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Patient Care III > Etiology of Periodontal Diseases & Risk Assessment > Flashcards

Etiology of Periodontal Diseases & Risk Assessment Flashcards

1
Q

What should gingival health look like in color?

A

Coral pink in color

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2
Q

What should the interdental papilla look like in gingival health?

A

Peaked and pointed

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3
Q

What should the surface texture be in gingival health?

A

Stippled

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4
Q

What should gingiva look like in health?

A
  • Coral pink in color
  • Free from inflammation/edema
  • Firm and resilient
  • Scalloped gingival margin that envelops the teeth
  • Peaked and pointed interdental papilla
  • Stippled surface texture
  • No bleeding upon probing
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5
Q

How is gingival health achieved?

A
  • Plaque free tooth surfaces (i.e., brushing, flossing properly)
  • Healthy diet
  • Regular dental visits
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6
Q

What is the primary factor for gingival diseases?

A

plaque and a susceptible host

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7
Q

What is the primary factor for perio?

A

plaque and a susceptible host

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8
Q

How does plaque biofilm affect healthy gingiva?

A
  • Lingering biofilm on a clean tooth results in inflammatory process
  • Local inflammation persists as long as biofilm is present around gingival tissues
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9
Q

Inflammation resolves after removal of…

A

biofilm

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10
Q

What is gingivitis?

A

Inflammation of the gingival tissues

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11
Q

Gingivitis affects more than ___% of adult population

A

82%

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12
Q

Is gingivits reversible?

A

Yes

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13
Q

What is the primary etiologic factor for gingivitis?

A

plaque

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14
Q

What is gingivitis characterized by?

A
  • Inflammation of gingival margins and interdental papilla, redness, bleeding on probing
  • NO attachment loss
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15
Q

Cessation of oral hygiene leads
to gingivitis within _____ weeks in
healthy adults

A

2-3

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16
Q

What is gingivitis histologically characterized by?

A
  • dense infiltrate of lymphocytes
  • mononuclear cells fibroblast alterations
  • increased vascular permeability
  • continuing loss of collagen in response to the microbial challenge
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17
Q

Gingivitis is fully reversible in healthy people once…

A

local factors and decrease of the microbial load around teeth reduced

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18
Q

Gingival diseases modified by systemic factors including…

A
  • Endocrine changes (i.e., puberty, menstrual cycle, pregnancy, diabetes)
  • Results from effects of systemic conditions on host’s cellular and immunologic functions
  • Primary etiology is still plaque
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19
Q

How often does gingivitis occur during pregnancy?

A

30-100% of the time

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20
Q

Prenancy and gingivitis has a dramatic increases in the levels of what type of bacteria?

A

P. intermedia

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21
Q

Prenancy and gingivitis has a dramatic increases in what hormones in the crevicular fluid?

A

steroid hormones

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22
Q

Some pregnancies result in the presence of what kind of tumor?

A

pyogenic granulomas

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23
Q

What percent of pregnancies have pyogenic granulomas?

A

0.2-9.6%

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24
Q

When do pyogenic granulomas often appear in pregnancy?

A

2nd or 3rd month of pregnancy

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25
Q

What are the features of pyogenic granulomas?

A

they bleed easily and become hyperplastic or nodular; when excised, the lesion usually does not leave a large defect

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26
Q

Alveolar bone loss is or is not usually associated with pyogenic granulomas of pregnancy

A

IS NOT

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27
Q

What kinds of medications cause gingival overgrowth?

A
  • Anticonvulsants (Phenytoin, sodium valproate)
  • Immunosuppressive drugs (cyclosporine)
  • Calcium channel blockers (nifedipine, verapamil, diltiazem)
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28
Q

What are the types of anticonvulsants that cause gingival overgrowth?

A
  • Phenytoin
  • sodium valproate
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29
Q

What is the immunosuppressive drugs that causes gingival overgrowth?

A

cyclosporine

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30
Q

What are the types of calcium channel blocker that cause gingival overgrowth?

A
  • nifedipine
  • verapamil
  • diltiazem
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31
Q

Bright red, swollen, bleeding gingival associated with __________ deficiency

A

vitamin C

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32
Q

Diets that contain foods rich in ____________ are beneficial

A

antioxidants

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33
Q

Foods that contain high levels of _________ ____________ are detrimental to the inflammatory process

A

refined carbohydrates

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34
Q

Increased carbohydrate intake has implications on…

A

gingivitis and occurrence of dental caries

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35
Q

What is more common: plaque-induced gingivitis and non-plaque-induced gingival disease?

A

plaque-induced gingivitis

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36
Q

What does the non-plaque-induced gingival disease category encompass?

A

lesions of autoimmune or idiopathic etiology manifesting on the gingiva

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37
Q

What are non-plaque-induced gingival diseases?

A

Gingival diseases of bacterial, viral, fungal, genetic, systemic, foreign body or traumatic origins

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38
Q

What is localized gingivitis?

A

Confined to the gingiva of single tooth or group of teeth affecting <30% of remaining teeth

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39
Q

What is generalized gingivits?

A

Involves more than 30% of remaining teeth

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40
Q

What is marginal gingivitis?

A

involves the gingival margin

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41
Q

What is papillary gingivitis?

A

involves interdental papillae, often extending into adjacent portion of gingival margin

*earliest signs of gingivitis often occur in the papillae

42
Q

What is diffuse gingivitis?

A

affects gingival margin, attached gingiva and interdental papillae

43
Q

What kind of gingivitis?

A

Localized marginal gingivitis

44
Q

What kind of gingivitis?

A

Localized papillary gingivits

45
Q

What kind of gingivitis?

A

Generalized diffuse gingivitis

46
Q

2 earliest signs of gingival inflammation that precede established gingivitis are:

A
  • increased gingival crevicular fluid
  • increased bleeding from the gingival sulcus on gentle probing
47
Q

________ appears earlier than change in color or other visual signs of inflammation

A

Bleeding on Probing (BOP)

48
Q

Why does Bleeding on Probing
(BOP) occur?

A

ulceration of the sulcular epithelium due to engorgement of capillaries that are close to the surface of the thinned-out connective tissue

49
Q

_________ ________ suppresses gingival inflammatory response, thus decreasing presence of BOP

A

Cigarette smoking

50
Q

What medications can cause gingival bleeding?

A
  • Antiplatelet medications (aspirin)
  • anticoagulants (warfarin, eloquis)
  • Oral contraceptives
51
Q

Gingivitis commonly noted in ____________________ around facial aspect of gingiva with patients who are mouth breathers

A

maxillary anterior teeth

52
Q

What does gingival inflammation from mouth breathing look like?

A

Affected gingiva appears red, shiny, edematous (may be related to dehydration)

53
Q

What is hyperplasia?

A

increase in NUMBER of CELLS in tissues resulting in increase tissue volume

54
Q

What is hypertrophy?

A

increase tissue size and volume resulting from increase CELL SIZE

55
Q

What is fibrosis?

A

pathologic process in which disrupted wound healing is associated with defective cell proliferation

56
Q

What are the main facts about gingivitis?

A
  • Inflammatory response only affecting the gingiva
  • Occurs because of biofilm (plaque) accumulation that is not removed
  • Reversible
  • Precedes periodontitis but does not always progress to periodontitis
57
Q

What are the main facts about periodontitis?

A
  • Follows gingivitis
  • Not reversible
  • Inflammatory process extends to affect the PDL and alveolar bone, resulting in clinical attachment loss (CAL)
  • Can be stabilized and maintained with gingival health on a reduced periodontium
58
Q

What is dysbiosis?

A

an imbalance between the types of organisms present in a person’s natural microflora which is thought to contribute to a range of conditions of ill health

59
Q

What is periodontitis?

A

Chronic inflammation of the gingival tissues resulting in breakdown of surrounding periodontal tissues

60
Q

What is periodontitis characterized by?

A
  • Bone loss
  • Apical migration of the Junctional Epithelium
61
Q

What is periodontitis initiated by?

A

a dysbiosis of biofilm and modulated by the host response

62
Q

What are the steps involved in transitioning from gingival health to periodontitis?

A
  • Plaque around gingival tissues causes microbial challenge for healthy tissues
  • Inflammatory change of the gingival sulcus begins
  • Cellular and fluid inflammatory exudate causes degeneration of surrounding connective tissues, including gingival fibers
  • Apical to JE, collagen fibers are destroyed and area if occupied by inflammatory cells and edema
63
Q

What is first stage of periodontal disease: Initial Lesion?

A
  • Clinically healthy gingival tissues
  • Develops within 2-4 days of the accumulation of plaque
64
Q

What is second stage of periodontal disease: Early Lesion?

A
  • Early gingivitis that is clinically evident
  • Develops approximately 1-2 weeks of continued plaque accumulation
65
Q

What is third stage of periodontal disease: Established Lesion?

A
  • Established chronic gingivitis
  • Progression to this stage dependent on many factors
66
Q

What is fourth stage of periodontal disease: Advanced Lesion?

A
  • Transition from gingivitis to periodontitis
  • Progression to this stage dependent on many factors
67
Q

What is the job of the junctional epithelium?

A

Acts as a physical barrier against plaque bacteria

68
Q

What type of epithelium is the junctional epithelium?

A

Stratified squamous nonkeratinized

69
Q

What attaches the junctional epithelium to the tooth?

A

internal basal lamina

70
Q

What attaches the junctional epithelium to the connective tissue?

A

external basal lamina

71
Q

What is a pseudopocket?

A

gingiva is very high due to hyperplasia (not a true periodontal pocket)

72
Q

What is a true periodontal pocket?

A

pocket caused by bone loss associated with apical migration of the junctional epithelium

73
Q

What is a suprabony pocket?

A

bottom of pocket is coronal to the crest of the alveolar bone

74
Q

What is a infrabony pocket?

A

bottom of the pocket is apical to crest of the alveolar bone

75
Q

The alveolar crest should be ____ mm apical to the CEJ

A

1-2 mm

76
Q

What are the two types of radiographic bone loss?

A

horizontal and vertical

77
Q

Which is harder to treat: horizontal or vertical bone loss?

A

vertical

78
Q

What is the necessary information for a periodontal diagnosis?

A
  • Description of the clinical appearance of the soft tissues
  • Probing depths
  • Plaque and bleeding index
  • Recession/ Clinical Attachment Loss (CAL)
  • Radiographs
79
Q

What is the primary etiology of periodontal disease?

A

plaque and a susceptible host

80
Q

What is the secondary etiology of periodontal disease?

A

local and environmental factors

81
Q

What are the local factors that contribute to periodontal disease?

A
  • Calculus
  • Carious lesions
  • Overhangs
  • Malpositioned teeth
  • Xerostomia
  • Furcations
  • Food impaction
  • Occlusal trauma
  • Orthodontics
  • Poor crown margins
82
Q

What are the systemic factors that contribute to periodontal disease?

A
  • Medication
  • Stress
  • Diabetes
  • Obesity
  • Cardiovascular disease
  • Immuno-compromised
  • Smoking
  • Nutritional deficiencies
  • Age
  • Genetics
83
Q

What kind of shifts does the oral microbiota make when going from health to disease in the periodontium?

A
  • From gram+ to gram-
  • From cocci to rods (and later to spirochetes)
  • From nonmotile to motile organisms
  • From facultative anaerobes to obligate anaerobes
  • From fermenting to proteolytic species
84
Q

What are the primary bacterium associated with periodontitis?

A
  • Aa
  • P. gingivalis
  • P. intermedia
  • T. forsythia
  • T. denticola
85
Q

During pregnancy increased tissue edema can lead to increased pocket depths and may be associated with…

A

transient tooth mobility

86
Q

Most studies support a _______ relationship regarding periodontitis during pregnancy and an increased risk of adverse pregnancy outcomes

A

causal

87
Q

Periodontal disease adversely affects pregnancy outcomes such as…

A

potential of leading to preterm, low-birthweight (PLBW) infants and increasing the mother’s chances of experiencing more attachment loss of the periodontium

88
Q

What is the bacterium most associated with periodontitis and pregnancy?

A

P. intermedia

89
Q

What are the organisms most associated with plaque and were detected at higher levels in women who had preterm, low-birthweight (PLBW) babies?

A

P. intermedia
T. forsythia
P. gingivalis
Aa
T. denticola

90
Q

What are the three main risks for periodontal disease?

A
  • tobacco smoking
  • diabetes
  • Pathogenic bacteria and microbial tooth deposits
91
Q

When ____ ______ are present, they increase the likelihood that an individual will develop the disease

A

risk factors

92
Q

In order to be identified as a risk factor, the exposure must occur _____ disease onset

A

before

93
Q

Studies have shown that smoking has a negative impact on the response to ________

A

therapy for periodontal disease

94
Q

Association between smoking and periodontal disease are independent or dependent on factors, such as oral hygiene or age?

A

indpendent of

95
Q

What is the most important variable in the relationship between peridontal disease and diabetes?

A

the level of diabetic control

96
Q

What is more important in plaque: the quantity of plaque or the quality/composition of plaque?

A

quality/composition

97
Q

What are other risk factors for periodontal disease besides the main three (smoking, diabetes, pathogenic bacteria)?

A
  • genetics
  • age
  • gender
  • socioeconomic status
  • stress
98
Q

What is the primary etiologic factor for gingivis/perio?

A

PLAQUE IN A SUSCEPTIBLE HOST

99
Q

What are the secondary etiologic factors for gingivis/perio?

A

Local factors:
* Calculus, caries, tooth position, anatomical features, trauma

Systemic factors:
* Smoking habit, health of individual, diet, obesity, hormone changes

100
Q

Males or females are more likely to have attachment loss?

A

Males

101
Q

Males or females have poorer oral hygiene?

A

males

102
Q

Prevalence and severity of periodontal disease increases, decreases, or stays the same with age?

A

increases

Patient Care III (33 decks)

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