6. Periodontal disease and conditions Flashcards
When does plaque induced gingivitis occur?
During puberty
What are two conditions that commonly result in plaque induced gingival enlargement?
mouth breathers
active ortho treatment
What drugs commonly cause gingival enlargement?
Anti-seizure (Dilantin)
Cyclosporine (immunosuppressant)
Calcium Channel Blockers (diltiazem, nifedipine, amoldipine)
Does drug induced gingival enlargement occur over edentulous areas?
No
Where are gingival abscesses found?
marginal gingiva or interdental papilla
Where is it most common to see pericornitis?
3rd molars
What are the signs and symptoms associated with Vitamin C deficiency gingivitis?
edematous, spongy non-specific gingiva
spontaneous bleeding
delayed wound healing
What is the primary bacteria in chronic periodontitis?
P. gingivalis
What are the signs and symptoms of ANUG?
rapid painful onset of inter proximal and marginal necrosis and ulceration
At what age is ANUG typically seen?
late teens/early 20s in the US
younger in less developed
T/F: Patients with diabetes are at increased risk of earlier onset of periodontitis even if they have similar plaque/calculus levels as healthy controls
True
Where is localized aggressive periodontitis in the primary dentition most commonly seen
primary molars
What is the etiology of prepubertal periodontitis?
A.a.
Leukocyte chemotaxis defect
Cementum defect
What is definition of localized aggressive periodontitis?
bone loss around incisors, first molar and no more than 2 other teeth
pt otherwise systemically healthy, age of onset 10-15
What is etiology of localized aggressive periodontitis?
A.a
neutrophil chemotaxis and phagocytosis
over reactive monocyte response
genetic defect in gene encoding IgG2
What is the dental sequale of hypophosphatasia?
early loss of primary teeth due to abnormal cementum formation
Exfoliated with intact roots, before complete root formation, in order of eruption
permanet teeth may be unaffected
What are the 5 levels of severity of hypophosphatasia?
perinatal (lethal) infantile childhood adult odontohypophosphatasia
What is the etiology of hypophosphatasia
defect or deficient in tissue nonspecific alkaline phosphatase (TNSALP)
How do you diagnose hypophosphatasia
low AKP increased phosphoethanolamine (urine) or phosphate (blood)
What is the enzyme therapy for treatment of hypophosphatasia
Asfotase Alpha
What is the definition of mucogingival defect
pocket depth > width of attached keratinized gingiva (KG
Where is it most common to have a mucogingival defect
lower incisors due to labial position
How do you calculate attached keratinized gingiva
Attached KG = MGJ to FGM (note sites < 1 mm)
What is pseudo-recession?
recession like appearance without root exposure
What should normal bone height be and how do you measure it?
interproximal crest should be 1-2 mm apical of CEJ as seen on BWX
How do you measure attachment loss
Attachment loss = Pocket depth - (distance from CEJ to FGM)
What percentage of patients with downs syndrome have periodontal disease?
60-100%
What systemic condition has the radiographic appearance of “floating teeth”
Langerhans cell histiocytosis (X)
What is the etiology of Langerhans cell histiocytosis (X)
abnormal proliferation and dissemination of histiocytic cells of the Langerhans system
What is the treatment for Neutropenia?
systemic granulocyte colony stimulating factor (G-CSF) to treat underlying cause
What are systemic conditions that have periodontal consequences?
Hypophosphatasia Leukocyte adhesion defect (LAD) Papillon-LeFevre syndrome Downs syndrome Chediak-Higashi syndrome Neutropenia Langerhans cell histiocytosis (X) Leukemia
What are signs/symptoms of Chediak Higashi syndrome?
Oculocutaneous albinism photophobia nystagmus peripheral neuropathy periodontitis
What are signs and symptoms of papillon-LeFevre syndrome?
palmar and plantar hyperkeratosis
Attachment loss (due to A.A. bacteria) causing early loss of primary/perm dentition
What are signs and symptoms of Leukocyte adhesion defect (LAD)?
Generalized periodontitis in primary and permanent dentition
Frequent respiratory, skin, ear and other soft tissue bacterial infections
What are dental manifestations of leukemia?
gingival enlargement
hyper plastic, edematous, blue/red gingiva due to infiltration of leukemic cells (mostly seen in AML)
petechiae or mucosal ulcerations may be present with any form of leukemia
What condition is pyogenic granuloma commonly associated with?
pregnancy
what % of teenagers have BOP?
60%
what systemic factors may increase risk of plaque induced gingivitis?
steroid hormones - puberty, pregnancy, menstruation and oral contraception
what local factors may contribute to plaque induced gingivitis
crowding, ortho appliances, mouth breathing, eruption, calculus
What percentage of children and teenagers have calculus?
10% children
33% (1/3) teenagers
what are clinical features of plaque induced gingival enlargement
enlarged interdental papilla and/or marginal gingiva
may be generalized or localized
what are clinical features of drug influenced gingival enlargement
painless enlargement of interdental and marginal gingiva, may go over crowns
fibrous tissue
related to plaque control
what are predisposing factors to ANUG
malnutrition, stress, lack of sleep
what is the dental management for ANUG
local debridement
NSAIDS
ABX: penicillin or metronidazole
What percentage of adolescents (14 to 17) have attachment loss of at least 2 mm in one or more sites?
20%
What bacterial species is most commonly associated with periodontitis
P. gingivalis
