Chapter 7 Flashcards
What is periodontitis?
Complex microbial infection that triggers a hot-mediated inflammatory response within the periodontium
What does periodontitis result in?
The destruction of the PDL and alveolar bone. Also affects the gingiva and cementum
What is periodontitis a result of the action between?
Plaque biofilm and the hosts immune response
Is clinical appearance a reliable indicator of the presence or severity of chronic periodontitis?
No. Chronic disease may present with less bleeding or visible inflammation. Some signs and symptoms can be indicative of conditions other than periodontitis. Differential diagnosis needed.
Probing and radiographs needed
What are some symptoms of perio that may be related to other issues?
Red, swollen gingiva- severe gingivitis
Bleeding from brushing- gingivitis
Bad taste in mouth- medication
Bad breath- diet, tongue coating
Sensitivity- recession, traumatic brushing
Pus- endodontic origin
What is the etiology of periodontitis?
Bacterial plaque and calculus
Characteristics of clinical attachment loss
Apical migration of JE
Destruction of gingival and PDL fibers
Loss of AB
Possible furcation involvement
Tooth mobility/migration
Factors contributing to periodontitis
Smoking
Diabetes
HIV status
Genetics
Local factors: crowding/malposition
Overhanging restoration margins
Symptoms that may be reported by the patient
Bleeding gums
Spaces developing btw their teeth
Loose teeth
Increased food impaction or tooth sensitivity
Pain- only with acute exacerbations of disease
What is an abscess?
Acute infection involving a circumscribed accumulation of pus within the gingival wall of the periodontal pocket
What is pus or exudate?
Whitish-yellow, consisting of dead and dying neutrophils, bacteria, cellular debris, and fluid from BV
How are acute abscesses characterized?
Rapid onset
Constant and localized pain
Usually an exacerbation of a chronic inflammatory periodontal lesion
How are chronic abscesses characterized?
Grows slowly, usually asymptomatic because of drainage through sinus tract
Typically painless but may cause dull pain
Characteristics of periodontal abscesses
May be chronic or acute
Localized swelling in periodontium
Possible increase in mobility
Radiographic bone loss, not involving tooth apex
Tooth usually vital
Possible elevated temp
May release pus through sinus tract
Causes of periodontal abscess
Blockage of the orifice of a pocket
Accidental introduction of a foreign object into the pocket: popcorn husk
Incomplete calculus removal
Classifications of abscesses by location
-Gingival- GM or papilla
-Periodontal- Deeper structures, usually occurs at site of previous perio/attachment loss
-Pericoronal- around partially erupted tooth (3rd molar)
What is an operculum?
Flap of tissue
What is the infection caused by biofilm or debris becoming trapped within an operculum?
Strep milleri
How are abscesses of the periodontium managed?
Establish path of drainage- pocket via curettage or over abscess w/ scalpel
Perio instrumentation- debridement and calc removal
Pain relief- antibiotics and saline rinse
How do we manage pericoronitis?
Estabish path of drainage
Irrigation under operculum
Instrumentation of tooth surfaces
Pain relief
Possible antibiotics
What is the rate of progression of periodontitis?
Continual, slow process w/ periond of remission and exacerbation
Rapid progression in a limited number of individuals
Does not affect all teeth equally
Risk factors for more rapid progression
Interproximal sites
Biofilm accumulation
Malpositioned teeth
Overhanging margins
Food impaction
Deep pockets
Furcations
Specific perio pathogens
What is the best predictor of disease progression?
Individual’s previous history of disease extent and progression
What are the therapeutic endpoints and goals?
-Elimination of microbial etiology and other inflammatory factors
-Preservation of a state of health for teeth and periodontium
-Prevention of disease recurrence
What does refractory mean?
Does not respond to adequate treatment. Contributing factors may complicate thing long-tern
Why are recurrent and refractory periodontitis no longer distinct categories?
Not enough evidence to substantiate that they are distinct disease entities but still important to discuss the two forms
What is recurrent periodontitis?
-Destructive periodontitis returns
-Any treated pt is susceptible
-Common w/ poor homecare or non-compliance w/ perio maint.
-Responds to treatment and compliance
What is refractory periodontitis?
Destructive perio returns
Any treated pt is susceptible
Happens w/ appropriate therapy and satisfactory homecare
Unknown etiology
Does not respond to conventional treatment
