Flashcards in aetiology and pathogenesis of periodontal disease Deck (27)
describe gingvival health
clearly defined gingival margin, knife edge, scalloped
what is the clinical definition of gingival health?
absence of bleeding on probing, erythema and edema, patient symptoms, attachment and bone loss, bone level range from 1-3mm apical to ACJ
<10% bleeding sites w/ probing depths
describe plaque induced gingivitis (intact periodontium)
-lost knife edge
what are the local plaque retention factors?
what are the systemic modifying factors?
what happens to neutrophils, lymphocytes etc. gin gingiivitis?
influx higher than normal
is periodontitis reversible?
is gingivitis reversible?
what is periodontitis?
loss of periodontal attachment
bone >3mm away from ACJ
describe a periodontal pocket
what is a false pocket?
proliferation of sulcular epithelium leads to enlarged gingivae
probe disappears but no loss of attachment
in what group are pockets without inflammation common?
what is the normal bone level from the ACJ?
how do you determine if there has been bone loss?
check if bone level consistent on radiographs
how much bone loss relative to root length
-apex -> ACJ
what determines horizontal vs vertical bone loss?
how thick alveolar bone is between teeth
describe the progression from gingivitis -> periodontitis
once initiated, progression of attachment loss may be episodic, different sites may be affected differently
generally very slow but variable
2mm loss over 5 years = rapid progression
what happens when the biofilm migrates apically?
what is the host immune response?
-shedding of cells
-production of inflammatory mediators
inflammatory and immune responses
describe connective tissue matrix degradation
matrix malloproteinases are a family of zinc & ca dependent proteolytic enzymes which include collagenases
matrix degradation largely a result of MMP's secreted by host inflammatory cells
immune cell activation of osteoclasts via RANK/RANKL/ other cytokine
what are anatomical risk factors?
what are tooth position risk factors?
what are iatrogenic risk factors?
defective crown margins
poorly designed partial dentures
why is smoking a risk factor?
vasoconstriction of gingival vessels and increased gingival keratinisation
impaired antibody production
depressed numbers of Th lymphocytes
impaired PMN function
increased prod. pro-inflammatory cytokines
what are environmental risk factors?
local risk factors
what is the impact of periodontitis?
most common cause of bone loss
50% population affected
what is the extent and severity dependant on?
interaction between microbiome and host