Periodontics Flashcards
(112 cards)
1
Q
give a definition of gingival health (3 points)
A
knife edges scalloped gingival margin
pink
absence of BOP
2
Q
give four examples of local plaque retentive factors
A
calculus
restorative margin
crowding
mouth breathing
3
Q
give two examples of systemic modifying factors that increases plaque retention
A
sex hormones
medication
4
Q
what is a false pocket
A
proliferation of sulcular epithelium and enlargement of gingivae with no clinical LOA
5
Q
what is a true pocket
A
apical migration of sulcular epithelium and plaque accumulation on root surface which perpetuates inflammation and continued apical migration of epithelium
6
Q
how far away from the ACJ does alveolar bone usually sit
A
1-2 mm
7
Q
what is the keystone pathogen of periodontal disease
A
P. gingivalis
8
Q
what aspects of immune response protects against plaque
A
saliva
epithelium (physical)
GCF which has antimicrobial properties and antibiotics
9
Q
what are MMPs
A
matrix metalloproteinases which are degradative enzymes secreted by inflammatory cells causing tissue destruction
10
Q
in periodontitis what cells secrete MMPs
A
host cells
11
Q
name three effects smoking has on the gingiva
A
increased gingival keratinisation
vasoconstriction of gingival tissues
impaired antibody function
12
Q
name the two types of BPE probes
A
WHO probe
UNC 15 probe
13
Q
what is the WHO probe
A
0.5mm ball
black band at 3.5mm-5.5mm
black band 8.5mm-11.5mm
14
Q
what is a requirement for BPE
A
must be at least 2 teeth in the sextant
15
Q
what is the treatment if the highest BPE score is a 1
A
OHI
16
Q
what is the treatment if the highest BPE score is a 2
A
PMPR and OHI
17
Q
what is the treatment if the highest BPE score is a 3
A
OHI and RSD
18
Q
what is the treatment if the highest BPE score is a 4
A
OHI RSD and assess for more complex
19
Q
what is the treatment plan for a BPE of 3
A
radiographs
initiate periodontal therapy (PMPR) and 6PPC after 3 months
20
Q
what is the treatment plan for BPE of 4
A
radiographs and full perio assessment (6PPC)
21
Q
what are the six Ramfjord’s teeth
A
16, 21, 24, 36, 41, 44
22
Q
what modified plaque and bleeding scores would you find in an engaged patient
A
less than 35% bleeding
less than 30% plaque
more than 50% reduction in BOTH
23
Q
what is a grade 0 tooth mobility score
A
tooth moves around 0.1-0.2mm in horizontal direction
24
Q
what is grade 1 tooth mobility score
A
tooth moves 1mm in horizontal direction
25
what is grade 2 tooth mobility
tooth moves more than 1mm in horizontal direction
26
what is grade 3 tooth mobility
tooth moves in horizontal and vertical direction
27
when might single tufted brushes be used
clean malaligned teeth
clean distal surfaces of last molar teeth
clean teeth affected by localised gingival recession
28
give three advantageous properties of chlorhexidine mouthwash
long substantivity
broad antimicrobial spectrum
adsorption to oral surfaces - including enamel
29
give two disadvantages of chlorhexidine mouthwash
interferes with taste
stains teeth
30
according to SDCEP guidelines when is the only time anti-plaque mouthwash should be prescribed
when pain limits patient's ability to perform mechanical plaque removal
31
what is the TIPPS acronym
talk
instruct
practice
plan
support
32
what three things should be on the patient agreement form
diagnosis
self care plan
agreement statement
33
name the desired outcome of scaling and RSD
create a root surface compatible with biological reattachment
34
what effect does PMPR have on the microflora
significantly reduces levels of pathogenic species - p.gingivalis and t.denticola
35
what 3 effects does PMPR have on the soft tissues
decrease in gingival inflammation
recession of gingival tissues due to shrinkage
increase in collagen fibres in connective tissue
36
what is gain in attachment following RSD attributed to
long junctional epithelium formation and replacement of inflammatory infiltrate by collagen
37
when is greatest change seen in tissues after RSD
4-6 weeks after therapy
38
give three reasons why periodontal treatment may fail
inadequate patient plaque control
residual subgingival deposits
systemic risk factors
39
what is marginal bleeding
bleeding from gingival margin when gingivae have been gently touched - indicator of self-performed plaque control
40
what is bleeding on probing
bleeding from base of the pocket which indicates presence of inflammation - does not mean there is active disease
41
what is the name of the probe used for furcation assessment
Naber's probe
42
give three components of gingival crevicular fluid
AMPs
cytokines
IgG
43
give four virulence factors of P.gingivalis
asaccharolytic
gingipains
atypical LPS
inflammophilic
44
what does asaccharolytic mean
displays nutrients from breakdown of proteins and peptides
45
how does the host detect bacteria on gingival epithelial cells
via TLRs
46
what does TLR activation lead to
production of pro-inflammatory mediators which trigger the acute inflammatory response
47
what does the TLR activation of the chemokine/ cytokine gradient lead to
monocytes and lymphocytes follow the gradient into the gingival tissue
48
what are the purpose of the monocytes and lymphocytes in gingivitis
they phagocytose invading bacteria
release degradative enzymes into GCF
49
what is the role of neutrophils in the periodontal tissues
to ensure health
they release their contents in GCF
50
what is the result of excessive neutrophils in a dysbiotic environment
leads to chronic inflammation and contributes to periodontal destruction
51
what is the role of MMPs in periodontitis
remove damaged tissue, degrade it and allow for regeneration of tissue
however chronic recruitment leads to bone destruction
52
what are osteoclasts derived from
immune cell - monocytes
53
How are osteoclasts made
activated T/B cells release RANKL into the perio lesion
RANKL binds to RANK receptor on pre-osteoclast
when it binds - causes differentiation into osteoclast
54
what is the role of OPG
to inhibit RANKL binding to RANK and inhibiting bone resorption
55
how does OPG work
binds to RANK receptor on pre-osteoclast
RANKL cannot bind
results in less bone resorption
56
what is inflammation in relation to OPG and RANKL
high RANKL and low OPG levels
57
what is the function of a mini sickle
removes supragingival calculus from buccal and lingual
triangular in cross section
sharp pointed - not to be used below gingival margin
58
what is the function of a columbia curette
semi circular cross section
used for supra and subgingival scaling throughout the whole mouth
59
what is the function of the yellow hoe scaler
buccal and lingual sub-gingival scaling
60
what is the function of the red hoe scaler
mesial and distal surface sub-gingival scaling
61
what is the function of the grey gracey curette
subgingival scaling of upper and lower anterior teeth
62
what is the function of the orange gracey curette
mesial scaling of posterior teeth
63
what is the function of the green gracey curette
buccal and lingual scaling of posterior teeth
64
what is the function of the blue gracey curette
distal surfaces of posterior teeth
65
what is the first step in the bsp periodontal treatment
building foundations for optimal treatment outcomes - eg explaining risk factors, control plaque and bleeding through OHI
removing plaque retentive factors
66
when should you reevaluate a patient after BSP step 1 periodontal treatment
after 6-8 weeks
67
if 6 weeks after step 1 the patient is seen to be non-engaging, what would be the next step
repeat step 1
68
if 6 weeks after step 1 the patient is seen to be engaging, what is the next step
step 2 - subgingival instrumentation
69
what is involved in S3 step 2 periodontitis treatment
reinforce OHI
subgingival instrumentation
use systemic antimicrobials if required
70
name the structures blanked out by the navy squares
71
name the five cardinal signs of inflammation
pain
heat
redness
swelling
loss of function
72
what is biofilm
aggregate of microorganisms that adhere to each other on a surface - these cells are embedded within a self produced matrix
73
what is the keystone pathogen in periodontal disease
porphyromonas gingivalis
74
name four ways that P gingivalis can evade the host immune system
gingipains
adhesions
fimbriae
capsular polysaccharide
75
what is a periodontal emergency
gum swelling, mouth pain, difficulty brushing/ eating due to pain, unexplained bleeding and loose teeth
76
how should acute periodontal emergencies be managed in the first instance
with local measures - do not prescribe abx unless systemically unwell or signs of spreading infection
77
what is a perio-endo lesion
a pathological communication between endodontic and periodontal tissues of a given tooth
78
how is a periodontal abscess differentiated from a periapical abscess
if the tooth is non-vital or not
if non-vital = periapical
79
name the four components of the periodontium
gingiva, periodontal ligament, cementum, alveolar bone
80
how do endo-perio lesions present on radiographs
as a J-shaped lesion - with radiolucencies around the roots of the teeth only
81
what are treatment options for a tooth with an endo-perio lesion
XLA
pulp extirpation
abx if systemic involvement
subgingival instrumentation after endo treatment or XLA
82
what are the two forms of internal root resorption
inflammatory
replacement
83
what is internal inflammatory resorption
caused by trauma or damage to predentine
root canal coronal to lesion is necrotic but apically is vital
appears as round radiolucency of root canal
84
what is treatment for internal inflammatory resorption
orthograde endodontics, intervisit medicament and thermal GP obturation
85
what is internal replacement resorption
uncommon, associated with previous trauma, caries or periodontal infection affecting pulp
tooth root as cloudy appearance and outline of canal appears wider
86
what is the treatment for internal replacement resorption
orthograde endodontics and obturation with thermoplastic GP
87
what are the four types of external root resorption
cervical
inflammatory
replacement
surface
88
what is external surface root resorption
pressure induced resorption which stops progressing once pressure removed
root apices appear blunt or shorter than unaffected teeth - PDL intact
89
what is the treatment for external surface resorption
remove source of pressure
90
what is external inflammatory resorption
pulp is necrotic - triggered by damage to root surface and periodontium
roots appear short and ragged root ends with a periapical radiolucency
91
what is the treatment for external inflammatory resorption
endodontic treatment
92
what is external cervical resorption
tooth has pink spot at cervical aspect
causes - damage to subepithelial cementum, infection, orthodontics, non-vital tooth whitening
93
what is the treatment for external cervical resorption
monitor
XLA and prosthetic replacement
surgical repair and endodontics
94
how is external cervical root resorption classified
1 - affects crestal area
2 - affects coronal 1/3
3 - affects mid 1/3
4 - affects apical 1/3
95
what is external replacement resorption
caused by severe luxation or avulsion injury
the PDL is crushed and degenerates - osteoclasts come and remove degenerated PDL but also some cementum
osteoblasts lay down alveolar bone - tooth becomes ankylosed and infra-occluded
clinically has high pitched percussion note
96
what is the treatment for external replacement resorption
monitor (if non-growing patient)
decoronate
allow for healing (rare)
97
what are the aims of step 3 periodontal treatment
treat non-responding sites
consider referral for non-responding pockets more than 6mm
adjunct options
98
name examples of treatment adjuncts for step 3 periodontal treatment
local antimicrobials (chlorhexidine or tetracyclines)
periochip
dentomycin periodontal gel
99
what is periochip
biodegradeable gelatin matrix
2.5mg chlorhexidine digluconate
inserted into pocket following PMPR
releases slowly over 7 days
100
what is dentomycsin periodontal gel
2% mincocycline gel
syringed into pocket after PMPR
3-4 applications every 2 weeks
reduces pathogenic load in pocket
101
when are systemic antimicrobials considered for perio patients
in young patients with rapidly progressing disease (C)
only delivered by specialists
full mouth PMPR in 24 hour period with 400mg metronidazole TID for 7 days
102
what is periostat
use of drugs to modify host inflammatory system
sub antimicrobial dose doxycycline
103
when is periodontal surgery considered
stage III
residual pockets of 6mm or more
quality non-surgical periodontal treatment has not resolved pocketing
104
what patient factors must be considered for periodontal surgery
compliance
good plaque control and little bleeding
cost and patient acceptance
105
what tooth factors must be considered for periodontal surgery
tooth position
anatomy of tooth
shape of defect
access to non-responding sites
106
what systemic factors must be considered before periodontal surgery
smoking
poorly controlled diabetes
unstable angina or stroke or MI within 6 months
immunosuppression
anticoagulants
107
why are monofilament sutures used after periodontal surgery
to prevent plaque adhering to it
108
what are the three most common mucogingival surgeries
free gingival graft
pedicle graft
connective tissue graft
109
what are three aetiological aspects of gingival recession
local - excessive toothbrushing, traumatic incisor relationship, chewing habits
generalised - periodontal disease
local or generalised - complication of ortho treatment
110
what is the classification for gingival recession
1 - no interproximal tissue loss
2 - interproximal tissue loss not as significant as mid-buccal
3 - interproximal tissue loss worse than buccal loss
111
name three treatment options for gingival recession
eliminate habits and remove piercings
oral hygiene instruction
topical desensitising agents
gingival veneer
mucogingival surgery
112
