aetiology and pathogenesis

Question 1

describe gingival health

Answer 1

clearly defines , scalloped, knife edge gingival margin that is pink in colour
abscence of bleeding on probing ( less than 10% of sites) and no probe depths more than 3mm

Question 2

gingivitis

Answer 2

result of plaque accumulation
redness and swelling of gingiva with bleeding upon probing/brushing ,
definition - pocket depth no more than 3mm
no attachment or bone loss, bleeding on probing at less than 30% but mre than 10% of sites, clinical changes are reversible!!

Question 3

periodontitis

Answer 3

loss of periodontal attachment and potential alveolar bone loss
pocket depths of more than 3mm
irreversible!

Question 4

false pocket

Answer 4

sulcular epithelium proliferates in response to plaque an gingiva enlarges - probe will disappear but not actually any attachment loss

Question 5

true pocket

Answer 5

sulcular epithelium migrates apically, plaque then accumulates on the root and apical migration continues. this is couples with inflammation

Question 6

what is the normal distance of alveolar bone from the cemento-enamel junction

Answer 6

1-2mm

can be seen using radiographs

Question 7

horizontal bone loss

Answer 7

bone lost in fairly consistent and flattish pattern across teeth

Question 8

vertical bone loss

Answer 8

bone loss more extensive on one side than the other

Question 9

what does the pattern of bone loss depend upon

Answer 9

the amount of bone between teeth
most apical point of plaque has a 2mm destruction zone , if there is lots of bone between teeth a vertical pattern will be seen, if not a lot of bone a horizontal pattern

Question 10

furcation bone loss

Answer 10

bone loss in furcations , in severe bone loss probe can go right through furcations

Question 11

keystone pathogen of periodontitis

Answer 11

p.gingivalis

Question 12

what attachment loss is considered rapid progression

Answer 12

more than or equal to 2mm over 5 years

Question 13

describe the differences in microbial balance and host immune responses between health, gingivitis and periodontitis

Answer 13

health - symbiosis and proportionate immune response
gingivitis - dysbiosis and proportionate immune response
periodontitis - dysbiosis and disproportionate immune response resulting in soft and hard tissue damage

Question 14

what enzymes are largely responsible for soft tissue destruction (matrix degradation) and where do they come from

Answer 14

MMPs (matrixmetalloproteinases)

these are degradative enzymes released by host inflammatory cells e.g macrophages, lymphocytes

Question 15

what causes hard tissue/ bone destruction

Answer 15

increased action of osteoclasts as excessive immune response is assosciated with increased RANKL

Question 16

why does smoking increase your risk of periodontitis

Answer 16

it impairs aspects of the immune response