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Periodontology > Intro to perio > Flashcards

Intro to perio Flashcards

1
Q

What year are the new periodontal classifications from?

A

2017

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2
Q

What are the two states in healthy periodontium?

A

Intact periodontium

Reduced periodontium

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3
Q

What are the types of reduced periodontium?

A
  • Reduced periodontium in a non-periodontitis patient

- Reduced periodontium in a successfully treated stable periodontitis patient

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4
Q

What is a reduced periodontium in a non-periodontitis patient?

A
  • Clinical signs of periodontal health on a periodontium with pre-existing loss of connective tissue and/or loss of bone due to non-periodontitis (e.g. traumatic toothbrushing or crown lengthening)
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5
Q

What is reduced periodontium in a successfully treated periodontitis patient?

A
  • Clinical signs of periodontal health on a periodontium with pre-existing loss of connective tissue and alveolar bone due to periodontitis, but had been successfully treated and is currently stable
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6
Q

Define periodontal health

A
  • State free from inflammatory periodontal disease that allows an individual to function normally and avoid consequences due to current or past disease.
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7
Q

What are the clinical features of gingival health?

A

Absence of BOP (<10% of sites), erythema, edema and patient symptoms

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8
Q

What are the clinical INDICIES for gingivitis

A

> 10% bleeding sites

Probing depths <3mm

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9
Q

What are the two main categories of gingivitis

A
  • Dental plaque biofilm induced gingivitis

- Non-dental plaque biofilm induced gingivitis

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10
Q

What is plaque biofilm induced gingivitis

A

An inflammatory lesion resulting from interactions between dental plaque biofilm and the hosts immune-inflammatory response

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11
Q

What is the treatment for plaque biofilm induced gingivitis

A

Removal of plaque

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12
Q

What are the local plaque retentive factors resulting in gingivitis?

A
  • Overhangs
  • Subgingival margins
  • Surface irregularities
  • Caries
  • Intraoral appliance (ortho or dentures/clasps)
  • Crowding
  • Erupting teeth
  • Calculus
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13
Q

How do systemic factors increase the risk of periodontal disease?

A

They alter the immune response, resulting in an exaggerated inflammatory response to plaque

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14
Q

List the main systemic risk factors for periodontal disease?

A
  • Smoking
  • Diabetes
  • Drugs
  • Vitamin C deficiency
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15
Q

What are the clinical signs of inflammation?

A
  • Erythema, edema, pain, heat and loss of function
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16
Q

How do the clinical signs of inflammation manifest in gingivitis?

A
  • Swelling (loss of knife edge appearance)
  • BOP
  • Redness
  • Discomfort (brushing or probing)
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17
Q

List symptoms of gingivitis

A
  • Bleeding gums
  • Metallic taste
  • Soreness
  • Halitosis
  • Difficulty eating
  • Aesthetics
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18
Q

What are non-dental plaque biofilm induced gingival conditions?

A

Gingival abnormalities that are not caused by plaque and do not resolve following plaque removal, but likely a gingival manifestation of a systemic condition

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19
Q

List some causes of non-dental plaque biofilm induced gingivitis

A
  • Genetics - hereditary gingival fibromatosis
  • Infections - gonorrhea, tuberculosis, herpes
  • Inflammatory - contact allaery, plasma cell gingivitis
  • Pemphigus vulgaris, pemphigoid, LP, LE, crohns
  • Vitamin C deficiency
  • Neoplasms
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20
Q

What is the main marker for progression from gingivitis to periodontitis?

A
  • Pathological apical migration of the junctional epithelium (indicates destruction of alveolar bone)
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21
Q

What are the signs of periodontitis?

A
  • Continued inflammation (gingivitis signs BUT pockets >4mm are true and irreversible)
  • CAL
  • Migration of JE
  • Destruction of bone and PDL
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22
Q

Staging criteria for periodontitis

A

Stage I = <15% or 1-2mm CAL
Stage II - 16-33% or 3-4mm CAL
Stage III - 34-66% or middle/apical third of root
Stage IV - >66% or middle/apical third of root

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23
Q

What does the staging and grading tell us about periodontits?

A

Stage - the severity

Grade - rate of progression

24
Q

How to calculate the grade of periodontitis

A

Bone loss / age

25
What are the grades for periodontitis
Grade A - <0.5% bone loss/age or no evidence of bone loss over 5 years Grade B - 0.5-1% bone loss/age or <2mm over 5 years Grade C - >1% bone loss/age or >2mm over 5 years
26
What is the criteria for the extent and distribution of periodontitis
Localised - <30% Generalise - >30% Molar-incisor pattern
27
List the radiographic features of healthy bone levels
- At the CEJ (can be higher or lower with physiological bone loss) - Good quality bone and stable lamina dura - Crestal bone 2-3mm from CEJ - Bone in the furcations
28
What is periodontal stability?
Successful treatment of local/systemic risk factors resulting in minimal bop (<10%), stable probing depths and lack of further periodontal destruction
29
What is the main indicator for periodontal stability?
Absence of inflammation/BOP
30
What makes up the periodontium?
``` Gingiva (free and attached) Alveolar mucosa Cementum Periodontal ligament Alveolar bone ```
31
What is the junctional epithelium?
Epithelial attachment between the connective tissue and tooth surface
32
Where is the junctional epithelium located?
Below the gingival sulcus (sucular epitheium)
33
How is JE attached to the enamel?
Via a basal lamina and intercellular hemidesmosome
34
What is the turnover of the JE?
4-6 days - this is rapid in comparison to the oral epithelium (6-12 days)
35
Difference between oral epithelium and JE/SE?
Oral epithelium is keratinised (resist mechanical forces) | JE and SE are non-keratinised
36
What is the periodontal ligament?
A group of specialised connective tissue fibres, which connects the tooth to the alveolar bone
37
What are the components of the pdl
``` Principal fibres Loose connective tissue Blasts and blast cells Oxytalan fibres Cell rests of Malassez ```
38
What are the three categories of principal fibres?
``` Dentoalveolar (around roots) Gingival fibres (around cervical portion of the tooth) ```
39
List the gingival principal fibres
Transseptal Attached gingival Free gingival Circular
40
What are the roles of the gingival fibres?
Transseptal - resist tooth separation mesial and distally | The rest - resist gingival displacement
41
List the dentoalveolar principal fibres
``` Apical Oblique Horizontal Alveolar crest Interradicular ```
42
What are the two components of the alveolar bone?
- Alveolar process | - Alveolar bone proper
43
What is the role of the alveolar process
Provide structural support to the teeth
44
What is the role of the alveolar bone proper
Provide an attachment site for the PDL and the tooth
45
Where is the alveolar bone proper?
In the portion of bone lining the tooth socket
46
What are the histological lesions of periodontal disease?
Initial lesion Early lesion Established lesion Advanced lesion
47
What occurs in the initial lesion?
- Vasodilation results in neutrophil migration, IGG, complement and fibrin - Increase in permeability (increased GCF) - Localised to gingival sulcus
48
What occurs in the early lesion?
- Localised epithelial proliferation of JE and SE - Further vascular changes occur with increased GCF - Neutrophils dominate but there is local accumulation of lymphocytes (T cells)
49
What are the signs of epithelial proliferation in the early lesion?
- Rete peg hyperplasia | - Microulceration of the sucular epithelium (why it bleeds on probing)
50
What occurs in the established lesion?
- Further proliferation of JE and SE with some loss of collagen (no attachment loss) - T cells dominate and plasma cells are found (mainly IgG and IgA) - Maximum GCF - Neutrophils persist
51
What occurs in the advanced lesion?
- Pocket formation, LOA, collagen and bone loss - IgG, IgA and IgM present - Dense infiltrate of lymphocytes, plasma cells and macrophages - Bystander damage - Neutrophils persist
52
What is bystander damae?
Breakdown of the epithelial barrier (pocket lining) allowing antigens direct access to periodontal tissues to activate immune cells
53
What is the key point of chronic inflammation?
There is persistent inflammation with attempts of repair
54
What are the roles of the B cells in periodontitis?
- Differentiate into plasma cells to form antibodies (neutralise, aggregate and opsonisation)
55
What are the roles of T cells in periodontitis?
- CD4 secrete cytokines to activate immune cells
56
What are the main cytokines?
- IL1 (pro-inflammatory)

Periodontology (6 decks)

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