3. Etiology of Periodontal Disease Flashcards
Multifactorial infections
____- is the primary and essential etiology for periodontal disease
Initiation and progression of disease frequently requires the collaboration of a complex array of local, ____, genetic, ____, and environmental factors.
biofilm-bacterial plaque
systemic
pharmacologic
The Risk Factors of Periodontitis
Tobacco use
•____ modifiable risk factor and predictor of future disease.
•Smokers are ____ times more likely to have periodontal disease than nonsmokers.
•Smokers have ____ times more periodontal pathogens compared with nonsmokers.
Poor oral hygiene
•Increased ____ or reduced host defense may cause periodontal destruction.
•Löe et al observed 480 tea plantation workers that were not exposed to preventive care for 15 years. They
found that 8% of the population had rapid progression to periodontal disease, 11% had no progression, and 81% had moderate progression.
Diabetes
•____ times more bone loss and attachment loss has been found in patients with diabetes.
•After treatment of periodontal disease, there is a ____ drop in sugar levels.
Genetics
• In a study by Kornman et al, 86.0% of the severe periodontitis patients were either ____ or had the ____ genotype.
• The evidence for risk factors is stronger than it is for risk indicators… • ACA I - healthy; ACA II - problems that are under control ○ Smoking is \_\_\_\_ • Smoking inhibits \_\_\_\_ • Ingredient in tea can inhibit \_\_\_\_ within the gingiva… • Diabetes ○ Measure via \_\_\_\_ § Blood sugar control over \_\_\_\_ days (lifespan of the RBC)
strongest
2.7
18
plaque mass
three
10%
smokers
interleukin 1
ASA II
wound healing
Hba1c
90
The Risk Indicator of Periodontitis
- ____
- Sex
- ____ status •Race
- Obesity
- ____
- Stress
- ____
- Related to periodontal disease
- ____ are prone to contract aggressive periodontitis
age
socioeconomic
alcohol
contraceptives
african americans
Major periodontal pathogens:
Aggregatibacter actinomycetemcomitans
Campylobacter rectus
Eubacterium nodatum*
Fusobacterium nucleatum
Herpesvirus
Peptostreptococcus micros
Prevotella intermedia/nigrescens
Porphyromonas gingivalis*
Streptococcus intermedius
Tannerella forsythia (B. forsythus)*
Treponema denticola*
Current list of suspected periodontopathogens includes 20-30 bacterial species. - late colonizers- “Red Complex”
• Attachment loss is usually caused by \_\_\_\_ system, not a \_\_\_\_ effect of bacterial cells
host immune
direct
Criteria for Defining Pathogenic Microorganisms
Koch’s postulates (1882)
A bacteria should be able to be ____ from diseased tissues
____ cultures of that bacteria can be obtained
Bacteria inoculated in ____ animals should cause the disease
The bacteria should then be ____ in the diseased tissues of the animal
• This theory does not work in the dental field ○ Oral health is more complex, not just stemming from one \_\_\_\_ (mixed biofilm) • Excessive mouth rinsing ○ \_\_\_\_ infection ○ Eliminating \_\_\_\_
isolated
pure
experimental
isolated
bacterium
fungal
bacteria
Microbiologic Etiologic Factors
Health- and disease-associated bacteria reside in loosely or tightly structured tooth-associated biofilm
Health-related bacteria
Predominantly ____ filamentous ____ and ____ ____ or ____ species
____
____, ____ complex (Socranky 1998)
Disease-related bacteria Predominantly \_\_\_\_ \_\_\_\_, \_\_\_\_, and \_\_\_\_ Strict or \_\_\_\_ species Maybe be \_\_\_\_ or \_\_\_\_ \_\_\_\_, \_\_\_\_ complex (Socranky 1998)
gram-positive rods cocci aerobic facultative anaerobic nonmotile yellow purple
gram-negative rods vibros spirochetes facultative anaerobic nonmotile motile orange red
Alternative Criteria for Defining Key Bacteria in Periodontal Infections
• Socransky’s alternative criteria (1997)
- The presence of the putative pathogen in ____ to the periodontal lesions and in ____ numbers compared to either the absence of the bacteria or presence in much smaller numbers in healthy subjects
- Patients infected with these periodontal pathogens often develop high levels of ____ in serum, saliva, and gingival crevicular fluid and may also develop a ____ immune response to the putative pathogen
- These bacteria can often demonstrate in vivo production of ____ that can be correlated with clinical histopathology
- Experimental implantation of the organism into an animal model should lead to at least some characteristics of ____ occurring periodontal disease
- Clinical treatment that eliminates these bacteria from periodontal lesions should result in ____
proximity high antibody cell-mediated virulence factors naturally clinical improvement
Biofilm
• Biofilms are ____ communal aggregations of microorganisms that may form on a ____ range of the surface.
natural
wide
Characteristics of biofilms
____ communities
Metabolic ____
Primitive ____ system
Resist host ____
Resist ____ or ____ antibiotics and antimicrobial agents
Bacteria grown in biofilms communicate with each other through ____. Quorum sensing is important in the regulation of expression of specific
____.
• Quorum sensing ○ Cytokine releasing a share a [???]
dynamic cooperativity circulatory defenses systemic local quorum sensing genes
Dental plaque formation
____ phase (Formation of the pellicle)
____ phase (Initial adhesion and attachment of bacteria (____ grow phase
____ and plaque maturation (____ phase)
adherence lag rapid colonization steady
Q: What are plaque and calculus?
Plaque is an ____ mass consisting mainly of microorganisms that adhere to the teeth. It consists of bacterial byproducts such as ____, food debris, ____, and phosphate.
The organic composition is ____ and proteins, and the inorganic composition is ____ and phosphorus.
Calculus is made of ____ salts.
• Where is calcium coming from? ○ Food and saliva (supragingivally) § More gram-positive, aerobic ○ GCF (subgingivally) § More gram-negative, anaerobic
organized
enzymes
calcium
polysaccahrides
calcium
calcium phosphate
Plaque Hypotheses in the Initiation of Periodontal Disease
• Nonspecific plaque hypothesis (1960s)
- Periodontal disease results from the elaboration of noxious products by the plaque biomass, indicating that the ____ of plaque is of most importance in the initiation of disease. This hypothesis is contradicted by the finding that some patients with little plaque have severe periodontitis.
• Specific plaque hypothesis (1970s)
- The pathogenic potential of plaque is dependent on the presence of, or increasing numbers of, specific ____. As a result, many years have been spent trying to identify the specific pathogens associated with disease.
• Ecological plaque hypothesis
- Putative periodontal pathogens are present in both ____ and ____ sites. A change in the ____ environment (e.g., a change in the ____ status) is the primary cause for the overgrowth of the putative pathogens.
quantity microorganisms healthy diseased nutrient
- ____ accumulation
- Some gingival swelling
- Patient complain: orthodontist referred, bone loss
- ____ periodontitis
plaque
aggressive
• SRP, no antibiotics ○ Not all aggressive periodontitis recover as well as this ○ Etiology = [discussed in D2] § More \_\_\_\_ genotype § Higher \_\_\_\_ reaction • Most would extract teeth • Vertical bone loss ○ Regrowth is \_\_\_\_ § Sooner the patient enters, the better the outcome
IL1
immune
unpredictable
Experimental Gingivitis Model
In this model, periodontal health is established by professional cleaning and personal oral hygiene measures. This is followed by a 21-day period of abstinence from all oral hygiene measures. The initial microbiota is composed of ____ rods and cocci and ____ cocci. In the transition to gingivitis, gram-negative ____ and ____ appear, followed by ____ and ____ microorganisms.
gram-positive
gram-negative
rods
filaments
spirochetal
motil
How does calculus attach to teeth
- Attachment via ____ on enamel
- Mechanical locking into surface ____.
- Close adaptation of calculus ____ depressions to cementum.
- Penetration into ____
• Splinting with \_\_\_\_ ○ Only for patient comfort ○ Creates a greater chance of harboring \_\_\_\_ ○ Doesn't maintain \_\_\_\_ • Hard to rinse biofilm due to adhesion ○ Must use \_\_\_\_ means to remove
organic pellicle
irregularities
undersurface
cementum
tooth mobility
etiology
periodontium
mechanical
Pathogenic Role of Calculus
By itself, does not initiate or cause progression of periodontal disease - acts as a ____
Acts as a ____ for the development of biofilm
May also have food and tissue debris - ____ - associated with the biofilm communities
Materia alba is a concentration of ____, salivary proteins and ____, desquamated epithelial cells, and ____ that is less ____ than dental plaque. The presence of bacteria may lead to ____ serving as an irritant to gingival tissues.
local contributing biologic niche materia alba microorganisms lipids leukocytes adherent materia alba
Local Contributing Factors
____ Contributing Factors ____ Contributing Factors ____ Contributing Factors ____ as Contributing Factors
Anatomic
Restorative
Orthodontic
Habits
Anatomic Contributing Factor
____ contact relation
____ and Enamel Pearls
____ bifurcation ridge
____ anatomy
proximal
cervical enamel projections
intermediate
root
• Left: amalgam restoration
○ Open contact
§ ____ easily slides interproximally
• Right: ○ CE-projection: enamel should be located more coronally, but it lasts in the bifurcation § No attachment on enamel (junctional epithelium: not true attachment) § Very easy to bring pathogen apically and expose \_\_\_\_ area § Grade I, grade II, gradeIII □ III is inside \_\_\_\_ ○ Difficult to \_\_\_\_ this area ○ Remove \_\_\_\_ with high-speed to make some attachment available
food bifurcation bifurcation clean enamel
Cervical enamel projections (CEP)
CEP are tooth developmental deformities of the ____ found on ____
Predisposes to disease because ____ can’t attach to enamel
Increased risk for ____ involvement
Classification
Grade I: minimal projection of enamel toward the entrance of the furcation
Grade II: CEP approximates the entrance of the furcation
Grade III: CEP is well within the ____
• Requires \_\_\_\_ intervention
CEJ molars connective tissue furcation furcation surgical
Root Anatomy
Palataogingival groove Attachment area Root trunk length Interrot separation Root fusion Cement tear Accessary canals Root proximity Adjacent teeth
• PG groove ○ Fissure from \_\_\_\_ down to \_\_\_\_ ○ Contributing factor… not a \_\_\_\_ • Attachment area ○ \_\_\_\_: furcation area ○ [NOTES] • Cemental tear ○ Etiology: \_\_\_\_; more related to \_\_\_\_ ○ Slight \_\_\_\_ widening ○ Open flap, clean tissue and let it heal • Accessory canal ○ Triggered by an \_\_\_\_ infection ○ Treat \_\_\_\_ before perio…
enamel
cementum
causality
fornix
unknown
occlusion
PDL
endontogenic
endo
Furcation anatomy
In many instances, the entrance or bifurcations or trifurcations is restricted enough to limit access for ____
Once access to the intrafurcal space has been achieved, concavities in the ____ aspects of molar roots will limit instrumentations as well
Intermediate bifurcation ridges
Convex ridge of ____ extending from the ____ furcation surface of the ____ root across the roof of the bifurcation to the distal surface of the ____ root of ____
These ____ anatomic deformities interfere with a patient’s ability to effectively remove plaque biofilm
• \_\_\_\_ root trunk the tooth has a better prognosis
mechanical root instrumentation
furcal
cementum medial distal medial mandibular molars
common
longer
Accessory root canals (ARC)
Accessory root canals can act as a ____ to patterns of periodontal disease.
The true combined endo-perio lesion must be treated in the proper sequence, ____ therapy followed by periodontal treatment
Root proximity
____ roots
Access for effective ____ and root planing is extremely limited
Cemental tears
a piece of detached ____, often with some ____, that may remain attached to ____
induced by ____ trauma or other forms of ____ trauma
It can lead to rapid periodontal bone loss and produce a ____ bony defect
contributing factor
endodontic
kissing
scaling
cementum dentin PDL occlusal acute vertical
Restorative Contributing Factor
\_\_\_\_ Restorations \_\_\_\_ Location \_\_\_\_ Contours \_\_\_\_ Form Restorative \_\_\_\_
overhanging margin crown pontic material
Restorative Contributing Factor
• JE should be on \_\_\_\_ theoretically for younger patients; as you age recession • 3mm rule ○ Including the \_\_\_\_ epithelium • Violate biologic width > \_\_\_\_ inflammation
enamel
sulcular
gingival
Restorative Contributing Factor
• Ovate ○ Most \_\_\_\_ design ○ \_\_\_\_ control becomes difficult
• Sanitary ○ Most ideal design for \_\_\_\_ control • Attachment loss on abutment ○ Tooth becomes \_\_\_\_ ○ \_\_\_\_ caries ○ Worsens the long-term prognosis
aesthetic
plaque
plaque
mobile
secondary
Restorative Contributing Factor
• Violation of the ____
- Restorative margins that violate the biologic width may result in ____ or bone loss
- This is the reason why we may do preemptive ____
- Periodontal health is best achieved by placement of restorative margins ____ or at the ____
"biologic width" chronic inflammation crown lengthening supragingivally gingival margin
Restoration Material
• Gingiva are inflamed ○ Erythema • Inflammation a cause of: ○ Violation of \_\_\_\_ ○ Allergic to the \_\_\_\_ used • Redness on finger: ask if \_\_\_\_ to any material • Gold is used often because it has high \_\_\_\_
biological width
material
allergic
biocompatibility
Orthodontic Contributing Factors
____
____
Malocclusion
manifest as irregular alignment of the teeth, may create plaque retentive areas and make plaque removal more difficult.
Roots of teeth that are ____ in the arch or that are associated with ____ attachments often exhibit gingival recession.
____ drift and/or ____ associated with failure to replace missing teeth may result in occlusal problems that contribute to food impaction and plaque retention.
crowding malignment prominent frenum mesial extrusion
Habits as Contributing Factors
• Left: ○ \_\_\_\_ too hard ○ \_\_\_\_ infection § Discomfort? When did happen? Severity? § Fever? • Right: ○ \_\_\_\_ too hard ○ Repair via \_\_\_\_ § Plaque control is important
brushing
herpes
brushing
grafting
Habits as Contributing Factors
____ and Floss Trauma
____ and Tongue Thrust
____ Injuries
toothbrush
mouth breathing
self-inflicted
Iatrogenic Risk Factors
Malocclusion
- Manifest as irregular alignment of the teeth
- Mesial drift and/or extrusion associated with failure to replace missing teeth
Faulty dental restorations
- Manifest by ____ margins, rough surfaces, open margins, open ____, and overcontoured crowns They may also interfere with interdental ____ control
Orthodontic movement of periodontally involved teeth
- Increase ____ retention
- Excessive ____ on the periodontium
- In all cases, periodontal health should be established prior to initiating ____ therapy
overhanging
contacts
plaque
plaque
forces
orthodontic
