what is a pregnancy tumor?
localized area of pyogenic granulation tissue
what bacteria is found in juveline perio?
A. Acintomhcetemcomitans
what is the etiologic agent that contributes to disease?
bacteria in the biofilm
the gingiva is reddened, may appear blue red, probing depths increase, pus forms and tissue swells…. capillaries proliferate, T and B lymphocytes occur in equal numbers, extensive collagen destruction occurs, junctional epithelium thickens, rete pegs extend into connective tissue, plasma cells infiltrate, edema increases
established stage 3 gingivitis
this is unresponsive to treatment, gen or localized, no single bacteria identified, several species, multiple attempts have been made to control, patients harbor organisms that are tenacious and resistant
Refractory perio
what is the defining element for classifying perio disease?
the level of attachment loss from the CEJ which indicates bone loss
this is a pathologically deepened sulcus
periodontal pocket
what does a periodontal pocket contain?
subgingival plaque biofilm
metabolic products from biofilm
copious amounts of gingival fluid
calculus
pus
lippopolysacharides
Where is supragingival calculus most abundant?
whartons duct and stensons duct
what two reasons can periodontal pocket depths increase?
coronal movement of the gingival margin through swelling or deepening of the sulcus (gingival enlargements)
perio pockets reflect a progressive deepening of the sulcus through tissue destruction and associated with bone loss
What are the steps of calculus attaching to the tooth structure?
attachment occurs in the relationship with the plaque pellicle forms bacterial plaque begins with gram + cocci calcification occurs 5 days plaque becomes filamentous increase tenacity of calculus attachment mineralization begins 4-8 hrs 50% mineralized in 2 days 90% mineralized in 12 days
what are other names for supragingival calculus?
supramarginal, extragingival, coronal calculus, or salivary calculus
what two microbes are associated with NUG?
disinformation bacillus
spirochete
The gingiva reddens, stippling appears, pus may appear and BOP.. T lymphocytes increase, cells congregate under sulcular epithelium, gingival fluid flow increases, collagen is defrayed, lengethed junctional ep. is distrusted and fibroblasts destroyed
early stage gingivitis stage 2
what are the two mechanisms for the initial of spread of infection?
bacteria and products may break down interface between epithelium and cause detachment of junctional epithelium
bacterial products interfere with normal growth and maintenance of the junctional and sulcular epithelium causing a break down
what happens with the sodium content of calculus as the pocket deepens?
increases
what is another name for subgingival calculus?
submarignal or serumal
how does subgingival calculus attach to the tooth structure?
pellicle attachment to cementum is mode of adherence
crystal grow deep into cemental irregularities
appear similar to cementum, termed calculocementus
not site specific
must use xray to detect
this is not a benign substance to the pathogenesis of gingival and periodontal disease, but plays a much smaller part in these disease than bacterial plaque biofilm
calculus
what causes the increase of neutrophils with the pathogensis of perio?
chemotaxis
this is the loss of crestal alveolar bone through the inflammatory response
periodontal bone loss
where does subgingival calculus form from?
from mineralized plaque biofilm
what are the trace elements found in supragingival calculus?
fluoride,zinc, and stronium
what does calculus provide a reservoir for?
bacteria and endotoxins
what is calculus divided into?
supragingival and subgingival
this is the extension of inflammation into the attachment apparatus and development of periodontal pockets
pathogenicity
what is associated with dark staining and increased calculus deposition?
chlorhexadine
what are some plaque retention factors?
dental restorations
crown contour and margins (over and undercontoured restorations, margins of cast restorations should be kept away from the gingival )
amalgam overhangs (most common, detected by xray and explorers)
removeable partial denture (collect supragingival calculus, shuld be removed from appliance)
what is present when perio disease is established?
both plasma and lymphocytes
how are periodontal pockets classified?
suprabony (occur above the crest of alveolar bone)
infrabony(extend apically from the crest of the alveolar bone)
these are calcium channel blockers and cause gingival enlargement
nifedipine and verapamil
what inhibits hydroxyapatite growth?
pyrophosphates
what do light calculus formers have?
high level of partoid phosphate
Inorganic mineral content makes up about 80% of supragingival calculus.. what are the minerals?
calcium phosphate 75.9%
calcium carbonate 3.1%
and traces of magnesium, sodium, and potassium
what is calculus formed by?
the deposition of calcium and phosphate salts present in bacterial plaque
Where is supragingival calculus found?
on the clinical crowns of the teeth, above the margin of the gingiva
what are characteristics that may be related to an increased rate of calculus formation?
elevated salivary PH
concentration of calcium in saliva
concentration of salivary bacterial protein and lipid
lower individual inhibitory factors
higher salivary urea and protein from the submandibular glands
higher total salivary lipid levels
what are the main crystal types and percentages found in calculus?
58% hydroxyapatite
21% octacalcium phosphate
21% magnesium whitlockite
9% brushite
there are no clinical signs of this, however.. blood vessels dilate, PMN’s migrate into connective tissue, plasma leaks into connective tissue, gingival fluid flows from pockets, T lymphocytes predominate
initial stage 1 gingivitis
what does periodontitis begin with?
apical migration of the junctional epithelium and loss of alveolar crest bone
this type of periodontitis is characterized by bone resorption that progresses slowly and predominantly in a horizontal direction… not clinically significant until about age 35 and more common in men
chronic periodontitis
this is the most common form of periodontal disease
chronic periodontitis
this is porous and rough and provides a lattice on which plaque can grow
supragingival calculus
what dentition does aggressive perio effect and what is it called?
can affect both primary and secondary dentition
prepubertal perio
what systemic diseases are related to perio?
IDDM
AIDS
down syndrome
papillon lefevre syndrome
what are the characteristics of subgingival caluclus?
forms on root surfaces, tenacious and black in color, deposited in rings or ledges
what are the channels of subgingival calculus filled with?
bacteria
this is similar to stage 3, destructive changes into bone and other tissues
advanced gingivitis stage 4
what is the organic matrix made up of mineral crystals?
plaque microbes
glucans
glycoproteins
lipids
this is used for immunosuppressant causes gingival englargment
cyclosporine
the most common gingival disease of fungal origin is from?
candida albicans
why do perio pockets deepen
due to break down of collagen fibers due to collagenase released bacteria
what is the most common medications for gingival disease?
antiseizure- phenytoin associated with gingival hyperplasia
these do NOT reduce calculus present, but aids in inhibiting formation of new calculus
anticalculus agents
what is the severity of chronic periodontitis directly related to?
the accumulation of plaque biofilm and calculus on surfaces of teeth
what are some conditions that can affect the periodontal health?
ortho appliances
malocclusion
unreplaced missing teeth
mouth breathing
anatomic anomalies
tobacco and alcohol use
what are the characteristics of rapidly progressive perio?
ages 20-30
most teeth involved
severe inflammation, plaque and calculus
rapid bone loss over weeks and months
genetic component
what are the stages of gingivitis?
Stage 1 (initial or subclincal stage) stage 2 (early stage) stage 3 (established) stage 4 (advanced stage)
what is the diagnosis of rapidly progressive perio?
less than 30 multiple areas of 5 mm attachment loss 6mm pockets P gingivalis and P intermedia E corrodens and Cr Rectus
what is the difference between supra and sub gingival calculus when it comes to where it is derived from?
the mineral is derived from crevicular fluid not saliva
associated with chronic nature and progression of peiodontal diseases
subgingival calculus
what is another common name for calculus?
tartar
this is characterized by extreme bone loss, usually seen around permanent molars and incisors…in patients younger than 20?
juvenile perio
what 2 mechanisms can cause pregnancy tumor
increase in pathogenic bacteria and increase in Prostoglandin E
this type of perio progresses rapidly with massive bone loss
aggressive perio
inflammation of the gingival tissues and is reversible.. occurs in periodontium with no attachment loss or with loss that is not progressing
gingivitis
how do you treat rapidly progressive perio?
plaque control
subgingival scaling
perio surgery
antibiotics such as tetracycline,metronidazole, amoxicillin/clauvanic acid, ciprooxacin
