Exam 2 part 2

Question 1

What are the bacteria involved in both NUG and NUP

Answer 1

P. intermedia, Spirochetes, Fusiformbacteria

Question 2

What kind of tissue is involved in NUG

Answer 2

Involves both stratified squamous epithelium & underlying CT

Question 3

Define NUG

Answer 3

Acute necrotizing inflammation of the gingival margin

Question 4

Is NUG contagious?

Answer 4

No

Question 5

What is another name for NUG and why was that made popular?

Answer 5

Trench mouth

1914 WWI, WWII

Question 6

Age groups that NUG occurs in

Answer 6

Occurs in all ages but mainly 20-30

Question 7

Visually what do you see in NUG

Answer 7

Forms Pseudomembrane

• Replaces destroyed epithelium
• Meshwork of fibrin, necrotic epithelial cells, PMN’s and various microorganisms

Question 8

Clinical features of NUG

Answer 8

1. Rapid onset
2. Severe pain
3. Gingival bleeding; may or may not be spontaneous
4. Interdental Crater, punched put papilla, PSEUDOMEMBRANE, fetid (sulfur) breath

Question 9

Etiology - Host Response of NUG

Answer 9

Systemic predisposing factors
Immunosuppression - AIDS
Stress
Smoking
Diet

Question 10

Etiology - Oral Hygiene of NUG

Answer 10

Pre-existing gingivitis

Opportunistic microorganisms

Question 11

Main Etiology of NUG

Answer 11

Microorganisms
  - P. intermedia, Spirochetes, Fusiformbacteria
Other Factors
  - Host resistance + smoking
  - Oral hygiene
  - Local irritants

Question 12

In what zone is NUG of the Listgarten’s 4 zones

Answer 12

Zone 4: Zone of spirochetal infiltration

- Well-preserved tissue infiltrated with spirochetes

Question 13

Describe the pseudomembrane feature of NUG

Answer 13

Replaces destroyed epithelium

Meshwork of fibrin, necrotic epithelial cells, PMN’s, and various microorganisms

Question 14

Treatment of NUG

Answer 14

• First visit - debridement, OHI
  
  • Evaluate systemic factors
• Recall visit - 1-2 weeks, eval. OH, further tx
• Final re-eval - 4-6 wks, consider surgery
• If fever present give antibiotics first: Amoxicillin and Metronidazole

Question 15

Extraoral and systemic signs and symptoms of NUG

Answer 15

• Slight elevation in temperature
• Local lymphadenopathy
• Patients usually ambulatory with no systemic complications

Question 16

What are the Listgarden’s 4 zones for NUG

Answer 16

Zone 1: Bacterial zone
- Superficial, contains bacteria
Zone 2: Neutrophil-rich Zone
- Numerous leukocytes, mostly PMN’s, bacteria, spirochetes
Zone 3: Necrotic Zone
- Dead cells, fibers, spirochetes, and other bacteria
Zone 4: Zone of spirochetal infiltration
- Well-preserved tissue infiltrated with spirochetes

Question 17

What is NUP

Answer 17

Essentially that same as NUG, however there is bone loss involved in NUP

Question 18

In what people can Primary herpes occur

Answer 18

In kids & Immunocompromised adults

- All races equally, both sexes

Question 19

In what tissue does primary herpes occur?

Answer 19

Bound & Unbound tissue

Question 20

Describe the 4 phases of clinical features of Herpes

Answer 20

Prodromal phase
Active phase
Latency
Reactivation

Question 21

Describe the clinical features of the prodromal phase of herpes

Answer 21

Fever
Irritability
Headache
Gingival Inflammation

Question 22

Describe the clinical features of the active phase of herpes

Answer 22

Vesicles rupture, yellow ulcers, red halo
Viral shedding (Ave. 12 days)
Mobile and Attached tissue
Heal in 7-14 days with no scarring

Question 23

Describe the clinical features of the latency phase of herpes

Answer 23

Virus resides in ganglia
Non-replicating state
Latency associated transcripts (LAT)

Question 24

Describe the clinical features of the reactivation of herpes

Answer 24

Recurrent herpetic stomatitis
Spontaneous or stimuli related
Virus migrates
Herpes labialis (extra-oral)
Bound down tissue - Attached gingiva (Intra-oral)
Virus overwhelms local immune response

Question 25

What 4 things may be involved in virus activation

Answer 25

Sunlight Trauma Fever Stress

Question 26

Describe herpetic whitlow

Answer 26

Recurrent infection Fingers and hands Latent site - dorsal root ganglion Debilitating

Question 27

T or F, Primary Herpetic Gingivostomatitis is contagious

Answer 27

True

Question 28

Diagnosis of herpes includes

Answer 28

History and clinical findings Tzanck smear Serum antibody titer ELISA or PCR

Question 29

T or F, If young adults contract primary herpes it is less severe than if they were children

Answer 29

False, More severe

Question 30

Treatment of primary herpes

Answer 30

``` Supportive treatment - Bed rest, bland mouthwashes (alcohol free) - Force fluids, Antipyretics - Lidocaine gel, CHX Systemic medication - Valcyclovir, Vibaradine, Acyclovir ```

Question 31

Describe the periodontium in children or deciduous dentition

Answer 31

Pale pink Firm Either smooth or stippled (stippled in 35% of children between ages of 5-13) Interdental gingiva is broad facio-lingually, and narrow mesiodistally

Question 32

Mean gingival sulcus depth in deciduous dentition

Answer 32

1mm

Question 33

Is PDL of deciduous teeth more narrow or wider than permanent teeth

Answer 33

Wider than that of permanent teeth

Question 34

Describe the trabeculae in alveolar bone of deciduous dentition

Answer 34

Trabeculae in alveolar bone are fewer but thicker than in the adult

Question 35

Crests of interdental bony septa of deciduous dentition compared to permanent dentition

Answer 35

Deciduous dentition are flat

Question 36

Chronic Marginal Gingivitis (deciduous dentition)

Answer 36

``` Most prevalent disease of childhood Looks like chronic gingivitis BOP and pocketing is less common Plaque etiology (less than in adults) - Calculus (4-6, 9%; 7-9, 18%; 10-15, 33-43%) ```

Question 37

Malpositioned teeth in deciduous dentition:

Answer 37

``` Accumulate more plaque Increased gingivitis - excessive overbite - excessive overjet - nasal obstruction - mouthbreathing ```

Question 38

Diseases altering oral mucosa including the gingiva in deciduous dentition

Answer 38

Varicella Rubeola (measles) Scarlatina (scarlet fever) Diphtheria

Question 39

Describe the pre-eruption bulge

Answer 39

Before crown appears in oral cavity, the gingiva presents a bulge that is firm, slightly blanched and conforms to the shape of the underlying crown

Question 40

T or F, during mixed dentition, it is normal for the marginal gingiva around the permanent teeth to be very prominent, especially in the maxillary anterior region

Answer 40

True

Question 41

Suprabony pocket vs Intra/Infrabony pocket

Answer 41

Suprabony - Base of pocket is coronal to level of underlying bone - Horizontal bone loss - Transseptal CT fibers are horizontal Infra/Intrabony - Base of pocket is apical to the level of the adjacent bone - Vertical bone loss - Transseptal CT fibers run length of defect vertically (obliquely)

Question 42

Why do we do pocket reduction therapy?

Answer 42

- Rationale for pocket reduction is based on the need to eliminate areas of plaque accumulation - Pockets create area where daily plaque removal becomes impossible

Question 43

Define Periodontal abscess

Answer 43

Acute localized accumulation of viable and nonviable PMNs within the pocket wall

Question 44

Define Gingival Abscess

Answer 44

Acute localized purulent infection that involves the marginal gingiva and interdental papilla due to bacteria carried into gingival tissue

Question 45

Etiology or causes of Periodontal abscess

Answer 45

Extension from infected pocket: G- MO Incomplete removal of calculus Root fracture Multiple abscesses

Question 46

Clinical features of periodontal abscess

Answer 46

Localized purulent inflammation in periodontal tissues Dull, constant pain, recent origin Edematous, erythematous, smooth, shiny surface Mobility Rapid pocket formation Discharge of pus with probe or pressure

Question 47

Fenestrations vs Dehiscence

Answer 47

Fenestrations: Window in bone on facial or lingual Dehiscence: Loss of alveolar bone on the facial (rarely lingual) aspect of a toothat that leaves a characteristic oval, root-exposed defect from the cementoenamel junction apically

Question 48

Normal bone morphology

Answer 48

1. Crest follows the CEJ and is 1-2 mm apical 2. Interproximal higher (more coronal) than facial and lingual 3. Scalloped 4. Usually thicker facial alveolar bone than lingual alveolar bone