Perio final exam

Clinical differences in pediatric versus adult gingival tissue’s

Gingival appears reddish

Smooth texture

Appears loose

saddle like interdental papilla

Contour is more round at gingival margin

Radiographic differences in pediatric versus adult

Widen PDL

Prominent lamina Dura

Les trabeculae in alveolar bone

Pediatric gingival disease does not correlate with level of inflammation due to the amount of biofilm?

True

What are all the gingival diseases and function/ treatment ?

eruption gingivitis: occurs in permanent and primary teeth, area of bio film presented while the permanent or primary teeth is erupting, short-lived, subsides after tooth eruption

Treatment: good oral hygiene

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Pericoronitis: occurs on partially or fully erupted teeth. Flap tissue is covering the crown of the tooth. Usually the third molars the flap is called operculum usually supperation can occur.

Treatment: surgical removal of operculum. If not treated, it can cause serious consequences

What is plaque induced gingivitis?

Puberty associated

Inflammation, limited to gingival margin

Treatment: professional care and good daily self-care calculus removal may be necessary

What is the side effect of medication on the gingiva?

Gingival overgrowth

Explain drug induced gingivitis

Exaggerative inflammatory response to put biofilm

Explain drug influenced gingival enlargement and meds

Increase size of gingiva

Medication: anti-convalescence, immuno suppressants, calcium channel blockers

When do drug induced gingival enlargement occur? And what does it affect first

1-3 months after the initiation of taking the medication

Affects the facial, entered into popular and progresses to the lingual margin

Drug influence, ginger, boiler event did not bleed easily, firm and resilient, and biofilm is not necessary for initiation of gingival enlargement, but will exacerbate the disease?

True

What are the common types of periodontitis in pediatric patients

Chronic periodontitis

Aggressive periodontitis

Which one is more common

Aggressive

Explain the primary and secondary features of aggressive periodontitis

Primary feature: disruption of the bone and PDL

Hereditary

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Secondary features: small amount of plaque biofilm exaggerates severity

* Elevated AA
* Impaired phagocytosis
* Hyper inflammatory to bacterial endotoxins
* Lack of clinical signs of inflammation
* Poor respond to periodontal therapy
* Episodic

What are the two forms of aggressive periodontitis?

Localize- first molar and incisor and two other teeth

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Generalized- first molar, an incisor and three other teeth

Describe localized aggressive periodontitis

Attachment loss affecting first molar and incisor, and two other teeth that are not a first molar and incisor

Can affect permanent and primary teeth

A child, who is affected with localized, aggressive, may experience severe periodontitis

Unknown onset

Early indications found on radiograph where bone loss around primary molars and incisors

What is the treatment of localized aggressive?

nonsurgical/surgical therapy

Anabiotic such as tetracycline with Metronidazole

Pediatrician

Frequent recall appointments and maintenance

Describe generalized aggressive periodontitis

Attachment loss of the first molar and incisor, and three other teeth that are not first molars or incisors

Permanent teeth are affected more

Episodic

Ginger disappears, fiery, red, and cutely, inflamed, and ulcerated

What is the treatment of generalize aggressive?

Same as localized, aggressive, but generalize will not always respond well to nonsurgical therapy and anabiotic’s

What are factors that predispose children?

Viral infection

Malnutrition

Emotional stress

Lack of sleep

Systematic disease

What are the common acute periodontal condition seen in pediatric patients?

Herpes virus infection

Recurrent oral herpes simplex labialis

Recurrent Aphthous ulcers

Explain herpes, virus infection

Widespread. Inflammation. Occurs anywhere on marginal and attached gingiva

Intensify gingivitis

Occurs as small clusters of yellowish white fluid filled vesicles

When vesicles pop if forms in ulcer surrounding by red halo

Explain recurrence oral herpes Simplex labialis

Also known as cold, sores, or fever blisters

Infection of the mouse by reactivation of herpes virus Symplex type one

Contagious

May feel tingling near the lip

Blisters can appear on mouth, lip, tongue, nose, or gums

Blisters can grow in clusters together

Explain recurrent aphthous ulcers

Also called  Aphthous stomatitis or canker sore

Small ovoid ulcer well defined red margins and central yellow or grey floor

Typically develops on nonkeratinized tissue

This is caused by trauma, allergy to toothpaste, ingredients, nutritional deficiency, food sensitivity, salivary Dsyfunction, emotional stress

What is a dental implant

A biological device surgically implanted into the jawbone for a missing tooth, or to provide support for a prosthetic denture

True or false the hygienist must distinguish from a healthy Peri implant versus a diseased peri implant

True

True or false it is the hygienist job to manage and maintain implants differently from natural teeth

True

Describe the component of a conventional dental implant

Dental body: the root of the implant that is inserted into the alveolar bone

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Abutment: titanium that is inserted into the implant body, and a crown is placed on top

What is it called when the titanium/abutment does not reject with the body

Biocompatible

What is a disadvantage of titanium?

Softer than other dental restorative metals

Unfavorable immuno logic reaction in some patient

True or false Peri implant tissues are soft tissues surrounding the dental implant

True

What tissue surround the implant

Epithelium/connective/bone

Describe the implant to epithelial tissue interference

The epithelial create a Bio-logic, seal, creating a barrier between the implant in the oral cavity

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The sulcular epithelium surrounds the implant abutment post

Describe the implant to connective tissue interference (significantly different then Natural tooth)

It is not the same for Natural tooth

Titanium contains no cementum or allows PDL’s to attach to the titanium

True or false in the implant to connective tissue interference. The paradoxical pathogens can destroy bone faster along a dental implant, then a natural tooth.

True

Describe implant to bone interference

Bone is direct contact with the implant body this is osseo integration

True or false Osseo integration is successful if there is no mobility, no inflammation no bone loss or radiolucency and no pain

True

What are the two forms of Peri implant disease

Peri implant mucositis: gingivitis plaque induced, reversible

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Perry implantitis- . Periodontitis, such as bone loss, nonreversible

In Peri implantitis, the implant does not become mobile until what stage

Final stage

True or false mobile implants that show signs of loss of Osseo integration should be removed

True

What are some risk factors for implant failure?

Previous history of periodontal disease

Poor plaque biofilm control

Smoking

Biochemical overload

What is bio chemical overload?

Collective force place on an implant

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Implant has direct contact with the bone therefore fourth place on the implant is transmitted directly to the bone

When probing an implant, you should use light force when probing with a

Plastic or metal probe

when polishing an implant it is indicated to use

Rubber cups with nonabrasive polishing paste

Implants, abutments and components do not require routine polishing

True

What is the best axillary aid to use on an implant?

Interdental brushes

Tuft, dental floss

Oral irrigation do you want to insert wraparound?

How to clean a removable prosthesis

Soft, bristle brush

Interdental brush with nylon wire

A tuft dental floss wrapped around (shoeshine)

What are the three mechanisms that link periodontitis to systematic disease?

Metastatic infection

Inflammation

Immune response

What is metastatic infection?

Infection disease that is mediated by micro organisms

This is not limited to just the periodontium or oral cavity

The oral bacteria in the DNA can travel to the bloodstream and adhere to a non-body site

Explain inflammation

Infection in the periodontal pocket spreads inflammatory mediators that cause systematic inflammation

Explain immune response

Host Immune cells, secrete pro-inflammatory mediators, such as TNF-a that is associated with obesity, diabetes and periodontitis

Examples of systematic conditions associated with periodontitis

Arthrosclerosis sclerotic cardiovascular

Adverse pregnancy outcome

Diabetes mellitus

Pneumonia

Chronic kidney disease

Rheumatic disease

Conjunctive impairment

Obesity

Metabolic syndrome

What is arthersclerotic cardiovascular disease?

A group of heart or a vascular disease, including angina, myocardial infarction, stroke transient ischemic attack, peripheral disease

Explain arthrosclerosis, cardiovascular disease

Arthrosclerosis is the common component of CVD( thickening of the walls of the arteries

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Artheroma is a fatty deposit in the inner lining of an artery

ACVD inflammatory mediators

The inflammatory mediator enters the bloodstream and heightened, systematic, inflammation promoting thickening of the arteries

ACVD C- reactive protein

A special plasma proteins

An important cardiovascular risk predator

ACVD HOST IN RESPONSE

Cross-reactivity occurs when an antibody reacts with an antigen other than one that initially produce its production

ACVD ELEVATED LEVELS OF FIBRINOGEN

Elevated fibrinogen is a risk factor for arthrosclerosis

ACVD Dyslipidemia

Elevated serum cholesterol and low density, lipoprotein’s and triglycerides

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This is referred to as normal amounts of lipids in the blood

Adverse pregnancy outcome: strength of association is modest for

Low birth weight

Preterm birth

Preclampsia

True or false adverse pregnancy outcome shares additional risk factors like tobacco, alcohol, obesity, and diabetes

True

What are the two pathways of adverse pregnancy outcome?

Direct pathway: oral microorganism spread from the oral cavity directly into the placenta, causing inflammatory immune response

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Indirect pathway has 2 proposed mechanisms

* First proposed is that the maternal paradoxical tissue produces pro-inflammatory mediators that enter into the bloodstream and travel into the placenta
* Second propose mechanism, is that the oral bacteria, and just the bloodstream and circulate deliver. This will increase cytokines and c reactive protein production, and they will spread, and eventually have an adverse effect on the placenta

What is pneumonia?

Inflammation in one or both lungs

What are the two types of pneumonia?

Community acquired pneumonia: contracted outside the hospital setting

Hospital acquired pneumonia: contracted inside the hospital during a state or a long-term care faculty

Ventilator associated is acquired after

Intubation

Community acquired pneumonia: in most cases are caused by

Aspiration of oral pharyngeal organisms

Hospital acquired pneumonia results from organisms called

Potential respiratory pathogen’s

potential respiratory pathogen colonizing the mouth and oropharynx is at an increased risk for developing hospital, acquired pneumonia

True

potential disease and poor oral hygiene may be associated with hospital acquired pneumonia

True

Rheumatic arthritis is an auto immune disease that causes redness want swelling and pain to the joint. This has a little connection to the

Periodontal disease

Cognitive impairment ability, including memory, and thinking skill, have a weak connection between

Periodontal disease

Obesity, patients are more likely to suffer with periodontitis compared to normal weight individuals

True

Metabolic syndrome includes clusters of condition, such as increase, blood pressure, high blood sugar, fat around the waist, abnormal levels of cholesterol increase, heart attack, stroke, and diabetes, but has a little evidence to support connection with

Periodontal disease

True or false the dental hygienist should provide the highest establish standard of care

True

Successful of lawsuit depends on the quality of the chart notes

True

What are the concepts of malpractice and tort law?

Standard of care

Liability

Malpractice

Tort

Intentional tort

Negligence

Upcoding

What is standard of care?

A dental care profession that is required to exercise the same degree of skill and care

What is liability?

A dental care profession is obligated to provide service to another person

What is malpractice?

Negligent treatment by a healthcare provider, that result in injury or damage to the patient

What is tort

Tort is a civil wrong with a person has reached a duty to another

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Tort is the legal basis for more lawsuit against Dennis and then I hygienist

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Tort is the law that permits an injured person to recover compensation from the person who caused the injury

Intentional tort

Action of injury or another person or his or her property

What is battery?

The unlawful or unwanted, touching of another person with the intention of bringing harm

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Example: forceful discipline on child in dental chair

What is assault

Unlawful, threat, or attempt to do bodily injury to another

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Example: threatening a minor patient without proper parental consult

What is inflection of emotional distress?

Actions are words that cause emotional distress for a patient

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Example: talking in a loud or harsh voice to a child

What is fraud?

Achieving personal Gaines, while causing injury to another person

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Example: being untruthful on insurance claim

What is misrepresentation?

A healthcare provider delivery devices a patient about possible outcomes

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Example: you are going to look like a movie star after ortho treatment

What is defamation

Communication of false statements to a third-party about a person that injure the reputation of others from assaulting with that person

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Example: a Dennis learns that a dental assistant is making comments about his work

What is trespass?

Infringing on the privacy time or attention of another

Discussing a patient’s personal information with someone without patients permission

What is negligence?

The failure to exercise, reasonable care to avoid injuring others

* The failure to do something that a reasonable person would do under the same circumstances

Examples of negligence is

Accidentally spilling a chemical on a patient

Not updating the medical history

Incorrect treatment of periodontal disease

What is up upcoding

Reporting a higher level of service than what was actually performed

Documentation of periodontal care is a legal document. It is the first offense in legal malpractice suit and faulty records can be the most important reason for the loss of a lawsuit.

True

General guidelines for chart entry should be in permanent ink should initial every entry

Periodontal maintenance therapy is

Customize for each individual

One started maintenance. He needs to continue throughout life.

Is to prevent the recurrence of disease

It is an essential element of successful periodontal therapy

Without regular maintenance reoccurrence of perio

What are other terms for periodontal maintenance therapy?

Supportive therapy and recall therapy

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Not dental prophylaxis

What are the three importance of periodontal maintenance?

Disease, stability. Patient comfort and function.

what is the goal of periodontal maintenance?

To prevent the reoccurrence in the progression of periodontal disease

Prevent tooth loss

Prevent any other oral conditions

The goal is to maintain the dentition throughout life

For a successful maintenance who is required active participation

dentist

Patient

Dental hygienist