D4 Perio OSCE questions and answers 2023

D4 Perio OSCE questions and answers 2023 Another name for Biologic Width = Supracrestal Attachment Supracrestal Attachment = dimension of the soft tissue attached to the tooth coronally to the alveolar crest A = Sulcus Depth (1mm) B = Epithelial Attachment (1mm - 0.69) C = CT Attachment (1mm - 0.98) Crown Lengthening Indications - Can't see crown margins once placed - Not enough biologic width/too close to bone Goals: - make crown longer - improve long-term prognosis of crown Calculating BW - Want 2mm of attachment (or 3 mm from bone to prep margin) Radiographic Assessment - What can you evaluate on radiographs? - Furcation - Shape of Root - Trunk Length - Widened PDL (Occlusal Trauma) - Bone Loss - Crown to Root Ratio Why can some aspects not be visible on radiographs? = Imposition of Structures (i.e., Peri-Implant Cement on B/P aspect) What conditions require antibiotic prophylaxis? - Prosthetic cardiac valve - Prosthetic material used for cardiac valve repair - Previous history of IE - CHD - Cardiac transplant recipients with valvulopathy - Compromised immunity (transplant, neutropenia, cancer therapy) Dental Procedures Requiring Antibioic Prophylaxis in Select Patients = all procedures involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa - Extraction - Cleaning - SCRP - Periapical RCT - Orthodontic bands - Placing subgingival medications - Biopsy - Suture removal Antibiotic Prophylaxis First Line: 2g Amoxicillin - 1 hour before Second: 600 mg Clindomycin 1 hr before Antiplatelet Therapy (Primary Step) 1. Acetylsalicylic Acid (Aspirin) - IRREVERSIBLE inhibition of COX-1 and 2 - COX1 and COX2 are enzymes involved in synthesis of PGE2 and PGF2a, which mediate pain Anticoagulants (Secondary Step) 1. Warfarin (Coumadin) - blocks formation of Vit K dependent factors (2, 7, 9, 10) 2. Heparin - potentiates antithrombin (inactivates thrombin to prevent conversion of prothrombin to thrombin) - also inactivates other proteases in blood clotting - prevents coagulation by directly preventing soluble fibrinogen conversion into insoluble fibrin Anticoagulant Tests INR -> Warfarin/Coumadin, INR = 2-3, 1 for normal people PTT -> Heparin, renal dialysis, hemophilia PT -> Anticoagulants Bleeding Time --> platelet function CBC -> anemia, leukopenia, thrombocytopenia Medications Causing Gingival Enlargement 1. Calcium Channel Blockers (anti-hypertensive, Nifedipine, Amlodipine, Verapamil) 2. Immunosuppressives (cyclosporin) 3. Anticonvulsant (Dilantin, Phenytoin) Chlorhexidine Gluconate = use 15 mL (1 Tbsp) 2x/day for 30 seconds CG - Side Effects = LIMIT LENGTH OF USE - no drug interactions - can have ALLERGIC REACTION (hives, rash, wheezing, swelling) - no long-term studies in pregnant women - STAINING OF TEETH AND OTHER ORAL SURFACES - can increase calculus - altered sense of taste - toothache - oral mucosa irritation - sialandenitis (inflammation of salivary gland) Properties of CG - 0.12% solution (KNOW) - FDA approved in 1986 - Stored at room temperature - ANTISEPTIC and ANTIMICROBIAL oral rinse - Kills bacteria by binding to cell walls Etiologic Factors of PD - ANYTHING that retains plaque Local: caries, overhang, open contact, tooth morphology, gingival form, calculus Systemic: SMOKING and DIABETES (also stress, osteoporosis, genetics, age, gender, SES, neutrophil disorder) Diabetes and PD o Prevalence of periodontitis is high among diabetics o Poor glycemic control is associated w inc severity of periodontitis o Biological mechanisms involve deregulated immune response, impaired collagen and bone metabolism and healing response o IMMUNE DYSFUNCTION, CELLULAR STRESS, CYTOKINE IMBALANCE o Periodontal therapy may improve glycemic control (Dec inflammatory burden) Diagnosing Diabetes o Fasting plasma glucose test (plasma glucose mg/dL) § <99=normal § 100-125=prediabetes § >125=diabetes (confirmed by repeating test on different day) o Oral Glucose tolerance test (2hr plasma glucose mg/dL) § <139=normal § 140-199=prediabetes (impaired glucose tolerance) § >200=diabetes (random blood glucose level of 200 mg/dL or more) HbA1c test Clinical Testing for Diabetes - for HbA1c, want <7 - for random glucose test, want <200 PD and Smoking o DEC HOST RESPONSE - impaired neutrophil function, altered macrophage function o DEC WOUND HEALING - inhibit revascularization, inhibit collagen production, suppress osteoblasts, vasoconstriction o ALTERED IMMUNE EFFECTS - inc WBC, inc CD8, dec CD4, dec NK cells, dec Ig o INC ORAL BACTERIA - more plaque, more red complex, less responsive to therapy o WORSE PERIO - more prevalent, inc severity, inc rate of progression Occlusal Trauma = diagnosed through widened PDLs from radiographs Primary: WIDENED PDL, normal PDs, no perio disease (HEALTHY PERIODONTIUM) Secondary: Occlusal trauma superimposed on dentition WITH PERIODONTAL DISEASE - Secondary occlusal trauma CONTRIBUTES to periodontal disease progression What's the difference between Stage III and Stage IV Chronic Periodontitis? Stage III: < or equal to 4 teeth lost due to periodontitis Stage IV: > or equal to 5 teeth lost due to periodontitis - NEED FOR COMPLEX REHABILITATION (masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collape, <20 remaining teeth) Generalized Aggressive Periodontitis - usually affects people under 30, but pts may be older - generalized interproximal attachment loss affecting AT LEAST 3 PERMANENT TEETH OTHER THAN FIRST MOLARS AND INCISORS - AL occurs in pronounced episodic periods of destruction - Poor serum antibody response to infecting agents is frequently detected Aggressive Periodontitis Pathogens - Actinobacillus Actinomycetemcomitans - Porphyromonas Gingivalis - Neutrophil function abnormalities Localized Aggressive Periodontitis -Disease that begins at age 11 to 13 with strong familial tendency - attachment loss at first molars and incisors Non-Surgical Therapy = Soft Tissue Management 1. SCRP (limited access) 2. Laser/Antibiotics/Antiseptics 3. Maintenance