aetiology and pathogenesis of periodontal disease

Question 1

describe gingvival health

Answer 1

clearly defined gingival margin, knife edge, scalloped
possible stippling
pink

Question 2

what is the clinical definition of gingival health?

Answer 2

absence of bleeding on probing, erythema and edema, patient symptoms, attachment and bone loss, bone level range from 1-3mm apical to ACJ
<10% bleeding sites w/ probing depths

Question 3

describe plaque induced gingivitis (intact periodontium)

Answer 3

red margin
rolled
-lost knife edge

Question 4

what are the local plaque retention factors?

Answer 4

calculus
restoration margins
crowding
mouth breathing

Question 5

what are the systemic modifying factors?

Answer 5

sex hormones

medication

Question 6

what happens to neutrophils, lymphocytes etc. gin gingiivitis?

Answer 6

influx higher than normal

Question 7

is periodontitis reversible?

Answer 7

no

Question 8

is gingivitis reversible?

Answer 8

yes

Question 9

what is periodontitis?

Answer 9

inflammation
loss of periodontal attachment
bone >3mm away from ACJ

Question 10

describe a periodontal pocket

Answer 10

probe disappears

bleeding

Question 11

what is a false pocket?

Answer 11

proliferation of sulcular epithelium leads to enlarged gingivae
probe disappears but no loss of attachment

Question 12

in what group are pockets without inflammation common?

Answer 12

smokers

Question 13

what is the normal bone level from the ACJ?

Answer 13

1-2mm

Question 14

how do you determine if there has been bone loss?

Answer 14

check if bone level consistent on radiographs
how much bone loss relative to root length
-apex -> ACJ
-give %

Question 15

what determines horizontal vs vertical bone loss?

Answer 15

how thick alveolar bone is between teeth

Question 16

describe the progression from gingivitis -> periodontitis

Answer 16

once initiated, progression of attachment loss may be episodic, different sites may be affected differently
generally very slow but variable
2mm loss over 5 years = rapid progression

Question 17

what happens when the biofilm migrates apically?

Answer 17

severe inflammation

bone loss

Question 18

what is the host immune response?

Answer 18

saliva
epithelium
-physical barrier
-shedding of cells
-production of inflammatory mediators
GCF
inflammatory and immune responses

Question 19

describe connective tissue matrix degradation

Answer 19

matrix malloproteinases are a family of zinc & ca dependent proteolytic enzymes which include collagenases
matrix degradation largely a result of MMP’s secreted by host inflammatory cells
immune cell activation of osteoclasts via RANK/RANKL/ other cytokine

Question 20

what are anatomical risk factors?

Answer 20

enamel pearls/projections
grooves
furcations
gingival recession

Question 21

what are tooth position risk factors?

Answer 21

malalignment
crowding
tipping
migration
occlusal forces

Question 22

what are iatrogenic risk factors?

Answer 22

restoration overhangs
defective crown margins
poorly designed partial dentures
orthodontic appliances

Question 23

why is smoking a risk factor?

Answer 23

vasoconstriction of gingival vessels and increased gingival keratinisation
impaired antibody production
depressed numbers of Th lymphocytes
impaired PMN function
increased prod. pro-inflammatory cytokines

Question 24

what are environmental risk factors?

Answer 24

local risk factors
local microbiome
stress

Question 25

what is the impact of periodontitis?

Answer 25

most common cause of bone loss

50% population affected

Question 26

what is the extent and severity dependant on?

Answer 26

interaction between microbiome and host

Question 27

what is the primary aetiological agent?

Answer 27

microbial plaque