Final Flashcards
1-Advanced Chronic Periodontitis
2-how much gum disease is there
3-untreated periodontitis
4-periodontal disease & systemic health
1-periodontitis is asymptomatic
2-half of american adults suffer from gum disease
3-perpetually deteriorating environment leading to loss of function…deepened gingival crevice “pocket” creates a large surface area of ulcerated epithelium
4-in untreated perio gram neg bacteria found in perio pockets surrounding each diseased tooth in approximation to ulcerated epithelium
1-dental infections
2-transient bacteremia
1-pathway of dental disease for metastatic infection…transient bacteremia from oral infection
2-mastication alone can produce a transient bacteremia in the presence of advanced perio —and not in perio healthy individuals
- gentle mastication is able to induce release of bacterial endotoxins from oral origin into bloodstream
- bacteremia will usually clear w/in min
- can effect heart valve replacement, total joint replacememnt, immunocompromised patients
1-bacteremia & seeding of atheromas
2-perio as an inflam process
3-systemic cytokines are elevated w/ periodontitis
1-perio pathogens have been found infecting atherosclerotic plaques
2-coronary artery disease(strongest in males)—acute ischemic events & hyperlipidemia
- preterm= low birth weight babies
- diabetes mellitus
3-gram neg infections= release cytokines that induce changes in lipid metabolism
- inc in serum Ab against p. gingivalis & inc levels of cytokines
- correlates w/ elevated serum IL1 IL6 TNFa
1- scaling & root planing w/ low birth weight babies
2-diabetes mellitus
1-reduces preterm birth & low birth weight
2-w/ poor perio health= greater risk of developing poorer glycemic control & getting cardio renal diseae/death
- more severe in Type 1 than type 2
- treatment, esp. in type 2 improves glycemic control
1-risk
2-prognosis
3-establishing a prognosis
1-probability that an individual will develop a specific disease in given period
2-prediction of probable course, duration, & outcome of a disease once that disease is present
***patients w/ diabetes or patients who smoke are more at risk for getting perio disease, and once they have it they have a worse prognosis
3-determined after the diagnosis is made but before the treatment plan can be formulated
- med & dental, history review, clinical & radiographic exam
- diagnosis, risk assessment, prognosis, assessment
- treatment plan
1-good prognosis
2-fair prognosis
3-poor prognosis
4-questionable prognosis
5-hopeless prognosis
1-control of etiologic factors, adequate perio support, ensures tooth will be easy to maintain by patient & clinician
2-25% atachement loss w/ class 1 furcation
3-50% attachment loss, class 2 furcation involvement
4-over 50% attachment loss, poor crown to root ratio, poor root form, class 2 furcations or class 3
5-inadequate attachment to maintain health, comfort & function
1-GOOD prognosis
2-guarded fair prognosis
3-guarged poor prognosis
4-guarded questionable prognosis
5-hopeless prognosis
1-adequate remainign bone support
no or controlled risk factors
easy to maintain for patient & clinician
2-25-40% attachment loss
grade 1 furcation
adequate maintenance w/ patient compliance
controllable risk factors
3- 40-50% attachment loss
grade 2 furcation
proper maintenance is challenging
patient compliance is erratic
uncontrollable risk factors
4->50 % attachment loss
inaccessible grade 2 furcation w/ grade 3 furcation
-poor crown to root ratio w/ class 2 mobility
-poor root form, root proximity issues
risk factors present or poorly controlled
5-inadequate attachment to maintain health, comfort, & function
>75 bone loss
grade 3 furcation
class 3 mobility
recurrent infection w/ uncontrolled risk factors
1-factors to consider when determining a prognosis
2-clinical factors
3-patient ages
4-disease severity
1-overall clinical factors, systemic/environmental factors, local factors, anatomic factors, prosthetic & restorative factors
2-age, severity, plaque control, patient compliance
3-2 remaining CT attachment & alveolar bone is better for the older of the 2
bc for younger the prognosis isnt as good bc of the shorter time frame where period destruction has occured so the younger patient may have an aggresive type & even though they are expected to have a greater reparative capacity the occurrence of destruction in short time span would exceed any natural repair
4-height of remainign bone, enough bone to support teeth?
-horizontal/vertical bone defect
1-base of pocket
2-30% rule
3-plaque control
1-prognosis is adversely affected if base of pocket is close to root apex, presence of apical disease as result of endodontic involvement, also worsens prognosis
2-more than 30% have good prognosis then general prognosis is good
- more than 30% have questionable then is questionable
- 30% of teeth hopeless prognosis then prognosis is hopeless
3-primary etiology of perio disease is pathogenic bacteria in plaque
-effective removal of plaque on daily basis by patient is critical to sucess of therapy
1-chronic periodontitis
2-smoking
3-diabetes
4-genetic factors
5-stress
1-slowly progressive
- local environmental factors
- slight to moderate perio the prognosis is good, provided the inflammation can be controlled through good oral hygiene & removal of local plaque retentive factors
- non compliant patients w/ oral hygience= prognosis will be downgraded
2-tobacco use will adversely affect long term prognosis of perio involved teeth
3-patients at risk for diabetes show by identified early…well controlled= slight/moderate perio
good glycemic control= max prognosis
4-IL1= inc production of IL1B are associated w/ inc in risk for severe, generalized & chronic perio
-early detection of patients at risk= early preventative treatment
5-physical, emotional, substance abuse
1-local tooth factors
2-plaque & calculus
3-subgingival retorations
1-plaque & calculus
-subgingival restorations
2-microbial challenge collects locally acts globally
-poorly fitting or contoured restorations will interfere w/ plaque removal
3-contribute to inc plaque accum inc inflammation, and increase bone loss when compared w/ supragingival margins
- discrepancies in these margins can neg impage periodontium
- tooth w/ subgingival margins have poorer prognosis than tooth w/ well contoured supragingival margins
1-poor crown/ root ratio
2-cervical enamel projections
3-enamel pearls
4-furcations
5-root concavities
1-prognosis is poor for teeth w/ short tapered roots & relatively large crowns
-disproportionate crown to root ratio & reduced root surface…available for perio support, periodontium may be susceptible to injury by occlusal forces
2-flat ectopic extensions of enamel…extend beyond normal contours of cementoenamel junction
3-round deposits of enamel that can be located in furcations or other areas on
4-presence of these enamel projections on the root surface intereferes w/ attachement apparatus & prevent regenerative procedures from achieving their max potential
- negative effect on prognosis for individual tooth
- scaling w/ root planing is fundamental procedure in perio therapy
- -anatomy of furcation favors retention of bacterial plaque
5-exposed through loss of attachement can vary from shallow flutings to deep depressions
max first premolar, mesiobuccal root of max 1st molar, roots of mandibular 1st molars, mandibular incisors
1-access to furcation areas
2-developmental grooves
3-mobility:occlusal trauma
1-furcation entrance diamete is narrower than width of conventional perio curettes
-max 1st premolars present greatest difficulties & therefore prognosis is unfavorable wen lesion reaches mesiodistal furcation
2-initiate on enamel & extend a significant distane on root surface, plaque retentive area, difficult to instrument
-similarly…root proximity can result in interproximal areas that are difficult to access
3-injury resulting in tissue changes w/in attachment apparatus bc of occlusal force
1-radiology
2-crookes tube
3-atoms
1-imaging technology to diagnose & treate disease
-PA radiographs, bitewings, panoramic, occlusal, cephalometric, CBCT
2-electrons go in straight lines from cathode on left, seen by shadow cast by cross on fluoresence on right h. wall…anode is at bottom
3-7 protons, 7 neutrons, & 7 electrons around nucleus
4-number of e-‘s equals the number of protons in an atom so that the atom has no net charge (electrically neutral)
-e- maintained in their orbits around the nucleus by 2 opposing forces, electrostatic force= attraction between negative e- & posotive protons…so electrons pulled towards protons in nucleus, keeps electrons from dropping into nucleus, other force= centrifugal force pulls e-away
1-electrostatic force
2-centrifugal force
3-electromagnetic radiation
1-attraction between positive protons & neg electrons
- electrons in orbit closest to nucleus= greater electrostatic force than electrons in orbits further away= binding engery
- –amt of energy required to overcome force to remove an e- from its orbit
- electrostatic & binding energy are teh same
- higher anatomic number of an atom the higher force
2-pulls electrons away from nucleus
***balance between electrostatic & centrigufal keeps e- in orbit
3-xray= electromagnetic radiation
- electromagnetic radiation represents the movement of energy through space as combination of electric & magnetic fields
- electromagnetic radiation= alllll da waves
- xrays=photons, photons travel at speed of light & specific energy
1-wavelength & frequency
2-cosmo rays
3-radio waves
4-xray energy
1-wavelength= distance from one crest of 1 wave to the crest of the next wave
frequency= number of waves in given distance D
-distance between wave decreases (w= shorter) frequency will increase
-short wavelength= high frequency= high energy
-long wavelength= low frequency= low energy
2-shortest wavelength
3-lowest frequency
4-energy of wave of electromagnetic radiation represents ability to penetrate object—higher energy, more easily the wave will pass through object
-shorter wavelength, greater energy will be & higher frequency
1-which above xrays has highest energy
2-xray characteristics
3-xray equipment
1-shortest wavelength, highest frequency
2-high energy waves, short w’s & travel at speed of light
- no mass & no charge, cant be seen
- travel in straight lines, cant curve around a corner
- xray beam cant be focused to a point, xray beam diverges as it travels toward and through patient
- more dense materials will absorb more xrays than less dense material—can be harmful to living tissue so keep the number as low as possible
3-xray tubehead= xrays
support arms= move tubehead around
control panel= allows you to alter duration of xray machines, intensity energy
1-focusing cup
2-filament
3-electron stream
4-vacuum
5-target
6-copper stem
7-leaded glass
8-xray
9-beryllium window
10-cathode
1-focuses e- on target
2-release e- when heated
3-e- cross from filament to target during length of exposure
4-no air or gases inside xray tube, interact w/ e- crossing tube
5-xrays produced when electrong strike target
6-helps remove heat from target
7-keeps xrays from exiting tube in wrong direction
8-produced in target are emitted in all directioN
9-non-leaded glass alows xrays to pass through
-PID is directly in line w/ window
10-cathode= composed of tungsten filament= centered in focusing cup, E are produced by filament and are focused ont arget of anode where xrays are produced
-focusing cup= neg charge and helps direct e- to the target
1-thermaionic emission
2-anode
3-line focus principle
1-depress exposure button electricity flows through filament in cathode, causing it to get hot
- hot filament then releases electrons which surround filament
- hotter filament gets, greater # of electrons that are released
2-anode in xray rube= tungsten target in copper stem, e- from filament enter target & generate xrays so heat is produced…copper helps take some heat away from target
3-sharpness of images sene on a radiograph is influenced by size of focal spot…smaller of focal spot the sharper image of teeth will be
- lot of heat is generate if target is too small, overheat & burn up…
- target is at an angle to e- beam from filament—xrays exit through PID appear to come from smaller focal spot
1-line focus principle etc
2-2 electrical circuits
3-xray exposure
4-exposure button
1-actual focal spot size, the lenght is indicated by white dotted lines—target is at an angle to e- beam, looked up through the PID at this angled target= appears smaller
2-first = low voltage circuit that control the heating of the filament —when exposure button is depressed, this low voltage circuit operates for 1/2 sec or less to heat up filament—no xrays
-high voltage circuit= activated…potential difference between anode & cathode & e- flow from cathode to anode
3-depress exposure button
- activate low voltage circuit to heat filament
- activate high voltage circuit to pull e- across tube
- e- cross tube, strike target & produce xfays
- xray production stops when exposure time ends
- release exposure button
4-timer determines length of exposure not how long you hold down exposure button
- cant overexpose by holding exposure button down for extended period
- underexpose by releasing exposure button too soon, exposure terminates as soon as you release
1-step down transformer
2-oil in tubehead
3-bremmstrahlung x rays
1-voltage flowing through filament= too high, filament will burn up
- reduce voltage, current flows through step down transformer before reaching filament
- reduces incoming voltage to about 10 volts
2-surrounds transformers, xray tube & electrical wires
-oil is to insulate electrical components—helps to cool anode
filtration of xray beam…barrier material prevents oil from leaking out of tubehead but allows most xrays to pass through
3-produced when high speed electrons from filament are slowed down as they pass close to, or strike, nuclei of target atoms
1-preventing pulpal problems
1-hydrodynamic theroy of pulpal pain proposes pain is perceived as a result of fluid movememnt in dentinal tubules or invasion of bacteria/bacterial toxins
- pulpal nerve fibers enter dentinal tubules w/ odontoblastic projections & pick up sensations
- it stands to reason that blocking orifices of dentinal tubules= paramound to preventing fluid or bacteria/toxins
Pulp Protection Materials
1-varnishes, dentin sealers & dentin desensitizers= thin layer of material to seal dentinal tubules
2-bases= .75 mm of material to serve as a seal, thermal insulator & mechanical support of overlying restoration
3-liners= .5 mm material used to stimulate formation of reparative dentin
1- direct pulp capping
2-indirect pulp capping
1-there is NO RDT, more successful in younger patients
- attempt to repair small direct pulp exposure
- D3110
2-.5 or less of RDT
- incomplete caries removal
- no direct pulp exposure but attempt to stimulate reparative dentin growth
- D3120
Top line= EITHER
adhesive bonding system (composite)
or dentin desensitizer(amalgam)
middle line= base
bottom line= calcium hydroxide (CaOH)
