10. Acute and Chronic Periodontal Conditions

Question 1

Etiology of periodontal abscess
• Failure of \_\_\_\_ to drain
• Changes in \_\_\_\_ environment 
• Introduction of \_\_\_\_ 
• Furcations
• Poorly controlled \_\_\_\_

Answer 1

pocket
local
foreign body
diabetics

Question 2

The periodontal abscess
• Gingival abscess-confined to the ____

We have a gingival or periodontal abscess. The differences is gingival abscess is ____ to the pdl and alveolar crest, and periodontal abscess is within.

Answer 2

gingiva

coronal

Question 3

The periodontal abscess

• Periodontal abscess-an acute exacerbation of ____ process

Answer 3

inflammatory

Question 4

Clinical features of an abscess
• \_\_\_\_ pain
• \_\_\_\_ soft tissue swelling
• The tooth feels ”\_\_\_\_”
• Possible \_\_\_\_ glands,facial swelling 
• Possible \_\_\_\_

Answer 4

throbbing
localized
elevated
swollen
fever

Question 5

Treatment of periodontal abscess

• FIRST PHASE
• ____
• Occlusal adjustment
• ____ if necessary
• SECOND PHASE
• ____ planing
• ____ elimination

Answer 5

incision and drainage
antibiotics
scaling and root
pocket

Question 6

Necrotizing ulcerative gingivitis
CLINICAL FEATURES 
• Ulcerations of \_\_\_\_ 
• Pain and bleeding
• Foul odor

It causes ulceration of ____. They are normally triangular and fill inter proximal space but a patient with this condition the papillae are cratered. The reason this disease is interesting is because invasion of spirochetes into tissue and it is closely correlated with ____. People with this condition are tense, it is prevalent among ____. It is usually the first oral sign of ____

Answer 6

papillae
interdental papillae
emotional stress
smokers
HIV

Question 7

General description (NUG)
• The disease is mostly seen in \_\_\_\_- income countries in the context of severe debilitation and malnutrition. In addition, poor oral hygiene, \_\_\_\_ infection, measles, local irritation from food impaction and \_\_\_\_ are associated factors.

Answer 7

low- and middle
HIV
smoking

Question 8

Bacteria in ANUG

There is a frank invasion of ____ in the tissue

Answer 8

spirochetes

Question 9

ANUG- ____ of the gingiva

You can see the scarring of the gingiva, there is ____ architecture of the gingiva which means there is a crater in the interdental papilla, it hurts

Answer 9

scarring

reverse

Question 10

ANUG –Scarring of the Gingiva

Repeated episodes of ANUG causes ____ scarring of gingiva so you have this type of architecture. If a pt presents like this why is it not conducive to maintaining good oral health? This is called ____ tissue architecture, in normal architecture the interdental papilla should be coronal to the facial lingual margins, but here it is reverse so every time they eat there is a force of ____ impaction that accumulates and its difficult to keep the mouth clean

Answer 10

permanent
reverse
food

Question 11

ANUG-ulceration

This is a micrograph schematic diagram of tissue so you have this epithelium with rete pegs and you have blood vessels and bacteria. The outer layer of the epithelium becomes ____ and the blood vessels are at the ____ and it bleeds easily, is very painful

Answer 11

ulcerated

surface

Question 12

ANUG-etiology
• Bacterial changes (invasion of \_\_\_\_)
• Excessive \_\_\_\_ 
• Debilitating \_\_\_\_ 
• Emotional \_\_\_\_

Answer 12

spirochetes
smoking
diseases
stress

Question 13

ANUG-TREATMENT

• INITIAL VISIT
• Gentle ____
• Oral ____ instructions
• Subsequent visits
• ____
• Continue OHI
• Possible surgical appointment to correct surgical deformities

Unlike an abscess, generally speaking ____ therapy is usually unnecessary. You do a gentle debridement or else there will be a lot of pain. If the tissue heals you will be able to clean more thoroughly so there can be several visits. Usually these patients are ____. Consult with smoking cessation.
Repeated episodes of NUG can cause NUG/periodontis so it can affect the ____ now. You will have to have surgery that involves bone manipulation.

Answer 13

debridement
hygiene
scaling

antibiotic
non-compliant
bone

Question 14

Acute herpetic gingivostomatitis
• \_\_\_\_ picture
• Diffuse erythema and vesicular eruptions 
• \_\_\_\_
• Pain
• Possible \_\_\_\_

This can mimic ANUG, as the term implies this is caused by ____ virus. Primarily in children but it can affect adults going through emotional stress

Unlike ANUG and abscess, you actually have a ____ and its exquisitely painful. Some patients are in such pain that they cannot eat and need ____ fluid. The way you recognize this disease is ____ eruptions that can be on the palate, on the lips

Answer 14

clinical
fever
dehydration

herpes
fever
IV
vesicular

Question 15

AHGS-diffuse redness

You could see, you have to think herpetic gingivostomatitis. Do you remember the difference between diffuse and localized inflammation. The typical periodontal inflammation if it is caused by bacteria, the inflammation is confined to ____ nd interdental papilla.

But more systemic factors, the inflammation is diffuse so it extends apical to the ____. You can see the inflammation extends to the entire area.

AHGS-Ulceration of the ____

Answer 15

gingival margin
mucogingival junction
lip

Question 16

AHGS-TREATMENT
• ____
• Supportive fluids
• ____ ointment

The treatment is mostly palliative unless now there is ____ and other antiviral medications if necessary. You have to make sure the patient gets supportive fluid and rest.

The acute phase lasts a ____ and another week for treatment. Surprisingly, sometimes you have to treat with ____, of course they are ineffective against viruses but the multiple ulcerations can cause secondary infection by bacteria.

Answer 16

palliative
orabase

acyclovir
week
antibiotics

Question 17

PERICORONITIS
• ____ PICTURE
• Acute
• Chronic

The last acute condition that I want to discuss that you are likely to see is pericoronitis. Inflammation around the ____.

This happens where there is excessive ____ surrounding the tooth and that excessive tissue that partially covers the crown can trap food and bacteria which are not cleanable and it becomes highly inflamed.

It happens not infrequently around the ____ because they are the last to erupt. There is nothing inherently different about third molars, it means there is not enough room in the oral cavity to erupt so over the years of our development we used to have a much longer face but over the years they have decreased anteriorly posteriorly but we have the same number of teeth. So the third molars are often ____ erupted. In some people who have had their third molar removed and now they are getting pericoronitis around their second molar because their mouth is small

Answer 17

clinical
crown
tissue
third molars
partially

Question 18

Pericoronitis

Once again, the disease is caused by ____ in origin but flares up in acute stress.

Answer 18

bacteria

Question 19

Periocoronitis

Clinical features:

• the partially erupted or impacted ____ is the most common site of periocoronitis
• the space between the ____ of the tooth & overlying ____ is an ideal area for the accumulation of food debris & bacterial growth

Answer 19

mandibular third molar
crown
gingival flap

Question 20

Pericoronitis-etiology
• Infection due to retention of ____ and stagnation of food debris
• Trauma from the ____ tooth

How do you treat the acute phase. You may have to use ____. Sometimes we give patient a syringe with ____ to rinse and relieve the pain. Then you have to make a decision how to handle it permanently.

You can do a small ____ and restore the area to good health but sometimes the only way to permanently solve the area is to extract the tooth especially if it is misplaced and there is not enough room to erupt.

Answer 20

bacteria
opposing
antibiotics
chlorohexidine
gingivectomy

Question 21

Pericoronitis-treatment
• \_\_\_\_
• Drainage
• \_\_\_\_-if necessary
• Extract the tooth or remove the flap of tissue

Answer 21

cleanse

antibiotics

Question 22

Chronic conditions affecting the ginigiva
• ____ lesions
• Gingival ____
• Gingival enlargements(____)

Answer 22

desquamative
recession
fibromatoses

Question 23

Desquamative lesions

These lesions cause ____ of the epithelium and diffuse inflammation. There are a zillion of desquamative lesions but one of the underlying conditions is especially women during ____ or post menopause. There is a thinning of epithelium and sloughs off easily.

Pemphigus and Pemphigoid like lesions there is a fluid accumulation between connective tissue and epithelium that bursts and causes inflammation. They all result in diffuse ____.

Board question. A diffuse inflammation is not a classic manifestation of gingivitis, you have to look at underlying systemic causes. Diffuse means inflammation that extends apical to the ____. As you can see the gingiva is thin, lack of keratin and areas of bleeding

Answer 23

thinning
menopause
inflammation
APJ

Question 24

Desquamative Gingivitis

Diffuse inflammation, this is definitely not the time to give them good ____ instruction because it would do very little to address it.

The treatment is to treat the underlying ____, work in conjunction with their physician.

Someone post menopause may need ____ replacement therapy. An allergic reaction needs a medical history, change in toothpaste, diet, acidic foods, do they have an acidic reflux.

These can all cause a thinning of gingiva. Do they have any other lesions anywhere int he body. ____, pemphigoid like disease, lichen planus, these are all conditions that have manifestations so work with the internist and ____.

There are local ____ to put in mouth rinses like prednisone that can alleviate the symptoms.

Answer 24

oral hygiene
cause
hormone
pemphigus
dermatologist
steroids

Question 25

Gingival recession

You will likely encounter the various types of gingival recession.

In healthy gingiva the gingival margin is ____m coronal to the cej. If at the ____ or below we now have gingival recession.

Not all gingival recession has been created equal. Some people people are ____ more prone, orthodontic tooth movement, excessive toothbrushing, poor hygiene.

In response to irritation thick tissue is more likely to result in ____ and thin tissue is more likely to end up with gingival ____.

Answer 25

1 to 2
CEJ
genetically
swelling
gingival recession

Question 26

Gingival recession- associated with Occlusal Trauma

One of the most important thing you have to look at is how far the gingival margin is from the mucogingival junction. Why is it important?

You need the ____ tissue, a tight gingiva. Why do you want to have a tight gingiva?
You examine the patient and see something like this, recession, the patient is not sensitive.
It is rare that someone has exposed bone during recession because as gum recedes ____ recedes

If I have a long sleeved shirt and I unbutton, my sleeve will move up and down as I move my arm. The point of a zone or keratinized attached gingiva is to ____ the muscles pull so every time you eat, speak, move your lip the gum doesn’t just ride up and down apical coronal pull

We believe that at least ____mm of keratinized attached gingival to dissipate muscle pull. When you eat when you bite there is tremendous apical pull on the gingiva and unless you have this sleeve or keratinized tissue the muscle pull will not be dissipated.

Answer 26

keratinized
bone
dissipated
1

Question 27

Gingival Recession-self inflicted (biting ____)

Gingival Recession due to ____ abrasion

Gingival recession due to ____ surgery

Answer 27

nails
toothbrush
periodontal

Question 28

Gingival Recession-____

When you have something like this, an inadequate zone of keratinized gingiva, this is a ____ problem. The gingiva will continue to recede. This doesn’t mean you always have to do gingival graft but you at least need to note it in your chart.

When you do complete Perio charting you have to worry about the zone of keratinized attached gingiva because when the gingival margin meets the mucogingival junction means there is zero keratinized gingiva and nothing to ____ muscle pull.

In which area of the mouth you don’t have to worry about it? The ____. It is all ____. We use the ____ to harvest tissue to reinsert it and increase the zone of keratinized tissue.

Answer 28

frenum pull
mucogingival
dissipate
palate
keratinized
palate

Question 29

____ to correct recession

Answer 29

free gingival graft

Question 30

Altered Passive Eruption

Something you will definitely be seeing. Not every recession is to be treated but you need to note it in your chart and make sure it has follow up.

The opposite of recession is altered ____. In recession you have a dentogingival unit that is apical to the cej. In altered passive eruption you have the same healthy unit but it is ____ to where it should be. The clinical picture is most of the crown is covered by ____. Patients think they have ____ teeth but they have altered passive eruption.

Answer 30

passive eruption
coronal
tissue
small

Question 31

Altered passive eruption

What is the etiology. Teeth erupt in two stages.

First when tooth bursts through the mucosa it carries the mucosa with it almost like putting hand under sheet in a bed and finally the sheet bursts and there is a hole and it starts receding. In altered passive eruption there is a failure for the gingival margin to ____ back to its normal level. This is the ____ stage of eruption which is not functioning well.

Besides being an aesthetic issue, it is not really a ____ issue but it is a problem when a patient needs a crown. Some dentists make a tiny crown that keeps falling off several times.
So either aesthetic treatment that needs to be addressed or considerations for retention for complete restorations like crowns or bridges. Some of the ____ needs to be taken away so good retention can be obtained.

Answer 31

recede
second
pathologic
gingiva

Question 32

Fibromatosis - Cyclosporin Hyperplasia

Increased amount of ____ overgrowth. There are several different reasons for overgrowth. The most common was ____ hyperplasia that was from a drug used to treat epileptic seizures. The second reason that is more recent is from ____ a drug used to prevent rejection in organ transplant patients.

What type of drugs that cause excessive gingival swelling? ____ blockers for hypertension cause enlargement although that enlargement is a little different form cyclosporin and dilantin. Cyclosporin and dilantin create a ____ tissue and if patient stops taking the medication this would not ____.

If a patient taking calcium channel blockers and changes medication there is more spontaneous ____. The enlargement from calcium channel blockers the tissues are more ____ rather than hypertrophyed meaning there is more ____ there they are more likely to bleed. It is amazing that many cardiologists do not advise this side effect.

Answer 32

gingival overgrowth
dilantin
cyclosporine

calcium channel
fibrous
recede

healing
hyperplastic
fluid

Question 33

Fibromatosis - Cyclosporine Hyperplasia

The treatment for dilantin and cyclosporin hyperplasia is ____. There is also idiopathic fibrzomatosis where patients through some ____ mutation they inherited they develop this for no reason. Sometimes ____ gingivectomies are necessary.

Answer 33

gingivectomy
genetic
repeated

Question 34

Lichen planus

It is a mysterious condition that doesn’t usually cause discomfort unless it becomes ____. It has a ____ like spider web appearance.

Sometimes it appears somewhere else on the body and on the cheeks. Some controversy whether it is a precancerous lesion and you really have to pay attention because people mistake ____ cancer for lichen planus and it can be dangerous. The only way to make sure is to take a ____ and send it for analysis to make sure there is no malignant features.

Answer 34

erosive
lace

oral
biopsy