Perio Problems Flashcards
1
Q
Gingivitis
A
Inflammation of gingival tissues
No loss of attachment or bone
Occurs in response to plaque bacteria
2
Q
Clinical signs of gingivitis
A
Erythema
BOP
Edema
3
Q
Young children has less
A
Plaque and less reactivity to plaque
4
Q
Puberty Gingivitis
A
Some children exhibit severe gingivitis at puberty
5
Q
Puberty gingivitis peak prevalence is
A
10 years in girls and 13 years in boys
6
Q
Puberty gingivitis gingiva enlarged with
A
Granulomatous changes similar to pregnancy
Related to increase in steroid hormones
7
Q
Local factors of gingivitis
A
Crowded teeth
Ortho
Mouth breathing
Erupting primary and permanent teeth
8
Q
Treatment of gingivitis
A
Reversible
Improve oral hygiene
Appropriately sized toothbrush
Patently assistant 8-10 years of age
9
Q
Long-standing gingivitis can lead to
A
Chronic inflammatory gingival enlargement
10
Q
Common chronic sites
A
Around ortho appliances
Areas chronically dried by mouth breathing
11
Q
Chronic inflammatory gingival enlargement the ___enlarged
A
Interdental papillae and marginal gingiva
12
Q
Chronic inflammatory gingival enlargement tissue tends to
A
Bleed easily and erythematous
13
Q
Chronic inflammatory gingival enlargement tissue may be
A
Soft friable with a smooth shiny surface
14
Q
Chronic inflammatory gingival enlargement may resolve
A
Slowly when adequate plaque control is instituted
15
Q
Chronic inflammatory gingival enlargement ___often required
A
Gingivectomy
16
Q
Drug induced gingival overgrowth
A
Phenytoin
Cyclosporine
Calcium channel blockers
17
Q
Phenytoin
A
Anti convulsants
18
Q
Cyclosporine
A
Immunosuppressant for host resection
19
Q
Calcium channel blockers
A
Hypertension control
20
Q
Drug-induced gingival overgrowth differs
A
From chronic inflammatory enlargement
21
Q
Drug-induced gingival overgrowth appears
A
Fibrous firm and pale pink with little tendency to bleed
22
Q
Drug-induced gingival overgrowth occurs
A
Slowly
23
Q
Drug-induced gingival overgrowth occurs first in
A
Papilla
24
Q
Drug-induced gingival overgrowth spreads to
A
Gingival margin
25
Drug-induced gingival overgrowth may cover
And interfere with eruption or occlusion
26
Drug-induced gingival overgrowth may improve or resolve
When medication is discontinued
27
Drug-induced gingival overgrowth severity affected by
Adequacy of oral hygiene and concentration of medication in gingiva
and susetable is genetic compontic
28
Drug-induced gingival overgrowth if medication cant be stopped
Overgrowth can be surgically removed but will recur
29
Drug-induced gingival overgrowth tissue can be removed by
Gingivectomy or by flap with internal bevele
30
Drug-induced gingival overgrowth surgery indicated when
Appearance is unacceptable to patient
Interferes with function
Overgrowth has produced periodontal pocket that cannot be maintained
31
Teeth erupt through
Existing band of keratinized gingiva
32
Width of keratinized gingiva band and relationship to teeth
Changes very little during subsequent growth and development
33
Deflection in path of eruption due to over crowding or over retention of primary teeth
May result in narrowed band of attached gingiva
34
Development and defects of the attached gingiva common when
Mandibular incisor erupt labial to alveolar ridge
35
If band of attached gingiva narrow
Small loss of attachment results in mucogingival defect (Pocket depth exceeds width of keratinized gingiva)
36
Development and defects of the attached gingiva recession may occur
Rapidly
37
Gingival architecture makes
Labially erupted teeth difficult to clean even more so after recession
38
__________vulnerability to peridonits and attachment loss
Plaque increases vulnerability
39
Other factors that may contribute to recession
Use of smokeless tobacco
Habit related self induced injury
40
Gingival graft to
Stabilize and replace lab nail kerat5nized gingiva
41
When defect not severe
Best to postpone grafting until after orthodontic treatment
42
Orthodontic movement of back onto alveolar ridge
May produce increase in attached gingiva and place tooth in periodotnally more stable position
43
Maxillary frenum penetrating incisive papilla often accompanied by
Large midline diastema
44
Maxillary frenum penetrating incisive papilla traumatic forces
On the facial attached gingiva will cause loss of papilla
45
Maxillary frenum penetrating incisive papilla look for
Blanching
46
Maxillary frenum penetrating incisive papilla treatment can be
Delayed until permanent teeth present
47
Prominent maxillary frenum treatment usually delayed
Until permanent incisor or cuspids erupted to allow natural closure of diastema
48
Prominent maxillary frenum treatment indicated
If appearance unacceptable after closure or ortho
49
Tip of papilla will
Fill embrasure
50
Ankyloglossia
Restricted tongue movement
51
Restrictive lingual frenum (“tongue tie”) prevelance
Common in children
52
Restrictive lingual frenum (“tongue tie”) if normal mobility limited treatment may be indicated
Speech
Feeding
Or if tongue cannot be protrude or touch upper alveoplasty process
53
Frenectomy
Infant surgery for feeding controversial
Evidence to improve speech very limited
54
Chronic Periodontitis
Attachment loss >2 at >1 site
Number and severity of affected sites increases with age
55
Molar/Incisor pattern ( Aggressive periodontitis)
2 forms
Localized and generalized
56
Molar/Incisor pattern ( Aggressive periodontitis)
| Localized form affects
Young patients
57
Molar/Incisor pattern ( Aggressive periodontitis)
| Generalized form affects
Young adults
58
Molar/Incisor pattern ( Aggressive periodontitis)
| Characterized by
Loss of attachment and bone around permanent incisor and 1 permanent molar
59
Molar/Incisor pattern ( Aggressive periodontitis)
| Attachment loss is
Rapid occurring at 3x rate of adult onset disease
60
Molar/Incisor pattern ( Aggressive periodontitis)
| Most commonly seen in
African American population
61
Molar/Incisor pattern ( Aggressive periodontitis) may be seen
After mild trauma luxates tooth
62
Molar/Incisor pattern ( Aggressive periodontitis)
| Undetected diseases in primary dentin
Suggest that LAP and prepub are all same
63
Molar/Incisor pattern ( Aggressive periodontitis)
| Linked to
A neutrophil chemotactic defect and can be inherited
64
Molar/Incisor pattern ( Aggressive periodontitis)
| Linked to presence of
A. A.
65
Molar/Incisor pattern ( Aggressive periodontitis)
| Successful treatment outcomes
Correlate well with eradication of the bacteria
66
Molar/Incisor pattern ( Aggressive periodontitis) treatment
SRP combined with systemic antibiotic therapy and monitoring
67
Molar/Incisor pattern ( Aggressive periodontitis)
| Systemic antibiotic choice
Tetracyclines
Metronidazole alone or with amoxicillin
Newest therapy azithromycin
- concentrates in neutrophils
- short course compliance superior
68
Molar/Incisor pattern ( Aggressive periodontitis)
| After treatment
Some reattachment and resolution can occur after antibiotic therapy
69
Localized surgery intervention
Often necessary for residual defects
70
Localized aggressive (formerly prepubertal) periodontitis is
Localized loss of attachment in the primary dentition
71
Localized aggressive (formerly prepubertal) periodontitis occurs in
Children without evidence of systemic disease
72
Localized aggressive (formerly prepubertal) periodontitis most commonly manifested in
Molar area
73
Localized aggressive (formerly prepubertal) periodontitis usually
Bilaterally symmetrical loss of attachment
74
Localized aggressive (formerly prepubertal) periodontitis may be present
Calculus may be present
Heavier than average plaque
75
Localized aggressive (formerly prepubertal) periodontitis commonly 1st diagnosed in
Late primary dentition or early transitional dentition
76
Localized aggressive (formerly prepubertal) periodontitis may progress to
Localized aggressive periodontitis in permanent dention...probably the same disease
77
Localized aggressive (formerly prepubertal) periodontitis believed to be the result of
A bacterial infection combined with specific but minor host immunologic deficit is
78
Tetracyclines commonly used to treat
LJP contraindicated for LPP because of potential for staining of developing permanent teeth
79
Treatment of LPP
Metronidazole and amoxi
Or
Azithromycin
80
Systemic disease in the immune system
Neutropenia may cause loss
81
Systemic diseases in developmental defect
In the attachment apparatus as in hypophosphatasia
82
Systemic diseases of neoplastic cells
In leukemia can lead to loss
83
Diabetes has increased risk
And earlier onset of periodontitis in diabetes Mellitus types 1 and 2
84
10-15% of teenagers with type 1 diabetes
Have significant periodontal disease
85
Periodontitis may worsen
Glycemic control
86
Down syndrome
3 copies of chromosome 21
87
Down syndrome increased
Susceptibility periodontist
88
Most Down syndrome patients develop periodontist by age
30
89
Down syndrome plaque levels high but
Severity of periodontal diseae out of proportion
90
Down syndrome various minor immune deficits
Particularly in neutrophil function
91
Down syndrome predisposed to recession because
Shallow anterior mandibular vestibule
Frenum pull common
92
Hypophosphatasia
Genetic disorder in which the enzyme bone alkaline phosphatase is deficient or defective
93
Hypophosphatasia diagnosed by
A finding of low alkaline phosphatase levels in serum sample
94
Hypophosphatasia phenotypes vary from
Premature loss of deciduous teeth to severe bone abnormalities leading to neonatal death
95
Hypophosphatasia the earlier the presentation of symptoms
The more severe the diseae
96
Hypophosphatasia in mild form 1st clinical sign
Early loss of primary teeth
Bone symptoms common in later adulthood
97
Hypophosphatasia early tooth loss is a result of
Defective cementum formation that results in weakened attachment of tooth to bone
98
Hypophosphatasia roots
Not resorbed
Development may not be complete
99
Hypophosphatasia teeth are affected in order
Of formation so that those that form the earliest are most likely to be involved and the most severely affected
100
Hypophosphatasia primary incisor exfoliated at
1-2 years
101
Hypophosphatasia permanent dention
May be normal
102
Hypophosphatasia other signs
Fair caucasians
| Frontal bossing
103
Leukocyte
adhesion
deficiency (LAD) is a group of
Rare recessive genetic syndromes
The severity is variable
104
Leukocyte
adhesion
deficiency (LAD) affects how
White blood cells respond and travel to site of wound or infection
105
Leukocyte
adhesion
deficiency (LAD) susceptible to
Bacterial infections and lack of pus at infection sites
106
_____ can be curative for LAD
Bone marrow transplant
107
Leukocyte
adhesion
deficiency (LAD) recurrent
Otitis media and other bacterial infections of soft tissues
Periodontal disease symptoms manifest in primary dentition
108
Neutropenia is
Suppressed neutrophil counts in blood and bone marrow
109
Neutropenia diagnosed by
Depressed neutrophils count on differential blood count
110
Neutropenia increased susceptibility to
Recurrent infections
111
Neutropenia will have severe
Gingivitis and pronounce alveolar bone loss that rapidly progressing
112
Neutropenia patients may not
Be able to maintain level of oral hygiene necessary to prevent disease
113
Papillon-LeFèvre syndrome
Rare genetic disorder with onset of severe periodontitis in primary or transitional dention
114
Papillon-LeFèvre syndrome severe
Inflammation and rapid bone loss characteristic
115
Papillon-LeFèvre syndrome easily identified by
Hyperkeratosis of the palms of the hands and soles of the feet
116
Papillon-LeFèvre syndrome therapy
Consists of aggressive local measures to control plaque
117
Papillon-LeFèvre syndrome successful treatment in children
Have been reported with antibiotic therapy
118
Langerhans Cell Histiocytosis (LCH)
Infiltration of bones skin liver and other organs with histiocytes
119
Langerhans Cell Histiocytosis (LCH) will have
Gingival enlargement ulceration mobility of teeth with alveolar expansion and discreet destructive lesions of bone on radiographs
120
Langerhans Cell Histiocytosis (LCH)
| Radiograph
Teeth may be left floating in air and eventually exfoliated
121
Langerhans Cell Histiocytosis (LCH) diagnosed by
Biopsy
122
Langerhans Cell Histiocytosis (LCH) therapy
Local measures such as radiation and surgery to remove lesions and systemic chemo for disseminated cases
123
Leukemia best prognosis
Acute lymphoblastic leukemia’s
124
Leukemia poorer long term survival
Acute myeloid leukemia
125
AML but not ALL
May present with gingival enlargement caused by infiltrates of leukemia cells
126
AML lesions are
Bluish red and may invade bone
127
AML patient will have
Fever mailable gingival or other bleeding and bone or joint pain
128
AML may be diagnosed by
Complete blood cell count
Anemia
Abnormal leukocyte and differential counts
Thrombocytopenia
129
Periodontal health of children should be
Assessed at each examination
Plaque index provides method for monitoring and documenting oral hygiene practices
130
Most common calculus sites
Lingual mandibular incisors
Buccal of maxillary molars
131
Erupting teeth can be probed
All the way to the CEJ
Deep pockets are normal
132
Normal crystal height within
1-2 mm of the CEJ
