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NBDE II Board Busters > Periodontics > Flashcards

Flashcards in Periodontics Deck (210):
1

periodontium is composed of? (4)

-gingiva
-PDL
-cementum
-alveolar and supporting bone

2

attachment apparatus (3)

-alveolar bone proper
-PDL fibers
-cementum

3

gingival apparatus (2)

-gingival fibers
-epithelial attachment

4

gingival ligament (3)

fibers:
-dentogingival
-alveologingival
-circular

5

Alveolar process

1. Alveolar bone proper - inner layer of compact lamellar bone, surrounds where PDL fibers attach, vessels and nerves pass btw PDL and bone marrow

2. Supporting alveolar bone - cortical plate (compact lamellar), spongy (cancellous, NOT in anterior mouth)

6

small collagen fibers in the PDL that run in all directions and are assoc. with larger principal collagen fibers is the

indifferent fiber plexus

7

free gingiva components (4)

1. gingival margin
2. free gingival groove - sep. free gingiva from attached, only in 33% ppl
3. gingival sulcus - btw marginal gingiva and tooth, bound by sulcular epithelium laterally and JE apically
4. interdental (interprox) gingiva

8

gingival fibers have type __ collagen

found in what part of gingiva?

Type I

free gingiva, continuous with PDL

9

types of gingival fibers (5)

1. alveologingival - alveolar process to lamina propria in free gingiva

2. circular - resists ROTATION, inserts into cementum and lamina propria of free gingiva and alveolar crest

3. dentogingival - from cementum apical to epithelial attachment (JE); into lamina propria of gingiva

4. dentoperiosteal - cervical cementum to periosteum of cortical plates

5. 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

ATTACHED GINGIVA

-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

where is the narrowest band of attached gingiva

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

with of facial attached gingiva ranges from __ to __ mm

where is it widest? narrowest?

1-9 mm

facial of mx lateral; narrowest on facial of md canine and 1st PM

13

what is the functionally adequate zoe of gingiva

keratinized, firmly bound to tooth and underlying bone, 2mm_ wide, resistant to probing and gaping when lip is distended

14

boundaries of attached gingiva

MGJ to gingival groove (base of sulcus)

15

MGJ separates __

free gingival groove separates __

free gingiva extends from __ to __

attached gingiva from alveolar mucosa

free gingiva from attached gingiva

free gingival groove to gingival margin

16

what is stippling?

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

what type of epithelium is all oral mucosa?

stratified squamous REGARDLESS if it's keratinized or not

18

non-keratinized oral mucosa found in

-buccal and alveolar mucosa
-tongue's inferior (ventral) surface
-soft palate
-FOM
-special and lining mucosa
-col
-crevicular epithelium

19

alveolar mucosa

-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

keratinized oral mucosa found in

-hard palate
-attached gingiva

21

functional oral mucosa includes (3)

1. masticatory - free and attached gingiva, KERATINIZED

2. lining (reflective) - whole oral cavity except gingiva, anterior palate, dorsum of tongue, movable, NON-keratinized

3. specialized - NON-keratinized, tongue dorsum, taste buds

22

PDL

-highly vascular
-cellular CT surrounds roots of teeth
-most fibers are collagen; ground substance consists of proteins and polysacchs
-hour-glass shaped

23

most abundant cell type in PDL

fibroblasts
-ovoid/elongated, exhibit pseudo-podial-like processes

24

epithelial rests of malassez

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