Periodontology Flashcards
(116 cards)
1
Q
In what situation would mouthwash be recommended for use?
A
When a patient cannot effectively clean mechanically
2
Q
Name all seven components of toothpaste
A
- Abrasives
- Detergent
- Binding agents
- Thickeners
- Humectants
- Preservatives
- Flavours and sweeteners
3
Q
What toothpaste component is used to aid plaque/stain removal?
A
Abrasives
4
Q
What component of toothpaste causes it to foam?
A
Detergent
5
Q
What is the role of binding agents as a toothpaste component?
A
Prevent separation of liquid and solid phases of paste during storage
6
Q
What is the role of thickeners as a toothpaste component?
A
They give consistency
7
Q
What toothpaste component conserves moisture?
A
Humectants
8
Q
What is the role of preservatives as a toothpaste component?
A
Prevent bacterial growth
9
Q
What is the most likely toothpaste component that patients can be allergic to?
A
Flavourings
10
Q
What toothpaste is advised for use when a patient presents with large calculus build-up?
A
Triclazan
11
Q
What is the effect of calculus build-up on plaque?
A
It causes plaque to accumulate
12
Q
What mouthwash can increase calculus formation as well as staining?
A
Chlorohexidine
13
Q
What is staining, induced by chlorohexidine, causd by?
A
CHX binding tannins
14
Q
Can mouthwash penetrate the biofilm?
A
No
15
Q
What does PMPR stand for?
A
Professional mechanical plaque removal
16
Q
What are the aims of non-surgical periodontal debridement? ( i.e. hand instrumentation and ultrasonics)
A
To remove supra- and subgingival calculus deposits from the tooth surface, as well as disrupting pathogenic subgingival plaque biofilm
17
Q
If calculus is essentially an inert mineralised deposit, why is it necessary to remove it?
A
Because calculus acts as a plaque trap, promoting further build up of plaque. Removal of calculus also makes maintaining OH easier for patients
18
Q
What two key health instructions could be given to patient to prevent future build-up of calculus?
A
Oral hygiene instruction and smoking cessation
19
Q
Why do we get less BOP in smokers?
A
Mainly due to the ‘masking effect’ which means there are reduced levels of periodontal inflammation and gingival vascularity.
20
Q
What is important to warn smoking patients about for if they stop smoking and their OH improves?
A
That their gums may BOP
21
Q
Why is sub-gingival PMPR usually carried out with LA?
A
Because patients may experience pain during subgingival PMPR due to the nerve supply from the periodontal soft tissues and the root dentine
22
Q
What is the recommended time before a pocket should be re-probed following subgingival PMPR?
A
10-12 weeks
23
Q
Ideally, when should you see a pateint post subgingival PMPR, only to check OH is being maintained?
A
4-6 weeks
24
Q
What are the four stages of periodontal wound healing?
A
- haemostasis
- inflammation
- proliferation
-remodelling
25
Angiogenesis is an essential phase in the proliferation stage of wound healing. Define angiogenesis.
New blood vessels form from pre-existing vessels
26
At what depth are perio pockets when periodontitis status is at ‘currently stable’?
4mm or less
27
Why is there usually more recession following non-surgical periodontal treatment?
Reduction in inflammatory swelling results tissue shrinkage (more recession)
28
If a perio patient has to move from a small tepe brush for interproximal cleaning to a large tepe brush is this good or bad, and why?
A good thing, shows that there has been shrinkage in tissue due to reduced inflammation
29
What are the two phases of perio healing?
- reattachment
- new attachment
30
Re-union of tissue with a root which has been pathologically exposed due to periodontitis, is known as?
New attachment
31
What structures make up the periodontium?
- PDL
- root cementum
- alveolar bone
- gingival tissues ( gingival epithelium and connective tissue)
32
what does regeneration of the periodontium mean?
Returning the periodontium to normal as if disease never happened
33
what four tissues can be involved in periodontal pocket healing?
- gingival epithelial cells
- gingival connective tissue cells
- bone ells
- periodontal ligament cells
34
Which tissue, involved in perio pocket healing, is the fastest cell type to develop following perio treatment?
Gingival epithelium
35
What is the negative impact of fast growing gingival epithelium cells?
They can block the growth of other cell types involved in perio pocket healing, preventing regeneration of perio tissues
36
What type of epithelium do fast growing gingival epithelial tissues form?
Long junctional epithelium by new attachment
37
What are the three reasons for reduced probing depth following successful perio treatment?
- reduction in inflammatory swelling
- improved tissue resistance to probing
- formation of the long junctional epithelium
38
What type of patients tend to have worse treatment outcomes, with less successful pocket depth reduction.
Smokers
39
In what situation would 4mm perio pockets be deemed ‘currently stable’?
If there is no BOP
40
What are the key features of periodontal treatment success?
- pateint is comfortable
- all pockets are 4mm or less
- consistently low BOP below 10%
- adequate plaque control
- cleansable restorations
41
what would be the next step for a patient with successful non-surgical perio treatment?
Move patient onto maintenance/ supportive periodontal therapy (SDL)
42
If a perio patient is young and very susceptible to periodontal disease, how long between maintenance appointments should be left?
3 months
43
What are key features of perio treatment failure?
- discomfort of patient
- deep persistent pockets that aren’t maintainable by OH at home measures
- persistent BOP
- persistent suppuration
- increasing LOA
44
What are the five main causes of periodontal treatment failure?
- inadequate plaque control
- original assessment/diagnosis incorrect
- inadequate debridement
- patient is a poor responder to treatment ( possible underlying medical condition)
- inadequate maintenance/SPT
45
What is the most common cause of periodontal treatment failure?
Inadequate plaque control
46
What perio patient may require palliative care?
Patients who refuse to take responsibility for condition and treatment plans (OH), also those who have failed non-surgical perio treatment for other reasons.
47
What is palliative care?
Form of medical care that relives symptoms without dealing with the cause of the condition
48
To decide whether to provide perio treatment after failure, ask yourself what three questions?
1. Are you sure diagnosis of failure is correct?
2. Why has the treatment failed?
3. Can this be corrected?
49
What are the three aims of periodontal palliative care?
Keep patient:
1. comfortable
2. Functioning
And
3. Slow the progression of periodontal disease
50
What are the required pocket depths for Jon-surgical perio treatment to be effective?
6mm or less
51
If a pateint has perio pockets that are 6mm or more, what should be done?
Refer to a specialist
52
What society have guidance on referrals to specialists?
The British society of Periodontology (BSP)
53
The ability of an organism to maintain the internal environment of the body within limits that allow it to survive, is known as?
Homeostasis
54
What protein is most important in homeostasis of the oral cavity and turnover in the PDL?
Collagen
55
The movement of something into, through and out. The rate at which something is depleted and replaced. This is known as?
Turnover
56
What does BPE stand for?
Basic periodontal examination
57
What is a screening system used to identify individuals who require a more detailed periodontal examination?
BPE
58
What patients require a BPE?
- new patients
- recall patients who haven’t has a perio examination in a year
59
What teeth are generally not included in BPE charting?
3rd molars
60
What should your probing pressure be when carrying out a BPE?
20-25g
61
What code would be given for:
- pockets < 3.5mm
- no calculus/overhangs
- no BOP
- first black band on who probe completely visible
CODE 0
62
What code would be given for:
- pockets < 3.5mm
- supra or sub gingival calculus/overhangs
- first black band on who probe completely visible
CODE 2
63
What code would be given for:
- pockets < 3.5mm
- no calculus/overhangs
- BOP
- first black band on who probe completely visible
CODE 1
64
What code would be given for:
- pockets 3.5mm - 5.5mm
- first black band on who probe partially visible
CODE 3
65
What code would be given for:
- pockets >5.5mm
- first black band on who probe completely in pocket
CODE 4
66
What does a BPE code of 4 indicate about pocket depth?
That pocket depth is 6mm or more
67
What are the disadvantages of BPE?
- no indication of which teeth are affected/specific site
- BPE alone doesn’t account for bone loss
-can’t be used to monitor disease
68
What are the three stages that BSP guidelines advise on BPE?
1. Carry out a patient history
2. Examine intra and extra orally
3. Screen for periodontal disease (BPE)
69
What are the two types of intra-oral radiographs commonly taken on clinic?
- bitewing
- periapical
70
What are the two types of bitewing radiographs?
Horizontal bitewing and vertical bitewing
71
What is the radiograph called that gives an entire view of the dentition?
DPT
72
When would use of a DPT be required in replacement to intra-oral radiographs?
If a patient gags and cannot tolerate the film sitting in their mouth
73
What are the four key disadvantage of radiographs?
- superimposition of structures
- radiation exposure
- does not show disease activity
- underestimates bone loss
74
What 3 ways can extent of bone loss in periodontitis be described?
1. Distribution (localised or generalised)
2. Pattern ( horizontal or vertical on radiograph)
3. Severity ( bone loss expressed in % proportion to tooth length)
75
How many stages of bone loss are there?
4
76
Bone loss of <15% would be described as incipient. What stage of bone loss is this?
Stage 1
77
What stage describes bone loss of the mid 1/3 of the tooth root (33-50% bone loss)?
Stage 3
78
What stage describes bone loss in the coronal 1/3 of the tooth root (15-33%)?
Stage 2
79
What stage describes bone loss in the apical 1/3 of tooth root (>50%)?
Stage 4
80
How is grade of disease calculated?
% bone loss /patient age
81
How is severity of bone loss calculated?
(Measurement of ACJ to bone crest/ measurement of ACJ to root apex) x100
82
What is a medico-legal requirement to carry out in order to take periodontal treatment plan forward?
A radiographic report
83
What was the main focus of the 2017 world workshop on periodontitis?
- periodontal health and gingival disease/ conditions on an intact and reduced Periodontium
- the biological features of disease and risk factors
84
What are the three types of periodontal disease according to new classifications?
1. Necrotising periodontal disease
2. Periodontitis
3. Periodontitis as a manifestation of systemic disease
85
What guide should be used to diagnose the stage and grade of periodontal disease?
Extent- periodontitis- stage- grade- stability -risk
86
What can the extent of periodontitis be?
- molar-incisal
- localised
- generalised
87
Why should periodontitis be graded?
To estimate the risk of progression of periodontitis and to guide recall
88
If the % bone loss/age is less than half the pateints age (<0.5) what grade of periodontitis is this?
Grade A
89
If the % bone loss/age is half the pateints age (0.5-1) what grade of periodontitis is this?
Grade B
90
If the % bone loss/age is more than half the pateints age (>1) what grade of periodontitis is this?
Grade C
91
What is Grade A periodontitis normally driven by?
High plaque levels
92
What is grade B periodontitis normally driven by?
High plaque levels and additional risk factors
93
Which grade of periodontitis has the highest risk of relapse?
Grade C
94
What would be the recall time for a grade A periodontal patient?
After about 1 year
95
What would be the recall time for a grade B periodontal patient?
3-6 months
96
Which grade of periodontitis requires a discussion to be had with the patient about the genetic risk of other family members to periodontitis?
Grade C
97
Would periodontitis be described as stable, in remission, or unstable if:
BOP <10%, pocket depth is <4mm
Stable
98
Would periodontitis be described as stable, in remission, or unstable if:
pocket depth is >5mm or 4mm pockets BOP
Unstable
99
Would periodontitis be described as stable, in remission, or unstable if:
BOP >10%, pocket depth is <4mm, no BOP at 4mm pockets
In remission
100
What are the top three risk factors for periodontitis that need to be controlled in order for treatment to be successful?
- Plaque control
- smoking
- diabetes
101
Fill the gap.
The most severe periodontitis patients have a _____________ immune system.
Hyper- responsive
102
What stages of periodontitis are treatable by GDP?
Stages 1-3
103
What stage of periodontitis should be treated by a specialist?
Stage 4
104
What are S3 guidelines?
The highest level of evidence-based guidelines
105
What is the BSP recommended four step approach to structure periodontal treatment planning?
1. Risk factor management including OHI and supra-gingival PMPR
2. Subgingival PMPR
3. Reassessment
4. Maintenance/ supportive periodontal treatment
106
What is the most fundamental factor to perio treatment success?
Individualised oral hygiene instruction
107
What approach of PMPR is not recommend for patients with systemic disease (e.g. cardiovascular disease) and why?
Full mouth approach where PMPR is carried out over one or two appointments all typically within 24 hours.
Due to risk of increased systemic inflammation
108
For patients who initially had BPE scores of 3 or 4, when should they be reassessed?
After 3 months
109
Why should caution be taken when putting patients on palliative care?
There is a risk of accusation of supervised neglect
110
What are features of a healthy Periodontium?
- pink/racial pigmentation
- stippled
- knife-edge margins
- papillae fill interdental space
- no BOP
111
What are features of an unhealthy Periodontium?
- red, swollen/ inflamed gingiva
- loss of knife-edged margins
- papillae over or under fill interdental spaces
- loss of stippling
- BOP
112
What is the primary cause of gingivitis and periodontitis?
Plaque-induced inflammation
113
LOA is associated with gingivitis. True or false?
False. No associated LOA with gingivitis. There is only LOA associated with periodontitis
114
What epithelium in the gingival sulcus is the weak point in the gingival barrier against invading plaque bacteria?
Junctional epithelium
115
If inflammatory reactions are higher, what’s happens to the levels of gingival crevicular fluid?
Increases
116
What pieces of information do we need to formulate a periodontal treatment plan?
- patient history
- periodontal examination
- further/special investigations
