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Periodontics I > Acute Periodontal Lesions & Mucogingival Conditions > Flashcards

Acute Periodontal Lesions & Mucogingival Conditions Flashcards

1
Q

Acute periodontal lesions include:

A
  1. Periodontal abscesses
  2. Necrotizing periodontal diseases
  3. Endo Perio lesions
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2
Q

_____% of all emergency patients, 3rd most common

_____% of untreated periodontal patients

_____% of patients in active periodontal treatment

_____% of patients in periodontal maintenance

A

7-14% of all emergency patients, 3rd most common

60% of untreated periodontal patients

13.5% of patients in active periodontal treatment

37% of patients in periodontal maintenance

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3
Q

What is the etiology of periodontal abscesses?

A
  1. pulp necrosis
  2. periodontal infections
  3. pericoronitis
  4. trauma
  5. surgery
  6. foreign body impaction
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4
Q

Localized accumulation of pus located within the gingival wall of the periodontal pocket , with an expressed periodontal breakdown occurring during a limited period of time, with easily detectable clinical symptoms:

A

Periodontal abscess

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5
Q

List the sequence of events leading to periodontal abscess formation:

A
  1. Occlusion of existing periodontal pocket
  2. Bacterial invasion of soft tissue wall
  3. Leukocytic infiltration (neutrophils)
  4. Vascular thrombosis
  5. Edema & swelling
  6. Tissue necrosis & liquefaction
  7. Collagenolysis & bone resorption
  8. Production of purulent exudate

OBLV ETCP

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6
Q

List the most common symptoms of acute periodontal disease in order from MOST common to LEAST common:

A
  1. pain
  2. swelling & edema
  3. lymphadenopathy
  4. Fever
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7
Q

_____ formation is often a manifestation of:

-diabetes (uncontrolled or undiagnosed): most common cause
-AIDS (compromised immune system
-Depressed immune system (steroid therapy, chemotherapy)

A

Multiple abscess

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8
Q

MULTIPLE ABCESS FORMATION is often a manifestation of: (3)

A
  1. Diabetes
  2. AIDS
  3. Depressed immune system
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9
Q

What is the MOST common cause of multiple abscess formation?

A

Uncontrolled or undiagnosed diabetes

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10
Q

65% of the microbial flora that cause periodontal abscesses are _____ and ____

A

Gram negative; anaerobic

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11
Q

Bacteria that produce ______, such as P. Gingivalis & P. Intermeia are important in the pathogenesis of the periodontal abscess since they increase the availability of nutrients, and thereby increase the number of bacteria within the abscess environment

A

proteinases

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12
Q

Bacteria that produce proteinases such as _____ & _____ are important in the pathogenesis of periodontal abscess

A

P. gingivalis; P. intermedia

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13
Q

Bacteria that produce proteinases such as P. Gingivalis & P. intermedia are important in the pathogenesis of the periodontal abscess since they increase _____ and thereby increase the _____ within the abscess environment

A

the availability of nutrients; number of bacteria

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14
Q

List the common pathogens found in a periodontal abscess: (7)

A
  1. Candida albicans
  2. Fusobacterium nucleatum
  3. Peptostreptococcus micros
  4. Porphyromonas gingivalis
  5. Prevotella intermedia
  6. Taneralla forsythia
  7. Treponema (spirochetes)

CF 3P 2T

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15
Q

List the characteristic histopathology of a periodontal abscess:

A
  1. acute inflammatory infiltrate
  2. vascular hyperemia & thrombosis
  3. lysis of collagen matrix in the lamina propria and the gingival fibers
  4. ulceration and apical proliferation of the JE
  5. osteoclastic mediated bone resorption
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16
Q

A periodontal abscess in a periodontitis patient could represent a period of:

A

disease exacerbation

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17
Q

A periodontal abscess in a periodontal patient could represent a period of disease exacerbation due to: (5)

A
  1. tortuous pocket
  2. furcation involvement
  3. vertical defect
  4. composition of microflora
  5. decreased host defense
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18
Q

When is a periodontal abscess in a periodontitis patient due to an acute exacerbation?

A
  1. in untreated periodontitis
  2. in patients non-responsive to periodontal therapy
  3. patients on supportive periodontal therapy
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19
Q

A periodontal abscess in a periodontitis patient can form after _____ and so there is need for _____

A

treatment (post-scaling & post-surgery); post-medication (antimicrobials & nifedepine)

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20
Q

List some causes of a periodontal abscess in non-periodontitis patients: (5)

A
  1. impaction of foreign bodies
  2. harmful habits
  3. orthodontic factors
  4. gingival enlargement
  5. alteration of root surfaces
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21
Q

List some examples of alteration of root surfaces that may lead to a periodontal abscess in non-periodontitis patients:

A
  1. dens invaginatus
  2. cemental tears
  3. enamel pearls
  4. perforations (iatrogenic)
  5. severe root damage (VRF or CTS)
  6. external root resorption
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22
Q

What are the clinical signs of a periodontal abscess: (10)

A
  1. pain
  2. localized swelling & fluctuance
  3. purulent exudate
  4. deep periodontal pocket
  5. vital pulp
  6. fistula
  7. tooth mobility
  8. sensitivity to percussion
  9. low-grade fever
  10. lymphadenopathy
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23
Q

The following are all ____ of _____

  1. pain
  2. localized swelling & fluctuance
  3. purulent exudate
  4. deep periodontal pocket
  5. vital pulp
  6. fistula
  7. tooth mobility
  8. sensitivity to percussion
  9. low-grade fever
  10. lymphadenopathy
A

Clinical signs of periodontal abscess

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24
Q

List some differential diagnosis for periodontal abscess:

A
  1. periapical abscess
  2. acute pulpitis
  3. tooth or root fracture
  4. pericoronitis
  5. lateral periodontal cyst
  6. gingival cyst
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25
Q
  1. periapical abscess
  2. acute pulpitis
  3. tooth or root fracture
  4. pericoronitis
  5. lateral periodontal cyst
  6. gingival cyst

These are all:

A

differential diagnosis for periodontal abscess

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26
Q

List some complications of periodontal abscesses:

A
  1. tooth loss (up to 45% of teeth with perio abscesses in maintenace are extracted)
  2. bacteremia (following abscess treatment)
  3. chronic or episodic bacteremia from untreated periodontal disease
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27
Q

One complication of perio abscess is tooth loss. Provide the statistic:

A

Up to 45% of teeth with perio abscesses in maintenance are extracted

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28
Q

A complication of perio abscess is bacteremia. This can be chronic or episodic from untreated perio disease OR following abscess formation.

A

Both statements true

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29
Q

List the potential treatment options for a perio abscess: (5)

A
  1. Non-surgical drainage & debridement with LA
  2. Surgical drainage for large abscess
  3. Surgical therapy with flap reflection, debridement with ultrasonic, sutures
  4. Antibiotics if systemic infection indicated by fever or lymphadenopathy
  5. Reevaluation and any further needed therapy
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30
Q

Non-surgical drainage and debridement for treating a perio abscess is typically done under:

A

Local anesthetic

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31
Q

When would surgical drainage be a likely treatment option for a perio abscess?

A

Large abscess

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32
Q

Describe surgical therapy for treatment of a perio abscess:

A
  1. Surgical therapy with flap reflection
  2. debridement with ultrasonic
  3. sutures
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33
Q

When would antibiotics be indicated for perio abscess treatment?

A

If systemic infection is indicated by:
1. fever
2. lymphadenopathy

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34
Q

What are the components of diagnosis with dealing with a perio abscess?

A
  1. Health history + medications
  2. Dental history
  3. Current perio status
  4. Current status of effected tooth
  5. PA radiographs
  6. clinical exam
  7. determine etiology
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35
Q

When taking the health history and medications for patient with a perio abscess, you should look out for:

A
  1. diabetes
  2. systemic antibiotic use
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36
Q

When diagnosing a perio abscess, how can the current status of the affected tooth be determined?

A
  1. cold & EPT tests vital
  2. pain on percussion
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37
Q

What type of radiographs should be taken for a potential perio abscess?

A

PA radiographs

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38
Q

What should you be looking for when clinically examining a patient when diagnosing a perio abscess?

A
  1. redness
  2. swelling
  3. purulent discharge
  4. lymphadenopathy
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39
Q

-calculus fragments from recent cleaning
-systemic antibiotic treatment without subgingival debridement
-acute exacerbation of untreated periodontitis
-foreign body impaction
-endodontic perforation
-cemental tear

These are all:

A

potential etiologies of perio abscess

40
Q

What are the two categories of treatment options for perio abcess?

A
  1. closed approach
  2. open approach
41
Q

Describe the closed approach treatment to perio abscess:

A
  1. incision & drainage through the pocket
  2. root planing to depth of sulcus
42
Q

Describe the open approach trreatment to perio abscess:

A
  1. sulcular incisions and full thickness flap
  2. remove all visible soft & hard deposits from root and adjacent bone
  3. replace flap & suture closed
43
Q

In both closed & open approach treatment option, there should be thorough ____ & consideration of ____

A

thorough irrigation; consideration of systemic antibiotics (though usually not needed)

44
Q
  1. incision & drainage through the pocket
  2. root planing to depth of sulcus
A

Closed approach

45
Q
  1. sulcular incisions and full thickness flap
  2. remove all visible soft & hard deposits from root and adjacent bone
  3. replace flap & suture closed
A

Open approach

46
Q

T/F: With both closed approach & open approach treatment, systemic antibiotics should be considered but are usually not needed

A

true

47
Q

Post-operative therapy for both closed & open approach perio abscess treatment includes:

A
  1. home care
  2. prescribe analgesics
  3. re-evaluation
  4. frequently monitor radiographically & clinically for perio disease
48
Q

Acute periodontal diseases include:

A
  1. acute periocoronitis
  2. acute periodontal abscess
  3. acute herpetic gingivostomatitis
  4. acute necrotizing ulcerative gingivitis
  5. endo-perio lesions
49
Q

Describe normal healthy gingiva:

A

-coral pink
-stippled
-scalloped
-firm
-resilient
-peaked interdental papilla

50
Q

T/F: It is not possible to maintain periodontal health in the absence of keratinized gingiva

A

False- it is possible to maintain periodontal health in the abscess of keratinized gingiva

51
Q

According to Lang & Loe, how much keratinized gingiva is considered enough? How much attached gingiva is considered enough?

A

2 mm keratinized
1 mm attached

52
Q

According to the 2017 classification of mucogingival deformities & conditions around teeth the PERIODONTAL BIOTYPE can be categorized as:

A
  1. thin scalloped
  2. thick scalloped
  3. thick flat
53
Q

According to the 2017 classification of mucogingival deformities & conditions around teeth GINGIVAL /SOFT TISSUE RECESSION may be categorized as:

A
  1. facial or lingual surfaces
  2. interproximal (papillary)
  3. severity of recession
  4. gingival thickness
  5. gingival width
  6. presence of NCCL/Cervical caries
  7. Patient esthetic concern
  8. Hypersensitivity
54
Q

According to the 2017 classification of mucogingival deformities & conditions around teeth GINGIVAL EXCESS can be categorized as:

A
  1. pseudopocket
  2. inconsistent gingival margin
  3. excessive gingival display
  4. gingival enlarement
55
Q

Determine the periodontal phenotype according to the 2017 classification of mucogingival deformities & conditions around teeth:

A

Thin scalloped

56
Q

Determine the periodontal phenotype according to the 2017 classification of mucogingival deformities & conditions around teeth:

A

Thick scalloped

57
Q

Determine the periodontal phenotype according to the 2017 classification of mucogingival deformities & conditions around teeth:

A

Thick flat

58
Q

Periodontal phenotype is based on anatomical characteristics including:

A
  1. gingival phenotype
  2. bone morphotype
  3. tooth position
59
Q

Gingival phenotype is based:

A

keratinized tissue width

60
Q

Gingival phenotype is based on keratinized tissue width, with an average of ____mm for thick biotype and an average of ____ mm for thin phenotype

A

Thick= 5.72 mm
Thin= 4.15 mm

61
Q

What is the range for gingival thickness?

A

0.63 mm to 1.24 mm

62
Q

What is the mean value for bone morphotype for THIN biotype? What is it for THICK/AVERAGE phenotype?

A

Thin= 0.34 mm
Thick/average= 0.754 mm

63
Q

-gingival phenotype
-bone morphotype
-tooth position

These are all determining characteristics for:

A

periodontal phenoytpe

64
Q

Apical migration of the gingival margin with concomitant exposure of the root surface:

A

Gingival recession

65
Q

T/F: Gingival recession affects a large population only due to oral hygeine

A

False- this condition affects a large population irrespective of oral hygiene

66
Q

What is the prevalence of gingival recession?

A

54.5% of young adults

67
Q

______ of middle-aged elderly adults suffer from gingival recession with an average prevalence of ____

A

100% ; 78.6%

68
Q

What can be seen in the following image?

A
  1. Decreased vestibular depth
  2. Lack of keratinized gingiva
69
Q

What can be seen in the following image?

A

Aberrent frenum/muscle position

70
Q

What are the categories of gingival excess?

A
  1. pseudopocket
  2. inconsistent gingival margin
  3. excessive gingival display
  4. gingival enlargement
71
Q
  1. pseudopocket
  2. inconsistent gingival margin
  3. excessive gingival display
  4. gingival enlargement

These are all types of:

A

gingival excess

72
Q

What can be seen in the following image?

A

Gingival excess

73
Q

What can be seen in the following image?

A

Non-carious cervical lesions (NCCL)

74
Q

What can be seen in the following image?

A

Root caries

75
Q

Describe “CLASS A neg” CEJ:

A

Step: -
Descriptors: CEJ detectable without step

76
Q

Describe “CLASS A pos” CEJ:

A

Step: +
Descriptors: CEJ detectable with step

77
Q

Describe “CLASS B neg” CEJ:

A

Step: -
Descriptors: CEJ undetectable without step

78
Q

Describe “CLASS B pos” CEJ:

A

Step: +
Descriptors: CEJ undetectable with step

79
Q

T/F: In Class B, the CEJ is undetectable

A

True

80
Q

T/F: In class A, the CEJ is detectable

A

True

81
Q

What are the most common mucogingival defects in daily practice?

A
  1. gingival recessions
  2. inadequate zone of keratinized gingiva
82
Q

Predisposing factors for gingival recessions & inadequate zones of keratinized gingiva include:

A
  1. periodontal biotype & attached gingiva
  2. the impact of tooth brushing
  3. the impact of cervical restorative margins
  4. the impact of orthodontics
  5. other conditions
83
Q
  • Gingival recession with NO loss of interproximal attachment
  • interproximal CEJ was NOT detected either on the mesial or distal aspect of the tooth
A

Recession Type 1 (RT1)

84
Q
  • Gingival recession associated with LOSS of interproximal attachment
  • The amount of interproximal attachment loss was less or equal to the buccal attachment loss
A

Recession Type 2 (RT2)

85
Q
  • Gingival recession with the LOSS of interproximal attachment
  • Interproximal attachment loss is GREATER than the buccal attachment loss
A

Recession Type 3 (RT3)

86
Q

Cairo classification for gingival recession is:

A

treatment oriented

87
Q

In cairo classification for gingival recession RT1 (Miller class I & II): _______ can be predicted

A

100% root coverage can be predicted

88
Q

In cairo classification for gingival recession RT2 (Overlapping miller class III): _____ can be predicted

A

mixed results

89
Q

In cairo classification for gingival recession RT3 (Overlapping miller class IV): _____ can be predicted

A

full root coverage is NOT achievable

90
Q

Cairo classification classifies:

A

gingival recession (treatment oriented)

91
Q

Cairo RT1 can be compared to:

A

Miller class I & II

92
Q

Cairo RT2 can be compared to:

A

Miller class III

93
Q

Cairo RT3 can be compared to:

A

Miller class IV

94
Q

What occurs when an existing lesion is left untreated?

A

Progression

95
Q

T/F: For the treated & untreated sites studies

1) 83% of the 64 treated sites showed recession reduction while 48% of the 64 untreated sites experienced increased recession

2) The number of increase in recession was abundant

3) Thin gingival biotypes augmented by grafting remained stable over time compared to untreated areas with thin biotypes

4) Untreated areas also showed a tendency to develop new recession

A

1) true

2) false- it was limited

3) true

4) true

96
Q
A

Periodontics I (17 decks)

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