133 Questions
What is the purpose of Step 1: Plaque or Biofilm Control Instruction?
To improve home care skills and reduce gingival inflammation
What occurs about 1 week after therapy in the healing process?
Formation of a long junctional epithelium
What is the critical probing depth that determines the need for surgical intervention?
5.4 mm
What is the purpose of Step 3: Recontouring Defective Restorations and Crowns?
To adjust defective restorations and crowns
What happens at the reevaluation appointment after phase I procedures?
Periodontal tissues are probed to determine if further treatment is needed
What must be considered when determining the phase I treatment plan?
General health, number of teeth present, patient cooperation, alignment of teeth, attachment loss, furcation involvement
What happens as a result of tissue shrinkage during healing?
One or two millimeters of recession is often apparent
What is the purpose of Step 4: Management of Carious Lesions?
To treat carious lesions
What is the objective of cause-related therapy in phase I periodontal therapy?
To alter or eliminate the microbial etiology and factors contributing to gingival and periodontal diseases
What is a critical aspect for the long-term success of periodontal surgical treatment?
Maintaining the plaque or biofilm control results achieved with phase I therapy
What is included in phase I periodontal treatments?
All of the above
What is one of the problems that must be managed during phase I therapy?
Elimination of defective restorations and treatment of carious lesions
What is the rationale behind phase I periodontal therapy?
All of the above
What does phase I therapy aim to achieve?
Halting the progression of disease and returning the dentition to a state of health and comfort
What is emphasized as a part of phase I treatments?
The initiation of a comprehensive daily plaque or biofilm control regimen
Which type of calculus is generally less tenacious and less calcified?
Supragingival calculus
Which instruments are preferred for subgingival scaling and root planing due to their design?
Curettes
What type of tips are used for scaling of deep pockets and furcations?
Thin ultrasonic tips
What is essential for subgingival scaling and root planing?
Correct cutting edge adaptation and working angulation
What can excessive pressure in ultrasonic instrumentation cause?
Dampening of the vibration of the tip and overheating of the tooth
What is the primary objective of scaling and root planing?
To restore gingival health by completely removing elements that provoke gingival inflammation
What is the purpose of root planing?
To produce a smooth, hard, clean surface by removing residual embedded calculus and portions of cementum from the roots
What is the effect of scaling and root planing on inflammation?
Reduction or elimination of inflammation clinically
What is the relationship between scaling and root planing?
They are not separate procedures; all the principles of scaling apply equally to root planing
What is the main focus of scaling?
Removal of biofilm and calculus from both supragingival and subgingival tooth surfaces without deliberate attempt to remove tooth substance along with the calculus
Which chemical agent has demonstrated some capacity for penetration of biofilm?
Chlorhexidine (CHX)
What is the primary mechanism of action for chemical biofilm control?
Preventing bacterial adhesion
What is the main reason for adjunctive use of chemical agents in biofilm control?
Inadequate control with mechanical devices alone
What is a limitation of most chemical agents in biofilm control?
They can only act against the most external parts of the biofilm
What is the role of mechanical devices in biofilm control?
To reduce the biofilm and disturb its structure
Which chemical agent affects the plaque sufficiently to show a benefit in terms of gingivitis and/or caries control?
Antiplaque agents
What is the main side effect associated with Essential Oil mouthrinses?
Burning sensation
Which chemical agent has been shown to be active against Gram (+), Gram (-) bacteria, yeast, and viruses?
Chlorhexidine digluconate
What is the primary purpose of using chemical biofilm control in patients with intermaxillary fixations?
To decrease the risk of infection of the surgical area (postoperative)
What is an ideal feature of a chemical agent for biofilm control that refers to its ability to maintain sustained antimicrobial effects?
Substantivity
Which type of biofilm is highly structured and complex, making it difficult for the patient to clean?
Subgingival biofilm
What strength of antibiotic may be needed to effectively combat bacteria arranged in biofilms?
500 times greater than the usual therapeutic dose
What is the logical approach for periodontal pocket treatment involving systemic anti-infective therapy?
Mechanical treatment followed by anti-infective therapy
How can chemotherapeutic agents contribute to reducing bone loss in periodontal diseases?
By modulating the host's immune response to bacteria
What is the rationale for using anti-infective agents as adjuncts to periodontal therapy?
To reduce bacterial challenge to the periodontium
What is the primary objective of systemic anti-infective therapy in periodontal diseases?
To reduce bacterial challenge to the periodontium
What is the primary purpose of systemic administration of antibiotics in reducing bacteria in diseased periodontal pockets?
To inhibit or eliminate periodontal pathogens
What is the differentiation between bacteriostatic and bactericidal antibiotics?
Bacteriostatic antibiotics inhibit bacterial growth, while bactericidal antibiotics kill bacteria
What are the characteristics of an ideal antibiotic for periodontal treatment?
Broad spectrum, high bioavailability, and resistance to degradation by periodontal pathogens
What is one of the challenges in using a single antibiotic to eliminate all periodontal pathogens?
The potential for development of antibiotic resistance in periodontal pathogens
What factors should be considered in antibiotic selection for periodontal treatment?
Severity of the periodontal disease and presence of systemic conditions
What is the investigative use of tetracyclines as adjuncts for the treatment of localized aggressive periodontitis?
They inhibit the growth of Aggregatibacter actinomycetemcomitans
What are the characteristics and clinical use of metronidazole in periodontal treatment?
It has a broad spectrum of activity against various oral pathogens and is used as an adjunct to scaling and root planing
What are the characteristics, clinical use, and side effects of penicillins, including amoxicillin and amoxicillin + clavulanate potassium?
They have a broad spectrum of activity, are effective against many oral pathogens, and may cause allergic reactions or gastrointestinal disturbances as side effects
What is the primary goal of host modulation therapy (HMT) in periodontitis?
To manipulate the immune response with chemotherapeutic agents and prevent/reduce tissue destruction
What is the main effect of subgingival plaque bacteria accumulation in periodontitis?
Inducing vasodilation and permeability in the gingiva
What is the definition of host modulation in the context of periodontitis?
Alteration of function/status of the host in response to a stimulus
What is the role of chemotherapeutic agents in host modulation therapy (HMT) for periodontitis?
Manipulating the immune response and preventing/reducing tissue destruction
What is the effect of host modulation therapy (HMT) on tissue destruction in periodontitis?
Prevent/reduce tissue destruction by manipulating the immune response
What is the main goal of manipulating the immune response with chemotherapeutic agents in host modulation therapy (HMT)?
To prevent/reduce tissue destruction and treat periodontitis
What is the primary role of Specialized Pro-Resolving Mediators (SPMs) in periodontal therapy?
Initiating proresolving pathways and promoting the termination of inflammation for restoration of tissue homeostasis
What is the effect of topical application of SPMs in periodontal therapy?
Preventing alveolar bone resorption and promoting a host-mediated shift in the subgingival microflora
Why are clinical studies deemed necessary for the use of Specialized Pro-Resolving Mediators (SPMs) as future drug candidates?
To validate their efficacy and safety in human subjects
What is the primary function of Systemic application of SPMs in periodontal therapy?
Regulating immune response
What is the potential benefit of systemic application of SPMs in periodontal therapy?
Regulating immune response to support resolution of inflammation and tissue homeostasis
What is the potential benefit of topical application of Specialized Pro-Resolving Mediators (SPMs) in preventing alveolar bone resorption?
Promoting a host-mediated shift in the subgingival microflora reversing dysbiosis
What is the primary function of Systemic application of Specialized Pro-Resolving Mediators (SPMs) in periodontal therapy?
Regulating immune response.
Which of the following is the only FDA and ADA-approved drug for periodontal diseases?
Sub-antimicrobial-dose doxycycline (SDD)
What is the primary aim of host modulation therapy (HMT) in periodontal diseases?
To reduce excessive inflammation, enzymes, cytokines, and prostaglandins
Which adjunct treatment option should not be used in gingivitis or acute periodontal conditions?
Sub-antimicrobial-dose doxycycline (SDD)
What is the main side effect associated with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen?
Gastrointestinal problems
What is the only adjunct treatment option that has been found to be better than mechanical therapy alone in protecting against bone loss?
Sub-antimicrobial-dose doxycycline (SDD)
Which systemic adjunct treatment was not found to be better than scaling and root planing alone in protecting against bone loss?
Systemic bisphosphonates as adjuncts to scaling and root planing (SRP)
Which of the following is NOT a cardiovascular disease mentioned in the text?
Atherosclerosis
How should appointments be scheduled for hypertensive patients?
In the afternoon when blood pressure levels are lower
What is recommended to minimize pain for hypertensive patients during dental treatment?
Using local anesthesia without epinephrine
What action is recommended if a hypertensive patient feels symptoms of hypoglycemia during treatment?
Check blood glucose levels immediately
How should hypertension be diagnosed according to the text?
From two or more BP recordings at two or more appointments
What is important to consider when scheduling appointments for hypertensive patients?
The time of day and stress levels
What is the suggested action if a hypertensive patient experiences symptoms of hypoglycemia during treatment?
Check blood glucose levels immediately
How should appointments be scheduled for hypertensive patients based on their blood pressure levels?
Appointments should be scheduled in the afternoon when blood pressure levels are lower
What is the primary objective of controlled-release delivery systems for antimicrobials in periodontal pockets?
To deposit antimicrobials directly into the periodontal pocket
What is the duration over which chlorhexidine chip releases chlorhexidine into the gingival crevicular fluid (GCF)?
7 to 10 days
How is the mixed product of doxycycline gel described after the syringe mixing process?
A viscous liquid of 500 mg containing 50 mg of doxycycline hyclate
What is the recommended post-placement precaution for patients who receive a chlorhexidine chip?
Avoid dental floss for 10 days
What is the characteristic of biodegradable material as mentioned in the context of chlorhexidine chip and doxycycline gel?
"Things that can be disintegrated by bacteria"
"The aim of controlled-release delivery systems is to deposit antimicrobials directly into the periodontal pocket." This statement suggests that these delivery systems:
"Are designed to target specific sites within the periodontal pocket"
What is the purpose of using adjunct therapy with controlled-release antimicrobials alongside scaling and root planing (SRP)?
To enhance the effectiveness of SRP by maintaining effective drug concentrations over time
What should patients avoid for 10 days after receiving a chlorhexidine chip?
Dental floss
What is the recommended period for avoiding hard or sticky food after using minocycline microspheres?
10 days
What is the main reason for not requiring removal of minocycline microspheres?
They are biodegradable
What is the purpose of using locally delivered antimicrobials in periodontal treatment?
To achieve higher concentrations of active antimicrobials
What is an adverse effect associated with tetracycline-based products in periodontal treatment?
Discoloration during tooth development
What is the recommended duration for avoiding interproximal cleaning after using locally delivered antimicrobials?
10 days
What is the primary benefit of using locally delivered antimicrobials in periodontal treatment?
Achieving higher concentrations of active antimicrobials
What is an adverse effect associated with chlorhexidine-based products in periodontal treatment?
Discoloration during tooth development
Why is periodontal dressing not necessary when using minocycline microspheres?
They are biodegradable and do not require dressing
What is a potential risk associated with the use of locally delivered antimicrobials?
Overgrowth of opportunistic microorganisms
Which factor has a significant impact on the periodontium during puberty?
Immune function
What is the primary effect of estrogen during puberty on periodontal tissues?
Osteoblastic differentiation of PDL cells
What is a common manifestation of gingival response to local factors during puberty?
Erythematous and inflamed tissues
What is the role of ovarian hormones during menstruation in relation to gingival tissues?
Inflammation in gingival tissues
What hormonal imbalance or increase aggravates gingival inflammation during menstruation?
Progesterone
What is the primary purpose of managing Premenstrual Syndrome (PMS) symptoms during menstruation?
Addressing mood swings and tenderness
What is a risk indicator for periodontal disease before menopause during menstruation?
Menstrual cycle irregularity
Which of the following is a common oral manifestation of pregnancy?
Gingival bleeding
What is the effect of pregnancy hormones on the maternal immunoresponse?
Depression of cell-mediated immunity
Which hormone affects the ground substance of connective tissue by increasing fluidity?
Estrogen
What is the role of pregnancy hormones in increasing bleeding tendency?
Increase vascular dilatation and permeability
What is the effect of pregnancy on subgingival plaque composition?
Higher concentrations of Prevotella intermedia
What is a common oral condition associated with pregnancy?
Pregnancy gingivitis
What is the effect of pregnancy hormones on the absolute numbers of certain immune cells in peripheral blood?
Decrease in absolute numbers of CD3+, CD4+, and CD19+ cells in peripheral blood during pregnancy versus postpartum
What is the effect of pregnancy hormones on prostaglandin production?
Stimulation of prostaglandin production
What is the range of probing depths in the primary dentition?
1-2 mm
At what age does stippling appear in children's gingiva?
3 years
What is the normal labial frenum attachment percentage in infants?
85%
What is the color of gingival tissues in edentulous infants?
Pale pink
What happens to the gingival width as children transition from primary to permanent dentition?
It increases
Which age group is recommended to start more explicit periodontal assessments according to the text?
Children between the ages of 12 to 19 years
What is the suggested age for adding flossing to the home care routine for children?
When interdental contacts develop
Why are antimicrobial mouth rinses not indicated for very young children according to the text?
They pose a risk of ingestion of chemical agents
What is a characteristic feature of the periodontium of the primary dentition as mentioned in the text?
It undergoes normal development resulting in changes
When should mechanical toothbrushes with rotary heads be encouraged, according to the text?
When children have permanent incisors and first molars
What is the cause of plaque-induced gingivitis in children?
Dental plaque
What is the primary factor associated with puberty gingivitis?
Hormonal changes
What can lead to drug-induced gingival enlargement in children?
Organ transplantation
What is the effect of mouth breathing on plaque and gingival inflammation?
Increased plaque and gingival inflammation
What is a common manifestation of herpes simplex virus infection in children?
Primary herpetic gingivostomatitis
What is the recommended analgesic for pain relief in patients with necrotizing ulcerative gingivitis (NUG)?
Ibuprofen
What is the primary treatment for pericoronitis when evaluating occlusion and the presence of a swollen and fluctuant pericoronal flap?
Surgical removal of the tooth
What is the recommended duration for the use of chlorhexidine mouth rinses in patients with necrotizing ulcerative gingivitis (NUG)?
2-3 weeks
What is the initial treatment approach for primary herpetic gingivostomatitis in children?
Immediate initiation of antiviral therapy
What is the primary consideration when evaluating the prognosis after acute symptoms are relieved in pericoronitis?
Bone loss distal to the involved tooth
What is the primary aim of the treatment of Necrotizing Ulcerative Gingivitis (NUG)?
Alleviation of the acute inflammation by reduction of the microbial load and removal of necrotic tissue
What is emphasized during the comprehensive evaluation for Necrotizing Ulcerative Gingivitis (NUG)?
Thorough medical history and psychosocial parameters
What are the key treatment procedures for Necrotizing Ulcerative Gingivitis (NUG)?
Alleviation of acute inflammation by reduction of microbial load and removal of necrotic tissue
What is the purpose of the follow-up in Necrotizing Ulcerative Gingivitis (NUG) treatment?
To assess the patient's response to treatment and provide education
What is the primary goal in the treatment of Acute Gingival/Periodontal Conditions?
Easing acute symptoms and correcting underlying chronic gingival or periodontal disease
Study Notes
Scaling and Root Planing Techniques
- Scaling and root planing are essential components of periodontal therapy
- Supragingival calculus is generally less tenacious and less calcified than subgingival calculus
- Instruments such as sickles, curettes, and ultrasonic and sonic instruments are used for supragingival calculus removal
- Subgingival calculus is usually harder and more difficult to remove than supragingival calculus
- Subgingival instrumentation is challenging due to obscured vision from bleeding and tissue
- Curettes are preferred for subgingival scaling and root planing due to their design
- Thin ultrasonic tips are used for scaling of deep pockets and furcations, but must be used on low power to avoid burnishing the calculus
- Subgingival scaling and root planing are accomplished with either universal or area-specific (Gracey) curettes
- Correct cutting edge adaptation and working angulation are essential for subgingival scaling and root planing
- Ultrasonic instrumentation requires a light-to-moderate grasp and varying pressure to effectively remove deposits
- Excessive pressure in ultrasonic instrumentation can cause dampening of the vibration of the tip and overheating of the tooth
- The terminal 1 to 2 mm of the ultrasonic tip produces maximum vibration for calculus removal
Antibiotics in Periodontal Treatment
- Definition of anti-infective agent, antibiotic, and antiseptic
- Purpose of systemic administration of antibiotics in reducing bacteria in diseased periodontal pockets
- Differentiation between bacteriostatic and bactericidal antibiotics
- Characteristics of an ideal antibiotic for periodontal treatment
- Challenges in using a single antibiotic to eliminate all periodontal pathogens
- Factors to consider in antibiotic selection for periodontal treatment
- Responsibilities of the clinician in choosing the correct antimicrobial agent
- Tetracyclines' ability to concentrate in periodontal tissues and their role in inhibiting the growth of Aggregatibacter actinomycetemcomitans
- Investigative use of tetracyclines as adjuncts for the treatment of localized aggressive periodontitis
- Characteristics and clinical use of tetracyclines: tetracycline, minocycline, and doxycycline
- Characteristics, clinical use, and side effects of metronidazole in periodontal treatment
- Characteristics, clinical use, and side effects of penicillins, including amoxicillin and amoxicillin + clavulanate potassium
Adjunct Treatment Options for Periodontal Diseases
- In 2023, periodontal diseases involve a complex interplay of immune cells such as neutrophils, macrophages, T lymphocytes, and B lymphocytes, as well as the action of matrix metalloproteases (MMPs) and inflammatory mediators like cytokines and prostaglandins.
- Host modulation therapy (HMT) aims to reduce excessive inflammation, enzymes, cytokines, and prostaglandins, and modulate osteoclast and osteoblast function, affecting normal tissue turnover.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen reduce periodontal attachment loss and alveolar bone loss, but they have significant side effects such as gastrointestinal problems and a rebound effect upon discontinuation.
- Bisphosphonates, used to manage osteoporosis, reduce alveolar bone loss but have side effects like inhibiting bone calcification and increasing the risk of bone necrosis after dental extractions.
- Systemic bisphosphonates, both oral and parenteral, as adjuncts to scaling and root planing (SRP) were not found to be better than SRP alone in protecting against bone loss.
- Sub-antimicrobial-dose doxycycline (SDD) is the only FDA and ADA-approved drug for periodontal diseases. It does not have antimicrobial effects but inhibits enzymes, cytokines, and osteoclasts, showing more clinical benefits than mechanical therapy alone.
- SDD reduces bleeding on probing, decreases probing depth, regains clinical attachment level, and has biochemical efficacy, with no overgrowth of opportunistic pathogens observed.
- SDD is indicated for patients with aggressive periodontitis, chronic periodontitis refractory to non-surgical treatment, and those undergoing periodontal surgery, but should not be used in gingivitis or acute periodontal conditions.
- Probiotics, particularly Lactobacillus and Bifidobacterium-based, when used adjunct to SRP, can modulate the microbiome, inhibit inflammatory pathways, and improve epithelial barrier function, but clinical efficacy and safety need further establishment.
- Systemically administered statins, used for managing hyperlipidemia, increase the expression of bone morphogenetic protein and vascular endothelial factor, promoting bone formation.
- Topical application of bisphosphonates and statins has shown reductions in periodontal pocket depth, regaining clinical attachment levels, and bone fill of intrabony defects, but the evidence is limited to studies from a single research group.
- Further research and clinical trials are necessary to establish the clinical efficacy, safety, and host modulatory potentials of adjunct treatment options such as probiotics, statins, and topical bisphosphonates in periodontal diseases.
Childhood Gingival Diseases and Periodontal Changes
- Primary dentition has prominent lamina dura and wider periodontal space compared to permanent dentition
- Before tooth eruption, the gingiva shows a firm pink bulge due to the underlying tooth crown
- Eruption cysts, bluish or deep red enlargements, can occur over erupting teeth and may require marsupialization
- Malocclusion and mucogingival problems are associated with crowding and late-erupting canines during mixed dentition
- Plaque-induced gingivitis in children is less severe than in adults and is primarily caused by dental plaque
- Eruption gingivitis results from plaque accumulation around erupting teeth and causes pain during brushing
- Puberty gingivitis peaks at 9-14 years old and is attributed to hormonal changes
- Drug-induced gingival enlargement can be caused by medications used in childhood conditions like organ transplantation and epilepsy
- Orthodontic appliances can lead to gingival changes and exacerbate inflammatory changes associated with puberty gingivitis
- Mouth breathing is associated with increased plaque and gingival inflammation, particularly in the maxillary incisors
- Primary herpetic gingivostomatitis is a common manifestation of herpes simplex virus infection in children and requires fluid intake and analgesics for treatment
- Aggressive periodontitis and gingival manifestations of systemic diseases like diabetes and leukemia can lead to premature tooth loss in children
Test your knowledge of Phase I Periodontal Therapy with this quiz based on the resources of Newman and Carranza’s Clinical Periodontology.
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