Midterm

PICO Steps

  • P: Patient or problem

    • Describing the specific patient population or problem you are addressing

  • I: Intervention

    • Specific diagnostic test, treatment, adjunctive therapy, medication, product, or clinical procedure

  • C: Comparison

    • Identifies the alternative therapy you wish to compare to the main intervention

  • O: Outcome

    • Identifies outcomes you plan to accomplish, improve, or influence

Duration for Clinical Research

  • Takes up to 20 years for original research to become a part of clinical practice

Acceptable Irrigating Solutions:

  • Water

    • Effective in clinical trials

    • Readily available, cost-effective, and no side effects

  • chlorhexidine gluconate

  • povidone-iodine + water

  • stannous fluoride rinse

  • tetracycline dilutions

  • essential oil rinse

Water Flosser Mechanism

  • Pulsating fluid uses alternating compression and decompression phases to displace biofilm, bacteria, and debris

    • creating two zones of fluid movement, termed hydrokinetic activity

    • delivered above the gingival margin and into pockets or sulcus

  • combination of pulsation and pressure produces shear hydraulic forces that remove biofilm from treated areas

Flushing Zone Vs. Impact Zone

  • Flushing zone: depth of fluid penetration within the subgingival sulcus or pocket

  • Impact zone: area of initial fluid contact near the gingival margin

Indications for Water Flossers

NOTE: water flossing is superior to STRING FLOSS for reducing inflammation

  • gingivitis and stable periodontitis

  • noncompliant patients

  • special needs

  • dental implants

  • diabetes

  • orthodontic appliances

Subgingival Irrigation Before Periodontal Instrumentation

  • reduce incidence of bacteremia and number of microorganisms present in aerosols during the procedure

Setting of Subgingival Irrigation Tips

  • Set to the lowest pressure setting

Subgingival Irrigation Tip

  • Design: soft rubber-tipped end for deeper subgingival placement and pocket penetration

  • Indications: deep pockets, furcation areas, dental implants, or difficult areas to access with standard tip

  • Sequence: after full-mouth irrigation with different tip type

Systemic Review

  • Reduces bias and subjectivity

Topical Delivery Of Chemical Agent

  • Refers to intraoral placement of a chemical agent or local delivery using controlled-release devices into periodontal pocket, where the chemical agent comes in contact with biofilm

    • Example: mouth rinse or toothpaste containing a chemical agent that can kill bacteria growing in biofilm

Effective Antibiotics against Specific Perio Disease

  • Penicillin and amoxicillin

  • Tetracyclines

  • Erythromycin

  • Metronidazole

  • Clindamycin

Chlorhexidine Side Effects and Concentration

  • Side effects: allergic reactions, extrinsic staining, discoloration of tongue, alteration of taste, increase in calculus formation, and transient anesthesia

  • Concentration: 0.12% in mouth rinses

Autograft

  • source: own body

  • osteogenic potential: high

  • mechanism: osteogenesis and osteoconduction

  • example: intraoral bone chips and extraoral iliac crest

Allograft

  • source: another person

  • osteogenic potential: low

  • mechanisms: osteoinduction and osteo-conduction

  • example: freeze-dried bone allograft (FDBA)

Xenograft

  • source: another species

  • osteogenic potential: minimal

  • mechanism: osteo-conduction

  • examples: bovine-derived bone (Bio-Oss)

Periocoronitis

  • soft-tissue inflammation associated with an abscess

  • signs and symptoms:

    • pain

    • swelling of the operculum

    • trismus

    • elevated body temperature

    • lymphadenopathy

Peri-Implant Tissues

  • soft and hard tissues that surround and support a dental implant

Substantivity Importance in Mouth Rinses

  • active ingredient would be retained in the oral cavity following rinsing and would be released over time

    • important since biofilm grows and matures continuously

Peri-implantitis and Peri-Mucositis (Peri-Gingivitis)

  • Peri-mucosititis: plaque biofilm-induced inflammation of soft tissues with no loss of supporting bone

    • REVERISIBLE

    • bleeding and/or suppuration

  • Peri-implantitis: characterized by plaque biofilm-induced inflammation and progressive loss of alveolar bone

    • bleeding and/or suppuration

    • bone loss> 3 mm and/or PD> 6 mm

3 Classification for Dental Implants and Tissue Conditions

  • Peri-implant health: absence of erythema, bleeding on probing, swelling, and suppuration

  • Peri-implant mucositis (peri-implant gingivitis): plaque biofilm-induced inflammation of soft tissues with no loss of supporting bone

  • Peri-implantitis: characterized by plaque biofilm-induced inflammation (soft and hard tissues) and progressive loss of alveolar bone

Causes of Soft and Hard Tissue Deficiencies

  • Contributing factors:

    • loss of periodontal support caused by periodontitis

    • endodontic infection

    • thin buccal bone plates

    • extraction with additional trauma to tissues

    • traumatic injury

    • systemic disease impairing bone remodeling

    • pneumatization of maxillary sinus

Implant Update Radiographically

  • once a year

Cement on Implant

  • induces inflammation due to a rough surface providing an environment for bacterial attachment

Indication of Implant Failure

  • mobility

Operculum

  • flap of soft tissue covering a portion of the crown or partially erupted tooth

Implication of Furcation Involvement and Periodontal Classification

  • Furcation involvement: occurs in multirooted teeth when periodontal infection invades the area around the roots

  • Periodontal Classification: stage refers to severity of a disease, and grading is how rapidly the disease is expected to progress

= furcation involvement class II or III → Stage III (automatically NOT stage I/II)

Implications of Smoking and Grading

  • Smoking: Grade modifiers

    • increase risks for periodontal diseases (attachment and tooth loss)

    • decreased inflammation and blood flow

= smoking LESS than 10 cigarettes a day → Grade B OR smoking 10 or MORE cigarettes → Grade C

Clinical Attachment Loss

  • Clinical attachment loss appearing as migration of the junctional epithelium to a position apical to the level of the CEJ

    • PD + recession = CAL

Sjögren’s Syndrome

  • autoimmune disorder in which the immune system attacks body’s own gland (salivary and tear glands)

    • can cause xerostomia or periodontal disease

Dental Implant parts

  • implant body (fixture)

    • acts as a ‘root”

    • placed into alveolar bone

  • abutment

    • metal post that connects the prosthetic crown to implant body and secures it in place

    • protrudes into oral cavity

  • prosthetic crown or prosthesis

    • acts as the “crown” of the dental implant

Oral vs. Non-oral malodor causes

  • oral causes: dental caries, gingivitis, periodontitis, low salivary flow, and tongue coating (dorsal tongue ideal for bacterial reservoir)

  • non-oral causes: coffee consumption, nose and throat conditions, uncontrolled diabetes and ketoacidosis, lung disease, GI tract, liver disease, fetor hepaticus, kidney disease, hormonal changes, and metronidazole (antimicrobial drug)