Periodontal Disease

Question 1

_________ is the initial process of swollen and/or inflamed gingival margins +/- hemorrhage. This is caused by bacterial plaque in conjunction with host responses.

Answer 1

gingivitis

Question 2

T/F: gingivits is a multifactorial disease process

Answer 2

true – bacterial presence + host response to bacteria

Question 3

What are the risk factors for gingivitis?

Answer 3

1. age
2. breed (toys)
3. crowding of teeth
4. soft foods
5. chewing habits
6. lack of oral care

Question 4

________ is an organic, transparent, adhesive BIOFILM that colonizes the teeth in 24-36 hours after cleaning or brushing.

Answer 4

plaque

Question 5

T/F: plaque is food residue left behind after meals that is removed by brushing

Answer 5

false – NOT food residue. its a biofilm

Question 6

what are the 3 steps to plaque formation?

Answer 6

1. attachment and colonization
2. growth and proliferation
3. maturation and detachment

Question 7

what type of bacteria are involved with gingivitis?

Answer 7

anaerobes and spirochetes
gram negatives

Question 8

what does the gingival inflammatory response to plaque involve?

Answer 8

1. vasculitis
2. edema
3. collagen loss

Question 9

What occurs after plaque calcifies into dental calculus?

Answer 9

calculus attracts more plaque which promotes periodontal disease

Question 10

progressive periodontitis destroys the ___________.

Answer 10

periodontium (hard and soft tissues)

Question 11

describe stage 0 of periodontal disease

Answer 11

normal – no gingivitis or bone loss

this is practically never seen and is the ONLY exception to the rule of not grading periodontal disease solely by appearance/without radiographs.

Question 12

describe stage 1 of periodontal disease

Answer 12

gingivitis only, no bone loss.

Question 13

describe stage 2 of periodontal disease

Answer 13

<25% attachment loss or stage 1 furcation involvement

Question 14

Stage 3 of periodontal disease has _____% attachment loss or stage 2 furcation involvement

Answer 14

25-50%

Question 15

Stage 4 periodontal disease has ____% attachment loss or stage 3 furcation involvement.

Answer 15

> 50%

Question 16

__________ furcation involvement is when periodontal probe extends LESS THAN half way under the crown of a multirooted tooth

Answer 16

stage 1

Question 17

__________ furcation involvement is when periodontal probe extends greater than halfway under the crown of a multirooted tooth, but NOT all the way through

Answer 17

stage 2

Question 18

__________ furcation involvement is when periodontal probe extends under the crown of a multirooted tooth from one side through to the other side.

Answer 18

stage 3

Question 19

what is the ONE exception to for which you can make a diagnosis of stage 4 periodontal disease WITHOUT needing dental radiographs to prove bone loss?

Answer 19

stage 3 furcation involvement. This is automatically stage 4 PD.

Question 20

how do we treat stage 1-2 PD?

Answer 20

dental cleaning and subgingival scaling

Question 21

how do we treat stage 3 PD?

Answer 21

dental cleaning
subgingival scaling
closed root planing (aggressive scaling to remove subgingival calculus and diseased tissue)

Question 22

what is the purpose of preparing a periodontal pocket?

Answer 22

1. remove plaque, calculus, and bacteria from root surface
2. remove inflamed soft tissue from pocket lining.

Question 23

What can we instill into the gingival sulcus that binds to calcium, has antimicrobial activity for 10-14 days, and has anticollagenase activity for weeks to months?

Answer 23

Doxirobe (doxycycline gel)

Question 24

what product can we instill into the gingival sulcus that has antimicrobial activity for 7-10 days but NO anticollagenase activity?

Answer 24

Clindoral

Question 25

For all PD stages, we should apply ________ to delay the reattachment of plaque and promote healing.

Answer 25

barrier sealant (oravet or sanos)

Question 26

Stage 4 peridontal disease with deep pockets must be treated with a surgical approach and open root planing or extraction. What is the downside to open root planning in these cases?

Answer 26

you would create a flap, curette the calculus, pack with bone graft, and then close. This can stimulate new bone growth and provide support to the tooth. The downside is that is requires EXCELLENT home care.

Question 27

what are the 3 bone graft options?

Answer 27

1. autograft 2. allograft 3. synthetic consil

Question 28

T/F: pre-operative antibitoics do NOT prevent bacteremia and should NOT be used unless there is a tooth root abscess with facial swelling

Answer 28

true

Question 29

T/F: perioperative IV antibiotics prevent bacteremia

Answer 29

false -- they dont prevent it, but they are indicated with invasive procedures, prolonged procedures, in immunocompromised patients, or in patients with underlying diseases (ex. chronic kidney failure)

Question 30

when can antibiotic therapy be extended for dental procedures?

Answer 30

in cases of osteomyelitis that is present on radiographs.

Question 31

what should antibiotic therapy cover?

Answer 31

pathogenic oral flora (gram negatives and anaerobes) clindamycin and clavamox are great options.