Etiology of Periodontal Diseases & Risk Assessment Flashcards
What should gingival health look like in color?
Coral pink in color
What should the interdental papilla look like in gingival health?
Peaked and pointed
What should the surface texture be in gingival health?
Stippled
What should gingiva look like in health?
- 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
How is gingival health achieved?
- Plaque free tooth surfaces (i.e., brushing, flossing properly)
- Healthy diet
- Regular dental visits
What is the primary factor for gingival diseases?
plaque and a susceptible host
What is the primary factor for perio?
plaque and a susceptible host
How does plaque biofilm affect healthy gingiva?
- Lingering biofilm on a clean tooth results in inflammatory process
- Local inflammation persists as long as biofilm is present around gingival tissues
Inflammation resolves after removal of…
biofilm
What is gingivitis?
Inflammation of the gingival tissues
Gingivitis affects more than ___% of adult population
82%
Is gingivits reversible?
Yes
What is the primary etiologic factor for gingivitis?
plaque
What is gingivitis characterized by?
- Inflammation of gingival margins and interdental papilla, redness, bleeding on probing
- NO attachment loss
Cessation of oral hygiene leads
to gingivitis within _____ weeks in
healthy adults
2-3
What is gingivitis histologically characterized by?
- dense infiltrate of lymphocytes
- mononuclear cells fibroblast alterations
- increased vascular permeability
- continuing loss of collagen in response to the microbial challenge
Gingivitis is fully reversible in healthy people once…
local factors and decrease of the microbial load around teeth reduced
Gingival diseases modified by systemic factors including…
- 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
How often does gingivitis occur during pregnancy?
30-100% of the time
Prenancy and gingivitis has a dramatic increases in the levels of what type of bacteria?
P. intermedia
Prenancy and gingivitis has a dramatic increases in what hormones in the crevicular fluid?
steroid hormones
Some pregnancies result in the presence of what kind of tumor?
pyogenic granulomas
What percent of pregnancies have pyogenic granulomas?
0.2-9.6%
When do pyogenic granulomas often appear in pregnancy?
2nd or 3rd month of pregnancy
What are the features of pyogenic granulomas?
they bleed easily and become hyperplastic or nodular; when excised, the lesion usually does not leave a large defect
Alveolar bone loss is or is not usually associated with pyogenic granulomas of pregnancy
IS NOT
What kinds of medications cause gingival overgrowth?
- Anticonvulsants (Phenytoin, sodium valproate)
- Immunosuppressive drugs (cyclosporine)
- Calcium channel blockers (nifedipine, verapamil, diltiazem)
What are the types of anticonvulsants that cause gingival overgrowth?
- Phenytoin
- sodium valproate
What is the immunosuppressive drugs that causes gingival overgrowth?
cyclosporine
What are the types of calcium channel blocker that cause gingival overgrowth?
- nifedipine
- verapamil
- diltiazem
Bright red, swollen, bleeding gingival associated with __________ deficiency
vitamin C
Diets that contain foods rich in ____________ are beneficial
antioxidants
Foods that contain high levels of _________ ____________ are detrimental to the inflammatory process
refined carbohydrates
Increased carbohydrate intake has implications on…
gingivitis and occurrence of dental caries
What is more common: plaque-induced gingivitis and non-plaque-induced gingival disease?
plaque-induced gingivitis
What does the non-plaque-induced gingival disease category encompass?
lesions of autoimmune or idiopathic etiology manifesting on the gingiva
What are non-plaque-induced gingival diseases?
Gingival diseases of bacterial, viral, fungal, genetic, systemic, foreign body or traumatic origins
What is localized gingivitis?
Confined to the gingiva of single tooth or group of teeth affecting <30% of remaining teeth
What is generalized gingivits?
Involves more than 30% of remaining teeth
What is marginal gingivitis?
involves the gingival margin
What is papillary gingivitis?
involves interdental papillae, often extending into adjacent portion of gingival margin
*earliest signs of gingivitis often occur in the papillae
What is diffuse gingivitis?
affects gingival margin, attached gingiva and interdental papillae
What kind of gingivitis?
Localized marginal gingivitis
What kind of gingivitis?
Localized papillary gingivits
What kind of gingivitis?
Generalized diffuse gingivitis
2 earliest signs of gingival inflammation that precede established gingivitis are:
- increased gingival crevicular fluid
- increased bleeding from the gingival sulcus on gentle probing
________ appears earlier than change in color or other visual signs of inflammation
Bleeding on Probing (BOP)
Why does Bleeding on Probing
(BOP) occur?
ulceration of the sulcular epithelium due to engorgement of capillaries that are close to the surface of the thinned-out connective tissue
_________ ________ suppresses gingival inflammatory response, thus decreasing presence of BOP
Cigarette smoking
What medications can cause gingival bleeding?
- Antiplatelet medications (aspirin)
- anticoagulants (warfarin, eloquis)
- Oral contraceptives
Gingivitis commonly noted in ____________________ around facial aspect of gingiva with patients who are mouth breathers
maxillary anterior teeth
What does gingival inflammation from mouth breathing look like?
Affected gingiva appears red, shiny, edematous (may be related to dehydration)
What is hyperplasia?
increase in NUMBER of CELLS in tissues resulting in increase tissue volume
What is hypertrophy?
increase tissue size and volume resulting from increase CELL SIZE
What is fibrosis?
pathologic process in which disrupted wound healing is associated with defective cell proliferation
What are the main facts about gingivitis?
- 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
What are the main facts about periodontitis?
- 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
What is dysbiosis?
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
What is periodontitis?
Chronic inflammation of the gingival tissues resulting in breakdown of surrounding periodontal tissues
What is periodontitis characterized by?
- Bone loss
- Apical migration of the Junctional Epithelium
What is periodontitis initiated by?
a dysbiosis of biofilm and modulated by the host response
What are the steps involved in transitioning from gingival health to periodontitis?
- 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
What is first stage of periodontal disease: Initial Lesion?
- Clinically healthy gingival tissues
- Develops within 2-4 days of the accumulation of plaque
What is second stage of periodontal disease: Early Lesion?
- Early gingivitis that is clinically evident
- Develops approximately 1-2 weeks of continued plaque accumulation
What is third stage of periodontal disease: Established Lesion?
- Established chronic gingivitis
- Progression to this stage dependent on many factors
What is fourth stage of periodontal disease: Advanced Lesion?
- Transition from gingivitis to periodontitis
- Progression to this stage dependent on many factors
What is the job of the junctional epithelium?
Acts as a physical barrier against plaque bacteria
What type of epithelium is the junctional epithelium?
Stratified squamous nonkeratinized
What attaches the junctional epithelium to the tooth?
internal basal lamina
What attaches the junctional epithelium to the connective tissue?
external basal lamina
What is a pseudopocket?
gingiva is very high due to hyperplasia (not a true periodontal pocket)
What is a true periodontal pocket?
pocket caused by bone loss associated with apical migration of the junctional epithelium
What is a suprabony pocket?
bottom of pocket is coronal to the crest of the alveolar bone
What is a infrabony pocket?
bottom of the pocket is apical to crest of the alveolar bone
The alveolar crest should be ____ mm apical to the CEJ
1-2 mm
What are the two types of radiographic bone loss?
horizontal and vertical
Which is harder to treat: horizontal or vertical bone loss?
vertical
What is the necessary information for a periodontal diagnosis?
- Description of the clinical appearance of the soft tissues
- Probing depths
- Plaque and bleeding index
- Recession/ Clinical Attachment Loss (CAL)
- Radiographs
What is the primary etiology of periodontal disease?
plaque and a susceptible host
What is the secondary etiology of periodontal disease?
local and environmental factors
What are the local factors that contribute to periodontal disease?
- Calculus
- Carious lesions
- Overhangs
- Malpositioned teeth
- Xerostomia
- Furcations
- Food impaction
- Occlusal trauma
- Orthodontics
- Poor crown margins
What are the systemic factors that contribute to periodontal disease?
- Medication
- Stress
- Diabetes
- Obesity
- Cardiovascular disease
- Immuno-compromised
- Smoking
- Nutritional deficiencies
- Age
- Genetics
What kind of shifts does the oral microbiota make when going from health to disease in the periodontium?
- 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
What are the primary bacterium associated with periodontitis?
- Aa
- P. gingivalis
- P. intermedia
- T. forsythia
- T. denticola
During pregnancy increased tissue edema can lead to increased pocket depths and may be associated with…
transient tooth mobility
Most studies support a _______ relationship regarding periodontitis during pregnancy and an increased risk of adverse pregnancy outcomes
causal
Periodontal disease adversely affects pregnancy outcomes such as…
potential of leading to preterm, low-birthweight (PLBW) infants and increasing the mother’s chances of experiencing more attachment loss of the periodontium
What is the bacterium most associated with periodontitis and pregnancy?
P. intermedia
What are the organisms most associated with plaque and were detected at higher levels in women who had preterm, low-birthweight (PLBW) babies?
P. intermedia
T. forsythia
P. gingivalis
Aa
T. denticola
What are the three main risks for periodontal disease?
- tobacco smoking
- diabetes
- Pathogenic bacteria and microbial tooth deposits
When ____ ______ are present, they increase the likelihood that an individual will develop the disease
risk factors
In order to be identified as a risk factor, the exposure must occur _____ disease onset
before
Studies have shown that smoking has a negative impact on the response to ________
therapy for periodontal disease
Association between smoking and periodontal disease are independent or dependent on factors, such as oral hygiene or age?
indpendent of
What is the most important variable in the relationship between peridontal disease and diabetes?
the level of diabetic control
What is more important in plaque: the quantity of plaque or the quality/composition of plaque?
quality/composition
What are other risk factors for periodontal disease besides the main three (smoking, diabetes, pathogenic bacteria)?
- genetics
- age
- gender
- socioeconomic status
- stress
What is the primary etiologic factor for gingivis/perio?
PLAQUE IN A SUSCEPTIBLE HOST
What are the secondary etiologic factors for gingivis/perio?
Local factors:
* Calculus, caries, tooth position, anatomical features, trauma
Systemic factors:
* Smoking habit, health of individual, diet, obesity, hormone changes
Males or females are more likely to have attachment loss?
Males
Males or females have poorer oral hygiene?
males
Prevalence and severity of periodontal disease increases, decreases, or stays the same with age?
increases
