Flashcards in Perio I Deck (108):
3 Lesions of Gingivitis:
The Lesion of Periodontitis:
Initial, Early, Established
The Initial Lesion in Gingivitis develops in ___ to ___ days.
Inflammatory cell infiltrate is primarily ______
2 to 4 days
In the Initial Lesion of Gingivitis there is Vasculitis, increase in GCF, no bone loss, no clinical attachment loss, but a loss of Perivascular ___
The Early Lesion of Gingivitis evolves at ____ days
Along with neutrophils, the chronic cell infiltrate begins to appear and is made up of _____ and ______
The dominant infiltrate cell is...
What stage of Gingivitis sees the beginnings of a pseudopocket, loss of gingival stippling, and BOP?
Early Lesion (4-7 days)
Classic "gingivitis," or a transition to periodontitis, aka...
The Established Lesion of Gingivitis establishes itself at _____
At 2-3 weeks in the Established Lesion, _____ persist but ______, _____, and ______ dominate
lymphocytes, macrophages, plasma cells
What stages of Gingivitis is there BOP?
Early lesion (4-7 days)
Established lesion (2-3 weeks)
The established lesion can last for years, and the mechanisms that proceed to periodontitis is not well understood
What stage of Gingivitis is characterized by Rete Pegs in the Junctional Epithelium and Erythema?
An Advanced Lesion, aka
What defines an Advanced Lesion?
Activation of Osteoclasts
(alveolar bone resorption)
Aggressive periodontitis refers to:
Severe refers to:
Name 3 Endocrine conditions that can create Gingival Disease:
What bacteria thrive in the endocrine conditions created by Puberty, Pregnancy, and Diabetes?
A blood dyscrasia that can lead to gingival disease:
Is there bone loss with Dyscrasias?
Name 3 drugs that can elicit Gingival Enlargement:
Phenytoin sodium (Dilantin)
Ca Channel Blockers (Nifedipine)
Name 3 bacteria that don't produce plaque but can induce gingival disease:
Name 2 Viruses that can induce gingival disease:
Herpes I and II
Name 3 Fungi that can induce gingival disease:
Linear gingival erythema
Localized vs. Generalized periodontitis happens at ____ % of teeth involved.
What are the 4 components of the Periodontium?
Alveolar Bone proper
What periodontal tissue has the capacity to become keratinized?
What does not?
Oral sulcular epithelium
Stippling is present in 40% of the population
Gingival Margin to MGJ (mucogingival junction) - sulcus depth =
Normal probing depth:
CAL is measured from the...
What is the Gold Standard for monitoring the trends of perio disease?
If BOP is negative, there is...
no active disease
On average, the Biological Width is ___ mm
Biological width is made of the Junctional Epithelium, the CT attachment to the alveolar bone, and the sulcular epithelium
*not the sulcular epithelium
What is the Biological Width made up of? (2 components)
Attached epithelium to the bone
What is the average width of the PDL in an Adult?
What are the 3 classes of Tooth Mobility?
Class I: 0.2 to 1 mm
Class II: greater than 1 mm
Class III: greater than 1 mm + Axial displacement
Probing depth, BOP, CAL, width of attached gingiva, recession, furcation involvements, Mobility, Radiographic evidence of bone loss, and plaque/calculus are all used for what?
Clinical diagnosis of Perio disease
ANUG has an age of onset between ____ and ____ years
it is commonly associated with stress and ______
15 and 30
What 2 systemic antibiotics are used to address ANUG?
What are the 4 microscopic zones of ANUG?
Neutrophil rich zone
zone of Necrosis
zone of Spirochete Infiltration
What 2 conditions can result in multiple Acute Periodontal Abscess formation?
What % of flora is G- in an Acute Periodontal Abscess?
What are 2 Important bacteria in Acute Periodontal Abscess?
P. gingivalis and P. intermedia
Proteinases increase nutrients
Unlike Acute Periodontal Abscess (which is caused by blockage of a periodontal pocket), what causes Acute Gingival Abscess?
impaction of foreign body
What type of Periodontitis sees furcation invasion?
Chronic Periodontitis can be treated with Systemic Antibiotics
Chronic Periodontiti is painfule
*painless except w/ abscess
Chronic Periodontitis - classification by Severity:
Slight: 1-2 mm CAL
Moderate: 3-4 mm CAL
Advanced: 5 (or greater) CAL
What is Excessive PD without the loss of clinical attachment?
(an increase bulk of the gingiva)
What is excessive PD with loss of clinical attachment?
What are the 2 types of Periodontal Pockets?
How are Intrabony pockets classified?
Suprabony pockets tend to be associated with ____ alveolar bone loss
Intrabony pockets tend to be associated with ____ alveolar bone loss
Untreated Chronic periodontitis progresses at 0.1-0.3 mm/yr for facial/lingual surfaces and 0.3 mm/yr for interproximal areas
In a 10 year period, untreated Chronic periodontitis pts will lose 3.5-4.0 teeth while pts that are treated will only lose 1 tooth.
What is the Red Complex
(A.a. = adolescent)
How does NUP differ from ANUG?
clinical attachment loss and alveolar bone loss
(both consistent in NUP)
NUP is associated with AIDS, and 73% of pts die within 24 months of NUP diagnosis
Low grade fever, lymphadenopathy, moderate/severe pain, periodontal abscesses, aggressive necrosis, aggressive loss of alveolar bone, exposure of interproximal alveolar bone (necrotizing stomatitis):
Necrotizing Ulcerative Periodontitis (NUP)
NUP has all the microbes as Advanced Chronic Periodontitis, plus what 3 more species?
(also Candida and EBV)
Tx for NUP is soft tissue debridement, scaling/root planing, CHX, and what 2 drugs?
Cytoplasmic granules (Basophils/Mast Cells) contain what 5 important factors?
Platelet activating factor
What 3 SRS-As (slow reacting substances of anaphylaxis) are in Basophils/Mast cells?
Leukotriene C4, D4, and E4
Monocyte/Macrophage (along with phagocytosis/antigen recognition), synthesizes what 5 cytokines/lymphokines?
Lipid mediators (prostaglandin, leukotriene, Platelet Activating Factor)
activates - osteoclasts, B-lymphocytes, CD8 lymphocytes
interferes with viral replication
What lymphocyte activates macrophage, CD8 (cytotoxic) T cells, and B-lymphocytes that secrete IG's
The CD8 Lymphocyte (cytotoxic) destroys cells with Cytotoxins (lymphokines) and synthesizes what other 3 factors?
Cell population, inflammation, Initial Stage:
Cell population, inflammation, Acute Stage:
PMN's, Macrophage, a few Lymphocytes (B and T-cells)
Cell population, inflammation, Chronic Stage:
mostly Lymphocytes and Plasma Cells (B-lymphocytes)
A dense collection of inflammatory cells, primarily neutrophils, combined with tissue necrosis and walled off by immature connective tissue:
Periodontitis is always accompanied by inflammation
Gingivitis differs from Periodontitis b/c it lacks Bone Loss, PDL destruction, and apical migration of the JE
Everyone with poor plaque control eventually develops gingivitis
Plaque is necessary but not sufficient to initiate pariodontitis
Perio disease theory includes the Continuous model and an asynchronous multiple burst model, the latter of which is the more probable
What are soluble, locally active plypeptides that regulate cell growth, differentiation and/or function?
IL-1 functions (3):
osteoclast, fibroblast, macrophage
B and T cells
4 functions of PGE2
Mast cell mediator release
Neutrophils always come through the JE, even in healthy gingiva
Increase in chronicity =
In an Early Lesion there is a ___ % loss of collagen in the gingival lamina propria
There is also Vascular ______
What class of endopeptidase is active against most extracellular matrix macromolecules?
MMP 1 (2 types of collagenase)
MMP 2 (1 collagenase, 1 gelatinase)
MMP 8 (1 collagenase)
MMP 9 (gelatinase, collagenase)
MMP 12 (elastase)
MMP 13 (collagenase)
Type IV, Fibroblast
Neutrophil, Type IV
Junctional Epithelium - Initial
Rete pegs with microulcers
Advanced Lesion (periodontitis) cell profile:
plasma cells (cytopathlogically altered), lymphocytes, macrophagess
When does loss of epithelial intermediate, tight, and gap junctions occur?
In the Established Lesion
How much bone volume/density needs to be lost before radiographic detection?
Significant attachment loss precedes bone loss by ____ to ____ months
6 to 8
Puberty sees an increase in Estrogen/Progesterone and levels of what microbe?
What is the essential nutrient for P. intermedia?
What is a substitute for this in progesterone?
Name 5 primary Periodontal Pathogens:
(this is pregnancy related)
Stage 1 Hypertension:
140-159 / 90-99
Stage 2 Hypertension:
(greater than) 160 / 100
At what BP would there be an immediate referral and the performance of emergency dental care only?
How long should Tx be deferred following an MI?
In Congestive Heart Failure, treat the patient in what position?
What are 3 Periodontal pathogens that may be involved in Infectious Endocarditis
*Alpha-hemolytic strep is most common etiological agent
Following a CVA (cerebrovascular accident) wait ___ months before initiating perio Tx
*CVA = stroke
Pts with CVA require an M.D. consult regarding ______
Periodontitis from Type I diabetes is usually the result of _______
The link between obesity and Perio disease is an inflammatory association
HbA1c above ____%, don't do electives
Xerostomia and Candidiasis are some signs of Diabetes
What increases with age?
There are more older adults with Advanced Disease
*fewer - probably b/c problem teeth have been removed
What drug used for bone cancer and osteoporosis causes jaw necrosis?
*BIONJ - bisphosphonate induced osteonecrosis