LO 3 Flashcards
(49 cards)
1
Q
Define Pathogenesis
A
- The sequence of events that occur during the development of a disease or abnormal condition
- Disease Progression
2
Q
What are the 3 basic states of the periodontium?
A
- Health - Absence of disease
- Gingivitis - Confined to gingiva
- Periodontitis - Affects all of periodontium
3
Q
Describe periodontal disease
A
- bacterial infection of the periodontium
- Two types - gingivitis, periodontitis
4
Q
Describe gingivitis
A
- Onset 4 to 14 days after plaque biofilm accumulation in gingival sulcus
- Acute gingivitis lasts for a short period of time. It is characterized by fluid in the gingival connective tissues that results in swollen gingiva.
- Chronic gingivitis lasts months or years - May persist for years without becoming periodontitis
- Fibrotic tissue due to excess collagen growth
- Tissue Enlargement: Gingival enlargement may be caused by swelling (acute gingivitis) or fibrosis (chronic gingivitis).
- Tissue enlargement causes the gingival margin to cover more of the anatomic crown which results in deeper probing depths.
- This enlargement of the gingival tissue is said to produce a false gingival pocket, known as a pseudopocket.
- A gingival pocket has a sulcus depth greater than 3 mm. This increased probing depth is caused solely by enlarged gingival tissue.
- Think 4 mm PD and FGM reading of -4mm
5
Q
What does gingivitis look like clinically?
A
- Gingival tissue red or reddish-blue (cyanotic) - increased blood flow = red, prolonged/pooling blood = cyanotic
- Gingival margin swollen - Excessive fluid accumulation in the tissues, known as edema
- Interdental papillae bulbous, swollen
- Bleeding upon gentle probing (BOP)
- Probing depths greater than 3 mm (psuedopockets)
- There is no apical migration of the junctional epithelium in gingivitis!!
6
Q
What happens at the microscopic level in gingivitis?
A
- hemidesmosomes still attach to enamel coronal or AT CEJ
- JE & SE/ CT junction: WAVY - JE extends ridges into CT due to destruction of gingival fibers creating space for growing epithelium
- Gingival fibers: reversible damage to supragingival fiber bundles
- Bone: intact
- PDL: intact
- Cementum: intact/covered
7
Q
What is periodontitis characterized by?
A
- Apical migration of junctional epithelium
- Loss of connective tissue attachment
- Loss of alveolar bone
- Tissue destruction in intermittent manner at different rates throughout mouth
8
Q
What does periodontitis look like clinically?
A
- Visible alterations in color, contour, and consistency
- Gingival margin may be swollen or fibrotic
- Interdental papillae may balloon out or be blunted
- Bleeding upon probing common
- Suppuration possible
- Pocket depths 4 mm or greater
9
Q
Describe the microscopic picture of periodontitis
A
- Apical migration of junctional epithelium - Coronal-most portion detaches from tooth surface, Extracellular matrix of gingiva and collagen fibers destroyed
- Junctional epithelium and sulcular epithelium extend into connective tissue - Small ulcerations of pocket epithelium expose underlying inflamed connective tissue
10
Q
Describe the junctional epithelium in periodontitis
A
- The JE is located on the cementum, apical to (below) its normal location.
- The extracellular matrix of the gingiva and the attached collagen fibers at the apical edge of the JE are destroyed.
- The coronal-most portion of JE detaches from the tooth surface.
- As the bacterial infection progresses, the apical portion of the JE moves further in an apical direction along the root surface creating a periodontal pocket.
11
Q
What happens to the Epithelial-Connective Tissue Junction during periodontitis?
A
- The JE proliferates and extends epithelial ridges into the connective tissue.
- The SE of the pocket wall thickens and extends epithelial ridges deep into the connective tissue. Small ulcerations of the pocket epithelium expose the underlying inflamed connective tissue.
12
Q
What happens to gingival connective tissue during periodontitis
A
- Widespread destruction of collagen and supragingival fiber bundles, allowing junctional epithelium migration
- Pathologic tooth migration possible - if inflammation is > ability for transeptal fibers to hold arch in place
- Destruction of alveolar bone, ligament fiber bundles - Epithelium grows over the root surface in where fiber bundles have been destroyed. The loss of fiber attachment is permanent because epithelium growing over the root surface prevents the reinsertion of the PDL fibers in the cementum!
- Cementum exposed to plaque biofilm
- Inflamed pulp, pulpal necrosis, vascular congestion, and dentin demineralization possible
13
Q
Describe pathogenesis of bone destruction
A
- Inflammation - Response to injury or pathogenic invasion; In periodontitis, permanently destroys tissues
- Alveolar bone loss - Resorption of alveolar bone due to periodontitis
14
Q
Describe changes in Alveolar Bone Height in Disease
A
- Bone height in health and gingivitis - Crest of alveolar bone 2 to 3 mm apical to CEJs of teeth
- Horizontal bone loss most common in periodontitis - Even, overall height reduction with perpendicular margin
- Vertical bone loss (angular bone loss) less common - Uneven reduction in height with more rapid resorption
15
Q
Describe the Pathway of Inflammation in Horizontal Bone Loss
A
- Within gingival tissue along connective tissue sheaths
- Into alveolar bone
- Into periodontal ligament space
- Path of least resistance
16
Q
Describe the Pathway of Inflammation in vertical Bone Loss
A
- Within gingival connective tissue
- Directly into periodontal ligament space
- Into alveolar bone
- Weakened crestal periodontal ligament fibers no longer barrier
17
Q
Describe a Suprabony pocket
A
- Occurs in horizontal bone loss
- The base of the pocket is coronal to the alveolar crest
18
Q
Describe an Infrabony pocket
A
- Occurs in vertical bone loss (less common)
- Pocket in which the base of the defect extends apical to the residual alveolar crest.
19
Q
Describe a One-Wall Intrabony Defect (could also be two or three walls)
A
- Also called hemiseptal defect
- Half of interdental septum lost
- Other half remains attached to tooth
20
Q
Describe a proximal bone contour
A
- Bone contour from facial to lingual dips apically
- Forms osseous crater
- Affects two adjacent root surfaces
- Interdental area difficult to clean
21
Q
Describe bone loss in furcation areas (AKA furcation involvement)
A
- Occurs on multirooted tooth when periodontal infection invades area between and around roots
- Results in loss of alveolar bone between roots
- May be hidden by gingival tissue or clinically visible
22
Q
Describe attachment loss in periodontal pockets
A
- Destruction of fibers and bone that support teeth
- Spreads apically and laterally
- Pocket on different root surfaces can have different depths
23
Q
Describe inactive and active disease sites (Areas of tissue destruction)
A
- Inactive disease site - Junctional epithelium attachment level stable over time
- Active disease site - Shows continued apical migration of junctional epithelium
- Assess with periodontal probe and record in chart!
24
Q
Describe periodontal pockets
A
- Areas of tissue destruction left by disease process
- Not necessarily indicator of active disease
- Most pockets in adult patients are inactive disease sites
25
What are pseudopockets/false pockets?
1. Deepening of gingival sulcus due to swelling
2. Causes of increased probing depth - Detachment of coronal portion of junctional epithelium AND Increased tissue size due to swelling of tissue
26
What are the 3 causes of periodontal pockets?
1. Apical migration of junctional epithelium
2. Destruction of periodontal ligament fibers
3. Destruction of alveolar bone
27
Pattern of disease progression may vary from:
1. One individual to another
2. One site to another in person’s mouth
3. One type of periodontal disease to another
28
Describe the Continuous Progression Theory (Historical View of Disease Progression: Prior to 1980)
1. Periodontal disease progresses throughout entire mouth in slow, constant rate over adult life
2. All untreated gingivitis cases progress to periodontitis.
3. All cases of periodontitis progress at slow, steady rate
*Research in early 1980s indicated periodontal disease: Does not progress at constant rate; Does not affect all areas of mouth simultaneously
29
Describe the Intermittent Progression Theory (Current View)
1. Periodontal disease characterized by periods of disease activity and inactivity (remission)
2. Tissue destruction sporadic and occurs at different rates
3. Most untreated gingivitis does not progress to periodontitis
4. Different forms may progress at different rates
5. Susceptibility to periodontitis varies greatly by individual - Determined by the host response to periodontal pathogens
30
________ is the study of health and disease within the total population, rather than an individual and the risk factors that influence health and disease.
Epidemiology
31
Describe epidemiologists
1. Epidemiologists study periodontal disease
2. to determine its occurrence in population & to identify risk factors for periodontal disease
32
List example risk factors that may lead to disease development
1. Heredity
2. Gender
3. Physical environment
4. Systemic factors
5. Socioeconomic status
6. Personal behaviour
33
The number of all cases of a disease (both old & new) that are identified in a specific population at a given point in time is the ________ of disease
prevalence
34
The number of new disease cases in a population that occur over a period of time is the ________ of disease
incidence
35
How does gender impact periodontal disease?
1. Males have greater prevalence & severity of PD over females
2. likely due to differences in variables within group – such as oral hygiene practices, frequency of dental care etc.
36
How does access to dental care impact periodontal disease?
1. Individuals who desire or need dental care may not have access to care & therefore do not seek care they need.
2. Major contributor to all health issues in small rural settings
3. Examples of barriers to dental care - transportation to and from a dental office; financial expense of dental care
37
How does tobacco use impact periodontal disease?
1. important behavioral risk factor for development of periodontal disease
2. All tobacco products have a negative impact on periodontium
38
How does aging impact periodontal disease?
1. Incidence & severity of periodontal diseases increase with age
2. Likely result of “cumulative effects” of bacterial inflammation of tissues over many years
3. Could also be result of an increase in exposure to other risk factors - systemic illness; Medications; Stress
39
How does Socioeconomic Status & Educational Level impact periodontal disease?
1. greater incidence of PD in individuals with lower levels of income
2. Underdeveloped countries have a higher incidence of periodontitis
3. greater incidence of PD in individuals with less than high school education & living below poverty level
40
Why is periodontal disease difficult to measure?
1. Periodontal disease involves hard & soft tissues
2. Multiple variables to consider are - Tissue color changes and swelling; Loss of bone and supportive structures; Degree of bleeding; Probing depths
41
What has research shown about periodontal disease?
1. PD is one of most widespread diseases in adults
2. Most individuals who have PD do not know that they have it
3. PD is leading cause of tooth loss in adults older than age 45 years
42
Describe disease classification system
1. Grouping of similar entities based on certain differing characteristics
2. Provides tool to understanding of etiology, pathogenesis, and treatment of periodontal diseases
3. Evolves as new evidence-based knowledge develops - Expected to change over time
43
The Periodontal Classification System Provides information necessary in:
1. Communicating clinical findings to other providers
2. Formulating diagnosis and devising individualized treatment plan
3. Predicting treatment outcomes (prognosis)
4. Submitting information to insurance providers
44
Describe the 2017 AAP/EFP Classification of Periodontal and Peri-Implant Diseases and Conditions
1. American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP)
2. Initiated currently accepted classification system by organizing World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions
3. Over 100 experts from around world developed new disease classification
4. Accounts for scientific advances since previous classification developed in 1999
5. Strives to standardize definition of diseases and conditions
6. Most recent, internationally accepted classification system
45
Gingivitis can either be _________ or __________
1. Dental biofilm-induced
2. nondental biofilm induced
46
What are the three forms of periodontitis?
1. Necrotizing periodontal disease
2. Periodontitis
3. Periodontitis as a manifestation of systemic disease
47
What are other conditions affecting the periodontium?
1. Systemic diseases or conditions affecting the periodontal supporting tissues
2. Perio abcessess and endodontic lesions
3. Mucogingival deformities and conditions
4. Traumatic occlusal forces
5. Tooth and prosthesis related factors
48
What are the 4 peri-implant diseases and conditions?
1. Peri-implant health
2. Peri-implant mucositis
3. Peri-implantitis
4. Peri-implant soft and hard tissue deficiencies
49
List updates in the 2017 classification system from the 1999 system
1. Includes new category: “Periodontal/Gingival Health”
2. Includes case definition of “intact periodontium” versus “reduced periodontium”
3. Groups previous “chronic” or “aggressive” forms into single disease entity known as “periodontitis”
4. Classification system based on multidimensional staging and grading system - Allows provider to individualize patient-specific treatment
5. New classification category that accounts for peri-implant diseases and conditions
