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PERI
Intro to Periodontics
| Question | Answer |
|---|---|
| 3 zones of oral mucosa | 1 Masticatory 2 Specialized 3 Oral mucous membrane |
| 4 parts of the gingiva | 1 Marginal 2 Gingival sulcus 3 Attached 4 Interdental |
| Define Mucogingival junction | The point at which the attached gingiva and alveolar mucosa come together |
| Define marginal gingiva. Width? Non/keratinized? | It is the coronal border of the gingiva. 1 mm wide. Keratinized |
| Ideal sulcus depth is... ? What is the normal sulcus depth? | 0 mm. 1-3 mm. |
| Define attachment gingiva. What does its width depend on? Non/keratinized? | It is the part of the gingiva attached to the underlying bone. Width depends on age. Always keratinized |
| Define Interdental gingiva. What determines its shape? | The gingiva that forms a pyramid or col interdentally. Shape depends on the contact area of te tooth |
| Function of gingival epi | Protect the underlying strucutres while allowing a selective interchange wtih the oral cavity |
| 3 areas of gingival epi | 1 Oral 2 Sulcular 3 Junctional |
| Oral epi: Non/keratinized? | Para or keratinized |
| Sulcular epi: Non/keratinized? | Non-keratinized |
| Junctional epithelium: Non/Keratinized? | Nonkeratinized |
| Main mechanism of junctional epithelium attachment? (What sticks the junctional epi together?) | Hemidesmosomes |
| 3 components of the periodontal ligament, which is most important? | 1 Perio fibers - Most important! 2 Ground substance 3 Cellular components |
| Most important group of periodontal fibers | Principal fibers |
| 5 reasons for having periodontal fibers | 1 Allow movement 2 Allow sensitivity 3 Apply pressure to bone 4 Protect vessels and nerves 5 attach tooth to bone and gingival tissues |
| 3 components of ground substance | 1 Glycoproteins 2 Glycosaminoglycans 3 Cementicles |
| 4 cellular elements of the PDL | 1 CT cells 2 Epithelial rest cells 3 Immune system cells 4 Neurovascular cellsq |
| 3 CT cells | 1 fibro 2 cemento 3 osteoblasts |
| 4 components of cementum | 1 acellular 2 cellular 3 Sharpey's extrinsic fibers 4 Intrinsic fibers |
| When is acellular cementum made? What about cellular? | Before tooth reaches occlusal plane. After eruption. |
| Common feature of both types of cementum | Lamellae |
| Coronal and apical cementum thicknesses | Coronal: 16-60 micrometers . Apical: 150-200 micrometers |
| What % of CEJ is represented by Overlapping, Meeting, and Gapping? | O - 60-65. Meeting - 30%. Gapping - 5-10% |
| 4 Characteristics of biofilm | 1 Adheres to surfaces 2 Embedded in an extracellular slime layer 3 has many bact species 4 forms quickly |
| Initial biofilm is formed by what type of interactions? | Bacterial interactions with the tooth |
| Define dental plaque | Soft deposits that form the biofilm, which adheres to any hard surface in the oral cavity |
| Define Materia Alba | Soft accumulations of bacteria and cells that lack organization of dental plaque (easily washed away) |
| Define Calculus | Hard deposits formed by mineralized dental plaque |
| Gram Positive cells are (+/-) for crystal violet | They are crystal violet POSITIVE |
| Intercellular matrix makes up _____ % of the plaque mass | 20-30% |
| Source of inorganic material for the intercelluar matrix is...? | Saliva |
| How long does it take for plaque to form? | 24-48 hours |
| 3 phases of plaque formation | 1 formation of pellicle 2 initial colonization 3 secondary colonization and plaque maturation |
| How do initial colonizers bind the the pellicle? | Weak forces |
| Are the initial colonizers an/aerobic? | Aerobic |
| Are the secondary colonizers an/aerobic? | Anaerobic |
| Name the most important secondary colonizer | Porphyromonas Gingivalis |
| 2 Reaosns that supra and subgingival calculus differ | 1 Oxygen presence 2 Presence of Gingival cervicular fluid |
| Tooth plaque bact: Gram positive or negative? | Positive |
| Tissue plaque: Gram positive or negative? | Negative |
| Do primary colonizers use sugar? | Yes, from saliva |
| Do secondary colonizers use sugar? | No, amino acids instead |
| What's quorum sensing? | The process that bact undergo. Bact signal to each other within the biofilm to tell when the population has reached critical threshold |
| Name 3 microorganisms beneficial to perio | 1 .S. sanguis 2 Veilonella parvula 3 c. ochracea |
| Where are beneficial microogranisms found? | Sites without attachment loss |
| 2 viruses associated wtih chronic periodontitis | 1 Epstein-Barr 2 Human cytomegalovirus |
| Major microorganism for localized aggressive periodontitis? | A. Actinomycetemcommitans |
| Gene mutated to cause systemic disease and periodontitis? | Cathepsin C |
| 2 ways to ID periopathogens | 1. culture 2 pcr |
| Why is PCR better at ID perio pathogens? | don't need viable organisms, it is very sensitive |
| Why are there so fue true periopathogens? | They must demonstrate virulence factors to cause destruction of perio tissues! |
| 2 killing mechanisms for pathogens? | 1. oxidative 2 non-oxidative |
| 2 requirements for oxidative killing? | Oxygen and red-ox potential |
| 2 requirements for non-oxidative killing? | Lysosomes and lysosomal secretions |
| APCs present antigen to ______ cells | CD4+ |
| If there is no costimulation, what happens to T-cells? | They become unresponsive and die |
| Ig antibody associated wtih B-cells? | IgM |
| What is a gingival pocket = pseudo pocket? | A pocket formed by gingival enlargement |
| What is a periodontal pocket? | A pathologically deepened gingival sulcus |
| Is there pathology present in gingival = pseudo pockets? | Nooooo. |
| What's the only reliable method of finding periodontal pockets? | Probing |
| What is the succession of plaque formation to even more plaque formation? | Plaque --> Gingival inflammation --> Pocket forms --> More plaque collects because flossing/brushing can't get it |
| First pathology in response to bacterial challenge? | Inflammation of the gingiva |
| Does pink/firm gums indicate "healthy" tisse? | Not always! |
| According to Boards, what does Bleeding on Probing indicate? | Active periodontal disease |
| Is it acceptable to anesthetize locally for probing/S&RP? | Yes |
| If pocket depth is unchanged, what has happened to attachment loss? | it has increased |
| If attachment loss is unchanged, what has happened to pocket depth? | It has decreased |
| According to Prichard, what is the requirement for a good perio radiograph? | Lamina dura |
| Normally, how far should the CEJ be to the crest of the septal bone? | 2 mm |
| How is crest of the interdental septum determined? | It is measured as parallel to a line drawn between the CEJ of adjacent teeth |
| 3 radiographic changes in periodontitis? | 1. Fuzines and a break in the lamina dura at M or D 2 Wedge-shaped radiolucency at M or D 3 Height of interdental septum is reduced |
| How should you poke the probe in to determine interdental craters? | Hold the probe at an angle just below the contact point |
| What probe is used to determine furcations? | Nabers probe |
| Can radiographs be used to definitively determine fucation? | NO! you have to feel it |
| What percentage of workers in the Loe bone loss study had: Rapid loss of .1-1 mm attachementloss/year? Moderate with .05-.5 mm/year? No bone loss? | 8, 81, 11% |
| What the ultimate determinant of pocket depth? | Putting gutta percha point in and taking an xray |
| Which always comes first, gingivitis or periodontitis? | Gingivitis - always, but doesn't always progress to periodontitis |
| 6 genetic disease of interest to perio? | 1. Hypophosphatasia 2 Papillion-Lefevre Syndrome 3 Acatalasia 4 Neutropenia 5 Chediak-Higashi syndrome 6 Leukocyte adhesion deficiency syndrome |
| What characterizes Hypophosphatasia? | Mutations in the alkaline phosphatase gene, causing premature loss of teeth |
| What characterizes Papillion-Lefevre Syndrome ? | Mutation in the cathepsin C gene, causing early onset periodontitis |
| What characterizes Acatalasia ? | Block of catalase enzyme |
| What characterizes Neutropenia? | Low number of neutrophils |
| What characterizes Chediak-Higashi syndrome ? | Abnormal transport of neutrophil lysosomes |
| What characterizes Leukocyte adhesion deficiency syndrome? | No adhesion between leukocytes and endothelium |
| 2 most common supragingival calculus accumulation sites? | 1 Lingual of lower anteriors 2 Buccal of upper posteriors |
| What 4 vitamin deficiencies impact perio tissues? | ABCD |
| What is the definition of biologic width? | Dimension of space that the healthy gingival tissue occupies above the alveolar bone |
| What is the average biologic width? | 2 mm |
| What is the "mainstya of perio diagnosis"? | PPD - Pocket probing depth |
| Define Class I tooth mobility (how many mm does a tooth have to move, horizontal/vertical?) | up to 1 mm horizontal |
| Define Class II tooth mobility (how many mm does a tooth have to move, horizontal/vertical?) | up to 2 mm horizontal |
| Define Class III tooth mobility (how many mm does a tooth have to move, horizontal/vertical?) | More than 2 mm horizontal OR vertically compressible |
| Ideally, to test for tooth mobility, should you use instruments or just your fingers? | Two instruments are ideal |
| Sensitivity to (horizontal/vertical) forces upon percussion si often a sign of perio probs. | Horizontal |
| Define Class I furcation involvement (how many mm have to show? Must it be through-and-through?) | Less than or up to 3 mm (not through and through) |
| Define Class II furcation involvement (how many mm have to show? Must it be through-and-through?) | Greater than 3 mm but not through and through |
| Define Class III furcation involvement (how many mm have to show? Must it be through-and-through?) | Through and through furcation invovement |
| BOP is a sign of ... | inflammation |
| ___ % is slight bone loss, ___-____ is moderate, >____ is severe. | 15, 15-60, >60 |
| Differentiate between a fistula and a periodontal abcess. | Fistula is a drain from the pocket. Abcess is a localized accumulation of pus in a pocket |
| What comes first, clinical or radiographic change? | CLINICAL |
| Are radiographs alone enough to make an accurate perio diagnosis? | NO |
| T/F: Plaque must be present for gingivitis to occur. | True |
| Initial gingival lesions (gingivitis) occurs wtihin ___ -__ days of plaque accumulation and (does/does not) show clinical signs. | 2-4 days. NO clinical signs. |
| Early gingival lesions occur between ____ and ____ days, characterized by: | 4-7 days, erythema and maybe some BOP |
| Established gingival lesion occurs between ____ and ___ days and this is the stage of "classic" gingivitis. | 14-21 days |
| If you can see the tooth's ______, there is gingival recession! | root |
| What three systemic medications may cause gingival enlargement? | 1. Anticonvulsants 2 Calcium channel blockers 3 Immunosuppressants |
| What is the best way to eliminate gingival enlargement? | Change medications |
| What is the most common anticonvulsant that causes gingival enlargement? | Dilantin (Phenytoin) |
| Linear gingival erythema is associated with what virus? | HIV |
| What id desquamative gingivits? | Erythema, desquamation, and ulceration of gingiva. |
| Define AAP Case Type I | Gingivitis only, no loss of supporting tissues |
| Define AAP Case Type II | Early/slight/mild periodontitis, inflammation, PPD of 3-4 mm |
| Define AAP Case Type III | Moderate periodontitis, inflammation, noticable bone loss, maybe mobile, furcations involved, PPD 4-6 mm |
| Define AAP Case Type IV | Severe periodontitis, inflammation, major bone/attachment loss, increased mobility, furcations involved |
| Severe bone and attachment loss indicates (acute/chronic). | Chronic |
| Genetic and systemic factors will cause (passive/aggressive) loss. | Aggressive |
| In ANUG, there is a characteristic gray pseudomembrane that (can/cannot) be wiped off. | CAN |
| what is the only difference between ANUG and ANUP? | ANUP has rapid and irregular bone loss. |
Created by:
janygb143