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Oral Soft Tissue (Exam 1) > E1: OST > Flashcards

E1: OST Flashcards

1
Q

Q1:

What two factors are associated with periodontal disease?
– Diagnosis of perio looks at???

A

Increased in probing depth and CAL (clinical attachment loss)

–Probing depths and clinical attachment

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2
Q

Q2:

What is the primary etiology in periodontal disease?

A 
Primary = Bacterial Plaque
Secondary = Contributing factors/ Susceptible host
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3
Q

Q3: Chronic Periodontitist – Sub-classifications

Extent:

  • considered LOCALIZED when?
  • considered generalized when?
A

• Localized chronic periodontitis:
≤ 30% sites involved
• Generalized chronic periodontitis:
> 30% sites involved

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4
Q

Q3:

Severity:
Slight = ____ mm CAL
Moderate = ______mm CAL
Sever = _______ mm CAL

A

Clinical Attachment Loss (CAL) (**ONLY for Chronic)
o Slight (Mild) 1-2 mm CAL
o Moderate 3-4 mm CAL
o Severe ≥ 5 mm CAL

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5
Q

Q3:

Most people exhibit what type of perio?

A

Slight perio

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6
Q

Q4:

What is the most important factor for periodontics?

A

Diagnosis

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7
Q

Q5:

Guidelines for Management:
What is a level 1 patient?

A

Level 1:
– Patients who may benefit from comanagement by the referring dentist and the periodontist.
–Patients with periodontal inflammation and:
 Diabetes
 Pregnancy
 Cardiovascular disease
 Chronic respiratory disease

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8
Q

**Q5:

Guidelines for Management:
What is a level 2 patient?

A

– Patients who would likely benefit from comanagement by the referring dentist and periodontist.
– Any patient with periodontitis who demonstrates at reevaluation or any dental examination one or more of the following risk factors / indicators:
 Periodontal Risk Factors / Indicators:
 Early Onset periodontitis,
 Unresolved inflammation,
 Pocket depths ≥ 5 mm,
 Vertical bone defects,
 Progressive tooth mobility or attachment loss, Anatomic gingival deformities or exposed root surfaces.
o Medical or Behavioral Risk Factors
 Smoking, tobacco use
 Diabetes
 Osteoporosis/osteopenia,
 Drug-induced gingival conditions
 Compromised immune system

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9
Q

**Q5:

Guidelines for Management:
What is a level 3 patient?

A 
-- Level 3
o	Patients who should be treated by a periodontist
	Severe chronic periodontitis
	Furcation involvement
	Vertical/angular bone defects
	Aggressive periodontitis 
	Periodontal Abscess or other acute conditions
	Significant root surface exposure 
	Peri-implant disease.
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10
Q

Q6:

Anatomy of the periodontium includes what five tissues?

A
    • Gingiva
    • Alveolar mucosa
    • Periodontal ligament
    • Cementum
    • Alveolar bone
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11
Q

**Q6:

Periodontal Attachment is associated with what three tissues?

A
    • PDL
    • Cementum
    • Alveolar bone
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12
Q

Q7:

What kind of tissue levels change throughout life and what type of epithelium is it comprised of?
– Does the MGJ change throughout life?

A

Mucogingival (attached) gingival levels change throughout life and gingiva is KERATINIZED
– MGJ (Mucogingival Junction) does NOT change throughout life

LEVELS: YES JUCTION: NO

    • Pink is Gingiva: Keratinized
    • Red is alveolar mucosa: non-keratinized
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13
Q

Q8:

List the teeth associated with Width of Gingiva (from most to least):

  • Width of Gingiva => Most to Least = Most Keratinized to LEAST Keratinized
A

INCISORS > MOLARS > PREMOLARS

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14
Q

Q9:

What type of epithelium is the same in tooth and implants.
- Hemidesmosomes: Cell to tooth/implant

A

Junctional epithelium

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15
Q

Q10: Gingival Epithelium

Junctional epithelium is:

    • What type of keratinized?
    • How many cells thick?
    • It’s length?
    • Associated with what type of cell connection?
    • Turnover rate?
A

Junctional Epithelium:
• Non-keratinized
• 2 – 30 cells thick
• 0.25-1.35 mm length

Hemidesmosomes
o	Cell to tooth/implant
o	Cell to Connective tissue
•	* Same for tooth & implant
•	Turnover 1-6 days
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16
Q

Q11:

What is the normal contour of healthy normal marginal gingiva

  • -What kind of collar?
    • What kind of margin, firm or not firm, resilient or non resilient, what kind of collagen?
A

Thin “knife-edged”

a) Scalloped – collar
b) Resilient, firm, free margin* and dense collagen

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17
Q

Q12:

Normal gingiva may be what?

A

Stippled- Depressions/raised

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18
Q

**Q7:

Is all keratinized tissue attached?

A

NO

– However, even you floss the sulcular epithelium of the gingiva will become keratinized.

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19
Q

Q13:

Define the mucogingical junction:

A

Line between attached and alveolar mucosa (the red line dividing the attached keratinized, pink and firm gingival mucosa from the unattached, moveable non keratinized alveolar mucosa).

Free tissue (gingival sulcus) –> attached tissue –> MGJ –> mucosa

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20
Q

Q13:

What line is used to distiguish btwn alveolar mucosa and attached gingiva?

A

MGJ

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21
Q

Q14:

The terminal portion of principal fibers that insert into CEMENTUM and ALVEOLAR bone is termed?
– Is this fiber present on implants?

A
    • SHARPEY’s FIBERS

- - NOT ON IMPLANTS

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22
Q

Q15: Gingival fibers

What kind of fiber group provides support and contour to free gingiva

A

Circular fibers

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23
Q

Q16:

What group of fibers absorb the most occlusal forces?
– Largest or smallest group?

A

Oblique Periodontal fibers

– Largest group

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24
Q

Q17:

The cementum width is greatest where?

A

Cementum width greatest at APICES/ROOT…. not coronal

25
Q

Q18:

What is biological width?

    • Is the biological width always present?
    • Its the width cervical to what bone?
A

Biological width (A) = Junctional Epithelium (C) + Gingival Connective tissue (D)
( The physiologic zone of gingival tissue coronal to the alveolar bone crest)
– Width cervical to the alveolar bone

– Biological width always present

26
Q

Q19:

What is the average biological width?

A

2-3mm

27
Q

Q20:

What does CAL stand for and what is its definition

A

CAL= Clinical Attachment Loss
–CAL (clinical attachment loss) is the distance from the CEJ (cementum enamel junction) to the base of sulcus or pocket or PD (periodontium)

CALCULATED.. NOT MEASURED

28
Q

Q20:

Give the equation to find CAL:
– CEJ to GM may be:
(+) GM value if………
(-) GM value if……..

A

CAL = PD (MM) + CEJ to GM(mm)

PD= periodontium
CEJ= cementum enamel junction
GM= gingival margin

CEJ to CG may be:
(+) Positive if apical to CEJ -Where there’s recession
(-) Negative if coronal to CEJ – excess tissue that needs to be substracted to get the true bone loss measurement.

– Example:
ABOVE THE CEJ:
Use (-) value for GM
CEJ= 6

CAL = SUM OF GM + CEJ + PD
CAL = (-3) + 6 = 3mm == Excess tissue

CAL= (0) + 6 = 6mm == Normal tissue

CAL = (+3) + 6 = 9mm = Recession

29
Q

Q21:

Pregnancy gingivitis is associated with what type of gingivitis ( Plaque or Non-plaque… and what else?)

A

Pregnancy gingivitis:

Is a Plaque induced gingivitis modified by systemic factors

30
Q

Q22:

Candididal gingivitis is associated with what type of gingivitis ( Plaque or Non-plaque… and what else?)

A

Candididal gingivitis:
Is a Non-plaque induced gingivitis
(fungal origin)

31
Q

Q23:

List the three types of medication (and it’s effects) associated with PI Gingivitis

A

a. Anti-seizure – Dilantin
b. Calcium channel blockers – Nifedipine (hypertension)
c. Immunosuppressant – Cyclosporin (transplant pts)

32
Q

Q24:

Define Risk:

A

The likelihood of a person will get a disease in a SPECIFIED TIME PERIOD (specific time)

33
Q

Q25:

Define RISK FACTOR:

A

Characteristic that places one at greater risk for developing the disease:

    • Factors are: conditions, behaviors, environmental exposure, inborn or inherent characteristics
    • Increases probability of occurrence
    • PROTECTIVE FACTORS: are risk factor that lower the probability of an event occurring.
34
Q

Q26:

List the four pyramids associated with Pathogenesis of human periodontitis

A
  1. (antigens, LPS, and other virulence factors) Microbial Challenge
  2. Host immuno-inflammatory response
  3. (–> cytokines and prostaglandons, and matrix metalio-proteinases. )Connective Tissue and Bone metabolism
  4. Clinical signs of disease and progression

2 & 3: associated with Environmental and acquired risk factors
2 & 3: associated with genetic risk factors

35
Q

Q27:

What are the five microbes associated with periodontitis:
– What are the three associated with the red complex

A

Red Complex:

a. P. gingivalis
b. T. forsynthia
c. T. denticola

d. P. intermedia
e. A. a

….. but I thought the main three were P. gingivalis, A. actinomyctemcomitans and Treponema sp

– A.a mostly associated with endo?

36
Q

Q28:

What is another term used for biofilm
– Can we remove it. How?

A

Dnetal plaque

– Must be physically removed.

37
Q

Q29:

Biofilm is:

a) resistant to what?
b) What two things are enhanced?
c) They’re microcolonies surrounde by what?
d) Not the same as in what type of culture?

A
  1. Biofilms
    a. Resistant to antibiotics
    b. Bacterial pathogenesis and virulence enhanced (because the bacteria are protected against brushing/flossing
    c. Microcolonies surrounded by protective matrix
    d. NOT same as in planktonic cultures
38
Q

**Q29:

Biofilm:

a) First bacteria found in biofilm is what?
b) As plaque ages, what decreases and what increases?

A
    • G+ cocci (aerobic)
    • As plaque ages, aerobes DECREASE and anaerobes INCREASE….
    • G+ is replaced with mixture of G- and G+ cocci.
39
Q

Q30:

Subgingiavl plaque that has the less virulent microbes:
– Are attached or unattached

A

– Unattached

40
Q

Q31:

What kind of microbes are found in SUBgingival plaque–
– What is unique regarding to these microbes?

A
  1. LPS – gram negative cell wall (primarily found subgingivally)
41
Q

Q32:

What is Calculus?
– When calculus harbors bacteria, what happens?

A

Calcified plaque
Calculus harbors bacteria – enhances gingival inflammation
a. Calculus does not enhance gingival inflammation because of mechanical irritation (cuz mechanical irritation is tooth brush abrasion) — because of harboring bacteria

42
Q

Q33:

Gingivitis is reversible or irreversible?
Microbes associated with gingivitis is predominantly what?

A
    • Gingivitis is REVERSIBLE (T)
    • Predominate bacteria are NOT gram (-) ==> GRAM (+)
    • Gram (-) ==> PERIO
43
Q

Q34:

What type of microbe is first to migrate into the sulcus– at the INITIAL stage of gingivitis?

A

PMN’s are the first to migrate into the sulcus – at the initial stage of gingivitis

44
Q

Q35:

In the stages of gingivitis, when is the first clinical sign of gingivitis present?
– List the four stages of gingivitis

A

EARLY STAGE:

The order goes:

a. Initial –> subclinical, no gingivitis
b. Early –> clinical signs of gingivitis
c. Established –> chronic gingivitis
d. Advanced –> Periodontitis

45
Q

Q36:

List the cytokines associated with bone resorption:
– Which one is not associated with bone resorption, and what is it associated with?

A

Associated with bone resorption:

a. IL-1 beta
b. PGE2
c. TNF alpha (w/ PGE2)

d. NOT MMP (1&8) – cuz this one is associated with ct breakdown (collagen breakdown) –collagenases

46
Q

Q37:

Is Bacteria alone sufficient enough to cause periodontal disease?
– What else is equally as important?

A

Bacteria alone is insufficient to cause Periodontal Disease. Genetics and environment are equally important

47
Q

Q38:

In the stages of pathogenesis:

    • Early stage involves what kind of cell?
    • Advanced stage involves what kind of cells?
A

In the stages of pathogenesis—Early stage involves T cell, advanced stage involves B cell

  • – in order:
    1) PMNS – 1st responder, migrates into sulcus/pocket
    2) Mast cell – releases amines, increases vascular permeability
    3) Macrophage –Present antigen to T- cells
    4) T-lymphocytes – Lymphokines and delayed hypersensitivity
    5) B-lymphocytes – may differentiate into plasma cells – active in antibody formation
48
Q

Q39:

What is involved during the advanced stage–
– What disease is associated with the advance stage?

A

THIS IS THE ADVANCED STAGE – involves B cells – irreversible alveolar bone loss, increasing CAL

– Periodontitis disease

49
Q

Q40:

Polymorphism (in the gene cluster) is the increased production of what?

A

Polymorphism is the increased production of IL-1 beta:

a. Genetic polymorphism which makes the response to periodisease more severe (influence of PD)
- - Does NOT cause the disease, it makes the individual response more severe.

50
Q

Q41:

Does Low- dose tetra replace mechanical therapy?

    • Low- dose tetra reduces what type of production?
    • Reduces what type of breakdown?
A

Low-dose tetra does not replace mechanical therapy

    • Low-dose tetra reduces collagenase production
    • reduce collagen breakdown

Extra notes:
Low dose doxycycline is a pill taken orally. However there are low dose of tetracycline or odoxycyline that stays and binds in the pocket. Therefore you don’t need to take the therapy orally, it can be placed directly in the pocket *key is that it is a low dose which is sub-anti-microbial.

51
Q

Q42:

Smoking gives what type of effect on SCRP

A

– Negative effect

52
Q

Q43:

Smokers have more inflammation or less inflammation than non-smokers?

    • What type of pockets do smokers have
    • What type of loss?
A

Smokers – less inflammation than non smokers.
( smokers have less clinical inflammation than non-smokers with similar local factors)
a. Have deeper pockets and more attachment loss

53
Q

Q44:

    • Smoking increases pathogens in what type of pockets?
  • – Does it have an effect on the rate of plaque accumulation?
A

Smoking Increases pathogens in deep and shallow pockets and smoking has no effect on the rate of plaque accumulation

54
Q

*Q45:

Arrestin and periostat are types of products that is known as what type of therapy?

– What does it do to the bacteria and our body?

A

**Arrestin, periostat, these types of products are what are known as HOST MODULATORY THERAPIES, changing the body’s response to the bacteria, not affecting the actual bacteria. Will not get periodontal disease as bad with these products, possibly.

55
Q
  • 46:

- Is there a PDL on an implant?

A

No

56
Q
  • 47:

- Is there cementum on an implant?

A

No

57
Q

*48:

Is there alveolar bone on an implant?

A

Yes– implant is in bone (in intimate contact with implant

58
Q

*49:

IS there junctional epithelium on an implant?

A

Yes– Same for tooth and implant

59
Q
  • 50:

What is experimental gingivits

    • gingival health: any oral hygiene?
    • Initial plaque consist of what microbe?
    • After 5-7 days: what type of organisms present
    • After 10 days: what of organism present?
    • From 10-21 days – What disease develops?
    • If you resume brushing– What happens?
A 
Experimental Gingivitis
•	Gingival health – then no oral hygiene
•	Initial plaque – G+ cocci and rods
•	After 5-7 days – filimentous organisms
•	After 10 days – spirochetes
•	From 10-21 days – gingivitis develops
•	Resume brushing – return to health within 10 days

Oral Soft Tissue (Exam 1) (1 decks)

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