Perio 2 final

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  1. What factor decreases long term success of perio lesion treatment?
    • multirooted w/ furcation involvement
    • 31-57% mortality vs 7-10%
  2. Grade I furcation
    • initial attachment loss w most bone in tact.
    • No radiographic change
  3. Grade II furcation
    • bone defect is cul de sac w/ definite horizontal bone loss (vertical maybe)
    • opening to furca w/ bony wall at deepest portion (filled to roof still)
    • may have radiographic presentation
  4. grade III furcation
    • bone loss throughout width of furcation
    • no attachement to furcation roof
    • radiolucency in coronal furcation
  5. Grade IV furcation
    • bone loss across is accompanied with gingival recession w clinically visible furcation
    • radiolucent coronal furcation
  6. Where is the anatomical groove in lower molars?
    • lateral aspect of roots (especially mesial)
    • makes instrument access difficult
    • use ultrasonic scalers or diamond burs(slow speed)
  7. Root trunk
    • distance between CEJ and beginning of furcation
    • longer improves prognosis
  8. ___ furcation with ___ mm or less pocket depth may be tx with initial therapy.  Most other furcations require _____
    • Grade I, 4mm, surgical therapy
    • Grade I furcation with 4 mm or
    • less pocket depth may be treated with initial therapy. Most other furcations
    • require, in addition, surgical therapy
  9. Grade II treatment
    • resective osseous surgery
    • bone removed to create positive architecture
    • flap apically positioned to follow contour and minimal surgical pockets developed
  10. OHI for furcations
    • end-tufted brush
    • CHX
  11. Advanced bone loss tx
    • regenerative surgery(emdogain)
    • periosteal graft
    • works better for Grade II than III
  12. Grade III furcation tx
    • root resection, endo therapy, special contour crown
    • implant
    • hemisection: lower molars, create 2 premolars involves endo and new crowns
  13. Mouth breathing gingivitis tx
    • initial therapy
    • OHI
    • CHX and vaseline
  14. What drug commonly causes ginigival hyperplasia (epilectic)?
    • phenytoin Dilantin (PDGF)
    • initial therapy
    • electric toothbrush
    • flap surgery
  15. What drug of transplant pts cause gingival hyperplasia?
    • immunosuppresant &
    • nifedipine and Ca2+ channel blockers
  16. tx of inherited gingival fibromatosis
    • Autosomal dominant
    • surgery
  17. Herpetic viral gingivostomatitis tx
    • tx fever, dehydration & pain
    • antiviral (acyclovir topical 5% or systemic 80mg/kg/day
  18. max dose for acyclovir?
    • 80mg/kg/day
    • herpetic viral gingivostomatitis
    IS CLASSIFIED AS _______
  21. Cyclic Neutropenia
    Young patients develop advanced bone loss and Necrotizing Gingivitis only when their systemic resistance to Dental Plaque is seriously depressed
  22. Local Aggressive periodontitis with
    juvenile onset
    These cases can present with
    advanced bone loss affecting first molars 
    and incisors
    Etiology is not clear but may
    involve specific Grand Negative Bacteria such as _______ or a possible _________.
    • Aggrebacter Actinomycetemcomitans 
    • P.M.N. Dysfunction
  23. Papillon Lefevre Syndrome
    • generalized aggressive periodontitis
    • Autosomal Recessive disease
    • affecting children with associated palmo
    • plantar hyperkeratosis
    • Deficiency of Cathepsin C results in abnormal  P.M.N. and Immunolgical function
  24. hypophosphatasia
    Image Upload 1
    rare genetic with suppressed cementum formation
  25. bacteremia is usually cleared in ___ mins
  26. Most dental bacteremia are considered ________
    low grade intensity 1-­‐12 cfu/ml of blood
  27. What procedure has highest incidence of bacteremia?
    • intraligamentary injection 
    • (into PDL space)
  28. incidence and magnitude of oral bacteremia areproportional to the
    amount of inflammation and degree of trauma
  29. bacteremia protocol
    • OHI
    • reduce # visits
    • CHX
    • 7 days btwn appointments
    • change antiobiotic regimen
  30. when should you use antibiotic prophy?
    • cardiac: infective endocarditis, pericarditis, myocarditis
    • prosthetic joint(not necessary 12/12)
    • poor controlled diabetes >8% HbA1c
    • HIV: CD4 count < 200, less than 60k platelets, <500 neutrophils/mm3
    • perio surgery
    • others: imunnosuppressed, transplant complications, splenectomy
    • refer to AHA guidelines
  31. most common bacteria of infective endocarditis
    • Strep Viridians
    • alpha-hemolytic strep
    • S. mutans, S. sanguis, S. oralis
    • non-strep: Aa, Capnocyphacga, Lactobacillus
  32. IE pathophysiology
    • sthenotic or incompetent valve -> turbulent flow-> damaged endothelium->platelets/fibrin->thrombus
    • infection occurs on wall or downstream near orifice where flow eddies
    • emoblize to anywhere-> immunolgic response
  33. Endocarditis types
    • acute: agressive bacteria, S. aureus, group B strep
    • subacute: already diseased or damaged valve S. Viridians
    • prosthetic valve
  34. IE mortality
    • 25%
    • Left-sided: 50%
    • reduce mortality: improved heath, OHI, AB prophylaxis
  35. IE mortality due to ____
    secondary CHF congestive heart failure
  36. Which cardiac conditions usually require AB prophylaxis
    • 1. hx of IE
    • 2. prosthetic valves
    • 3. cardiac transplant w valvuopathy
    • 4. congenital: unrepaired cyanotic CHD, repaired prosthetics w inhibited endothelization, completely repaired CHD w prosthetics withing 1st 6 months

    Usually carry a AHA card
  37. IE: prohylaxis AB regimen
    • ALL 30-60 mins prior
    • Amoxicillin: 4 500 mg tablets(2g) 
    • peniciilin allergy?
    • clindamycin: 4 150 mg (600 mg)
    • azithromycin: (1 500 mg tab)
    • clarithromycin: 2 250 mg tabs (500 mg)

    IV: ampilcillin 2g IV/IM, clindamycin (600mg IV
  38. child AB prophylactic regimen
    • Amoxicillin: 50 mg/kg
    • clindamycin: 20 mg/kg
    • azithromycin: 15 mg/kg
    • clarithromycin: 15 mg/kg
    • do not exceed adult dose
    • IV: 50mg/kg ampicillin
    • 20 mg/kg clindamycin
  39. glycosylated HbA1c measures avg blood glucose in preceding ___
    • 2-3 months
    • 4-6% normal
    • 7-8% moderately controlled
    • >8% needs improvement
  40. prophylactic AB in perio surgeries are usually what type of procedures
    • bone grafting
    • implants
    • CHX most effective
    • premed: need not clear
  41. AB prophylactic is ___ times the maintenence dose?
  42. Inithial therapy takes __ days to reverse bleeding?
  43. Hyperplastic gingivitis tx
    inithial therapy, CHX
  44. Crown lengthening factors
    • gingival crevice depth
    • BIOLOGICAL WIDTH: maintain 1mm CT btween crevice and bone
    • adequate width of keratinized gingiva
  45. bio width states you need _ mm between CT coronal to bone margin
    • 1mm
    • gingival margin will be 2mm coronal to crevice.
  46. for crown lenthing what are the 2 procedures and what are the adv and disadv
    • gingivectomy: precise contour control, low necrosis risk, limited
    • flap: wide range of cases, bone recontoured
  47. what tool is used to refine gingival contours in gingivectomy?
    kirkland knife
  48. describe some tools used in flap crown lengthening.
    • 15 c scaplel: for gingival contours
    • 12 B scalpel: for full thickness flap and preservation of interdental papillae
    • back action hoe: incised gingiva removal
  49. postsurgical recommendations from crown lenghtening?
    • no post surgical brushing or flossing
    • CHX 3x day
    • until 12 weeks
    • use soft brush and CHX (2nd week post op
  50. where is correct position for incisal edge of centrals?
    2mm below lip line at rest
  51. when can lasers be used?
    for gingivectomy (can curette bone blindly)
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Perio 2 final
perio2 final
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