Term
| What are the structures that make up the periodontium? |
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Definition
Gingiva (clinically seen)
PDL (space in the radiograph)
Cementum (seen in recession)
Alveolar bone proper (radiograph) |
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Term
| What are the 2 types of gingiva? |
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Definition
Free gingiva (where sulcus is)
Attached gingiva (attached to bone and root surface) |
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Term
| This is part of the gingiva that extends from where attached gingiva starts down to the CEJ. It is a very weak attachment made of hemidesmosomes. |
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Definition
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Term
| This part of the gingiva starts at the CEJ and ends at the bone crest. It is a strong bond because collagen fibers are inserted into the root. |
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Definition
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Term
What are the gingival fibers that extend from cervical cementum to the gingival margins?
What are the ones that extend from the cementum over the alveolar process and extend apically?
What are the ones that extend between adjacent teeth?
What are the ones that circle the tooth? |
|
Definition
dentogingival
dentoperiostal
transceptal (what you excise)
circular |
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Term
| What type of tissue is the PDL mostly made of? |
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Definition
| connective tissue (also has cells, vascular supply, innervation) |
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Term
| What structure acts as towards proprioception (bite force) and shock absorber? |
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Definition
| Periodontal ligament (also supplies to gingival tissue, reparative function, and allows teeth to move) |
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Term
| What is the part of the fibers of the PDL that enter into the bone or root structures? |
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Definition
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Term
| What are the 2 types of cementum? |
|
Definition
cellular (apical third of root-important for ortho)
acellular (around coronal root) |
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Term
| How far away should alveolar bone be from the CEJ? |
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Definition
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Term
What is it called when you have a window of missing bone that can be located anywhere on the root surface?
What is it call when you have an absence of bone from the CEJ down the too? |
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Definition
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Term
| What are the 3 vascular supply of the periodontium? |
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Definition
Supraperiosteal blood vessels (come above periosteum and extend to the tip of the gingiva)
Blood vessels of the Periodontal ligament
Blood vessels of the Alveolar bone |
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Term
| What must you do in order to diagnose periodontal disease? |
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Definition
Medical and dental histories
Clinical examination
Radiographic examination |
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Term
| How do you measure the clinical attachment level? |
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Definition
| Probing depth + gingival recession |
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Term
| What is all involved in a clinical exam? |
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Definition
Oral hygiene (Plaque Index)
Gingival health (Gingival Index)
Periodontal Probing
Furcation analysis
Mucogingival examination
Mobility
Occlusal analysis |
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Term
| What are the 2 types of bone loss? |
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Definition
horizontal
vertical or angular |
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Term
| ___-___% of mineral content has to be clinically destroyed before it can be detected radiographically |
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Definition
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Term
| What is normal probing depth? |
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Definition
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Term
Determine the classification #
Necrotizing periodontal diseases
Developmental or acquired deformities and conditions
Gingival diseases
Chronic periodontitis
Periodontitis as a manifestation of a systemic disease
Aggressive periodontitis
Abscesses of the periodontium
Periodontitis associated with endodontic lesions |
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Definition
Necrotizing periodontal diseases - V
Developmental or acquired deformities and conditions- VIII
Gingival diseases-I
Chronic periodontitis-II
Periodontitis as a manifestation of a systemic disease-IV
Aggressive periodontitis-III
Abscesses of the periodontium-VI
Periodontitis associated with endodontic lesions-VII |
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Term
| Periodontal and Gingival disease progress from the __________. |
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Definition
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Term
| What is periodontal and gingival diseases caused by? |
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Definition
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Term
| What does successful colonization of biofilms require? |
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Definition
Stable nutrient supply
Environment conductive to proliferation with limited hazards
Initial attachment to dwelling site followed by multiplication and addition of new inhabitants |
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Term
| Do biofilms being spread vertically or laterally first? |
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Definition
| lateral spread then vertical expansion |
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Term
| What are the benefits of a biofilm for the bacteria? |
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Definition
shared resources and interrelated activities
protection from other colonizers and sudden harmful changes (they start protecting each other) |
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Term
___________ is essential for optimal interaction of biofilms
-signaling molecules by "__________" or exchange of genetic information |
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Definition
communication
"quorum sensing" |
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Term
Where does plaque formation start?
Where are places that plaque like to colonize? |
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Definition
gingival margin then subgingivally
irregularities in the tooth (fissures, pits, grooves, cracks) |
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Term
True or false:
100% of the population is susceptible to periodontitis. |
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Definition
False
100% of the population is susceptible to gingivitis ( not periodonitits) |
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Term
| What type of organisms would you expect to see in a patient that has plaque over 3 days? |
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Definition
less gram + cocci and rods than normal
more gram - cocci and rods than normal
some filaments and fusobacteria |
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Term
True or False:
Gingival disease are a spectrum of diseases and not a single one and it is confined to the gingival complex |
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Definition
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Term
Gingivitis or periodontitis?
No involvement of the PDL, alveolar bone or cementum
No attachment loss
No bone loss |
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Definition
|
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Term
| What are the 2 large categories that gingivitis is divided into? |
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Definition
Dental Plaque-induced Gingival Diseases
Non_plaque-induced Gingival Lesions |
|
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Term
| What are other reasons besides dental plaque only that would cause Plaque-induced Gingival Diseases? |
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Definition
systemic factors
medications
malnutrition |
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Term
| What percentage does it have to be in order to be considered as localized gingivitis? |
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Definition
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Term
| What are the 3 things that you must specify when diagnosing plaque-induced gingival disease? |
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Definition
Mild, moderate or severe
Localized or Generalized
Marginal, papillary or diffuse (papilla, margin, and attached gingiva, rare) |
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Term
| What percentage of the US population of the US population have plaque-induced gingivitis? |
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Definition
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Term
| Where does plaque-induced gingival disease begin? |
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Definition
| at gingival margin (plaque present at gingival margin) |
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Term
What is NOT a characteristic of plaque-induced gingivitis?
Change in gingival color
Change in gingival contour-edema
Sulcular temperature change
Increased gingival exudate
Bleeding on probing
Attachment loss
Reversible with plaque removal |
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Definition
| Attachment loss (and NO bone loss) |
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Term
What is the clinical condition of histological perfection?
Is it possible to have this clinical condition? |
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Definition
pristine gingiva
no one has this (can get close) |
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Term
| What are the features of healthy/pristine gingiva? |
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Definition
1) exudate of fluid into tissues and the gingival sulcus
2) migration of leukocytes into the junctional epithelium and gingival sulcus |
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Term
What is the clinical condition of an initial lesion?
What are the features of this clinical condition?
When does this usually happen? |
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Definition
normal health gingiva
1) Vasculitis of vessels
2) Exudate of fluid into tissues and gingival sulcus
3) Increased polymorphonuclear leukocytes (PMN)
4) Presence of serum proteins
5) Loss of collagen (loss of volume, not attachment loss)
3-4 days |
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Term
What is the clinical condition of an early lesion?
When does this happen? |
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Definition
|
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Term
| What are features of an early lesion (early gingivitis)? |
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Definition
1) accentuation of the features in initial lesion (collagen destruction becomes larger with persistence of inflammation)
2) Lympocytes dominate (3/4 of all cells), macrophages, plasma cells (secrete IgG) and mast cells (histamine)
3) Changes in resident fibroblasts |
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Term
| What is the clinical condition of an established lesion with no bone loss nor apical epithelial migration (plasma cell density between 10% and 30% of leukocyte infiltrate)? |
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Definition
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Term
What clinical condition is it when the following cells dominate?
plasma cells
lymphocytes
leukocytes |
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Definition
Established gingivitis
Early gingivitis
normal healthy gingiva |
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Term
| What are the features of an established lesion (established gingivitis)? |
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Definition
1) persistence of inflammatory features
2) increase plasma cells (IgG) but no bone loss
3) continuing loss of collagen (to make room for cells)
4) proliferation, apical migration, and lateral extension of the junction epithelium (not normal)
5) early pocket formation may appear due to gingival swelling (false pocket) |
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Term
True or False:
In gingivitis, if you have a probing depth of 4 or 5, it is considered a pocket. |
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Definition
False
In gingivitis you can have probing depth of 4 or 5 but it’s not a pocket unless there’s attachment loss (pseudo or false pocket) |
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Term
| What are the systemic factors that can cause plaque-induced gingival diseases? |
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Definition
Puberty
menstrual cycle
pregnancy
Diabetes
blood dyscrasias (ex: leukemia) |
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|
Term
True or false:
Pregnancy-associated gingivitis is due to significant increase in levels of progesterone and estrogen. |
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Definition
False
It is due to an increase in vascular permeability leading to an increased inflammatory response (heightened response to biofilm) |
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|
Term
| How frequent is the pregnancy-associated gingivitis? |
|
Definition
|
|
Term
| What periodontal bacterial pathogen is increased in pregnancy-associated gingivitis? |
|
Definition
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|
Term
| How do you treat pregnancy-associated gingivitis? |
|
Definition
removal of plaque and calculus
meticulous oral hygiene
spontaneous reduction in the size of gingival enlargement follows the termination of pregnancy |
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Term
| What is a central mass of connective tissue with numerous, engorged and newly formed capillaries found in 2-5% of pregnant women? |
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Definition
| pregnancy-associated pyogenic granuloma (pregnancy tumor) |
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Term
When do pregnant women usually get a pregnancy-associated pyogenic granuloma (pregnancy tumor)?
How often does this happen in pregnant women? |
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Definition
after 3rd month of pregnancy
2-5% |
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Term
| How do you treat pregnancy-associated pyogenic granuloma (pregnancy tumor)? |
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Definition
| surgical excision (and then meticulous oral hygiene and removal of plaque and calculus) |
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Term
| What are the 3 medications that are most likely to cause gingival enlargement? |
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Definition
anticonvulsants (phenytoin)
antihypertensive (calcium channel blockers)
immunosuppressive drugs (cyclosporin) |
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Term
| How do you treat gingival disease modified by medications? |
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Definition
| excision (a lot of fibrotic tissue), instruct them in oral hygiene and talk to physician prescribing that medication about alternative meds |
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Term
What specific bacteria is usually the cause of non-plaque induced gingival lesion?
How would you figure this out? |
|
Definition
Neisseria gonnorhea
Treponema pallidum
streptococcal species
culturing (this disease is very rare) |
|
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Term
| What is the main virus that can cause non-plaque induced gingival lesions? |
|
Definition
|
|
Term
| What are some systemic conditions that can cause non-plaque induced gingival lesions? |
|
Definition
mucocutaneous disorders ("desquamative gingivitis")
allergic reactions to dental material, food additives, etc |
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Term
| What is the only way to diagnose/confirm desquamative gingivitis? |
|
Definition
|
|
Term
| What type of gingivitis does not have a specific disease entity but a gingival response associated with a variety of conditions (75% have a dermatologic genesis)? |
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Definition
|
|
Term
| What 2 diseases account for 95% of dermatologic cases in desquamative gingivitis? |
|
Definition
| pemphigoid and lichen planus |
|
|
Term
What are some features of desquamative gingivitis?
What age/sex does this more frequently affect? |
|
Definition
keratotic, reticular, papular, atrophic, ulcerative or bullous appearance (painful)
middle-aged females |
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|
Term
What is NOT a non-plaque induced gingival lesion?
Gingival diseases of specific bacterial origin
Gingival diseases of viral origin
Gingival diseases of fungal origin
Gingival lesions of genetic origin
Gingival manifestations of systemic conditions
Traumatic lesions
Foreign body reactions
all of the above |
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Definition
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Term
| What is the primary etiology of periodontitis? |
|
Definition
|
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Term
| If inflammation extends beyond the gingiva and into surrounding tissues, is it gingivitis or periodontitis? |
|
Definition
|
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Term
| If there is an apical migration of the junctional epithelium, is it gingivitis or periodontitis? |
|
Definition
|
|
Term
| What is the major environmental factor that causes periodontitis? |
|
Definition
| smoking (2.5 to 6x more than a patient that doesn't smoke) |
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|
Term
What age group is chronic periodontitis most prevalent?
Can periodontitis be episodic? |
|
Definition
generally 35 years old or older (can be younger)
yes |
|
|
Term
Identify if this is mild, moderate or severe chronic periodontitis.
2 mm of attachment loss
3 mm of attachment loss
4 mm of attachment loss
6 mm of attachment loss |
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Definition
mild (1-2 mm)
moderate (3-4 mm)
moderate
severe (5-6 mm) |
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Term
| Where in the mouth is chronic periodontitis most and least severely affected |
|
Definition
Maxillary molar >>> Mandibular canines (last tooth affected)
Interproximal sites > labial surfaces |
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|
Term
If a patient has generalized moderate chronic periodontitis,
list the % of affected sites and mm of attachment loss? |
|
Definition
30% or more
3-4 mm of attachment loss |
|
|
Term
| What age group does aggressive periodontitis usually affect? |
|
Definition
| typically before 35 but can happen at any age |
|
|
Term
What is NOT a characteristic of aggressive periodontitis?
Exacerbation and remission
Marked gingival inflammation
Limited amount of local factors (plaque and calculus)
A slow, progressive course |
|
Definition
| a slow progressive course |
|
|
Term
| What teeth are more likely to get aggressive periodontitis? |
|
Definition
| first molars and incisors |
|
|
Term
True or False:
You would use antibiotics to treat aggressive periodontitis but would generally not use antibiotics to treat chronic periodontitis? |
|
Definition
| True (along with cleaning and surgery) |
|
|
Term
If a patient says, "This tooth just recently moved and now I have a space here that I didn't use to have."
Would that be an indication of chronic or aggressive periodontitis? |
|
Definition
|
|
Term
| What are 2 disorders that would periodontitis as a manifestation of systemic disease? |
|
Definition
hematological disorders
genetic disorders |
|
|
Term
| What are the 2 types of necrotizing periodontal disease? |
|
Definition
necrotizing ulcerative gingivitis (NUG)
necrotizing ulcerative periodontitis (NUP) - bone is visible |
|
|
Term
| If a patient has inter proximal cratering, pain, bleeding, pseudomembrane formation, papillary inflammation, odor and maybe lymphadenopathy, malaise and fever. What would you suspect they have? |
|
Definition
| necrotizing periodontal disease |
|
|
Term
| What are some causes of necrotizing periodontal disease? |
|
Definition
| stress, poor oral hygiene, poor immunological state (HIV, AIDS) |
|
|
Term
| What are the 3 types of abscesses of the periodontium? |
|
Definition
Gingival abscess
Periodontal abscess-localized accumulation of pus within the gingival wall of a periodontal pocket
Pericoronal abscess - when wisdom teeth is partially erupted and opposing teeth bites down on it |
|
|
Term
| What are some developmental or acquired deformities and conditions? |
|
Definition
Localized tooth‐related factors that modify or predispose to plaque-induced gingival diseases/ periodontitis (groove on maxillary lateral incisor)
Mucogingival deformities and conditions around teeth (gingival recession, lack of keratinized gingiva)
Mucogingival deformities and conditions on edentulous ridges
Occlusal Trauma (must have inflammation) |
|
|
Term
Periodontal abscess or acute periapical abscess:
Periodontal pocket
Localized and coronal
More apical
Less likely vital
Less likelihood of caries |
|
Definition
periodontal abscess
periodontal abscess
acute periodical abscess
acute periodical abscess
periodontal abscess |
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