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--What are the 3 different presentations of Periodontitis according to the 2017 Classification Framework

*1) Necrotizing Periodontitis

2) Periodontitis as a direct manifestation of systemic diseases

3) Periodontitis - Localised, Generalised, Molar Incisor Pattern.

--List Factors that affect the severity of Periodontitis (7)

*1) Smoking

2) Diabetes

3) Stress

4) Diet

5) Illness

6) Sleep

7) Exercise

--What are the secondary features of Periodontitis (5)

*1) Microbial Deposits not consistent with destruction

2) Elevated levels of A.a and P.g

3) Phagocyte Abnormalities

4) Hyper responsive inflammatory and immune response

5) Attachment and Bone Loss may be self-arresting.

--Genetic Polymorphism can be a risk factor for Rapidly Progressing Periodontitis.

Describe the correlation between Polymorphonuclear Defects and Periodontal Disease (3)

*PMN defects result in severe periodontal disease.

Localised Rapidly Progressing Periodontitis is associated with a PMN defect.

Patients with Rapidly Progressing Periodontitis have a hyper-responsive PMN

--How is Necrotising Periodontal Disease characterised (4)

*1) History of Pain

2) Presence of Ulceration at Gingival Margin

3) Fibrin Deposits at site decapitated gingival papillae

4) Exposure of Marginal Alveolar Bone

--When are Radiographs taken for Periodontal Disease

*Radiographs should be available for all code 3 and code 4 sextants. The type of radiograph is a matter of clinical judgement but the bone levels should be seen

--Why is it important to diagnose Periodontal Disease (4)

*1) It is a Medico-Legal Requirement

2) Early Management Priority

3) Treatment Modality

4) Early Referral

--Why are Systemic Antibiotics indicated in Rapidly Progressing Periodontitis

*Pathogens such as A.a and P.Gingivalis are tissue destructive and invasive and mechanical therapy is insufficient to eliminate them.

--What are the 2 main antibiotic regimens prescribed for Periodontal Disease

*1) Amoxicillin 500mg + Metronidazole 400mg TDS for 7 Days

2) Azithromycin 500mg once daily for 3 days.

--Whilst Calculus is not a causative Factor for Periodontal Disease, it can be regarded as a contributory factor. Explain why

*Calculus is a calcified dental plaque.

Sub-gingival calculus can act as a barrier to sub-gingival cleaning. Sub Gingival Calculus can absorb Bacterial Endotoxins

Supra-gingival calculus impedes tooth brushing and interdental bleeding.

Sub & Supra Gingival Calculus can impede the passing of Periodontal Probe therefore pocketing pocket depths.

--What Anatomical Factors can cause Non-Surgical Periodontal Therapy to fail? (6)

*1) Multiple Intra Bony Defects >3mm

2) Furcation Involvements

3) Very Deep Sites

4) Difficult Anatomy of Tooth Bone or Roots

5) Difficult Access

6) Gingival Biotype

--When is Surgical Therapy considered for Management of Periodontal Disease

*1) When Non-Surgical Therapy has not worked

2) Anatomical Sites requiring Surgical Correction

3) Severe Cases Higher Likelihood of Needing Surgery

--Once Non Surgical Therapy +/- Surgical Therapy is complete, we begin the Maintenance Phase.

What occurs in this phase

*- Key for all Patients to have 3 monthly hygienist visits initially.

- Supportive Periodontal Therapy including OHI

- Review Annually including Risk Factors, Hygiene Methods & Motivation.

--Which Patients get considered for Specialist Periodontal Care

*1) BPE scores of 3 & 4

2) Severe Periodontitis

3) Rapid Rate Progression (Stage C) Periodontitis

4) Medical Conditions or Syndromes that affect Periodontal Status

5) Mucogingival Problems, Gingival Recession or Periodontal Defect for which surgery may be indicated, following initial therapy

6) Periodontal-Endodontic Lesions

--What are the three components of Oral Aesthetics

*1) Teeth

2) Gingiva

3) Lipline

- High or Low

--What aesthetic considerations are made about the gingiva (5)

*1) Colour

2) Form/Shape

3) Position

- Is it Receding

- Is it Inflamed

4) Symmetry

5) Relationship to Upper Lip

--What is the ideal aesthetic gingival form (5)

*1) Pink

2) Knife Edged Margins

3) Smooth Transition from Gingiva to Tooth

4) Fill the Embrasures

5) Light Stippling

--Gingival Recession can be Localised or Generalised. What are possible aetiologies for both types

*Localised

- Tissue Biotype

- Trauma

- Crowding due to orthodontic treatment where the tooth has been moved to a more buccal position

Generalised

- Periodontal Disease

- Tissue Biotype

--What are the Unhelpful effects of Periodontal Treatment on Aesthetics (2)

*1) Recession

- Teeth will look longer as the gingiva swelling which covered tooth surface will be reduced

2) Poor Contour

- Loss of attachment in interdental region

- Loss of interdental papilla

--What are the 2 types of Gingival Veneer

*1) Hard

2) Soft

Usually both Veneers are made and patient decides which one they want to wear

--How is Gingival Recession corrected through Periodontal Plastic Surgery

*Gingival Grafting