Chapter 3 Flashcards
What is disease progression (pathogenesis)?
The sequence of events that occur during the development of a disease or abnormal condition
What are the components of the periodontium?
Gingiva
PDL
Bone
Cementum
What are the two types of periodontal disease?
Gingivitis
Periodontitis
What is gingivitis?
Bacterial infection confined to the gingiva
Reversible
What is periodontitis?
Bacterial infection (and inflammatory response) of ALL PARTS of the periodontium including: gingiva, PDL, bone, cementum
Results in irreversible tissue destruction
What are the two levels of healthy periodontium?
Pristine Periodontal Health- bleeding absent
Clinical periodontal health- bleeding <10% of sites
What is gingivitis characterized by?
Changes in color, contour and consistency of gingiva
How many days after plaque biofilm accumulation can gingivitis be observed?
4-14 days
What is acute gingivitis?
Short term
Fluid accumulation in tissue
Redness
What is chronic gingivitis?
Months to years
Collagen formation may result in enlargement
Fibrotic appearance
Decreased redness
What is the state of the junctional epithelium in the presence of gingivitis?
Does not affect normal attachment of the JE
Color of gingivitis clinically
Variable: red to reddish-blue, less so in chronic state
State of gingival margin with gingivitis, clinically
Loses thin edge, may cover more of the tooth (enlarged)
State of papilla with gingivitis
Enlarged, bulbous
What kind of bleeding would we see clinically in a state of gingivitis?
Bleeding upon probing, may decrease in chronic state and with smokers
State of the sulcus in presence of gingivitis
Probing depth may increase (pseudopockets from enlargement)
No apical migration of JE
What are the microscopic clinical features of gingivitis?
Hemidesmosomal attachment coronal to CEJ
JE extends in epithelial ridges due to destruction of supragingival fiber bundles
What is periodontitis characterized by?
Apical migration of the JE
Loss of CT attachment
Loss of AB
Irreversible tissue damage
Describe periodontal destruction
Intermittent with extended periods of disease inactivity followed by short bursts of destructive activity
Progresses at different rates throughout the mouth and at a few specific sites at a time
Clinical color of periodontitis
Bluish or purplish red edematous (spongy) tissue
Clinical consistency of tissue with periodontitis
Pinkish leathery or firm, nodular tissue
Clinical state of gingival margin in periodontitis
Loses thin edge, swollen (rolled) or fibrotic
Position in highly variable due to underlying attachment loss (root may be exposed)
State of papilla in periodontitis
May not fill embrasure
Bleeding in presence of periodontitis
Often bleeding on probing
Variable pus or spontaneous bleeding
Depths of pockets with periodontitis
> 4mm due to apical migration of JE
Location of JE in periodontitis
Apical to normal on the root
Most coronal portion of JE detaches from the tooth surface
What happens to gingival connective tissue with periodontitis?
Collagen destruction, supragingival fiber destruction, PDL fiber destruction
However, transseptal fibers continually regenerate and are intact across the crest of bone (separates inflammation from bone)
Microscopic features of periodontitis
Permanent destruction of alveolar bone and PDL fibers
Cementum exposed to bacterial biofilm
Pulp may be inflamed, edematous, necrotic or show signs of resorbed dentin
What is inflammation?
The body’s response to injury or invasion by disease-producing microorganisms
What is responsible for the destruction that occurs in periodontitis?
Bacterial induced inflammation
Pattern of bone loss depends on pathway of inflammation
Where is the AB located in a healthy mouth?
2mm apical to the CEJ- space is required for soft tissue
Where is the AB located in gingivitis?
2mm apical to the CEJ- JE is in same position as in a healthy mouth as bone loss has not yet occurred
Where is the AB located in periodontitis?
More than 2mm apical to the CEJ
Progressive bone loss can lead to tooth loss
What is the most common pattern of bone loss?
Horizontal- Fairly even reduction in bone height
Describe vertical bone loss
Uneven reduction of bone height
Progression more rapid next to root surface
Creates trench-like defects
What is the pathway of inflammation in horizontal bone loss?
CT–>AB–>PDL
Occurs in gingival CT tissue first
Then into the AB
Then into the PDL space
Path of least resistance
What is the pathway of inflammation in vertical bone loss?
CT–>PDL–>AB
Gingival CT tissue
Then to the PDL
Then to the AB
Occurs when crest fibers are too weak to barrier
How are infrabony defects classified?
By the number of bony walls
Root of tooth not counted as a wall
Craters occur at the crest of the bone
How would you classify this infrabony defect?
3 wall defect
How would you classify this infrabony defect?
1 Wall defect
What type of infrabony defect is seen here?
Interproximal osseous crater
How would you classify this infrabony defect?
2 wall defect
Where do furcation involvements occur?
On multi-rooted teeth when bone loss invades the area between the roots
How are furcations graded?
By their extent: early invasion of the space between the roots to a through and through
How would you classify the defect on #21D?
2 Wall defect
What type of infrabony defect is shown here?
Circumferential
What is a gingival pocket?
Deepening of the gingival sulcus resulting from inflammation
What happens to the JE in the gingival pocket?
No apical migration of JE
Coronal potion of JE detaches from tooth, increasing probe depths
Swelling may also occur and increase probe depth
“Pseudopockets”–> no destruction to PDL
What is a periodontal pocket?
Pathological deepening of the gingival sulcus as a result of: apical migration of JE, destruction of PDL fibers and AB
What are the two types of periodontal pockets?
Suprabony
Infrabony
Describe a suprabony periodontal pocket?
Occurs with horizontal bone loss
JE is located coronal to the crest of the AB
Supra= above
Describe an infrabony periodontal pocket?
Occurs with vertical bone loss
JE is apical to the crest of the AB
Base of pocket is within the bony defect adjacent to the root surface
Infra= within
What is a disease site?
Area of tissue destruction- may involve one to all tooth surfaces
What are the two types of disease sites? Which is more likely to occur?
Active and inactive
More likely to be inactive as the body is always trying to heal itself
What is attachment loss?
Destruction of tooth supporting fibers and AB
Pockets may exhibit irregular patterns of destruction
Characteristic of active disease sites
Shows continued migration of JE toward apex
Characteristics of inactive disease sites
Site is stable with attachment level of JE at the same level over a period of time
What is a periodontal pocket an indicator of?
Past disease activity
Presence of a pocket does not indicate current disease activity
What does disease progression mean in the context of periodontal disease?
Means the disease gets worse
Describe the pattern of disease progression
Varies between people
Varies from one site to another in the same person
Varies by type of periodontal disease
What is the current theory of disease progression?
Destruction occurs in short bursts with long periods of no activity
Occurs at diff rates and times in diff sites
Diff forms of disease occur at diff rates and patterns
Host response varies
What is the intermittent theory of disease progression?
In the majority of cases, untreated gingivitis does not progress to periodontitis
What is epidemiology?
The study of health and disease within the total population rather than the individual
What are the three research objectives in epidemiology?
Determine the amt and distribution of disease in a total population and in subgroups
Investigate causes of disease
Use the knowledge to prevent and control a disease
What are the risk factors for disease?
Heredity, genetics
Gender
Physical environment
Systemic factors
Socioeconomic factors
Socioeconomic status
Personal behavior/lifestyle
Why do epidemiologists study periodontal disease?
To determine its occurrence in a population, and to identify risk factors for periodontal disease
Provides current information about success in prevention and treatment
What is prevalence?
Total number of old and new cases of a disease identified in a specific population at a given point in time
Ex. How many people in total are living with cancer
What is incidence?
Number of NEW cases in a specific population occurring during a specific period of time
Ex. How many new cases of cancer have been diagnosed in the last year
What do we use to measure and assess periodontal disease?
Color, edema, loss of PDL, AB loss, furcation, BOP, probing depths
Can be difficult to measure given the involvement of both hard and soft tissue and when paired with gingivitis can be more difficult to measure
Which is most prevalent, mild, moderate or sever periodontitis?
Moderate- 30%
