Diagnosis of Periodontal Diseases Flashcards
1
Q
6 characteristics common to all dental plaque-induced gingival diseases
A
- Signs and symptoms confined to gingiva
- Presence of plaque
- Clinical signs of inflammation
- Periodontium with NO LOSS of attachment OR a stable but reduced periodontium
- Reversibility of the disease
- Possible role as a precursor to attachment loss
2
Q
4 clinical signs of inflammation of gingiva
A
- Enlarged gingival contours due to edema or fibrosis
- Color transition to a red and/or bluish-red
- BOP
- Increased gingival exudate
3
Q
2 drug-influenced gingival diseases
A
- Drug-influenced gingival enlargements
- Drug-influenced gingivitis
4
Q
Example of drug-induced gingivitis
A
Oral contraeptive-associated gingivitis (frank signs of gingival inflammation in the presence of relatively little plaque)
5
Q
Example of a gingival disease modified by malnutrition
A
Ascorbic acid deficiency gingivitis or scurvy
6
Q
Describe ascorbic acid deficiency gingivitis/ scurvy
A
Gingiva is bright red, swollen, ulcerated and tendency toward bleeding and alteration toward a spongy consistency
7
Q
10 characteristics of plaque-induced gingivitis
A
- Plaque precent at gingival margin
- Disease begins at gingival margin
- Change in gingival color
- Change in gingival contour
- Sulcular temperature change
- Increased gingival exudate
- Bleeding upon provocation
- Absence of attachment loss
- Absence of bone loss
- Reversible with plaque removal
8
Q
Color of normal gingiva
A
Pale pink
9
Q
Color of gingiva with gingivitis
A
Reddish/bluish-red
10
Q
Size of normal gingiva (describe papillary, marginal and sulcular)
A
- Papillary gingiva fills interdental spaces
- Marginal gingiva forms knife edge with tooth surface
- Sulcus depth ≤ 3 mm
11
Q
Size of gingiva with gingivitis
A
Swelling both coronally and bucco-lingually
Pseudopocket
12
Q
Shape of normal gingiva
A
Scalloped - troughs in marginal areas rise to peaks in interdental areas
13
Q
Shape of gingiva with gingivitis
A
Edema which blunts the marginal and papillary tissues leads to the loss of the knife edge adaptation. Marginal swelling leads to less accentuated scalloping
14
Q
Consistency of normal gingiva
A
Firm
15
Q
Consistency of gingiva with gingivitis
A
Soft; pressure-induced pitting due to edema
16
Q
Clinically define pyogenic granuloma (pregnancy tumor)
A
Not a real tumor, but an exaggerated inflammatory response during pregnancy to plaque. Painless protuberant, exophytic mass that is attached by a sessile or pedunculated base from the interproximal space
17
Q
Cause of pyogenic granuloma
A
Combination of the vascular response induced by progesterone and the matrix stimulatory effect of estradiol
18
Q
Histological feature of pyogenic granuloma
A
Highily vascularized mass of granulation tissue
19
Q
Most common area of mouth affected by pyogenic granuloma
A
Anterior papillae of the maxillary teeth
20
Q
When do pyogenic granulomas regress?
A
Following parturition (not always)
21
Q
3 main classes of medication implicated in drug-influenced gingival enlargement
A
- Anticonvulsant
- Immunosuppressant
- Calcium channel blockers
22
Q
2 examples of anticonvulsants implicated in drug-influence gingival enlargement
A
Phenytoin
Valproic acid
23
Q
Example of immunosuppressant implicaed in drug-influenced gingival enlargement
A
Cyclosporine
24
Q
Most common location for drug-influenced gingival enlargement
A
Anterior gingiva first observed at the interdental papilla
25
Age group with higher prevalence for drug-influenced gingival enlargement
Children
26
Time of onset of drug-ingluence gingival enlargement
Within 3 months
27
13 characteristics of drug-influenced gingival enlargement
1. Variation in interpatient and intrapatient pattern
2. Predilection for anterior gingiva
3. Higher prevalence in children
4. Onset within 3 months
5. Change in gingival contour leading to modification of gingival size
6. Enlargement first observed at the interdental papilla
7. Change in gingval color
8. Increased gingival exudate
9. Bleeding upon provocation
10. No evidence that attachment loss is a sequela, but can be superimposed on pre-existing periodontitis
11. Pronounced inflammatory response of gingiva in relation to the plaque present
12. Reducations in dental plaque can limit the severity of lesion
13. Histological characteristics of the enlarged tissue may be similar to normal gingiva
28
3 examples of gingival diseases of specific bacterial origin
* *Neisseria gonorrhea*-associated lesions
* *Treponema pallidum-*associated lesions
* Streptococcal species-associated lesions
29
Example of gingival disease of viral origin
Herpes virus infections
30
3 examples gingival diseases of fungal origin
* *Candida*-species infections
* Linear gingival erythema
* Histoplasmosis (a granulomatous disease caused by the fungus *Histoplasma capsulatum*)
31
Example of gingival lesion of genetic origin
Hereditary gingival fibromatosis
32
2 examples of gingival manifestations of systemic conditions
* Mucocutaneous disorders
* Allergic reactions
33
3 types of traumatic lesions causing gingival lesions
* Chemical injury
* Physical injury
* Thermal injury
34
8 non-plaque-induced gingival lesions
1. Gingival diseases of specific bacterial origin
2. GIngival diseases of viral origin
3. Gingival diseases of fungal origin
4. Gingival lesions of genetic origin
5. Gingival manifestations of systemic conditions
6. Traumatic lesions
7. Foreign body reactions
8. Not otherwise specified
35
3 ways that gingival lesions of specific bacterial origin may manifest
* FIery red edematous painful ulcerations
* Asymptomatic chancres or mucous patches
* Atypical non-ulcerated, highly inflamed gingiva
36
3 main viruses known to cause gingivitis
* HSV-1
* HSV-2
* Varicella-zoster virus
37
Describe how some viruses may manifest as gingival diseases
Usually enter human body in childhood and may give rise to oral mucosal disease followed by periods of latency and sometimes reactivation
38
Classic initial manifestation of HSV-1
Primary herpetic gingivostomatitis
39
Characteristic manifestation of primary herpetic gingivostomatitis
Painful severe gingivitis with ulcerations and edema accompanied by stomatitis. Characteristic feature is formation of vesicles which rupture, coalesce and leave fibrin-coated ulcers
40
When does healing occur for primary herpetic infection
Spontaneously without scarring in 10 - 14 days (but virus remains latent in ganglion cell)
41
Manifestation of recurrent intraoral herpes
Usually presents in the form of herpes labialis but recurrent intraoral herpes characteristically manifests as a cluster of small painful ulcers in the attached gingiva and hard palate (NOT on alveolar mucosa)
42
3 factors triggering reactivation of latent herpes virus
Trauma
UV light
Fever
43
Primary infection of varicella-zoster virus
Chickenpox
44
Location of latent VZV
Dorsal root ganglion
45
Latent reactivation of VZV from trigeminal ganglion
Herpes zoster (shingles) (20% of cases)
46
Primary VZV infection oral manifestation
Small ulcers usually on the tongue, palate and gingiva
NOTE: If the second and third branch of the trigeminal nerve is involved, skin lesions may also be associated
47
Characteristics of herpes zoster intraorally
* Unilateral lesions following the infected nerve
* Initial symptoms = pain and paresthesia which may be present before lesions occur
* Lesions initiate as vesicles involving the gingiva
* Vesicles rupture to leave fibrin-coated ulcurs which often coalesce to irregular forms
48
Potential manifestation of VZV in immunocompromised patients
Severe tissue destruction with tooth loss and necrosis of alveolar bone and high morbidity
49
When does infection by *C. albicans* typically occur? (4 conditions)
Infection is considered opportunistic and usually occurs as a consequence of reduced host defense, including immunodeficiency, reduced saliva secretion, smoking and treatment with corticosteroids
50
Oral manifestations of candidosis (1 typical and 4 other)
* Erythema of attached gingiva often associated with a granular surface sometimes referred to as linear gingival erythema
* Other = pseudomembranous candidosis, erythematous candidosis, plaque type candidosis, nodular candidosis
51
Describe pseudomembranous candidosis
Whitish patches which can be wiped off with a gauze leaving a slightly bleeding surface
No major symptoms
52
Describe erythematous candidosis
Erythematous lesions can be found anywhere in the oral mucosa. Intensely red lesions usually associated with pain, sometimes even severe
53
Describe plaque-type candidosis
Whitish plaque which cannot be removed
Usually asymptomatic
Lesion is clinically indistinguishable from oral leukoplakia
54
Describe nodular candidosis
Nodular candidal lesions are infrequent in the gingiva.
Slightly elevated nodules of white or reddish color
55
Define linear gingival erythema
LGE is regarded as a gingival manifestation of immunosuppression characterized by a distinct linear erythematous band limited to the free gingiva and a disproportion of inflammatory intensity for the amount of plaque present. No evidence of pocketing or attachment loss.
56
Key feature of linear gingival erythema
Lack of BOP
57
Microflora of lingear gingival erythema
Comprises both C. albicans and a number of periodontopathogens
58
Treatment for linear gingival erythema
Conventional therapy plus rinsing with 0.12% chlorhexidine gluconate twice daily --\> significant improvement over 3 months
59
Define histoplasmosis
Granulomatous disease caused by *Histoplasma capsulatum* which is a soil saprophyte found mainly in feces from birds and cats
60
Course of infection of histoplasmosis in a normal host
Subclinical (usually must be immunocompromised for symptoms)
61
Clinical manifestations of histoplasmosis
Acute and chronic pulmonary histoplasmosis and a disseminated form mainly occurring in immunocompromised patients
62
Describe the oral lesions of histoplasmosis
May affect any area of the mucosa including the gingiva. Initiate as nodular and papillary and later become ulcerative and painful. Sometimes granulomatous and clinical appearance may resemble a malignant tumor
63
Treatment for histoplasmosis
Systemic antifungal therapy
64
Define hereditary gingival fibromatosis
Gingival hyperplasia of genetic origin. May be an isolated disease entity of part of a syndrome. Uncommon condition
65
6 clinical manifestations that may be associated with hereditary gingival fibromatosis in the setting of a syndrome
* Hypertrichosis
* Mental retardation
* Epilepsy
* Hearing loss
* Growth retardation
* Abnormalities of extremities
66
Characteristics of hereditary gingival fibromatosis
* Diffuse gingival enlargement, sometimes covering major parts of, or the total tooth surface
* Typically presents as large masses of firm, dense, resilient, insensitive fibrous tissue covering the alveolar ridges and extends over the teeth resulting in extensive pseudopockets.
* Color may be normal or erythematous
67
Treatment for hereditary gingival fibromatosis
Surgical removal, but relapses are common
68
5 mucocutaneous disorders that present gingival manifestations in the form of desquamative lesions or ulceration of the gingiva
* Lichen planus
* Pemphigoid
* Pemphigus vulgaris
* Erythema multiforme
* Lupus erythematosus
69
Most common characteristic oral manifestations of lichen planus
White papules with white striations which often form reticular patterns
70
6 forms of lichen planus
* Papular
* Reticular
* Plaque-like
* Atrophic
* Ulcerative
* Bullous
71
7 dental restorative materials that may cause an allergic reaction
* Mercury
* Nickel
* Gold
* Zinc
* Chromium
* Palladium
* Acrylics
72
Describe lesions associated with allergic reactions to dental restorative materials
Reddish or whitish, sometimes ulcerated lesions that have clinical similarities with oral lichen planus or leukoplakia which resolve after removal of the offending material
73
Causative agents in toothpastes and mouthwashes that may cause allergic reactions
Flavor additives or preservatives
74
Clinical manifestations of allergic reactions to toothpastes and moutwashes
Fiery red edematous gingivitis sometimes with ulcerations or whitening
May involve labial, buccal and tongue mucosa. Cheilitis may be seen
75
Describe oral lesions associated with Crohn's disease
Irregular long ulcerations with elevated borders with a cobblestone appearance. Granulomatous gingival hyperplasia.
76
Type of leukemia most commonly associated with gingival changes
Acute myeloid leukemia
77
5 clinical characteristics of leukemia-associated gingivitis
* Pronounced inflammatory response of gingiva in relation to plaque present (NOTE: plaque not a prerequisite for oral lesions)
* Change in gingival color (red to deep purple)
* Change in gingival contour with possible modificatino of size (swollen, glazed, spongy)
* Gingival enlargement first at interdental papilla --\> maginal and attached gingiva
* Gingival bleeding (may be one of initial signs and may indicate underlying thrombocytopenia)
78
5 oral manifestations of leukemia
* Cervical adenopathy
* Petechiae
* Mucosal ulcers
* Gingival inflammation
* Gingival enlargement
79
4 causes of chemical injury to gingiva
* Chlorhexidine-induced mucosal desquamation (pictured)
* Aspirin burn
* Cocaine burn
* Slough due to dentifrice detergents
80
3 causes of physical injury to gingiva
* Oral hygiene agents, great brushing force and improper technique
* Dental flossing
* Self-inflicted (picking or scratching gingiva with a nail)
81
Describe how physical trauma to gingiva may manifest
* If limited, gingival response = hyperkeratosis
* More violent trauma = superficial gingival lacerations to major loss of tissue resulting in gingival recession
82
Describe how thermal injury may orally manifest
* Most often occur on palate and labial mucosa
* Area involved is painful and erythematous and may slough a coagulated surface
* Vesicles may also occur and sometimes lesions present as ulceration, petechiae or erosion
83
Definition of chronic periodontitis
An infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. Characterized by pocket formation and/or gingival recession. Most common form of periodontitis
84
Role of plaque in chronic periodontitis
Initiator and sustainor
85
4 primary clinical features of chronic periodontitis
* Clinical attachment loss
* Alveolar bone loss
* Periodontal pocketing
* Gingival inflammation
86
5 secondary clinical features of chronic periodontitis
* BOP
* Increased tooth mobility
* Enlargement or recession of gingiva
* Drifting of teeth
* Tooth loss
87
Define localized chronic periodontitis
≤30% of sites are affected
88
Define generalized chronic periodontitis
\>30% of sites are affected
89
Define slight/mild chronic periodontitis
1 - 2 mm clinical attachment loss
90
Define moderate chronic periodontitis
3 - 4 mm clinical attachment loss
91
Define severe chronic periodontitis
≥5 mm of clinical attachment loss
92
5 histopathological characteristics of chronic periodontitis
* Periodontal pocketing
* Location of the JE apical to the CEJ
* Loss of collagen fibers subjacent to the pocket epithelium
* PMNs in the JE and pocket epithelium
* Dense inflammatory cell infiltrate with plasma cells, lymphocytes and macrophages
93
3 major features of aggressive periodontitis
* Non-contributory medical history
* Rapid attachment and bone loss
* Familial aggregation
94
What does diagnosis of aggressive periodontitis require
Exclusion of the presence of systemic diseases that may severely impair host defences and lead to premature tooth loss (ie. periodontal manifestation of systemic disease)
95
5 secondary features of aggressive periodontitis
* Amount of microbial deposits inconsistent with severity of periodontal destruction
* Elevated proportions of *aggregatibacter actinomycetemcomitans* and *porphyromonas gingivalis*
* Phagocyte abnormalities
* Hyper-responsive macrophage phenotype, including elevated production of PGE2 and IL-1B in response to bacterial endotoxins
* Progression of attachment loss and bone loss may be self arresting
96
Define localized aggressive periodontitis
* Localized to first molar/incisor presentation with interproximal attachment loss on at least 2 permanent teeth, one of which is a first molar and involving no more than 2 teeth other than first molars and incisors
* NOTE: circumpubertal onset and robust serum antibody repsonse to infecting agents
97
Define generalized aggressive periodontitis
* Generalized interproximal attachment loss affecting at least 3 permanent teeth other than first molars and incisors
* NOTE: usually affecting persons under 30 y-o but may be older, prnounced episodic naure and poor serum antibody response to infecting agents
98
Define incidental attachment loss
Attachment loss that does not fit the specific diagnosis criteria established for AgP or chronic periodontitis
NOTE: patients with this clinical diagnosis should be considered as high risk for AgP or chronic periodontitis
99
3 examples of incidental attachment loss
* Recessions associated with trauma or tooth position
* Attachment loss associated with impacted third molars
* Attachment loss associated with removal of impacted third molars
100
Oral manifestation of malignant neutropenia
Ulceration and necrosis of the marginal gingiva
101
Oral manifestation of cyclic, chronic and familial benign neutropenia
Lesions are frequently severe with deep periodontal pockets and extensive generalized bone loss involving permanent dentition
102
Oral manifestation of cyclic neutropenia (condition characterized by fluctuations in neutrophil counts with a periodicity of 14-36 days)
Oral ulceration, an exaggerated inflammatory response to plaque and aggressive periodontitis of early onset
Occasionally bone resorption may be seen in deciduous dentition
103
Describe the oral manifestation of Chediak-Higashi syndrome
Neutrophil chemotaxis and bactericidal functions are abnormal --\> generalized severe gingivitis, extensive alveolar bone loss and premature tooth loss
Patients are extremely susceptible to bacterial infections
104
Periodontal features of histiocytosis syndrome (3)
* Punched-out necrotic ulcers with considerable granulation tissue
* Tissue necrosis
* Bone loss
NOTE: May clinically resemble NUP lesions
105
DIagnostic management of histiocytosis
Hematological and immunological investigations at an early stage. May be assisted by a biopsy of the granulation tissue associated with deep lesions
106
What is periodontal disease in Down syndrome characterized by?
A generalized early periodontitis which commences in the deciduous dentition and continues into the adult dentition. Progression is very rapid.
107
Describe the oral manifestation of hypophosphatasia
Decreased serum alkaline phosphatase and severe loss of alveolar bone and premature loss of the deciduous teeth, particularly anteriorly
108
Describe the clinical manifestation of Papillon-Lefevre syndrome
* Disease characterized by hyperkeratotic skin lesions
* Palmar-plantar keratosis
* Severe generalized periodontitis occuring commonly before puberty with early loss of deciduous and permanent teeth
109
Two types of Ehlers-Danlos syndrome that have an increased susceptibility to periodontitis
Types IV and VIII
110
Oral manifestations that Type VIII Ehlers-Danlos syndrome is particularly associated with
* Fragile oral mucosa and blood vessels
* Severe generlized periodontitis with the clinical appearance of early-onset periodontitis
111
Define glycogen storage disease 1b
Autosomal recessive condition in which there is faulty carbohydrate metabolism and an association with low neutrophil numbers, impaired neutrophil function and periodontal disease
112
Define infantile genetic agranulocytosis
Rare autosomal recessive disorder, which features severe neutropenia and has been associated with periodontitis resembling the early-onset form
113
Define Cohen's syndrome
Autosomal recessive disorder characterized by non-progressive mental and motor retardation, obesity, dysmorphia and neutropenia. More frequent and extensive alveolar bone loss
114
Hallmark of necrotizing ulcerative gingivitis
Pain
115
4 signs and symptoms of NUG
* Pain
* Lymphadenopathy
* Fever
* Malaise
116
Predominant factor in the development of NUG
Immunosuppression
117
4 risk factors for NUG
* Smoking
* Emotional stress
* Alcohol Use
* Inadequate sleep
118
3 microorganisms involved in NUG
* Fusiform bacteria
* Prevotella intermedia
* Spirochetes
119
Describe the oral manifestation of NUG
* Interdental gingival necrosis often describe as "punched out" ulcerated papillae and bleeding
* Ulcers are covered by a yellowish-white or grayish slough or "pseudomembrane"
* The zone between the marginal necrosis and the relatively unaffected gingiva usually exhibits a well-demarcated narrow erythematous zone, sometimes referred to as linear erythema
120
5 constituents of the sloughed material from the ulcers in NUG
* Fibrin
* Necrotic tissue
* Leukocytes
* Erythrocytes
* Masses of bacteria
121
Define necrotizing ulcerative periodontitis
An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. Most commonly observed in individuals with systemic conditions such as HIV infection, severe malnutrition and immunosuppression
122
What may NUP be a sequela of?
Single or multiple episodes of NUG or may be the result of the occurence of necrotizing disease at a previously periodontitis-affected site
123
Describe the lesions of NUP (4)
* Same clinical appearance as NUG except sites demonstrate loss of clinical attachment and alveolar bone
* Similar clinical, microbiologic and immunologic characteristics as NUG
* Lesions are seldom associated with deep periodontal pockets because extensive gingival mecrosis often coincides with loss of crestal alveolar bone
* Necrotic areas originating from neighboring interproximal spaces frequently merge to form a continuous necrotic area
124
Define necrotizing stomatitis
Further progression of NUP beyond the mucogingival junction. Severe tissue destruction characteristic of this diseae is related to seriously compromized immune functions typically associated with HIV and malnutrition
125
Etiology of NUP vs. PHS (primary herpetic gingivostomatitis)
Bacteria vs. Herpes simplex virus
126
Age of affected persons in NUG vs. PHS
15 - 30 years vs. children frequently
127
Site of NUG vs. PHS
Interdental papillae vs. gingiva and the entire dental mucosa
128
Symptoms of NUG vs. PHS
Ulceration and necrosis and a yellowish-whitish plaque vs. multiple vesicles which burst --\> small round fibrin-coated ulcers which tend to coalesce
129
Duration of NUG vs. PHS
1 - 2 days if treated vs. 1 - 2 weeks
130
Contagiousness of NUG vs. PHS
Not contagious vs. Contagious
131
Immunity towards NUG vs. PHS
None vs. Partial
132
Result of healing of NUG vs. PHS
Destruction of periodontal tissue remains vs. no permanent destruction
133
6 contents of a periodontal abscess
* Bacteria
* Bacterial products
* Inflammatory cells
* Tissue breakdown products
* Serum
* Neutrophils in the central area
134
Define a gingival abscess
Localized purulent infection that involves marginal gingiva or interdental papilla. Usually an acute inflammatory response to foreign substances forced into the gingiva. Early stages appear as a red swelling with a smooth shiny surface
135
Define periodontal abscess
A Localized purulent infection within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone. Calculus often detected on the root surface.
136
Microorganisms that colonize the periodontal abscess
Gram-anaerobic rods (same microbiota than in deep periodontal pockets)
137
Suggested main cause for tooth extraction during SPT
Periodontal abscesses
138
6 clinical features of periodontal abscess
* Smooth shiny swelling of the gingiva
* Suppuration from either a fistula or the pocket
* BOP
* Increase in probing depth
* Tooth may be mobile
* Extrusion of the involved tooth
139
Radiographic appearance of periodontal abscess
* Discrete radiolucency along lateral border of root
* May have normal apeparance of the interdental bone or some bone loss, ranging from widening of the PDL space to pronounced bone loss involving most of the affected tooth
140
2 symptoms of periodontal abscess
* Pain or tenderness
* Sensitivity to percussion
141
6 differential diagnoses of periodontal abscess
* Periapical abscess
* Vertical root fracture
* Lateral periodontal cyst
* Endo-perio abscesses
* Tumors
* Osteomyelitis
142
4 factors associated with the formation of acute periodontal abscess
* Marginal closure of a deep periodontal pocket and lack of proper drainage
* Deep, tortuous pockets and deep concavities associated with furcation lesions
* Systemc antibiotic treatment
* Diabetes
143
Explain how systemic antibiotic treatment may lead to periodontal abscess
In patients with untreated periodontitis, systemic antibiotics may lead to superinfection with opportunistic organisms resulting in development of an abscess
144
Describe the mechanism of post-scaling periodontal abscess
Related to the presence of small fragments of remaining calculus that obstruct the pocket entrance or it can be caused by small fragments of calculus that have been forced in to the deep portion of the periodontal tissues during scaling
145
Describe the mechanism of post-surgery periodontal abscess
The results of incomplete removal of subgingival calculus or the presence of foreign bodies in the periodontal tissues, such as sutures or periodontal pack
146
Define pericoronal abscess
A localized purulent infection within the tissue surrounding the crown of a partially erupted tooth
147
Describe the mechanism of periodontic-endodontic lesions
The inflammation from inflamed and necrotic pulps can spread through lateral canals and accessory foramina into the PDL. An apical endodontic lesion may also extend and drain along the periodontium
148
4 localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis
* Tooth anatomic factors
* Dental restorations/appliances (overhangs, violation of biologic width)
* Root fractures
* Cervical root resorption and cemental tears
149
6 tooth anatomic factors that modify or predispose to plaque-infuced gingival diseases/periodontitis
* Cervical enamel projections and enamel pearls
* Furcation anatomy and location
* Tooth malposition
* Root proximity
* Open contacts
* Grooves (i.e. palato-gingival grooves on maxillary incisors)
150
6 mucogingival deformities and conditions around teeth
* Gingival/soft tissue recession
* Lack of keratinized gingiva
* Decreased vestibular depth
* Aberrant frenum/muscle position
* Gingival excess
* Abnormal color
151
4 examples of gingival excess
* Pseudopocket
* Inconsistent gingival margin
* Excessive gingival display
* Gingival enlargement
152
6 mucogingival deformities and conditions on edentulous ridges
* Vertical and/or horizontal ridge deficiency
* Lack of gingiva/keratinized tissue
* Gingival/soft tissue enlargement
* Aberrant frenum/muscle position
* Decreased vestibular depth
* Abnormal color
153
Define occlusal trauma
Injury resulting in tissue changes within the attachment apparatus as a result of occlusal forces
154
Define primary occlusal trauma
Injury resulting in tissue changes from **excessive occlusal forces** applied to a tooth of:
* Normal bone levels
* Normal attachment levels
* AND excessive occlusal forces
155
Define secondary occlusal trauma
Injury resulting in tissue changes from **normal to excessive occlusal forces** applied to a **tooth with reduced support**. It occurs in the presence of:
1. Bone loss
2. Attachment loss
3. AND normal/excessive occlusal forces
156
Describe how occlusal trauma can contribute to periodontitis
* Trauma from occlusion alone cannot induce periodontal breakdown
* It does however result in resorption of alveolar bone --\> increased tooth mobility that is transient or permanent. This is a **physiologic** adaptation of PDL and alveolar bone to traumatizing forces
* In teeth with progressive, plaque-associated periodontal disease, trauma can enhance the rate of progression of the disease
