Second half Flashcards
(128 cards)
1
Q
CAL
A
Measured pocket (probe depth) + visible recession below CEJ
(In this image the CAL= 8mm)
2
Q
Plaque disclosing agents
A
-Fuchsia-colored erythrosine sodium solution
-Visual aid for patients to see plaque build up
3
Q
What drugs are associated with gingival enlargements (hyperplasia)?
A
- Calcium channel blackers (Nifedipine & Diltazem)
- Anticonvulsants (phenytoin)
- Immunosuppressants (cyclosporin)
4
Q
A tooth brush should have a ______ head (about ________ in size).
It should have ____, _______, ________ bristles, usually in ____ rows.
A
-relatively small head
-1-1.25 inches for adults
-soft nylon
-multitufted
-polished
-3
5
Q
The force of which bristles are applied to the tooth should not exceed
A
300-400g
6
Q
Modified Bass technique
A
Effective toothbrush technique, ESPECIALLY for patients with ginigivitis & periodontitis.
Bristles at 45 degree angle, small vibratory/circular motions (known as sulcular brushing).
7
Q
Natural vs. Synthetic toothbrush bristles
A
Natural bristles contain gaps that bacteria can colonize.
They don’t have rounded ends, which can cause lesions to the gingiva.
Synthetic bristles have end-round filaments that reduce the damage to gingiva.
8
Q
Modified Stillman method
A
-Vertical, Rotary brushing
-a series of brush movements repeated 5-10 times in the same area
9
Q
When is vertical brushing indicated?
A
-Overlapped teeth
-Open interproximal areas
-areas of recession
10
Q
Fones method of brushing
A
Max teeth closed, circular motion from max gingiva to mand gingiva
11
Q
Where is toothbrush trauma most frequently seen?
A
The facial surfaces of canines & premolars
12
Q
What is the purpose of interdental care?
A
Disease originates in the interproximal areas.
The purpose is to remove plaque, NOT food debris.
13
Q
What dictates the effectiveness of dental floss?
A
The anatomy of the tooth (areas might be missed due to shape of the tooth)
14
Q
Pre-Armitage classification of gingival diseases
A
-Older classification system of gingivitis vs. periodontits based on probing depth (NOT attachment loss)
-Didn’t account for many systemic health considerations
-Had the term “refractory periodontitis”
15
Q
Armitage classification of gingival diseases
A
-Gingival disease classification system that is based primarily on attachment level/loss
-Didn’t account for many systemic health considerations
16
Q
Current classification of gingival diseases
A
-Oncology model
-Has stage and grade
17
Q
In the new periodonal classification system, does the stage or grade improve with periodontal treatments?
A
The grade can improve with treatment and better oral hygiene, but the stage will never improve (can get worse).
18
Q
Classifies severity and extent of disease based off measurable data, helps assess complexity.
A
Periodontal Staging
4 stages (see attached picture)
19
Q
Used to indicate the rate of periodontitis progression, responsiveness to therapy, and potential impact on systemic health.
A
Periodontal Grading
3 Grades (A-C; see chart)
20
Q
Intitial examination determines:
A
-Diagnosis
-Tx plan
-Prognosis
21
Q
What is included in the exam/data collection of the initial exam?(6)
A
- Medical hx
- Chief complaint
- Dental hx
- Radiographs
- Extra-oral exam
- Intra-oral exam
22
Q
What % of patients at dental schools require medical consultation?
A
25%
23
Q
What are the 4 categories of periodontal health?
A
- Pristine periodontal health
- Clinical periodontal health
- Periodontal disease stability
- Periodontal disease remission/control
24
Q
Clinical Periodontal health
A
-absence/minimal levels of clinical inflammation
-normal osseous support
-CAL exists, but due to predisposting factors (recession, fenestrations, toothbrush abrasion)
-NOT due to active periodontal disease activity
25
Periodontal disease stability
-absence of inflammation & infection (reduction in predisposing factors and control of modifying factors)
-reduced periodontium
-the goal of perio patients
26
Periodontal disease remission/control
-Cannot fully control modifying/predisposing factors
-decreased inflammation
-improved clinical parameters
-stabilization of disease progression to low disease activity
-an acceptable alternative threapeuting goal in long-standing perio disease patients
27
Health vs. Stability
Health= minimal recession w/out pre-existing active perio disease
Stability= healthy state of a patient with previous perio disease (has attachment loss)
28
Pristine clinical health
Absence of :
-attachment loss
-BOP
-Clinical erythma, edema, & pus
-pocket depths greater than 3mm
29
What cells are increased in the initial lesion of healthy gingiva (clinically)?
Neutrophils
30
What cells are increased in early lesions of clinically evident early gingivitis?
T lymphocytes
31
What cells are increased in established lesions of established chronic gingivitis?
Plasma cells
*note, NO appreciable bone loss*
32
What cells are increased in advanced lesions (the transition from gingivitis to periodontitis)?
Cytopathically altered plasma cells
33
Gingivitis is associated with ___________.
It is mediated by _______ or ______ factors.
What external factor can influence gingival hypertrophy?
-dental biofilm
-systemic
-local
-medications
34
Plaque-induced gingivitis is exacerbated by ______
sex steroid hormones (puberty, menstrual cycle, pregnancy, oral contraceptives)
35
Pyogenic granuloma
-Vascular epulis (tumor)
-almost exclusively in pregnant women
36
Granuloma
A tiny cluster of WBCs and other tissue.
Non-cancerous.
37
Pre-malignant neoplasms
1. Leukoplakia (often associated w/tobacco use)
2. Erythroplakia
38
Malignant neoplasms
1. Squameous cell carcinoma
2. Leukemic cell infiltration
3. Lymphoma (Hodgkins & Non-Hodgkins)
39
When probing, when the gingival margin appears at a level between prob marks, do you read the higher or the lower mark as the measurement?
The higher mark
40
When charting in axium, if the pocket depth is 3mm and there is no sign of attachment loss, what value should you enter for the gingival margin?
-3 (put the negative value of the pocket depth)
41
When charting in axium, if the pocket depth is 5mm but the gingiva is inflamed and the gingival margin is above the CEJ (toward the crown), what value should you enter for the gingival margin?
Assume -2mm so that the pocket depth is at 3mm
42
When charting in axium, if the pocket depth is 4mm and the gingiva is located at the CEJ (can see black triangles), what value should you enter for the gingival margin?
0mm (reflects 4mm of attachement loss)
43
Scaling
The instrumentation of the crown & root surfaces to remove plaque, calculus, & stains w/out removing tooth substance
44
Root planing
The removal of cementum & surface dentin that's impregnated w/calculus.
Objective= produce a smooth, hard, clean surface.
45
Why is root planing necessary?
Calculus becomes embeded in the irregularities of the cementum, thus it needs to be removed & a smooth surface established
46
Indications for SRPs
-inflamed/bleeding/edematous gingival tissues
-Gingival hyperplasia
-4mm+ pockets
-plaque, calculus, diseased cementum, endotoxins
47
SRP results (5)
-decreased inflammation & edema
-decreased pocket depth
-improved tissue tone
-smoother root surface
-decreased bacteria, plaque, and calculus
48
Subgingival calculus vs. Supragingival calculus
Subgingival is harder & more tenacious than supragingival calculus.
Subgingival calculus can be removed in an open or closed surgical procedure.
49
Does gingival curettage add any benefit to healing from SRPs?
No
50
For pocket depths >5mm, what is the success in total removal of calculus?
Failure of total removal of calculus dominates
51
What is one of the side effects of SRPs?
It exposed the dentinal tubules, which exposes the dentin to irritants that can cause pain.
Increases sensitivity to air, tactile, and thermal stimuli.
52
How long should you wait before scheduling a re-evaluation for SRP patients?
4-6 weeks
53
Healing after SRPs:
What happens immediately after (2-8 hrs) root planing?
-Blood clot fills the gingival sulcus
-Hemorrhagine w/in tissue
-Appearance of PMNs leukocytes on the wound surface
54
Healing after SRPs:
8-24 hours after, what is the clinical appearance?
Gingiva appears hemorrhagic & bright red
55
Healing after SRPs:
2-7 days after what occurs?
Restoration & epithelialization of the sulcus (*note, this is keratinized epithelium*).
Reduction in the height of the gingival margin.
Gingiva is slightly redder than normal, but less so than the previous days.
56
Healing after SRPs:
After 2 weeks:
-Gingiva regains normal color, consistency, surface texture, and contour
-Gingival margin is well adapted to the tooth
-Appearance of immature collagen
57
Healing from SRPs results in the formation of a
long junctional epithelium
(sometimes the long JE is interrupted by islands of CT attachment)
58
Chlorhexidine/Peridex
Antiseptic mouthwash that kills germs & destroys their protective coverings.
Can be used to prevent plaque.
Use prior to using a Cavitron.
59
Side effects of Chlorhexidine/Peridex
-increased calculus formation
-staining
-altered taste
60
Chlorhexidine/Peridex works due to
Substantivity (it remains on the pellicle & works for an extended period of time).
61
When is periodontal surgical intervention indicated after SRPs?
-Consistantly acceptable levels of oral hygiene
-A number of gingival sites are still bleeding upon probing
-Significant reduction in probing depths has NOT been achieved
62
When should a patient NOT be considered an acceptable candidate for periodontal surgery after SRPs?
-Poor oral hygiene
-Lack of motivation/ability to exercise proper home care
63
When is a does a patient NOT require further perio treatment (other than routine maintenance)?
-Acceptable oral hygiene
-No gingival inflammation or BOP
-Probing depths significantly reduced
-Clinical attachment levels have improved
64
Any patient with probing depths of ______ or greater should be referred to a periodontist
6mm
65
In private practice, Stage ____ or _____ and Grade ___ perio patients should be IMMEDIATELY referred to a periodontitis.
-III
-IV
-C
66
Phase I therapy
-AKA Hygienic Phase
-Elimination of active disease
-Goal is to reduce gingival inflammation and reduction of pocket depth through reduction of swelling
67
What is included under Phase I therapy?
-OH instructions
-Prophy or SRP
-Antimicrobial agents
-Extraction of hopeless teeth
-Caries control
-Endo tx
68
Ideal goal of treatment of periodontitis
periodontitis
-form new attachment
-regeneration of lost structures (alveolar bone, PDL, cementum, surrounding tissues)
*note that there isn't "regeneration" after an SRP, but there is healing with the long junction epithelium*
69
Repair vs. Regeneration
Repair: healing of a wound by tissue that does not fully restore architecture or function of the part
Regeneration: reproduction or reconstitution of lost or injured part
70
New attachment
The union of CT and epithelium w/root surface that was deprived of its original attachment.
71
Reattachment
To attach again.
Reunion of epithelium w/root surface & bone after incision/injury.
72
What types of instruments are used for SRPs?
-Hand instruments
-Ultrasonic instruments
73
What are the actions of ultrasonic scalers? (4)
1. Allows for rapid removal of calculus
2. Mechanical
3. Cavitation (formation & collapse of bubbles by high-frequency waves surrounding ultrasonic tip)
4. Irrigation (therapeutic washing of the pocket & root surface)
74
________ are released from Gram negative bacterial cell walls and is toxic to humans. Release from bacteria covering the cementum triggers the _______. ______ penetrated deeply into the cementum and are held w/in calculus not removed during instrumentation.
-Lipopolysaccharides
-immune response
-Endotoxins
75
Prior to instrumentation of subgingival area, what microorganisms dominate?
What microorganisms dominate after SRPs?
-Anaerobic, gram negative, motile bacteria
-Aerobic, gram positive, non-motile bacteria
76
Why are perio maintenance recall exams every 3-4 months?
Anaerobic bacteria will become more active and need to be removed
77
Contraindications of Ultrasonic instruments (10 points)
1. Certain pacemakers
2. Communicable diseases
3. Medically compromised patients
4. Patients at respiratory risk
5. Patients with swallowing difficulty
6. Titanium implants
7. Some restorative materials (porcelain, composite, laminate veneers)
8. Areas of demineralization
9. Hypersensitive teeth
10. Kids w/mixed dentition
78
Universal (Straight) tip for ultrasonic scalers
-reaches all accessible surfaces
-MOST effective on buccal & lingual surfaces of all teeth and interproximal surfaces of anteriors
79
Curved tips for ultrasonic scalers
Used for:
-interproximal surfaces of posteriors
-Furcations
-Mispositioned molars
-Concave surfaces
80
Instrumentation fundamentals
-Use light lateral pressure
-Keep tip moving at all times
-Let the tip do the work
81
If there's a 1mm loss of an instruments tip, what % efficiency is lost? If there's 2mm loss?
-25%
-50%
82
Manual curette vs. Sonic/Ultrasonic
Manual is more efficient but requires increased time, effort, and expertise.
Ultrasonic insert designs are an adjunct to hand instrumentation.
*The difference is clinically insignificant as long as you have achieved your goal of total debridement*
*Best results usually from starting with sonic/ultrasonic instruments followed by hand scaling*
83
Terminal shank
From the end of the working end to the first bend.
84
Functional shank
From the working end to the handle
85
Universal curette
Hand instrument used to treat subgingival surfaces; it has a blade with an unbroken cutting edge that curves around the toe and a flat face set at a 90-degree angle to the lower shank.
86
Gracey curette
Curette with one cutting edge, "area specific"; it is designed to adapt to specific tooth surfaces (mesial or distal).
87
curved sickle scaler
to remove large amounts of deposits from supragingival surfaces
88
Straight sickle scaler
to remove large amounts of deposits from supragingival surfaces
89
Overjet
-Excessive protrusion of the maxillary incisors
-Horizontal overlap
90
Open bite
Open bite
No incisal contact; posterior teeth in normal occlusion
91
Underjet
Maxillary teeth are lingual to mandibular teeth.
92
Edge-to-Edge
Incisal edge to incisal edge of anterior teeth
93
Anterior crossbite
maxillary incisors are lingual to the mandibular incisors
94
Deep (severe) anterior overbite
Incisal edge of maxillary tooth is at the level of the cervical third of the facial surface of the mandibular anterior tooth
95
Pathologic alteration/adaptive changes which develop in the periodontium as a result of undue force.
Trauma from occlusion
(Excessive occlusal force may cause TMJ, injury to masticatory muscles or pulp tissue.)
96
Traumatizing forces may act on an individual tooth or groups of teeth in premature contact. This can occur in conjugation with ______ or ______.
-parafunctional habits
(clenching/bruxing)
-loss/migration of premolars/molars
97
A reaction that's elicited around a tooth w/normal height of the periodontium
Primary trauma from occlusion
98
Occlusal forces cause injury in a periodontium of reduced height
Secondary trauma from occlusion
99
Regardless of primary or secondary trauma from occlusion, the alterations which occur in the periodontium as a consequence of trauma from occlusion are __________.
Subjective symptoms of trauma from occlusion may develop only in situation when ___________ elicited by occlusion is so high that the periodontium around the exposed tooth cannot __________ with unalter position & stability of the tooth involved.
-similar & independent of the height of the periodontium
-magnitude of the load
-properly withstand & distribute the resulting force
100
Causes of primary occlusal trauma
1. High fillings
2. Prosthetic replacements that create excessive forces on abutments and antagonistic teeth
3. Drifting/extrusion of teeth into space created by unreplaced teeth
4. Ortho movement into fx unacceptable positions
101
Effect of occlusal forces on the periodontium is influenced by
-Magnitude
-Direction
-Duration
-Frequency
102
Tissue responses to increased occlusal forces (3 stages)
Stage I= Tissue Injury (produced by excessive occlusal forces)
Stage II= Repair
Stage III= Adaptive remodeling of the periodontium
103
Stage II of tissue responses to increased occlusal forces
Repair.
Damaged tissues removed, new CT & fibers, bone, & cementum formed in attempt to restore the injured periodontium.
Force remain traumatic ONLY as long as the damage produced exceeds the reparative capacity of the tissue.
104
Stage III of tissue responses to increased occlusal forces (4)
Adaptive remodeling of the periodontium.
Results in thickened PDL.
Involved teeth can become loose.
NO ATTACHMENT LOSS
105
Radiographic signs of occlusal trauma (3)
-Wide PDL w/thick lamina dura
-Vertical appearance of destruction
-Root resorption?
106
T/F- Trauma from occlusion is reversible when the traumatic force is removed
True
107
Result of periodontal infection; tooth moves up and down w/in socket
Pathological migration of teeth
108
What happens with increasing the magnitude of occlusal forces?
The PDL thickens (increase in # and width of fibers)
109
What happens with changing the direction of occlusal forces?
Reorientation of the stresses & strains.
Note that principal fibers of the PDL are arranged to accommodated forces along the long axis of the tooth.
Lateral & rotational forces can injure the periodontium.
110
Duration of occlusal forces
Constant pressure on the bone is more injurious than intermittent forces
111
Frequency of occlusal forces
The more frequent the application of an intermittent force, the more injurious the force is to the periodontium
112
Tooth Mobility= 0
Within physiological limits
113
Tooth Mobility= 1
less than 1mm movement in a BL/MD direction
114
Tooth Mobility= 2
1mm + movement in a BL/MD direction
115
Tooth Mobility= 3
exceeds 1mm movement in a BL/MD direction AND depressible occluso-apical direction
116
Tipping movements occur when there are excessive force directed _______.
______ and _______ zones will develop within the _____ and _____ parts of the periodontium.
_______ alterations occur within theses zones, allowing the tooth to tilt in the direction of the force.
When the tooth has escaped the trauma, __________ of the periodontial tissues takes place.
In the absence of inflammation, there is NO apical down-growth of the _____.
-horizontally
-Pressure
-Tension
-marginal
-apical
-Tissue
-complete regeneration
-JE
117
Movement of the tooth due to pressure & tension over the entire tooth surface.
Bodily movement
No inflammatory rx in gingiva of down-growth of JE (in the absence of inflammation)
118
Buttressing bone
-the bone formation that occurs to repair trauma from occlusion
-attempt to reinforce weakened trabeculae
-may produce a bulbous/ridge-like distortion (lamellar bone with osteoclasts & osteoblasts)
119
T/F- Trauma from occlusion, without inflammation, can induce periodontal tissue breakdown
False
120
Which tooth has the worst prognosis in the mouth?
Maxillary 2nd molar
121
What bacterium can be found in hidden pockets of localized aggressive periodontitis?
Actinobacillus actinomycetemcomitans
122
D1110
Prophylaxis
(for healthy/gingivitis patients; 6mo recall)
123
D4910
Periodontal maintenance (STP)
For patients who have completed SRPs; 3 month recall
124
T/F- Metal instrumentation is used for calculus removal on implants
False; plastic instruments ONLY
125
T/F- Acidic fluoride prophylactic agents are avoided for patients with implants
True; acidity damages the titanium abutments
126
Peri-implant mucositis
Gingivitis around implant
127
Per-implantitis
Periodontal disease around implants
128
How do you calculate the attachment loss with both pocket depth and external measurements of the gingiva?
Measurement of mucogingival junction to gingival margin - pocket depth= remaining attachment
