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3rd year dentistry > Periodontology > Flashcards

Periodontology Flashcards

1
Q

What are the types of systemic antimicrobials?

A
  • Amoxicillin 500mg + metronidozole 400mg - Metronidozole alone - Erythromycin - Doxycyclin - Tetracycline
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2
Q

Give the applications of the mini-sickle (red)

A

Red A point scaler with two cutting edges on each blade. Used on buccal and lingual embrasure surfaces supra gingivally

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3
Q

Give the applications of the columbia curette (red)

A

Red A universal curette with two cutting edges on each blade. Used for sub gingival scaling anywhere in the mouth Limited access to deep pokets

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4
Q

Give the applications of the Gracey curette 1-2 (grey)

A

Grey single cutting edge used for fine/deep sub gingival scaling upper and lower anteriors

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5
Q

Give the applications of the Gracey curette 7-8 (green)

A

Green Single cutting edge Buccal and lingual surfaces of posterior teeth

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6
Q

Give the applications of the Gracey curette 11-12 (orange)

A

Orange mesial surfaces of posterior teeth

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7
Q

Give the applications of the Gracey curette 13-14 (blue)

A

Blue distal surfaces of posterior teeth

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8
Q

Give the applications of the hoe scaler 134-135 (yellow)

A

Yellow Gross supra and sub gingival scaling of buccal and lingual surfaces

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9
Q

Give the applications of the hoe scaler 156-157 (red)

A

Red supra and subgingival scaling mesial and distal surfaces

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10
Q

What is necrotising ulcerative gingivitis?

A

A common, non contagious infection of the gums. Acute necrotising ulcerative gingivitis is the usual course the disease takes. If improperly treated NUG may become chronic and/or recurrent

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11
Q

What is necrotising ulcerative periodontitis

A

This is where the infection leads to attachment loss. NUG and NUP are classified together under ‘necrotising periodontal disease’

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12
Q

What is necrotising stomatitis?

A

Progression of NUP into tissue beyond the mucogingival junction. Mostly seen in malnutrition and HIV infection. May result in denudation of the bone leading to osteitis and oro-antral fistulas

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13
Q

List some of the signs/symptoms that a diagnosis of necrotising periodontal disease is based on

A
  • Ulcerated and necrotic papillae and gingival margin resulting in a characteristic punched out appearance. - The ulcers are covered by a yellowish/white/grey slime made of fibrin, necrotic tissue, leucocytes, erythrocytes and mass of bacteria - Lesions develop quickly -Lesions are very painful - Bleeding readily provoked -The first lesions are most often seen interproximally in the manibular anterior region -Foul smell -Ulceration often associated with deep pockets as gingival necrosis coincides with loss of crestal alveolar bone -Sequestrum formation; necrosis of small or large parts of the alveolar bone. Not only interproximal but also adjacent oral and facial bone - Swelling of lymph nodes
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14
Q

What are some risk factors associated with necrotising perio disease (NP)

A

-malnourished - psychological stress - Sleep deprivation -Poor OH -Smoking -Immunosuppresion

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15
Q

Give the four stages of treatment for NP

A

1). Ultrasonic debridment 2). Pain may prevent patient from brushing, instead 0.2% chlorhexidine mw 2 x daily 3). Patients with malaise, fever and lassitude, lack of response to mechanical therapy and impared immunity; 200mg/400mg metronidazole TID for 3 days 4) Smoking cessation, vitamin supplements, dietary advice

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16
Q

What are the stages of biofilm formation?

A

Planktonic cells -> Attachment to surface -> Attached cell monolayer -> cell-cell adhesion and proliferation -> maturation -> detachment

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17
Q

When should local antimicrobials such as periochip and chlorhexidine gel be used?

A

1) Only in persisting pockets >5mm (at review/maintenance visit) 2) Always along with RSD 3) Not many, if a lot of persisting pockts in the quadrant OFD is more beneficial or systemic ABs within 24 hours from starting ABs 4) In case of perio abscesses after evacuation of pus and RSD

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18
Q

Name two antimicrobial antibiotics

A

* Arestin - 1mg minocycline HCl microspheres

* Atridox - doxycycline hyclate 10%

*Elyzol - 25% metronidazole

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19
Q

What are the four types of occlusal forces?

A

*Tension

*Compression

*Viscous forces

*Horizontal forces (constant = orthodontics, intermittent = occlusal ‘jiggling’)

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20
Q

What can non axial occlusal load lead to?

A

Areas of intermittent pressure and tension. This causes hypermobility of teeth and widening of the PDL

21
Q

What is a physiological response of the PDL to occlusal forces?

A
  • PDL width increases until forces can be adequately dissipated, the PDL width should then stabilise
  • Tooth mobility will be increased as a result
  • This can be recorded as successful adaptation to increased demand, therefore physiolocical
22
Q

What is a pathological response of the PDL to occlusal forces?

A
  • If demand of PDL is reduced the PDL width should return to normal (spysiological)
  • If the demand of occlusal forces is too great of the adaptive capacity of the PDL reduced, PDL width may continue to increase
  • PDL and tooth mobility fail to reach a stable phase
  • This failure of adaptation is regarded as pathological
23
Q

When should tooth mobility due to occlusal forces not be accepted?

A
  • If it is becoming increasingly worse
  • If it gives rise to symptoms
  • It creates difficulty with resortative treatment
24
Q

What three treatments are available to reduce tooth mobility?

A
  • Correction of plaque induced inflammation
  • Correction of occlusal relations (selective grinding, restorations, ortho)
  • Splinting
25
Q

When is splinting of mobile teeth appropriate?

A
  • mobility is due to advanced loss of attachment
  • Mobility is causing discomfort or difficulty in chewing
  • Teeth need to be stabilised for debridement
26
Q

What are some reasons for tooth migration?

A
  • Loss of perio attachment
  • Unfaviourable occlusal forces
  • Unfavourable soft tissue profile
27
Q

What are some treatment options for a deep traumatic over bite?

A
  • Treat plaque related inflammation
  • Relieve trauma (occlusal splint - palliative. Orthodontic/orthognatic treatment. Restorative; must include occlusal stops for ant teeth)
28
Q

Define periodontal disease (gingivitis/periodontitis)

A

A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque.

  • Gingivitis does not always progress to periodontitis.
  • Periodontitis may progress at different rates at different sites in the mouth and in different people
29
Q

What is periodontal health?

A

The outcome of the balance between bacteria of the dental plaque and the host immune system

30
Q

What are some modifying risk factors associated with periodontal disease?

A
  • Smoking
  • Systemic diseases (diabetes melitus, leukaemia, HIV, osteoperosis, osteopenia)
  • Stress
  • Drugs (calcium channel blockers, immunosuppresants, anti-convulsants)
  • Nutrition and obesity
  • Pregnancy
31
Q

What are some risk determinants of periodontal disease?

A
  • Genetic polymorphism can affect expression levels of genetic products.
  • Sex
  • Genetic disorders and syndromes
  • Socio-economic status
32
Q

What are some local risk factors of periodontal disease?

A

Plaque retentive factors such as; calculus, restorations, carious cavities, partial dentures, orthodontic appliances, malpositioned teeth

Other factors such as traum from occlusion and insufficient oral hygiene

33
Q

Explain how smoking can have an impact on periodontal health

A
  • Effect on oral microbiota
  • Increased activation of the immune system
  • Decreased healing capacity (reduced blood flow)
34
Q

What drugs can have an impact on gingival health and how can this present?

A
  • Anti-convulsants such as phenytoin.
  • Immunosuppresants (in implant patients)
  • Calcium channel blockers (nifedipine, amlodipine)
  • Can cause ginigival enlargement = more fibroblasts
  • Can cause gingival swelling = more intercellular fluid, increased permeabilisation of the vessels
35
Q

What is the biological width?

A
  • On average is approximately 2mm
  • The natural distance between the base of the gingival sulcus and the height of the alveolar bone.
  • Biological width is the distance established by the junctional epithelium and the connective tissue attachment to the root surfcace
36
Q

There are 7 stages of tissue healing following gingivectomy, what are they?

A

1) Vascular granulation tissue grows coronally, creating new free gingival margin and sulcus
2) Cells advance and become fixed to substrate by hemidesmosomes and new basement lamina 5-14days
3) Vasolilation and vascularity begin to decrease after the fourth day of healing and are normal by 16 days
4) Flow of GCF initially increased after gingivectomy maximal at one week (time of maximal inflammation)
5) Capillaries derived from blood vessels of PDL migrate into granulation tissue and connect with gingival vessels (within two weeks)
6) Surface epithelialisation complete at approx 14 days, complete epithelial repair takes about one month
7) Complete repair of connective tissue takes about 7 weeks

37
Q

Give some ways to achieve predictable aesthetics with metal ceramic and all ceramic crowns

A
  • Aesthetics success has more to do with soft and hard tissue management than choice of restoration.
  • Imperative to bring gingival tissues to optimal health prior to treatment
  • Attain optimum soft tissue health prior to impression making
  • Minimis iatrogenic soft tissue trauma during margin placement and gingival displacement procedures
  • Provide provisional restorations of excellent quality
  • Eliminate all excess temporary cement
  • Wait an appropriate time to allow tissues to heal after perio surgery therapy
38
Q

What are the aims of the 2018 periodontal classification?

A
  • Capture the extent, severity (amount of periodontal tissue loss)
  • Patient susceptibility (estimated by historical rate of progression)
  • Current periodontal state (pocket depths/BoP)
  • A system that can be further proffed for update with new biomarker information
39
Q

What are the four staging categories of periodontal disease?

A
  1. Early/mild. Interproximal bone loss at worst site <15% or 2mm
  2. Moderate. Bone loss; coronal third of root
  3. Severe. Potential for additional tooth loss. Bone loss; mid third of root
  4. Very severe. Potential for loss of dentition. Bone loss; apical third of root

*Use maximum bone loss at worst site. If BWRs are all that’s available, measure from CEJ. If known to have lost teeth due to periodontitis - can be assigned stage four

40
Q

What are the three categories of grading periodontal disease?

A

A. Slow. <0.5 (max bone loss less than half patients age)

B) Moderate. 0.5-1

C Rapid. >1.0 (max bone loss more than patients age)

41
Q

How is local and generalised periodontal disease or gingivitis defined?

A

< 30% is of teeth/gums affected = localised

> 30% teeth/gums affected =generalised

42
Q

How do you carry out an assessment of current periodontitis status?

A

*Currently stable - BoP <10%. PPD <4mm. No BoP at 4mm sites

*Currently in remission - BoP >10%. PPD <4mm. No BoP at 4mm sites

*Currently unstable - PPD >5mm or PPD >4mm and BoP

43
Q

How should a statement of periodontal diagnosis be stated?

A
  1. Extent 2. Periodontitis 3. Stage 4. Grade 5. Stability 6. Risk factors
44
Q

What is the BPE?

A

The BPE is a screening tool employed to rapidly guide clinicians to arrive at a provisional diagnosis of periodontal health, gingivitis or periodontitis, irrespective of historical attachment loss and bone loss. As such, the BPE guides the need for further diagnostic measures prior to establishing a definitive periodontal diagnosis and appropriate treatment planning

45
Q

What are the definitions of periodontal health?

A
  • Patients with an intact periodontium
  • Patients with a reduced periodontium due to causes other that periodontitis
  • Patients with a reduced periodontium due to periodontitis
46
Q

Describe gingival health

A
  • Clinical gingival health on an intact periodontium is characterised by the absence of BoP, erythema and edema, patient symptoms, and attachment and bone loss
  • Physiological bone levels range from 1-3mm apical to the cemento-enamel junction
  • For an intact periodontium and a reduced and stable periodontium, gingival health is defined as <10% bleeding sites with probing depths <3mm
47
Q

What are some modifying factors of plaque induced gingivitis?

A
  1. Associated with bacterial dental biofilm only
  2. Systemic conditions (sex steriod hormones, hyperglycemia, leukaemia, smoking, malnutrition). Prominent subgingival restoration margins. Hyposalivation
  3. Drug influences gingival enlargements
48
Q

Give some non plaque induced gingival diseases and conditions

A
  • Genetic/developmental disorders eg hereditary gingival fibromatosis
  • Specific infections eg herpetic gingival stomatitis
  • Inflammatory/immune conditions eg lichen planus or benign mucous membrane pemphigoid
  • Traumatic lesions
  • Gingival pigmentation
49
Q

What are the three recession types in relation to mucogingival deformaties and conditions?

A
  • Recession Type 1 - gingival recession with no loss of interproximal attachment. Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth
  • Recession Type 2 - Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the depth of the interproximal sulcus/pocket) is less than or equal to the buccal attachment loss
  • Recession Type 3 - Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss, is greater than the buccal attachment loss

3rd year dentistry (16 decks)

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