Etiology of Periodontal disease (Final review) Flashcards
Describe healthy gingiva:
-firm & resistant
-coral pink
-scalloped gingival margin
-peaked/pointed interdental papilla
-stippled surface texture
-No BOP
-Consistent with good oral hygiene
Lingering biofilm on a healthy tooth results in:
inflammatory process
_____ persists as long as biofilm is present around gingival tissues
local inflammation
When does inflammation of gingiva caused by biofilm resolve?
AFTER removal of biofilm
Inflammation of the gingival tissues
gingivitis
Gingivitis affects more than ____% of the population
82%
Is gingivitis reversible?
yes
What is the PRIMARY etiologic factor of gingivitis?
Plaque
Characterized by:
-inflammation of the gingival margins & interdental papilla
-redness
-BOP
-NO attachment loss
Gingivitis
What is the most common form of gingival disease?
Dental plaque-induced gingival disease
Dental plaque-induces gingival diseases may occur:
without attachment loss or on a reduced periodontium
In dental plaque-induced gingival diseases the inflammatory lesion is:
within the gingiva
T/F: Dental plaque-induced gingival diseases are NOT associated with progressive attachment loss
True
Result of the microbial challenge between bacteria and plaque biofilm & host response:
Gingivitis associated with dental plaque only
Cessation of oral hygiene leads to gingivitis within _____ in healthy adults
2-3 weeks
Gingivitis associated with dental plaque only is histologically characterized by: (4)
- dense infiltrate of lymphocytes
- mononuclear cell fibroblasts alterations
- increased vascular permeability
- continuing loss of collagen in response to the microbial challenge
- dense infiltrate of lymphocytes
- mononuclear cell fibroblasts alterations
- increased vascular permeability
- continuing loss of collagen in response to the microbial challenge
the following are histological signs of:
Gingivitis associated with dental plaque only
What is the primary etiologic factor of gingivitis?
plaque
What can alter the severity/duration of the inflammatory response in gingivitis associated with dental plaque only?
modifying local or systemic factors
Gingivitis associated with dental plaque only is fully _____ in healthy persons once:
reversible; once local factors & microbial load around teeth are reduced
What are the systemic factors that may modify gingival health & disease?
Endocrine changes- puberty, menstrual cycle, pregnancy, diabetes
Specifically what aspect of gingival health and disease are altered by systemic factors?
host’s cellular & immunmologic functions
What is pregnancy induced gingivitis caused by?
Primarily caused by hormonal imbalances associated with pregnancy
What percentage of pregnancies experience pregnancy gingivitis?
more than 30%
Describe pregnancy induced gingivitis:
Characterized by mild to severe gingival inflammation as well as pain; some cases may have significant hyperplasia & bleeding; resolves itself after deliver
What bacteria is responsible for pregnancy induced gingivitis?
P. intermedia
Gingival diseases may be modified by medications, give an example:
gingival overgrowth due to anticonvulsant drugs
List the anticonvulsant drugs that may cause gingival overgrowth:
- Phenytoin
- immunosuppressive drugs (Cyclosporine)
- Calcium channel blockers (Nifedipine, Verapamil, Diltiazem, Sodium Valproate)
Give an example of a gingival disease being modified by malnutrition:
Bright red, swollen, bleeding gingiva associated with vitamin C deficiency
T/F: non-plaque induced gingival disease are more common than plaque-induced
False- less common
What category of gingival diseases encompasses lesions of autoimmune or idiopathic etiology manifesting on the gingiva?
Non-plaque-induced gingival diseases
Benging mucous membrane pemphigoid associated with sloughing gingival tissues, & painful ulcerations of the gingiva is example of:
Non-plaque-induced gingival disease (Autoimmune/idiopathic etiology)
Gingival diseases of bacterial, viral, fungal, genetic, systemic, foreign body, or traumatic origins fall under what category of gingival disease?
Non-plaque-induced gingival diseases
Confined to the gingiva of a single tooth or group of teeth, affecting LESS THAN 30% of remaining teeth:
Localized gingivitis
Gingivitis that involves MORE THAN 30% of remaining teeth:
Generalized gingivitis
Gingivitis that involves the gingival margin:
Marginal gingivitis
Gingivitis that involves interdental papillae, often extending into adjacent portion of the gingival margin:
Papillary gingivitis
The earliest signs of gingivitis often occur:
In the the papillae
Gingivitis that affects gingival margin, attached gingiva & internal papillae:
Diffuse gingivitis
Two earliest signs of gingival inflammation that PRECEDE established gingivitis are:
- increased GCF
- increased bleeding from gingival sulcus upon gentle probing
When one experiences BOP where is the bleeding coming from?
junctional epithelium in the gingival sulcus
BOP is easily detectible/valuble for:
early diagnosis & prevention of advanced gingivitis
T/F: BOP appears earlier than change in color or other visual signs of inflammation
true
What does BOP indicate?
inflammatory lesion in the epithelium of connective tissue
What type of sign is BOP for the examiner?
objective
T/F: Absence of BOP is desirable as it implies low risk of attachment loss
true
What is BOP used to measure (on patients end):
Homecare
What is a situation where someone might have suppression of the gingival inflammatory response affecting BOP?
Cig smoker
What types of medications increase bleeding tendencies of gingival tissues?
- antiplatelet medication (aspirin)
- anticoagulants (Warfarin, Eliquis)
What effects would aspirin, warfarin or eliquis have on the gingival tissues?
Increased bleeding tendencies
Gingivitis noted in the maxillary buccal area may be due to the patient:
mouth breathing
Describe the gingiva of a mouth breather:
Gingivitis located in maxillary buccal area- characterized by red, shiny, edematous
Increase in the number of cells in a tissue, resulting in increased tissue volume:
hyperplasia (more cells come to play)
Increase in tissue size and volume resulting from increased cell size:
Hypertrophy (bodybuilder wants a big trophy)
Pathologic process in which disrupted wound healing is associated with defective cell proliferation:
Fibrosis
Inflammatory response affecting only the gingiva:
gingivitis
Follows gingivitis:
peridontitis
Not reversible:
periodontitis
Occurs because of biofilm (plaque) accumulation that is not removed:
gingivitis
Reversible:
gingivitis
Precedes periodontitis but does not always progress to periodontitis:
gingivitis
Inflammatory process extends to affect the PDL and alveolar bone resulting in clinical attachment loss:
Periodontitis
Can be stabilized and maintained with gingival health on reduced peridontium
Periodontitis
Chronic inflammation of the gingival tissues resulting in breakdown of surrounding periodontal tissues:
periodontitis
Periodontitis can be described as: (two terms)
Complex & multifactorial
Periodontitis is initiated by ____ of biofilm and _____ by the host response
Dysbiosis; modulated
What is periodontitis characterized by?
- bone loss
- apical migration of the JE
Clinically healthy gingival tissues; develops within 2-4 days of plaque accumulation:
initial lesion
What is the timeline of an initial lesion forming?
2-4 days
Early gingivitis that is clinically evident. Develops approximately 1-2 weeks of continued plaque accumulation:
early lesion
What is the timeline of an early lesion forming?
1-2 weeks of continued plaque accumulation
In what stage is early gingivitis clinically evident?
early lesion
Describe the gingival tissues in an initial lesion:
clinically healthy
Established chronic gingivitis. Progression to this stage is dependent on many factors:
established lesion
In what stage is chronic gingivitis present?
established lesion
Transition from gingivitis to periodontitis. Progression to this stage is dependent on many factors:
Advanced lesion
Features of the JE:
- acts as a ___ against plaque bacteria
- ____ in nature
- attached to the tooth by _____ and to connective tissue by ____
- exhibits _____ to cells, gingival fluid and host defense molecules
- ___ rate of cellular proliferation and turnover
- physical barrier
- stratified squamous nonkeratinized
- internal basal lamina; external basal lamina
- higher permeability
- high
Pocket caused by bone loss associated with apical migration of the JE:
Periodontal pocket (true pocket)
When the bottom of a periodontal pocket it coronal to the crest of the alveolar bone:
suprabony
When the bottom of a periodontal pocket is apical to the crest of the alveolar bone:
infrabony
Pseudopockets are ALWAYS _____
suprabony
Complete periodontal assessment requires:
- description of the clinical appearance of the soft tissues
- probing depths
- plaque & bleeding index
- recession/CAL
- radiographs
Primary etiology of periodontal disease:
plaque in a susceptible host
Secondary etiology of periodontal disease:
local/environmental factors
-calculus
-carious lesions
-food impaction
-furcations
-malpositioned teeth
-occlusal trauma
-orthodontics
-overhangs
-poor crown margins
These are all:
Local contributing factors to periodontitis
CCFFMOOOP
-age
-cardiovascular disease
-diabtetes
-genetics
-immuno-compromised
-medications
-nutritional deficiencies
-obesity
-smoking
-stress
Systemic factors to periodontal disease
Primary bacteria associate with periodontitis: (5)
- Aggregatibacter actinomysetecomitan (Aa)
- P. gingivalis
- P. intermedia
- T. forsythia
- T. denticola