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What factor decreases long term success of perio lesion treatment?
- multirooted w/ furcation involvement
- 31-57% mortality vs 7-10%
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Grade I furcation
- initial attachment loss w most bone in tact.
- No radiographic change
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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
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grade III furcation
- bone loss throughout width of furcation
- no attachement to furcation roof
- radiolucency in coronal furcation
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Grade IV furcation
- bone loss across is accompanied with gingival recession w clinically visible furcation
- radiolucent coronal furcation
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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)
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Root trunk
- distance between CEJ and beginning of furcation
- longer improves prognosis
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___ 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
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Grade II treatment
- resective osseous surgery
- bone removed to create positive architecture
- flap apically positioned to follow contour and minimal surgical pockets developed
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Advanced bone loss tx
- regenerative surgery(emdogain)
- periosteal graft
- works better for Grade II than III
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Grade III furcation tx
- root resection, endo therapy, special contour crown
- implant
- hemisection: lower molars, create 2 premolars involves endo and new crowns
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Mouth breathing gingivitis tx
- initial therapy
- OHI
- CHX and vaseline
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What drug commonly causes ginigival hyperplasia (epilectic)?
- phenytoin Dilantin (PDGF)
- initial therapy
- electric toothbrush
- flap surgery
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What drug of transplant pts cause gingival hyperplasia?
- immunosuppresant &
- nifedipine and Ca2+ channel blockers
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tx of inherited gingival fibromatosis
- Autosomal dominant
- surgery
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Herpetic viral gingivostomatitis tx
- tx fever, dehydration & pain
- antiviral (acyclovir topical 5% or systemic 80mg/kg/day
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max dose for acyclovir?
- 80mg/kg/day
- herpetic viral gingivostomatitis
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PLAQUE INDUCED PERIODONTITIS IS RARELY SEEN IN CHILDREN AND IF IT OCCURS IS USUALLY ASSOCIATED WITH ________
GENETIC OR ACQUIRED IMMUNOLOGICAL DEFECTS
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PERIODONTAL BONE LOSS IN CHILDREN
IS CLASSIFIED AS _______
AGGRESSIVE PERIODONTITIS
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Cyclic Neutropenia
Young patients develop advanced bone loss and Necrotizing Gingivitis only when their systemic resistance to Dental Plaque is seriously depressed
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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
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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
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hypophosphatasia
rare genetic with suppressed cementum formation
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bacteremia is usually cleared in ___ mins
15
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Most dental bacteremia are considered ________
low grade intensity 1-‐12 cfu/ml of blood
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What procedure has highest incidence of bacteremia?
- intraligamentary injection
- (into PDL space)
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incidence and magnitude of oral bacteremia areproportional to the
amount of inflammation and degree of trauma
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bacteremia protocol
- OHI
- reduce # visits
- CHX
- 7 days btwn appointments
- change antiobiotic regimen
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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
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most common bacteria of infective endocarditis
- Strep Viridians
- alpha-hemolytic strep
- S. mutans, S. sanguis, S. oralis
- non-strep: Aa, Capnocyphacga, Lactobacillus
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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
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Endocarditis types
- acute: agressive bacteria, S. aureus, group B strep
- subacute: already diseased or damaged valve S. Viridians
- prosthetic valve
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IE mortality
- 25%
- Left-sided: 50%
- reduce mortality: improved heath, OHI, AB prophylaxis
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IE mortality due to ____
secondary CHF congestive heart failure
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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
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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
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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
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glycosylated HbA1c measures avg blood glucose in preceding ___
- 2-3 months
- 4-6% normal
- 7-8% moderately controlled
- >8% needs improvement
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prophylactic AB in perio surgeries are usually what type of procedures
- bone grafting
- implants
- CHX most effective
- premed: need not clear
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AB prophylactic is ___ times the maintenence dose?
2-4x
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Inithial therapy takes __ days to reverse bleeding?
10-14
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Hyperplastic gingivitis tx
inithial therapy, CHX
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Crown lengthening factors
- gingival crevice depth
- BIOLOGICAL WIDTH: maintain 1mm CT btween crevice and bone
- adequate width of keratinized gingiva
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bio width states you need _ mm between CT coronal to bone margin
- 1mm
- gingival margin will be 2mm coronal to crevice.
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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
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what tool is used to refine gingival contours in gingivectomy?
kirkland knife
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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
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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
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where is correct position for incisal edge of centrals?
2mm below lip line at rest
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when can lasers be used?
for gingivectomy (can curette bone blindly)
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