Gingival and periodontal disease

Question 1

What is periodontology

Answer 1

The study of the periodontal tissues in health and disease; including the causes, prevention and treatment of diseases of the periodontal tissues.

Question 2

What is the periodontium

Answer 2

Gingivae
Periodontal ligament
Root cementum
Alveolar bone

Question 3

What are the two subsections of alveolar bone

Answer 3

Alveolar bone proper
Alveolar process

Question 4

What is the name of the thin plate of bone immediately adjacent to the periodontal ligament

Answer 4

Alveolar bone proper

Question 5

What does CEJ stand for

Answer 5

Cemnetoenamel junction

Question 6

What determines periodontal health

Answer 6

The outcome of the bacteria of the dental plaque and the host immune system

Question 7

What are periodontal diseases

Answer 7

A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque

Question 8

What are two periodontal diseases

Answer 8

Gingivitis
Periodontitis

Question 9

Does Gingivitis always progress to periodontitis

Answer 9

No

Question 10

What is inflammation

Answer 10

A Biological response to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process.

Question 11

What are cardinal signs of inflammation

Answer 11

Pain - dolor
Heat - calor
Redness - rubor
Swelling - tumor
Loss of function - functio laesa

Question 12

What is the resolution of inflammation in periodontitis

Answer 12

There is none

Question 13

In relation to internal vessels and cells what occurs to cause inflammation

Answer 13

-Dilatation of blood vessels​
-Increased permeability of vessel walls​
-Inflammatory exudate​
-Emigration of white blood cells from​ blood vessels into the connective tissue​

Question 14

Periodontal disease is a multifactorial condition depending on general health conditions but what is the main factor at play

Answer 14

The function of the host immune system and its interplay with the bacteria of the plaque

Question 15

How can general health lead to periodontal disease

Answer 15

Stress
Fatigue
Smoking
Diet
Medications
Hygienic habits

Question 16

What are some local risk factors of developing periodontal disease

Answer 16

Acquired: plaque, calculus, overhanging and poorly contoured restorations ​

Anatomical: malpositioned teeth, root groves, concavities and furcations, enamel pearls​

Question 17

What are the systemic risk factors for periodontal disease

Answer 17

Non-modifiable: aging, genetic factors​

Modifiable: smoking, poorly controlled diabetes, stress, medications, hormonal changes, poor nutrition, socioeconomic status ​

Question 18

What were the multiple theories behind periodontal disease over the years

Answer 18

Non-specific plaque
Specific plaque
Ecological plaque
Polymicrobial dysbiosis
(Keystone-Pathogen hypothesis)

Question 19

Who developed the non-specific plaque theory

Answer 19

1884 Black
1899 Miller

Question 20

What does the specific plaque theory conclude

Answer 20

Few species of the total microflora are actively involved in disease

Question 21

What is the ecological plaque theory

Answer 21

Combines key concepts of the earlier two hypotheses adding that changes in environment like pH, redox potentially lead to favourable growth certain species of bacteria​

1994 Marsh​
“everything is everywhere but environment selects”​

Composition of the dental plaque depends on environment​

Question 22

What is a biofilm

Answer 22

An aggregate of microorganisms in which cells adhere to each other on a surface. These adherent cells are embedded within a self-produced matrix of extracellular polymeric substance (EPS) – DNA, proteins, polysaccharide.
Resistance to antibiotics, antibacterial agents, hidden from immune system of the host.

Question 23

Where may biofilms form

Answer 23

Biofilms may form on living or non-living surfaces and can be prevalent in natural, industrial and hospital settings: Biofilms can form inside water and sewage pipes​

Question 24

Is dental plaque a type of biofilm

Answer 24

Yes

Question 25

What are the steps to formation of biofilm

Answer 25

Pellicle Association adhesion Growth Mature

Question 26

What occurs during the growth stage of biofilm

Answer 26

Microcolonies - production of polysaccharide matrix

Question 27

When do microcolonies transition into metaboli8c complexes in biofilm formation

Answer 27

Maturation stage

Question 28

What is association adhesion

Answer 28

Trailblazing bacteria 'streptococcus, actinomyces' posses adhesion molecules

Question 29

What is keystone bacteria theory

Answer 29

Certain low-abundance microbial pathogens can cause inflammatory disease by increasing the quantity of the normal microbiota and by changing its composition and by interfering with the host immune system ​

Question 30

What bacterium is the keystone pathogen hypothesis based on

Answer 30

'red complex' Porphyromonas gingivalis

Question 31

What disrupts the homeostasis between the bacteria of the biofilm and the immune system

Answer 31

1) Genetic conditions associated with the impairment of immune system:​ Papillon-Lefevre syndrome, Chediak-Higashi syndrome, LAS syndrome, Down’s syndrome, chronic granulomatous disease​ 2) Diseases leading to impairment of immune system: Leukaemia, agranulocytosis, neutropenia, HIV infection

Question 32

What produces calculus

Answer 32

Calcification of dental plaque

Question 33

Signs of gingivitis

Answer 33

Erythema (redness) Swelling Bleeding on gentle probing

Question 34

When might pain occur with periodontitis

Answer 34

Pain occurs very rarely mostly in necrotising ulcerative periodontal disease​

Question 35

What are clinical examination signs of periodontitis

Answer 35

Bleeding on gentle probing​ Erythema, fibrosis, loss of Knife edge Margin​ Halitosis​ Swelling – falls pocket formation​ Bone loss​ Increase clinical probing depths - True pocket formation​ Recession​ Mobility​ Purulence​

Question 36

What indicates a true pocket

Answer 36

Loss of attachment

Question 37

What could produce a false pocket

Answer 37

Gingival swelling

Question 38

Why cant antibiotics be prescribed to resolve periodontitis

Answer 38

Biofilm protects the bacteria from antibiotic and mouthwash and chemicals

Question 39

What must be done before prescribing antibiotics or chemical agents to remove bacteria in biofilm

Answer 39

Disrupt the biofilm first before use of substance

Question 40

What is the difference between biofilm and dental plaque

Answer 40

Dental plaque is a type of biofilm