Aetiology and Pathogenesis

Question 1

What should healthy gingiva look like

Answer 1

knife edge, scalloped gingival margin​

Stippling (in about 30%)​

Pink

Question 2

What is the written definition of gingival health

Answer 2

Clinical gingival health on an intact periodontium is characterized by the absence of bleeding on probing, erythema and edema, patient symptoms, and attachment and bone loss.

Physiological bone levels range from 1.0 to 3.0 mm apical to the cemento-enamel junction.

Question 3

How is gingival health defined/tested on clinic

Answer 3

< 10% bleeding sites with probing depths ≤3 m

Question 4

What are local plaqure retention factors

Answer 4

Calculus​

Restoration Margins​

Crowding​

Mouth Breathing

Question 5

What factors of gingival retention are considered systemic

Answer 5

Sex Hormones

Medication

Question 6

What rate of attachment loss is considered rapid progression of periodontal disease

Answer 6

Greater or equal to 2mm of loss over 5 years is rapid

Question 7

What does dysbiotic biofilm indicate

Answer 7

No homeostasis
There is an imbalance of the micro-organisms and leads to pathogenesis
(not enough bacteria incompatible with inflammation allowing inflammophilic pathobionts control creating periodontal pockets)

Question 8

What 4 main aspects contribute to periodontitis

Answer 8

Behavioral risk factors
Environmental risks
Genetic risk factors
Epigenetic effects

Question 9

What makes up the host immune response

Answer 9

Saliva​

Epithelium​
- physical barrier​

- shedding of cells​

- production of inflammatory mediators​

GCF (gingival crevicular fluid)

Inflammatory and Immune Responses

Question 10

How does connective tissue matrix degradation occur with periodontitis

Answer 10

In periodontitis, matrix degradation is largely a result of MMP’s secreted by host inflammatory cells​

Immune cell activation of osteoclasts via RANK/RANKL/other cytokines

Question 11

What are MMP’s

Answer 11

Matrix metalloproteinases are a family of zinc and calcium dependent proteolytic enzymes, which include collagenases

Question 12

What anatomical features are local risk factors for periodontitis

Answer 12

Enamel pearls/projections
Grooves
Furcations
Gingival recession

Question 13

How can tooth position be a risk factor for periodontitis

Answer 13

Malalignment
Crowding
Tipping
Migration
Occlusal factors

Question 14

What Iatrogenic factors pose risk for potential periodontitis

Answer 14

Restoration overhangs
Defective crown margins
Poorly designed partial dentures
Orthodontic appliances

Question 15

How does smoking increase the risk of periodontitis in patients

Answer 15

Effect on subgingival plaque is uncertain​

Vasoconstriction of gingival vessels and increased gingival keratinisation​

Impaired antibody production​

Depressed numbers of Th lymphocytes​

Impaired PMN function​

Increased production of pro-inflammatory cytokines

Question 16

What percentage of periodontal disease is likely to be a result of genetic factors

Answer 16

50%

Question 17

What does environmental risk include

Answer 17

Local risk factors
Local microbiome
Stress

Question 18

Across the population what percentage have periodontitis and what percentage have SEVERE periodontitis

Answer 18

50% of the population have periodontitis

10% of the population have SEVERE

Question 19

How does vertical bone loss arise

Answer 19

The gap between teeth is greater than the usual 2mm damage area which arises