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ODDR- Periodontal disease treatment > Aetiology of Periodontal Diseases > Flashcards

Aetiology of Periodontal Diseases Flashcards

1
Q

Describe how healthy gums would look

A
  1. Pink, firm, scalloped gingival margin with knife-edged papillae
  2. Free (marginal) gingiva
  3. Gingiva cuff 1-2mm wide around the neck of the tooth
  4. external wall of gingival sulcus 1-2mm deep
  5. mucoperiosteum bound to bone 2hcih splits at mucogingival junction-alveolar mucosa
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2
Q

What does interdental mean?

A

Between two teeth

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3
Q

What is found between teeth?

A

Soft tissues called inter proximal or interdental gingiva

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4
Q

what is free gingiva?

A

Gingiva hat is not attached to teeth or bone

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5
Q

What does free gingiva do?

A

Forms the wall of the gingival sulcus or crevice

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6
Q

What is the gingival margin?

A

Knife edged margin

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7
Q

What are the two basic periodontal diseases?

A
  1. Gingivitis
  2. Periodontitis
    Both are inflammatory conditions triggered by bacteria
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8
Q

What are the differences between gingivitis and periodontitis?

A

Both are diseases of the gums but Gingivitis is reversible but Periodontitis is nor irreversible

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9
Q

What is the sequence of events that can lead to periodontitis?

A
  1. Supragingival plaque builds up
  2. This leads to gingivitis
  3. Crevice deepens (more than 3mm) and plaque extends subgingivally
  4. Leading to periodontitis
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10
Q

If the gingival crevice depth increases beyond a certain value Gingivitis can become Periodontitis. What is this depth value?

A

3mm

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11
Q

What is the most common type of gingivitis?

A

Plaque induced gingivitis

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12
Q

What are some clinical features of Plaque induced gingivitis

A
  1. Red, swollen, bleeding gingiva
  2. Blunting of papillae, loss of contour
  3. Reversible on removal of aetiological agent, plaque
  4. False pocket, not associated with bone loss
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13
Q

Name some microorganisms responsible for causing gingivitis

A
  1. Actinomyces israelii
  2. A. naeslundii,
  3. A.odontolyticus,
  4. Veilonella parvula,
  5. Campylobacter spp
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14
Q

Why might false pockets form?

A

May occur on periodontium with reduced support

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15
Q

Which white blood cell is the first to arrive when plaque accusation increases?

A

Neutrophiles

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16
Q

What are the 3 key features of periodontitis?

A
  1. Loss of periodontal connective tissue attachment
  2. Apical migration of junctional epithelium
    formation of periodontal pocket, lined with pocket epithelium
  3. Alveolar bone loss
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17
Q

What is the eventual result of periodontitis?

A

Tooth loss

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18
Q

Give some features you would see in a section a tooth which has periodontitis

A

1, The gingival margin willl be at the top of the pocket

  1. Neutrophils will migrate
  2. Clinical attachment loss from the cement enamel junction
  3. Ulcerates cake epithelium
  4. Heavy inflammatory infiltrates
  5. Bone loss and loss periodontal tissue
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19
Q

How do you diagnose periodontitis?

A
  1. Can take pocket measurement

2. Take radiographs to see if bone has been loss

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20
Q

How can you measure the pocket depth

A

Using a probe (usually BPE probes)
You introduce the probe into the sulcus
Record the depth of the probe going into the sulcus

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21
Q

What is the aetiology for periodontal disease?

A

Microbial plaque is he primary aetiological age in periodontal disease

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22
Q

What is an aetiological agent?

A

A causative agent

23
Q

What are some secondary modifying features causing aetiology

A
  1. Local factors

2. Systemic factors

24
Q

How can you see plaque in the mouth?

A

By using a disclosing tablet

25
Q

What is plaque?

A

Complex microbial community in matrix of polymers of bacterial & salivary origin
It is a biofilm

26
Q

Describe plaque as a biofilm

A
  1. A community of micro organism attached to the surface
  2. Spatial organised into a 3D structure
  3. Enclosed in a matrix of extra cellular material from cells themselves and the environment
27
Q

How do we classify plaque?

A

Can be

  1. Supragingival
  2. Subgingival
28
Q

What is Supragingival plaque?

A

Plaque found above the gingival margin

ie on the tooth surface

29
Q

What is Subgingival plaque?

A

Plaque found below the gingival margin

ie inside the gingival sulcus on the root surfaces

30
Q

Describe Supragingival plaque

A
  1. Mostly made up of gram +ve cocci and rods
  2. Aerobic unless there’s a thick layer
  3. Low species diversity
31
Q

Describe Subgingival plaque

A
  1. Mostly made up of gram -ve rods, spirochaetes
  2. Highly anaerobic
  3. Great series diversity
32
Q

How many species have we discovered to be found in the mouth?

A

600 ish

33
Q

What makes plaque pathogenic?

A

They have Virulence (toxic) factors

34
Q

Name some Virulence (toxic) factors of plaque

A
  1. Proteases
  2. Bone resorbing factors
  3. Cytotoxic metabolites
  4. Leukotoxin
  5. Capsule
  6. Induction of inflammatory response
35
Q

What is calculus?

A

Calcifies plaque due to mineralisation of long term plaque on the tooth

36
Q

What causes the mineralisation of plaque into calculus?

A

Minerals in the saliva and gingival crevicular fluid interacting with plaque causing it to calcify

37
Q

Describe supragingival calculus

A

creamy yellow colour

it is clearly visible

38
Q

Where is supraginigval plaque usually found?

A

Openings salivary ducts as there’s a surplus of minerals at these openings
(buccal side of upper molars and lingua spect of incisors)

39
Q

Where do salivary glands open?

A

buccal side of upper molars

Lingual aspect of incisors

40
Q

Describe subgingival calculus

A

dark brown or black in colour can’t be seen as it is below the gum line
It is highly adherent

41
Q

Where is subginigval plaque usually found?

A

Any subginigval location in the mouth

Mineral salts are from the gingival crevicular fluid

42
Q

What are the 3 theories explain why calculus deposition occurs

A
  1. Precipitation of mineral salts into plaque (occurs 2-14 days after plaque formation)
  2. Element in plaque acts as a nucleation or seeding site
  3. Bacterial viability within calculus (Theres a reservoir of bacteria)
43
Q

What are the 3 plaque hypotheses?

A
  1. Non specific (1986)
  2. Specific (1976,1979)
  3. Ecological ( 1991, 1994)
44
Q

Explain the non specific hypotheses of plaque

A

Theres plaque all over the mouth and all the plaque is responsive for the destruction of periodontal tissue

45
Q

Explain the specific hypotheses of plaque

A

Certain bacteria are pathogenic not the entire bacterial microflora

46
Q

Explain the ecological hypotheses of plaque

A

Unless there’s a shift in the balance (dysbiosis) due to environmental change plaque will not become pathogenic
If it does become pathogenic then destruction will occur

47
Q

Which of the 3 plaque hypotheses is the most accepted ?

A

The ecological

48
Q

According to the ecological model what happens if the ginigva is healthy?

A
  1. Plaque is reduced
  2. Reduced inflammation
  3. Low GCF flow
  4. Higher redox potential (more aerobic)
  5. predominantly gram +ve microflora
  6. Mainly facultative anaerobes
49
Q

According to the ecological model what happens if there is gingivitis?

A
  1. Plaque accumulates
  2. Increased inflammation
  3. Higher GCF flow
  4. Lower redox potential (anaerobic)
  5. predominantly gram -ve microflora
  6. Mainly obligate anaerobes
50
Q

What are the host defence in the mouth

A
  1. Saliva
  2. Epithelium
  3. Inflammatory response
  4. Immune response
  5. Mediators
51
Q

Name the putative periodontal pathogens

A
  1. Aggregatibacter actinomycetemcomitans
  2. Tannerella forsythensis
  3. Campylobacter rectus
  4. Eikonella corrodens
  5. Fusobacterium nucleatum
  6. Porphyromonas gingivalis
  7. Prevotella intermedia
  8. Peptostreptococcus micros
  9. Spirochaetes
52
Q

Define risk factors

A

Characteristic, aspect of behaviour or environmental exposure associated with destructive periodontitis, not necessarily causal

53
Q

Name some local risk factors associate with periodontal disease

A

Subgingival calculus

54
Q

Name some systemic risk factors associate with periodontal disease

A
  1. smoking
  2. poorly controlled diabetes
  3. stress

ODDR- Periodontal disease treatment (9 decks)

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