Periodontal Diagnosis

Question 1

common bacteria that causes gingivitis associated with dental plaque only in absence of AL

Answer 1

Actinomyces viscosis

Question 2

gingival inflammation on a reduced periodontium

Answer 2

inflammation and recession but no evidence of active periodontitis

Question 3

clinical features of dental plaque induced gingival diseases

Answer 3

1. redness
2. edema
3. BoP
4. smooth and shiny surface texture
5. no radiographic bone loss (unless on a reduced periodontium)
6. gingival cratering where the buccal and lingual tissues are present but directly intterproximally, some tissue is absent

Question 4

gingival diseases modified by systemic factors

Answer 4

1. pregnancy gingivitis
2. puberty gingivitis
3. associated with diabetes

Question 5

puberty gingivitis is associated with what bacteria?

Answer 5

Prevotella intermedia (Pi)

Question 6

gingival enlargement due plaque induced, drug influenced gingivitis is due to what?

Answer 6

an increase in fibroblast activity as a response to inflammation resulting in increased CT formation with a decrease in production of enzyme collagenase

Question 7

drugs that induce gingival enlargement

Answer 7

1. anti-convulsant medication - phenytoin
2. immunosuppressants (for transplant patients) - cyclosporin
3. calcium channel blockers - nifedipine, verapamil, amlodipine

Question 8

how is acute necrotizing ulcerative gingivitis (classified under necrotizing perio disease) characterized?

Answer 8

1. pain
2. spontaneous bleeding
3. punched-out interdental papillae
4. gray necrotic pseudomembrane
5. erythematous borders
6. fetid odor
7. possible lymphadenopathy
8. modified by malnutrition

Question 9

viral non-plaque induced gingivitis

Answer 9

acute herpetic gingivostomatitis (children)

Question 10

genetic non-plaque induced gingivitus

Answer 10

hereditary gingival fibromatosis

Question 11

what is the hallmark for periodontitis?

Answer 11

progressive attachment loss in the presence of inflammation

Question 12

periodontitis is most typically (but not always) is accompanied with what?

Answer 12

1. periodontal pockets

2. radiographic bone loss

Question 13

what factors must be taken into consideration when dx’ing periodontitis?

Answer 13

1. radiographic bone loss
2. clinical attachment loss
3. pocket depth
4. inflammation

Question 14

where will the jxnal epithelium be if there is facial, lingual, or proximal gingival recession in the absence of inflammation (a reduced but healthy periodontium)?

Answer 14

will also be on the root

Question 15

is patient considered to have periodontitis if there is radiographic bone loss but no inflammation?

Answer 15

the disease may be inactive

Question 16

pseudo-pocket

Answer 16

gingiva several mm coronal to CEJ without attachment loss

Question 17

the most typical pattern of perio disease progression occurs where?

Answer 17

at interproximal sites

Question 18

what is the most diagnostic descriptor of periodontal disease?

Answer 18

forms of periodontitis

Question 19

chronic periodontitis affects who?

Answer 19

most prevalent in adults over 35, but can occur younger adults destruction is consistent with local factors

Question 20

how can chronic periodontitis be classified?

Answer 20

1. basis of extent (localized or generalized)

2. severity (slight, moderate or severe)

Question 21

aggressive periodontitis is associated with what?

Answer 21

immunologic defects (familial aggregation but patients are otherwise healthy)

Question 22

who is affected by localized aggressive periodontitis?

Answer 22

1. circumpubertal (adolescent) onset

2. greater incidence in African-Americans

Question 23

characteristics of localized aggressive periodontitis

Answer 23

1. neutrophil chemotaxis defect

2. robust serum antibody response

Question 24

where does localized aggressive periodontitis affect?

Answer 24

localized to 1st molar/incisor involvement with no more than 2 other involved permanent teeth

Question 25

which bacteria is traditionally associated with localized aggressive periodontitis?

Answer 25

Aggregatibacter actinomycetemcomitans (Aa)

Question 26

T/F: for patients with localized aggressive periodontitis, there may be a burst of activity followed by a prolonged period of inactivity (quiescence) or burn-out (not episodic) however may generalize in later life

Answer 26

true

Question 27

T/F: patients with localized aggressive periodontitis may have their incisors undergo pathologic migration/drifting/shifting

Answer 27

true

Question 28

who is affected by generalized aggressive periodontitis?

Answer 28

persons under 30 years of age (age is important)

Question 29

characteristics of generalized aggressive periodontitis

Answer 29

1. poor serum antibody response to infecting agents 2. pronounced (exaggerated) episodic pattern for attachment loss and bone loss at different sites 3. generalized interproximal attachment loss on at least 3 permanent teeth in addition to first molars and incisors

Question 30

periodontitis due to systemic disease associated with hematologic disorders

Answer 30

1. acquired neutropenia | 2. leukemia (various forms)

Question 31

periodontitis due to systemic disease associated with genetic disorders or inborn errors of metabolism (frequently neutrophil defects present)

Answer 31

1. familial and cyclic neutropenia 2. Down's syndrome 3. leukocyte adhesion deficiency 4. Papillon-Lefevre syndrome 5. Chediak-Higashi syndrome 6. histiocytosis 7. genetic agranulocytosis 8. Ehlers-Danlos syndrome (collagen synthesis defect) 9. hypophosphatasia

Question 32

nectrotizing ulcerative periodontitis (NUP) may be associated with what type of patients?

Answer 32

patients who are HIV+

Question 33

clinical findings of nectrotizing ulcerative periodontitis (NUP)

Answer 33

1. gingival craters/loss of interproximal papillae 2. pseudo-membranous slough 3. linear gingival erythema 4. possibly exposed bone 5. fetid odor 6. lymphadenapthy 7. angular chelitis

Question 34

predisposing factors of nectrotizing ulcerative periodontitis (NUP)

Answer 34

1. smoking 2. stress 3. poor OH 4. poor nutrition

Question 35

types of abscess of periodontium

Answer 35

1. gingival 2. periodontal 3. pericoronal

Question 36

how is abscess of periodontium treated?

Answer 36

1. I&D | 2. amoxicillin

Question 37

mucogingival deformities

Answer 37

1. gingival recession 2. lack of keratinized tissue (gingiva) 3. pocketing that reaches mucogingival junction and aberrant frenum or muscle pull

Question 38

primary occlusal trauma

Answer 38

excessive forces on a normal periodontium

Question 39

secondary occlusal trauma

Answer 39

normal or excessive forces on a weakened periodontium

Question 40

localized

Answer 40

less than 30% of teeth involved (different criteria for generalized aggressive)

Question 41

generalized

Answer 41

equal to or greater than 30% of teeth involved

Question 42

slight bone loss

Answer 42

1-2 mm attachment loss

Question 43

moderate bone loss

Answer 43

3-4 mm attachment loss

Question 44

severe bone loss

Answer 44

5 mm or greater attachment loss