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Periodontics > Written Paper > Flashcards

Written Paper Flashcards

1
Q

4 components of the periodontium

A

Gingiva
Periodontal ligament
Alveolar bone
Cementum

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2
Q

4 features of healthy gingiva

A

Pink
Stippled in texture
Knife-edged margins
Scalloped profile

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3
Q

2 functions of gingiva

A

Attachment between oral mucous membrane and hard tissues
Protects the underlying periodontal tissues from invasion by bacteria

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4
Q

3 types of gingival epithelium

A

Junctional epithelium
Sulcular/crevicular epithelium
Oral gingival epithelium

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5
Q

5 features of junctional epithelium

A

Stratified squamous non keratinised epithelium
Forms attachment of gingiva to tooth by hemi-desmosomes and internal basal lamina
Epithelial attachment to enamel which terminates apically at cementum-enamel junction
Very high cell turnover
Permeable epithelium

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6
Q

3 features of crevicular epithelium

A

Stratified squamous non-keratinised epithelium
Lines gingival crevice, not attached to tooth surface
0.5-2 mm in depth

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7
Q

3 features of oral gingival epithelium

A

Stratified squamous, keratinised epithelium
Masticatory mucosa
Rete pegs interdigitate with dermal papillae of the underlying connective tissue

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8
Q

4 components of gingival connective tissue

A

Collagen fibres embedded in an extra cellular matrix
Fibroblasts
Many blood vessels
Nerve cells

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9
Q

2 functions of fibroblasts

A

Secrete all components of the extracellular matrix including collagen fibres
Responsible for degradation of the matrix through secretion of MMPs

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10
Q

What is the periodontal ligament

A

A specialised gomphosis fibrous attachment of the tooth to alveolar bone

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11
Q

What is alveolar bone

A

The component of the maxilla or mandible which surrounds and support the teeth

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12
Q

3 components of alveolar bone

A

Alveolar bone proper
Cancellous/spongy bone
Cortical plates

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13
Q

What is cementum

A

Calcified mesenchymal tissue that covers entire root surface

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14
Q

2 types of cementum

A

Cellular cementum
Acellular cementum

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15
Q

3 functions of cementum

A

Anchorage
Protection
Repair

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16
Q

8 plaque retentive factors

A

Calculus
Poor restoration margins
Tooth position
Developmental anomalies
Oral appliances
Xerostomia
Gingival enlargement
Incompetent lip posture

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17
Q

6 stages in classifying periodontal disease

A

Condition
Pattern
Stage
Grade
Stability
Risk factor profile

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18
Q

6 considerations for risk factor status

A

Smoking
Poorly-controlled diabetes
Family history
Poor plaque control
Subgingival deposits of calculus
Local factors: mouth-breathing, crowding

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19
Q

6 periodontal indices

A

Plaque index
Periodontal pocket depths
Bleeding on probing
Mobility
Gingival recession
Presence of furcation defects

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20
Q

Choice of radiographs for generalised moderate/advanced periodontal disease

A

OPT plus anterior IOPAs

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21
Q

Choice of radiographs for mild periodontal disease

A

Bite-wings plus anterior IOPAS

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22
Q

Choice of radiographs for localised advanced periodontal disease

A

Additional IOPA

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23
Q

3 methods of mechanical plaque control

A

Bass method of toothbrushing – intrasulcular
Interdental flossing
Interdental brushing

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24
Q

Method of chemical plaque control

A

Chlorhexidine mouthwash: 0.2% chlorhexidine gluconate, 10ml rinse (20mg)

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25
Q

Mechanical and hand-instrumentation methods of root surface debridement (RSD)

A

Mechanical: ultrasonic scalers, sonic scalers

Hand instrumentation: site-specific curettes, hoes

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26
Q

4 modes of action of mechanical scalers

A

Mechanical energy
Irrigation
Cavitation
Acoustic microstreaming

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27
Q

Features of piezo–electric ultrasonic scaler

A

Linear movements of tip
Vibrations caused by oscillations of quartz crystals in the handpiece

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28
Q

Features of magnetostrictive ultrasonic scaler

A

Eliptical movements of tip
Magnetic energy converted to mechanical energy to create vibrations

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29
Q

5 principles of ultrasonic instrumentation

A

0 -15 degrees to tooth
Insertion at gingival margin
“Exploring” pressure
Keep tip in motion
Bidirectional stroke

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30
Q

4 advantages of ultrasonic scaling

A

Irrigation with water clears the field of debris and blood
Allow quick removal of gross deposits
Less tiring for the operator
Can be used to remove overhanging margins on amalgam restorations

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30
Q

5 disadvantages of ultrasonic scaling

A

Generate significant heat and require continual water coolant
Generate contaminated aerosols
Water/aerosol can obscure vision
Can damage teeth and restorations
Cause significant sensitivity

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31
Q

What are the types of Graceys curettes and what surfaces of which teeth are they used for

A

1, 2: all surfaces of anterior teeth

5, 6: all surfaces of anterior teeth

11, 12: buccal, lingual, mesial surfaces of posterior teeth

13, 14: distal surface of posterior teeth

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32
Q

4 advantages of hand scaling

A

Hand instruments allows the operator tactile sensitivity
No aerosol is generated
May provide better access, especially deeper sites (>5mm)
Patients report less sensitivity and less discomfort during the procedure

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33
Q

3 disadvantages of hand scaling

A

Can cause more operator fatigue
Are more time consuming compared to ultrasonics
Are more difficult to use effectively

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34
Q

5A’s of smoking cessation

A

Ask
Assess
Advise
Assist
Arrange

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35
Q

4 host defence mechanisms against periodontal disease pathogens

A

Saliva
Epithelial barrier
Inflammatory response
Immune response

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36
Q

2 functions of inflammation

A

Isolate, neutralise and remove cause
Initiate healing and repair

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37
Q

Red complex organisms

A

Porphyromonas Gingivalis
Treponema Denticola
Tannerella Forsythia

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38
Q

2 Porphyromonas gingivalis virulence factors

A

Production of proteases which degrade complement, immunoglobulins and collagen
Polysaccharide capsule

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39
Q

2 Tannerella forsythia virulence factors

A

Production of trypsin-like proteases Production of glycosidase enzymes

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40
Q

Treponema denticola virulence factor

A

Production of potent hydrolytic enzymes including collagenases and proteases

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41
Q

3 patients who would benefit from being prescribed high fluoride toothpaste

A

High caries risk
Xerostomia
Orthodontic appliances

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42
Q

2 concentrations of high fluoride toothpaste

A

2800ppm
5000ppm

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43
Q

Describe the Bass technique of toothbrushing

A

45 ̊ angle to the tooth surface
Bristles below the gum margin
Circular motion
Firm yet gentle pressure
At least 2 minutes

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44
Q

Concentration of the active ingredient in Chlorhexidine mouthwash

A

0.2% chlorhexidine gluconate

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45
Q

2 important properties of Chlorhexidine mouthwash

A

Antibacterial
Substantivity

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46
Q

3 possible side effects of Chlorhexidine mouthwash

A

Staining
Altered taste sensation
Hypersensitivity

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47
Q

4 signs of inflamed gingiva

A

Red colour
Bleeding on brushing/probing
Bad breath
Receding gingiva

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48
Q

4 areas early plaque formation occurs faster in

A

Lower jaw
Molar areas
Buccal tooth surfaces
Interdental regions

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49
Q

5 bacterial pathogens associated with periodontal disease

A

Porphyromonas Gingivalis
Tannerella Forsythia
Treponema Denticola
Fusobacterium Nucleatum
Prevotella Intermedia

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50
Q

Define the periodontium

A

Supporting apparatus of the tooth

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51
Q

Describe the variation in width of attached gingiva

A

Wider in incisor regions
Narrower over canines and 1st premolars

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52
Q

Describe the role of collagen fibres in withstanding occlusal loading during tooth function

A

Capable of remodelling and stretching during occlusal loads whilst maintaining their overall structure

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53
Q

Describe the role of GAGs in withstanding occlusal loading during tooth function

A

Bind water and act as a hydraulic cushion to allow the PDL to resist compressive forces

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54
Q

4 antibacterial effects of saliva

A

Washing effects
Inhibition of attachment of bacteria (sIgA)
Killing bacteria by peroxidase system
Killing bacteria by lysozyme, lactoferrin, histatins

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55
Q

3 causes of xerostomia

A

Drug-induced: antihypertensives, antidepressants
Head and neck radiation
Salivary disease

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56
Q

6 methods of bacterial pathogenic synergy in periodontal disease

A

Bacterial signalling relays information about the biofilm environment
Bacterial gene transfer
Co-adhesion between bacteria allows organisation of the biofilm architecture
Protection provided by extracellular polymeric matrix and other bacteria
Provision of essential nutrients
Adherence to the enamel pedicle to resist the removal forces of GCF

57
Q

Describe how to measure probing pocket depth

A

Gingival margin – base of pocket

58
Q

Describe how to measure clinical attachment loss

A

Cementum-enamel junction – base of pocket

59
Q

When does clinical attachment loss > probing pocket depth

A

Gingival recession

60
Q

When does probing pocket depth > clinical attachment loss

A

Gingival swelling

61
Q

Define Miller’s index score 0

A

No, or physiological movement

62
Q

Define Miller’s index score 1

A

Buccal-lingual movement <1 mm

63
Q

Define Miller’s index score 2

A

Buccal-lingual movement ≥1mm

64
Q

Define Miller’s index score 3

A

Buccal-lingual movement ≥1mm and vertical movement

65
Q

Describe Miller’s index

A

Used to assess the mobility of teeth by using the ends of a dental instrument e.g mirror

66
Q

3 things accurate probing depends on

A

Probing force
Probe placement
Probe angulation

67
Q

4 potential problems that may affect your ability to complete an accurate probing record

A

False pocketing
Subgingival calculus
Overcrowding
Orthodontic appliances

68
Q

Define gingivitis

A

Inflammatory response of the marginal gingiva, reversible condition

69
Q

Define periodontitis

A

Inflammatory condition resulting in the irreversible loss of the tooth supporting structures, periodontal ligament and alveolar bone

70
Q

5 features of supra-gingival calculus

A

Attached to tooth
Creamy-yellow
Brittle
Easily removed from tooth
Visible

71
Q

5 features of sub-gingival calculus

A

Attached to root surfaces
Brown/Black
Very hard
Tenacious
Detected by gentle probing/ radiograph

72
Q

6 clinical presentations of periodontitis

A

Formation of periodontal pockets
Bleeding on probing
Gingival inflammation
Drifting of teeth
Tooth mobility
Gingival recession

73
Q

Radiographic presentation of periodontitis

A

Loss of alveolar bone - >1.5mm apical to CEJ

74
Q

Classify the pattern of periodontitis

A

Localised: ≤ 30% teeth involved
Generalised: > 30% teeth involved
Molar-incisor distribution: only molar and incisor teeth involved

75
Q

Classify the staging of periodontitis

A

Stage I : < 15% or < 2mm attachment loss from CEJ
Stage II : coronal third of the root
Stage III : middle third of the root
Stage IV: apical third of the root

76
Q

Classify the grading of periodontitis

A

Grade A: < 0.5
Grade B: 0.5-1
Grade C: > 1

77
Q

Classify the current disease status of periodontitis

A

Stable: BoP<10%; PPD≤4mm, no BoP at 4mm sites
Remission: BoP≥10%; PPD≤4mm; no BoP at 4mm sites
Unstable: PPD≥5mm or PPD≥4mm with BoP

78
Q

3 types of hand scalers

A

Gracey curettes
Periodontal hoes
Sickle scaler

79
Q

2 types of mechanical scalers

A

UItrasonic scalers
Sonic scalers

80
Q

2 types of ultra-sonic scalers

A

Piezo-electric
Magnetostrictive

81
Q

3 histological changes following successful non-surgical therapy

A

Decreased vasodilation and number of inflammatory cells
Remodelling of alveolar bone
Deposition of collagen fibres

82
Q

5 clinical changes following successful non-surgical therapy

A

Decreased inflammation and swelling
Decreased redness
Decreased bleeding
Decreased probing depths
Reduction in subgingival calculus

83
Q

4 important factors for successful non-surgical treatment

A

High standard of plaque control
Smoking cessation
Good quality root surface debridement
Good quality restorative treatment

84
Q

Features of alveolar bone proper

A

Consists of thin lamella of bone that surrounds the root of the tooth
Gives attachment to the principal fibres of the periodontal ligament
Perforated due to ingress of vessels/nerves

85
Q

Features of cancellous bone

A

Surrounds the alveolar bone proper and gives support to the socket
Spongy bone consists of widely spaced concentric or tranverse lamella enclosing the marrow spaces

86
Q

Features of cortical plates

A

Forms the outer and inner plates of the alveolar bone

87
Q

Cells responsible for alveolar bone resorption

A

Osteoclasts

88
Q

Cells responsible for alveolar bone deposition

A

Osteoblasts

89
Q

Features of cementum

A

It is avascular and not innervated
Formed slowly throughout life
Thicker at root apices
Resistant to resorption

90
Q

Features of cellular cementum

A

Contains cementocytes in lacunae which resorb cementum
Communicate with each other through a network of canaliculi

91
Q

Features of acellular cementum

A

Forms a thin surface layer which is often confined to cervical portions of the root
Cementoblasts are found on its surface

92
Q

Define hypercementosis

A

Excessive deposition of cementum usually at apical area of roots

93
Q

4 host defence mechanisms

A

Saliva
Epithelial barrier
Inflammatory response
Immune response

94
Q

Features of inflammation response

A

Rapid
Relatively non-specific

95
Q

Cellular exudate of inflammatory response

A

Neutrophils
Macrophages

96
Q

2 disorders which affect inflammatory response in periodontal disease

A

Leucocyte adhesion deficiency
Cyclic neutropenia

97
Q

Features of adaptive immune response

A

Exhibits memory
Highly specific

98
Q

Histology of healthy gingiva

A

Few PMNs migrating through JE

99
Q

Histopathology of early lesion (4-7 days)

A

Increased neutrophil migration
Macrophage and lymphocytic infiltrate
Localised collagen degradation
Localised fibroblast degeneration

100
Q

Histopathology of established lesion (14-21 days)

A

Neutrophils walling off plaque
Increased lymphocytic infiltrate
60-70% collagen destruction
Lateral proliferation of JE with micro-ulceration
False pocket formation

101
Q

Histopathology of periodontitis

A

Apical migration of JE
Loss of periodontal ligament attachment
Loss of alveolar bone
Micro-ulceration of JE
True pocket formation

102
Q

When do you get false pocket formation

A

Gingivitis

103
Q

5 stages of development of a plaque biofilm on a clean tooth surface

A
  1. The pellicle derived from saliva forms on a clean tooth surface
  2. Initially gram-positive cocci predominate in oral biofilms
  3. After a few hours the plaque bulk increases by bacterial division
  4. As plaque matures, gram positive bacteria are gradually replaced by gram negative species
  5. Gram negative filamentous forms such as fusiforms and spirochaetes appear in the later stages of plaque maturation
104
Q

Composition of dental plaque

A

80-90% water

105
Q

Composition of calculus

A

70-80% inorganic salts

106
Q

Bacteria found in supra-gingival plaque

A

Mostly gram positive, aerobic bacteria

107
Q

Bacterial composition of sub-gingival plaque

A

Gram negative rods and spirochetes, anaerobic bacteria

108
Q

Describe the ecological plaque hypothesis for the development of periodontal disease

A

Organisms associated with disease may be found at healthy sites but at levels that are too low to be clinically relevant

Disease occurs as a result of a shift in the balance of the resident microflora due to a change in the local environmental conditions

The amount of dental plaque and the specific microbial composition of the plaque contribute to the transition from health to disease

The destruction in periodontal disease is the outcome of interactions between the host and the microbial challenge

109
Q

Important message of the Ecological plaque hypothesis

A

Periodontal disease can be prevented, not only be targeting the putative pathogens, but also by interfering with the environmental factors which drive the changes in the balance of microflora

110
Q

5 components of bacterial pathogenic synergy in periodontal disease

A

Bacterial signalling relays information about the biofilm environment
Bacterial gene transfer
Co-adhesion between bacteria allows organisation of the biofilm architecture
Protection provided by extracellular polymeric matrix and other bacteria
Provision of essential nutrients
Adherence to the enamel pedicle to resist the removal forces of GCF

111
Q

Calculation to determine plaque score

A

Number of surfaces exhibiting plaque / number of available surfaces x 100

112
Q

2 probes for measuring periodontal disease

A

Williams probe
WHO probe

113
Q

Light probing force

A

20-25g

114
Q

Features of WHO probe

A

Ball end is 0.5mm in diameter
First black band is found at 3.5mm to 5.5mm

115
Q

5 things radiographic periodontal assessment allow us to determine

A

Bone loss: severity, pattern
Presence of sub-gingival calculus
Restoration margins
Presence of furcation
Peri-apical radiolucencies

116
Q

4 components of periodontal disease prevention

A

OHI
Diet advice
Smoking cessation advice
Medication advice

117
Q

What does non-surgical management of periodontal disease involve

A

Removal and control of plaque bacteria and their products
Removal of plaque-retentive factors

118
Q

Uses for a WHO probe

A

Detect developing periodontal pockets
Measure the depths of the pockets and any loss of attachment to periodontal structures
Detect calculus and measure furcation involvement

119
Q

Describe BPE 0 score

A

Pockets <3.5mm (black band entirely visible)
No calculus/overhangs, no bleeding on probing

120
Q

Describe BPE 1 score

A

Pockets <3.5mm (black band entirely visible)
No calculus/overhangs, bleeding on probing

121
Q

Describe BPE score 2

A

Pockets <3.5mm (black band entirely visible)
Supra or subgingival calculus/overhangs

122
Q

Describe BPE score 3

A

Probing depth 3.5-5.5mm (black band partially visible)
Indicating pocket of 4-5mm)

123
Q

Describe BPE score 4

A

Probing depth >5.5mm (black band disappears)
Indicating a pocket of 6mm or more

124
Q

Describe * BPE

A

Furcation involvement

125
Q

Management of BPE score 0

A

No need for periodontal treatment

126
Q

Management of BPE score 1

A

OHI

127
Q

Management of BPE score 2

A

OHI
Removal of plaque retentive factors

128
Q

Management of BPE score 3

A

OHI
Removal of plaque retentive factors
Root surface debrivement if required

129
Q

Management of BPE score 4

A

OHI
Removal of plaque retentive factors
Root surface debridement
Referral to specialist if indicated

130
Q

Define chemotaxis

A

The movement of an organism in response to a chemical stimulus

131
Q

Define cytokine

A

Small protein produced mainly by macrophages that facilitate cell-cell communication via paracrine/autocrine signalling

132
Q

Define phagocytosis

A

Process initiated by innate immune response, where pathogens are engulfed and degraded

133
Q

Under what circumstances can the clinical attachment loss measurement be greater than the probing pocket depth

A

When the patient has significant gingival recession most likely due to advanced periodontitis

134
Q

Recall for periodontal review

A

6/8 weeks

135
Q

Define cross infection

A

Transmission of a pathogenic organism from one person to another

136
Q

6 measures to prevent cross infection control

A

Dress code
PPE
Hand hygiene
Zoning
Decontamination
Segregation of waste

137
Q

How will Amiodipine therapy affect treatment

A

Calcium channel blocker
Risk of gingival overgrowth
Increased risk of gingivitis and periodontitis therefore need to emphasise good OHI

138
Q

How will Warfarin therapy affect treatment

A

Anticoagulant
Increased bleeding time
Need to check INR is below 4.0

139
Q

How is stage of periodontal disease determined

A

Extent of interproximal bone loss recorded in the site with the most bone loss

140
Q

How is grade of periodontal disease determined

A

Percentage bone loss at worst site / patients age

Periodontics (1 decks)

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