Week 6: Diagnoses and Treatment Planning- 1 Flashcards

Question

Describe Chronic Periodontitis

Answer 1

Chronic Periodontitis: * Most prevalent periodontal disease in adults, but may commence in younger patients * Local factors- plaque, calculus, overhangs * Subgingival calculus is usually detected at sites of periodontal pockets * Slow to moderate progression, may have rapid progression, in relation to increased risk * Modified by risk exposures such as tobaccao smoking, diabetes mellitus

Answer 2

Periodontal attachment loss: * Periodontal pockets * Gingival recession * Furcation invovlements (Classes 1-4, or partial/complete) * Tooth loss * Tooth drifting/pathological migration * Tooth hypermobility (Grade I-III)

Answer 3

Agressive Periodontitis: * Rapid periodnotal attachement loss and alveolar bone destruction * Familal aggregation often discovered * Periodontal destruction may ot be commensurate with local factors * May have a specific microbial association and undergo spontaneous remission * Localized: circumpubertal onset, first molar/incisor attachment loss on at least two teeth, and not more than two teeth other than first molars and incisors * Generalized: usually patients under 30, but may be older, attachment loss on three or more teeth other than incisors and first molars

Answer 4

Periodontitis as a manifestation of systemic disease: * associated with haematological disorders, such as leukemias, acuqired neutropenia (drug induced) * associated with genetic disorders such as Down Syndrome, familial and cyclic neutropenia, Papillon-Lefèvre syndrome

Answer 5

The new periodontal classification also classifies peri-implant diseases and conditions unlike the previous.

Answer 6

Periodontal abcess: * localized collection of pus adjacent to a periodontal pocket * occurs due to virulent microorganisms, reduced drainage potential, impaction of a forgein body like calculus, tooth pick etc. * Mostly seen in furcations * Recurrent abcesses may indicate immunocompromise e.g. poorly controlled diabetes * There may be swelling, pust, sinus, tender to percussion (ttp), signs of periodontitis and systemic involvement * periodontal abscesses have a higher incidence amngst patients with pre-existing periodontal pockets

Answer 7

* Intra-oral Periapical radiographs (IOPAs or PAs) are critical in evaluating the periodntal hard tissues * Widening of the periodontal ligaments and horizontal or vertical bone loss is often expected * Insertion of gutta-percha points along a sinus tract or into the periodontal poceket can identify the source of infection

Answer 8

Periapical abscess (usually) has: * Non-vital (tooth) * TTP vertically * May be mbile * Loss of lamina dura on the x-ray Peridontal abscess (usually) has: * Vital (usually the tooth is vital) * Paini on lateral movements * Mobile (usually) * Loss of alveolar crest on the x-ray

Answer 9

* Fleeting sensitivity/pain to hot, cold or sweet with immediate onset * Pain is usually sharp and may be difficult to locate * Quickly subsides after removal of the stimulus * Exaggerated response to pulp testing * Carious cavity/leaking restoration is present * Tooth not TTP * Remove caries, place a sedative dressing/permanent restoration with pulp proctection

Answer 10

* Spontaneous dull, throbbing pain lasts several minutes or hours * Usually worse at night * Pulsiate in nature * Exacerbated by hot and cold * A characteristic feature is that the pain remains after the removal of stimulus * Periapical tissues become more sensitive to pressure * Applicated of heat (e.g. warm gutta-percha) elicits pain * Exaggerated/reduced/no respnse to Eletrical Pulp Testing (EPT) * May become TTP

Answer 11

Dentine hypersensitivity * Pain arising from exposed dentine in repsonse to thermal, tactile, or osmotic stimulus * Dentinal fluid movement stimulate pulpal pani receptors * Prevalence is ~1:7 adults with a peak in young adults * Treatment invovles controlling aetiological factors (oral hygeine instructions, possibly including tooth-brushing technqiue, and intrinsic and extrinsic dental erosion) * Reducing permeablity of dentinal tubules by toothpaste containing strontium/fluoride; placement of varnishes, dentine desensitizers, dentine adhesive systems, resotraiton

Answer 12

Cracked Tooth Syndrome * Sharp pain on biting- short duration, few clinical signs and tricky to diagnose * Tooth often has a large restoratino and crack MAY NOT be apparent * Transillumination/removal of the restoration may aid visualization * There is a positive response to vitality (sensibility) testing * Pain elicitis by biting then releasing on a cotton-wool roll or a 'Tooth Slooth * May be assocaited with a bruxing habit * Direct/indirectio restoration with full occlusal coverage will be needed * Occasionally Root Canal Treatment (RCT) may be required

Answer 13

Periapical/Periradicular Pain * Progression of **IRREVERSIBLE PULPITIS** leads **to PULPAL NECROSIS** * Bacteria by-products lead to inflammatory changes and possibly pain in periapical tissue * Patient can identify the affected tooth, as the periodontal ligament is inflammed * Dull ache exacerbated by biting on the tooth, usully no response to sensibility (vitality) testing unless one canal of a multi-rooted tooth is still vital * The tooth will be TTP * Radiographically there is loss of lamina dura in the periapical region * The apical Perioodontal Ligamen (PDL) may be widened or there may be a periapical radiolucency

Answer 14

Acute Periapical Abscess * Severe pain which will disturb sleep * Tooth is tender to touch * Affected tooth is usually extruded, mobile, and TTP * May be associated with intra-oral/facial swelling/localized intra-oral swelling * Sensibility testing may be misleading as pus may conduct stimulus to apical tissues * Radiographic changes can range from a widended PDL to an obvious radiolucency * It is important to difference this condition from a periodontal abscess * Drain pus and, if indicated, prepare the canal and place a temporary dressing

Answer 15

**LIFE THREATENING (airways can be threatened)- RISKS LUDWIG'S ANGINA**

Answer 16

Prognosis * It is a prediction of the patient's future conditions based on present circumstances * Generally expressed as "excellent", "good", "fair", "poor", or "hopeless" * A prognosis can be made for a tooth, for various treatments or for the patients overall prognosis * Prognosis is aimed to predict the future course of the disease (progression or regression), both with and wihtout treatment * For a specific patient, varying pronoses can be determined for multiple disease processes, as well as for recommended treatments * Although the prognosis for the disease and the treatment may be related, they are not necessairly the same Examples: * A patient with moderate periodontitis may have a "good" prognosis for the control of the disease, but a "poor" prognosis for a long span bridge that is anchored on the invovled teeth * A patient with severe periodontits may be described as having a "poor" prognosis for the control of the disease, but a "good" prognosis for a related treatment such as implant-retained removeable partial denture

Answer 17

Combination Syndrome (CS) is a condition caused by the presence of mandibular anterior teeth no posterior teeth. This results in significant maxillary anterior alveolar resorption. Why is this important? This is important to identify in the first visit because: - Special tray needs to be designed differently. Extra spacing and pressure relief holes are required in this area - Use lower viscosity impression material for the impression - Avoid compressing mucosa in the flabby ridge area when taking impression - Apply seating pressure in the palatal area only to avoid compressing the flabby ridge area (usually in the anterior section). ## Footnote *flabby ridge is combination syndrome and combination syndrome is flabby ridge

Week 6: Diagnoses and Treatment Planning- 1 Flashcards

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