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Periodontics I > Intro to periodontics > Flashcards

Intro to periodontics Flashcards

1
Q

List the macroscopic features of the gingiva: (4)

A
  1. marginal gingiva
  2. gingival sulcus
  3. attached gingiva
  4. interdental gingiva
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2
Q

List the microscopic features of the gingiva: (3)

A
  1. oral epithelium
  2. sulcular epithelium
  3. junctional epithelium
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3
Q

Unattached gingiva may also be called:

A

free gingiva

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4
Q

What is considered a normal measurement of free/unattached gingiva?

A

1-3 mm

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5
Q

In ___% of cases, the free gingiva is demarcated from the attached gingiva by a free gingival groove

A

50%

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6
Q

What is being measured? What can be seen?

A

free/unattached gingiva; free gingival groove

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7
Q

Attached gingiva is bound to:

A

underlying periosteum of alveolar bone

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8
Q

Describe the attached gingiva:

A

firm & resilient

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9
Q

The attached gingiva is bordered apically by:

A

the mucogingival junction (MGJ)

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10
Q

The attached gingiva varies in width being widest at the _____ and narrowest at the _____

A

widest: max anterior facial

narrowest: mandibular premolar (mandibular posterior)

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11
Q

Any changes in attached gingiva occurs at the:

A

coronal end

(because the apical end does not change)

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12
Q

The ____ is not attached to enamel or cementum:

A

gingival sulcus

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13
Q

The gingival sulcus is bounded apically by the _____ on the ____

A

free gingival groove; oral epithelium

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14
Q

Results from attachment loss of the gingival sulcus:

A

periodontal pocket

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15
Q

T/F: Whenever you see a periodontal pocket, you don’t know clinically if there is bone loss so you have to refer to radiographs

A

True

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16
Q

Equation for attached gingiva:

A

(keratinized gingiva) - (probing depth) = attached gingiva

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17
Q

When the teeth come together, you have facial papilla and lingual papilla; where this meets =

A

gingival col

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18
Q

What is the significance of the gingival col?

A

Its lined by unkeratinized epithelium making it susceptible to inflammation

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19
Q

The gingival col is only seen in:

A

posterior teeth

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20
Q

What makes the gingival col susceptible to disease?

A

lined by unkeratinized epithelium

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21
Q

Pyramidal or col shaped; occupies the embrasure:

A

interdental gingiva

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22
Q

Describe the make up & turnover of the oral epithelium:

A
  • keratinized stratified squamous epithelium
  • turnover of 30 days
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23
Q

Describe the make up & measurement of the sulcular epithelium:

A
  • ~1mm
  • unattached to enamel
  • non-keratinized stratified squamous epithelium
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24
Q

Describe the make up, measurement & turnover of the junctional epithelium:

A
  • ~1mm
  • attached by hemidesmosomes
  • non-keratinized stratified squamous epithelium
  • high rate of turnover (7-10 days)
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25
Q

What portion of epithelium is keratinized?

What portion of epithelium is non-keratinized?

A

oral epithelium

sulcular & junctional epithelium

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26
Q

What portion of epithelium is attached by hemidesmosomes?

A

junctional epithelium

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27
Q

What is shown by the blue line in the following image?

A

oral epithelium

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28
Q

What is the main goal of the oral epithelium?

A

protection

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29
Q

The oral epithelium is keratinized stratified squamous epithelium comprised of the following layers: (4)

A
  • stratum corneum
  • stratum granulosum
  • stratum spinosum
  • stratum basale
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30
Q

The rate of turnover within the oral epithelium is:

A

30 days

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31
Q

Keratinized gingiva is designed to:

A

withstand frictional forces

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32
Q

What are the main cells of the oral epithelium?

A

keratinocytes (which produce keratin)

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33
Q

Although the majority of cells in the oral epithelium are keratinocytes, there are also non-keratinocytes that comprise this including:

A
  • melanocytes
  • langerhans cells
  • merkel cells
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34
Q

What is the function of the melanocytes found within the oral epithelium?

A

production of melanin

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35
Q

What is the function of the Langerhans cells found within the oral epithelium?

A

these cells capture, uptake and process antigens

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36
Q

What is the function of the Merkel Cells found within the oral epithelium?

A

sense of touch & found within the stratum basal

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37
Q

What is the function of the keratinocytes (majority of cells) found within the oral epithelium?

A

production of keratin

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38
Q

What is lined by green in the following image?

A

Sulcular epithelium

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39
Q

What causes BOP?

A

microscopic ulceration of the sulcular epithelium

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40
Q

Is the sulcular epithelium keratinized or non-keratinized?

A

non-keratinized (& semi-permeable)

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41
Q

The sulcular epithelium is comprised of:

A

stratified squamous epithelium

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42
Q

What does the sulcular epithelium lack? (compared to the oral epithelium)

A
  • stratum corneum
  • stratum granulosum
  • Langerhan’s Cells
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43
Q

What is the importance of the sulcular epithelium?

A

It is a semi-permeable membrane against bacterial products passing into underlying tissue

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44
Q

What is represented by the yellow line?

A

junctional epithelium

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45
Q

Is the junctional epithelium keratnizied or non-keratinized?

A

non-keratinized

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46
Q

What comprises the junctional epithelium?

A

Stratified squamous epithelium

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47
Q

Describe the rate of turnover of the junctional epithelium:

A

Rapid turnover ~10.4 days

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48
Q

Describe the attachments of junctional epithelium:

A

attachment to the tooth surface via hemidesmosomes & non-collagenous proteins (proteoglycans & glycosaminoglycans)

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49
Q

The clinical probing depth/sulcus depends on where the probe actually stops, which is dependent on many factors including: (3)

A
  1. tissue inflammation
  2. probe diameter
  3. probing pressure
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50
Q

What are the components of the supracrestal attachment?

A
  1. JE
  2. Connective tissue attachments

(together around 2mm total)

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51
Q

What microscopic feature of the gingiva functions to keep the gingiva in place?

A

connective tissue attachment

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52
Q

The connective tissue attachment may also be referred to as:

A

supracrestal attachment

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53
Q

If you impede on biologic width (supracrestal attachment) this will result in:

A

bone loss

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54
Q

Removing bone to bring down the JE and connective tissue to create a larger biologic width; controlled removal of bone to re-establish a deeper margin:

A

crown lengthening

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55
Q

List the three groups of gingival fibers:

A
  1. gingivodental (dentogingival)
  2. circular
  3. transeptal
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56
Q

What gingival fiber group attaches the cementum to the gingiva?

A

gingivodental group

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57
Q

What gingival fiber group is present around the tooth in the gingiva?

A

circular group

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58
Q

What gingival fiber group attaches cementum to the cementum of the adjacent tooth?

A

transeptal

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59
Q

Main type of collagen present in the gingiva:

A

type 1 collagen

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60
Q

The gingival fibers are critical in:

A

keeping the gingiva attached to the tooth

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61
Q

The gingival fibers that are in close proximity to the alveolar crest contribute to the connective tissue attachment component of the:

A

supracrestal attachment

62
Q

What are some clinical features of the gingiva to be noted? (4)

A
  1. color
  2. contour
  3. consistency
  4. texture
63
Q

Is a form of adaptive specialization or reinforcement for function:

A

stippling

64
Q

What percent of the population has stippling of the gingiva?

A

40%

65
Q

Suspensory mechanisms attaching tooth to alveolar bone:

A

PDL

66
Q

The PDL absorbs:

A

occlusal forces

67
Q

What is responsible for transmitting occlusal forces to bone?

A

PDL

68
Q

Describe what components make up the PDL: (3)

A
  1. blood vessels
  2. collagen (type I, III, IV)
  3. proprioceptive nerve endings
69
Q

The PDL contains proprioceptive nerve endings that:

A

transmit pressure & pain via trigeminal nerve

70
Q

List the cells present in the PDL:

A
  1. undifferentiatied mesenchymal cells
  2. fibroblasts
  3. cementoblasts/clasts
  4. osteoblasts/clasts
  5. inflammatory cells (in disease)
  6. epithelial rests of malassesz (remnants of henrtwigs root sheath)
71
Q

List the groups of PDL: (5)

A
  1. alveolar crest
  2. horizontal
  3. oblique
  4. apical
  5. interradicular
72
Q

PDL fiber group that connects the cementum to the crest of the alveolar bone; prevents extrusion & lateral movements:

A

Alveolar crest

73
Q

PDL fiber group that connects the cementum to the alveolar bone @ 90 degrees; opposes lateral forces:

A

Horizontal

74
Q

PDL fiber group that connects the cementum to the coronal end of alveolar bone; resists the vertical masticatory forces:

A

oblique

75
Q

PDL fiber group that connects cementum to the apical alveolar bone; resists tipping:

A

apical

76
Q

PDL fiber group that connects cementum to the furcation bone; resists lunation & tipping:

A

Interradicular

77
Q

Label the PDL fiber group that matches the prompt:

  1. prevents extrusion and lateral movements
  2. opposes lateral forces
  3. resists vertical masticatory forces
  4. resists tipping
  5. resists luxation & tipping
A
  1. alveolar crest
  2. horizontal
  3. oblique
  4. apical
  5. interradicular
78
Q

What PDL fiber group is the “largest”?

A

oblique

79
Q

Calcified mesenchymal tissue that contains 45-50% hydroxyapatite:

A

cementum

80
Q

Describe the vascularity of cementum:

A

non-vascularized; no nerves & no lymphatics

81
Q

How does cementum grow?

A

apposition

82
Q

Cementum is attached to fibers of the:

A

PDL

83
Q

What is the specific type of PDL fibers that are extended into the cementum to provide attachment?

A

Sharpey’s Fibers

84
Q

What is the significance of a patient who has exposed cementum?

A
  1. rough surface facilities plaque adherence
  2. porosities facilitate attachment of calculus
  3. porosities facilitate absorption of bacterial enzymes
  4. smear layer inhibits attachment of connective tissue
85
Q

With exposed cementum the rough surface facilitates:

A

plaque adherence

86
Q

With exposed cementum the porosities facilitate: (2)

A
  1. attachment of calculus
  2. absorption o bacterial enzymes (i.e. endotoxin)
87
Q

With exposed cementum the smear layer:

A

inhibits attachment of connective tissue

88
Q

What is the main function of the alveolar process?

A

supports the tooth

89
Q

Describe the vascularity of the alveolar process:

A

Vascularized- lymphatics + nerves (but nerves are in the periosteum & not bone)

90
Q

The alveolar process is attached via:

A

sharpey’s fibers

91
Q

Portion of PDL fibers inserting into the alveolar process:

A

Sharpey’s fibers

92
Q

List the components of the alveolar process: (3)

A
  1. external plate
  2. inner socket wall
  3. cancellous trabeculae
93
Q

In regards to the alveolar process, the inner socket wall is the:

A

alveolar bone proper

94
Q

In regards to the alveolar process; the bundle bone is the:

A

attachment of PDL fibers into the bone

95
Q

Where do we have the best quality of bone for implant placement?

A
  1. mandibular posterior
  2. maxillary anterior

because good balance between dense cortical bone & spongy trabecular bone

96
Q

Where is the bone extremely dense thus making it a non-ideal area to place implants?

A

mandibular anterior

DENSEEEEEE

97
Q

What is the shape of the alveolar process in the following areas?

Anterior:
Posterior

A

Anterior: scalloped

Posterior: Flattened scallop

98
Q

The shape of the alveolar process is dependent on:

A

interdental distance, tooth controls, & root contours

99
Q

The alveolar process distance from the CEJ in health is:

A

1 to 1.5mm

100
Q

The alveolar process distance from CEJ in health is ____ in an adult (taking into account the concept of supracrestal attachment)

A

1.5 - 2.0mm

101
Q

T/F: Bone loss precedes attachment loss

A

False- attachment loss precedes bone loss

102
Q

Lack of bone on the facial or lingual of the tooth but with interproximal bone:

A

Dehiscence

103
Q

Lack of bone on the facial or lingual of the tooth resembling a “window”:

A

fenestration

104
Q

“marginal bone is missing”:

A

dehiscence

105
Q

Occurs due to the “thinness” of bone:

A

fenestration

106
Q

Which line is pointing to dehiscence? Which line is pointing to fenestration?

A

Left: Fenstration
Right: Dehiscence

107
Q

Thin facial and lingual cortical plates overlying root surfaces:

A

alveolar process

108
Q

What occurs in the alveolar process in adults over the age of 40 years?

A

increased fibrosis and increased lipid cell content in marrow spaces (therefore a decrease in progenitor cell populations)

109
Q

In adults over the age of 40 years old, the alveolar process experiences increased ____ and increased ___ in the marrow spaces (and therefore a decrease in progenitor cell populations)

A

increased fibrosis & increased lipid cell content

110
Q

List the top 4 reasons of adult tooth loss & include percentages:

A
  1. Periodontal disease (70%)
  2. Caries (20%)
  3. Prosthetics (9%)
  4. Other (1%)
111
Q

Atleast ____% of dentate U.S. adults aged 30-90 have periodontitis

Of these adults, ____ % have a mild form; while ___ % have a moderate or severe form

A

48%; 30.5%; 17.7%

112
Q

List the Five F’s of periodontics:

A
  1. Failure to diagnose
  2. Failure to treat
  3. Failure to refer for treatment
  4. Failure to establish and follow an appropriate maintenance schedule
  5. Failure to accept treatment (patient)
113
Q

List the court dictated role for general dentists in regards to perio: (4)

A
  1. must DIAGNOSE periodontal disease
  2. must INFORM the patient of clinical findings
  3. must REFER patient to periodontist or treat them yourself
  4. must TREAT to the current standard of care
114
Q

According to the 2017 classification, periodontal diseases & conditions include:

A
  1. Periodontal health and gingival conditions
  2. Periodontitis
  3. Other conditions affecting the periodontium
115
Q

According to the 2017 classification, peri-implant diseases & conditions include:

A
  1. Peri-implant health
  2. Peri-implant mucositis
  3. Peri-imiplantitis
  4. Peri-implant hard and soft tissue defects
116
Q

Stage of periodontitis characterized by 1-2 mm CAL:

A

Stage 1: Initial

117
Q

Stage of periodontitis characterized by LESS than 15% bone loss (RBL):

A

Stage 1: Initial

118
Q

Stage of periodontitis characterized by NO tooth loss due to periodontal disease:

A

Stage 1: Initial & Stage 2: Moderate

119
Q

Stage of periodontitis characterized by probing depth of 4mm or less:

A

Stage 1: Initial

120
Q

Stage of periodontitis characterized by mostly horizontal bone loss:

A

Stage 1: Initial & Stage 2: Moderate

121
Q
  • 1-2 mm CAL
  • less than 15% RBL
  • No tooth loss due to periodontal disease
  • PD 4mm or less
  • mostly horizontal BL
A

Stage 1: Initial

122
Q

Stage of periodontitis characterized by 3-4 mm CAL:

A

Stage 2: Moderate

123
Q

Stage of periodontitis characterized by 15-33% BL:

A

Stage 2: Moderate

124
Q

Stage of periodontitis characterized by PD of 5mm or less:

A

Stage 2: Moderate

125
Q

What is similar between Stage 1 and Stage 2 of periodontitis?

A
  • no teeth lost due to periodontal disease
  • mostly horizontal bone loss
126
Q

Stage of periodontitis considered severe with potential for additional tooth loss:

A

Stage 3

127
Q

Stage of periodontitis characterized by 5mm or more of CAL:

A

Stage 3: Severe

128
Q

Stage of periodontitis characterized by RBL beyond 33%:

A

Stage 3: Severe

129
Q

Stage of periodontitis characterized by loss of 4 teeth or less due periodontal disease:

A

Stage 3: Severe

130
Q

Stage of periodontitis characterized by complexity factors such as PD of 6mm or more:

A

Stage 3: Severe

131
Q

Stage of periodontitis characterized by vertical bone loss of 3mm or more:

A

Stage 3: Severe

132
Q

Stage of periodontitis characterized by Class II & Class III furcations:

A

Stage 3: Severe

133
Q

Stage of periodontitis characterized by moderate ridge defects:

A

Stage 3: Severe

134
Q

Stage of periodontitis characterized by the need for complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collapse, pathologic migration of teeth, and less than 20 remaining teeth:

A

Stave 4: Severe with potential for loss of dentition

135
Q

At what stage of periodontitis should you automatically refer to perio?

A

Stage III & IV

136
Q

Why is grading used?

A

used to indicate the risk of progression

137
Q

What grade would given to someone with low risk of progression?

A

Grade A

138
Q

What grade would be given to someone with moderate risk of progression?

A

Grade B

139
Q

What grade would be given to someone with high risk of progression?

A

Grade C

140
Q

You should initially assume grade ___ then seek specific evidence to shift to other grades

A

Grade B

141
Q

Describe the DIRECT evidence used in grading:

A
  1. historical radiographic bone loss
  2. clinical attachment loss
142
Q

Describe the INDIRECT evidence used in grading:

A
  1. % bone loss per patient age
  2. case phenotype
  3. heavy plaque accumulation but minimal destruction
  4. minimal plaque accumulation but major destruction
143
Q

What grade would be given for the following example:

No loss over 5 years

A

Grade A

144
Q

What grade would be given for the following example:

Less than 2mm of loss over 5 years

A

Grade B

145
Q

What grade would be given for the following example:

Greater than 2 mm of loss over 5 years

A

Grade C

146
Q

How do you calculate bone loss per age of individual. Include the category ranges:

A

Bone loss % divided by age
40%/ 60 years old = 0.66 (B)

A: Less than or equal to 0.25
B: 0.25-1.0
C: Greater than or equal to 1.0

147
Q

List some examples of things that would be considered grade modifiers:

A

smoking & diabetes

148
Q

Describe the smoking and diabetic status for someone considered grade A:

A

Non-smoker; non-diabetic

149
Q

Describe the smoking and diabetic status for someone considered grade B:

A

less than 10 cigs per day; HBA1C = less than 7%

150
Q

Describe the smoking and diabetic status for someone considered grade C:

A

Greater than or equal to 10 cigs per day; HBA1C greater than 7.0%

151
Q

What are the goals of the new staging and grading system? (3)

A
  1. easy to use
  2. better communication
  3. identify response to treatment
152
Q
A

Periodontics I (18 decks)

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