Diagnostic Findings Flashcards
keratinized gingiva
dense fibrous CT (free gingiva + attached gingiva)
T/F: mucogingival jxn is everywhere except the palate
true
T/F: inflamed gingiva is collagen poor (collagen is lost and cell rich)
true
boundaries of the normal sulcus includes what?
- sulcular epithelium (non-keratinized)
- dento-gingival jxn
- surface of gingiva is keratinized, the sulcus and interdental col are not keratinized
junctional epithelium (non-keratinized)
immediately apical to sulcus/pocket base
supra-crestal CT
collagenous gingival fiber insertion into cementum between junctional epithelium and alveolar crest
Sharpey’s fibers
collagenous fiber insertion from bone to cementum
PDL fibers
- transseptal
- alveolar crest
- horizontal
- oblique
- apical
- interradicular
type 1 and 3 collagens are in what?
- PDL
- gingival fibers
- gingival CT
- matrix for bone and cementum
type 4 collagen is in what?
basement membrane (basal lamina)
supraperiosteal supplies blood for which tissues?
facial/lingual
clinical findings are based on what?
- probing depth
- bleeding on probing (inflammation)
- tooth mobility
- furcations
- clinical attachment level (attachment loss)
- attached gingiva
- gingival recession
the presence of shallow probing depths in the absence of inflammation (e.g. no BoP) are what?
GOOD negative predictors of disease progression
T/F: lack of BoP may indicate health but bleeding may or may not indicate the presence of periodontitis
true
T/F: the presence of deep pockets and gingival inflammation have HIGH positive predictive value for hte progression of periodontitis
false, LOW so it not reliable in prediciting periodontal disease progression
what is the hallmark of periodontal disease progression?
loss of attachment
clinical attachment level
probe depth plus recession (distance from CEJ to the base of the pocket)
attached gingiva
portion of the keratinized tissues (gingiva) that is firmly bound down to underlying tooth or periosteum (not part of the pocket wall)
width of attached gingiva (width of keratinized gingiva)
distance from gingival line to mucogingival line minus probe depth
mucogingival defect (deformity)
insufficient attached gingiva (<1mm) with probe depth reaching or exceeding (traversing) the mucogingival junction, lack of keratinized tissue, aberrant frenum, shallow vestibule
Glickman classification of grade 1 furcation
incipient
Glickman classification of grade 2 furcation
catches the furcation roof
Glickman classification of grade 3 furcation
through-and-through
Glickman classification of grade 4 furcation
open (not filled with soft tissue)
location of furcations on max molars
- ML
- mid-facial
- distal
location of furcations on max 1st premolar
- mesial
2. distal
location of furcations on mandibular molars
- mid-facial
2. mid-lingual
what is the most common bony defect?
interdental craters
examples of bony defects
- interdental craters
- hemiseptums
- moats
- defect walls and dimensions
bony DEHISCENCE
absence of all or a portion of the bony covering of the buccal or lingual aspect of the root of a tooth
bony FENESTRATION
window in the bone surrounded on all sides by bone
how is radiographic bone loss calculated?
using the amount of bone loss and the total length of the root
slight bone loss
<20%
moderate bone loss
≥20%, but <50%
severe bone loss
≥50%
what is the alveolar normal crest height?
2 mm of the CEJ
what causes fistula?
pathologic or atypical passage that is the result of poor healing
fistula
an unintended or unwanted pathway between differing internal structures or one that connects an internal structure to the (external) surface of a body
sinus tract
drains an abscess with purulence to a body cavity
oroantral fistula
an atypical communication between the maxillary sinus and the oral cavity
orofacial fistula
an atypical communication between the cutaneous surface of the face and the oral cavity
oronasal fistula
an atypical communication between the nasal cavity and the oral cavity
diagnostic sensitivity
detects disease whenever it is present (few false negatives) - disease won’t be missed
diagnostic specificity
detects absence of disease in a healthy population (few false positives) - health wont be missed
the greatest diagnostic potential of perio disease is in the contents of what?
gingival crevicular fluid
what does gingival crevicular fluid contain?
- host derived enzymes
- inflammatory mediators and indicators of immunity
- host CT breakdown products
- specific bacterial pathogens
- bacterial products
what is involved in CT breakdown?
lysosomal enzymes released by PMN/neutrophil lysosomes
what indicates host cell injury and cell necrosis?
intracellular cytoplasmic enzymes
which inflammatory mediators may initiate osteoclastic bone resorption?
- prostaglandins (PGE2)
- interleukins (IL-1B, IL-6)
- TNFα
how are specific bacterial pathogens identified?
DNA probe analysis
bacterial products
- bacterial enzymes (e.g. bacterial collagenase)
2. lipopolysaccharides (endotoxin)
Periodontal Susceptibility Test (PST) screens for what?
interleukin-1 gene polymorphism
