Final Exam Flashcards
1
Q
What is the basis for patient care?
A
- ADPIED
2
Q
What do we do for documentation?
A
Reference
History
Educational
Medical and legal
3
Q
What do take for medical history ?
A
- Ensures safety of PT
- Aids Clinician
- Verified with interview
4
Q
What do we take for Dental History ?
A
Chief Complaints
All dental past and present history
ORal practices
Habits
5
Q
Why do we do EO/IO?
A
To know the presence of path
6
Q
What are the gingival caracteristics?
A
Color
Contour
Consistency
Texture
7
Q
What does OH assess?
A
Plaque
Calculus
Tooth Topograghy
Stain
8
Q
What are the different types of stains?
A
Brown: Tobacco and Stainous Flouride
Green: Enamel cuticle, flurorescent bacteria
Orange : Chromogenic bacteria
Black: Ferric Sulfide (With Good Oral Hygiene)
9
Q
What is Probing depth ?
A
- Support treatment decisons
- Cannot detect disease activity or predict destruction
10
Q
What are the furcation involvement grades?
A
Grade I- Interradicular bone intact
Grade II- Interradicular bone loss
Grade III- Complete loss no communication to otherside
Grade IV- Loss attachment and gingival recession
FITS
11
Q
What are the mobilty grade?
A
Grade 0; physiological
1: Slight BL
2: Moderate BL
3: Severe BL, MD and depression
12
Q
What is Fremitus?
A
Vibrational movement- only maxillary teeth tested
13
Q
What is the G.V blacks classifications?
A
- Class 1: Pits and fissures
- Class 2: Proximal areas Premolars and molars
- Class 3: Proximal incisors and Canine ( No edge)
- Class 4: Proximal incisors and Canine ( with edge)
- Class 5: Gingival third cavities
- Class 6: Incisal and cusp tip
14
Q
What type of epithelium is the gingiva?
A
Stratified squamous epithelium
15
Q
What is the gingival epithelium?
A
Protection of underlying structures
16
Q
What are the epithelial layers of the oral cavity?
A
- Corneum
- Granulosum
- Spinosum
- Basal
- Lamina propria
17
Q
What are the major cell types within the mouth?
A
- Kerotinocytes- Responsible for color
- Melanocytes- Dendritic cell and synthesizes melanin
- Langerhans cells- Spinosum, phagocytes: early defense
- Merkel cell- touch cell
18
Q
What are the sulcular epithelium?
A
- Lines the gingival sulcus
- Acts as a semipermeable membrane
19
Q
What is the Junctional epithelium?
A
- As two layers: Basale and spinosum
- Attached by epithelial attachment
- Basement lamina and hemidesmosomes from enamels
20
Q
What are the turn over time ?
A
Palate , tongue, cheek: 5-6 days
Gingiva: 10-12 days
JE: 4.7 days
21
Q
What does the disease needs to developement ?
A
Causative Agent
Environment
Host
22
Q
Bacterial plaque contributes to periodontal breakdown by:
A
Direct injury to tissues
Indirect activation of host immune and inflammatory systems
23
Q
What are the host responses?
A
- Protective: defence mechanism
- Destructive: Tissue destruction
24
Q
What are the stages of inflammation ?
A
- Immediate
- Acute
- Chronic
- All is controlled by granulocytes and agranulocytes
25
What is acute inflammation?
Calls other cells
* neutrophils
* macrophages
* lymphocytes
| neutro and macro eliminates = phagocytosis
26
What is Chronic Inflammation ?
Immune System activated
27
What are the leukocytes?
Granulocytes:
neutrophils= 1st to arrive and PMNS
eosinophils= Allergic respinse
basophils= increase vascular permeability
Agranulocytes: Lymphocytes- blastlike cells multiply as immunologic needs arises.
Monocytes: 2nd cell to help in inflam response ( For Chronic inflammation)
28
What does neutrophils produce?
Prostaglandins and cytokines
29
Macrophages produces?
* Destructive enzymes
30
Mast cells produces?
Inflammatory mediator and anaphylaxis
31
What does the complement system do?
Destroys pathogens (lysis)
32
What is the function of leukocytes?
* Phagocytic, immunologic and of functions related to inflammatory process
* Detection and monitoring of disease states
33
T- Lymphocytes comes from?
Derived from stem cells and matures in thymus
34
What are the inflammaortoy biochemical mediators?
Cytokines
Prostaglandins
Matrix Metalloproteinases
35
What interleukin ( Cytokines) are important to periodontitits?
* Interleukin 1,6,8 and TNF-a (Tissue neucrosis factor)
36
What are other protective response?
Gingival sulcular fluid: present during inflammation
Saliva: Lubrication, physical protectionm cleaning, buffering, remineralizing
37
What is material alba vs Oral biofilm?
Material alba- loosely adherent
mass of bacteria, viruses and yeasts.
Oral Biofilm- Attached to surfaces and one another
38
Describe bacteria microcolonies?
* Not evenly distrubuted
* Forms mushroom shaped
* Attached to tooth with narrow base
39
What is the glycocalyx (slime layer)?
Glucose polymer glucan (made by bacteria)
Protective barrier- adherence and aggregation
40
what is the fluid channels?
Fluid channels that penetrates slime layer and provides nutrients and oxygen to bacteria. This helps with movement
41
What is dental biofilm?
* Adherenes tenaciously to tooth surfaces and restorations and others
42
What is symbiosis and dysbiosis?
Sym: Normal flora
Dysbiosis: imbalance
43
What is subgingival biofilm?
It is resistant to everything except mechanical removal.
44
What is the pattern of development?
* Attachement
* inital colonization (2 days)
* Secondary colonization
* Extracelluar slime layer
* Formation
45
What is subgingival plaque?
* supragingival plaque influences it
* anaerobic
* Motile
* Gram-
* Causes direct injury
* HAs 3 zones
46
What are the 3 zones of subgingival plaque?
* Tooth attachemnt- Less Varelent (Gram +)
* Epithelial (Densly pack)- More varelent ( Gram -)
* Unattached (Gram + -)
47
What are the two bacterial characteristics ?
Health- Gram pos, saccharolytic (needs sugar)
Disease- Gram Neg, Asaccharolytic (needs protein)
48
What are the two bacterias assoicated with health?
Streptococci and Actinomyces
49
What Red Complex bacteria is associated with periofontitis?
* Porphyromonas Gingivalis ( Destroys host cytokines and chemokines)
* Tannerella Forsythia- Chronic and recurrent periodontitits: S', aids in phagocytosis
* Treponema Denticola-Chronic periodontitis
50
Fusobacterium nucleatum is?
ASSOCIATED WITH EARLY STAGES OF GINGIVITIS
51
What bacteria can be transfered and associated with agrressive and refractory periodontitis?
Aggregatibacter actinomycetemocomitians
52
What bacteria initiates early tissue changes and severe to attachment loss?
Fusobacterium nucleatum
53
What is T. Denticola?
Makes lipopolysaccharides
54
Which group of bacteria directly invades the host tissue cells?
A.a
P. Gingivalis
T. Denticola
T. Forsythia
55
What two bacteria has easier penetration of sulcular epithelium?
A.a
P.Gingivalis
56
What is the 1989 system shortcomings?
* Overlap
* Abscences of gingival disease components
57
What is the 1999 classification?
Eliminate refractory periodontittis
Has NUG AND NUP
58
What is the 2017 Classifications?
Removed chronic and aggressive forms of periodontitits and incorporated staging and grading
59
What is dental calculus ?
* Irrritant
* biofilm retentive- rough and porous, irregular surface and ledges
* Reservoir for bacteria and toxins
60
What is supragingival calculus ?
* Does not interlock
* Forms on crowns, restorations prothesis exposed roots
* site specific
* 30 % minerlized by saliva
* 70-90 % inorganic components: Calcium phosphate
* 10-30% Organic: colonies, proteins, cells, WBC, lipids
* Changes through crystalline forms: new (Brushite), less than 6 months is whitokite and more than 6 months is hydroxypatite
*
61
What is the subgingival Calculus?
Mineral from gingival crevicular fluid
60& mineralized
No salivary proteins
62
What is the radiographic evaluation of subgingival calculus in percentage?
onky 45% if surfaces
63
What is Plyrophosphates?
* inhibits hydroxyaptitecrystal growth
* Do not elimate existing cal
64
What is fenestration?
Looks like a window. when the marginal bone is still intact
65
What is Dehescences?
Looks like a door, mo marginal bone
66
What is the cervical enamel projection?
Extension of enamel from CEJ to the entrance of furcation only on Bucal mandibular 2nd molars
67
What are determinats within gingival disease?
* Host
* Microbiological
* Environemntal
68
What are the periodontal health levels?
* pristine periodontal health
* Clinical periodontal health
* Periodontal disease stability
* Periodontal disease remission/ control
69
What is gingivitis manifestation?
* enlarged contours
* Red/Bluish tissue
* BOP
* Discomfort on probing
70
What is the Extent of inflammation?
* Localized
* Generalized
71
What is gingivitis biofilm induced ?
* Plaque at gingival margin
* Redness and tenderness
* swollen rolled margins
* Bleeding
* Reversiable with removal
72
What is reduced successfully treated perio?
* History of attachment loss which is not progressing
* controlled and redeveloped gingivitis
73
What can occur on the gingva during the 2nd and 3rd trimester of a pregnancy?
Pyogenic granoluma on the maxilla or papilla- maxillary most common
74
What are some dental biofilm induced systmic factors?
* Diabetes, Leukemia, Smoking and nutrition
75
What is leukemia?
Braod group of disorders characterized by overproduction of atypical wbc
76
What are some oral factors for dental biofilm induced?
* Subgingival restoration margins
* Oral dryness
77
What does the gingiva look like with drug influenced gingival enlargement?
* Gingival enlargement- from medications= no attachement loss.
* Exaggerated inflammatory response to plaque and a systemic medication
78
What are the most common medications associated with enlargement ?
Anticonvulsant Drugs
Calcium channel blocker
Cyclosporine
79
What are the mechanisms for action of a drug influenced gingival enlargement ?
* Individual susceptibitlity
* Immunological and genetic factos
* Fibroblast Sensitivity
80
Gingival diseases of non dental biofilm induced is?
* Not caused by bacterial plaque
* Do not disappear after plaque removal
* Presence of plaque could increase severity of inflammation
81
What is a genetic development disorder that affects the gingiva?
Hereditary Gingival fibromatosis
82
What are some gingival lesions caused by ?
STDS: Neisseria gonorrhea, treponema pallidum
Stretocci: pharyngitis
83
Vitamins C, A and B helps the oral cavity how?
Vitmain A- Healthy sulcular epithelium
Vitamin B- Mucosal tissue
Vitamin C- Absorbic acid
84
What is periodontal disease?
BActerial infection of the periodontium
85
What is a pseudopocket/ false pocket?
Deeping of sulcus and enlargement
86
What is the difference between actue and chronic gingivitis ?
Acute: Swelling
Chronic: Repair attempts- excess collagen= fibrosis
87
What is periodontitis?
* Bacterial infection of all parts of the periodontium
* Marked changes in the CT and JE
* Regeneration of transseptal fibers
88
What is the attachement apparatus?
PDL and Alveolar bone
89
What is the suprabony pocket/supracrestal ?
* pocket adjacent to alveolar bone
* horizontal bone loss
90
What is infrabony/ subcrestal?
* pocket adjacent to alveolar bone
* vertical bone loss
91
What is the pathway of inflammation for both horizontal and vertical bone loss?
Vertical: CT, PDL then bone
Horizontal: CT, Bone then PDL
92
Where are the different bone loss located?
Vertical (Wide crestal septum)- molars
Horizontal ( Narrow crestal septum)- MAndibular anteriors teeth
93
What is hemiseptum?
One wall
94
What is a interdental crater?
Facial and lingual wall remaining
95
What is necrotizing periodontal disease associated with?
Host immune system impairment
96
What are the 3 types of necrotizing periodontal disease?
* Necrotizing gingivtis (trench mouth)
* Necrotizing Periodontitis
* Necrotizing stomatitis
97
What is necrotizing gingivitis?
* Only to the gingval tissue
* Caused by fusiform bacillus and spirochetes
98
What is the clinical features of * Necrotizing gingivitis ?
* Pesudomembrane present
* lymphodenopathy
* fever
* Fetid odor
* metallic tatse
* rapid onset
99
What is the treatment for * Necrotizing gingivitis?
W/ fever and malaise- penicillin and metronidazole
100
What is necrotizing mucositis?
Limited to the mucosa and areas not continous with gingiva
101
What is the old name for necrotizing periodontitis?
* HIV periodontitis
* NUP
102
What is the clinical features for Necrotizing periodontitis?
* Rapid bone loss
* extremely painful
* halitosis
* gingival bleeding
* pseudo formation
* deep crater
* mimics odontogenic pain when roots become exposed
103
What is * Necrotizing stomatitis Clinical features?
* Bone exposed
* Untreat NuP spreads
* rapid progressive opportunistic infection
* Normal flora becomes pathogenic
104
What are the three componets of periodontitis?
Identifcation of pt as periodontitis case
Identification of specific form
Description of clinical presentation
105
What causes periodontitis?
Bacteria
106
What are the stages of periodontitis?
* I- inital
* II- moderate
* III- severe- potential for bone loss
* IV-severe- loss of dentition
107
What are the three elements of periodontitis?
Severity
Complexity
Extent and distribution
108
What are the parameters for periodontitis?
* Role of progression
* recognized risk factors
* risk affecting systemic health
109
What are symptoms of periodontitis?
* painless
* mimics odontogenic pain
* itching
* pain with food impaction
110
What is the complexity of vertical bone loss molar incisor?
* A. acinomycetemcomitis primary pathogen
* Red comolex induced: P.gingivalis and T. Forsythia
111
Describe horizontal bone loss
* Greater than 30 years old
* Slow rate
* No familial nature
* Local factors are abundant plaque and calculus
112
Describe vertical boneloss/ molar-incisor pattern
* Less than 30 year old
* Rapid
* Familial nature
* Local factors- relative absence
113
What is pericoronal abscess?
* Tissue around the crown of partially erupted tooth
* Has trimus
* 3rds most common
114
What is a gingival abscess?
* occurs in the free gingival margin
* acute localized pain
* coronal infection
* no sign of periodontitis
* caused by foreign object
115
What is periodontal abscess?
* Within tissue adjacent to periodontal pocket
* localized purulence in wall
* pre-exisitng periodontitis
* molar furcation area
* Incomplete CAL removal
116
What are differential diagnosis for periodontal abscess ?
* pericoronitis
* endo-perio abcess
* pyogenic granuloma
* osteomylitis
* odontogenic keratocyst
* tumors lesions
* diabetes more suscepitble
117
What is a periaprical abscess?
* (MGJ)
* results from infection and death of pulp by toxins
* nonvital
* untreated can lead to death
118
What is a endo-periolesions ?
* exist independently
* caused by infection from pulp tissue
* treatment: Both root canal and periodontal tissue
119
What is endodontic lesion ?
* Necrotic pulp
* Chronic inflammation
* border of lesion wider at apex
* Isolated periodontal problem
120
What is periodontal lesions?
* Mimics endodontic lesion
* wider at gingival margin
* vital pulp
* leads to endo infection
