Test 3

Question 1

Anything deeper than ___ mm is too deep for scalers and curettes to clean during SRP

Answer 1

4 mm

Question 2

7 factors that make SRP difficult

Answer 2

1. Probing depth >5 mm
2. Furcations
3. Root Proximity
4. Root Flutings
5. CEJ Relationship
6. Restorations
7. Bony defects

Question 3

Name 6 locations where locally delivered antimicrobials might be effective

Answer 3

1. Pockets of greater than or equal to 5 mm
2. maint. pts with isolated PD of 5-6 mm
3. Early stage perio abscesses
4. PD at DF line angle of 2nd molars related to 3rd molar extractions
5. Failing implants
6. Furcations

Question 4

Name 3 types of locally delivered antimicrobials and main ingredient

Answer 4

1. PerioChip - CHX
2. Atridox - Doxyclycline
3. Arestin** - Minocycline

Question 5

Which locally delivered antimicrobial is easiest to use and longest lasting?

Answer 5

Arestin - 28 days, preloaded cartridge

Question 6

Describe the characteristics a locally delivered antimicrobial must have for efficacy. 1. ____ or ____ the appropriate target microbes. 2. Reach the disease ____. 3. Achieve adequate _____ for effectiveness. 4. Achieve appropriate _____ of effect. 5. Have few ___ ___ and or cause no harm to the patient.

Answer 6

Inhibit or kill
Site
Concentration
Duration
Side effects

Question 7

How does low dose doxy affect the pathogenesis of perio disease?

Answer 7

Inhibits cytokines, prostanoids & MMPs (Inflammation) therefore stopping CT and bone metabolism

Question 8

How does locally delivered antimicrobials affect the pathogenesis of perio disease?

Answer 8

Inhibits microbes, antigens, LPS, virulence factors therefore decreasing host immuno-inflammatory response (microbes reappear in 9-11 weeks)

Question 9

What kind of pocket change can you expect to see with SRP alone?

Answer 9

(Deeper the pocket, greater the change)
About 2 mm (possibly 3 in ideal situations)
(studies show on avg its 1.23 reduction and .81 change in CAL) IDK

Question 10

What common antibiotic can you not drink alcohol while taking?

Answer 10

Metronidazole ( 250 mg 3x daily)

Question 11

6 advantages to systemic antibiotics

Answer 11

1. affects bacterial reservoirs
2. Targets multiple sites of infection
3. Reduces chair time required to tx pts
4. absorbs into soft tissues adjacent to infected site
5. penetrates to base of infected pocket
6. wide choice of different antibiotics

Question 12

11 disadvantages to systemic biofilms

Answer 12

1. Allergy
2. GI intolerance / nausea
3. Patient compliance
4. potential for drug interaction
5. Cost to patient
6. Inability to penetrate an intact biofilm
7. Bacterial resistance
8. Photosensitivity
9. Decreases effect of BC
10. Esophagitis
11. Candidiasis

Question 13

What 2 situations call for systemic antibiotics?

Answer 13

1. Patient with aggressive perio disease (younger pts)

2. pts with GENERALIZED SEVERE perio disease (not localized)

Question 14

5 reasons for SRP failure

Answer 14

1. pt non-compliance
2. inability to penetrate infection
3. inability to eradicate source of infection
4. cost to pt
5. inability to penetrate intact biofilm

Question 15

At re-evaluation, what 11 things do you look for in the clinical evaluation?

Answer 15

1. visual examination (color, contour, consistency, texture of gingiva)
2. PD
3. GR
4. CAL
5. plaque control
6. BOP
7. mucogingival defects
8. furcation involvements
9. mobility/fremitus
10. occlusion
11. caries

Question 16

What is a treatment plan?

Answer 16

A working document - unforseen development during tx may require modification of the plan and/or sequence of tx

Question 17

5 phases of a perio tx plan

Answer 17

1. Urgent - pain
2. Control - caries/perio
3. Re-eval - response to initial tx & design for prosth
4. Definitive - prosth/implants/orthro
5. Maintenance - regular re-care exams & OHI

Question 18

What are the 4 considerations when determining prognosis of perio tx?

Answer 18

1. Diagnostic - prognosis w/o tx
2. Therapeutic - effect of tx on disease
3. Prosthetic - w/ anticipated results, what is the forecast for the success of the prosthetic restoration
4. Provisional - prognosis prior to initial tx, may change

Question 19

8 factors that effect overall prognosis of perio tx

Answer 19

1. systemic background (also age/habits)
2. pt compliance
3. availability of mainenance care
4. bone loss
5. furcation involvement
6. pt history
7. skill/interest of operator
8. finances

Question 20

6 factors that effect prognosis of a single tooth with perio disease

Answer 20

1. PD
2. bone loss
3. tooth morphology
4. furcation
5. intraradicular morphology
   6, mobility

Question 21

what is the single most important risk factor in perio tx prognosis?

Answer 21

Smoking - cigarette smokers are 5-8 times more likely than non smokers to develop periodontitis

Question 22

Avg % of teeth lost with furcation involvement following tx?

Answer 22

35.7% @ 20.5 years

Question 23

PD is less important than ____ or _____

Answer 23

CAL or bone loss

Question 24

Following SRP at PD > 5 mm, residual calculus will remain ___ % of the time

Answer 24

85%

PD over 6 mm will be difficult to maintain without surgery

Question 25

Curette efficiency ___mm

Answer 25

3.73 mm

Question 26

What are the Classes for furcation prognosis?

Answer 26

Class I - fair Class II - questionable ( best is mandibulats and buccal maxillary) Class III/IV - hopeless

Question 27

What type of teeth have worse prognosis when it comes to mobility?

Answer 27

multi-rooted teeth

Question 28

Gingivitis diagnosis criteria

Answer 28

BOP PD 1-4 No CAL, bone loss, mobility, furcation

Question 29

mild chronic perio criteria

Answer 29

BOP CAL 1-2 PD 3-4 bone loss

Question 30

Moderate chronic perio

Answer 30

``` BOP Inflammation to the bone CAL 3-4 mm PD 5-6 mm bone loss 20 -40% class I and II furcation class I and II mobility ```

Question 31

Advanced chronic perio

Answer 31

``` inflammation to the bone BOP CAL >5 PD >7 bone loss > 40% Class I, II, III furcation and mobility ```