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Flashcards in Perio I Deck (108):
1

3 Lesions of Gingivitis:

The Lesion of Periodontitis:

Initial, Early, Established

Advanced

2

The Initial Lesion in Gingivitis develops in ___ to ___ days.

Inflammatory cell infiltrate is primarily ______

2 to 4 days

Neutrophils

3

In the Initial Lesion of Gingivitis there is Vasculitis, increase in GCF, no bone loss, no clinical attachment loss, but a loss of Perivascular ___

CT

(collagen)

4

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...

4-7

lymphocytes, macrophages

T-cell

5

What stage of Gingivitis sees the beginnings of a pseudopocket, loss of gingival stippling, and BOP?

Early Lesion (4-7 days)

6

Classic "gingivitis," or a transition to periodontitis, aka...

Established Lesion

7

The Established Lesion of Gingivitis establishes itself at _____

2-3 weeks

8

At 2-3 weeks in the Established Lesion, _____ persist but ______, _____, and ______ dominate

neutrophils

lymphocytes, macrophages, plasma cells
(chronic infiltrate)

9

What stages of Gingivitis is there BOP?

Early lesion (4-7 days)

Established lesion (2-3 weeks)

10

T/F
The established lesion can last for years, and the mechanisms that proceed to periodontitis is not well understood

True

11

What stage of Gingivitis is characterized by Rete Pegs in the Junctional Epithelium and Erythema?

Early

12

An Advanced Lesion, aka

Periodontitis

13

What defines an Advanced Lesion?

Activation of Osteoclasts

(alveolar bone resorption)

14

Aggressive periodontitis refers to:

Severe refers to:

Adolescents

Adults

15

Name 3 Endocrine conditions that can create Gingival Disease:

Puberty

Pregnancy

Diabetes

16

What bacteria thrive in the endocrine conditions created by Puberty, Pregnancy, and Diabetes?

P. intermedia

17

A blood dyscrasia that can lead to gingival disease:

Is there bone loss with Dyscrasias?

Leukemia

no

18

Name 3 drugs that can elicit Gingival Enlargement:

Phenytoin sodium (Dilantin)

Cyclosporine (Sandimmune)

Ca Channel Blockers (Nifedipine)

19

Name 3 bacteria that don't produce plaque but can induce gingival disease:

Neisseria gonorrhea

Treponema pallidum

beta-hemolytic Strep

20

Name 2 Viruses that can induce gingival disease:

Herpes I and II

Varicella-zoster

21

Name 3 Fungi that can induce gingival disease:

Candida albicans

Histoplasmosis

Linear gingival erythema

22

Localized vs. Generalized periodontitis happens at ____ % of teeth involved.

30

23

What are the 4 components of the Periodontium?

Gingiva

Periodontal Ligament

Cementum

Alveolar Bone proper

24

What periodontal tissue has the capacity to become keratinized?

What does not?

Oral sulcular epithelium

Junctional epithelium

25

T/F
Stippling is present in 40% of the population

True

26

Gingival Margin to MGJ (mucogingival junction) - sulcus depth =

Attached Gingiva

27

Normal probing depth:

0-3 mm

28

CAL is measured from the...

CEJ

29

What is the Gold Standard for monitoring the trends of perio disease?

BOP

30

If BOP is negative, there is...

no active disease

31

On average, the Biological Width is ___ mm

2 mm

32

T/F
Biological width is made of the Junctional Epithelium, the CT attachment to the alveolar bone, and the sulcular epithelium

False

*not the sulcular epithelium

33

What is the Biological Width made up of? (2 components)

Junctional epithelium

Attached epithelium to the bone

34

What is the average width of the PDL in an Adult?

0.17 mm

35

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

36

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

37

ANUG has an age of onset between ____ and ____ years

it is commonly associated with stress and ______

15 and 30

smoking

38

What 2 systemic antibiotics are used to address ANUG?

Amoxicillin

Metronidazole

39

What are the 4 microscopic zones of ANUG?

Bacterial zone

Neutrophil rich zone

zone of Necrosis

zone of Spirochete Infiltration

40

What 2 conditions can result in multiple Acute Periodontal Abscess formation?

Diabetes (uncrontrolled)

AIDS

41

What % of flora is G- in an Acute Periodontal Abscess?

65%

42

What are 2 Important bacteria in Acute Periodontal Abscess?

Why?

P. gingivalis and P. intermedia

Proteinases increase nutrients

43

Unlike Acute Periodontal Abscess (which is caused by blockage of a periodontal pocket), what causes Acute Gingival Abscess?

impaction of foreign body

44

What type of Periodontitis sees furcation invasion?

Chronic perio

45

T/F
Chronic Periodontitis can be treated with Systemic Antibiotics

False

46

T/F
Chronic Periodontiti is painfule

False

*painless except w/ abscess

47

Chronic Periodontitis - classification by Severity:

Slight: 1-2 mm CAL

Moderate: 3-4 mm CAL

Advanced: 5 (or greater) CAL

48

What is Excessive PD without the loss of clinical attachment?
(an increase bulk of the gingiva)

Pseudopocket

49

What is excessive PD with loss of clinical attachment?

Periodontal Pocket

50

What are the 2 types of Periodontal Pockets?

Suprabony

Intrabony

51

How are Intrabony pockets classified?

Walls (1-3)

Circumferential

Interdental Craters

52

Suprabony pockets tend to be associated with ____ alveolar bone loss

Intrabony pockets tend to be associated with ____ alveolar bone loss

Horizontal

Vertical

53

T/F
Untreated Chronic periodontitis progresses at 0.1-0.3 mm/yr for facial/lingual surfaces and 0.3 mm/yr for interproximal areas

True

54

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.

True

55

What is the Red Complex

*Aggressive Periodontitis

Porphyromonas gingivalis

Tannerella forsythia

Treponema denticola

Aggregatibacter actinomycetemcomitans

(A.a. = adolescent)

56

How does NUP differ from ANUG?

clinical attachment loss and alveolar bone loss

(both consistent in NUP)

57

T/F
NUP is associated with AIDS, and 73% of pts die within 24 months of NUP diagnosis

True

58

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)

59

NUP has all the microbes as Advanced Chronic Periodontitis, plus what 3 more species?

Clostridium

Klebsiella

Enterococcus


(also Candida and EBV)

60

Tx for NUP is soft tissue debridement, scaling/root planing, CHX, and what 2 drugs?

Metronidazole

Fluconazole (Diflucan)

61

Cytoplasmic granules (Basophils/Mast Cells) contain what 5 important factors?

Histamine

Platelet activating factor

Heparin

TNF-alpha

SRS-As

62

What 3 SRS-As (slow reacting substances of anaphylaxis) are in Basophils/Mast cells?

Leukotriene C4, D4, and E4

63

Monocyte/Macrophage (along with phagocytosis/antigen recognition), synthesizes what 5 cytokines/lymphokines?

IL-1

IL-6

TNF-alpha

INF

Lipid mediators (prostaglandin, leukotriene, Platelet Activating Factor)

64

Function, IL-1:

IL-6:

TNF-alpha:

INF:

activates - osteoclasts, B-lymphocytes, CD8 lymphocytes

activates osteoclasts

endothelium/inflammatory mediator

interferes with viral replication

65

What lymphocyte activates macrophage, CD8 (cytotoxic) T cells, and B-lymphocytes that secrete IG's

CD4

66

The CD8 Lymphocyte (cytotoxic) destroys cells with Cytotoxins (lymphokines) and synthesizes what other 3 factors?

INF-gamma

TNF-alpha

TNF-beta

67

Cell population, inflammation, Initial Stage:

PMN's

68

Cell population, inflammation, Acute Stage:

PMN's, Macrophage, a few Lymphocytes (B and T-cells)

69

Cell population, inflammation, Chronic Stage:

few PMN's/Macrophage

mostly Lymphocytes and Plasma Cells (B-lymphocytes)

70

A dense collection of inflammatory cells, primarily neutrophils, combined with tissue necrosis and walled off by immature connective tissue:

Abscess

71

T/F
Periodontitis is always accompanied by inflammation

False

72

T/F
Gingivitis differs from Periodontitis b/c it lacks Bone Loss, PDL destruction, and apical migration of the JE

True

73

T/F
Everyone with poor plaque control eventually develops gingivitis

True

74

T/F
Plaque is necessary but not sufficient to initiate pariodontitis

True

75

T/F
Perio disease theory includes the Continuous model and an asynchronous multiple burst model, the latter of which is the more probable

True

76

What are soluble, locally active plypeptides that regulate cell growth, differentiation and/or function?

Cytokines

77

IL-1 functions (3):

IL-6 function:

IL-8 function:

osteoclast, fibroblast, macrophage

B and T cells

PMN's

**all pro-inflammatory

78

TNF-alpha activates...

osteoclasts

79

4 functions of PGE2

Vasodilation

Pyrogenic

Mast cell mediator release

cell-mediated cytotoxicity

80

T/F
Neutrophils always come through the JE, even in healthy gingiva

True

81

Acute =

Chronic =

Increase in chronicity =

PMN's

Lymphocytes

Plasma cells

82

In an Early Lesion there is a ___ % loss of collagen in the gingival lamina propria

There is also Vascular ______

70

Hyperemia

83

What class of endopeptidase is active against most extracellular matrix macromolecules?

MMP's

84

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)

Interstitial, Fibroblast

Type IV, Fibroblast

Neutrophil

Neutrophil, Type IV

Macrophage

Fibroblast

85

Junctional Epithelium - Initial

Early

Established

PMN infiltration

Rete pegs

Rete pegs with microulcers

86

Advanced Lesion (periodontitis) cell profile:

PMN's

plasma cells (cytopathlogically altered), lymphocytes, macrophagess

87

When does loss of epithelial intermediate, tight, and gap junctions occur?

In the Established Lesion

88

How much bone volume/density needs to be lost before radiographic detection?

30-50%

89

Significant attachment loss precedes bone loss by ____ to ____ months

6 to 8

90

Puberty sees an increase in Estrogen/Progesterone and levels of what microbe?

P. intermedia

91

What is the essential nutrient for P. intermedia?

What is a substitute for this in progesterone?

Menadione (methyl-naphthanlenedione)

naphthoquinone

92

Name 5 primary Periodontal Pathogens:

(this is pregnancy related)

P. gingivalis

Tannerela forsythia

Campylobacter rectus

Prevotella intermedia

Treponema denticola

93

Stage 1 Hypertension:

140-159 / 90-99

94

Stage 2 Hypertension:

(greater than) 160 / 100

95

At what BP would there be an immediate referral and the performance of emergency dental care only?

180/100

96

How long should Tx be deferred following an MI?

6 months

97

In Congestive Heart Failure, treat the patient in what position?

Upright

98

What are 3 Periodontal pathogens that may be involved in Infectious Endocarditis

*Alpha-hemolytic strep is most common etiological agent

Eikenella corrodens

A.a.

Capnocytophaga spp.

99

Following a CVA (cerebrovascular accident) wait ___ months before initiating perio Tx

*CVA = stroke

6 months

100

Pts with CVA require an M.D. consult regarding ______

anticoagulants

101

Periodontitis from Type I diabetes is usually the result of _______

Cellular starvation

102

T/F
The link between obesity and Perio disease is an inflammatory association

*think cytokines

True

103

HbA1c above ____%, don't do electives

6.5%

104

T/F
Xerostomia and Candidiasis are some signs of Diabetes

True

105

What increases with age?

Cementum

106

T/F
There are more older adults with Advanced Disease

False

*fewer - probably b/c problem teeth have been removed

107

What drug used for bone cancer and osteoporosis causes jaw necrosis?

Bisphosphonates

*BIONJ - bisphosphonate induced osteonecrosis

108

NUP is treated with soft tissue debridement, scaling/root planing, _____, _____, and ______

CHX

Fluconazole (Diflucan)

Metronidazole

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