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247 Periodontics > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

What is disease progression (pathogenesis)?

A

The sequence of events that occur during the development of a disease or abnormal condition

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2
Q

What are the components of the periodontium?

A

Gingiva
PDL
Bone
Cementum

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3
Q

What are the two types of periodontal disease?

A

Gingivitis
Periodontitis

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4
Q

What is gingivitis?

A

Bacterial infection confined to the gingiva
Reversible

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5
Q

What is periodontitis?

A

Bacterial infection (and inflammatory response) of ALL PARTS of the periodontium including: gingiva, PDL, bone, cementum

Results in irreversible tissue destruction

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6
Q

What are the two levels of healthy periodontium?

A

Pristine Periodontal Health- bleeding absent
Clinical periodontal health- bleeding <10% of sites

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7
Q

What is gingivitis characterized by?

A

Changes in color, contour and consistency of gingiva

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8
Q

How many days after plaque biofilm accumulation can gingivitis be observed?

A

4-14 days

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9
Q

What is acute gingivitis?

A

Short term
Fluid accumulation in tissue
Redness

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10
Q

What is chronic gingivitis?

A

Months to years
Collagen formation may result in enlargement
Fibrotic appearance
Decreased redness

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11
Q

What is the state of the junctional epithelium in the presence of gingivitis?

A

Does not affect normal attachment of the JE

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12
Q

Color of gingivitis clinically

A

Variable: red to reddish-blue, less so in chronic state

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13
Q

State of gingival margin with gingivitis, clinically

A

Loses thin edge, may cover more of the tooth (enlarged)

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14
Q

State of papilla with gingivitis

A

Enlarged, bulbous

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15
Q

What kind of bleeding would we see clinically in a state of gingivitis?

A

Bleeding upon probing, may decrease in chronic state and with smokers

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16
Q

State of the sulcus in presence of gingivitis

A

Probing depth may increase (pseudopockets from enlargement)
No apical migration of JE

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17
Q

What are the microscopic clinical features of gingivitis?

A

Hemidesmosomal attachment coronal to CEJ
JE extends in epithelial ridges due to destruction of supragingival fiber bundles

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18
Q

What is periodontitis characterized by?

A

Apical migration of the JE
Loss of CT attachment
Loss of AB
Irreversible tissue damage

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19
Q

Describe periodontal destruction

A

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

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20
Q

Clinical color of periodontitis

A

Bluish or purplish red edematous (spongy) tissue

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21
Q

Clinical consistency of tissue with periodontitis

A

Pinkish leathery or firm, nodular tissue

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22
Q

Clinical state of gingival margin in periodontitis

A

Loses thin edge, swollen (rolled) or fibrotic
Position in highly variable due to underlying attachment loss (root may be exposed)

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23
Q

State of papilla in periodontitis

A

May not fill embrasure

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24
Q

Bleeding in presence of periodontitis

A

Often bleeding on probing
Variable pus or spontaneous bleeding

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25
Q

Depths of pockets with periodontitis

A

> 4mm due to apical migration of JE

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26
Q

Location of JE in periodontitis

A

Apical to normal on the root
Most coronal portion of JE detaches from the tooth surface

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27
Q

What happens to gingival connective tissue with periodontitis?

A

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)

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28
Q

Microscopic features of periodontitis

A

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

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29
Q

What is inflammation?

A

The body’s response to injury or invasion by disease-producing microorganisms

30
Q

What is responsible for the destruction that occurs in periodontitis?

A

Bacterial induced inflammation
Pattern of bone loss depends on pathway of inflammation

31
Q

Where is the AB located in a healthy mouth?

A

2mm apical to the CEJ- space is required for soft tissue

32
Q

Where is the AB located in gingivitis?

A

2mm apical to the CEJ- JE is in same position as in a healthy mouth as bone loss has not yet occurred

33
Q

Where is the AB located in periodontitis?

A

More than 2mm apical to the CEJ

Progressive bone loss can lead to tooth loss

34
Q

What is the most common pattern of bone loss?

A

Horizontal- Fairly even reduction in bone height

35
Q

Describe vertical bone loss

A

Uneven reduction of bone height
Progression more rapid next to root surface
Creates trench-like defects

36
Q

What is the pathway of inflammation in horizontal bone loss?

A

CT–>AB–>PDL

Occurs in gingival CT tissue first
Then into the AB
Then into the PDL space

Path of least resistance

37
Q

What is the pathway of inflammation in vertical bone loss?

A

CT–>PDL–>AB

Gingival CT tissue
Then to the PDL
Then to the AB

Occurs when crest fibers are too weak to barrier

38
Q

How are infrabony defects classified?

A

By the number of bony walls

Root of tooth not counted as a wall

Craters occur at the crest of the bone

39
Q

How would you classify this infrabony defect?

A

3 wall defect

40
Q

How would you classify this infrabony defect?

A

1 Wall defect

41
Q

What type of infrabony defect is seen here?

A

Interproximal osseous crater

42
Q

How would you classify this infrabony defect?

A

2 wall defect

43
Q

Where do furcation involvements occur?

A

On multi-rooted teeth when bone loss invades the area between the roots

44
Q

How are furcations graded?

A

By their extent: early invasion of the space between the roots to a through and through

45
Q

How would you classify the defect on #21D?

A

2 Wall defect

46
Q

What type of infrabony defect is shown here?

A

Circumferential

47
Q

What is a gingival pocket?

A

Deepening of the gingival sulcus resulting from inflammation

48
Q

What happens to the JE in the gingival pocket?

A

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

49
Q

What is a periodontal pocket?

A

Pathological deepening of the gingival sulcus as a result of: apical migration of JE, destruction of PDL fibers and AB

50
Q

What are the two types of periodontal pockets?

A

Suprabony
Infrabony

51
Q

Describe a suprabony periodontal pocket?

A

Occurs with horizontal bone loss
JE is located coronal to the crest of the AB

Supra= above

52
Q

Describe an infrabony periodontal pocket?

A

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

53
Q

What is a disease site?

A

Area of tissue destruction- may involve one to all tooth surfaces

54
Q

What are the two types of disease sites? Which is more likely to occur?

A

Active and inactive

More likely to be inactive as the body is always trying to heal itself

55
Q

What is attachment loss?

A

Destruction of tooth supporting fibers and AB

Pockets may exhibit irregular patterns of destruction

56
Q

Characteristic of active disease sites

A

Shows continued migration of JE toward apex

57
Q

Characteristics of inactive disease sites

A

Site is stable with attachment level of JE at the same level over a period of time

58
Q

What is a periodontal pocket an indicator of?

A

Past disease activity

Presence of a pocket does not indicate current disease activity

59
Q

What does disease progression mean in the context of periodontal disease?

A

Means the disease gets worse

60
Q

Describe the pattern of disease progression

A

Varies between people
Varies from one site to another in the same person
Varies by type of periodontal disease

61
Q

What is the current theory of disease progression?

A

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

62
Q

What is the intermittent theory of disease progression?

A

In the majority of cases, untreated gingivitis does not progress to periodontitis

63
Q

What is epidemiology?

A

The study of health and disease within the total population rather than the individual

64
Q

What are the three research objectives in epidemiology?

A

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

65
Q

What are the risk factors for disease?

A

Heredity, genetics
Gender
Physical environment
Systemic factors
Socioeconomic factors
Socioeconomic status
Personal behavior/lifestyle

66
Q

Why do epidemiologists study periodontal disease?

A

To determine its occurrence in a population, and to identify risk factors for periodontal disease

Provides current information about success in prevention and treatment

67
Q

What is prevalence?

A

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

68
Q

What is incidence?

A

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

69
Q

What do we use to measure and assess periodontal disease?

A

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

70
Q

Which is most prevalent, mild, moderate or sever periodontitis?

A

Moderate- 30%

247 Periodontics (19 decks)

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