Perio Test 2

  1. McCall’s Festooning
    • A ring-shaped enlargement of the gingival margin on the vestibular surface (buccal or labial) of canines and premolars. It may be associated with occlusal trauma.
    • "Lifesaver"
  2. Stillman’s Cleft
    Small fissures extending apically from the midline of the gingival margin in teeth subjected to trauma.
  3. What does PSR stand for?
    Periodontal Screening and Recording
  4. Who probe
    • Color-coded band at 3.5-5.5 mm 
    • Ball tip
  5. Performing PSR
    • Divide mouth into 6 sextants 
    • Probed all surfaces of all teeth
    • Record only the highest code for each sextant.
  6. PSR Code 0
    • Color band is completely visible in deepest sulcus of the sextant 
    • No calculus or defective margins 
    • No BOP
    • No further documentation is needed
  7. PSR Code 1
    • Color band is completely visible in deepest sulcus of the sextant 
    • No calculus or defective margins 
    • BOP is present
    • (Gingivitis-no further documentation is needed, but Dr. Baker recommends documenting pt. ed.)
  8. PSR Code 2
    • Color band is completely visible in deepest sulcus of the sextant 
    • Calculus or defective margins are present
    • (Gingivitis-no further documentation is needed, but Dr. Baker recommends documenting pt. ed.)
  9. PSR Code 3
    • Color band is only partially visible in deepest sulcus of the sextant 
    • This means probing depth is at least 3.5 and less than 5.5
    • (If only in one sextant a comprehensive eval on that sextant; if more than one sextant a comp eval on entire mouth.)
  10. PSR Code 4
    • Color band is NOT visible in deepest sulcus of the sextant 
    • This means probing depth is greater than 5.5
    • (In any sextant a comprehensive eval of entire mouth)
  11. PSR Code *
    • Added to any other code to note:
    • Furcation 
    • Mobility 
    • Recession beyond the color band 
    • Mucogingival defects
  12. Mobility Class I
    • Slightly mobile 
    • < 1 mm, horizontal
  13. Mobility Class II
    > 1 mm, horizontal
  14. Mobility Class III
    • >1mm, horizontal, 
    • Vertical (compressible) 
    • Rotates with finger pressure
  15. Furcation Class I
    • Concavity can be felt 
    • Bone in furcation is intact 
    • Not detectable on radiographs
  16. BOP
    • Bleeding on probing is sometimes delayed
    • Lack of BOP is NOT always a sign of health, but BOP is ALWAYS a sign of disease.
  17. Furcation Class II
    • Probe enters furcation but can't pass through
    • Slightly widened PDL in furcation on radiograph
  18. Furcation Class III
    • Probe passes all the way through to the other side
    • Radiolucency in furcation on radiograph
  19. Furcation Class IV
    Same as Class III only visible.
  20. Calculating Width of Attached Gingiva
    • Measure from gingival margin to mucogingival junction
    • Then subtract probing depth
  21. Calculating Clinical Attachment Level (CAL)
    • If recession is present: Recession + probing depth
    • If margin is swollen apical to CEJ: probing depth - distance from CEJ to margin
  22. 5 Perio Assessment Tests
    • Gingival crevicular fluid assessments (GCF)
    • Salivary Testing
    • Microbial Tests
    • Immunologic Test
    • Genetic Testing
  23. GCF Assessments
    • GCF volume increases with inflammation
    • GCF content changes with inflammation:
    • Increased # of immune cells
    • Chemical mediators of inflammation
    • Host enzymes (especially collagenase
    • Prostaglandins
    • Testing is simple and cheap; similar to litmus paper testing that diabetics use
  24. Microbial Tests
    • Cultures can look for specific periodontal pathogens
    • Cultures take time to grow and are fairly costly
    • Microbial DNA test can be used for refractory or  aggressive disease
  25. Immunologic Tests
    • Can test for the host response antibody to a specific organism.
    • Expensive
    • Currently not applicable to office use; only in research studies
  26. Genetic Testing
    • Few patients are genetically programmed to produce too much Interleukin-1
    • Saliva can be tested for this genotype
    • These patients can be monitored closely
    • (Interleukin-1 is one of the cytokines produced by the inflammatory cells in response to bacteria)
  27. Radiographic Signs of Bone Loss
    • Widening of PDL
    • Presence of calculus
    • Loss of Lamina Dura in interproximal alveolar crest
    • Radiolucent projections radiating from the PDL
    • Reduction of interproximal bone height
  28. Horizontal Bone Loss
    • Most common type of bone loss
    • Suprabony pockets
  29. Vertical Bone Loss
    • Uneven resorption of alveolar bone
    • Forms trenches or craters in the bone
    • Infrabony pockets
  30. Cone Beam CT
    • State of the art when assessing bone quality and quantity
    • Especially good prior to implant placement
    • Cone beam is smaller machine than medical CT's
  31. Acute Gingivitis
    • Bright red
    • Papillae enlarged
    • Rolled margins
    • Soft, flabby, delicate consistency
    • Appears "tight"
    • Bleeding and/or exudate
    • Tissue returns quickly to normal after treatment
    • May progress to periodontitis
  32. Chronic Gingivitis
    • Deeper red, bluish, or paler b/c more keratin
    • More fibrotic
    • Margins and papillae are still enlarged, but more blunted
    • Less bleeding and exudate
    • Tissue changes take longer to resolve than acute
    • May be present for years without progressing, but could progress at any time
  33. Plaque-Induced Gingivitis
    • Most commonly occurring type
    • Plaque control will return tissues to health
    • No attachment loss
    • If existing attachment loss: plaque control can further prevent more loss, but tissues are more susceptible to additional break-down
  34. Peri-Implant Gingivitis
    Factors that contribute to gingival or periodontal disease also contribute to gingivitis and loss of attachment around an implant.
  35. Non-Plaque Induced Gingivitis
    • Treatment is different
    • Skin disease: Lichen planus, Pemphigus
    • Infections: primary herpes, candidiasis
    • Allergic reactions
  36. What is the most common cause of tooth loss in Adults?
  37. Clinical Signs of Periodontitis
    • Red, swollen tissues or Gray, fibrotic tissues
    • Bleeding during brushing
    • Bad taste, bad breath
    • Loose teeth
    • Purulence (pus)
    • No pain in most cases
  38. Types of Periodontitis
    • Chronic (most common form)
    • Aggressive
    • Manifestation of systemic disease
    • Necrotizing diseases
    • Periodontal abscesses
    • Associated with endodontic lesions
    • Associated with developmental or acquired conditions
  39. Chronic Periodontitis
    • Onset may occur at any age
    • Usually takes until 35 to cause significant attachment loss
    • Initiated by bacterial plaque biofilms
    • Host response to plaque is responsible for destruction
  40. Localized
    Less than 30% of mouth
  41. Generalized
    More than 30% of the mouth
  42. Severity of Periodontitis
    • Depends on: 
    • Rate of progression and 
    • Amount of clinical attachment loss
  43. Slight to Moderate Severity of Attachment Loss
    Less than 30% of the supporting structures for a given tooth have been lost
  44. Advanced Severity of Attachment Loss
    • more than 30% of support lost 
    • 5mm or more of attachment lost 
    • Class III furcations
  45. What is the purpose of the PSR?
    • To separate patient into 2 groups:
    • Periodontal health or gingivitis
    • Periodontitis
  46. Treatment of Chronic Periodontal Disease
    • Reduce plaque biofilm to a level that is not a challenge to the host 
    • Eliminate risk factors 
    • Stop disease progression 
    • Prevent recurrence
  47. Recurrent Periodontitis
    • Relapse after successful therapy 
    • Patient has reverted to old habits 
    • Short maintenance interval may prevent this
  48. Refractory Periodontitis
    • ANY periodontitis that DOES NOT RESPOND to treatment. 
    • Attachment loss continues despite excellent treatment and self-care. 
    • Smokers more likely to have this. 
    • Refractory is no longer a separate diagnostic category, but the term is still useful for both chronic and aggressive diseases.
  49. Aggressive Periodontitis
    • May be genetic predisposition 
    • Possible neutrophil defect 
    • Very rapid attachment/bone loss 
    • Poor response to therapy 
    • Usually some teeth will be lost 
    • Severity of disease seems excessive for amount of plaque 
    • Tissue does not appear inflamed 
    • No contributing systemic disease
  50. Localized Aggressive Periodontitis
    • Formerly known as Localized Juvenile Periodontitis (LJP) 
    • Becomes evident early in life (teens)
    • More females than males 
    • More people of African descent
    • 1st molars and incisors most often affected 
    • Strong association with A.a. Actinomyces actinomycetomicans 
    • Abnormal neutrophil function 
    • Vertical bone loss is common
  51. Generalized Aggressive Periodontitis
    • Formerly known as Rapidly Progressing Periodontitis (RPP)
    • Usually evident before age 30 
    • Rapid destruction of supporting tissues throughout the mouth 
    • Higher levels of A.a and Porphyromonas gingivalis 
    • Abnormal neutrophils
  52. Treatment of Aggressive Periodontitis
    • Localized variety MAY subside in adulthood 
    • In severe cases, goal is to slow progression of disease 
    • Maintain as many teeth for as long as possible 
    • Evaluate family members for genetic risk 
    • Short recall intervals!!!!
  53. Necrotizing Periodontal Diseases
    • Most patients are smokers. 
    • NUG:
    • Most cases resolve with treatment 
    • No permanent attachment loss 
    • A few cases progress to…
  54. Necrotizing Ulcerative Periodontitis (NUP)
    • Necrosis extends to PDL and bone 
    • Very rapid destruction 
    • Very painful 
    • Usually associated with impaired immune system (especially HIV/AIDS)
  55. Treatment of Necrotizing Diseases
    • Irrigation and debridement 
    • Self-care instructions 
    • Rest and good nutrition 
    • Soft, bland foods at first 
    • May need liquid supplement
  56. Periodontitis Associated with Endodontic Lesions
    • Perio/Endo:
    • Periodontal attachment loss is severe enough to extend to accessory pulp canals 
    • Pulp becomes infected 
    • Endo/Perio: 
    • Tooth has a non-vital pulp 
    • Endodontic abscess extends into PDL and drains into the sulcus
  57. Abnormal Development or Acquired Periodontal Conditions
    • Local tooth related defects: Enamel pearls 
    • Muco-gingival defects 
    • Trauma from occlusion 
    • Remember - - for occlusal forces to CAUSE damage to the periodontium, there must be existing attachment loss
Card Set
Perio Test 2
Assessment, RAD, disease