Perio

Front 1

When are probing depths equal to CAL?

Back 1

When the gingival margin coincides with the CEJ, then CAL and probe score are equal
If GM=CEJ, then PD=CAL

Front 2

Gingival Margin is a above the CEJ, how do you calculate CAL?

Back 2

When the GM is above the CEJ, the clinician must subtract the distance from the CEJ to the GM from the probe score.
CAL: PD-(GM to CEJ)
PD>CAL

Front 3

Gingival Margin is a below the CEJ, how do you calculate CAL?

Back 3

Recession!
When the gingival margin is below to the CEJ. CAL = PD + Recession
CAL> PD

Front 4

AAP Periodontal Classification:
slight:
moderate:
severe:

Back 4

AAP Periodontal Classification:
1-2 mm CAL = slight
3-4 mm CAL = moderate
> or equal to 5 = severe

Front 5

What does AAP stand for?

Back 5

American Academy of Periodontology

Front 6

What is PSR?
What kind of probe is used?

Back 6

PSR
This is frequently used in private practice for unassisted dental hygienists, to monitor probing at every visit.

Periodontal Screening and Recording System:
-0.5mm ball tip
-Color-coded band extending 3.5-5.5mm from tip

Front 7

How is PSR calculated?
0=
1=
2=
3=
4=

Back 7

PSR
MOUTH IS DIVIDED INTO SEXTANTS
0 = Colored area is completely visible, no calculus or defective margin, no bleeding
1 = Same as above except bleeding is present
2 = Similar to zero & one except calculus or defective margin is present
3 Colored area of probe is partly visible
4 = Colored area of probe is NOT visible (>5.5mm)

Front 8

Tooth Mobility
- Pathologic Migration of Teeth
Grade I:

Back 8

Tooth Mobility
- Pathologic Migration of Teeth
Grade I:
Slight pathologic mobility, app. 1 mm buccolingually

Front 9

Tooth Mobility
- Pathologic Migration of Teeth
Grade II:

Back 9

Tooth Mobility
- Pathologic Migration of Teeth
Grade II:
Moderate pathologic mobility, app. 2mm buccolingually, no vertical displacement

Front 10

Tooth Mobility
- Pathologic Migration of Teeth
Grade III:

Back 10

Tooth Mobility
- Pathologic Migration of Teeth
Grade III:
Sever pathologic mobility, >2mm buccolingually or mesiodistally, combined with vertical displacement.
-- puss and suppuration might be present

Front 11

What is Tooth Migration?

Back 11

What is Tooth Migration?
Physical movement of tooth

Front 12

What is Mobility?

Back 12

What is Mobility?
Movement within the socket

Front 13

Furcation Identification and Measurement
Grade I:

Back 13

Furcation Identification and Measurement
Grade I:
Pocket formation into the flute of the fruca, but the interradicular bone is intact

Front 14

Furcation Identification and Measurement
Grade II:

Back 14

Furcation Identification and Measurement
Grade II:
Loss of interradicular bone, with pocket formation of varying depths into the fruca but not completely through to the opposite side of the tooth.

Front 15

Furcation Identification and Measurement
Grade III:

Back 15

Furcation Identification and Measurement
Grade III:
Complete loss of interradicular bone, with pocket formation that is completely probable to the opposite side

Front 16

Furcation Identification and Measurement
Grade IV:

Back 16

Furcation Identification and Measurement
Grade IV:
Loss of attachment and gingival recession making the furca clearly visible

Front 17

Periodontal Implications of Implants
Define Perimucositis:

Back 17

Periodontal Implications of Implants
Define Perimucositis:
Inflammation of the mucus membrane around the implant

Front 18

Periodontal Implications of Implants
Define Peri-implantitis:

Back 18

Periodontal Implications of Implants
Define Peri-implantitis:
Failure of implant

Front 19

Why probing should be avoided right after implant placement?

Back 19

Probing should be avoided for the first three months after abutment connection.
After implant is placed osseointegration has to occur to be successful

Front 20

What are considered healthy pockets around implants?

Back 20

What are considered healthy pockets around implants?
4-5mm

Front 21

What is an indication of implant failure?

Back 21

What is an indication of implant failure?
radiographic bone loss and mobility

Front 22

What can be the reason for implant failure?

Back 22

What can be the reason for implant failure?
Occlusal trauma causes implant failure

Front 23

What's an example of "parafunctional" habits?

Back 23

What's an example of "parafunctional" habits?
granding, biting nails, bruxism

Front 24

Define Hypersensitivity?

Back 24

Define Hypersensitivity?
Allergic reaction

Front 25

G.V. Black Cavity Classification
Class I

Back 25

G.V. Black Cavity Classification
Class I:
Pit and Fissures
- occlusal surface of premolars and molars
- occlusal 2/3 of facial and linguals on molars
- lingual surface of max. incisors

Front 26

G.V. Black Cavity Classification
Class II

Back 26

G.V. Black Cavity Classification
Class II:
Proximal cavities in premolars and molars

Front 27

G.V. Black Cavity Classification
Class III

Back 27

G.V. Black Cavity Classification
Class III
Proximal cavities in incisors and canines (does not involve incisal edges)

Front 28

G.V. Black Cavity Classification
Class IV

Back 28

G.V. Black Cavity Classification
Class IV:
Proximal cavities in incisors and canines (involve incisal edges)

Front 29

G.V. Black Cavity Classification
Class V

Back 29

G.V. Black Cavity Classification
Class V:
Gingival third cavities (does not include pits and fissures)
--> root exposure, root caries

Front 30

G.V. Black Cavity Classification
Class VI

Back 30

G.V. Black Cavity Classification
Class VI
Incisal edge and cusp tip cavities

Front 31

What toothpaste was specially formulated for erosion?

Back 31

What toothpaste was specially formulated for erosion?
Sensodyne ProNamel Toothpaste

Front 32

Define Abrasion:

Back 32

Abrasion – wearing away of tooth structures (buccal, incisal, & occlusal) resulting from excessive abrasive forces by a foreign object.
- mostly cervical third of tooth below the CEJ

Front 33

So, if abrasion is recession caused by excessive abrasion from a foreign object, can recession occur without abrasion? What causes it?

Back 33

Yes, bacteria & inflammation can cause recession

Front 34

How does Abrasion looks like?

Back 34

How does abrasion looks like?
-"V" or wedge-shaped defects or notches
- ditches, notches, or indentations

Front 35

What causes Abrasion?

Back 35

Mechanical process of foreign objects:
toothbrush, personal habits

Front 36

What is the precess leading to abfraction?

Back 36

Abrasion may lead to recession and then to abfraction

Front 37

Does alveolar bone regenerate after assault?

Back 37

Does alveolar bone regenerate after assault?
Alveolar bone re-mineralizes and re-intergrates but DOES NOT regenerate
- you may stop the progression of disease/ bone loss but you can not regain bone --> periodontal disease

Front 38

Define Abfraction:

Back 38

Abfraction – cervical V- or wedge shaped lesions (apical to the CEJ) caused by occlusal forces such as bruxism.

Front 39

How do you address abfraction?

Back 39

How do you address abfraction?
-Night guard - helps in distribution of uneven occlusal forces
-Fluoride treatement

Front 40

Can abrasion occur below the gum line?

Back 40

Abfraction can occur below the gum line! Abrasion can not!
Because recession must occur for abrasion to occur

Front 41

What other evidence can you find in the mouth to support the etiology of bruxism? What other symptoms would you see?

Back 41

Linea Alba, scalloped tongue, sensitivity, cracked teeth, pitted molars, craze lines, attrition, cheek biting, clicking TMJ, tight cheeks

Front 42

Define Attrition:

Back 42

Attrition – wear from tooth-to-tooth contact (occlusal and incisal).

Front 43

What causes Attrition?

Back 43

Tooth-to-tooth contact resulting from deep overbite, crossbite, or other functional contact

Front 44

How would you describe Attrition?

Back 44

How would you describe Attrition?
-Flatening or well-defined facets (incisal or occlual)
- Facet and ledges
(buccal and lingual surface)

Front 45

Define Erosion:

Back 45

Erosion – loss of enamel and dentin (any surface) resulting form chemical action of acids.

Front 46

What could cause erosion, OTHER than an eating disorder?

Back 46

What could cause erosion, OTHER than an eating disorder?
Sodas, Orange Juice, Lemons, GERD
-> dietary and gastric acids

Front 47

Aggressive and Localized Periodontitis cause bone loss? Which?

Back 47

Aggressive and Localized Periodontitis cause bone loss? Which?
- rapid bone loss
- vertical bone loss

Front 48

Abrasion & Abfraction cause bone loss? Which?

Back 48

Abrasion & Abfraction cause bone loss? Which?
- slow progression for a long time
- horizontal bone loss

Front 49

How does assaulted lamina dura looks like on a radiograph?

Back 49

How does assaulted lamina dura looks like on a radiograph?
It is widen and radiopaque due to occlusal forces

Front 50

PDL space is ...

Back 50

PDL space is radiolucent

Front 51

Radiolucency around alveolar crest indicates what?

Back 51

Radiolucency around alveolar crest indicates what active bone disease.
- the alveolar crest (interdental septa) often look indistinct
- lamina dura looks fuzzy

Front 52

Limitations of Radiographic Assessment of Periodontal Disease:

Back 52

Limitations of Radiographic Assessment of Periodontal Disease:
1. Minor changes in bone mass are not detectable
2. Interdental Craters
- Internal morphologic features or depth of crater-like defects not shown
- Extent of involvement on buccal and lingual not shown

Front 53

Digital subtraction radiography (DSR)
Pros:

Back 53

Digital subtraction radiography (DSR)
-More efficient
-More accurate
-Image can be digitally enhanced for better detail and detection
-Image can be superimposed on the original radiograph

Front 54

Treatment Planning
Sequence of Periodontal Procedures

Back 54

Treatment Planning
Sequence of Periodontal Procedures
Preliminary Phase
Phase I Therapy (Etiologic Phase)
Phase II Therapy (Surgical Phase)
Phase III Therapy
Phase IV Therapy(Maintenance Phase)

Front 55

Preliminary Phase
Goal:

Back 55

GOAL: bring all emergency and critical situations under control.

Treatment of emergencies
Extraction of hopeless teeth and provisional replacement if needed

Front 56

What constitutes an emergency or critical situation?

Back 56

What constitutes an emergency or critical situation?
Pain, Abcess --> can kill
Mouth is very close to lymph nodes and the brain

Front 57

Why would extraction of hopeless teeth need to happen first? What makes them hopeless?

Back 57

Why would extraction of hopeless teeth need to happen first? What makes them hopeless?
cracked tooth --> all down to the root tip
- caries that is concave from clinical point of view
- root is cavitated and pulp infected
- the crown is gone

Front 58

Phase I Therapy (Etiologic Phase)

Back 58

Phase I Therapy (Etiologic Phase)

GOAL: control or eliminate etiologic factors of disease

- Plaque biofilm control
- Diet control (for patients at high caries risk)
- Scaling and root planing
- Antimicrobial therapy (local or systemic)
-Correction of contributing restorative and prosthetic factors
-Removal of caries and restoration of teeth
-Occlusal therapy. Why?
-Minor orthodontic movement
-Provisional splinting. What problems can arise from splinting?
-Evaluation of response to Phase I (occurs 1 month or longer after completion)
-Reassess gingival condition
-Pocket depth, attachment loss, and gingival inflammation
-Plaque biofilm, calculus, caries
-Stain removal

Front 59

What is the term used to describe restorations that are harmful to the surrounding tissues?

Back 59

Foostige

Front 60

Phase IV Therapy(Maintenance Phase)

Back 60

Phase IV Therapy(Maintenance Phase)

Plaque biofilm and calculus removal

-Monitoring
-Periodontal condition (pockets, CAL, inflammation)
-Occlusion and tooth mobility
-Other pathologic changes

Front 61

Role of the Dental Hygienist

Back 61

Role of the Dental Hygienist
Provide treatment during Phase I (nonsurgical or etiologic phase) and Phase IV (maintenance phase).

Front 62

Do you feel, as a clinician, that you provide more than just treatment to your patients?

Back 62

Do you feel, as a clinician, that you provide more than just treatment to your patients?
- we control bacteria
- we maintain care

Front 63

Considerations for Determining the Dental Hygiene Care Plan

Back 63

Patient ‘s general health and tolerance of treatment
-Number of teeth present
-Amount of supragingival & subgingival calculus
-Probing pocket depths
-Furcation involvement
-Alignment of teeth
-Margins and restorations
-Caries
-Developmental anomalies

Front 64

Considerations for Determining the Dental Hygiene Care Plan
Related to Patient:

Back 64

Physical barriers to access
Patient cooperation
Patient prevention education needs
Patient sensitivity

Front 65

Treatment Planning for Periodontal Disease
Classifications:

Back 65

Treatment Planning for Periodontal Disease:
Classifications:
1.Gingival diseases
2.Slight periodontitis
3.Moderate periodontitis
4.Severe periodontitis
5.Aggressive periodontitis

Front 66

Treatment Plan: Gingival diseases

Back 66

Treatment plan: Gingival diseases
- No Clinical Attachment Loss (LIMITED TO GINGIVA)
- Often completed in 1 visit
Treatment Plan:
1. Assessments
2. Patient education and plaque biofilm control instruction
3. Scaling and periodontal debridement
4. Establish appropriate maintenance interval
5. Re-evaluation at subsequent appointment or first maintenance visit

Front 67

Treatment Plan: Slight periodontitis

Back 67

Treatment Plan: Slight periodontitis
- 1-2 mm Loss (does that mean 1-2mm pockets?)
- Often requires more than one treatment visit

Treatment Plan:
1. Assessments
2. Patient education and plaque biofilm control instruction; probably more complex , requiring augmentation and reinforcement at subsequent visits
3. Scaling, root planning, and periodontal debridement by quadrant, often requiring anesthetics and analgesics
4. Establish appropriate maintenance interval. How is this determined?
5. Re-evaluation by dental hygienist and dentist

Front 68

Treatment Plan: Moderate periodontitis

Back 68

Treatment Plan: Moderate periodontitis
- 3-4 mm Loss
- Often treated by quadrants, requiring several treatment visits.

Treatment Plan:
1. Assessments, consider referral to periodontist
2. Patient education and plaque biofilm control instruction; probably more complex , requiring augmentation and reinforcement at subsequent visits
3. Scaling, root planning, and periodontal debridement by quadrant, often requiring anesthetic use
4. Establish appropriate maintenance interval
5. Re-evaluation by dental hygienist and dentist

Front 69

Treatment Plan: Severe periodontitis

Back 69

Treatment Plan: Severe periodontitis
->5 mm Loss
-Often treated by quadrants but may require therapy by sextants; requires several visits.

Treatment Plan:
1. Assessments, strongly consider referral to periodontist
2. Patient education and plaque biofilm control instruction; probably more complex , requiring augmentation and reinforcement at subsequent visits
3. Scaling, root planning, and periodontal debridement by quadrant or sextant
4. Establish appropriate maintenance interval

Front 70

Aggressive periodontitis

Back 70

Aggressive periodontitis
- Presents with a variety of signs and symptoms; may be treated in single or multiple treatment visits.

Treatment Plan:
1. Assessments, will require referral to periodontist
2. Patient education and plaque biofilm control instruction
Scaling, root planning, and periodontal debridement
3. More frequent recalls often required
4. Courses of antibiotics and microbiologic diagnostic monitoring may be required
5. Establish appropriate maintenance interval
6. Re-evaluation by dental hygienist and dentist

Front 71

What is Root planing?

Back 71

Root planing: goal was to remove surface layer of cementum/dentin on the root surface (associated with a perio pocket) and leave a hard almost glassy surface. Remove lipopolysaccharides (endotoxins) or embedded calculus. No evidence to support that root planed teeth are easier to maintain or less likely to be associated with perio disease than those who have had calculus/plaque biofilm removed.

Front 72

Scaling

Back 72

“instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.” (AAP)

Front 73

Scaling and Root Planing

Back 73

Scaling and root planing are not separate procedures; all the principles of scaling apply equally to root planing. The difference between scaling and root planing is only a matter of degree. The nature of the tooth surface determines the degree to which the surface must be scaled or planed.

Front 74

Root Planing

Back 74

Root Planing
“a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.” (AAP)

Root planing, like scaling, may be successfully performed by hand instrumentation or powered scaling devices.

Front 75

Difference between scaling and root planing?

Back 75

Difference between scaling and root planing?
Longer, lighter root-planing strokes are then activated with less lateral pressure until the root surface is completely smooth and hard. The instrument handle must be rolled carefully between the thumb and fingers to keep the blade adapted closely to the tooth surface as line angles, developmental depressions, and other changes in tooth contour are followed. Scaling and rootplaning strokes should be confined to the portion of the tooth where calculus or altered cementum is found; this area is known as the instrumentation zone. Sweeping the instrument over the crown where it is not needed wastes operating time, dulls the instrument, and causes loss of control.

Front 76

Periodontal Debridement

Back 76

Periodontal Debridement
Involves supragingival and subgingival scaling and root planing and disruption or removal of plaque biofilm with a minimum of tooth structure removal.

Removal of plaque biofilm, plaque retentive features, and calculus, both above and below the gingival margin.

The goal of periodontal debridement is to restore the periodontium to health, not to produce glassy, hard root surfaces that are free of various deposits.

Front 77

Prophylaxis

Back 77

Prophylaxis
Procedure to remove local irritants to the gingiva and includes complete calculus removal followed by root planing. It also includes polishing.

Prophylaxis is basically a preventive and maintenance procedure for periodontal patients.

Front 78

Coronal Polishing

Back 78

Coronal Polishing
The removal of stain and plaque biofilm from the teeth.
Polishing has no proven therapeutic value.

Front 79

Gingival Curettage

Back 79

Gingival Curettage
“scraping or cleaning the walls of a cavity or surface by means of a curette” (AAP)

The removal of the inflamed soft tissue lateral to the pocket wall.
It provides little therapeutic value.

Front 80

Rationale For Nonsurgical Periodontal Therapy

Back 80

Rationale For Nonsurgical Periodontal Therapy
To remove the etiologic agent of disease, bacterial plaque biofilm, and its associated factors.

Eliminate and control infection to prevent reinfection.

Scaling and root planing is the standard of care for nonsurgical and nonpharmacologic treatment of chronic periodontal diseases.

Front 81

Removal of the Cause

Back 81

Removal of the Cause
Plaque Biofilm
Calculus

Front 82

Toxins on Tooth Surface

Back 82

Toxins on Tooth Surface
Endotoxins do not penetrate deeply
Retained toxins are associated with missed calculus and plaque rather than “diseased” cementum.
Toxins are superficially located on root surfaces and easily removed.

Front 83

Soft Tissue Healing After Periodontal Debridement

Back 83

Soft Tissue Healing After Periodontal Debridement

Healing occurs in approximately 1 week.
Healing of inflamed connective tissue is complex, requiring many cells and mediators.
May take up to several months

Front 84

When do we probe after Periodontal Debridement?

Back 84

New connective tissue fiber attachment to the tooth surface is not predictable.
Rather, the development of an elongated junctional epithelial attachment may result.
Probing after treatment should be avoided for 4 weeks.

Front 85

Healing of epithelial lining:
Healing of CT:

Back 85

Healing of epithelial lining can be expected to take 5 to 12 days.

The underlying connective tissue takes at least 3 to 4 weeks to heal.

Avoid probing for at least 4 weeks.

Front 86

Repopulation of Micro-Organisms After Therapy

Back 86

Repopulation of Micro-Organisms After Therapy
Number of organisms are reduced dramatically.
Plaque shifts from gram-negative to gram-positive.
New flora similar to what you find in periodontally healthy sites

Front 87

Bacteria repopulate in a specific order:

Back 87

Bacteria repopulate in a specific order:
1. Streptococcus and Actinobacillus species
2. Veillonella, Bacteroides, Porphyromonas, Prevotella, and Fusobacterium species
3. Capnocytophaga species and spirochetes

Front 88

Clinical Response

Back 88

Clinical Response
-Shallower pockets show less improvement
-Redness and bleeding are reduced dramatically
-Healing is greatest 3 to 6 weeks after nonsurgical periodontal therapy. (Greenstein, 1992)
-Changes continue to occur up to 12 months after treatment, when the situation stabilizes.

Front 89

Clinical Response
Re-evaluation:

Back 89

Re-evaluation:
Expect to see changes in the following:
-Periodontal probes penetrate the epithelial attachment by 1 mm or more, especially in inflamed tissue.
-The periodontal probe is less likely to penetrate healed junctional epithelium and intact CT 4 weeks after SRP.

Front 90

ULTRASONICS:

Back 90

ULTRASONICS:
Vibrations range from 20,000 to 45,000 cycles per second.
Units use magnetostrictive or piezoelectric systems to generate ultrahigh frequencies of scaling tip movement.

Front 91

SONIC:

Back 91

SONIC:
3,000 to 8,000 cycles per second

Front 92

Ultrasonic and Sonic Devices
How do you use it?

Back 92

Ultrasonic and Sonic Devices
How do you use it?
Tip must be moved rapidly (constant motion).
Do not use lateral pressure – can lead to root damage.

Front 93

Ultrasonic and Sonic Devices
Which is better?

Back 93

Sonic scalers were at least as effective as ultrasonic scalers for calculus removal, if not slightly better.
Ultrasonic instruments caused slightly less trauma to the roots than sonic instruments.

Front 94

Endotoxin Removal

Back 94

Endotoxin Removal
Endotoxins (lipopolysaccharides) embedded in the root surface are removed by ultrasonic scaling with overlapping, light strokes of approximately 50 g, which is about the same pressure as light probing.

Front 95

Calculus Removal
Thin Tip:

Back 95

Calculus Removal
Thin Tip:
The thinner ultrasonic tips were 16% to 27% more effective in calculus removal (in deeper areas) than hand curettes and 27% to 46% better than standard ultrasonic tips.

Front 96

Lasers

Back 96

Lasers
♦ Diagnosis of pit and fissure caries
♦ Soft tissue incision and excision
♦ Gingival curettage
♦ Caries removal
♦ Cavity preparation

Front 97

Irrigation with Antimicrobial Agents

Back 97

0.12% chlorhexidine
0.4% stannous fluoride
0.05% povidone-iodine

Mechanical scaling and root planing is the primary antimicrobial treatment
Irrigation is not reliable in augmenting its effects.

Front 98

CHX

Back 98

CHX
Strength: 0.12%
Excellent Effectiveness
Delivery:
-ultrasonic
-cannula
-handpiece
long-lasting
Negatives: taste, inhibits fl, stain

Front 99

Stannous Fluoride

Back 99

Stannous Fluoride
Strength: 1.6%
Excellent Effectiveness
Delivery:
-cannula
-moderate lasting
Negatives:taste, short shelf life, stain

Front 100

Povidone Iodine

Back 100

Povidone Iodine
Strength:2.5%
Excellent
Delivery:
-ultrasonic
-cannula
-handpiece
short
Negatives: taste, allergic reaction,stain

Front 101

Local Delivery

Back 101

Local Delivery
♦ Advanced chronic periodontitis
♦ Refractory periodontitis
♦ Recurrent periodontal disease
♦ Indicated for isolated pockets of 5-7mm with bleeding