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247 Periodontics > Chapter 3 > Flashcards

Chapter 3 Flashcards

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1
Q

What is disease progression (pathogenesis)?

A

The sequence of events that occur during the development of a disease or abnormal condition

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2
Q

What are the components of the periodontium?

A

Gingiva
PDL
Bone
Cementum

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3
Q

What are the two types of periodontal disease?

A

Gingivitis
Periodontitis

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4
Q

What is gingivitis?

A

Bacterial infection confined to the gingiva
Reversible

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5
Q

What is periodontitis?

A

Bacterial infection (and inflammatory response) of ALL PARTS of the periodontium including: gingiva, PDL, bone, cementum

Results in irreversible tissue destruction

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6
Q

What are the two levels of healthy periodontium?

A

Pristine Periodontal Health- bleeding absent
Clinical periodontal health- bleeding <10% of sites

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7
Q

What is gingivitis characterized by?

A

Changes in color, contour and consistency of gingiva

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8
Q

How many days after plaque biofilm accumulation can gingivitis be observed?

A

4-14 days

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9
Q

What is acute gingivitis?

A

Short term
Fluid accumulation in tissue
Redness

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10
Q

What is chronic gingivitis?

A

Months to years
Collagen formation may result in enlargement
Fibrotic appearance
Decreased redness

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11
Q

What is the state of the junctional epithelium in the presence of gingivitis?

A

Does not affect normal attachment of the JE

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12
Q

Color of gingivitis clinically

A

Variable: red to reddish-blue, less so in chronic state

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13
Q

State of gingival margin with gingivitis, clinically

A

Loses thin edge, may cover more of the tooth (enlarged)

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14
Q

State of papilla with gingivitis

A

Enlarged, bulbous

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15
Q

What kind of bleeding would we see clinically in a state of gingivitis?

A

Bleeding upon probing, may decrease in chronic state and with smokers

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16
Q

State of the sulcus in presence of gingivitis

A

Probing depth may increase (pseudopockets from enlargement)
No apical migration of JE

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17
Q

What are the microscopic clinical features of gingivitis?

A

Hemidesmosomal attachment coronal to CEJ
JE extends in epithelial ridges due to destruction of supragingival fiber bundles

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18
Q

What is periodontitis characterized by?

A

Apical migration of the JE
Loss of CT attachment
Loss of AB
Irreversible tissue damage

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19
Q

Describe periodontal destruction

A

Intermittent with extended periods of disease inactivity followed by short bursts of destructive activity
Progresses at different rates throughout the mouth and at a few specific sites at a time

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20
Q

Clinical color of periodontitis

A

Bluish or purplish red edematous (spongy) tissue

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21
Q

Clinical consistency of tissue with periodontitis

A

Pinkish leathery or firm, nodular tissue

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22
Q

Clinical state of gingival margin in periodontitis

A

Loses thin edge, swollen (rolled) or fibrotic
Position in highly variable due to underlying attachment loss (root may be exposed)

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23
Q

State of papilla in periodontitis

A

May not fill embrasure

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24
Q

Bleeding in presence of periodontitis

A

Often bleeding on probing
Variable pus or spontaneous bleeding

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25
Depths of pockets with periodontitis
>4mm due to apical migration of JE
26
Location of JE in periodontitis
Apical to normal on the root Most coronal portion of JE detaches from the tooth surface
27
What happens to gingival connective tissue with periodontitis?
Collagen destruction, supragingival fiber destruction, PDL fiber destruction However, transseptal fibers continually regenerate and are intact across the crest of bone (separates inflammation from bone)
28
Microscopic features of periodontitis
Permanent destruction of alveolar bone and PDL fibers Cementum exposed to bacterial biofilm Pulp may be inflamed, edematous, necrotic or show signs of resorbed dentin
29
What is inflammation?
The body's response to injury or invasion by disease-producing microorganisms
30
What is responsible for the destruction that occurs in periodontitis?
Bacterial induced inflammation Pattern of bone loss depends on pathway of inflammation
31
Where is the AB located in a healthy mouth?
2mm apical to the CEJ- space is required for soft tissue
32
Where is the AB located in gingivitis?
2mm apical to the CEJ- JE is in same position as in a healthy mouth as bone loss has not yet occurred
33
Where is the AB located in periodontitis?
More than 2mm apical to the CEJ Progressive bone loss can lead to tooth loss
34
What is the most common pattern of bone loss?
Horizontal- Fairly even reduction in bone height
35
Describe vertical bone loss
Uneven reduction of bone height Progression more rapid next to root surface Creates trench-like defects
36
What is the pathway of inflammation in horizontal bone loss?
CT-->AB-->PDL Occurs in gingival CT tissue first Then into the AB Then into the PDL space Path of least resistance
37
What is the pathway of inflammation in vertical bone loss?
CT-->PDL-->AB Gingival CT tissue Then to the PDL Then to the AB Occurs when crest fibers are too weak to barrier
38
How are infrabony defects classified?
By the number of bony walls Root of tooth not counted as a wall Craters occur at the crest of the bone
39
How would you classify this infrabony defect?
3 wall defect
40
How would you classify this infrabony defect?
1 Wall defect
41
What type of infrabony defect is seen here?
Interproximal osseous crater
42
How would you classify this infrabony defect?
2 wall defect
43
Where do furcation involvements occur?
On multi-rooted teeth when bone loss invades the area between the roots
44
How are furcations graded?
By their extent: early invasion of the space between the roots to a through and through
45
How would you classify the defect on #21D?
2 Wall defect
46
What type of infrabony defect is shown here?
Circumferential
47
What is a gingival pocket?
Deepening of the gingival sulcus resulting from inflammation
48
What happens to the JE in the gingival pocket?
No apical migration of JE Coronal potion of JE detaches from tooth, increasing probe depths Swelling may also occur and increase probe depth "Pseudopockets"--> no destruction to PDL
49
What is a periodontal pocket?
Pathological deepening of the gingival sulcus as a result of: apical migration of JE, destruction of PDL fibers and AB
50
What are the two types of periodontal pockets?
Suprabony Infrabony
51
Describe a suprabony periodontal pocket?
Occurs with horizontal bone loss JE is located coronal to the crest of the AB Supra= above
52
Describe an infrabony periodontal pocket?
Occurs with vertical bone loss JE is apical to the crest of the AB Base of pocket is within the bony defect adjacent to the root surface Infra= within
53
What is a disease site?
Area of tissue destruction- may involve one to all tooth surfaces
54
What are the two types of disease sites? Which is more likely to occur?
Active and inactive More likely to be inactive as the body is always trying to heal itself
55
What is attachment loss?
Destruction of tooth supporting fibers and AB Pockets may exhibit irregular patterns of destruction
56
Characteristic of active disease sites
Shows continued migration of JE toward apex
57
Characteristics of inactive disease sites
Site is stable with attachment level of JE at the same level over a period of time
58
What is a periodontal pocket an indicator of?
Past disease activity Presence of a pocket does not indicate current disease activity
59
What does disease progression mean in the context of periodontal disease?
Means the disease gets worse
60
Describe the pattern of disease progression
Varies between people Varies from one site to another in the same person Varies by type of periodontal disease
61
What is the current theory of disease progression?
Destruction occurs in short bursts with long periods of no activity Occurs at diff rates and times in diff sites Diff forms of disease occur at diff rates and patterns Host response varies
62
What is the intermittent theory of disease progression?
In the majority of cases, untreated gingivitis does not progress to periodontitis
63
What is epidemiology?
The study of health and disease within the total population rather than the individual
64
What are the three research objectives in epidemiology?
Determine the amt and distribution of disease in a total population and in subgroups Investigate causes of disease Use the knowledge to prevent and control a disease
65
What are the risk factors for disease?
Heredity, genetics Gender Physical environment Systemic factors Socioeconomic factors Socioeconomic status Personal behavior/lifestyle
66
Why do epidemiologists study periodontal disease?
To determine its occurrence in a population, and to identify risk factors for periodontal disease Provides current information about success in prevention and treatment
67
What is prevalence?
Total number of old and new cases of a disease identified in a specific population at a given point in time Ex. How many people in total are living with cancer
68
What is incidence?
Number of NEW cases in a specific population occurring during a specific period of time Ex. How many new cases of cancer have been diagnosed in the last year
69
What do we use to measure and assess periodontal disease?
Color, edema, loss of PDL, AB loss, furcation, BOP, probing depths Can be difficult to measure given the involvement of both hard and soft tissue and when paired with gingivitis can be more difficult to measure
70
Which is most prevalent, mild, moderate or sever periodontitis?
Moderate- 30%

247 Periodontics (19 decks)

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