mouth breathing - palatal gingivitis
69
Why can overbite lead to recession?
biting down on gingival margin of lower incisors which can cause chronic continuous trauma which leads to recession and other issues
70
Why can an incompetent lip seal at rest lead to oral problems?
Drying of intra oral mucosa and potential gingivitis
71
What exam do we undertake in children aged 12-17?
FULL BPE - screening tool for perio disease that rapidly guides us to arrive at provisional diagnosis of perio health, gingivitis or periodontitis
72
What does the BPE not consider?
Historical attachment loss
bone loss - no staging or grading is done
73
What exam do we carry to in those aged 7-11?
Simplified BPE
74
What is the simplified BPE?
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
What do we use to carry out bpe?
who CITPN probe
76
What type of force do we use for BPE?
20-25g of force - enough to blanch nail beds
77
Where do we insert instrument when doing a bpe?
We insert parallel to root surface of tooth in question and walk around the gingival margin, coronally to ACJ
78
What teeth do we asses in SIMPLIFIED BPE?
UR6 UR1 UL6 LL6 LL1 LR6
79
What BPE codes do we use for those aged 7-11?
0-2
0 - no plaque, no bop, black band fully visible
1 - bleeding on probing
2 - calculus or plaque retentive factors
80
What BPE codes do we use on those aged 12-17?
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
What would a diagnosis of clinical gingival health signify?
Code 0/1/2
<10% bleeding on probing
82
What would a diagnosis of localised gingivitis signify?
code 0/1/2
10-30% bop
83
What would a diagnosis of generalised gingivitis signify?
code 0/1/2
>30% bop
84
If pt has a code 3 with no obvious evidence of internal recession what do we do?
Take radiographs then initiate perio therapy and review in 3 months with localised 6ppc
85
After a code 3 and after 6pppc when would we continue with code 0/1/2 pathway?
If no pockets >4mm and no radiographic evidence of bone loss due to perio
86
After a code 3 and after 6pppc when would we continue with code 4 pathway?
If pockets >4mm and or radiographic evidence of bone loss due to perio
87
What do we do if pt is code 4 and or has evidence of internal recession?
Radiographs
full perio assessment - 6PPC
88
What are the diff types of periodontitis?
Localised
generalised
molar incisor pattern
89
What must we do if pt has perio?
Stage, grade, current disease status, risk factor assessment in notes (DIAGNOSTIC STATEMENT)
90
What are plaque free and marginal bleeding charts?
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
What are plaque levels?
These are scores that indicate brushing habits and we can monitor them over time
92
What are the different plaque scores?
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
In 12-17yr olds if they score a bpe of 3 or 4 what do we do?
6PPC - if in 3 just 6ppc OF THAT AREA BUT IF 4 THEN FULL MOUTH
CHECK ALVEOLAR BONE LEVELS
94
What would <15% or 2mm bone loss indicate?
stage 1 - early/mild
95
What would coronal 1/3rd bone loss indicate?
Stage 2 - moderate
96
What would middle 1/3rd bone loss indicate?
stage 3 - severe
97
What would apical 1/3rd bone loss indicate?
stage 4 - very severe
98
What would <0.5 grading indicate?
Grade A - slow progressing bone loss
99
What would 0.5-1 grading indicate?
Grade B - moderate progression bone loss
100
What would >1 grading indicate?
Grade C - RAPID progression
101
What are some risk factor assessments?
Smoking
sub optimal controlled diabetes
102
How do we manage plaque induced gingivitis in kids?
Good brushing - OHI, brush all surfaces, demo, dj brush app, supervised brushing unit they can tie their own laces
disclosing tablets
fluoride mouthwash
103
What can be useful for pts undergoing fixed ortho?
225ppm fluoride mouthwash
104
If the code is 0 in kids BPE what tx do we do and at what frequency?
No tx, screen again in a year
105
If code 1 in kids bpe what tx do we do and what frequency?
OHI and prevention
bleeding and plaque charts
recall every 6 months (or yearly)
106
In code 2 what tx do we do and what freq?
OHI
Diet
Prevention
Scaling and removal of plaque retentive factors
6 months recall
107
What tx and review do we do in code 3 and 4?
full perio assessment, radiographs, scaling, RSD, OHI, diet advice
tx and review after 3 months
