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158 Cards in this Set
- Front
- Back
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Interradicular fibers
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stabilized the tooth, only in multi-rooted teeth
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bacteroides forythus is associated with what kind of periodontal disease
(AKA Tanerella forsythus) |
in subgingival plague samples in deep periodontal pockets, associated with AGGRESSIVE PERIO
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Incidence
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new cases in a given time period
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what two types of periodontal disease are closely associated with fusobacterium nucleatum
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in sub gingival plague w/severe attachment loss, initiates early stages of gingitis,
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AA
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aggressive, local and generalized, 25% of chronic, evade normal host response, destroy CT and Bone,
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Which of the cytokines do not stimulate bone resorption?
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They all do
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Which of the cytokines stimulate CT destruction?
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Interleukin 8 is the only one
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Which of the cytokines stimulate MMP production?
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TNF
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Which of the cytokines inhibit bone resorption?
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Interleukin 6
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Which of the cytokines are related to the severity of the disease?
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I-6 and I-1
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3 drugs that cause gingival hyperplasia
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CCB, anticonvulsants, immunosuppressive
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What do bacterial enzymes do?
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1. collagen break down of gingival CT
2. increase perm of sulcus 3. apical migration of the JE 4. widen intercellular spaces 5. dimishes effect of immunoglobulins |
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Name two bacteria that can directly invade the tissue?
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aggregatibacter actinomycetemcomitans and t. denticola
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local risk factors do these three things
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Increase plague retention
Increase plaque pathogenicity Cause direct damage to the periodontium |
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Calculus is what percentages organic/inorganic
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70-90 inorganic
10 organic |
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What kind of perio disease is Porphyromonas gingivalis related to?
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aggressive and generalized periodontitis, (they also destroy connective tissue, destroy bone, and can enter the JE
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Stages of Change Model
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Precontemplation--uninterested, unaware
Contemplation--considering Preparation--decide to change Action--making the change Maintenance--Maintain the behavoir Relapse |
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Precontemplation Stage
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resistant to change
Everyone else should change Blame other things, Defensive, Rationalize, Denile |
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Contemplation Stage
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Recognize problem, Resistant to change
Starting to feel confident about change Good intentions |
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Action stage
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Steps to change
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Maintenance Stage
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Relapse possible
Can mention temptations self blaming for failures |
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Intervention
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strategy intended to change a persons knowledge, attitudes, awareness or behavior.
FOCUS--not convice for change, but help progress through the stages of change. |
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Two important things to consider about a person's readiness to change
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1. Importance of the situation
2. confidence in their ability to change |
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Placate
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Telling them what you think they want to hear. I lose-you win
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Blame
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Lose-lose
Giving something responsibility for your behavior |
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Compute
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Act ultra-responsible
Dealing with a threat like harmless I win-you lose |
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Distract
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change topic
Ignore the issue lose-lose |
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Level
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win- win
telling truth builds healthy relationship |
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Which clients are the most compliant?
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non-smokers
insurance holders compliant the first year |
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Precomtemplation Intervention
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brief, simple advice
ask questions to stimulate thinking Support and encouragement Clarify goals, DON"T PUSH, avoid enabling, increase recare Understand what is important |
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Contemplation Intervention
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refrain from pushing
support, listen, give feedback empathize, praise ask about the attempts |
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Preparation stage Interventions
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identify barriers
guide into small steps encourage reinforce behaviors with phone calls or emails |
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Action Interventions
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ask about successes and difficulties
easy to lose momentum praise offer rewards |
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Maintenance
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give credit
support ask about successes and difficulties |
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Successful outcomes for periodontal treatment hinge on what three things?
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1. accept and undergo treatment
2. strict regimens of self care 3. periodontal maintenance |
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What is the objective of nonsurgical perio therapy?
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eliminating disease, return peridontium to healthy state to be maintained by pro and personal care.
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Other terms for non-surgical perio therapy
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initial periodnotal therapy
Initial therapy hygienic phase Anti-infective phase cause related therapy soft tissue management |
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T or F NSPT should be planned for clients with plaque-associated gingivitis and patients with chronic perio
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True
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T or F NSPT should be planned for ALL clients with aggressive periodontitis
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False, "NSPT is not necessarily the best therapy for...aggressive periodontitis"
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Goals of NSPT
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minimize bacteria
eliminate or control local risk factors minimize impact of systemic risk factors stabilize attachment level |
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What is the rationale for periodontal instrumentation in NSPT?
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Arrest progress of disease
positively change subgingival flora (count and content) permit tissue to heal and lower inflammation Increase effectiveness of home care Permits a re-evaluation of disease to see if surgery is needed Prevents recurrence through periodontal maintenance. |
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Scaling
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instrument of crown and root surfaces to remove plaque, calculus and stains
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Root Planing
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remove cementum or surface dentin rough and impregnated with calculus or contaminated with toxins or mo
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T or F Periodontal Debridement includes instrumentations of every square mm of root surfaces for removal of plaque, calculus and impregnated cementum.
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FALSE, it doesn't include removal of cementum
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How does healing occur after periodontal debridement?
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Formation of Long JE
(no formation of new bone, cementum or PDL during healing process) |
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T or F Dentinal Hypersensitivity is associated with exposed dentin. All exposed dentin will be hypersensitive
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First is True, second is false. Exposed dentin may have no pain associated with it.
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Sensitivity from gingival recession MOST often follows what kind of therapy?
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surgical periodontal therapy, but can also follow NSPT (261)
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Smear layer (in reference to root instrumentation)
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crystalline debris from tooth surface that covers the tubules and inhibits fluid flow, preventing d. sensitivity (261)
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Hydrodynamic Theory of dentin sensitivity
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dentinal tubules are in the dentin, filled with odontoblastic stuff, changes in temp create hydrodynamic forces in the fluid filled areas (stimulating nerve endings) and cause pain (262)
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How long does it take for a smear layer to form over exposed tubules?
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several weeks (pg 262)
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What do you need to warn your client about before NSPT (in regards to sensitivity)
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it may occur but will gradually disappear
daily plaque removal is important in controlling sensitivity and if not done will reduce effectiveness of other treatments for sensitivity No treatment will completely stop it, but there are some fluorides, calcium hydroxides and cavity varnishes that can help (263) |
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When should a NSPT client be rescheduled for a post op appointment?
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4-6 weeks (263)
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T or F Clients with any kind of aggressive periodontitis should be referred to a periodontist
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True (265)
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T or F Patients who exhibit continued periodontal breakdown despite thorough NSPT do not need a referral to a periodontist, but should should be put on a 2 month recare
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FALSE, should be referred to a periodontist (264)
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T or F, for most patients with gingivitis, NSPT should be sufficient to control disease
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True (although some may need it 266)
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T or F. For most patients with slight perio, NSPT should be sufficient to control disease
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True (266)
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T or F. Need for surgical therapy can vary with moderate chronic periodontitis. If surgical therapy is needed, the NSPT will be skipped
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True (266) and False! Always do NSPT first to determine need for surgery
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T or F. Studies show that a coated tongue contribute to perio disease and halitosis
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True (272)
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T or F. Tongue cleaning should be recommended to aging clients that have little desire to eat due to lack of taste.
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True, tongue coating can contribute to lack of taste (272)
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What role do Volatile Sulfur Compounds play in the health of our mouth?
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Hydrogen sulfide and methyl mercaptan causes STANK
May play role in pathogenesis of inflammatory perio (272) |
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Methyl mercaptain gas is especially significant because...
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increases permeability of intact mucosa and stimulate cytokine production
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Type I embrasure
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space filled by the interdental papilla. Dental floss is effective (pg 273)
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Type II embrasure
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height of interdental papilla is reduced. Interdental brushes, wooden interdental cleaners and toothpicks are effective (274)
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Type III embrasure
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papilla missing. Interdental brushes and end-tuft brushes are effective (274)
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What are the indications for Tufted Dental Floss?
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Type II embrasures
under pontic of bridge distal surface of last tooth in the arch plaque removal from proximal surfaces of widely spaced teeth (276) |
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T or F. Interdental brushes should only be used in embrasures that are partially or completely open.
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True (276)
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What are the indications for use of end-tuft brush?
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difficult to clean teeth like last in arch, lower linguals, or crowded teeth.
type III embrasures Type IV furcation sites (277) |
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Are perio-aids (wooden toothpick in a holder) effective for cleaning root concavities?
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Mostly not, only if the teeth are widely spaced. (277)
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Indications for Wooden toothpick in a holder
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below gingival margin for plaque removal
type II embrasures Root concavities ONLY if teeth are widely spaced Furcation areas(277) |
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What is the impact zone when using an oral irrigation device?
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area of the mouth where the solution initially contacts (280)
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What is the flushing zone when using an oral irrigation device?
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subgingival sulcus area solution penetrates (280)
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What is a standard irrigation tip like?
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plastic
place tip at 90 degree angle at the neck of the tooth near the GM Recommended for generalized, full mouth irrigation Penetrates 50% of a pocket (280) |
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What is a subgingival irrigation tip like?
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soft rubber tip
place gently beneath GM. penetrates 90% of a 6mm pocket only 64% of a 7mm + pocket Recommended for deep pockets, furcations, or difficult access (280) |
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What are the indications for recommendation of home oral irrigation?
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on Periodontal maintenance
Dental implants (daily with rubber tip and 0.06% CHX) Diabetes (twice daily) Orthodontics Prosthetic bridgework and crowns (daily) (281) |
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T or F Use of home oral irrigator can cause bacteremia.
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True, use care when suggesting this to clients. Med Consult may be necessary (281)
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After using anything other than water in your irrigator, how do you clean it out?
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fill the reservoir with warm water and run the unit in the sink until it's empty. Should be flushed after each use w/solution other than water.
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T or F. Clients should be instructed to use subgingival and standard irrigator tips at a medium setting.
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FALSE. Subgingival is LOWEST setting
Standard--start out lowest and as the tissues get more healthy it can be bumped up to medium setting. (283) |
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T or F. Clients may use a tongue irrigation tip with tongue jewelry in
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False. That's a big fat NO Also, don't use if you have an open wound. (283)
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Indications for suggestion of mouth rinses
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unable to maintain plaque
impaired dexterity systemically compromised just underwent perio surgical procedure (284) |
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T or F. Research studies have not documented the effectiveness of mouth rinses in the treatment of periodontitis
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TRUE (284)
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Mouth rinsing penetrates how far into a gingival pocket?
a. it doesn't b. 1 mm c. 2mm d. to the base of the pocket |
b. 1 mm
It cannot reach the base of the pocket and is for supragingival only (284) |
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What is bacteremia?
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presence of bacteria in the bloodstream. extent to which oral bacteria enter bloodstream is directly related to severity of gingival inflammation (210)
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T or F The best means to prevent bacteremia of oral origin is through pre-medication
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FALSE, "the maintenance of periodontal health" (210)
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Which of the following are at an increased risk for systemic complications from oral infections?
a. immunosuppressed b. hospitalized (unable to perform self care) c. artificial joint or heart valve replacements d. taking antibiotics that alter oral flora e. all of the above |
e. all of the above (210)
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IE affecting which side of the heart can have a rapid onset and fatal outcome?
a. left b. right |
a. left (211)
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T or F. It is important to record:
Type of diabetes Duration History of complications Medications Method of metabolic monitering |
True (212)
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Which statement is true concerning the hemoglobin A-one-C test
a. 1% is a normal reading b. 80-120 mg/dL is an ideal reading c. used to monitor daily blood glucose levels d. used to monitor the amount of sugar that is attached to hemoglobin. |
*d. used to monitor the amount of sugar that is attached to hemoglobin.
Goal for diabetics is typically 7% Goal for non-diabetics is 6% (212) |
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At what blood glucose range is there an increased risk of infection?
a. 80-120 mg/dL b. 180-300 mg/dL c. greater than 300 mg/dL |
*b. 180-300 mg/dL (212)
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T or F. Untreated perio disease could make it difficult for a diabetic to control their blood glucose
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T (213)
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______ weeks after smoking cessation, the patient may note gingival inflammation and bleeding that may last for several months
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10-12 weeks (213)
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How long after smoking cessation will the tissue assume a more normal anatomy?
1. 10-12 weeks 2. 4-6 months 3. 1 year 4. 2 years |
*3. one year (214)
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T or F. Smokers are equally as likely to quit if advised to do so by a health professional.
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False, MORE likely to quit (214)
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Why is a stress-reduction protocol used for patients with cardiovascular disorders?
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to maintain BP
heart rate and heart rhythm (215) |
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What is a possible side effect of calcium channel blocker?
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gingival hyperplasia (215)
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How might an antiarrythmic drug impact the periodontium?
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Xerostomia
Gingival Hyperplasia (215) |
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Do anti-coagulants have any relevant side effects?
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may see more bleeding, MED CONSULT needed
May indicate something not listed on HH, like prosthetic valve, valvular disorders, myocardial Infarction, stroke, or htromboembolism (215) |
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T or F. Clinicians should inform their clients that periodontal disease may be a risk factor for heart disease.
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True, may have twice the risk of having a fatal heart attack than someone without perio disease. (216)
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Are ultrasonic devices contraindicated for clients with COPD? Why or why not?
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Yes, because they could breathe in septic material into their lungs causing infection. (216)
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T or F. Plaque removal every 48 hours may be an effective way of preventing respiratory infection for hospitalized or nursing home patients.
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TRUE (216)
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Which of the following statements is false regarding strokes?
a. Stress reduction techniques should be incorporated like short, afternoon appointments b. CVA is sudden death of brain cells due to a problem with the blood supply. c. CVA's result in loss of neurological function for 24 hours or longer d. No periodontal treatment should be done on a stroke patient if blood pressure reading is 160/110 or higher. e. Bacterial infection may trigger clot formation and trigger another stroke f. Periodontal disease is a risk factor for stroke. |
a. FALSE, short MORNING appointments.
(217) |
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What is phenytoin used to treat?
a. high BP b. clients undergoing organ transplant c. anxiety d. epilepsy e. infective endocarditits |
d. epilepsy. also known as dilantin (218)
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T or F. A client on phenytoin can expect that the gingival overgrowth will cease after it has been surgically cut back.
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False, likely to recur within 1 to 2 years even in the presence of good plaque control, especially if the client is under 25 years old (218)
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Where is most of the clotting factor for the blood produced?
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the liver (219)
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Why should swallowing blood be minimized in clients with impaired liver function?
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liver plays an important role in digestion of proteins. (219)
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T or F. Acetaminophen is hepatotoxic in patients with severe liver disease.
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true (219)
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Which of the following disease CAN cause an increased risk of infection?
a. asthma b. liver disfunction c. epilepsy d. diabetes e. leukemia |
b. liver disfunction
d. diabetes e. leukemia (asthma could if they were on steroids) (chapter 14) |
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T or F Hydroxyapetite crystals in the teeth are metabolically available for the fetus and can account for an increased risk of caries during pregnancy.
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False, the clinician should explain that the calcium is NOT available for the baby and it is a misconception. (219)
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T or F. Pregnant women who have periodontal disease may be 7 times more likely to have a baby that is born too early and too small.
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True (219)
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What connects periodontal disease and an increased risk for premature births?
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PGE2 regulates onset of labor, uterine contractions and deliver. It also is important in the gingival inflammatory response. (219)
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Stress reduction techniques should be used for which of the following patients?
a. kidney disease b. stroke c. COPD d. Cardiovascular disorders e. organ transplant (because of effects of medications) |
All of the above
(Chapter 14) |
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T or F. Dialysis patients have an increased risk of IE.
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True (220)
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T or F. Dialysis patients may form calculus more quickly.
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True (220) frequent care recommended.
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What kind of disease is von Willebrand disease?
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bleeding disorder (220)
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What are some oral manifestations of bleeding disorders?
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petechiae
ecchymoses (bruising of mucous membrane) spontaneous bleeding prolonged massive bleeding during periodontal procedures (220) |
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Which of the following are true about the medications used to help with organ transplantation?
a. cyclosporin may cause gingival overgrowth as well as severe liver damage. b. azathioprine may cause anemia c. cortiocosteroids increase risk for infection and reduces ability to adjust to stress |
All are true (221)
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What oral manifestations are common with cancer patients undergoing radiation or chemotherapy
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Mucositis
Xerostomia Reduced healing Candidiasis (221-222) |
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What does PICO stand for
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Patient or Problem
Intervention Comparison Outcome (229) |
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Clinical Practice Guidelines
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statements that bring together best evidence to assist clinicians in arriving at decisions. No not tell the clinician exactly what to do.
(230) |
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Systematic Review
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highest level of evidence
summary of individual research studies. Overview (232) |
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Randomized controlled trials (RCT)
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second highest level
subjects randomly assigned an experimental or control group. minimizes bias (232) |
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cohort study
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(third highest)
one grp have a certain condition and in the other does not, followed over time limited because it isn't random and participants may drop out (232) |
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case-controlled study
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(4th highest)
restrospective identifies risk factors quick, inexpensive, but may be unreliable (232) |
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Case Series or case reports
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(5th)
collection of reports on the treatment of an INDIVIDUAL person. Results cannot be generalized into the population. (232) |
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Animal studies
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(6th)
conducted in the early phases of development of intervention cannot be generalized to humans (233) |
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Ideas, editorials and opinions
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(7th) NOT scientific results
(233) |
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In-vitro studies
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(8th and last)
lab setting, not on humans. (233) |
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What are the three questions you can ask to diagnose a client (ging, perio, etc)
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1. Health or Disease?
2. Periodontitis or Gingivitis? 3. What type? (240) |
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Which of the following are overt signs of inflammation?
a. color change in the gingiva b. bleeding on probing c. pus d. contour changes in gingiva e. consistency changes in gingiva f. bone loss |
*a. color change in the gingiva
b. bleeding on probing c. pus *d. contour changes in gingiva *e. consistency changes in gingiva (241) f. bone loss |
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Which of the following are hidden signs of inflammation in the periodontium?
a. color change in the gingiva b. bleeding on probing c. pus d. contour changes in gingiva e. consistency changes in gingiva f. bone loss |
a. color change in the gingiva
*b. bleeding on probing *c. pus d. contour changes in gingiva e. consistency changes in gingiva *f. bone loss (241) |
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T or F. The natural level of the gingival attachment is coronal to the CEJ
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True (242)
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Is the following statement true?
Slight disease is 1-2 mm attachment loss Mod disease is 3-4 mm attachment loss Severe disease is 5mm + |
TRUE (243)
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True or False?
Localized is 40% or less involved Generalized is 40% or more involved |
False, 30% (243)
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Is the following chart true?
Case Type I Gingivitis only Case Type II Slight periodontitis Case Type III Moderate Periodontitis Case Type IV Severe Periodontitis Case Type V Gingivitis on attachment loss |
False, there isn't a case type V listed in our book (243)
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Which of the following is not a component of the assessment and preliminary phase?
a. extraction of hopeless teeth b. treatment of emergency conditions c. assessment data collection d. nutritional counseling |
d. nutritional counselling is a part of phase I or nonsurgical periodontal therapy (244)
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What phase is smoking cessation apart of ?
a. assessment phase b. nonsurgical PT c. surgical therapy d. restorative therapy e. periodontal mainenance |
B. NSPT (244)
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Local Risk Factors do what
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do not initiate but act to contribute to perio disease
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Systemic Risk Factor do what
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contributes to susceptibility to disease-modifies host response
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Laterotrusion
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the Laterotrusive side is the functional side
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Mediotrusive side
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is the balancing side
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What happens with too much occlusal force?
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hyperfunction
-Bruxing -Clenching -No tooth mobility Trauma from occlusion |
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What happens with too little occlusal forces?
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Hypofunction
Disuse atrophy |
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T or F. Tobacco use can impair chemotaxis and phagocytosis of PMN's
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True
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What does C-reactive protein do?
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acute phase protein produced by the liver and released in response to inflammation
Activates complement system Accounts for LDL uptake by macrophage Positively correlates to IL-6 |
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What bacteria are directly associated with thickness of arterial walls?
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p. gingivalis, a.a., Treponema denticola, and T. forsynthensis
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Which perio pathogens are implicated in CVD
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P. Gingivalis
Tannerella forsynthensis Prevotella intermedia |
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What are four oral manifestations of diabetes?
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reduced salivary flow
burning tongue candida albicans periodontal disease |
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List some reasons why diabetes and perio are related
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-increased risk of infection
-cells that kill bacteria are less effective -high inflammatory mediators in gingival crevicular fluid -TNF large numbers in fat cells, significant role in insulin resistance -highets osteoblast death leading to less bone formation |
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What is a pyogenic granuloma?
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a pregnancy tumor
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Why does stress put you at an increased risk for attachment loss?
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-Cortisol is increased
-Cortisol increases MMP's |
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T or F. HRT for the first 5 years of menopause may help reduce the risk of attachment loss
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True
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Any client taking a _______ drug should be informed of possible Osteonecrosis of the Jaw
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bisphosphate drug
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Which kind of drugs are well known for producing gingival overgrowth?
a. antibiotics b. anticonvulsants c. antianxiety d. antihypertensive e. calcium blocker f. immunosuppressive g. nonsteroidal anti-inflammatory |
b. anticonvulsants (Phenytoin/dilantin)
e. calcium blocker (Nifedipine/Procardia) f. immunosuppressive (Cyclosporine/Sandimmune) |
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Which drugs inhibit alveolar bone loss?
a. antibiotics b. anticonvulsants c. antianxiety d. antihypertensive e. calcium blocker f. immunosuppressive g. nonsteroidal anti-inflammatory |
a. antibiotics (tetracycline/achromycin)
g. nonsteroidal anti-inflammatory (ibuprofen) |
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Which drugs decrease plaque formation?
a. antibiotics b. anticonvulsants c. antianxiety d. antihypertensive e. calcium blocker f. immunosuppressive g. nonsteroidal anti-inflammatory |
c. antianxiety (alprazolam/xanax)
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Which drug increases gingival inflammation?
a. antibiotics b. anticonvulsants c. antianxiety d. antihypertensive e. calcium blocker f. immunosuppressive g. nonsteroidal anti-inflammatory |
antihypertensive (enalapril/vasotec)
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What drugs make a client more susceptible to infection (listed in the powerpoint)
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Antihistamines
Antidepressants Cancer Drugs Steroids |
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Which of the fibers in the supragingival fiber grp are attached to cementum?
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Dentogingival
Transgingival Transseptal (over crest of alveolar bone) |
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Which of the fibers in the supragingival fiber grp are NOT attached to cementum?
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Alveologingival (bone)
Circular Periostogingival (periosteum) Intergingival Intercircular (doesn't specify) Interpapillary |
