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Periodontics Summer Final
Terms in this set (128)
What must be completed in the Periodontal Chart during a DW?
- Complete probing depths w/ plaque scores & calculation of CAL (measurement from GM to CEJ)
- Bleeding on probing
- Furcation involvement
The weakest part of the gingival attachment is at the __________ which is usually found _____________.
- Found under the contacts of molars
Where should a tooth be probed during periodontal charting? How much force should be used?
- 6 points: MB, midbuccal, DB, ML, midlingual, and DL
- 25 grams
The distance from the gingival margin to the base of the pocket is the __________. The distance from the CEJ to pocket depth is the ____________.
- Pocket depth
The normal position of the gingival margin interproximally is __________ the CEJ. This should record as a __________ number in Axium.
- Above the CEJ
- Negative number
Where can the furcations be probed in maxillary and mandibular molars?
- Maxillary: mid-buccal, DP, and MP
- Mandibular: mid-buccal & mid-lingual
Why is the distopalatal furcation of maxillary molars under the contact point but the mesiopalatal furcation is slightly palatal?
- The MB root is often much larger than the DB root
Svardstrom and Wennstrom found a greater prevalence of furcation involvement in mandibular molars than maxillary molars. The highest frequency of involvement was the distal aspect of the maxillary first molar. The lowest frequency of involvement was on the buccal of mandibular molars.
- False: greater in maxillary molars than mandibular molars
- False: lowest frequency on mesial of maxillary second molar
Describe the Grades of Furcation Involvement.
- Grade I: incipient, furcation barely detectable
- Grade II: probe goes into furcation, cul de sac
- Grade III: through and through but not clinically visible
- Grade IV: through and through & clinically evident
What is the average length of root trunks on molars?
- 3mm on mesial of upper, 4mm on buccal, 5mm on distal
- 3mm on buccal of lower, 4mm on lingual
Describe mucogingival involvement during periodontal charting.
- This is where the pocket depth is greater than the width of kertinized tissue (i.e., the patient has no attached tissue & the pocket depth extends into unattached mucosa)
Describe the Miller Classification of Mobility.
- Class 0: normal
- Class I: mobility greater than physiologic
- Class II: mobility of 1mm or greater
- Class III: mobility of 1mm or more, depressible in socket
What is looked at during the Radiological Findings section of the DW?
- Appearance of bone: trabeculation, root proximities
- Alveolar bone morphology, crestal lamina dura, bone loss patterns
- Peri-radicular bone appearance: radicular LD, PDL space, abnormal radiolucenies & radiopacities
- Dentition: missing teeth, calculus, overhangs, CRR, endo, implants, supernumerary teeth, etc.
A panoramic radiograph may be used for periodontal diagnosis and treatment planning. Horizontal bite-wing radiographs are preferred for periodontal treatment planning.
- False: a complete intra-oral series must be used for this
- False: vertical bitewings are typically preferred as horizontal bitewings can miss some of the crests of the LD with advanced perio
What is the difference in horizontal and vertical bone loss?
- Horizontal bone loss is typically generalized alveolar bone that is parallel to the CEJs of adjacent teeth
- Vertical bone loss is typically localized with alveolar bone that is not parallel to the CEJs of adjacent teeth
What is fremitus?
- Functional mobility which may be observed & should be recorded
When recording information about the gingival appearance, what should be noted?
- Any swellings, erythema, recession, blunting of the papillae, and lesions noted including on the lips, cheeks, and FOM
What is recorded during the occlusal analysis of the DW?
- Angle's Classification
- Wear Facets
- Opening deviations
- Protrusive excursions
- Centric prematurities
- Left/right lateral excursions
What is the primary etiologic factor for periodontal disease? Secondary factors?
- Plaque w/ host response
- Calculus, open margins, overhangs, malposed teeth, parafunctional habits, medications w/ xerostomia
Type II and III cases are classified as _______________ and further broken down into these two groups: ____________ and ____________.
- Chronic Periodontitis
- Localized (<30%) and Generalized (>30%)
The severity of Chronic Periodontitis can be broken down into what 3 groups?
- Mild: 1-2mm of CAL
- Moderate: 3-4mm of CAL
- Severe: >5mm CAL
You have a patient who has 168 probing sites. Of those, 130 probing sites show periodontal involvement w/ 15 sites >5mm CAL, 80 sites with 3-4mm CAL, and 45 sites with 1-2mm CAL. Diagnose the patient.
- Generalized Moderate Chronic Periodontitis
During the Systemic Phase of the DW form, what should be considered?
- Medical consults for anything picked up during the history & any recommendations made by the physician, such as prophylactic antibiotics or DM control
What occurs during the Hygienic Phase of treatment?
- Phase I includes OHI, SRP, interdisciplinary consults (endo, ortho, restorative, etc.), establishment of tentative restorative plan, re-eval in 4-6 weeks
When determining the prognosis of each tooth during the DW, what do you base the prognosis off of?
- General knowledge of the pathogenesis of the disease and the presence of the risk factors for the disease along w/ the condition of each tooth
List clinical, systemic, local, anatomic, and prosthetic factors associated w/ prognosis for each tooth.
: age, disease severity, plaque control, patient compliance
: smoking, systemic disease, genetic factors, stress
: plaque, calculus, subgingival
: short roots, cervical enamel projections, enamel pearls, root concavities, root proximity, developmental grooves, furcation involvement, tooth mobility
: abutment selection, caries, non-vital teeth, root resorption
Describe "Good, Fair, Poor, Questionable, and Hopeless" prognoses for teeth according to McGuire and Nunn.
: control of etiologic factors, adequate peridontal support
: up to 25% CAL or Class I furcation involvement
: up to 50% CAL or Class II furcation involvement
: >50% CAL, poor CRR, poor root form, deep Class II furcation, Class III furcation, > Grade 2 Mobility
: inadequate attachment to maintain health, comfort and function, non-restorable teeth
What are the 3 main components to a Periodontal Hand Instrument?
- Blade (the probe has a calibrated working end instead of a blade)
Periodontal probes are used to measure _____ and are calibrated in _____.
- Depths of pockets
The _____ probe is used to measure PDs in WREB. Furcation areas are best measured with the _____ probe. The _____ explorer is used for WREB.
- Marquis probe
- Nabers probe
- ODU 11-12
What is the purpose of the ODU 11-12 periodontal explorer?
- Used to located Subgingival calculus deposits and to check root smoothness after root planing
Describe the Sickle Scaler instruments:
- # of cutting edges
- Location of use
- Type of movement used
- 2 cutting edges that converge to a sharp point
- Supragingival calculus primarily
- Used w/ a Pull stroke
Subgingival adaptation around the root is better w/ a curette than w/ a sickle scaler. Sickle scalers are contraindicated for supragingival use.
- False: contraindicated for subgingival use
Why are Sickle scalers contraindicated for subgingival use?
- Sharp cutting edge can lacerate gingival tissue easily
- Cannot be used adapted to root concavities: results in gouging of the root surface
- Too bulky to go subgingival well
How is a curette different than a sickle scaler?
- Curette is finer and has a rounded toe to access deep pockets
- In cross-section the curette blade appears semi-circular w/ a convex base
What is the instrument of choice for removing deep, subgingival calculus? What else does this instrument do?
- Removes altered root cementum, removes soft tissue lining of periodontal pocket
What are the 2 main types of Curettes in the periodontal kits that we use?
- Universal Curettes
- Gracey Curettes
What are the differences between Universal and Gracey curettes?:
- Location of use
- Cutting edges
- Universal may be used for all areas and surfaces while Gracey curettes are area specific
- Universal curettes have 2 cutting edges while Gracey curettes have 1 cutting edge
- Universal curettes curve in 1 plane while Gracey curettes curve in 2 planes
- Universal curette blades are 90° to shank; Gracey curette blades are offset 60-70° to the shank
Which Gracey curette is used for the Anterior teeth? Mesials of posterior teeth? Distals of posterior teeth?
- Anterior: Gracey #1-2
- Mesial: Gracey #11-12
- Distal: Gracey #13-14
What instruments must be used to Scale and Curette Implants?
Plastic and Titanium instruments
must be used for Implants
List the General Principles of Instrumentation.
- Accessibility: patient and operator position
- Visibility: illumination and retraction
- Maintenance of a clean field (remove blood and excess saliva w/ suction & gauze)
- Instrument Condition & sharpness
- Instrument Stabilization (finger rests)
- Instrument Activation
- Instrument Choice
What are the cleaning and polishing instruments used in perio?
- Rubber cups
- Bristle brushes
- Dental floss/tape
- Air/powder polishing
When sharpening a perio instrument, what is important to remember?
- Evaluate sharpness w/ plastic stick
- Use of India/Arkansas stone
- Principles of sharpening
Periodontal disease is largely preventable with a large portion of many diseases due to behavioral or lifestyle choices. Human teeth along with many non-human teeth are self-cleansing.
- False: unlike non-human teeth, human teeth are not self-cleansing and accumulate plaque and microflora
What are the risk factors that play a role in periodontal disease expression?
- Subgingival flora
- Systemic disease
Describe the relationship between OH and gingivitis; describe relationship between OH and periodontitis.
- OH and gingivitis is simple: no OH, you get gingivitis after 2 weeks
- OH and periodontitis is complex: not everyone with gingivitis progresses to periodontitis (many other factors play a role)
The foundation of periodontal health and therapy is ____________.
- Adequate home care
Cariogenic plaque and periodontopathogenic plaque are similar in composition. OH refers to efforts made at home to remove supragingival plaque.
- False: they are different kinds of plaque; cariogenic is S. mutans that make acids while periodontopathogenic plaque are anaerobes that are free-living and motile
What did the Magnusson Study in 1984 show?
- Without proper OH instructions, patients who received SRP had as bad or worse periodontal flora than prior to the cleanings at 14 weeks
- With proper OH instructions, patients who received SRP were significantly healthier w/o periodontal pathogens
What is the code for OHI? At what appointments should OHI be reviewed?
Describe the procedure of OHI.
- Apply disclosing solution & calculate plaque %
- Hand patient mirror and show where OH was inadequate
- Discuss etiology of biofilm
- Brush patient's teeth w/ proper technique & let them brush the other half w/ corrections as needed
- Positive reinforcement w/ good brushing
We want our DW/SRP patients to have a plaque index of _____% or lower.
If the patient is a poor brusher, when should flossing be taught?
- At an appointment after when proper brushing as been achieved
What type of bristles on the toothbrush head are the most damaging to the gingiva? What is the diameter of most bristles?
- Hard & cut bristles compared to soft & rounded bristles
- Stated to be around 0.007"
What is the Bass-Sulcular Horizontal Technique of toothbrushing?
- Emphasizes sulcular brushing
- Bristles are angled at 45 degrees toward the sulcus & moved horizontally in short strokes allowing for penetration up to 1mm into the sulcus
What are the three keys to effective brushing?
- Adequate time for brushing
- Systematic approach
- Interdental aids required to clean interproximally
What does the choice of interdental aids depend on?
- Size and shape of the interdental embrasure and the degree to which soft tissue fills the space
Dental floss is the __________ common interdental cleaning aid. What is the difference in waxed and unwaxed floss? Which removes plaque better?
- Most common
- Waxed floss flosses between contacts easier
- Both remove plaque to a similar degree
Flossing aids provide a superior removal of plaque compared to normal floss. Floss should be made into a "C" shape around each tooth and moved in an apiocoronal direction for adequate plaque removal.
- False: some patients just prefer these compared to using their fingers
What are the other inter-dental cleaning aids available?
- Stimudent: more common in Europe, larger
- Toothpick Holder: move along gingival margin & under contacts
- Interdental Brush: used w/ open contacts, may damage gums
What is the most common method of chemical plaque control?
- Mouthrinse, such as Listerine
A prophy and a periodontal maintenance appointment are the same billing code.
- False: a prophy is a cleaning in a patient with no history of periodontitis; a preventive procedure
What are the codes for a Prophylaxis and a Periodontal Maintenance?
- D1110: 45 minutes
- D4910: 1 hour
What occurs during the Periodontal Maintenance Hour?
- Full mouth ultrasonic debridement
- Hand scaling
- Focused instrumentation on "active" sites with BOP or probing depths >5mm
According to Schallhorn and Snider in 1981, how long does a typical Periodontal Maintenance appointment take?
- 52.61 minutes
How are pathogens transmitted from person to person?
- Source of infectious microorganisms infects a susceptible host
- Susceptible host can transmit the microorganisms
Where does PPE break the chain of pathogen transmission?
- Stops the transmission of microorganism from a susceptible host to another person
High-speed handpieces create airborne contaminants from the saliva, tissues, blood, plaque, calculus, and fine dental debris. How do they get transmitted through airborne means?
- Exist in form of splatter, mists, and aerosols
Define splatter, mist, and aerosol.
: large, visible particles which are 50uM or larger that fall w/in 3 feet of the patient's mouth
: droplets that approch or exceed 50uM that settle after 10-15 minutes
: invisible particles that range from 0.5 to 50uM and can float in the air for hours
Define Standard Precautions.
- The minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient in any setting where the healthcare is delivered.
List what Standard Precautions should always be taken.
- Hand hygiene
- Use of PPE
- Respiratory hygiene/cough etiquette
- Sharps safety
- Safe injection practices
- Sterile instruments/devices
- Clean/disinfected environmental surfaces
What other methods can be used to reduce microbial exposure?
- Pretreatment mouthrinse
- Rubber dam
- High velocity air evacuation
What are the 6 routes of transmission? Describe each.
: drops containing microorganisms generated during coughing/sneezing/etc. touch the eye, nose, or mouth
: droplet nuclei or dust particles enter upper/lower respiratory tract
: instect/animal transmits pathogen from one host to another
: fomite, due to contact w/ a contaminated surface
: requires physical contact between infected and susceptible person
: enter body after ingestion from contaminated food/water source; shed in feces
Which of the 6 routes of transmission are of the most concern for dental personnel?
- Direct contamination w/ bodily fluids
- Indirect contamination w/ contact of unprotected operatory surfaces during treatment
What pathogen has the greatest blood-borne risk for heathcare workers?
- Hep B
- This is the most infections blood-borne pathogen known and transmitted by percutaneous or mucosal exposure to blood or body fluids from an infected person
List some examples of how someone was infected w/ HCV.
- IV drug abuser
- Multiple tattoos or body piercings
- Transfusion recipients
- Blood dyscrasias requiring multiple transfusions
Describe how HIV is passed from person to person.
- Sexual contact or sharing needles with an infected person (or blood transfusions)
How is MTB transmitted from person to person?
- Airborne droplets generated from sneezing, coughing, or speaking which are inhaled by susceptible individuals
List the most common infections that are spread from person to person from most to least common.
- HBV: 6-30%
- HBsAg+ & HBeAg+: 22-31%
- HBsAg+ & HBeAg-: 1-6%
- HCV: 1.8%
- HIV: 0.3%
Bloodborne pathogens are commonly spread through the aerosols created by high-speed handpieces. Hands are the most common mode of pathogen transmission.
- False: to date, there has been no evidence to show blood-borne pathogens can be created into aerosols
What is the most and least effective method of hand hygiene?
- Surgical antisepsis
- Alcohol based hand rub
- Antiseptic hand wash
- Handwash w/ plain soap
When should healthcare workers wash their hands?
- When visibly dirty
- After touching contaminated objects w/ bare hands
- Before glove placement & immediately after removal
What are common errors in infection control?
- Surface contamination: table, drawer handles, computer mouse, keyboard, etc.
- Inapproprate mask/eye wear
- Inadequate cleaning of suction, tubes, or chair
- Untied hair on patient's face
What is the rationale for preparation of the periodontium for restorative dentistry?
- Establishment of stable gingival margin
- Provision of adequate tooth length for tooth preparation, impression making, and finishing of restorative margins, and retention of final restorations
What Periodontal treatment should be done prior to operative procedures?
- Control of Active periodontal inflammation through both non-surgical and/or surgical means
- Preprosthetic periodontal surgery
Describe the control of active disease.
- Emergency treatment to alleviate symptoms and stabilize acute infection
- Extraction of hopeless teeth
- Oral hygiene instructions (though not effective in treating pockets >5mm)
- SRP w/ OHI to reduce gingival inflammation and prevent progression of periodontitis
- Re-evaluation to determine OH success
What pre-prosthetic surgery is completed prior to restorations?
- Mucogingival problems
- Ridge preservation following tooth extractions
- Crown lengthening
- Alveolar ridge reconstruction
Why can crown margins not extend past the MGJ?
- They have a decreased prognosis if the pocket/margin is past the MGJ
What are the indications for surgical crown lengthening?
- Subgingival caries or fracture
- Inadequate clinical crown length for retention (
- Unequal or unesthetic gingival heights (
What are the contraindications for surgical crown lengthening?
- Surgery would create and unesthetic outcome
- Deep caries or fracture would require excessive bone removal on contiguous teeth
- Tooth is a poor restorative risk
What biologic considerations need to be considered w/ surgical crown lengthening?
- Margin placement w/in biologic width
- Margin placement guidelines
- Provisional restorations
- Marginal fit
- Crown contour
- Subgingival debris
- Hypersentitivity to dental materials
When placing restorations, what can cause periodontal problems?
- Biologic width violation
- Poor provisional restorations
- Poor marginal fit
- Overcontoured restorations
- Subgingival debris
- Hypersensitivity to dental materials
What are the 3 options for Margin placement? Which ones are or are not well tolerated from a periodontal perspective?
- Supragingival: well tolerated
- Equigingival: well tolerated
- Subgingival: not well tolerated w/ greatest biologic risk due to violating the gingival attachment apparatus
What is the biologic width? What is the average width?
- The space that is located between the base of the sulcus and the crest of the alveolar bone
What tissue is found in the Biologic width?
- Connective tissue attachment
- Junctional epithelial attachment
What are the consequences of biologic width violation in these types of tissues?
- Thin, scalloped gingival biotype
- Thick, flat gingival biotype
- Thin: unpredictable bone loss and gingival recession
- Thick: gingival inflammation develops w/ unchanged bone level
What are the treatment options for a biologic width violation?
- Crown lengthening surgery: move bone away from the margin
- Orthodontic extrusion: move margin away from the bone
How do you accurately determine the actual Biologic width? The biologic width can range from _____ to _____ mm (average of 2mm).
- Bone sounding: push sterile periodontal probe through numb tissues from the sulcus to the underlying bone.
- Bone sounding measurement - Sulcus depth = Biologic width
- 0.75mm to 4.3mm
A margin placed in a deep sulcus is more likely to encroach on the biologic width. A margin placed in a shallow sulcus is more likely to have gingival recession.
- False: shallow sulcus more likely to encroach the biologic width
- False: deep sulcus more likely to have gingival recession
Even in health, the periodontal probe will enter about _______mm into the JE, so add that to the width of the biologic width.
- 0.5 to 1mm
How can a provisional restoration affect the success of the final restoration?
- Tissue architecture can be damaged by a poor interim restoration due to a rough or porous material surface, poor marginal fit, or overcontouring
An increase in the amount of marginal opening ____________ the gingival inflammation around a provisional restoration.
- Increases due to increased bacteria
How does a provisional crown contour affect the final restoration?
- Good contour allows for proper hygeine & looks good in esthetic areas
- Overcontoured restorations are a result of under-prepped areas by the dentist and increase gingival inflammation
- Under-contoured restorations don't increase periodontal effects but aren't as esthetic
How does subgingival debris affect the longevity of a restoration?
- Debris causes gingival inflammation following restorations
- Most commonly, cements, impression materials, temporary materials, or retraction cords
_____ allergy is the most common hypersensitivity to dental materials. Hypersensitivity to precious alloys is _____ (common, rare). Tissues are more common to respond to a material's ___________ than to its composition.
- Nickel allergy
- Surface roughness
What are the four pillars of Primary Periodontal Therapy?
& Periodontal Surgery (PRN)
- Periodontal Maintenance
What adjunctive therapies can be used in addition on selected cases to increase the effectiveness of the primary therapy?
- Periodontal splinting
- Local therapy
- Periodontal trays
- Nutritional supplements
- Photodynamic therapy
- Orthodontic therapy
What are the indications for periodontal splinting?
- Stabilize moderate to advance tooth mobility which hasn't responded to periodontal therapy
- Stabilize secondary occlusal trauma
- Stabilize teeth w/ mobility that interferes w/ function
- Facilitate SRP & surgery
- Prevent drifting, tipping, & extrusion
- Stabilize teeth for prosthodontics
What materials can be used for periodontal splinting?
- Ribbond Material
- Ortho Wire w/ composite
Splinting a tooth for 4-6 weeks decreases the mobility of the tooth. Splinting should not be left in place for more than 1 year.
- False: splinting doesn't cure anything but only holds it in place while it is bonded
- False: can be left in place for 5+ years
What are the common irrigating agents used for adjunctive therapy?
- Fluoride solution
What are the indications for using irrigating agents for adjunctive therapy?
- Acute periodontal lesions
- Following root planing w/ hand instruments
What is adjunctive local therapy? Give three examples.
- Placement of antimicrobial agent in non-responding pockets during maintenance phase of therapy
- PerioChip: 2.5mg Chlorhexidine
- Atridox: 10% doxycyline gel
- Arestin: minocycline microsphere (used at school)
Current research shows that use of ___________ and _____________ are good means for controlling inflammation in periodontal pockets.
- Rosuvastatin & metformin
What are periodontal trays?
- Trays where medicament can be loaded into and worn by the patient
Nutritional counseling for caries is similar to nutritional counseling for periodontitis patients. Patients with periodontal disease should be counseled to supplement with Vitamin C, Vitamin D, calcium, and antioxidants.
- False: sugars don't affect gum disease but vitamins do
Primates have a mutation in the _______________ gene, meaning they must supplement their diet with Ascorbic Acid. Vitamin C deficiency was first encountered by sailors, termed __________.
- L-Gulonolactone Oxidase
What are the functions of Vitamin C?
- Synthesis of collagen as cofactor for hydroxylation of lysine and proline
- Scavenging of ROS to limit inflammation
- Synthesis of NE from Tyr
- Synthesis of carnitine from gamma-butyrobetaine
How often do the collagen fibers in the periodontium turnover? What does lack of Vitamin C cause?
- 1x per 24 hours
- Bleeding gums, pain, tooth mobility, and tooth loss; bone turnover is slower so symptoms of that arise later
What are the current recommended doses for Vitamin C per day? When do symptoms of scurvy begin?
The site of the most rapid bone turnover in the body is in the __________________.
- Alveolar socket
Melanin protects against UV radiation & skin cancer but is helpful in the activation of cholesterol for Vitamin D synthesis. Recommended doses for >50 years old is 800-1000 IU/day
- False: melanin blocks the pathway for Vitamin D synthesis
- True: for <50 years, dose is 400-800 IU/day
Inadequate intake of calcium is related to osteoporosis and periodontal disease. Elderly males are at an increased risk for low calcium levels.
- False: elderly females are at the greatest risk
What is cyanidin?
- The anthocyanidin produced when a procyanidin is depolarized under oxidative conditions - the result of an antioxidant reaction
Where are procyanidins found?
- Apples, cranberries, grapes, cocoa, and red wine
What is the most common prescription mouthrinse given to patients? What should be patients be advised if they use this for long periods of time?
- Peridex (Chlorhexidine Gluconate 0.12%)
- Builds up supragingival calculus, diminishes sense of taste w/ long-term use, and causes tooth staining
What is photodynamic therapy?
- Methylene blue into the pocket & laser used at specific wavelength to destroy black-pigmented bacteria
What is the purpose of adjunctive orthodontic treatment?
- Align malposed teeth for better plaque control
- Vertical repositioning to eliminate osseous defects
- Improve gingival contours
- Before implant or other prosthodontic treatment
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