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DEN2SKC > WEEK 1 > Flashcards

WEEK 1 Flashcards

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1
Q

What is repair

A

physiological adaptation of a tissue to re establish continuity without replacing exact tissue

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2
Q

what is the principal tissue of repair in the gingiva?

A

long junctional epithelium

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3
Q

what does the long junctional epithelium do?

A

replaces the junctional epithelium that was lost through disease

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4
Q

After periodontal treatment what happens to the junctional epithelium?

A

it is repaired with long junctional epithelium

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5
Q

does it matter what type of epithelium is present?

A

not really, they have a similar resistance to plaque.

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6
Q

what is replacement?

A

the slow replacement of damaged tissue with an exact copy of what was there before

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7
Q

is morphology and functionality fully replaced during replacement?

A

YES

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8
Q

which tissues in the periodontium undergo replacement?

A

PDL, alveolar bone, and root cementum

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9
Q

do periodontal tissues repair or regenerate?

A

both

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10
Q

what are some characteristics of the junctional epithelium?

A
  • non-keratinized,
  • hemidesmosal attachment, fast tissue turnover
  • pathway for inflammatory exudate
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11
Q

what does scaling or debridement do to the perio pocket?

(microbial effects)

A
  • breaks up biofilm
  • removes plaque and calculus deposits
  • introduces oxygen to the site (anaerobic –> aerobic)
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12
Q

Tell me about the changes in the condition of the pocket in terms of what types of bacteria can survive?

A

starts as non-aerobic, protein rich and becomes aerobic and saccharolytic.

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13
Q

bacteria type before debridement

A

gram-negative anaerobic
pathogenic red and orange complex bacteria

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14
Q

bacteria type after debridement

A

gram positive aerobic
early coloniser species.

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15
Q

what happens to the bacteria if the patient doesn’t improve oral hygiene practices?

A

supragingival plaque reestablishes becoming more anaerobic triggering host defenses.

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16
Q

prinicpal healing events after debridment

A
  1. Immediately after debridement- RBC adhere to the root surface
  2. 60 min—RBCs form a fibrin clot. Inflammatory cytokines are released, increasing the permeability of capillaries
  3. 6 hrs - early inflammatory phase—fibrin network attached to the root surface, including clumps of RBCs. Neutrophils migrate to the dentine surface from CT through the dilated capillary network
  4. 3 days - late inflammation phase—macrophages arrive at the root surface to debride the wound. Reduction in swelling occurs within 24-48 hrs. LJE forms (basement membrane forms and hemidesmosomes attach to the root surface)
    Granulation tissue formation: granulation tissue is initially highly vascular and is subsequently remodeled. The fibrin clot matures, and fibroblasts are present.
  5. 7 days—highly cellular connective tissue attachment to the dentine surfaces
  6. 21 days—immature collagen present. Junctional epithelium reattaches to the root surface with the formation of a long junctional epithelial attachment. Gingival tissues are mature. Minimal inflammation is present.
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17
Q

what 3 factors affect healing after debridement?

A
  1. site level
  2. tooth level
  3. patient level
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18
Q

What would ideal site healing involve?

A

formation of new cementum, periodontal ligament and alveolar bone.

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19
Q

Most of the healing is achieved via a

A

long junctional epithelial scar

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20
Q

When should we re evaluate our gingivitis patients?

A

6 months

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21
Q

when should we re evaluate our moderate periodontitis patients (stage 2 grade b)

A

8-12 weeks

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22
Q

when should we re-evaluate our severe periodontitis patients? (stage 3-4 grade C)

A

6-8 weeks

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23
Q

what are the components of a reevaluation visit?

A

baseline exam
review teeth for new caries, implants, etc
visual gingiva examination
review oral hygiene routine
repeat diagnostic tests

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24
Q

During re evaulation what are the two questions we try to get answered?

A

was it a good treatment outcome?
what further treatment is required?

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25
Once a patient has periodontitis but then comes back with only gingivitis inflammation, is it deemed a gingivitis case?
No, it remains perio. the damage is irreversible.
26
What does the stage of a patient at the initial examination tell us?
how susceptible they are to ongoing attachment loss.
27
how much of a probing depth reduction can we expect in patients with shallow sites (0-3mm)?
less that 1mm
28
how much of a reduction in probing depths can we expect with patients with moderate probing depths? (4-6mm)
up to 1.25 mm
29
how much of a reduction in probing depths can we expect for patients with deep sites (>6mm)
up to 3mm
30
how long does it take to heal probing depths of less than 4mm?
4 weeks
31
how long does it take to heal probing depths of 4-6mm?
4-5 months with 2 recalls
32
how long does it take to heal probing depths of >6mm?
9-12 months with 3-4 recalls
33
How do we determine which sites require re-treatment at the re-evaluation appointment?
Unchanged BOP, PD or an increase
34
Does the staging of a patient change after a re-evaluation appointment?
no
35
Can the grade of a patient change after a re-evaluation appointment?
yes
36
What does it mean if a perio patient is currently stable?
BOP <10%, PD less than or equal to 4mm
37
What does it mean if a perio patient is currently in remission?
BOP greater or equal to 10%, PD less than or equal to 4mm with no bleeding at 4mm sites
38
What does it mean if a perio patient is currently unstable?
PD greater or equal to 5mm or 4mm with BOP at those sites
39
What does a patient need to achieve at the re-evaluation visit in order to be considered periodontally healthy?
PD less than 4mm.
40
What are some patient level risk factors?
diabetes, smoking, socioeconomic status, genetics, oral hygiene, full mouth bleeding percentages, full mouth plaque scores, compliance with maintenance
41
what are some tooth level risk factors?
restorative status, tooth position (crowding), furcations, xerostomia, mobility, iogenic factos, ortho, mouth breathing
42
what are some site level risk factors?
PD, BOP, CAL, furcation lesions, recession, vertical bone loss
43
How do you stage a patient?
extent + severity + complexity.
44
What does extent mean when staging a patient?
localized - less than 30 percent means localized generalized- more than 30 percent
45
what does complexity mean when staging a patient?
if they have furcations, deep pocket depths, CAL, and mobility
46
What is a stage 1 patient?
PD- 0-4mm CAL - less than 2mm BONE LOSS - less than 15% predictable outcomes
47
What is a stage 2 patient?
PD- less than, or 5mm CAL- 3-4mm BONE LOSS- 15-33% predictable outcomes
48
What is a stage 3 patient?
PD- greater than or 6mm CAL- greater than or 5 mm vertical bone loss, furcations loss of 4 or less teeth non predictable outcomes
49
What is a stage 4 patient?
extends to middle third of root or beyond mobility lost 5+ teeth non-predictable outcomes
50
How do you grade a patient?
bone loss percentage on worst tooth in the mouth divided by age
51
What is grade A?
ratio is less than 0.5
52
what is grade B?
ratio between 0.5 and 1
53
what is grade C?
ratio greater than 1
54
which grades include systemic risk factors?
B and C.
55
what are the systemic risk factors for grade B?
HbA1c less than 7 less than 10 cigarettes a day
56
what are the systemic risk factors for grade C?
HbA1c greater or equal to 7 10 or more cigs a day
57
What are some modifiable risk factors?
PD, BOP, plaque score, smoking, diabetes control, medications, oral hygiene compliance
58
What are some non-modifiable risk factors?
socioeconomic status, genetics, age, root morphology, horizontal bone loss, tooth loss
59
Does supportive periodontal therapy (SPT) help compensate for poor oral hygiene?
yes
60
What are the components of a spt with their time frames?
reevaluation exam (10-15 mins) reinstruction (5-7 mins) instrumentation (30-40 mins) treatment of reinfected sites, polishing and fluoride (8 mins)
61
what are periodontal risk assessment spider webs used for?
determining patient risk in the maintenance phase

DEN2SKC (13 decks)

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