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Perio lectures > Classification and Etiology of Perio Diseases > Flashcards

Classification and Etiology of Perio Diseases Flashcards

1
Q

What is gingivitis?

A

Inflammation of the Gingiva

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2
Q

Define Periodontitis…

A

Inflammation of the supporting tissues of the teeth. Usually a progressively destructive change leading to loss of bone and periodontal ligament. An extension of inflammation from gingiva into the adjacent bone and ligament.

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3
Q

What are the 8 Classifications of periodontal disease?

A
  • Gingival diseases
  • Chronic periodontitis
  • Aggressive periodontitis
  • Periodontitis as a manifestation of systemic diseases
  • Necrotizing periodontal diseases
  • Abscesses of the periodontium
  • Periodontitis associated with endodontic lesions
  • Developmental or acquired deformities and conditions
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4
Q

Describe dental plaque-induced gingival diseases…

A

Gingivitis associated with dental plaque only
Most common form of gingival diseases
Reversible once treated
Prevalence >90%
Characterized by the presence of clinical signs of inflammation confined to the gingiva

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5
Q

What are gingival diseases modified by medications?

A

Dental plaque-induced gingival diseases

Increasing in prevalence due to the increasing use of:
Anti-convulsant drug (50% of pts)s:
Phenytoin
Calcium channel blocker (25% of its)s:
Nifedipine, verapamil, diltiazem
Immunosuppressive drug (33% of its)s:
Cyclosporin A
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6
Q

What 3 origins contribute to nonplaque-induced gingival lesions?

A 
Gingival diseases of:
Bacterial origin
Neisseria gonorrhea, Treponema pallidum
Viral origin
Herpes simplex viruses 1 & 2, Varicella zoster virus
Fungal origin
Candidasis, histoplasmosis
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7
Q

What are traumatic lesions of the gingiva?

A 
Nonplaque-induced gingival lesions
Traumatic lesions
Factitial
Toothbrush trauma
Accidental
Damage through minor burns from hot food or drinks
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8
Q

What are 3 classifications of periodontitis?

A

Chronic periodontitis
Aggressive periodontitis
Periodontitis as a manifestation of systemic diseases

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9
Q

Describe Chronic Periodontitis…

A

Associated with plaque and calculus
irreversible
Generally slow to moderate rate of progression
Extent and severity may be increase with host-modifying factors
Diabetes, smoking, and stress

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10
Q

Chronic periodontitis descriptors according tot he AAP update in 2015…

A 
Localized
< 30% of sites
Generalized
> 30% of sites
Severity
Slight, moderate, severe
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11
Q

2015 update

A

Generalized chronic periodontitis may be classified as periodontitis without a clear pattern of disease distribution of the affected teeth or >30% of teeth affected
age at detection be considered as a guideline in diagnosing aggressive periodontal diseases. The recommended age of younger than 25 years at the time of detection can be used, along with other diagnostic criteria.

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12
Q

Describe what slight periodontitis is according to the update in 2015?

A 
Probing depths...>3 &amp; <5 mm
BOP...Y
Rad bone loss...Up to 15% of root length or
≥ 2mm &amp; ≤3 mm
CAL...1-2mm
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13
Q

Describe what moderate periodontitis is according to the update in 2015?

A

PD…≥5 & <7 mm
BOP…Y
Rad Bone Loss…16-30% or > 3mm & ≤5 mm
CAL…3-4mm

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14
Q

Describe what severe periodontitis is according to the update in 2015?

A

PD…≥7 mm
BOP…Y
Rad Bone Loss…>30% or > 5mm
CAL 5+mm

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15
Q

What is aggressive periodontitis?

A

Rapid attachment loss and bone destruction
Amount of microbial deposits inconsistent with disease severity
Familial aggregation of diseased individuals

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16
Q

Describe Localized Aggressive Periodontitis…

A

Circumpubertal onset
Specific, robust serum antibody response
Localized to first molar or incisor

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17
Q

Describe Generalized Aggressive Periodontitis…

A

Poor serum antibody response

Generalized proximal attachment loss affecting at least 3 permanent teeth other than first molars and incisors

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18
Q

What 2 disease categories make up periodontitis as a manifestation of systemic diseases?

A

Hematologic disorders

Genetic Disease

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19
Q

What are some examples of Perio Hematologic Disorders?

A

Leukemia & Acquired Neutropenia

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20
Q

What are some examples of Perio Genetic Diseases?

A

Cyclic neutropenia, Down syndrome, Leukocyte adhesion deficiency

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21
Q

What are the 2 categories of necrotizing periodontal diseases?

A

Necrotizing ulcerative gingivitis (NUG)

Necrotizing ulcerative periodontitis (NUP)

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22
Q

Describe NUG, what 3 elements constitute a diagnosis?

A 
Predisposing factors:
Stress, smoking, poor oral hygiene, &amp; immunosupression
Diagnosis based on three criteria:
1. Interproximal necrosis
2. Pain
3. Bleeding
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23
Q

Describe NUP…

A

Loss of attachment and bone
Ulceration and necrosis of gingival
Rapid destruction and exposure of underlying bone
Spontaneous bleeding and severe pain

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24
Q

What 4 clinical manifestations may come with an abscess?

A 
Localized purulent infection
May exhibit one or more of the following:
Gingival swelling
Draining fistula
Pain on percussion
Increased mobility
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25
Q

Common situations that predispose to abscess formation - can you think of 4?

A

Deep periodontal pockets
Incomplete calculus removal
Foreign body impaction
Repeat antibiotic use

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26
Q

What are the 3 Abscesses of the Peridontium?

A

Gingival
Periodontal
Pericoronal

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27
Q

Describe what a Gingival Abscess is…

A

Involves interdental or marginal gingival
Not associated with a periodontal pocket
Typically does not involve the PDL

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28
Q

Describe what a Periodontal Abscess is…

A

Most frequently encountered of the 3
Arises from a preexisting pocket
Bacterial etiology

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29
Q

Describe what a Pericoronal Abscess is…

A

Same as periodontal, though around a partially erupted tooth

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30
Q

Describe Periodontitis associated with endodontic lesions…

A

Combined lesions
Infections of periapical tissues caused by pulpal death can locally join with separate infections from periodontal pockets

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31
Q

Order of TX for combined endo/perio lesions?

A

The endodontic infection should be controlled before beginning definitive periodontal therapy
When regenerative or bone grafting techniques are planned

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32
Q

What are 4 categories of Developmental or acquired deformities and conditions?

A
  • Tooth anatomical factors
  • Mucogingival deformities around teeth
  • Mucogingival Deformaties on edentulous ridges
  • Occlusal Trauma
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33
Q

What are some examples of tooth anatomical factors that can affect Perio?

A

cervical enamel projections, enamel pearls, furcation anatomy, tooth positions and proximity

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34
Q

What are some characteristics of mucogingival Deformaties around teeth?

A

Soft tissue recession, lack of keratinized tissue, gingival excess

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35
Q

What are some examples of Mucogingival Deformaties on edentulous ridges?

A

Ridge deficiencies, lack of keratinized tissue, aberrant frenum, muscle position

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36
Q

What are the 2 sub groups of occlusal trauma?

A

Primary

Secondary

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37
Q

Primary Etiology?

A

Microbiological

Host

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38
Q

What is secondary etiology

A

Environmental

Local Factors

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39
Q

What is dental plaque?

A

Primary Factor
Organized mass adhering to teeth, prosthesis, and oral surfaces
Classified as supragingival and subgingival

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40
Q

What is the composition of plaque?

A

80% water
20% solid
Salivary glycoproteins, extracellular polysaccharides, proteins, lipids

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41
Q

Describe Supragingival Plaque…

A

Coronal to gingival margin
Forms rapidly
Aerobic > anaerobic

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42
Q

Describe Subgingival Plaque…

A

Apical to gingival margin
Growth may be influenced by supragingival plaque
Anaerobic > aerobic

43
Q

Where does early plaque formation occur faster

A

In the mandibular arch
Molar areas
Buccal surfaces of the maxillary teeth
Interdental regions compared to strict buccal or oral surfaces
Tooth surfaces facing inflamed gingival margins

44
Q

What is a Biofilm?

A

Organized Structure

Microcolonies of bacterial cells distributed in a shaped matrix or glycocalyx

45
Q

What are the Organic Constituents of a Biofilm?

A

Polysaccharides, proteins, glycoproteins and lipid material

46
Q

What are the Inorganic Constituents of a Biofilm?

A

Calcium, phosphorus, and trace minerals

As mineral content increases the plaque mass becomes calcified forming calculus

47
Q

What are some unique features of Biofilm?

A

Protection-glycocalyx that encloses microbial community
Nutrition-matrix is capable of trapping nutrients
Quorum sensing-communication between bacteria

48
Q

What are the 4 plaque development phases?

A

Adherence
Lag Phase
Rapid Growth Phase
Steady State

49
Q

What happens during the adherence phase?

A

Pellicle formation
Glycoprotein
Cell surface proteins
Initial colonization gram + facultative bacteria

50
Q

What happens during the lag phase?

A

Shift in genetic expression

51
Q

What happens during the rapid growth phase?

A

Plaque maturation
Co-aggregation/co-adhesion
Quorum sensing

52
Q

What happens during the steady state stage?

A

Internal transfer of nutrients
Growth slows
Tolerance
Resistance

53
Q

What is the Non-specific plaque hypothesis?

A

Disease results from “elaboration of noxious products by the entire plaque flora”
It is not the specific bacterial but the entire microbial community
Control of disease depends upon amount of plaque accumulation

54
Q

What is the Specific plaque hypothesis?

A

Only certain plaque is pathogenic

Pathogenicity depends on presence of or increase in specific microorganisms

55
Q

What factors contribute to bacterial pathogenicity?

A

Virulence factors
Influence attachment
Provide protection
Provide mechanism for penetration of host tissue
Fimbria, capsule, glycocalyx, endotoxin, proteolytic enzymes

56
Q

What type of bacteria are generally found in the Microbiota of periodontal health?

A

Gram-positive, Streptococcusand Actinomyces

57
Q

What type of bacteria are generally found in Chronic Periodontal disease Microbiota?

A

Gram-negative, P. gingivalis and T. forsythia

58
Q

What Microbiota are found in Localized Aggressive Periodontitis?

A

A. actinomycetemcomitans, Eubacterium, A. naeslundii, F. nucleatum, C. rectus

59
Q

What Microbiota are found in Generalized Aggressive Periodontitis?

A

P. gingivalis, T. forsythia, A. actinomycetemcomitans, Campylobacter species

60
Q

Periodontitist complexes

A

Blue, Purple, green, yellow, orange, red

61
Q

Red Complex

A

Porphyromonas gingivalis
Tannerella forsythensis
Treponema denticola

62
Q

Is there a Genetic Component to chronic periodontitis? If so, what percent?

A

Heritability for Chronic Perio=50%

IL-1β gene polymorphism

63
Q

What are contributing factors for calculus?

A 
Calculus
Smoking
Diabetes mellitus
Age
Anatomical factors
Other
64
Q

What is calculus?

A

Consists of mineralized bacterial plaque that forms on the surfaces of natural teeth and dental prostheses
Classified as supragingival and subgingival
Can form in as little as 48 hrs

65
Q

What is Supragingival calculus?

A

Coronal to gingival margin and visible in the oral cavity
Hard with claylike consistency, easily detached from the tooth surface
Heterogeneous, filamentous microorganisms
Mineralized from Saliva

66
Q

What is Subgingival calculus?

A

Located below the crest of the marginal gingiva
Typically hard and dense, may appear dark brown or greenish black
Homogenous, microorganisms are cocci, filaments and rods
Mineralied by GCF

67
Q

How does calculus attach to a tooth?

A

Organic pellicle on enamel
Mechanical locking into surface irregularities or undercuts
Resorption bays, cemental tears, root gouging/caries
Intimate adaptation of calculus to cementum

68
Q

How does one detect calculus clinically?

A

Probing

58% of surfaces thought to be clean had calculus (Sherman et al. 1991)

69
Q

Calculus detection radiographically….

A

Radiographically
Sensitivity = 43.8%
Specificity = 92.5%

70
Q

What are some stats regarding calculus removal efficacy based on PD?

A 
1-3mm = 83% effective
3-5mm = 39%
>5mm = 11%
71
Q

How does calculus play a role in dental disease?

A

Promotes the retention of dental plaque and may increase the rate of plaque formation
Porosity can serve as a reservoir for pathogens and can retain noxious bacterial components
Delay healing up to 120 days if left on surgically treated teeth

72
Q

Smoking effects on:

Local flora

A

No differences in bacterial counts between smokers and non-smokers(Preber and Bergstrom 1992)
Subjects positive for Aa, Tf, and Pgwas significantly higher in current smokers(Zambon et al. 1996)

73
Q

How does smoking effect vasculature?

A

Peripheral vasoconstriction

Local ischemia

74
Q

Smoking effects on surgical therapy? Non surgical therapy?

A

Non-surgical
Less favorable pocket depth reduction, less gain in CAL(Preber and Bergstrom 1985; Preber et al. 1995; Grossi et al. 1997)
Surgical
Less PD reduction and greater attachment loss(Ah et al. 1994)

75
Q

How does smoking effect fibroblasts?

A

Fibroblast effects
Reduction in fibroblast secretion, with dose-dependent inhibition of proliferation(Tipton et al. 1995)
Altered attachment of fibroblasts to teeth(Raulin et al. 1988)

76
Q

How does smoking affect PMN?

A

Decreased mobility and phagocytosis (Kenney et al. 1975)

77
Q

How does smoking effect macrophages?

A

Decreased functional activity of macrophages

78
Q

What are some general statistics in the US regarding Diabetes?

A

6-7% of the United States population has diabetes mellitus
40-50% of the people are unaware that they have the disease
Blacks and Hispanics have a higher prevalence

79
Q

How does diabetes affect the periodontium?

A 
Vascular changes
Increased collagen breakdown
Altered oral microbial flora
Advanced glycogen endproducts (AGEs)
Altered gingival crevicular fluid glucose
Altered defense mechanisms
80
Q

How does diabetes effect periodontal therapy?

A

Non-surgical
No difference in clinical, microbiological and immunological response after 4 months(Christgau et al. 1998)
Surgical and maintenance
Patients with diabetes respond well to treatment and remain successful with adequate

81
Q

How does controlled vs. non controlled diabetes differ in periodontal treatment?

A

The level of control seems to play a role in the level of gingival inflammation and attachment loss (Cohen et al. 1970)
Poorly controlled diabetic patients had more gingival bleeding than well to moderately-controlled diabetic patients (Ervasti et al. 1985)

82
Q

Age effects on:
Periodontium…

A

Decreased cellularity
Increased collagen fiber coarseness
Decreased collagen turnover
Gradual breakdown of the peridontium with age
Epithelium becomes thinner
Connective tissue becomes denser
PDL shows less fiber and cellular content and becomes irregular

83
Q

Age effects on:

Treatment

A

No difference between healing responses of three age groups <40, 40-49, >49(Lindhe et al. 1985)
More frequent recall appointments due to recession and greater amounts of exposed cementum(Robinson 1979)

84
Q

What are Cervical Enamel Projections? What are the 3 grades?

A

Prevalence
90% of isolated furcation involvements are associated with CEPs
Grade 1: Distinct change in the CEJ
Grade 2: Enamel projection approaching the furcation
Grade 3: Enamel projection extending into the furcation

85
Q

Where are enamel pearls usually found?

A

Prevalence
Most common in the furcation region, particularly on third molars
They range in size from small to large with large pearls having underlying dentin and possibly pulp

86
Q

What is an Intermediate bifurcation ridge?

A

Convex excrescence of cementum that runs longitudinally between the mesial and distal roots of mandibular molars
Prevalence
Found more frequently on first molars
Irregular contours make plaque and calculus removal difficult

87
Q

What 2 teeth typically present with palatoradicular grooves?

A

Prevalence
8.5% of patients
4.6% (centrals 3.4%, laterals 5.6%)
47% terminated > 5 mm on the root surface

88
Q

How can close root proximity effect periodontal treatment?

A

Areas of tight root proximity are difficult to treat and more vulnerable to breakdown

89
Q

What age group typically presents with cementum tears?

A

Prevalence

More common in older patients

90
Q

Accessory canals…

A

Prevalence
Occur in approximately 25-50% of molars
Tend to occur more frequently in first molars than second molars(Gutman 1978)

91
Q

What restorative defects can greatly hinder periodontal treatment?

A

Overhangs
Act to extend the sphere of influence of plaque apically
Removal should be completed during initial therapy
Margin location
Biologic width invasion

92
Q

What is Factitial injury?

A

Self-inflicted injuries can be difficult to diagnose
Injuries are produced in a variety of ways
Picking the gingiva with a fingernail
Improper use of toothpicks or other oral hygiene devices
Most often once identified pt can be instructed to avoid the injurious behavior

93
Q

Why have a classification system?

A

Sets the stage for context for treatment planning
Helps in estimating outcomes
Communication with colleagues and patients
Allows researchers to study the same disease

94
Q

Chronic Periodontal Prevalence

A

46% of adults over 30 years have chronic periodontitis
8.9% severe chronic periodontitis
37.1% non-severe chronic periodontitis
Likelihood of periodontitis increases with age

95
Q

2 Forms of bacteria in Mouth

A

Planktonic/free flotation

Plaque/biofilm

96
Q

Experimental Gingivitis in Man

A 
Gingivitis in 10-21 days
Increase quantity of plaque
Increased quality of plaque
Resolution within seven days of OH
Bacterial plaque causes gingivitis
Loe 1965
97
Q

Natural History of Periodontitis in Man

A 
480 male Sri Lankan tea laborers
No conventional OH or dental care
Three subpopulations
Rapid progression –8%
Moderate progression –81%
No progression -11%
98
Q

CEP’s

A

28.6% on buccal of mandibular molars
17% on buccal of maxillary molars
90% of isolated mandibular furcation involvements

99
Q

What are the squealae of Marginal ridge discrepancies?

A

May lead to food impaction
Inflammation
Bone loss
Attachment loss

100
Q

What are signs and symptoms of occlusal trauma?

A 
Signs and symptoms of occlusal trauma
Occlusal wear
Fremitus
Widened PDL
Local angular defect
Furcation bone loss
Pain
Fractured/chipped teeth
101
Q

Define primary occlusal trauma…

A

Excessive occlusal forces to a tooth or teeth with normal support

102
Q

Define secondary occlusal trauma

A

Normal or excessive occlusal forces applied to a tooth or teeth with a reduced periodontium

103
Q

traumatogenicocclusion

A

Any occlusion that produces forces that cause an injury to the attachment apparatus

104
Q

What are some long term complications of Diabetes?

A 
Long-term complications
Retinopathy
Neuropathy
Nephropathy
Macrovascular disease
Altered wound healing
Periodontitis

Perio lectures (10 decks)

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