Aetiology and Pathogenesis of Periodontal Disease

Question 1

describe the appearance of gingival health

Answer 1

knife edge, scalloped gingival margin, stippling, pink

Question 2

what are the physiological bone levels for gingival health?

Answer 2

1-3mm apical to the cemento-enamel junction

Question 3

what is gingival health defined as?

Answer 3

10% bleeding sites with probing depths <3mm

Question 4

what is clinical gingival health characterised by?

Answer 4

absence of bleeding on probing, erythema and oedema, patient symptoms, attachment and bone loss

Question 5

what are the local plaque retention factors for the pathogenesis of gingivitis?

Answer 5

calculus, restoration margins, crowding, mouth breathing

Question 6

what are the systemic modifying factors of the pathogenesis of gingivitis?

Answer 6

sex hormones and medication

Question 7

what is the primary thing needed for clinical gingivitis to occur?

Answer 7

microbial challenge (plaque)

Question 8

is gingivitis reversible?

Answer 8

yes

Question 9

if gingivitis progresses what can it turn into?

Answer 9

periodontitis

Question 10

what can be seen in periodontitis?

Answer 10

inflammation and loss of periodontal attachment

Question 11

what is a false pocket?

Answer 11

proliferation of sulcular epithelium and enlargement on gingivae when placing the probe into the pocket it will disappear but there is no loss of attachment so is deemed a false pocket

Question 12

what is a true pocket?

Answer 12

plaque accumulation on the root surface causing apical migration of epithelium which causes bone loss

Question 13

how do you check bone level?

Answer 13

using radiographs and looking for consistency in bone level

Question 14

what are the two types of bone loss?

Answer 14

horizontal and vertical

Question 15

what is horizontal bone loss

Answer 15

bone level more than a couple mm from ACJ and is continuous throughout

Question 16

what is vertical bone loss

Answer 16

where bone loss varies on each side of the tooth (one side is deeper than other)

Question 17

how do the different types of bone loss arise?

Answer 17

due to the thickness of the alveolar bone that rests between the teeth

Question 18

if there is thick alveolar bone between teeth which type of bone loss will occur?

Answer 18

vertical

Question 19

if there is thin alveolar bone between teeth which type of bone loss will occur?

Answer 19

horizontal

Question 20

how is furcation bone loss classified?

Answer 20

by how extensive it is

Question 21

what is class 1 furcation bone loss?

Answer 21

bone loss is 3mm into the furcation (about half way)

Question 22

what is class 2 furcation bone loss?

Answer 22

more than 3mm into the furcation (over halfway)

Question 23

what is class 3 furcation bone loss?

Answer 23

probe can go all the way through the furcation

Question 24

once in periodontitis what can the progression of attachment loss be?

Answer 24

episodic or continuous

Question 25

what is the usual progression of attachment loss per year

Answer 25

0.05-1mm

Question 26

what would be considered rapid progression of periodontitis?

Answer 26

> 2mm of attachment loss over 5 years

Question 27

where does the plaque biofilm migrate with periodontitis?

Answer 27

apically

Question 28

what is the keystone pathogen for periodontitis?

Answer 28

P. gingivalis

Question 29

what does a collection of bacteria do for the oral environment?

Answer 29

perpetuates the inflammation which creates good conditions for inflammatory thriving bacteria

Question 30

what does periodontitis need to occur?

Answer 30

the presence of bacteria

Question 31

what is the host immune response to periodontitis and bacteria?

Answer 31

saliva, epithelium barrier shreds cells and produces inflammatory mediators, gingival crevicular fluid produce, inflammatory and immune responses

Question 32

what contributes to the connective tissue matrix degradation?

Answer 32

matrix metalloproteinases and osteoclasts

Question 33

what produces MMPs in periodontitis?

Answer 33

host inflammatory cells

Question 34

what are MMPs

Answer 34

family of zinc and calcium dependent proteolytic enzymes including collagenases

Question 35

what do local risk factors for periodontitis include?

Answer 35

anatomical risk factors (enamel projections, grooves, gingival recession), tooth position (malalignment, crowding, migration), iatrogenic risk factors (restoration overhangs, defective crown margins)

Question 36

what is the effect of smoking on periodontitis?

Answer 36

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 37

what is the genetic risk for periodontitis?

Answer 37

polymorphisms in the gene for IL-1 (greater production of IL-1)

Question 38

what are the environmental risk factors for periodontitis?

Answer 38

the local risk factor, local microbiome, stress

Question 39

what is the casual theory for the aetiology of periodontitis?

Answer 39

you must have teeth and microbial challenge to get periodontitis but these 2 alone are not sufficient enough to get eh disease so other factors are included

Question 40

how many people suffer from periodontal disease?

Answer 40

50%

Question 41

what is the primary aetiological agent in inflammatory periodontal diseases?

Answer 41

microbial plaque

Question 42

what is the extent and severity of periodontal disease dependent on?

Answer 42

interaction between microbe and host

Question 43

what type of risk factors convey susceptibility for periodontitis?

Answer 43

ones which interfere with host defences