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mental dental > MD PERIO > Flashcards

MD PERIO Flashcards

1
Q

what are 4 components make up periodontium?

A

alveolar bone
PDL
cementum
gingiva

( what surrounds tooth)

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2
Q

what is the initating factor of periodontal disease?

A

microbial plaque ( biofilm)

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3
Q

probing depth is from where to where?

A

gingival margin -> base of pocket

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4
Q

clinical attachment loss CAL is measured where to where?

A

CEJ -> base of pocket

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5
Q

what is the best way to measure inflammation in period disease?

A

BOP

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6
Q

during a perio exam. a patient had a PPD of 4 mm with 2 mm of recession. what was the patients CAL?

A

4 + 2 = 6 mm

CAL= PPD + recession

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7
Q

patient had a PPD of 9 mm but tissue grew 3 mm. what was the cal

A

(9- 3 = 6 mm

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8
Q

gingival recession is measured from ___ to __

A

CEJ to gingival margin

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9
Q

miller classification of mobility for tooth moving more or equal to 1 mm is what class?

A

class 2

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10
Q

miller classification of mobility for tooth moving more than 1 mm and can be vertically displaced in socket

A

class 3

0, 1 ,2 ,3

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11
Q

what are the hamp classification furcation classes and what do they tell you?

A

0- none
1- horizontal involvement <3 mm
2- horizontal involvement > 3 mm
3- through and through involvement

YOU KNOW THIS FROM CLINIC!!

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12
Q

normal distance from CEJ to alveolar crest is how many mm?

A

2 mm

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13
Q 
when this defect is surrounded by 3 walls what bone defect is it?
1 wall
2 wall
3 wall
4 wall
A

3 wall defect

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14
Q

when defect is surrounded by 1 wall what is the defect?
when this defect is surrounded by 3 walls what bone defect is it?
1 wall
2 wall
3 wall
4 wall

A

1 wall defect

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15
Q

when the D,F,L wall of a defect is missing what wall is it?
when this defect is surrounded by 3 walls what bone defect is it?
1 wall
2 wall
3 wall
4 wall

A

1 wall

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16
Q 
crater is what defect?
when this defect is surrounded by 3 walls what bone defect is it?
1 wall
2 wall
3 wall
4 wall
A

2 wall (MOST COMMON)

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17
Q

hemiseptal is what wall defect?

1 wall
2 wall
3 wall
4 wall

A

1 wall defect

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18
Q

trough is what wall defect?

1 wall
2 wall
3 wall
4 wall

A

3 wall

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19
Q

easiest wall defect to graft?

1 wall
2 wall
3 wall
4 wall

A

3 wall b/c already 3 walls present

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20
Q

what is 4 wall defect?

A

extraction socket

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21
Q

millers classification of recession. which one has no likelihood of root coverage?

class 1, 2, 3, 4

A

class 3 wont have total root coverage but class 4 has no chance

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22
Q

most common gingival disease? **

A

plaque induced

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23
Q

plaque induced gingival disease is modified by what 3 things?

A

SYSTEMIC FACTORS: endocrine changes (puberty, pregnancy, diabetes)

MEDICATION

MALNUTRITION (vitamin C deficiency aka scyurvy)

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24
Q

what is a modification in nutrtition that contributes to plaque induced gingival diseases?

A

VITAMIN C DEFICIENCY

scurvy

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25
Q

what is systemic factor that contributes to plaque induced gingival disease?

A

endocrien changes ( puberty, pregnancy, diabetes)

leukeumoia

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26
Q

what is medication that contributes to plaque induced gingival disease?

A

C - ca+
D- dilantin
C- cyclosporin

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27
Q

patient walks in with inflammed gums that are non-hemmorrhagic and firm, what does patient have?

A

hereditary gingival fibromatosis

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28
Q

mm of call for moderat Perio disases?

A

3-4 mm

severe more than 5
slight 1-2

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29
Q

periodontal disease distrubution is what percent generalized?

A

> 30% ( more than or equal)

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30
Q

chronic vs agressive perio in terms of :
- are they clinically healthy?
slower or rapid progression>
are microbial deposits consistent with destruction?

A

chronic: clinically not healthy
agressive: clinically healthy

rapid bone : aggressive
slow: chronic

chronic: deposits consistent
aggressive: not consistent

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31
Q

4 clinical features of necrotizing perio disease ( ANUG, ANUP)

A

pseudomembrane
fetid breathe
blunted papillae
fever

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32
Q

predisposing factors of necrotizing perio disease

A

stress
smoking
immunosuppression

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33
Q

patient walks in with fever, rancid breathe, what is the diagnosis?

A

ANUG or ANUP ( necrotizing perio disaese)

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34
Q

type of bacteria in subgingival tissue?

A

anaerobic G(-)

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35
Q

type of bacteria in supragingival tissue?

A

aerobic ( g +)

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36
Q

describe the type of bacteria in supra and sub gingival tissue>

A

bacteria goes from g+ to G-

coronal -> apical

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37
Q

where does supra and subgingival bacteria accumulate from

A

supra: saliva
sub: GCF

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38
Q

what are the 3 steps and times of dental plaque formation?

A

pellicle (saliva outside teeth) : seconds

adhesion and attachment of bacteria: within minutes

Colonization/ plaque formation: 24-48 hrs

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39
Q

communication among bacteria to encourage growth of beneficial species and discourage competing species is called

A

quorum sensing

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40
Q

what is red complex bacteria associated with and the types? **

A

BOP and deep pockets:

P.Gingivalis
T. Denticola
T. Forsythia

TF/ TD/ PG (TF? touchdown Paul georgs)

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41
Q

what is orange complex bacteria associated with and the types? **

A

preceeeds presence of red complex supporting sequential nature plaque formation

Fusobacterium
Prevotella Intermedia
Campylobacter Rectus

FB, CR, PI

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42
Q

aggressive periodontitis is caused by what bacteria?

A

A. Actinomycetemcomitans (G-)

A-gressive caused by AA

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43
Q 
which bacteria found in ANUG, ANUP?
P.Gingivalis
T. Denticola 
Prevotella Intermedia
T. Forsythia
A. Actinomycetemcomitans
A

TDenticola ( red)

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44
Q 
which bacteria found in chronic periodontitis?
P.Gingivalis
T. Denticola 
T. Forsythia
Prevotella Intermedia
A. Actinomycetemcomitans
A

P. Gingivalis (red complex)

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45
Q 
which bacteria found found in preganncy gingivitis ?
P.Gingivalis
T. Denticola 
Prevotella Intermedia
T. Forsythia
A. Actinomycetemcomitans
A

P. Intermedia (orange compelx)

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46
Q

most common oral bacteria residing on tongue?

S. Mutans
Actinomyces
S. Salivarius
Pseudomonas

A

S. Salivarius

saliva = tongue

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47
Q

oral bacteria on root caries?

S. Mutans
Actinomyces
S. Salivarius
Pseudomonas

A

actinomyces

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48
Q

coronal caries?

S. Mutans
Actinomyces
S. Salivarius
Pseudomonas

A

s. mutans

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49
Q

bacteria found in implants?
most common oral bacteria residing on tongue?

S. Mutans
Actinomyces
S. Salivarius
Pseudomonas

A

pseudomonas (staph)

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50
Q

describe how calculus affects gingival tissue ?

A

calculus does not serve as the irritant ! but the plauqe it accumulates is what irritated the tissue

(calculus does not contribute to caries it is a natural seal)

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51
Q

describe supragingival and subgingival calculus?

- color, what causes it?

A

supra: white/yellowish ; mineralization due to saliva near salivary duct openings
subgingival: dark, mineralization due to GCF

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52
Q

soft cheeselike accumulation of bacteria easily displaced by water spray?

A

materia alba

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53
Q

Orange extrinsic staining usually where and due to what? **

A

anterior teeth, poor hygiene

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54
Q

brown extrinsic staining usually where and due to what? **

A

dark beverages, poor hygiene

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55
Q

yellow-brown extrinsic staining usually where and due to what? **

A

CHX and stannous fluoride

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56
Q

black extrinsic staining on cervical third usually where and due to what? **

A

iron

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57
Q

green and yelow extrinsic staining usually where and due to what? **

A

ant teeth, poor OH

chromogenic bacteria

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58
Q

bluish green extrinsic staining due to what

A

occupational exposure of metallic dust

59
Q

t or F undercountoured restorations worse than over contoured

A

F : overcontoured b/c forms plaque

60
Q

what is the first line of defense for fighting infection?
how do they move?
how does it kill bacteria?

A

NEUTROPHILS !

  • move via CHEMOTAXIS
  • kill via PHAGOCYTOSIS
61
Q

what is the most important enzyme involved in the destruction of periodontal tissues? **

how is it treated?

A

MMP- 8 ( neutrophil collagenase)

  • causes periodontitis, kills neutrophils

tetracycline

62
Q

antigen presenting cells like moncytes and dendritic cells regulate immune response via how?

A

cytokines such as IL-8

63
Q

this cell causes vascular permeability and dilation?

A

mast cell

64
Q

histamine releasing cell? what antibody does it have?

A

mast cell

IgE

65
Q

what cell makes antibodies?

A

B cells become PLASMA CELLS and make antibodies

66
Q

which cells kill intracellular antigens?

A

T cytotoxic cells (CD8)

67
Q

CD4 vs CD8 cells

A

CD4- T helper cells : communicate
CD8: kill intracellular antigens

lppk at slide 64

68
Q

these cells recognize and kill tumor and cirally infected cells

A

NK cells

69
Q

T cytotoxic cells vs NK cells

A 
TCyto cells ( CD8): kill intracellular antigens 
NK: recognize and kill tumor and virally infected cells
70
Q

this cytokine causes bone absorption

A

IL-1

71
Q

A member of a group of enzymes that can break down proteins, such as collagen, released by neutrophils

A

MMP

72
Q

this is a cytokine secreated by macrophages, NK cells,and lymphocytes used for necrosis or apoptosis

A

TNFa (tumor necrosis factor alpha)

protein important for necrosis and apoptosis and resistance to cancer

73
Q

what are 5 proinflammatory mediators?

A 
IL-1
iL-6
PGE2
TNFa
MMP
74
Q

what are antiinflammatory mediators

A

IL-4
Il-10
TIMPs

75
Q 
which one are anti and pro inflammatories 
IL-4
Il-10
TIMPs
IL-1
iL-6
PGE2
TNFa
MMP
A

anti: IL4, IL10, TIMPS

76
Q

4 stages of gingivitis?

A

1) 2-4 days : NEUTROPHILS infiltrate, Inc GCF
2) 4-7 days; T LYMPHOCYTES infiltrate, inc collagen loss, BOP
3) 14-21 B LYMPHOCYTES , mature plasma cells infiltrate, collagen loss, change in collar
4) PERIODONTITIS ( IRREVERSIBLE)

77
Q

what is the most important factor determining prognosis of a tooth?

A

CAL !!

78
Q

scaling vs root planing

A

scaling: remove supra and sub gingival plaque and calculus

root planning: remove embedded calculus and rough cementum

79
Q

sickle scalers remove what type of calculus>

A

supragingival

80
Q

curettes remove what type of calculus>

A

subgingival calculus

81
Q

ultrasonic scalers remove what type of calculus>

A

tenacious calculus

82
Q

the magnetostrictive ultrasonic vibrate in what type of pattern?

A

(cavitron) elliptical

83
Q

the piezoelectric ultrasonic vibrate in what type of pattern?

A

linear

84
Q

this type of stroke is for light feeling used with probes and explorers

A

exploratory

85
Q

this stroke is a short strong pull to remove hard deposits

A

scaling

86
Q

light intermitten strokes with tip parallell to tooth surface in constant motion

A

utrasonic

87
Q

when inserting curette into pocket, angulation of blade to tooth should be ___ and is changed to ____

A

0 (closed angle)

45-90 ( open angle)

88
Q

what type of bone should flap design incision be?

A

intact bone not defects or eminences !!!

89
Q

want sharp or round incision corners?

A

round

90
Q

WHAT IS THE MOST IMPORTANT PROCEDURE AFTER PERIO SURGERY?

A

post-op plaque control

91
Q

this flap thickness retract gingiva, submucosa and even periosteum?

A

full thickness flap ( mucoperiosteal)

92
Q

this type of flap is for mucogingival surgery where exposing bone not necessary?

A

split or partial thickness ( mucosal) flap

93
Q

this thickness flap used for osseous surgery and periodntal regeneration

A

full thickness flap

94
Q

whnwver alveolar bone is exposed during full thickness flaps, how much bone resoprtion is expected?

A

1 mm

95
Q

periodontal pack used for what and what is it made of how long to keep it on ? ?

A

ZOE

protects surgical wound and stops bleeding

PACK DONT ENHANCE healing ( ZOE SOOTHES)

1 week

96
Q

difference between gingivectomy and gingivoplasty?

A

ectomy: excision of gingiva to elimante suprabony pockets or enlargement
plasty: excision of gingiva to reshape tissue deformities

97
Q

maxillary distal wedge?

A

full thickness flap with parallel incision

98
Q

mandibular distal wedge

A

full thickness flap with V-Shape incision

99
Q

what happens during free gingival graft?

A

widen band of keratinized tissue

100
Q

connective tissue graft?

A

root coverage

take palatal tissue and suture over root surface

101
Q

frenectomy?

A

complete removal of frenum

102
Q

vestiibuloplasty

A

deepening of vestibule

103
Q

what is a free gingival graft?

A

transplanted WITHOUT nourishing blood supply so undregoes revascularization from recipient bed

104
Q

what is most common donor site for connective tissue graft and what is it for?

A

PALATe

root coverage

105
Q

ostectomy ?

A

removal of SUPPORTING bone

106
Q

osteotomy?

A

removal of NON SUPPORTING bone

107
Q

guided tissue regeneration regenerates what 3 things?

A

bone
cementum
PDL

108
Q 
CT cells
PDL Cells 
Bone Cells
EPithelial cells
which one heal fastest to slowest?
A

epi
ct
PDL
bone

109
Q 
what cells cause long  JE when healing?
CT cells
PDL Cells 
Bone Cells
EPithelial cells
A

Epithelial cells

CT cells

110
Q

2 examples of chelating agents and use?

A

EDTA and CITRIC acid

root surface treatment ?

111
Q

what is an allograft?

A

another human, usually cadaver

112
Q

what is an autograft?

A

bone graft from yourself

113
Q

what is an alloplast?

A

synthetic or onorganic bone graft

114
Q 
which is the best and worst?
autograft
allograft
xenograft
alloplast>
A

best: AUTOGRAFT
worst: ALLOPLAST

115
Q

what does osteoconductive mean?

A

bone forming cells move across scaffold and replace with new bone

116
Q

osteoinductive ?

A

convert neighboring progenitor cells into osteoblasts

117
Q

additive periodontal surgery?

A

periodontal regernaration
free gingival graft ( transplant w/out blood supply)
connective tissuse graft ( harvest inner CT)
coronally advanced flap

118
Q

substractive periodontal surgery summary

A

resective osseous surgery
gingivectomy
apically positioned flap

119
Q

when have 1 and 2 wall defect how do we fix?

A

RESECTION (ostectomy)

recontour bone to restore positive architecutre

120
Q

when have 3 and 4 wall defect how do we fix>

A

REGENERATION,
better blood supply and cell source proximity

REGENERATION better than RESECTION ( wall 1 and 2)

121
Q

when do you resection and when do you regenerate ( which bone wall defects)?

A

resection: 1 and 2

Regeneratgion: 3 and 4

122
Q

which Hamp classification is ideal for regenerating furcation defects?

class 1
class 2
class 3
class 4
A

class 2

123
Q

which miller class is ideal for regenerating recessive defects?

A

Class 1 ( nearly 100%)

124
Q

which phase should antibiotics be used?

A

phase 1 : non surgical procedures

125
Q

what type of periodontitis uses ANTIBIOTICS

A

agressive perio

126
Q

where is tetracycline concentrated at ?

A

GCF

127
Q

which tetracycline drug is best to take and why?

A

doxycycline only one dose per day

128
Q

most important combination drug for perio disease ? ***

A

amoxicillin (500mg TID) and Metronidazole ( 250 mg TID) for 14 days

AMX+ MTZ

TID+ 3x a day

duration more important than dose !!!

129
Q

Local delivery Antiobiotics are used when?

A

when localized recurrent PD pockets > 5 mm with inflammation are still present after therapies

130
Q

what are local delivery antibiotics and 3 examples?

A

MINOCYCLINE: arrestin
DOXYCYCLINE: atridox
CHX: periochip ( non antibiotic)

131
Q

host modulation therapy is used for what type of perio?

A

Reduces tissue destruction and stabilizes and regenerates inflammatory tissue

chronic periodontitis

132
Q

what do NSAIDS inhibit?

A

PROSTOGLANDIS ( cause inflammation)

133
Q

what do bisphosophonates inhibit? side effect?

A

osteoCLASTS

BRONJ ( bisphophonate related osteonecrosis of the jaw)

134
Q

subantimicrobial dose doxycycline inhibits what>

A

MMP ( collagenases)

135
Q

primary occlusal trauma caused by?

A

excessive forces on NORMAL periodontium

136
Q

secondary occlusal trauma caused by?

A

normal occlusal forces on reduced periodontium

137
Q

this occlusal trauma is vibration of tooth upon closing?

A

fremitus

138
Q

waterpik function is what?

A

reduce BACTERIAL LOAD ON GINGIVA

NOT biofilm on tooth surface !!

139
Q

chronic periodontitis is most prevalent in what demographic?

A

black males

140
Q

re- evaluation of perio should be when ?

A

after phase 1 non surgical : 4-8 weeks

141
Q

in osseous surgery what is positive architecture?

A

interproximal bone coronal to radicular bone ( what we want)

142
Q

in osseuous surgery what is flat architecture/

A

interproximal and radicular bone same height

143
Q

in osseous surgery what is negative architecture ?

A

interproximal bone apical to radicular bone ( not healthy)

mental dental (18 decks)

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