Periodontics Flashcards
(210 cards)
1
Q
periodontium is composed of? (4)
A
- gingiva
- PDL
- cementum
- alveolar and supporting bone
2
Q
attachment apparatus (3)
A
- alveolar bone proper
- PDL fibers
- cementum
3
Q
gingival apparatus (2)
A
- gingival fibers
- epithelial attachment
4
Q
gingival ligament (3)
A
fibers:
- dentogingival
- alveologingival
- circular
5
Q
Alveolar process
A
- Alveolar bone proper - inner layer of compact lamellar bone, surrounds where PDL fibers attach, vessels and nerves pass btw PDL and bone marrow
- Supporting alveolar bone - cortical plate (compact lamellar), spongy (cancellous, NOT in anterior mouth)
6
Q
small collagen fibers in the PDL that run in all directions and are assoc. with larger principal collagen fibers is the
A
indifferent fiber plexus
7
Q
free gingiva components (4)
A
- gingival margin
- free gingival groove - sep. free gingiva from attached, only in 33% ppl
- gingival sulcus - btw marginal gingiva and tooth, bound by sulcular epithelium laterally and JE apically
- interdental (interprox) gingiva
8
Q
gingival fibers have type __ collagen
found in what part of gingiva?
A
Type I
free gingiva, continuous with PDL
9
Q
types of gingival fibers (5)
A
- alveologingival - alveolar process to lamina propria in free gingiva
- circular - resists ROTATION, inserts into cementum and lamina propria of free gingiva and alveolar crest
- dentogingival - from cementum apical to epithelial attachment (JE); into lamina propria of gingiva
- dentoperiosteal - cervical cementum to periosteum of cortical plates
- transseptal - connect adj. teeth, classified within PDL principal fibers, embedded in cementum, not on facial, not attached to bone, maintain integrity of dental arches
10
Q
ATTACHED GINGIVA
A
- attached to underlying periosteum of alveolar bone and to cementum of CT fibers and epithelial attachment
- btw free gingiva and alveolar mucosa
- contains keratinized epithelium and lamina propria of dense fiber bundles with few elastic bundles
-firmly bound, color depends on keratinization, thickness, amt melanin, blood
11
Q
where is the narrowest band of attached gingiva
A
facial surfaces of md canine and 1st PM
lingual surfaces adj. to md incisors and canines
MB root of mx 1st molar
md 3rd molars
12
Q
with of facial attached gingiva ranges from __ to __ mm
where is it widest? narrowest?
A
1-9 mm
facial of mx lateral; narrowest on facial of md canine and 1st PM
13
Q
what is the functionally adequate zoe of gingiva
A
keratinized, firmly bound to tooth and underlying bone, 2mm_ wide, resistant to probing and gaping when lip is distended
14
Q
boundaries of attached gingiva
A
MGJ to gingival groove (base of sulcus)
15
Q
MGJ separates __
free gingival groove separates __
free gingiva extends from __ to __
A
attached gingiva from alveolar mucosa
free gingiva from attached gingiva
free gingival groove to gingival margin
16
Q
what is stippling?
A
irregular surface of attached gingiva
-at intersection of epithelial ridges -> cause depression and interspersing of CT papilla
-in absence of stippling, edema of CT, inflammatory degradation of gingival collagen, normal variation can result in areas of attached gingiva
17
Q
what type of epithelium is all oral mucosa?
A
stratified squamous REGARDLESS if it’s keratinized or not
18
Q
non-keratinized oral mucosa found in
A
- buccal and alveolar mucosa
- tongue’s inferior (ventral) surface
- soft palate
- FOM
- special and lining mucosa
- col
- crevicular epithelium
19
Q
alveolar mucosa
A
- fxns as lining
- apical to attached gingiva on facial and lingual side
- NON-KERATINIZED, has elastic fibers
- permits movement but can’t stand frictional stress
20
Q
keratinized oral mucosa found in
A
- hard palate
- attached gingiva
21
Q
functional oral mucosa includes (3)
A
- masticatory - free and attached gingiva, KERATINIZED
- lining (reflective) - whole oral cavity except gingiva, anterior palate, dorsum of tongue, movable, NON-keratinized
- specialized - NON-keratinized, tongue dorsum, taste buds
22
Q
PDL
A
- highly vascular
- cellular CT surrounds roots of teeth
- most fibers are collagen; ground substance consists of proteins and polysacchs
- hour-glass shaped
23
Q
most abundant cell type in PDL
A
fibroblasts
-ovoid/elongated, exhibit pseudo-podial-like processes
24
Q
epithelial rests of malassez
A
remnants of Hertwig’s root sheath, found as group epithelial cells in the PDL
-some degenerate; others become cementicles
25
PDL functions (5)
1. physical
2. formative
3. resorptive
4. nutritive
5. sensory
26
4 features that directly affect PDL health and its hard tissue anchorage to resist occlusal forces
1. anterior teeth have slight or no contact in MI
2. occlusal table is <60% overall F-L width of tooth
3. occlusal table at right angles to long axis
4. md molar crowns are inclined 15-20% to lingual
27
sensory fxns of PDL carried by what nerve?
2 types of nerve endings
CN V
1. free, unmyelinated -> PAIN
2. encapsulated, myelinated -> PRESSURE
28
PDL thickness avg?
PDL thickness depends on (4)
0.25 mm
1. age
2. stage of eruption
3. fxn of tooth
4. trauma hx
29
PDL has this type collagen fibers
what type of elastin fibers?
Type I collagen
2 immature elastin forms (oxytalan, eluanin) NO mature
30
__ fibers run parallel to root surface; bend to attach cementum in cervical third
oxytalan fibers
| -regulate vascular flow
31
PDL is derived from the
dental sac
32
PDL CT fibers, 2 groups
1. gingival - support marginal gingiva and papilla
incl. circular, dentogingival, dentoperiosteal, alveologingival, transseptal
2. principal - connect root cementum to bone
33
Sharpey's fibers
terminal part of PDL principal collagen fibers, embedded into cementum and bone
-diameter greater on bone side > cementum
34
principal fibers
1. horizontal
2. alveolar crest
3. oblique - resist along axis, mostly in root's middle third
4. apical - provides initial resistance in occlusal direction
5. interradicular - only multirooted teeth
35
gingival crevicular fluid
desquamating epithelium and neutrophils
- incr. flow is first sign of inflammation
- after inflammation -> high level of serum proteins and leukocytes
36
nutrients for gingival epithelium cells are from
capillaries in subjacent CT
37
dentojunctional epithelium
faces tooth, non-keratinized stratified squamous epithelium
composed of
1. sulcular epithelium
2. junctional epithelium
38
sulcular epithelium
lines sulcus, connects directly with JE
39
junctional epithelium
stratifed squamous epithelium attached by HEMIDESMOSOMES
10-20 cells thick at beginning -> few cell layers
2 layers - basal and suprabasal
in IDEAL gingiva, JE located entirely on enamel above CEJ
40
epithelial attachment is part of ___
components? (3)
JE, provides attachment
1. lamina lucida
2. lamina densa
3. hemidesmosomes
41
epithelial attachment does not contain ___ which free gingiva does
RETE PEGS
42
greatest contour of cervical lines and gingival attachments occur on the __ surface of the __ teeth
mesial surface of anterior teeth
| -mesial of central greatest
43
in absence of perio disease, crest of interdental alveolar septa is determined by
CEJ on adjacent teeth
44
width of interdental alveolar bone is determined by
tooth form present
45
autogenous free gingival graft
gingiva placed on viable C.T. bed where initially buccal or labial mucosa were present
- donor site is an edentulous region or palate
- maturation not complete til 10-16 wks
- most shrinkage in first 6 wks
46
free gingival graft
-remove attached gingiva from another part of mouth and suture it to recipient site
GOAL: more attached gingiva, root coverage
(hard to get root coverage because avascular graft/no blood)
INDICATIONS:
- prevent recession, widen attached gingiva
- cover dehiscences, fenestration
- with frenectomy
- correct localized NARROW recessions/clefts but not wide -> laterally repositioned flap (pedicle graft) better
47
FGG gets its nutrients from
viable C.T. bed
48
main reason FGG fails is
1. disruption of vascular supply
| 2. infxn
49
FGG rarely used for what surfaces
facial or lingual of md 3rd molars
50
FGG healing
- top layers last revascularized
- necrotic slough
- re-epithelialization by proliferation of epithelial cells from adj. tissue and surviving basal cells of graft tissue
51
free mucosal allograft is diff. from FGG in that
the transplant is C.T. without an epithelial covering
- epithelial differentiation is from underlying CT so grafts from keratinized areas will form keratinized tissue when transplanted
- often on CANINES where little keratinized gingiva exists to create some gingiva-like tissue
- healing is same as FGG
52
root amputation
usually mx 1st and 2nd molars
53
hemisection
usually md molar region
| -50% of tooth is ext if one specific root has excessive loss in osseous support
54
distal wedge (proximal wedge) flap
simplest distal flap for retromolar reduction
- often after 3rd molar ext (bone fill poor)
- region occupied by glandular and adipose tissue, covered by unattached, non-keratinized mucosa
-wedge base is periosteum overlying bone; apex is coronal gingival surface
55
where are distal wedge flaps
mx tuberosity
md retromolar triangle
distal to last tooth
mesial to tooth by edentulous area
56
osseous recontouring surgery goal
eliminate perio pockets
tx alternatives: periodic root planing, bone graft reattachment-fill procedures, hemisection, root amputation
57
most critical factor to determine if tooth should be ext or have surgery is
amt of attachment loss (apical migration of epithelium attachment)
58
primary objective of surgical flaps in treating perio disease is
access root surfaces for debridement
| -reduce/eliminate pockets, regrow bone, maintain biologic width, establish soft tissue contour
59
without visualization by flap, hard to root plane beyond __ mm of PD or into furcations of lesser depth
5 mm
60
if pt fails to demo good OH during initial therapy (SRP), ___ is contraindicated
surgery
- incidence of disease recurrence is greater if OH is poor
- --> stress OH, maintain with SRP
61
periodontal flap
design
segment of marginal perio tissue that's sx separated coronally and attached apically by pedicle of supporting vascular CT
- flap base must be uniformly thin 2 mm; corners ROUNDED
- base is wider than free margin (for blood)
- don't make incisions over defects in bone
- don't traverse bony eminence (canine) -> scar!
- don't incise in infected tissue (can spread)
- ROUND corners (or else delayed healing)
62
deep perio pockets are often treated by
flap surgery
| -reduced PD by formation of long junctional epithelium
63
best indicator of success of perio flap is
postop maintenance and plaque control by pt
64
most commonly used flaps
1. full thickness mucoperiosteal
- surface mucosa (epithelium, basement memb., CT., lamina propria), periosteum
- used when attached gingiva is < 2 mm
- APICALLY and CORONALLY positioned flaps
2. partial thickness
65
Modified Widman Flap (MWF) is what kind of flap?
used in?
what teeth?
full thickness mucoperiosteal
- used on open flap debridement; regenerative perio procedures
- single rooted teeth, flap surfaces of molars
66
Modified Widman Flap objectives?
indications?
- access, reduce pocket depth, preserve attached gingiva, heal by primary closure
- pocket bases coronal to MGJ, little or no thickened marginal bone, shallow to moderate pockets can be reduced, esthetics (anteriors)
67
Repositioned flaps incl. replaced flaps, MWF, excisional new attachment procedures
All heal by ___
repair - long junctional epithelium and CT adhesion or attachment, for POCKET REDUCTION
68
Partial thickness perio flap includes only __ epithelium and layer of __
used when attached gingiva is ___ mm
MUCOSA epithelium and layer of underlying C.T.
mucosa separated from periosteum by SHARP DISSECTION
to prepare sites for free gingival grafts, fix dehiscences/fenestrations
attached gingiva is THICK > 2 mm
69
___ and __ flaps can be displaced, but ___ cannot!
full thickness and partial thickness CAN
palatal CANNOT because it has NO unattached gingiva
70
3 types of POSITIONED FLAPS
1. Pedicle (laterally positioned) flap
- FULL thickness, fixes morphology/position/amt of attached gingiva
- indicated for NARROW gingival recession next to wide band of attached gingiva, corrects recession, WIDENS zone of gingiva
- attached at base by pedicle of lining mucosa and intact blood supply
2. Apically Positioned Flap
- FULL thickness, predictable, gets rid of deep pockets, retains attached gingiva, exposes alveolar margin (stimulates gingiva growth)
- indicated for moderate/deep pockets, furcations and CROWN LENGTHENING
- contraindicated for pts at risk for root caries
3. Coronally Positioned Flap
- FULL thickness
- to restore gingival height and attached gingiva over recession
71
double papilla flap is a variation of the __ flap
laterally positioned flap, the papilla on either side are placed over exposed root
72
no necrotic slough of positioned flaps because they ____
carry their vascular supply with them
73
Internal bevel incision objectives (3)
1. remove pocket lining
2. conserve uninvolved gingiva (if apically positioned, becomes attached gingiva)
3. produce a sharp, thin flap margin to adapt to the bone-tooth jxn
74
gingivoplasty is to
RESHAPE gingiva and papilla, NOT to get rid of pockets
ex. correct ANUG
75
gingivectomy is to ___
indications? contraindications?
ELIMINATE pocket depth by resecting tissue coronal to pocket base
- indicated for: pseudopockets, hereditary gingival enlargement, suprabony pockets, hyperplasia (Dilantin)
- contraindicated: infrabony pockets, lack of attached tissue, bad esthetics, no access, broad wounds
76
don't do a gingivectomy if ___
if base of pocket is located at the MGJ or apical to alveolar crest
77
factors to consider when electing to perform a gingivectomy rather than periodontal flap
- pocket depth
- access to bone
- amt of attached gingiva
78
___ is the removal of osseous defects or infrabony pockets by eliminating bony pocket walls
ostectomy
79
major contraindication for removing crestal bone is if ___
removal weakens the adjacent tooth's bony support
80
suprabony pockets, bone loss is horizontal/vertical?
horizontal, INTRAosseous
pocket base (epithelial attachment) is coronal to crest of alveolar bone
can be a GINGIVAL (relative/pseudopocket) - coronal movement of tissue, NOT apical, NO attachment loss
or PERIODONTAL (true) pocket - APICAL migration of epithelial attachment
81
horizontal/vertical? bone loss does NOT parallel CEJ, and is found in isolated teeth
VERTICAL
INFRAbony - classified by # bony walls left, pocket base is APICAL to crest of alveolar bone
82
Infrabony Wall Classifications
1-wall "hemiseptum" only proximal wall left, a "ramp" if only a facial or lingual wall is left
2-wall ex. interdental crater
3-wall an INTRAbony pocket, best for bone graft and regeneration
4-wall circumferential/moat, best for bone graft and regeneration
0-wall are dehiscences/fenestrations
combination - more walls apically > coronally
83
infrabony defects/pockets are contraindications for ___ surgery
MUCOGINGIVAL
84
osseous craters are __ % of all defects, and __ % of all mandibular defects?
more common in posterior/anterior?
1/3 (35%) of ALL defects
2/3 (62%) of all MANDIBULAR defects
more common in POSTERIOR
tx with osseous surgery
85
2 most critical factors to determine prognosis of periodontally involved tooth are
MOBILITY and ATTACHMENT LOSS
measuring attachment loss - probe from CEJ
ex. PD = 4 mm, recession = 3mm
- > loss = 7 mm
86
__ is reshaping/recontouring alveolar bone that does not provide attachment for periodontal fibers without removing supporting alveolar bone
OSTEOPLASTY
-similar to gingivoplasty (they're both not for eliminating pocket walls)
NON-supporting bone (bone not directly related to tooth support) removed ex. exostoses, edentulous ridges, tori
87
bone grafting most successful with a __(#) wall defect
least successful with?
narrow, 3-walled
> 2, 1
through and through furcation on Mx molar
88
most common side effect of autogenous bone grafts in infrabony pockets
root resorption
89
some postop probs that happen after osseous or marrow transplants
infection
graft exfoliation
prolonged healing
rapid defect recurrence
90
__ is a loss of buccal or lingual bone overlaying the root, leaving the root area only covered by soft tissue
dehiscence
91
__graft is taken from a HUMAN and placed in another HUMAN
ALLOgraft
92
__ __ is the bone donor graft with greatest osteogenic potential
hemopoietic marrow
93
Guided Tissue Regeneration (GTR) is?
placing non-resorbable barries or resorbable membranes & barriers over a bony defect
blocks re-population of root surface by long jxn epithelium & gingival CT -> allow PDL and bone cells to repopulate the defect
94
guided tissue regeneration assumes only __ cells have the potential to regenerate attachment apparatus
PDL cells
95
GTR non-resorbable barriers include
expanded polytetrafluoroethylene ePTFE
96
GTR resorbable membranes and barriers include
Type I bovine collagen, calcium sulfate, polyactic acid
97
tissue regeneration is predictable in these 4 circumstances
1. pt has good plaque control before and after
2. no smoking
3. there's occlusal stability
4. osseous defects are vertical with more walls
98
surgical dressing materials should be.. (4)
1. convenient
2. flexible, while providing stability
3. non-irritating
4. smooth surface
99
__ used to be the most popular agent in peiro dressings, but causes tissue injury and necrosis
today, dressings include (name 3)
EUGENOL
chemical cured - PerioCare, Coe-pak
visible-light cured - Baricaid
100
do periodontal dressings help healing?
NO, it's for comfort, tissue placement, and post-op bleeding
remove in 7-10 days
101
__ in gingiva has a turnover rate significantly greater than in tendons and palate, but not as rapid as in ___. It accounts for __ % of gingival protein
Type I collagen
not as rapid as in the PDL
60% of gingival protein
102
Vit C is required for hydroxylation of __ and __ which are essential for collagen formation
praline, lysine
103
junctional epithelium is
collar-like band of stratified squamous epithelium, 10-20 cells thick near sulcus -> 2-3 cells thick at apical end
ranges from 0.25-1.35 mm long
NON-keratinizing epithelium
has 2 basal laminas
104
__ cell layer is responsible for cell divisions, and contacts CT
proliferative cell layer
105
JE desquamative (shedding) surface is at the
coronal end, forms bottom of gingival sulcus
106
__ epithelium is more permeable than oral or sulcular epithelium
JXN
for passage of bacterial products from sulcus into CT, and for fluid and cells from CT into sulcus
107
long junctional epithelium refers to
junctional epithelium in disease
migration occurs with CT degeneration, as JE proliferates along root (gets longer), the coronal portion detaches
barrier membranes can help stop long JE from forming
108
epithelium attachment is the attachment apparatus that connects __ to __
JE to tooth surface via internal basal lamina and hemidesmosomes
109
etiology of gingivitis
bacterial plaque
gingivitis is the PREDOMINANT perio disease, NO radiographic features
110
3 stages of disease in developing gingivitis
1. transient (incipient) stage - leukocytes by JE
2. developing stage - fibrin, IgG, complement, B and T cells, macrophages
3. chronic stage - plasma cells, IgA in saliva
111
Ig_ is the most abundant in gingival exudates in gingivitis
IgG
lots of immunoglobulins are in epithelial and CT
112
ANUG - acute necrotizing ulcerative gingivitis "Vincent's infection" or "trench mouth" caused by these 2 bacteria
Signs and symptoms?
predisposing factors?
Tx?
```
Fusiform spirochetes (Treponema denticola)
Prevotella intermedia
```
odor, fever, lymphadenopathy, neutrophils dominate
factors - hx gingivitis, smoking, bad OH, fatigue, stress, nutrition, immunocompromised
Tx - debride, hydrogen peroxide, penicillin V
113
ANUG 2 most important clinical signs
1. interproximal necrosis & pseudomembrane formation on marginal tissues, NO attachment loss
2. Hx of soreness/pain and bleeding gums
114
gram (+/-) bacteria in acute gingivitis?
Gram +
| Actinomyces and Streptococci
115
__ are most abundant cells in ACUTE inflammation
phases (2)
PMNs (neutrophilic leukocytes)
-first line of defense, migrates into gingival sulcus
1. vascular - basophils, mast cells, platelets
2. cellular - PMNs (leukocytes) via chemotaxis (C5a, leukotriene B4)
macrophages represent a transition btw acute and chronic inflammation
116
local signs of acute inflammation usually accompanied by loss of fxn (5)
```
rubor (redness)
calor (heat)
tumor (swelling)
dolor (pain)
systemic effects
```
117
histamine is stored in what cells
mast cells, platelets, basophils
in VASCULAR phase of inflammation
anaphylactic response is characterized by degranulation of mast cells
118
gram (+/-) cells in CHRONIC gingivitis?
aerobic/anaerobic?
what 2 species account for 75?
gram - ANAEROBIC
provetella intermedia
capnocytophaga
119
in chronic gingivitis, there's an increase in what cells?
plasma -> secreting IgG
| B-lymphocytes
120
__ are most numerous cells in inflammatory exudates of acute perio abscesses
neutrophils
121
pellicle is a
type of bacteria?
glycoprotein deposit (plaque) from saliva
primary colonizers gram +
secondary are gram -
tertiary incl. spirochetes
122
pattern in plaque formation is a shift of gram __ bacteria to gram __ bacteria
gram + facultative aerobes ->
| gram - anaerobes
123
most abundant bacteria in a health sulcus are __ and __ species
streptococcus (gram +)
| actinomyces (filamentous)
124
normal gram + (list 4)
normal gram - (list 5)
gram +
streptococcus, peptostreptococcus, actinomyces, lactobacillus
gram -
veillonella, fusobacterium, corynebacterium, campylobacter, eikenella
125
pregnancy gingivitis
exaggerated response to plaque, loss in tissue tone, bright red, bleeding on pressure
1st or 2nd trimester can scale, polish, OHI
3rd - just OHI
during pregnancy, changes prob from PROGESTERONE and more MAST CELLS
126
pregnancy gingivitis assoc. with incr. levels of __
prevotella intermedia
127
most common gingivitis in school aged kids
localized acute gingivitis
128
desquamative gingivitis, most pts are males/females?
characterized by?
females 40-70, postmenopausal
chronic, erythematous, erosive, vesiculobullous, and/or desquamative involvement of free and attached gingiva
from allergic rxn, assoc. with dermatologic conditions
tx by topical corticosteroids
129
hereditary gingivofibromatosis
rare genetic disease, proliferation of gingiva
lack of inflammatory cells, proliferating capillaries, vascular engorgement
130
inflammatory gingival enlargement
increase in sulcular depth and pocket formation
131
drugs that induce OVERGROWTH (hyperplasia) of gingiva (3)
```
phenytoin (dilantin) <-- highest
cyclosporine A (immunosuppressant)
nifedipine (procardia) (Ca channel blocker)
```
132
how can you correct gingival contours for hereditary gingivofibromatosis and inflammatory gingival enlargement?
gingivectomy
133
periodontitis is marked by
apical migration of JE from CEJ, loss of CT attachment and PDL, bone destruction
134
more than __% of bone mass at the alveolar crest must be lost for a change in bone height to be recognized on radiographs
rdxn of __ to __ mm thickness of cortical plate is sufficient to permit xray visual of destruction of inner cancellous trabeculae
30%
| 0.5-1.0 mm
in health, crest lies 1-2 mm below CEJ
135
radiographic changes in periodontitis (3)
loss of lamina dura
horizontal or vertical bone resorption
widening of PDL space
136
loss of attachment is measured btw
attachment level is
CEJ and base of attachment
position of JE at base of pocket
137
__ is the most reliable indicator of gingival or periodontal inflammation
bleeding
138
clinical probing is greater/lesser than the histologic sulcus or pocket depth
ALWAYS GREATER
139
Naber's 2N (Hamp Probe) is used to
detect and dx 4 types of furcations
140
How can you treat Grade II furcations?
what teeth have the poorest prognosis after therapy?
guided tissue regeneration (GTR)
max 2nd molar
141
most common etiology for gingival recession is
toothbrush abrasion
142
toothbrush abrasion usually occurs on
canines and premolars
143
dentin is abraded __x faster, and cementum __x faster than enamel
dentin 25x
| cementum 35x
144
hydronamic theory
cause of root sensitivity, dentinal fluid movement in the tubules stimulate mechanoreceptors
145
dentinal hypersensitivity, main symptom?
how do you reduce it are removing a dressing?
COLD SENSITIVITY
keep roots free of plaque
146
how to treat dentinal hypersensitivity? (6)
1. topical fluoride - NOT acidulated phosphate fluoride
2. fluoride mouth rinses
3. desensitizing toothpastes
4. iontophoresis - electroplating fluoride
5. dentin bonding agents
6. root coverage with gingival surgery (FGG)
147
how do you calculate attached gingiva
subtract pocket depth from width of gingiva from free gingival margin to mucogingival margin
148
plaque is made of a
extracellular matrix contains:
inorganic compounds? (2)
dextran matrix
80% water, 20% solids (20% is bacteria)
1010 bacteria/mg
ECM contains protein, polysaccharide, lipids
calcium, phosphorus
149
bacterial constituents of plaque, early it's gram __ and as plaque ages the number of gram __ decreases while number of gram __ increases
Early, gram + facultative bacteria ->
Later, gram - anaerobic
As it ages, gram + aerobic DECR.
and gram - anaerobic INCREASES
150
Stages of plaque formation (3)
1. Acquired pellicle formation
- made of albumin, lysozyme, amylase, IgA, proline-rich proteins, mucins
- bacteria free
2. Bacterial colonization
3. Maturation
- bacterial intercellular adhesion -> calculus
151
primary plaque colonizers are
secondary plaque colonizers are
tertiary plaque colonizers are
1: gram + facultative bacteria
Strep sanguis, Strep mutans, Actinomyces viscosus
2: gram - bacteria
Fusobacterium nucleatum, Prevotella intermedia, Capnocytophaga species
3: gram - anaerobic rods
Porphyromonas gingivalis, campylobacter rectus, Eikenella corrodens, Actinobacillus actinomycetemcomitans/AA, spirochetes (treponema)
152
supragingival plaque is dominated by
subgingival plaque is dominated by
gram + facultative cocci
gram - anaerobic rods
153
what is the most plaque retentive factor
calculus
154
microbiologic etiologic factor in perio disease is __ but ___ is the most significant local contributing factor
dental plaque
calculus
155
composition of calculus is
70-90 % inorganic
^at least 2/3 of that is CRYSTALLINE
10-15% organic - microorganisms, epithelial cells, leukocytes, mucin
156
phases of calculus formation (3)
how many days does it take?
1. pellicle
2. plaque maturation
3. " mineralization, bathed plaque in calcium and phosphorus from saliva
12 days
157
supragingival calculus, main source?
__ __ is the most common echanism that allows it to attach to smooth enamel
saliva
salivary pellicle
158
subg calculus, source of minerals?
attachment is complicated by irregularities like:
crevicular fluid
darker from blood pigments, usually distributed evenly
irregularities: cemental tears, cemental voids (once occupied by Sharpey's fibers), resorption bays, other cementum defects
159
endotoxin is
LPS = lipopolysaccharide base
| constituent of gram - microorganisms, can promote bone resorption, inhibit osteogenesis, chemotaxis of neutrophils
160
enzymes that plaque bacteria produce (5)
collagenase - from bacteroides
hyaluronidase - from strep mitans and salivarius (breaks ground substance)
chondroitin sulfatase - by diptheroids (breaks ground substance)
elastase
proteases
161
aggressive periodontitis (previously juvenile or early onset) has 2 forms:
1. Generalized
prevotella intermedia, eikenella corrodens
2. Localized
gram - anaerobes
actinobacillus, capnocytophaga
confined to INCISORS and 1st MOLARS
162
AA & capnocytophaga are also assc. with perioodontitis in what condition
juvenile diabetes
163
bacteria assoc. with periodontal health are gram __
what 2 species?
+, nonmotile, facultative anaerobes
strep and actinomyces species
164
bacteria in perio disease are gram __
gram -, motile, strictly anaerobic
```
AA
P. gingivalis
Bacteroides forsythus
Treponema denticola, sokranskii
P. intermedia
Eikenella, Campylobacter, fusobacteirum, peptostreptococcus
Pseudomonas, eubacterium
```
165
juvenile periodontitis principal bacteria (3)
capnocytophaga
prevotella intermedius
eikenella corrodens
Generalized - assoc. with systemic diseases
Localized - first molars, anterior teeth, absence of plaque!
166
conditions that predispose a pt to developing inflammatory perio disease
```
pregnancy
neutropenia
agranulocytosis
leukemias
diabetes mellitus
```
167
perio disease might be an AUTOIMMUNE disorder, possible immune factors are:
interleukin-1 beta, interleukin-4, tumor necrosis factor alpha, prostaglandin E-2
168
in excess, cytokines overproduce the enzyme
collagenase! also causes inflammation, severe damage
169
people with hyper-inflammatory monocyte/macrophage phenotype secrete more
```
pro-inflammatory mediators like
IL-1 beta
IL4
TNF-alpha
PGE2
```
170
perio disease can be assoc. with these systemic diseases
Down's
HIV/AIDS
hormone imalances
uncontrolled type I and II diabetes
171
people with type I and II diabetes have __x the risk of getting perio disease
15x
172
the single major preventable risk factor for perio disease
smoking
- reduce oxygen, trigger cytokines
- cigars and pipes are equal risk
173
autoimmune conditions assoc. with perio disease
Crohn's
rheumatoid arthritis
lupus erythematosus
CREST syndrome
174
purpose of SRP is to remove (3)
calculus, bacteria, endotoxins
175
there's potential for abscess formation in a deep pocket only when
a superficial scaling is performed
176
sharpening, degrees?
__ is used with natural stone
__ used with synthetic
100-110
oil + natural
water + artificial
177
in RP, working stroke begins at __ edge of JE (base of the pocket)
APICAL
178
difficult to do SRP on these surfaces (3)
mesial of max premolars
proximal of md incisors
trifurcations of max molars
179
if after SRP pt returns in a week with hard, black deposits around gingival margin, it means
rdxn in inflammation, and now old calculus is exposed
180
best criterion to evaluate success of SRP is
no bleeding on probing
181
periodontal hoes and files are used exclusively for
heavy accessible SUPRAgingival calculus
hoes - single straight cutting edge, good for buccal and lingual surfaces
files - fxn to crush or fracture calculus, good for B/L, next to edentulous areas, reduce amalgam overhangs
182
order of strokes in root planing
vertical ->
oblique ->
horizontal
183
objective of gingival curettage
re-epitheliazation occurs within __ days
remove chronically inflamed, diseased epithelial lining and microorganisms from pocket to reduce edema and pocket depth
often with RP to promote soft tissue attachment
7-10 days
184
most important factor to determine amt of shrinkage is
degree of edema in tissue
healing starts with blood clot formation
185
instrument that's least traumatic and most effective for non-surgical RP
periodontal curette
for subg calculus
186
chisel designed to remove
SUPRAgingival calculus in IP areas
187
main fxn of cementum is
2 types of collagen are
attachment of PDL principal fibers
Sharpey's fibers - terminal parts of PDL, run PERPENDICULAR to cementum
Type I collagen fibers - PARALLEL to cementum
188
radicular cementum increases/decreases with age?
thickness?
2 types
INCREASES
0.05-0.6 mm
cellular - apical third, has cementocytes in lacunae
acellular - FIRST cementum to be formed, coronal 2/3, thinnest at CEJ and is part of tooth anchorage
189
primary occlusal trauma
early effects?
secondary occlusal trauma
normal supporting structures, no perio disease, reversible
early effects are hemorrhage and thrombosis of PDL blood vessels
secondary when periodontium compromised
190
teeth tend to loosen in what direction?
BL
191
most common symptom with PERIODONTAL ABSCESS is
tx if localized?
acute pain - constant, severe, dull throbbing
thermal changes don't elicit or modify the discomfort
localized -> drain, but if not then antibiotics
192
PERIO-ENDO ABSCESS tx?
Signs and symptoms?
RCT -> 2-3 months -> antibiotics, SRP, perio surgery if needed
radiographic involvement of periodontium and periapex, significant probing depths, percussion and pulpal sensitivity
193
PERIODONTAL CYST can present as a
localized tender swelling
- usually asymptomatic
- see on xray interproximal perio cyst on side of the root (can't differentiate from perio abscess)
194
APICAL PERIODONTAL CYST has a predilection for what area?
teeth are vital/non-vital? symptomatic/asymptomatic?
mandibular canine-premolar
vital, asymptomatic
-no perio pockets
-surgical removal of cyst
195
toothpaste ingredients (6)
1. Polishing
2. Binder (thickener)
3. Surfactant - sodium lauryl sulfate
4. Humectant - retains moisture
5. Flavoring
6. Active ingredient
196
Polishing (abrasive agent) in toothpaste can be (3)
what does it do?
contraindications of using abrasives and/or rotary polishing instruments are:
silica, calcium carbonate, alumina
removes stain, stained pellicle, plaque
contraindicaitons: pts with communicable disease/respiratory probs, "green stain," newly erupted teeth, pts at risk for caries
197
active ingredients in toothpaste include
```
fluoride
triclosan - antiplaque
pryophosphate - anticalculus
potassium nitrate - desensitizing
peroxides
```
198
3 toothbrushing methods
1. Bass (Sulcular) - 45 deg to tooth surface at gingival margin, PREFERRED METHOD
2. Modified Stillman (Roll) - bristles on cervical of tooth pointing to gingival margin, brush moves coronally
3. Charter's - point away from gingiva at 45 deg
199
what color stains on anterior teeth are caused by poor OH?
orange
green
brown
200
Other homecare perio aids (5)
1. Perio-Aid - like toothpick, clean at gingival margins
2. Stim-U-Dent for interndental recession
3. Interproximal brushes (proxabrush)
4. Interdental stimulator - rubber tip, stimulates circulation of interdental gingiva
5. Water irrigating devices - remove food debris, non-adherent bacteria, CONTRAINDICATED in pts with periodontal inflammation, pts on antibiotics (can cause bacteremia)
201
fluoride, ___, and __ can inhibit microbial plaque
fluoride
antibiotics
chlorhexidine
202
chlorhexidine gluconate
has alcohol, best antimicrobial for reducing plaque and gingivitis over long-term, absorbed onto teeth and pellicle and slowly released, stains oral tissues yellow-brown
203
what essential oils are the active ingredients in phenol based mouthrinses?
contain what % alcohol?
thymol
menthol
eucalyptol
methyl salicylate
20-27% alcohol
204
stannous fluoride antimicrobial action related to what ion?
it is anti-___
TIN
antiCARIES only
205
quaternary ammonium compounds are good for
getting rid of bad breath
| -contains cetylpyridinium
206
what is ATRIDOX?
doxycycline hyclate 10%
locally applied antibiotic, placed below gum line into pockets, bioabsorbable, releases abx for 21 days
207
what is ARESTIN?
minocycline hydrochloride
powder form, inside pockets after SRP, microspheres release abx 21 days
208
what is ACTISITE?
tetracycline hydrochloride
- periodontal fiber as adjunct to perio therapy to reduce pockets and bop
- NON-bioabsorbable -> remove ater 10 days
209
what is PERIOCHIP?
chlorhexidine gluconate
| -into pockets as adjunct to SRP, bioabsorbable
210
Extrinsic dental stains
1. brown is due to __
2. tobacco
3. black caused by
4. green or green-yellow common in what age group? due to what bacteria?
5. metallic
1. brown - pellicle, TANNIN
2. tobacco - coal tar
3. black - CHROMOGENIC bacteria (actinomyces)
4. green - kids, FLUORESCENT bacteria
5. metallic - metal dust, drugs with metals
