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Periodontics > Chapter 8 > Flashcards

Chapter 8 Flashcards

1
Q

what is periodontitis

A
  • alveolar and supporting bone destruction
  • can affect children and adults
  • not based on age, but on clinical and radiographic findings
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2
Q

what causes perio

A
  • bacteria, causing:
  • inflammatory/immune events
  • microscopic changes in the connective tissue and epithelium
  • development of perio
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3
Q

what are the 4 stages of of histopathogenesis

A
  • initial
  • early
  • established
  • advanced
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4
Q

what is the advanced lesion

A
  • alveolar and supporting
  • loss of connective tissue attachment
  • the inflammatory infiltrate spreads in the connective tissue
  • plasma cells (B cells) predominant
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5
Q

what is a pocket

A
  • a pathologically deepened gingival sulcus

- in disease, the junctional epithelium becomes pocket epithelium

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6
Q

when is it a periodontal pocket

A
  • when inflammation spreads into the body of the connective tissue – decreases collagen
  • gingival fibers and connective tissue are destroyed, followed by apical and lateral migration of the junctional epithelium
  • remember, a pocket refers only to soft tissue, not to bone. this is referred to as attachment loss
  • as a consequence to destruction of the gingival fibres and apical migration of the JE there is bone destruction
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7
Q

what will occur when the pocket depth increases in a periodontal pocket

A
  • ideal for bacterial growth

- difficult to maintain

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8
Q

what are the 2 types of periodontal pockets

A
  • suprabony

- infra bony

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9
Q

what cemental changes are seen in the root surface with disease

A
  • surface is rough
  • easily absorbs endotoxins
  • and bacteria and their by-products
  • called necrotic cementum
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10
Q

how is bone destroyed with perio

A
  • PMNs release prostaglandins. PGE2 destroys bone and PGs activate osteoclasts
  • endotoxins destroy bone, which are released by gram negative bacteria
  • B-cells
  • release of IL-1, which stimulates PMN and collagenase
  • cytokines from macrophages destroy bone, IL-1 also stimulates PGE2
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11
Q

is the degree of bone loss correlated with the depth of pockets

A
  • no

- radiographically, extensive bone loss can also be associated with shallow pockets, due to surgery or recession

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12
Q

what does the pattern of bone loss depend on

A
  • the route of the inflammatory infiltrate and route of tissue destruction
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13
Q

what are the 2 patterns of bone loss

A
  • horizontal

- vertical

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14
Q

what is horizontal bone loss

A
  • gingiva -> bone -> PD (principle fibers)
  • bone is lost equally
  • related to suprabony pocket
  • bone resorption occurs from the outer aspect
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15
Q

what is vertical bone loss

A
  • inflammation travels directly from the gingiva into the periodontal ligament
  • bone loss is more rapid on one side of the tooth than the other
  • gingiva to PDL to bone
  • base of the deepest portion of the bony defect is apical to the alveolar bone crest creating an infra bony defect
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16
Q

what are the different types of infrabony defects

A
  • vertical bone loss

- classified according to the number of osseous (bony) walls REMAINING around the defect

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17
Q

what is a 3 wall defect with an infrabony defect

A
  • 3 bony walls remain and one is missing (easiest to repair in surgery bc 3 walls to connect to)
18
Q

what is a 2 wall defect with an infrabony defect

A
  • 2 bony walls remain and 2 are missing

- ‘crater’-M and D on adjacent teeth are missing, buccal and lingual walls remain (most common)

19
Q

what is a 1 wall defect with an infrabony defect

A
  • one bony wall remains and 3 are missing

- ‘hemiseptum’ defect – only the buccal or lingual wall remains

20
Q

how far does the bone destruction process radiate

A
  • 2 mm of the plaque mass
21
Q

what are some factors impacting the pattern of bone loss

A
  • thickness and width of the interdental septum
  • wider interdental septum (>2 mm) (posterior teeth) versus septal bone (anterior teeth)
  • thus mandibular incisors - mostly horizontal loss
  • greater than 2 mm – probably vertical
22
Q

how do we classify periodontitis

A
  • extent
  • severity
  • grade
23
Q

what is the extent of periodontitis

A
  • localized: less than 30% of sites involved

- generalized: more than 30% sites involved

24
Q

what is the severity of periodontitis

A
  • stage I: CAL 1-2 mm
  • stage II: CAL 3-4 mm
  • stage III/IV: CAL greater than or equal to 5 mm
25
Q

what are some other factors that can affect periodontitis

A
  • smoking
  • diabetes
  • genetics
  • HIV
  • stress
  • local factors (tooth related)
26
Q

what types of bacteria are often found at periodontitis sites

A
  • P. gingivalis
  • T. forsythensis
  • E. corrodens
27
Q

when is periodontitis able to be diagnosed (what is present)

A
  • apical migration of the JE
  • alveolar and supporting bone loss seen on x ray
  • soft tissue recession may be present
28
Q

what is rapid progressing periodontitis

A
  • less common (1% of population)
  • replaces ‘early onset and aggressive periodontitis’ which included localized juvenile periodontitis, rapidly progressive periodontitis, and prepubertal periodontitis
  • can occur at any age not limited to patients under 35
  • divided into localized and generalized (localized replaces localized juvenile periodontitis)
29
Q

what are common features of localized and generalized rapid progressing periodontitis

A
  • patients are systemically healthy
  • rapid attachment loss and bone
  • familial predisposition
    other features may include
  • elevated levels of AA
  • abnormal functioning of phagocytes
  • elevated levels of PGE2 and IL-1
    (note: not all features here must be present for diagnosis)
  • often occurs at age of puberty
  • min biofilm
  • high levels of antibodies
  • localized destructive sites
30
Q

what is molar/incisor presentation for localized rapid progressing periodontitis

A
  • first molar/incisors with interproximal attachment loss on at least 2 permanent teeth
  • one of which is a first molar
  • and with no more than 2 teeth other than first molars and incisors
  • poor antibody response to the bacteria
  • generalized interproximal loss on at least 3 permanent teeth other than first molars and incisors
31
Q

what type of bacteria is often present with rapid progressive periodontitis

A
  • AA
  • PG
  • P. intermedia
  • C. rectus
  • C. sp.
32
Q

what are defects of the PMNs and macrophages

A
  • malfunctions in phagocytosis and chemotaxis
  • defect in either PMNs or macrophages but not both
  • seen in 70-80% of patients with aggressive perio
  • not seen in chronic periodontitis
33
Q

what is refractory periodontitis (old term)

A
  • do not respond favourably to conventions therapy and are considered resistant to treatment
    30% are smokers (AAP)
34
Q

what is peri-implantitis

A
  • loss of bone that surrounds a functioning implant

- periodontitis on an implant

35
Q

what is peri-implant mucositis

A
  • gingivitis on an implant
  • primary risk is bacteria
  • treatment is similar
36
Q

how can we treat periodontitis

A
  • non-surgical start:
  • re-evaluate 4-6/8 weeks
  • determine surgery: pocket reduction or elimination. chronic – this is best treatment
  • rapidly progressive perio: possible systemic antibiotics
37
Q

what type of bone loss is infrabony

A
  • vertical
38
Q

what type of bone loss is suprabony

A
  • horizontal
39
Q

what does localized aggressive periodontitis include

A
  • first molar or incisor with no more than 2 other teeth besides first molar/incisor
40
Q

what does generalized periodontitis include

A
  • generalized IP bone loss and destruction leaving at least 3 permanent teeth other than first molars/incisors

Periodontics (9 decks)

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