Perio Flashcards by Siobhan Cook

What is the likely cause of the gingival recession seen in the lower anterior sextant?

Traumatic overbite

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When would mechanical root surface debridement not be successful in eliminated pocket bacteria?

* Difficulty with access (especially in furcation). * Non compliant patient. * Inadequate RSD/inexperience of clinician. * Patient is immunocompromised. * Sites inaccessible to instruments. * Failure to disrupt biofilm

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When would antibiotics not be effective in periodontal disease?

* Antibiotics resisted by biofilms. * Concentration inadequate and not within the therapeutic range. * May not reach site of disease activity

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How would you manage a periodontal abscess with systemic involvement?

* Incision and drainage. * Gentle sub-gingival debridement. * HSMW * Extraction of tooth if poor prognosis. * Antibiotics * Follow up HPT

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What would be clinical signs of improved periodontal health?

* Reduced probing depth (<4mm). * BoP <10%. *Plaque scores <15%

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*A photo showing a space between 13 and 14*
What investigations should be carried out and why?

* BPE; a screening tool for periodontal health. *PGI to assess plaque and bleeding levels. *6PPC to assess periodontal disease. * Periapicals to assess prognosis of teeth, drifting by periodontal disease. * Study models (offers a point of reference)

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What bacteria are involved in ANUG?

P. Intermedia and fusobacterium as well as spirochetes such as treponema

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What are the clinical signs and symptoms of ANUG?

* Blunting of interdental papilla. * Halitosis. * Grey slough that wipes off to reveal ulcerative tissue. * crater like ulcers. * Reverse gingival architecture

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List 5 risk factors for ANUG

* Age (young) *Stress *Poor OH *Immunocompromised (HIV) *Smoking

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Briefly outline management of ANUG

* Ultrasonic debridement *Oxygenating MW (hydrogen peroxide 3%) *OHI modified for patient *Consider Chlorhexidine *Smoking cessation if needed * ABs if systemic or immunocompromised (Metronidozole 200mg 3 x daily for 3 days)

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Patient is obese and a reformed smoker, history of ischemic heart disease. Despite excellent OH he still has pockets of 6/7mm that BoP. You elect to undertake open flap curretage. What do you discuss with the patient to get informed consent?

* Risks; gingival recession, infection, pain, bleeding, swelling, bruising. *Benefits; effectively debride area with direct vision *Outcomes; possible reduction of pocket depths *Other treatment options; Repeat NSPT *Risks of no treatment; increase in pocket depth, increase in mobility, increased risk of tooth loss

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A patient has just completed surgical periodontal therapy, when should the patient be reviewed and what is the rationale?

8 weeks to allow sufficient time for healing.

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What are the clinical signs of improved health following HPT?

* Pocket depths <4mm *BoP <10% * Plaque score <15%

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Why might antibiotics not work for chronic periodontal disease?

* Biofilms resistant to antibiotics. * Antibiotic resistance. * Antibiotics inactivated by first pass metabolism. * Poor patient adherence to regime

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Describe how a modified plaque score is recorded

* Recorded for every patient

* 16, 21, 24, 36, 41, 44 (Ramfjords teeth)

* Each tooth is split into buccal/lingual.interproximal surfaces

* 2 = visible plaque

1 = Plaque revealed with probe

0 = no plaque

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Describe how a modified bleeding score is recorded

* Recorded for every patient

* Measures marginal bleeding rather than BoP

* Each Ramfjords tooth has a perio probe run gently at 45 degrees around the gingival sulcus in a continuous sweepl For up to 30 seconds after probing, check for the presence or absence of bleeding.

* mesial, distal, buccal, lingual

* Score of 1 or 0

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What are the four stages of periodontal disease?

Worst site of bone loss is used

Stage 1; (early/mild) <15% or <2mm from CEJ

Stage 2; (moderate) Coronal third of root

Stage 3; (severe) Mid third of root

Stage 4; (very severe) Apical third of root

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How is periodontal disease graded?

% of bone loss divided by patients age

Grade A slow rate of progression, <0.5

Grade B Moderate rate of progression, 0.5-1

Grade C Rapid rate of progression >1

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How do you rate the assessment of current periodontal status?

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

PPD >/= 4mm and BoP

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What clinical and lab investigations can be carried out to help aid a periodontal diagnosis? (3marks)

* Thorough history including family history.

* Periodontal pocket chart

* Microbiological analysis of swab of crevicular fluid

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In a patient with periodontal disease, how would you decide the prognosis for individual teeth? (3)

* Loss of attachment

* Mobility

* Furcation involvement

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What are some proposed biofilm resistance mechanisms?

*Antimicrobials may fail to penetrate beyond the surface layers of the biofilm

*Antimicrobials may be trapped and destroyed by enzymes.

*Antimicrobials may not be active against non-growing microorganisms

*Expression of biofilm specific resistance genes (eg efflux pumps)

*Stress response to hostile environment conditions

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Give 3 features of apical periodontitis

*Chronic poly-microbial infection

*Stimulation of host response

*Connective tissue destruction

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Besides the lower anterior sextant, where else might you expect to see signs of a traumatic overbite?

Study These Flashcards

Palatal gingivae of upper anteriors

Having completed a history, examined the soft tissues, charted the teeth and restorations present and examined the occlusion, list 5 other investigations you would perform.

\* BPE \* Full periodontal chart as indicated \* Clinical photographs \* Plaque and bleeding indices \* Radiographs \* Study models \* Mobility scores \* Sensibility testing

List two generatl approaches to this patients initial treatment

\* Hygiene phase therapy \* A bite raising appliance

At a re-evaluation appointment there are no deep pockets and the patients oral hygiene is excellent. But the lower incisors are still mobile and causing the patient concern, what further treatment would you offer to manage the mobility?

A lingual bonded splint. This would only be indicated if the patients oral hygiene is very good as in this case

Give four indications for the use of chlorhexidine mouthwash?

Pre surgery Post surgery Denture induced stomatitis Medically impared (case selective) Acute necrotising ulcerative gingivitis Treatment in dry socket Endo irrigant High caries risk (individual dependent)

What 3 features on a PA would lead you to a diagnosis of Generalised Aggressive Periodontitis?

\* Bone loss affecting at least 3 teeth \* Age of the patient \* Patient otherwise fit and well \* Vertical bony defects \* Rapid progression of bone loss

What clinical and lab investigations could you carry out for a pt with periodontitis?

Thorough history inc family history Periodontal pocket chart Microbiological analysis of sample (swab of crevicular fluid)

In a patient with periodontal disease, how would you decide the prognosis of each tooth?

Loss of attachment Mobility Furcation involvement

In what ways would you provide post perio surgery advice for a patient, and what would you like them to know to avoid post op complications?

\* Verbal and written \* Avoid smoking for one week if possible \* Avoid rinsing for that day, can rinse from the following day \* Avoid strenuous exercise \* Rinse with CHX mw 2 x daily 0.2% 10ml

How do you manage a perio abscess with sytemic involvement?

\* May require LA \* Achieve drainage via pocket or incision \* Gentle RSI short of the base of the pocket to avoid trauma \* Advise on analgesic use \* Give OHI including use of CHX mw until acute symptoms subside \* Provide antibiotics due to systemic involvement 500mg amoxicillin or 400mg metronidazole both 3 x daily for 5 days \* Review in ten days

What is a periodontal abscess?

Acute exacerbation of an existing periodontal pocket eg trauma or obstruction. Caused by food packing or inadequate RSD

What are some signs and symptoms of a periodontal abscess?

Pain on biting or spontaneously TTP Swelling Pus Pocketing at swelling Mobility

How is a periodontal abscess differentiated from a periapical abscess?

Sensibility testing vital vs non vital Also consider perio status of the rest of the mouth

How do you manage occlusal trauma in a patient with periodontal disease?

Address the cause; ease high restorations, address parafunction Bit raising appliance for night time wear HPT

What factors can influence localised mobility?

\* Existing periodontal disease \* Occlusal trauma causing widening of PDL \* Morphology and length of roots \* Alveolar bone loss \* Resorption/trauma

When might splinting be advised in a periodontitis patient?

Mobility due to advanced loss of attachment Mobility is causing discomfort or difficulty eating To facilitate RSD

Why is there a decease in mobility following perio treatment?

Increased tissue tone and long junctional epithelial attachment

What can be done if the PDL is still widened after successful treatment?

Reduce occlusal contacts

How are localised and generalised aggressive periodontitis different?

Local - localised LOA, 6s, incisors, initially occurs around puberty, robust antibody response General - Generalised LOA 6s, incisors and 3 + other teeth Onset usually under 30 years Poor serum antibody response Episodic nature

What bacteria is involved in aggressive periodontitis?

AA Porphymonas gingivalis

How is aggressive periodontitis initially managed?

Non surgical sub gingival PMPR. 2 weeks CHX mw and spray ABs (amoxicillin or metronidazole) Refer to specialise within 6-8 weeks

In periodontitis, what features would indicate a tooth had poor prognosis and why?

Mobility - reduced bone support Furcation involvement - more difficult to keep clean LOA - less supporting structures for tooth Loss of vitality

Diagnose

Angular bone loss

Besides clinically and radiographic, what other two pieces of information are needed before determining prognosis of teeth?

Smoking history Drug history Systemic disease

How is localised angular periodontitis caused?

When pathway of inflammation travels directly into PDL space, localised plaque retentive facors

How does a healthy periodontium react to occlusal trauma?

PDL widening - mobility No LOA or inflammation Will resolve when occlusion addressed

What category of drug is chlorhexidine?

Bisbiguanide antiseptic

What is the substantivity of CHX

12 hours

Give two commonly prescribed doses of chlorhexidine

0. 2% 10ml/ 20mg 2 x daily 0. 12% 15ml/18mg 2 x daily

Name four side effects of CHX

Staining Taste disturbance Salivary gland enlargement Anaphylaxis Interacts with SLS

List 8 uses for chlorhexidine

Surgical pre op rinse

What is TIPPS?

Delivery method of OHI Talk, instruct, practice, plan, support

What 7 things are recorded on a periodontal pocket chart?

Missing teeth Gingival margin Pocket depth LOA Mobility Furfaction BOP

Give two disadvantages of a pocket chart

Assumes all patients have same root length so may appear worse than it is Pobing depths are subjective/variation between clinicians

What are the local factors for gingival recession?

Periodontal disease Habits Traumatic tooth brushing Abraisive toothpaste High frenal attachment Crowding Traumatic overbite Orthodontic treatment Poor marginal fit restorations

How can localised recession be managed?

Atraumatic toothbrushing technique Minimise other risk factors Monitor Treat sensitivity Free/pedicle soft tissue graft Coronal advancement flap

Perio Flashcards

(59 cards)