FPC3: Midterm (all subjects) Diagram | Quizlet

What is the percentage of people who have MODERATE periodontitis?

30%

What is the percent of the US population that has periodontitis?

47%

True or false: A risk factor is a cause and effect relationship, and it has been confirmed in case study?

FALSE!

Risk factor relationship was confirmed in a LONGITUDINAL study

What are two known risk factors for periodontitis?

Smoking and Diabetes Mellitus

Nicotine concentrations are 300x concentration in the _______ than that in the plasma

Gingival Cervical Fluid

Smokers are _____x more likely to have periodontal disease

4

What are periodontal characteristics that are common for smokers?

Greater attachment loss

Deeper probing depths

Fewer teeth

more SUPRAgingival calculus

*may camouflage clinical signs of inflammation

DM patients with severe periodontitis had a _____ risk of worsening glycemic control over time compared to DM subjects without periodontitis

6x

Periodontal treatment can lower HbA1C at 3 months by how much?

0.36%

You should only treat your patient if there last HbA1c level was completed ____ months ago

3

What is ideal HbA1c levels?

<6.5%

What is poor HbA1c levels?

>8%

Probing depths greater than ______ mm is considered peroodontal disease

4

What is horizontal bone loss?

Bone reduced in height (flat)

Interdental septa, mesial height ≈ distal height

Buccal & lingual bone margins are also affected but not equally

What is vertical bone loss?

Defects occur in oblique direction

Leaving a hollowed out trough along side of the root

Base of defect is apical to surrounding bone

Which type of bone loss has the possibility for regrowing?

Vertical bone loss

What is considered Grade I in the Glickman system?

Pocket into flute, but intact interradicular bone

What is considered Grade II in the Glickman system?

Pocket into furcation & interradicular bone loss, but not completely through to opposite

What is considered Grade III in the Glickman system?

Communication from one furcation to another (through-and-through lesion)

What is considered Grade IV in the Glickman system?

Same as grade III with gingival recession, furcation clearly visible to clinical examination

What is the major etiology of pathological tooth migration?

Destruction of the attachment apparatus

Which teeth are prone to elongation and displacement?

Anterior teeth

Not protected by occlusal forces & no anterior-posterior contacts able to inhibit tooth migration

True or false:

Spontaneous correction of pathologic migration may follow periodontal treatment

True

What is the advantage to an implant?

Fixed

Maintain original occlusion

No need for teeth preparation

Stimulating alveolar bone

An implant is a ________ foreign object (mostly Ti) placed in the edentulous jaw to anchor prosthetic replacement teeth

biocompatible

An implant is a highly predictable treatment alternative to replace what?

missing dentition

What factors should be considered before placing an implant?

Medical/perio conditions

Prosthetic condition

Implant site condition

Timing

What are examples of medical/perio consideration for implant placement?

≤ ASA III

Patient compliance

No/stable periodontitis

Good OH & maintenance

No/quit smoking

No/controlled diabetes

Mouth opening restriction

How much vertical space is needed for an implant?

6-7 mm

How much distance (depth) between implant platform & future crown for anterior teeth?

4 mm

How much distance (depth) between implant platform & future crown for posterior teeth?

3mm

Where should the implant be placed in regards to buccal-lingual positioning

Stay on the line for future central fossa / cingulum

*direct the loading through the long axis of the implant

How thick should the buccal and lingual bone be to place an implant?

At least 1.5-2 mm

If your patient has an alveolar ridge deficiency, what treatment might you consider?

consider ridge augmentation or implant w/ smaller diameter

What are different types of bone grafting procedures that can be done before placing an implant?

Ridge/Socket Preservation

Guided Bone Regeneration

Sinus Lift

What is the minimum distance between an implant and a tooth?

1.5 mm

What is the minimum distance between an implant and an implant?

3 mm

Primary stability is associated with the ________ _________ of an implant with the surrounding bone

mechanical engagement

What is the key to prevent early implant failure?

Primary Stability

What is the recommended torque force?

30Nc

When is the lowest stability recorded for an implant during the healing process?

3-5 weeks after placement

DO NOT REMOVE Healing Abutment During this time!!!

How long does the patient have to wait for the crown after placing the implant?

3-4 months

How long does the patient have to wait to do implant placement after a ridge preservation?

3-4 months

Implant placement after a small defect should be _______ months after GBR/SL

6-7 months

Implant placement after a large defect should be _______ months after GBR/SL

>9 months

During the re-evaluation phase, what 3 things should you compare with your initial findings?

Probing depths

Bleeding on Probing

Oral Hygiene status (plaque score)

Which tissue is the only one that can regrow in the mouth?

Long junctional Epithelium

If your patient has gingivitis, when should you re-evaluate them after their non-surgical therapy?

2-4 weeks

If your patient has periodontitis, when should you re-evaluate them after their non-surgical therapy?

6-4 weeks

What is furcation invovement?

A condition when periodontal disease caused the bone resorption into the furcation of a multi-rooted tooth

What is the first non-surgical treatment that MUST be completed before you move onto other stages?

Must control systemic and social factors (glucose control, smoking cessation)

If your patient has adequate plaque control and a probing depth of <5mm, what type of treatment do they need?

Periodontal Maintenance

If your patient has inadequate plaque control and a probing depth of <5mm, what type of treatment do they need?

Reinforcement of OHI

Periodontal Maintenance

If your patient has adequate plaque control and a probing depth of ≥5mm, what type of treatment do they need?

Surgical Care

Refer to Periodontist

If your patient has Inadequate plaque control and a probing depth of ≥5mm, what type of treatment do they need?

Reinforcement of OHI

Refer to Periodontist

What treatment occurs in the Non-surgical Tx phase?

Scaling and Root Planing, OHI, Systemic, Social & Local Factor Control

Systemic & Local Factors: consider smoking, DM, overhangs, antibiotics

What treatment occurs AFTER the non-surgical tx phase?

Re-Evaluation ~4-6 weeks

After re-evaluation, if your patient has Gingival Health on Reduced Periodontium, what treatment do they need next?

Periodontal Maintenance (3 month intervals)

After the re-evaluation, if your patient has Periodontitis with Poor OH, what treatment do they need next?

They need to RESTART the Non-Surgical Tx Phase

(SRP, OHI, Control Systemic and Local Factors)

After the re-evaluation, if your patient has Remnant Periodontitis with good OHI, what treatment do they need next?

They go into surgery phase, Restorative phase, and then begin periodontal maintenance (3 month intervals)

If your patient has severe gingivitis, what type of treatment do they need?

They need Scaling in the presence of inflammation

Re-eval in 2-4 weeks

If your patient has Mild to Moderate gingivitis, what type of treatment do they need?

Prophylaxis

Re-eval every 6 months

What is the 3rd most frequent dental emergency?

Periodontal Abscess

What are the clinical features of a periodontal abscess?

Light to discomfort to severe pain

Sometimes can be asymptomatic

Gingival soft tissues along the lateral side of the root

*Usually found at a site with a deep periodontal pocket

What is CAL?

Clinical attachment loss from the CEJ to the base of the pockets

What is the HbA1C threshold level for Grade C?

7%

What is the best evidence for grading your periodontal patient's bone loss?

Use the RBL from 5 years ago

For a periodontal abscess drainage, what type of anesthetic injection is not recommended?

Infiltration is not recommended

Amalgam

What restoration is this?

Older composite restoration

What restoration is this?

Modern Composite Restoration

What restoration is this?

Porcelain fused to metal

What crown is this?

Porcelain fused to metal

What crown is this?

Porcelain fused to metal

What crown is this?

All ceramic crown

What crown is this?

Stainless steel crown

What crown is this?

Gold Crown

What crown is this?

All metal crown (Gold crown)

What crown is this?

All ceramic crown

What crown is this?

Stainless steel crown

What crown is this?

Amalgam

Which restorative material is not seen below?

a. PFM crown

b. Gutta-percha

c. Amalgam

d. Composite resin

e. Post

What are the types of bone loss patterns seen in periodontal disease?

Horizontal

Vertical

Buccal or lingual cortical plate loss

Osseous deformities in the furcations of multirooted teeth(Furcation involvement) Interdental craters

What is the normal alveolar height on a radiograph?

0.5-2mm below to the CEJ

post

What is this?

What are the FOUR major categories of information required to begin developing a treatment plan?

1.Patient History

2. Clinical Exam

3. Radiographic examination

4. Other diagnostic aids

True or false:

The patient's medical, dental, and social history CANT impact your treatment plan and outcomes

False!

They CAN impact tx plans and outcomes

What are 5 things that fall under Patient History?

1. Demographic Data

2. Chief Concern

3. General Health History

4. Oral Health History

5.Psychosocial History

What does HPI stand for?

History of Present Illness

What is the chief concern?

Its usually handled first

Determines Urgency vs routine

Signs vs Symptoms: What is the definition of Signs?

Findings discovered by the DENTIST during an examination (swelling, erythema, mobility, etc.)

Signs vs Symptoms: What is the definition of Symptoms?

Findings verbally revealed by the PATIENTS themselves, usually because they are causing problems (pain, swelling, broken/ sharp teeth, loose teeth, bleeding gums, esthetic concerns)

What should the General Health History include?

Allergies

Med list

Past medical/surgical history

Current active disease

What should Dental history include?

Date of last visit

Oral hygiene practices

Dental IQ

Age of existing restorations

Patient goals

What should a patients psychosocial history include?

Diet, habits, substance use

Mental Health

Patient assessment helps form both the problem list and diagnoses. It can also help determine _______

etiology

What should your physical examination include?

BP

Pulse

Posture + Gait

Exposed Skin

Cognition and mental acuity

Speech/ability to communicate

Weight

What are examples of conditions that are Patient modifiers?

Parkinsons

Arthritis

History of stroke

Pregnant

ADHD

What are examples of other diagnostic aids?

Study casts

Diagnostic wax ups

Occlusal splint

Caries excavation

Consultation

Clincial photos

Scanning

What are good online resources for us to use to further our knowledge in medications and patient assessment?

Lexicomp

ADA

Dental Specialist Associations

Dental Journals

NIH

PubMed

In our Michael Scott Case, he had PTSD and anxiety. What is a good resource we have to offer him?

Nitrous Oxide