Acute Periodontal Lesions & Mucogingival Conditions Flashcards
(96 cards)
1
Q
Acute periodontal lesions include:
A
- Periodontal abscesses
- Necrotizing periodontal diseases
- Endo Perio lesions
2
Q
_____% of all emergency patients, 3rd most common
_____% of untreated periodontal patients
_____% of patients in active periodontal treatment
_____% of patients in periodontal maintenance
A
7-14% of all emergency patients, 3rd most common
60% of untreated periodontal patients
13.5% of patients in active periodontal treatment
37% of patients in periodontal maintenance
3
Q
What is the etiology of periodontal abscesses?
A
- pulp necrosis
- periodontal infections
- pericoronitis
- trauma
- surgery
- foreign body impaction
4
Q
Localized accumulation of pus located within the gingival wall of the periodontal pocket , with an expressed periodontal breakdown occurring during a limited period of time, with easily detectable clinical symptoms:
A
Periodontal abscess
5
Q
List the sequence of events leading to periodontal abscess formation:
A
- Occlusion of existing periodontal pocket
- Bacterial invasion of soft tissue wall
- Leukocytic infiltration (neutrophils)
- Vascular thrombosis
- Edema & swelling
- Tissue necrosis & liquefaction
- Collagenolysis & bone resorption
- Production of purulent exudate
OBLV ETCP
6
Q
List the most common symptoms of acute periodontal disease in order from MOST common to LEAST common:
A
- pain
- swelling & edema
- lymphadenopathy
- Fever
7
Q
_____ formation is often a manifestation of:
-diabetes (uncontrolled or undiagnosed): most common cause
-AIDS (compromised immune system
-Depressed immune system (steroid therapy, chemotherapy)
A
Multiple abscess
8
Q
MULTIPLE ABCESS FORMATION is often a manifestation of: (3)
A
- Diabetes
- AIDS
- Depressed immune system
9
Q
What is the MOST common cause of multiple abscess formation?
A
Uncontrolled or undiagnosed diabetes
10
Q
65% of the microbial flora that cause periodontal abscesses are _____ and ____
A
Gram negative; anaerobic
11
Q
Bacteria that produce ______, such as P. Gingivalis & P. Intermeia are important in the pathogenesis of the periodontal abscess since they increase the availability of nutrients, and thereby increase the number of bacteria within the abscess environment
A
proteinases
12
Q
Bacteria that produce proteinases such as _____ & _____ are important in the pathogenesis of periodontal abscess
A
P. gingivalis; P. intermedia
13
Q
Bacteria that produce proteinases such as P. Gingivalis & P. intermedia are important in the pathogenesis of the periodontal abscess since they increase _____ and thereby increase the _____ within the abscess environment
A
the availability of nutrients; number of bacteria
14
Q
List the common pathogens found in a periodontal abscess: (7)
A
- Candida albicans
- Fusobacterium nucleatum
- Peptostreptococcus micros
- Porphyromonas gingivalis
- Prevotella intermedia
- Taneralla forsythia
- Treponema (spirochetes)
CF 3P 2T
15
Q
List the characteristic histopathology of a periodontal abscess:
A
- acute inflammatory infiltrate
- vascular hyperemia & thrombosis
- lysis of collagen matrix in the lamina propria and the gingival fibers
- ulceration and apical proliferation of the JE
- osteoclastic mediated bone resorption
16
Q
A periodontal abscess in a periodontitis patient could represent a period of:
A
disease exacerbation
17
Q
A periodontal abscess in a periodontal patient could represent a period of disease exacerbation due to: (5)
A
- tortuous pocket
- furcation involvement
- vertical defect
- composition of microflora
- decreased host defense
18
Q
When is a periodontal abscess in a periodontitis patient due to an acute exacerbation?
A
- in untreated periodontitis
- in patients non-responsive to periodontal therapy
- patients on supportive periodontal therapy
19
Q
A periodontal abscess in a periodontitis patient can form after _____ and so there is need for _____
A
treatment (post-scaling & post-surgery); post-medication (antimicrobials & nifedepine)
20
Q
List some causes of a periodontal abscess in non-periodontitis patients: (5)
A
- impaction of foreign bodies
- harmful habits
- orthodontic factors
- gingival enlargement
- alteration of root surfaces
21
Q
List some examples of alteration of root surfaces that may lead to a periodontal abscess in non-periodontitis patients:
A
- dens invaginatus
- cemental tears
- enamel pearls
- perforations (iatrogenic)
- severe root damage (VRF or CTS)
- external root resorption
22
Q
What are the clinical signs of a periodontal abscess: (10)
A
- pain
- localized swelling & fluctuance
- purulent exudate
- deep periodontal pocket
- vital pulp
- fistula
- tooth mobility
- sensitivity to percussion
- low-grade fever
- lymphadenopathy
23
Q
The following are all ____ of _____
- pain
- localized swelling & fluctuance
- purulent exudate
- deep periodontal pocket
- vital pulp
- fistula
- tooth mobility
- sensitivity to percussion
- low-grade fever
- lymphadenopathy
A
Clinical signs of periodontal abscess
24
Q
List some differential diagnosis for periodontal abscess:
A
- periapical abscess
- acute pulpitis
- tooth or root fracture
- pericoronitis
- lateral periodontal cyst
- gingival cyst
25
1. periapical abscess
2. acute pulpitis
3. tooth or root fracture
4. pericoronitis
5. lateral periodontal cyst
6. gingival cyst
These are all:
differential diagnosis for periodontal abscess
26
List some complications of periodontal abscesses:
1. tooth loss (up to 45% of teeth with perio abscesses in maintenace are extracted)
2. bacteremia (following abscess treatment)
3. chronic or episodic bacteremia from untreated periodontal disease
27
One complication of perio abscess is tooth loss. Provide the statistic:
Up to 45% of teeth with perio abscesses in maintenance are extracted
28
A complication of perio abscess is bacteremia. This can be chronic or episodic from untreated perio disease OR following abscess formation.
Both statements true
29
List the potential treatment options for a perio abscess: (5)
1. Non-surgical drainage & debridement with LA
2. Surgical drainage for large abscess
3. Surgical therapy with flap reflection, debridement with ultrasonic, sutures
4. Antibiotics if systemic infection indicated by fever or lymphadenopathy
5. Reevaluation and any further needed therapy
30
Non-surgical drainage and debridement for treating a perio abscess is typically done under:
Local anesthetic
31
When would surgical drainage be a likely treatment option for a perio abscess?
Large abscess
32
Describe surgical therapy for treatment of a perio abscess:
1. Surgical therapy with flap reflection
2. debridement with ultrasonic
3. sutures
33
When would antibiotics be indicated for perio abscess treatment?
If systemic infection is indicated by:
1. fever
2. lymphadenopathy
34
What are the components of diagnosis with dealing with a perio abscess?
1. Health history + medications
2. Dental history
3. Current perio status
4. Current status of effected tooth
5. PA radiographs
6. clinical exam
7. determine etiology
35
When taking the health history and medications for patient with a perio abscess, you should look out for:
1. diabetes
2. systemic antibiotic use
36
When diagnosing a perio abscess, how can the current status of the affected tooth be determined?
1. cold & EPT tests vital
2. pain on percussion
37
What type of radiographs should be taken for a potential perio abscess?
PA radiographs
38
What should you be looking for when clinically examining a patient when diagnosing a perio abscess?
1. redness
2. swelling
3. purulent discharge
4. lymphadenopathy
39
-calculus fragments from recent cleaning
-systemic antibiotic treatment without subgingival debridement
-acute exacerbation of untreated periodontitis
-foreign body impaction
-endodontic perforation
-cemental tear
These are all:
potential etiologies of perio abscess
40
What are the two categories of treatment options for perio abcess?
1. closed approach
2. open approach
41
Describe the closed approach treatment to perio abscess:
1. incision & drainage through the pocket
2. root planing to depth of sulcus
42
Describe the open approach trreatment to perio abscess:
1. sulcular incisions and full thickness flap
2. remove all visible soft & hard deposits from root and adjacent bone
3. replace flap & suture closed
43
In both closed & open approach treatment option, there should be thorough ____ & consideration of ____
thorough irrigation; consideration of systemic antibiotics (though usually not needed)
44
1. incision & drainage through the pocket
2. root planing to depth of sulcus
Closed approach
45
1. sulcular incisions and full thickness flap
2. remove all visible soft & hard deposits from root and adjacent bone
3. replace flap & suture closed
Open approach
46
T/F: With both closed approach & open approach treatment, systemic antibiotics should be considered but are usually not needed
true
47
Post-operative therapy for both closed & open approach perio abscess treatment includes:
1. home care
2. prescribe analgesics
3. re-evaluation
4. frequently monitor radiographically & clinically for perio disease
48
Acute periodontal diseases include:
1. acute periocoronitis
2. acute periodontal abscess
3. acute herpetic gingivostomatitis
4. acute necrotizing ulcerative gingivitis
5. endo-perio lesions
49
Describe normal healthy gingiva:
-coral pink
-stippled
-scalloped
-firm
-resilient
-peaked interdental papilla
50
T/F: It is not possible to maintain periodontal health in the absence of keratinized gingiva
False- it is possible to maintain periodontal health in the abscess of keratinized gingiva
51
According to Lang & Loe, how much keratinized gingiva is considered enough? How much attached gingiva is considered enough?
2 mm keratinized
1 mm attached
52
According to the 2017 classification of mucogingival deformities & conditions around teeth the PERIODONTAL BIOTYPE can be categorized as:
1. thin scalloped
2. thick scalloped
3. thick flat
53
According to the 2017 classification of mucogingival deformities & conditions around teeth GINGIVAL /SOFT TISSUE RECESSION may be categorized as:
1. facial or lingual surfaces
2. interproximal (papillary)
3. severity of recession
4. gingival thickness
5. gingival width
6. presence of NCCL/Cervical caries
7. Patient esthetic concern
8. Hypersensitivity
54
According to the 2017 classification of mucogingival deformities & conditions around teeth GINGIVAL EXCESS can be categorized as:
1. pseudopocket
2. inconsistent gingival margin
3. excessive gingival display
4. gingival enlarement
55
Determine the periodontal phenotype according to the 2017 classification of mucogingival deformities & conditions around teeth:
Thin scalloped
56
Determine the periodontal phenotype according to the 2017 classification of mucogingival deformities & conditions around teeth:
Thick scalloped
57
Determine the periodontal phenotype according to the 2017 classification of mucogingival deformities & conditions around teeth:
Thick flat
58
Periodontal phenotype is based on anatomical characteristics including:
1. gingival phenotype
2. bone morphotype
3. tooth position
59
Gingival phenotype is based:
keratinized tissue width
60
Gingival phenotype is based on keratinized tissue width, with an average of ____mm for thick biotype and an average of ____ mm for thin phenotype
Thick= 5.72 mm
Thin= 4.15 mm
61
What is the range for gingival thickness?
0.63 mm to 1.24 mm
62
What is the mean value for bone morphotype for THIN biotype? What is it for THICK/AVERAGE phenotype?
Thin= 0.34 mm
Thick/average= 0.754 mm
63
-gingival phenotype
-bone morphotype
-tooth position
These are all determining characteristics for:
periodontal phenoytpe
64
Apical migration of the gingival margin with concomitant exposure of the root surface:
Gingival recession
65
T/F: Gingival recession affects a large population only due to oral hygeine
False- this condition affects a large population irrespective of oral hygiene
66
What is the prevalence of gingival recession?
54.5% of young adults
67
______ of middle-aged elderly adults suffer from gingival recession with an average prevalence of ____
100% ; 78.6%
68
What can be seen in the following image?
1. Decreased vestibular depth
2. Lack of keratinized gingiva
69
What can be seen in the following image?
Aberrent frenum/muscle position
70
What are the categories of gingival excess?
1. pseudopocket
2. inconsistent gingival margin
3. excessive gingival display
4. gingival enlargement
71
1. pseudopocket
2. inconsistent gingival margin
3. excessive gingival display
4. gingival enlargement
These are all types of:
gingival excess
72
What can be seen in the following image?
Gingival excess
73
What can be seen in the following image?
Non-carious cervical lesions (NCCL)
74
What can be seen in the following image?
Root caries
75
Describe "CLASS A neg" CEJ:
Step: -
Descriptors: CEJ detectable without step
76
Describe "CLASS A pos" CEJ:
Step: +
Descriptors: CEJ detectable with step
77
Describe "CLASS B neg" CEJ:
Step: -
Descriptors: CEJ undetectable without step
78
Describe "CLASS B pos" CEJ:
Step: +
Descriptors: CEJ undetectable with step
79
T/F: In Class B, the CEJ is undetectable
True
80
T/F: In class A, the CEJ is detectable
True
81
What are the most common mucogingival defects in daily practice?
1. gingival recessions
2. inadequate zone of keratinized gingiva
82
Predisposing factors for gingival recessions & inadequate zones of keratinized gingiva include:
1. periodontal biotype & attached gingiva
2. the impact of tooth brushing
3. the impact of cervical restorative margins
4. the impact of orthodontics
5. other conditions
83
- Gingival recession with NO loss of interproximal attachment
- interproximal CEJ was NOT detected either on the mesial or distal aspect of the tooth
Recession Type 1 (RT1)
84
- Gingival recession associated with LOSS of interproximal attachment
- The amount of interproximal attachment loss was less or equal to the buccal attachment loss
Recession Type 2 (RT2)
85
- Gingival recession with the LOSS of interproximal attachment
- Interproximal attachment loss is GREATER than the buccal attachment loss
Recession Type 3 (RT3)
86
Cairo classification for gingival recession is:
treatment oriented
87
In cairo classification for gingival recession RT1 (Miller class I & II): _______ can be predicted
100% root coverage can be predicted
88
In cairo classification for gingival recession RT2 (Overlapping miller class III): _____ can be predicted
mixed results
89
In cairo classification for gingival recession RT3 (Overlapping miller class IV): _____ can be predicted
full root coverage is NOT achievable
90
Cairo classification classifies:
gingival recession (treatment oriented)
91
Cairo RT1 can be compared to:
Miller class I & II
92
Cairo RT2 can be compared to:
Miller class III
93
Cairo RT3 can be compared to:
Miller class IV
94
What occurs when an existing lesion is left untreated?
Progression
95
T/F: For the treated & untreated sites studies
1) 83% of the 64 treated sites showed recession reduction while 48% of the 64 untreated sites experienced increased recession
2) The number of increase in recession was abundant
3) Thin gingival biotypes augmented by grafting remained stable over time compared to untreated areas with thin biotypes
4) Untreated areas also showed a tendency to develop new recession
1) true
2) false- it was limited
3) true
4) true
96
