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Perio Final (NSPT (Involves (Patient educations, Homecare instructions,…

- - - - Previous periodontitis
      - Diabetes
      - Young age
      - Immediate loading
      - Smoking
      - Larger diameter of implant
  - - - Thinner, greater accuracy
      - More easier adaptive
    - - Titanium scalers
      - Subgingival air powder polisher
      - Povo-iodine irrigation at 10% unless allergic to iodine or shellfish
    - - Povo-iodine
      - Refer to dentist that did the implant
- - - - Physiologic halitosis
        
        Obvious malodor beyond socially acceptable
        
        TN-1
      - Pathologic halitosis
        
        Caused by disease or pathogen
        
        TN-1, TN-2, TN-3
    - - Obvious malodor not perceived by others but patient persists
      - TN-1 and TN-4
    - - After Tx for halitosis, a patient persists in believing they have halitosis although no physical or social evidence
      - TN-1 and TN-5
  - - - Explanation of data, continued instruction, education, and reassurance
    - - Referral to physician
    - - oral prophylaxis, treatment of oral disease (periodontal disease)
    - - explaination of halitosis and education on self care
    - - Referral to psychologist
- - - - Wavy border with epithelial ridges extending down into CT and CT papilla extending into epithelium. Wavy border increases surface area for attachment and increases nourishment reaching epithelium.
    - - Oral epithelium
        
        Epithelial covering of outer surface of free and attached gingiva
        
        Extends from the crest of gingival margin to the mucogingival junction
        
        May be keratinized or parakeratinized
        
        Wavy border with connective tissue
      - Sulucuar Epithelium
        
        Epithelial lining of sulcus
        
        Thin, nonkeratinized (less resistant to stress)
        
        Smooth border with connective tissue
        
        Permeable allowing flow of gingival crevicular fluid
      - Junctional Epithelium
        
        At the base of the sulcus
        
        Joins gingiva to tooth
        
        No wavy junction
        
        4-5 cells at the apical zone
        
        Protective barrier to pathogens
    - - Brace free gingiva around the tooth
      - Reinforce attachment of JE
      - Types
        
        Circular
        
        Alveologingival
        
        Dentinogingival
        
        Periostogingival
        
        Intergingival
        
        Intercircular
        
        Interpapillary
        
        Transgingival
        
        Transeptal
  - - - Sensory Function
      - Supportive Function
      - Formative Function
      - Resorptive Function
      - Nutritive function
- - - - Vertical bone loss
      - Horizontal bone loss
  - - - Incidence: the number of new cases or diseases per a specified number of persons occurring during a specified period of time
      - Prevalence: number of cases existing at a specific point in time in a specific population
      - Severity: how much destruction is present at one time
      - Simplified: when data are collected from a few representative teeth
- - - - Histamine: vasodialation, increase permeability
      - Serotonin: increased permeability
      - Prostaglandins
        
        PGE2 causes swelling, pain, fever
      - Cytokines
        
        Act as messengers
        
        IL-1 beta and TNF-alpha
      - Kinins
        
        Vasoactive peptides from a group of plasma proteins
      - Matrix metalloproteinases (MMPs)
  - - - Initiated directly by pathogen or indirectly by pathogen bound antibody
      - Assists antibodies in destroying bacteria
      - Rids area of antibody-antigen complexes
      - Clears pathogen
      - Initial trigger is classic and lectin pathway
        
        Classic Pathway
        
        C1 encounters antigen/antibody
        Proteins C4 and C2 start to split to get more proteins to help
        Blood vessels become dilated causing redness and swelling
        End result is to puncture cell membrane causing pathogen to die
        
        Lectin Pathway
        
        Initiated by interaction of PRR with C2 and C4
        Pattern recognition receptor is mannose-binding lectin
        C2 ad C4 start to split
        Generate C3 convertase
        
        Alternative Pathway
        
        Interaction with LPS (pathogen)
        Converges with classic and lectin pathway
        Serves as a positive feedback loop for classic and lectin pathways to amplify the system
  - - - Recognition of antigen by specific lymphocyte
      - Activate lymphocyte
      - Elimination of antigen
      - Response declines
      - Antigen specific cells that survive are responsible for memory
    - - Long term
      - T cells and B cells
      - Cell mediated
        
        Activation of phagocytes, antigen specific cytotoxic t lymphocytes, and release of cytokines
      - Humoral
        
        Relates to antibody production
        
        Memory cell generation
        
        Activated when inflammatory response is inadequate
    - - Very dependent on innate immunity-associated antigen presenting cells
      - Produce interleukins
      - Turn on B cell secretion of IgG
    - - Protective role in periodontal tissue dammage
      - Helps by limiting the inflammatory reaction
    - - Antigen presenting cell
      - Phagocytic
      - Tries to remain balance
      - Activated by LPS
    - - Activate the breakdown of the periodontal tissue through cytokine secretion
      - Predominant antigen-presenting cells
- - - - Increases glucose in saliva
      - Reduces PMNs
      - Reduces healing
      - Ketoacidosis: too much glucose in blood
      - Glucagon: release and insulin: store in liver
    - - Exaggerated response to irritants
    - - Exaggerated response to irritants
    - - Bone is more porous
      - Decreased hormones influence oral environment
    - - Cortisone increases, MMPs increase
    - - less O2 in blood stream
      - Impairs PMNs
      - vasoconstriction
    - - Bacteria: P. Gingivalis
  - - - Assess priorities for the periodontal treatment of an individual or group
    - - Used to assess gingival inflammation based on color, consistency, and bleeding
    - - Measure overall periodontal condition
    - - Looks at a subset of teeth to evaluate
    - - Used to assess clinical signs of inflammation. Assumes BOP is first sign
    - - Assess interdental gingival bleeding to monitor interdental health
- - - - More common, incidence increases with age
      - Initiated and continued by presence of plaque biofilm
      - Host response plays essential role
      - Progression is slow to moderate rate
      - Risk factors modify disease
    - - Swelling and redness
      - Bleeding and/or supperation
      - Periodontal pockets and bone loss
      - Mobility
      - Plaque and calculus
    - - Arrest disease progression
      - Minimize or eliminate risk factors
      - Control plaque levels
    - - Recurrent: Disease not adequately treated or poor self care by patient
      - Refractory: Additional attachment loss despite appropriate therapy, sufficient self care, and appropriate recare
  - - - Rapid destruction
      - No obvious signs of systemic disease
      - Severity seems excessive based on lower plaque levels
      - Lack of clinical signs
      - Poor response to therapy
      - Episodic disease progression
    - - Onset at puberty
      - Minimal signs of inflammation
      - 1st molars and incisors
      - More common in females
    - - Usually under 30 y/o
      - At least 3 permanent teeth besides incisors and first molars
      - Tissue appearance varies
    - - Refer to periodontist
      - Self care instructions
      - Periodontal instrumentation
      - Antimicrobial therapy
      - Removal / control of contributing factors
- - - - Open ended questions
      - Reflective listening
      - Affirmation
      - Summarize
      - Information and advice