exam 2 Flashcards
1
Q
—– —— is indicated to control the progress of perio destruction and attachment loss when more conservative non surgical treatment is insufficent
A
periodontal surgery
2
Q
True or false
almost all dental procedures would be considered surgery
A
true
3
Q
the major benefit and indication for perio surgery as an adjunct to non sugerical perio treatment is to gain access…
A
to the root surface for scaling and root planing. It also improves access for plaque biofilm control.
4
Q
perio surgery results in better access to
A
furcations, complex root surfaces, and infrabony pockets
5
Q
Improving access for plaque biofilm control by the patient may require removing tissues or bony forms that block the patient from adeqautely removing as much biofilm as necassary to control the disease
A
true
6
Q
disadvantages of perio surgery include
A
health status
age of the patient
and the specific limitatons of each procedure
7
Q
the patients opinion of the negatives of perio surgery are
A
time
cost
aesthetics
disomfort
8
Q
the healing after non surgerical therapies is atleast
A
4 weeks
9
Q
the amount of pocket reduction observed after these procedures inficates the extent of surgical procedures s
A
that are still required
10
Q
in prescribing perio surgery the periodontist carefully considers
A
probing pocket depth
amount of bone loss
importantce of the tooth to function and aesthetics
patients level of plaque biofilm control
patients general health
11
Q
is a deepended gingival sulcus with an infected root surface covered by an ulcerated epithelial surface with underlying inflamed connective tissue
A
periodontal pocket
12
Q
the periodontal pocket is bound ——– by the gingival margin on one side by the root surfae on the other sie by the epithelial surface and at the base by the junctional epithelium
A
coronally
13
Q
scaling and root planing is effective in controlling perio disease to probing depths of about 1
A
4 mm
14
Q
pockets deeper than 5 mm are
A
difficult to intstrument and therefore often remain infected even after the best care
15
Q
pockets greater than — -mm suggest extreme loss of attachment which makes the long term prognosis for retaing the affected teeth poor
A
9mm
16
Q
perio surgery is most succesful when treating perio pockets with probing depths of
A
5-9 mm
17
Q
probing depths is not always equal to
A
clinical attachment loss
18
Q
measurement from the crest of the gingival margin to the base of the pocket
A
probing pocket depth
19
Q
measured from the cemento enamel junction to the base of the pocket
A
attachment loss
20
Q
if the gingival margin is on the root surface as when there has been recession the attachment loss is greater
A
than the probing depth
21
Q
if the gingival margin is on the enamel surface of the crown as in the gingival hypertrophy than the attachment loss is less than the
A
probing depth
22
Q
attachment loss represents
A
bone destruction
23
Q
not all probing depths greater than five need surgery
A
true
24
Q
the 5mm guideline is only the
A
first step in identifying if patients need perio surgery
25
patients with 5-6 mm may be monitored with a --- and ---- approach to determine whether non surgical perio therapy and careful maintence are adequate
wait and see
26
to know that a disease is definitely progressing a --- mmm increase in probing depth must be observed over time. if surgery is postponed the dentist must be willing to risk this --- mm loss
2
27
the base of the perio pocket is not at the
level of the crest of the alveolar bone
28
there is usually --- to --- mm of connective tissue attachment covered by the epithilium between the probing depth and the alveolar bone
1-2 mm
BIOLOGIC WIDTH
29
bone loss caused by perio disease results in
osseous defects
30
osseous defects may occur
in a horizontal dimension where the bone resorbs equally on the mesial and distal surfaces or a vertical dimension where the resorption is unequal around the teeth
31
pockets that are coronal to horizontal bone loss are often called
suprabony pockets
32
pockets that extend apicaly beyond the crest of the bone are called
infrabony pockets
33
-- may also occur in a variety of configurations that are usually described by the number of bony walls remaining
vertical bone loss
34
when all the walls of the osseous defects are within the bone housing they may be termed
infrabony pockets
35
perio surgery that includes modification of the bone level or shape is called
osseous surgery
36
grafting or regenerations techniques may be required
if perio surgery isnt needed
37
generally osseous surgery performed to correct
irregulary shaped defects of the bony support around the tooth is indicated when at least half of the bone support remains.
38
an abutement tooth for a functioning fixed bridge can be importnat to the patient and often every attempt
to salvage a particular tooth through perio surgery is strongly indicated.
39
patients with pocking depths exceeding 5 mm and half there supporting bone lost who are relatively young (younger than ---) have an aggressive form of perio disease
30
40
patients oolder than --- years with the same clinical condition usually have a more slowly progressing form of the disease
60
41
the goal of --- --- --- is to reduce perio pocket depth by removing soft tissues to a level at which plaque biolfium control and maintence procedures are effective usually not exceeding 3 to 4 mm in depth
pocket reduction surgery
42
methods for pocket reduction include
excisoional perio surgery (gingevectomy) and incisional perio surgery (flap)
43
excisional perio surgery remove the excess tissue from
the wall of the perio pocket
used for rapid reduction of the gingival pockets
44
the most basic excisional surgical procedures are termed
gingivectomy or gingivoplasty
45
first consideriation for pocket reduction is usually
gingvectomy
| you can do that and gingivoplasty together
46
the presence of deep perio pockets with thick fibrous tissue is the major indication for
gingivectomy
47
drug induced gingival hyperplasia is treated with
gingivectomy
caused by antiseizure meds phenytoin ccb to control blood pressure or immunosupressive drugs
48
perio scaling and root planing should be completed (-- to -- weeks) before surgery allows tissues to heal
4 to 6
49
often, the need for gingivectomy cannot be determined until tissue shrinkage ater scaling and root plaing has occured
true
50
edematous friable and hemorrahagic tissues are not easily incised and therefore require adequate healing time ater scaling and root planing and before surgery
true
51
gingevectomy the gingiva is excised with knifes at
45 degree angle to the gingival surfacekeeping the incsion with the keritinized gingiva
52
healing is usually uneventful and the gingial epithelium is reestablished --- weeks after surgery
2
53
gingivectomy is rarely used for pocket reduction
due to the many contraindictions
54
the primary contraindiction to gingivectomy is
the procedure does not permit access to infrabony pockets, those below the crest of the alveolar bone, a highly common occurance in periodontisits
55
other negatives of gingivectomy is
wide wound is created, which makes healing slow discomfort.
the anatomy of the surrounding area may prevent incising the tissues at the proper angel or minimal width of attached gingiva may prevent keeping the incision with the keratinized tissue
unacceptable aesthetics sens. tp heat and cold and caries
56
incisional surgery
perio flap surgery or simple flap
57
incisional surgery
is the procedure of choice when excisional perio surgery cannot be performed for pocket reduction.
58
incisional surgery is called flap surgery because the
tissues are pushed away from the underlying tooth roots and alveolar bone much like a flap or envelope.
59
the usual incisional technique for pocket reduction with a flap surgery is called teh
apically positioned flap because the flap is sutured at a more apical location on the tooth roots to reduce pocket depths.
60
flap surgery has fewer contraindictions than
gingivectomy
61
the majority of implants used in dentristy are the root form type
endosseous implants which are based on the principles of osseointegreation
62
today in excess of 50 implant systems are avaiable with innovations being proposed and instituted by dinfferent manufactures through intense competition
true
63
ideally longitudinal trials of -- years or longer are required to forecast the validity of emerging treatment concepts
5
64
subperiosteal and transosteal
still seen but less often
65
custom made cast framework that is placed beneath he periosteum over the alveolar bone
subperiosteal implant can be used on top or bottom
66
in subperiosteal the frame rests
on the jawbone with no evidence of direct union with the bone in most cases
67
transosteal implants
traverse the mandible in a apicocoronal direction. they protrude through the gingival tissues into the mouth for prosthesis anchorage
68
a stabilization plate is placed along the inferior border of the mandible
with transosteal implants
69
tranosteal implants are often called
staple implants
70
the interfacial adaption between the subperiosteal and transosteal implants and bone resmembles that of a scar tissue with no direct bone anchorage
creates a compromised arrangement under occlusal loads
71
endossesous two types
blade and root
72
root form
screw or cylindicral shaped with different lengths diameters and specific design character.
73
the blade implant
no longer used because it has a high incidence of complications and failures
74
---- --- --- --- provide direct osseous anchorage through formation of an intimate lattice between the implant surface and bone
root form endossesous implant
most predictable and accepeted
75
scanning electron microscopy of the interface reveals a narrow nonminerilized zone approx --- to --- between the bone and the implant containing chondrotin sulfate glycosaminoglycans
20 to 40
76
the def of osseointegration as propsed by brainemark is
direct structural and functional connection between ordered living bone an the surgace of a load bearing implant
77
because implant integration involves soft and hard tissues the term --- ---- implant has been suggested to describe implant integration better
stably integrated
78
----- observation of the bone interace has also demonstrated that because of thedynamic nature of the bone 100 percent integration never develops and the bone to implant contact is both time dependant and influenced by implant surface characterisitcs
longitudinal.
79
the amount of bone to implant contact varies among different implant systems
30 to 70 the exact amount of bone to implant contact required for sucess has not been determined.
80
the bioloical process involved in attainment and maintents of implant integration depends on factors that include
```
biomaterials
bicompatibilty
implant design
bone factors
surgical and loading consideration
```
81
close contact of living cells at its surface which does not contain leachable that produce inflammation and which does not prevent growth and division of cells in culture
biocompatibility
82
molecules that seperate off the surface
leachables
83
gold, stainless steel, cobalt chromium alloys, bioactive glasses, niobium, hydroxyappetite, tricalcium, phosphate, polymers, zirconium, titatium
biomatierlas not all are compatible as an implant material.
84
any implanted material is consiered
a foreign body
85
metals in contact with tissue fluid are prone to
degration and dissoulotion by corrossion
86
exchange of protons with biological molecules leads to
antigen formation and cellular uptake
87
----- has become the standard in osseointegration
titanum
88
highly reative yet biocompatible metal
titanium
89
titanium rapidly forms a layer of surface oxides (--- to ----) mm thick most notably of titanium oxide when exposed to air or fluid
.3-.5mm
90
the oxide layer prevents ----- on the surface so that tissue integreation can occurs
erosion
91
advantages of titanium
light weight and can withstand occlusal forces
92
the length of implants are between --- to --- long
8 to 14
| based on avaibable bone height and proximity to votal structures such as nerve trunks and blood vessels
93
implant diameters range from
3 to 6
94
the selection of diamter is based on
the width of the jaw ridge at the implant site
95
the jaw ridge is narrower in the ---- so narrower implants are used there
lateral incisor
96
wider impants can be used in
molar region
97
the most common implant shape
cylindrical
98
implants exhibit
threaded surface design
99
there are --- implants also avaiable with no threads
hollow
100
the initial stability of the implants is in part dependant on the
surface texture
101
many studies have shown that a higher bone to implant contact is attained around
rough surfaced implants
102
methods for producing roughened implant surfaces include
grit blasting acid etching plasma spraying and using additive surfaces such as hydroxyappating coating
103
the amount of bone to implant contact achieved at the time of the implant placement isrelated to the quantiy and quality of bone and determines
fixture stabilty
104
there is variability in the
amount of cortical and cancellous tissue with the arch and between the maxilla and mandible
105
the volum density or cortical bone is
three to four times that of cancellous bone
106
------ contribute less to implant stability at placement
cancellous
107
resorption of the alvelous is a natural sequeale to
tooth loss
108
the extent of the resorption process is dependent on
the history or trauma, length of time since loss occured, and loading removable prosthesis
109
quality of bone is also influenced by systemic condition such as
osteoporosis and social factors such as smoking
110
there are no fixed guideline for the length of healing time after surgery and before prosthetic loading of implants
true
111
brianne orginally advised --- months for mandible and -- months for maxilla
3
6
112
movement of the implant more than ---- um during the healing phase may result in fibrous tissue encapsulation of the implant rather than osseointegration a result that does not provide long term functional occlusal load
100
113
------- is compatible with attaining osseointegration
immediate loading
114
treatment should be delayed in younger patients until growth is near completion because unlike the natural dentition
implant s remain stationary during dentoalveolar growth.
115
conditions that increase the patients susceptibilty to infection such as uncontrolled diabetes may result in
high incidence of peri implantitis and implant failure
116
osteoporosis
age related disease
117
decreased bone mass and increased susceptibility to fractures affects 20 million americans 80 percent of whom are older women
osteoporosis
118
hormone replacement therapy and osteoporosis do not appear to influence
implant survival in this population
119
therapy with bisphosphonates has been recently attribued to an increased risk of
jaw osteonecrosis and patients who have been treated with IV bisphosphonates are particularly at risk
120
patients recieving anticoagulant therapy must be consulted before surgery because they are at risk
of hemmoraging during surgical procedures
121
patients on steroid therapy may have
steroid induced complications
122
the natural dentition is surrounded by the periodontium comprising the gingiva cementum alveolar bone and perio ligament
true
123
the gingival sulcus is -- to --- mm deep in health
1 to 3
124
the base of the sulcus is formed by the coronal aspect of the
Junctional epithelium
125
the junctional epithilium is attacted to the root surface by
hemidesomosomes and a basal lamina
126
the cells of the JE have a high turnover rate and can migrate on the root surface to reestablish
an attachment or form a new one
usually occurs after a trauma, inflammation, and bone loss, resorative procedures
127
the peri implant soft tissue is shaped after
abutement connection or in the case of a single stage implant system forms aroun the transmucosal portion of the fixture
128
the collagen fibers are aligned parallel to an organized in a circular arrangement around the
supracrestal portion of the implants
129
there is no cemental layer over the implant surface so fiber insertion is
not possible
130
perimplant soft tissues adheres to the titanium collar of the implant by a
hemidesmosomal and basal lamina attachment mechanism, analougous to that of the JE to enamel attachment
131
the ----- provides anchorage in the alveolous for natural teeth and allows physiologic mobility and proprioceptive sensation from the dentition
PDL
132
the connective tissue fibers of the PDL attach to the alveolar bone and cememntum
perpendiculary and adapt to variations in occlusal load
133
the pdl space is highly
vasculuar
134
there is no pdl in
osseointegration
135
once osseointegrated orthodontic movement is not possible
true
136
unfavorable loading of implants is one etiologic factor for bone loss around implants
true
137
the biologic width around teeth that is the dimension of the epithilial and connective tissue attachments is approx
2mm
138
a similiar implant biologic width has also been described the per implant mucosa which
comprises a 2mm long JE and 1 mm zone of connective tissue
139
the connective tissue zone is poorly organized and exists between the JE which is typically attatched to the prosthetic components. called the
implant abutement and bone
140
the implant abutement exteneds from the implant through the soft tissues and can be
temporary or permanent.
141
the root analogue device in the bone
implant fixture, by an abutment screw
142
the osseous crest around natural teeth in healthy follows the outline of the cementoenamel junction at a distacne of
1 to 2 mm apically on the root surface
143
the location of the crestal bone level around implant depends on the implant deisgn and may vary from
.5 to 3 from the top of the implant fixture
144
the clinical success of implant therapy is assesed by
radiographic imaging, evaluation of tooth mobility, and obseving surrounding tissue
145
in regards to the gingival sulcus depth the teeth are ---- and the implants are ---------------------------
shallow
depth dependent on implant type and prosthethic component and length
146
in regards to the gingival fibers the teeth are ------ and the implants are ---------
inserted into supracrestal root cementum
fibers arranged parallel to implant
147
in regards to the location of the crestal bone the teeth are ---- and the implants are -----
1-2 mm from the cementoenamel junction
depended on implant design, ranges .5-2.5 mm from implant shoulder or to first thread
148
in regards to the connective tissue attachment the teeth are --- -and the implants are ----
sharpeys collagen fibers insrted into alveolar bone and cementum
bone implant interface has no fiber insertions filled with chondroitin sulfate glycosaminoglycans
149
in regards to mobility the teeth are --- and the implants are ----
physiolologic as a function of pdl
no pdl fixation similar to that of functional ankylosis
150
in regards to propriocetion the teeth are ----- and the implants are ---
receptors with the pdl
no receptors within interface
151
criteria for implant success
1. no peri implant radiolucency
2. absense of mobilitiy
3. bone loss no greater than 1/3 of implant
4. provide functional service for 5 years in 85 percent of cases in the anterior maxilla and 90 percent in the anterior mandible after 10 years, 80 percent sucess in the maxilla and 85 percent in the mandible
5. absense of persistent or irreversible signs or symptoms such as pain, infection, neuropathies, paresthesia, and violation of the manibular canal.
6. bone loss less than .2 mm annually after first year of service
7. implant design allows restoration satisfactory to patient and dentist
8. absense of continuous marginal bone loss
9 absense of continous marginal bone loss
10. probing depth less than 4-5 mm bone loss less than 4
11. no mechanical failure
152
trauma to bone during implant recipent site prepartion through overheating or use of excessive fore must be avoided to ensure treatment success
true
153
bone cells are irreversibly damaged if heated above ----- degree celcius for --- minute so copious irrigation with a coolant is required during surgery
47
one
154
there is no recommended aseptic protocol for implant surgery because the outcome of a therapy is similar when implant placement is performed under aseptic and clean conditionss
true
155
implant immobility throughout the healing period ranging from
3 to 6 months
156
to minimize the potential for a functional load on the implant during the healing phase
2 stage surgical approach
157
superstructure
restorations
158
after a throurough examination and planning process that includes appropriate radiographs, study casts, and fabrications of surgical guides (stents) implants are placed with the use of a submerged or non submerged protocol
true
159
requires two surgical procedures before the fabrication of the restorations that will be placed on the implants
submerged protocol
160
in submerged protocol the first surgery place the implant fixture with in the bone followed by a second surgery -- to --- months later to uncover the impant so it can be assesed through the e----
3 to 6
mucosa
161
after anesthesia is administered a ---- --- is made in the soft tissue along the crest of the alveolar ridge and a flap is reflected in the location where the impant is to be placed
crestal incision
162
with the aid of a ---- ----- drills specific for the implant system of choice are used under copious saline soloution irrigation to prepare the endosseous implant recipentant site to the pre determined lengeth and diameter
surgical stent
163
--- --- are used to verify the angulations and distance between implants or between the implant and surrounding teeth.
guide pins
164
implants are either slowly threaded into place in thecase of screw design implants or gently tapped in place in the case of non threaded cylindrical designs
true
165
the internal aspect of the implant is protected from ingrowht of tissue by placing a device called a ----- --- on top of the implant.
over screw
166
the patient should not wear dentures over the implant site for --- to --- weeks after surgery to avoid pressure on the implants
2-3 weeks
167
in postopeartive procedures the area should be cleansed with a ..... chlorexidine mouth wash twice daily and use of systemic antibiotics should be considered to minimize the chance of infection
.2 percent
168
3 months healing for
mandible
169
6 months healing for
maxilla
170
the cover screws are than replaced with
healing abutements
171
are transmucosal posts that allow healing and adaptation of the peri implant soft tissues to take place
healing abutements
172
restorative procedures can usually being after --- to ---- of soft tissue healing
3 to 4 weeks
173
the surgical approach for the nonsubmerged protocol for implant placement is similar to that described for the two stage submerged procedure excet that after implant placement the tissues are closed around the specially designed transmucoal portion of the implant or around the healing abutement
this eliminates the need for a 2nd surgery to uncover the implant which maiy reduce both the treatment time and patient discomfort
174
additional procedures may include soft tissue augmentation to increase the thickness or amount of keratinized tissue bone grafting guidied tissue regeneration or a combo of these procedures
true
usuaully for deformalilties
175
immediate placement of implants into extraction sockets leave
a gap between the nonengaged implant surface and the inner aspect of the socket wall
this distance is referred to as jumping distance
176
it is not known how wide a space can be tolerated and still permit normal healing. studies suggests that gaps of -- to -- mm can fill with bone without the use of adjunctive grafting materials
1 to 2 mm
177
if multiple implants are placed the temp restorations are typicallyu splinted together to minimize movement and promote even load distribution
true
178
prosthetic restoration mus be designed to avoid an excessive load on implants to protect them from bone loss and prosthetic component failure.
true
179
a delayed placement is
6-10 weeks after extraction
180
a late placement is
6 months or longer after extraction
181
implant location and aesthetic demand may favor
cementretained restorations.
182
with cementum the abutement is attached to the implant with a conventional screw system but the crown is
cemented on to the abutement typically with a temporary cement so that it can be removed if necassary
183
the purpose of regular periodic clinical evaluation of patients is to
detect early disease activity and to provide individualized maintenance protocols.
184
healthy implants are
osseointegrated
185
the absense of pdl around implants creates
a rigid bone implant interface the maintenace of which is key for the long term success of implants
186
studies have indicated that probe tip penetrates closre to bone in infalmed peri implant tissues than in healthy sites and that there is a tendenecy toward deeper probe depths around
implants
187
depths of ---- or less than -- to ---- are considered consitent with health because patients are able to maintain these depths with good oral hyg.
3
4-5
188
probing depths are dependent on
individual implant design abutement height and depth of fixture within bone
189
probing with implants
not very valuable
190
not probing during the first -- months after loading is advised so that healing is not distubered
3
191
---- around implants provides an assesment of inflammation parameters such as bleeding and supuration
probing
192
---- radiographs and panoramic images are used in conjunction with standard clinical examination to asses bone levels available for implant sites
periapical
only a 2 dimensional view of alveolar bone
193
after implants are placed images are used to asses the height of proximal bone the presence of anatomic structure anomolies or pathogenic lesions
true
194
3d view of implants
cross sectional and tomographic images can be obtained with the use of computed tomography
helps with bone density
195
quality of bone is better assessed at the
time of surgery
196
bone loss should not exceed ----- annually after the first year after loading in the absense of peri implant radiolucencies or associated conditions
.2 mm
197
radiographic follow up is recommend for implant sites at --,---,--- months and than every --- to --- years thereafter unless clinical symptoms are seen
6/12/36
2-3
198
some periodontists continue radiographs every -- months for the first year to ensure bone levels are stable
3 months
199
the need for kkeratinized tissue around implants remains
controversial
200
you can have good oral health with minimal or no ----
keritinzed tissue
201
factors determining whether the attached ginigiva is enough would include
```
inflammation present?
gingival recession
oral hyg status
patient complance
relationship between the ginigva and alveolar bone
tooth position with the arch
presence of restorations
asethetic demands
tooth sensitivity
```
202
asthetic demands may dictate that ---- be present at the implant stite
keritinzed tissue
203
is a collective term of inflammatory reactions in the tissues surrounding an implant
peri implant diseae
204
describes a reversible inflammatory reaction in the soft tissuess surrounding a functioning implant
peri implant mucositis
205
is a term for inflammatory reactions that affect soft and hard tissues around the implant leading to deepening of probing pocket depths and loss of supporting bone on functioning implants
peri implantitis
206
peri implant mucositis and peri implantis are associated with
bleeding on gentle probing
| redness and rarely pain
207
peri implantisis occurs in about --- to --- of implants
4 to 19 percent
208
is not synoymous with peri implantisis and refers to an implant that has loss osseointegration and is no longer an effective prosthetic anchor
failing implant
209
as with teeth --- --- is the primiary microbial etiologic fctor in peri implantitsi
plaque biofilm
210
perimplantisis and
periodontisis are similar
211
the microbiota around implants in edentulous implants form
early and appear to remain stable in the long term
212
teeth in partially dentate paients are a source of biota that colonize implants wihtin 2 weeks of exposure in the oral environment
true
213
subgingival sites in healthy implants are populated by high percentages of coccoid cells and nonmotile rods with few spirochetes
whereas actinobacillus actinomycetemocomitans porphyromonas gingivalis and prevotella intermedius have been cultured from implants in patient with min. visible plaque biofilm who had not had maintence visits for 6 months or more
214
in implants the only attachment mechanism involvees the
basal lamina and hemidesomnosomes or the epithelium.
215
inflammation within the peri implant tissues have a tendency to spread circumferetially and progression to bone may result in angular osseous defects radiographically where as clinically
it assumes the shape of a well circumscribed saucer
216
early implant failures are typically considered to be biologi
occuringwithin weeks or a few motnhs after placement
217
impants result in failure to achieve osseointegration possibly because
of inherent host tissue factors, bacterial contamination of wounds, poor surgical technique or instability of the implant at placement.
218
late implant failures result from factors that cause
breakdown of osseointegration
mech. overload fatigue failure of components and peri implant infection.
219
an inportnat treatment for periimplantisis is
antimicrobial therapy
220
antimicrobial therapy examples
combo of local or system ant. mic. therapy, debridge ment that involves thorough removal of plaque and calluclus, implant surface decontamination and regernation of defects.
221
plastic nylon titaniumm graphite or gold plated curette and air abrasive devices can be used safely around implants
true
222
what is a good choice for polishing around implants
tin oxide with rubber cups
223
is an inflmmation of microbial origin that is associated with accumulations of suppuration or purluence in the perio tissues
periodonatl abcess
pain swelling discomfort
224
the periodontal absess is characterized by ---- that have become established in the tissue as a result of trauma advancing disease process or incomlete scaling and root planing
microbiota
225
3 types of abscesses
periodontal gingival periapical
each can be acute or chronic
226
chronic perio abscesses is likely an acute absess that drains
true and they can be the combo
227
are associated with pre existing perio disease. they may occur around any tooth in the mouth when the perio pocket becomes occluded often as a result of a foreign object
acute perio absesess
228
in acute perio absesses if the pocket can drain through a sulcus or a fistula the infection can
stablized and be considered a chronic state
229
stabiliziation will not occur if
a foreign object such as a peanut skin popcorn hull or berry seed remains in the pocket
230
acute perio absesses appear as
shiny red raised and rounded masses on the gingival or mucosa pus is usually seen but not always
231
the most common sypmtom of acute perio absesses is pain others include
swelling
deep red to blue discoloration of the affected tissue
tooth sens to pressure
mobility
232
in acute perio absess patient may complain that the tooth feels high
true
233
a sinus opning on the lateral aspect of the tooth is usally associated with a periapical rather than perio absess
true
234
the microbiota in the acute perio absess are predominately
gram negative and anaerobic.
235
treatment of acute perio absess is mainly
drainage and the use of antibiotics or antimicrobial agents. must be treated immediately to alleviate pain and prevent spread of infection. it may be drained through the pocket opening or by access through incisoin
236
post operative instructions call for
rest fluid intake and warm salt water rinses to help reduce swelling.
237
overgrowth of pathogenic organsms that result in suppuration. usually painless because they drain into oral cavity either through opening or sinus tract
chronic perio absesses
238
in chronic perio the associated ginigva is
red and swollen as long as its draining it shouldnt be painful so patients tolerate it or dont even know its happenin
239
chronic treatment the affected tooth crown and root surfaces must be scaled and root planed curretage performed local antimicrobial therapy completed if needed and the patient seen for a follow up care to evalutate the need for further perio treatment often including perio surgery
true
240
perio absesses do not always result in tooth extraction
true
241
primarily distuingished from acute perio abcesses by taking a good medical and dental history
gingival absesses
242
gingival absesses often occur
in disease free areas and they may be related to a forceful inclusion of some forgein object in to the area
243
usually gingival absesses are found on the
marginal gingiva and are not associated with any abnormality of deeper tissues
244
gingival absesses usually appear
shiny raised area of acute inflammation that may be painful the swelling is large but usually confined to the marginal gingivia.
245
sometimes difficult to distuingish from an acute perio absesses
endodontic abcess
246
endodontic abssess result from
infection through caries traumatic failure of the tooth or trauma from a dental procedure.
247
most commonly microorganisms are spread from a carious lesion into the pulp through the denintal tubules
true
248
the endondontic abcess often appears on radiographs as
rounded radioluceny at the apex of the tooth,
249
---- percent of tooth pain is pupal and --- is periodontal
85
15
250
periapical pain is
sharp severe intermitten and difficult to localize
251
periodontal pain is
less severe constant localized.
252
treatment of endodontic absess requires
endodonti therpay or extrction from tooth.
253
if not treated endodontic absesses can lead to
absesses of brain or fascitis of the neck or chest wall
can be life threathing
254
combination absesses
can spread from the pulp to the periodontium or the perdidontium to the pulp
255
periodontal and periapical absesses can cause extensive damage to the surrounding peridontium because
systems can be intermittent causing patients to delay treament
256
combo absesses require
extensive therapy both perio and nedontic and often result in tooth loss.
257
perio absess are
constant localized severe sharp , tooth are vital, bone loss no apical radiolucencey
258
endodontic absesses are
intermittenet hard to localize extreemely severe usually non vital apical radiolucency common, widened pdl and other subtle changes and can sometimes be seen
259
is an abcess associated with a partially or fully erupted tooth that is covered completely or parly by a flap of tissue called an operculum
pericoronitis
260
the most commonly affected tooth is the
mandibular third molar but max third molar and other teeth that are the most distal in the arch and are also associated with the condition.
261
pericoronitis is generaly seen in
young adults and has been a serious problem form military personnel most of whom are 17 to 26 years old.
262
the symptoms of acute pericornotis are
swelling of the operculum and other gingiva associated with the most distal tooth in the arch redness and extreme pain. may be so swollen that it intereferes with mastiaction because it may be compressed durng chewing
263
wwith pericoronitis initial therapy is pallative. a topical anestic is applied the infected area must be debrided with instruments may not be tolerable at the first visit. usually bl flushing with warm water or chlorexidine.
the patient should return the next day, should be flushed and instrumented in possible.
264
opportunisitci infection of the ginigiva that is associated with stress lifestyles and some chronic illesses and condition such as blood dyscrasias human immunodeeficency virus inection and down syndrome
NUG
265
nug
trench mouth
266
is a recurring disease with a complex bacteriology consiting of large portions of spirochetes and gram negative roganisms
nug
267
the bacteria invade the tissue and cause teh characteristic
pseduomembranous appears of the disease
268
recurrent nug can result in
attachemtn loss
when this happen it is calle dnecrotizing ulerative periodontitis
269
with nug the involved papillary gingiva becomes
necrotic and appears cratered or punched out
270
with nug the surface of gingiva has a
pseduomembranous coaing made up of a necrotic bacteria and tissue. the gingiva is reddened and painful.
271
with nug the lesions may be
localized to specific areas or generalized throughout the mouth and patients often have a strong breath odor described as fetor oris.
272
three sings of nug
acute necrosis and ulceration of the interproximal papillae
pain
bleeding
273
necrotic papillae pain and bleeding occured
100 percent of the imte
274
fetis breath odor occured in
97 most cases
pseudomembranous in 87
lymp in 61
fever in 39
275
---- percent of patient with nug smoke
83
276
the goal of the treatment of nug is
to reduce the microbial load and remove necrotic tissue to assist healing
277
the first visit for nug requires a limited amount of debridgement only what the patient can tolerate
true
278
during the course of emergency management of nug the patent should be obstructed
to rest drink plenty of fluid avoid spicy foods rinse with warm salt water and refrain from smoking.
279
is the oral manifestation of primary infection with the herpesvirus usally herpes simplex virus one
acute herpetic gingivostomatis
280
approx --- to ---- of patients with intial infection with hsv1 are symptomatic
10 to 20
281
acute herpetic gingivostomatic has been seen primarily in
infants and young children
it is now found in young adults 20-30s possibly representing primary infection with genital herpesvirus herpes simplex virus 2
282
primary herpetic gingivstomtis in adolescents and older adult is usually caused by hsv 1 but may be the
inital manifestiation of hsv 2
283
acute herpetic gingivostomatisis is commonly associated with
prodromal symptoms such as fever malaise headache irritability and lumphadenopathy
284
oral lesions begin as
small yellow vessicles
285
the yellow vessicles coalese to form
larger round ulcers with graycenters and bright red borders.
can be on the lips tongue gingiva and bucca muscoasa
286
after the primary infection has occured the herpes virus travels through the nerves to reside in neuronal ganglia.
there it can be active again and recur most commonly in the form of herpes labialis.
287
the secondary lesions occur in about 1/3 of the world pipulation and are triggered by
sunlight trauma fever or stress
288
the treatment of acute herpetic gingivostomatitis is supportive because the disease runs its courise in
7 to ten days
extremely contagious .
