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Oral pathology > Perio > Flashcards

Perio Flashcards

1
Q

Re-evaluation falls under _________ phase

A

Non-surgical Phase

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2
Q

Re-evaluation _________ weeks after initial therapy

A

Re-evaluation 4-8 weeks after initial therapy

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3
Q

_________ is generally considered the
initiating factor of periodontal disease.

A

Microbial plaque

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4
Q
  • Probing pocket depth (PPD)—from __________ to ______
  • Clinical attachment loss (CAL)—from ______ to ______
  • Bleeding on probing (BOP)—best measure of _________
    in periodontal tissues
A
  • Probing pocket depth (PPD)—from gingival margin to base of pocket
  • Clinical attachment loss (CAL)—from CEJ to base of pocket
  • Bleeding on probing (BOP)—best measure of inflammation in periodontal tissues
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5
Q

CAL= ______+________

A

CAL= PPD + recession

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6
Q

Miller Classification (Mobility)

A
  • Class 0 normal physiologic mobility
  • Class 1 slightly more than normal
  • Class 2 moderately more than normal (≤1mm)
  • Class 3 severely more than normal (>1mm) and
    can be vertically depressed in socket
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7
Q

Certain factors can predispose a tooth to
furcation involvement:

A

– Short root trunk
– Short roots
– Narrow interradicular dimension
– Cervical enamel projection

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8
Q

Hamp Classification (Furcation)

A
  • Class 0 no furcation involvement
  • Class 1 horizontal furcation involvement <3mm
  • Class 2 horizontal furcation involvement >3mm
  • Class 3 through-and-through furcation
    involvement
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9
Q

Glickman Classification (Furcation)

A
  • Class 1 pocket formation into the FLUTE, incipient
  • Class 2 pocket formation into the FURCA, cul-desac
  • Class 3 through-and-through furcation lesion
  • Class 4 through-and-through furcation lesion that
    you can see through
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10
Q

Nabers probe is used in

A

Hamp Classification (Furcation)

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11
Q
  • Normal distance from CEJ to alveolar crest is
    ____mm
A

2 mm

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12
Q

Infrabony Defects
* 1 wall
* 2 wall
* 3 wall
* 4 wall

A

Infrabony Defects
* 1 wall hemiseptal
* 2 wall crater (most common)
* 3 wall trough
* 4 wall circumferential (extraction socket)

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13
Q

Partial root coverage is seen in __________ class of recession- millers classification.

A

3

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14
Q

Plaque-Induced Gingival Diseases
* Modified by systemic factors

  • Modified by medications
  • Modified by malnutrition
A

Plaque-Induced Gingival Diseases
* Most common
* Result of interaction between plaque bacteria and
inflammatory cells of host
* Modified by systemic factors
– Endocrine changes (puberty, pregnancy, diabetes)
– Blood dyscrasias (leukemia)
* Modified by medications
– DIGE with CCBs, dilantin, and cyclosporine
– Oral contraceptives
* Modified by malnutrition
– Vitamin C deficiency (scurvy)

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15
Q

Periodontal Disease (Severity)
Slight
Moderate
Severe

A

Periodontal Disease (Severity)
Slight
* 1-2mm CAL
Moderate
* 3-4mm CAL
Severe
* ≥5mm CAL

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16
Q
  • Pseudomembrane
  • Fetid breath
  • Blunted papillae represents ______ periodontitis
A

Necrotizing (ANUG, ANUP)

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17
Q

Aggressive Periodontitis
Localized version has _________
presentation

A

first molar/incisor

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18
Q

Dental Plaque Composition
* Supragingival= ________ organisms
– Tooth=
– Outer surface of plaque=
* Subgingival= anaerobic
– Tooth= _________ coronal and ____apical
– Epithelium= _______

A

Dental Plaque Composition
* Supragingival= aerobic
– Tooth= G+
– Outer surface of plaque= G-
* Subgingival= anaerobic
– Tooth= G+ coronal and G- apical
– Epithelium= G-

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19
Q

Supragingival components derive from _________,
subgingival components derive from _______

A

Saliva
GCF

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20
Q
  1. Pellicle Formation
    – Within _______
    – Consists of _________
    and other molecules that serve as __________
    sites for bacteria
A
  1. Pellicle Formation
    – Within seconds
    – Consists of glycoproteins, proline-rich proteins,
    and other molecules that serve as attachment
    sites for bacteria
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21
Q
  1. Adhesion and Attachment of Bacteria
    – Within _________
    – Initial adhesion is due to _________ and _______- forces
    – Firm attachment is due to ____ irreversible
    interactions between _________
    molecules and __________ receptors
A
  1. Adhesion and Attachment of Bacteria
    – Within minutes
    – Initial adhesion is due to weak reversible van der
    Waals and electrostatic forces
    – Firm attachment is due to strong irreversible
    interactions between specific bacterial adhesin
    molecules and host pellicle receptors
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22
Q
  1. Colonization and Plaque Maturation
    – Within _________ hours
    – Firmly attached primary colonizers provide new
    receptors for attachment of other bacteria in a
    process called ___________
A
  1. Colonization and Plaque Maturation
    – Within 24 to 48 hours
    – Firmly attached primary colonizers provide new
    receptors for attachment of other bacteria in a
    process called coadhesion
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23
Q
  • Quorum sensing refers to
A

Quorum sensing refers to communication among
bacteria in a biofilm to encourage growth of beneficial
species and discourage growth of competing species

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24
Q
  • Red complex is associated with _______ and __________
A
  • Red complex is associated with BOP and deeper
    pockets
    – P. gingivalis
    – T. denticola
    – T. forsythia
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25
Q
  • Orange complex precedes presence of red
    complex supporting sequential nature of _________
    maturation
A
  • Orange complex precedes presence of red
    complex supporting sequential nature of plaque
    maturation
    – Fusobacterium
    – Prevotella intermedia
    – Campylobacter rectus
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26
Q

A. Actinomycetemcomitans ______ periodontitis
* Protease that cleaves ____

A

Aggressive periodontitis
IgG

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27
Q

P. Gingivalis __________ periodontitis

A
  • Chronic periodontitis
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28
Q
  • Fimbriae
  • Capsule
  • Gingipain
    present in
A

P. Gingivalis

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29
Q
  • Actinomyces -
  • S. mutans -
  • S. salivarius -
  • Pseudomonas, Staph -
A
  • Actinomyces - healthy gingiva, root caries
  • S. mutans - coronal caries
  • S. salivarius - most common oral bacteria,
    resides on tongue
  • Pseudomonas, Staph - implants
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30
Q

F. Nucleatum induces apoptosis of ________ and release of tissue-damaging substances from ___________

A

Induces apoptosis of leukocytes and release of tissue-damaging substances from leukocytes

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31
Q
  • Motile, gram-negative rod
  • Polar flagellum
A

C. Rectus

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32
Q

Penetrates epithelium and connective tissue

A

T. Denticola

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33
Q

T. Denticola ___________ periodontitis

A

ANUG/ANUP

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34
Q

T. Forsythia protease that cleaves __________ and
______________

A

Protease that cleaves immunoglobulins and
complement factors

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35
Q

T. Denticola protease that can degrade __________

A
  • Protease that can degrade collagen,
    immunoglobulins, and complement factors
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36
Q

Pregnancy gingivitis caused by

A

P. Intermedia

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37
Q

Precipitation of mineral salts into plaque usually occurs within _________ days

A

1-14 days

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38
Q

Materia Alba is a

A

Soft white cheeselike unorganized
accumulation of bacteria, salivary proteins,
desquamated epithelial cells, and occasional
food debris

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39
Q

Extrinsic Stains
* Orange=
* Brown=
* Dark brown and black=
* Yellow-brown=
* Black=
* Green and yellow=
* Bluish-green=

A

Extrinsic Stains
* Do not contribute to gingival inflammation and are
primarily an esthetic concern
* Orange= usually on anterior teeth, poor OH
* Brown= drinking dark-colored beverages, poor OH
* Dark brown and black= tobacco
* Yellow-brown= CHX and stannous fluoride
* Black= thin lines on cervical third, found in healthy
mouths, consumption of iron
* Green and yellow= usually on anterior teeth, poor OH
and chromogenic bacteria
* Bluish-green= occupational exposure of metallic dust

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40
Q

Subgingival Margins
* Even when not faulty they are associated with
_____________, __________, and _________.

A

Subgingival Margins
* Even when not faulty they are associated with
plaque accumulation, gingival inflammation,
and deeper pockets

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41
Q

First line of defense _______ cells

A

Neutrophils

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42
Q

MMP-8 (neutrophil collagenase)= most important proteinase
involved in destruction of __________, inhibited by ___________

A

MMP-8 (neutrophil collagenase)= most important proteinase involved in destruction of periodontal tissues, inhibited by tetracyclines

43
Q

They internalize bacteria via _________ and kills them using “biologic bleach” of ______ and _________

A

They internalize bacteria via phagocytosis and kills them using “biologic bleach” of myeloperoxidase and oxygen radicals

44
Q

Defective neutrophil chemotaxis leads to
________

A

aggressive periodontitis

45
Q

Neutrophil abnormalities include __________

A

neutropenia, Chediak-Higashi syndrome, Papillon-Lefevre syndrome, and LAD-1 and LAD-2

46
Q

Macrophages
* Antigen-presenting cells (APCs) like __________
and__________ cells
* Regulate immune response via cytokine
release like ______

A

Macrophages
* Antigen-presenting cells (APCs) like monocytes
and dendritic cells
* Regulate immune response via cytokine
release like IL-8

47
Q

Mast Cells
fun:
* Ig_______

A

Mast Cells
* Vascular permeability and dilation
* IgE

48
Q

Lymphocytes
* B cells become ________ cells and make
_________
* T helper cells (CD4) help in
___________
* T cytotoxic cells (CD8) kill
* NK cells are T cells that can recognize
and kill ________ and _________ cells

A

Lymphocytes
* B cells become plasma cells and make
antibodies
* T helper cells (CD4) help in
communication
* T cytotoxic cells (CD8) kill intracellular
antigens
* NK cells are T cells that can recognize
and kill tumor and virally-infected cells

49
Q

Proinflammatory Mediators

A
  • IL-1= bone resorption
  • IL-6
  • PGE2
  • TNFa= macrophage activation
  • MMPs= collagen destruction
50
Q

Anti-inflammatory Mediators

A
  • IL-4
  • IL-10
  • TIMPs
51
Q

Pathogenesis of Gingivitis
* Stage 1,
* Stage 2,
* Stage 3,
* Stage 4,

A
  • Stage 1, Initial Lesion—2 to 4 days, neutrophil
    infiltration, increased GCF
  • Stage 2, Early Lesion—4 to 7 days, T lymphocyte
    infiltration, increased collagen loss, BOP
  • Stage 3, Established Lesion—14 to 21 days, B
    lymphocyte infiltration including mature plasma
    cells, collagen loss, clinical changes in color,
    contour, and consistency
  • Stage 4, Advanced Lesion—transition to
    irreversible damage of periodontitis
52
Q

Periodontal re-evaluation (pocket depths, inflammation) should occur ________ weeks after the completion of
phase _____ therapy to allow for ______ and formation of ______

A

Periodontal re-evaluation (pocket
depths, inflammation) should occur
4-8 weeks after the completion of
phase I therapy to allow for healing
and formation of JE

53
Q

Reduce or eliminate periodontal pockets in _____ phase

A
  1. surgical phase
54
Q
  • Periodontal therapy, including placement of
    implants
  • Endodontic therapy ______ phase
A

2

55
Q

Risk Determinants are

A

Genetic factors
* Age
* Gender
* Socioeconomic status

56
Q

Risk Indicators are

A

HIV/AIDS
* Osteoporosis
* Infrequent dental visits
* Stress

57
Q

Risk Markers

A
  • Previous history of periodontal disease
  • BOP
  • CAL
58
Q

Risk Factors

A
  • Smoking
  • Diabetes
  • Pathogenic bacteria
  • Microbial tooth deposits
59
Q

_________ is the most important factor in determining the prognosis!

A

CAL

60
Q

prognosis Local Factors

A

Local Factors
* Plaque and calculus
* Subgingival restorations

61
Q

Sickle Scalers
* For_________l calculus
* _______ cutting edges
* __________ in cross section

A

Sickle Scalers
* For supragingival calculus
* Two cutting edges
* Triangle in cross section

62
Q

Curettes
* For __________ calculus
– _____cutting edges
– __________ in cross section
* Gracey curettes adapt to specific areas of the mouth
– _______-cutting edge
– _________ in cross section

A

Curettes
* For subgingival calculus
* Universal curettes can be used in any area of the mouth
– Two cutting edges
– Semicircle in cross section
* Gracey curettes adapt to specific areas of the mouth
– One cutting edge
– Semicircle in cross section

63
Q

gracey curretes numbers and surfaces

A

– Gracey 1-2 and 3-4—anterior
– Gracey 5-6—anterior and premolars
– Gracey 7-8 and 9-10—posterior, facial and lingual
– Gracey 11-12—posterior, mesial
– Gracey 13-14—posterior, distal

64
Q

agitation observed in fluids by mechanical vibrations
that disrupts bacterial cell walls

A

Acoustic turbulence

65
Q

mechanically removes deposits and debris

A

Vibrations

66
Q

vacuum air bubbles collapse and release energy to flush debris

A

Cavitation

67
Q
  • When initially inserting a curette into the pocket, angulation between the blade and the tooth should be ____ degrees (closed-angle) and when scaling and root planing, this angulation is changed to ________ degrees (open-angle)
A
  • When initially inserting a curette into the pocket, angulation between the
    blade and the tooth should be 0 degrees (closed-angle) and when scaling
    and root planing, this angulation is changed to 45-90 degrees (open-angle)
68
Q

light to moderate pull stroke used for final smoothing

A
  • Root planing
69
Q

short, strong pull stroke to remove hard deposits

A
  • Scaling
70
Q

Prophy Jet uses:

A

remove extrinsic stains and soft deposits

71
Q
  • Vertical releases at
A

line angles

72
Q
  • Split or partial thickness (mucosal) flap
    – Used for _________ surgery because
    exposing the bone is unnecessary
  • Full thickness (mucoperiosteal) flap
    – Used for ________ surgery and periodontal
    regeneration to permit ______ closure as
    well as in _________ flaps
  • Whenever alveolar bone is exposed like in
    full thickness flaps, expect about _____mm of
    bone resorption and remodeling
A
  • Split or partial thickness (mucosal) flap
    – Gingiva/mucosa, submucosa
    – Used for mucogingival surgery because
    exposing the bone is unnecessary
  • Full thickness (mucoperiosteal) flap
    – Gingiva/mucosa, submucosa, periosteum
    – Used for osseous surgery and periodontal
    regeneration to permit primary closure as
    well as in apically repositioned flaps
  • Whenever alveolar bone is exposed like in
    full thickness flaps, expect about 1mm of
    bone resorption and remodeling
73
Q

Full Thickness Flap
* Involves _____ horizontal incisions, and they are

A

Full Thickness Flap
* Involves three horizontal incisions:
– Internal or reverse bevel—about 1mm from
the gingival margin, removes pocket lining
yet conserves outer gingiva
– Sulcular or crevicular—through base of
pocket to alveolar crest
– Interdental or interproximal—removes the
collar of tissue around the tooth you
created with the first two incisions

74
Q

three incisions and provides access to subgingival
areas for debridement with the goal of new
attachment

A

Modified Widman flap

75
Q

pocket reduction with additional vertical releasing incisions

A

Apically repositioned flap

76
Q

Periodontal Pack
* Usually consists of _____
* Leave in place for _______ week
* Packs are placed to protect the
* Packs do NOT enhance ________

A

Periodontal Pack
* Usually consists of ZOE
* Leave in place for 1 week
* Packs are placed to protect the surgical
wound, minimize discomfort, maintain tissue
placement, and help prevent post-op bleeding
* Packs do NOT enhance healing

77
Q

Gingival surgery healing is by _____ intension

A

secondary

78
Q

Pocket reduction ________ incision in maxilla and mandible

A

parallel, V-shaped

79
Q
  • Free gingival graft=
  • Connective tissue graft=
  • Frenectomy=
  • Frenotomy=
  • Vestibuloplasty=
A
  • Free gingival graft= widen
    band of keratinized tissue
  • Connective tissue graft= root
    coverage
  • Frenectomy= complete
    removal of frenum
  • Frenotomy= incision of
    frenum
  • Vestibuloplasty= deepen the
    vestibule
80
Q

Ideal thickness of graft is _________ mm

A

1-1.5mm

81
Q

revascularization from the recipient bed ______ graft

A

FGG

82
Q

________ is most common donor site for both
FGG and CTG

A

Palate

83
Q
  • Ostectomy= removal of __________ bone
  • Osteotomy= removal of ___________ bone
  • After ostectomy, peaks of bone often remain at
    the__________ called _______
A
  • Ostectomy= removal of supporting bone
  • Osteotomy= removal of non-supporting bone
  • After ostectomy, peaks of bone often remain at
    the line angles called widow’s peaks
84
Q

Wound Healing
* These cells populate a wound area during the
healing process from fastest to slowest:

A

– Epithelial cells (1)
– CT cells (2)
– PDL cells (4)
– Bone cells (3)

85
Q

Root Surface Treatment
* Chelating agents like_____ and _______can
expose the collagen fibrils through
demineralization and may improve new
attachment

A

EDTA and citric acid

86
Q
  • Autograft=
  • Allograft=
  • Xenograft=
  • Alloplast=
A
  • Autograft= from yourself
  • Allograft= from another human, usually cadaver
  • Xenograft= from another animal, usually cow
  • Alloplast= synthetic or inorganic
87
Q
  • Osteoconductive=
  • Osteoinductive=
  • Osteogenic=
A
  • Osteoconductive= scaffold
  • Osteoinductive= convert neighboring progenitor
    cells into osteoblasts
  • Osteogenic= make bone
88
Q
  • Barrier membrane is the “tank”—
  • Bone graft is the “damage”—
  • Biologic agent is the “healer”—
A
  • Barrier membrane is the “tank”—prevents soft tissue
    downgrowth and permits hard tissue ingrowth
  • Bone graft is the “damage”—osteoconductive,
    osteoinductive, and/or osteogenic
  • Biologic agent is the “healer”—creates an environment
    conducive to tissue formation
89
Q

Antibiotics
* Should only be used as an adjunct to
phase _________
* _________ and _________ periodontitis

A

(1) Antibiotics
* Should only be used as an adjunct to
mechanical debridement during phase I
* Aggressive and refractory periodontitis

90
Q

Local Delivery Antibiotics (LDA)
drugs:
When localized recurrent and/or residual PD
________mm with inflammation are still present
following conventional therapies

A

When localized recurrent and/or residual PD
≥5mm with inflammation are still present
following conventional therapies
* Arrestin= Minocycline
* Atridox= Doxycycline
* PerioChip= Chlorhexidine gluconate

91
Q

Host Modulation Therapy
* Should only be used as an adjunct to
mechanical debridement during phase _____
* _________- periodontitis

A
  • Should only be used as an adjunct to
    mechanical debridement during phase I
  • Chronic periodontitis
92
Q

Subantimicrobial Dose Doxycycline (SDD)
* Inhibits ________
* ______mg twice daily for ______ months (Periostat)

A

Subantimicrobial Dose Doxycycline
(SDD)
* Inhibits MMPs (collagenases)
* 20mg twice daily for 3-9 months (Periostat)

93
Q

Periostat-
Periochip-

A

Subantimicrobial dose doxycycline is periostat- 20 mg twice daily for 3-9 months
PerioChip= Chlorhexidine gluconate-Local Delivery Antibiotics (LDA)

94
Q

Locally Administered Host-Modifying
Agents
* These surgical adjuncts may also influence
_________ regeneration

A

Locally Administered Host-Modifying
Agents
* Emdogain= enamel matrix proteins
* PDGF= GEM 21S
* These surgical adjuncts may also influence
periodontal regeneration

95
Q
  • Primary occlusal trauma= caused by excessive
    forces on a _________l periodontium
  • Secondary occlusal trauma= caused by normal
    occlusal forces on a _______ periodontium
  • Fremitus=
A
  • Primary occlusal trauma= caused by excessive
    forces on a normal periodontium
  • Secondary occlusal trauma= caused by normal
    occlusal forces on a reduced periodontium
  • Fremitus= vibration of teeth upon closing
96
Q

coronoplasty is

A
  • Occlusal adjustment (coronoplasty)= selective
    reshaping of occlusal surfaces
97
Q

Replace brushes every ______ months

A

3

98
Q

Periodontitis most common to least common
most common in _______ descent

A

Chronic > LAP > GAP > Refractory
males of African descent

99
Q

Calculus contains _____ amounts of viable bacteria than plaque.

A

lower

100
Q

Smokinghas been shown to____________ the inflammatory response of gingival tissues, ___________probing depths

A

Smokinghas been shown todecrease the inflammatory response of gingival tissues, Increased probing depths

101
Q

Dental plaque starts as a pellicle and a few early colonizers and takes around ____ days to mature.

A

1-2 days

102
Q

What should clinicians initially assume for grading?

A

Grade- B

103
Q

This time frame allows for histologic healing of the periodontal tissues, which includes _____ weeks for the long junctional epithelium and __________ weeks for connective tissue.

A

This time frame allows for histologic healing of the periodontal tissues, which includes 2 weeks for the long junctional epithelium and 4-6 weeks for connective tissue.

104
Q
A

Oral pathology (14 decks)

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