Final Review May 2020 Flashcards
The _______ protects the underlying tooth structures from the oral environment
gingiva
In _________, the patient’s knowledge and preferences are considered, alongside the clinician’s expertise. The decisions they reachare founded on valid evidence.
shared decision making;
What are the characteristics of acute gingivitis?
- Short duration
- Resolves upon professional and good self-care
- Tissues appear bright red and shiny due to increased blood flow
__________ occurs when thereis a balance between disease promoting factors and health-promoting factors.
Biologic Equilibrium
What is Phase I of periodontal therapy and what does it include? This phase includes bacterial control, anti-infective therapy, assessment and preliminary therapy, nonsurgical periodontal therapy (NSPT)
Initial Therapy:
What are 4 of the cellular defender and mediators in the infalmmatory response?
- PMN’s
- Macrophages
- Lymphocytes
- Chemical Mediators (IL1, IL6, TNF-a prostaglandins & leukotrienes)
What are the clinical and histological signs of periodontitis?
Clinical: tissue that is pink/purplish, swollen/fibrotic, and bleeding
Histological: (Periodontal pocket) JE on cementum, supragingical fiber destruction present, alveolar bone destruction, PDL destruction
*irrevesible*
Dilation of the blood vessels, enhanced permeability of the bold capillaries, increased blood flow and leukocyte movement to tissue are all charateristics of _____.
inflammation
Which medication is a calcium channel blocker that resembles phenytoin-associated enlargement? Surgical elimination of tissue is often required.
A. Cyclosporine
B. Nifedipine
C. Phenytoin
B. Nifedipine
What is Phase III of periodontal therapy?
Restorative Therapy
The ______ suspends and maintains the tooth in its socket, provides sensory feeling to the tooth, provides nutrients, builds and maintains cementum and alveolar bone, and can remodel the alveolar bone in response to pressure.
periodontal ligament (PDL)
Which medication is an anticonvulsant that is more common in children and young adults? It begins with enlargement of interdental papilla.
A. Cyclosporine
B. Nifedipine
C. Phenytoin
C. Phenytoin
Signs of disease are features of a disease that can be observed or are measurable by a ______.
Signs
What are the anatomical areas of the gingiva?
- Alveolar Mucosa
- Mucogingival Junction
- Attached Gingiva
- Free Gingiva
- Interdental Gingiva (papilla)
Fever, malaise and swollen lymph nodes are systemic signs and symptoms of __________.
necrotic diseases
The hyperinflammatory response to the microbial challenge in periodontitis and impaired repair are partly mediated by the ________ interaction.
AGE-RAGE
Medical dental history, gingival observations, perio charting and radiographs are all tools that help the hygienist arrive at a periodontal diagnosis. This infomation is all classified as ________
assessment data
What is cementums primary function?
PDL attachment
Excess cementum in apical third of root is called ______which appears radiopaque on an x-ray.
hypercementosis
Which cytokine stimulates bone resorption and inhibits bone formation?
IL-6
What are the following signs and symptoms indicative of?
- Tissue enlargement
- Tissue redness
- Gingival bleeding upon probing
- Periodontal pockets
- Bone loss, which may be visible on radiographs
- Tooth mobility
- Suppuration (discharge of pus)
- Presence of subgingival calculus
periodontitis
A. actinomyce, tannerella forsythia and porphyromonas gingivalis are all ______ that can lead to periodontitis.
periodontal pathogens
What are the functions of the supragingival fiber bundles?
- Brace the free gingiva firmly against the tooth and reinforce the attachment of the JE to the tooth
- Provide the free gingiva with the rigidity needed to withstand the frictional forces that result during mastication
- Unite the free gingiva with the cementum of the root and alveolar bone
- Connect adjacent teeth to one another to control tooth positioning within the dental arch
________ biofilms are the cause of initial inflammation, but the ________ determines if periodontal destruction progresses.
Plaque ; host
______occurs when there is a balance between disease-promoting factors and health-promoting factors.
(Biologic) Periodontal equilibrium
______ is an intensive information-gathering process used to gather the detailed data needed to make a periodontal diagnosis and to document the periodontal health status to allow for long-term monitoring of the patient.
Comprehensive periodontal assessment CPC
List the 5 principle fiber groups of the PDL.
- Alveolar crest fibers
- Horizontal fibers
- Interradicular fibers
- Oblique fibers
- Apical fibers
What is Phase IV of the periodontal therapy?
Periodontal maintenance
_________ are biologically active compounds secreted by the immune cells that activate the body’s inflammatory response. They are the “middlemen” sent by the immune cells to activate the inflammatory response.
Biochemical mediators
________, also referred to as cribriform plate, is a thin layer lining the socket
Alveolar bone proper
The ______ is a layer of connective tissue that covers the outer surface of bone.
periosteum
_____ is an efficient information-gathering process used to determine the periodontal health status of the patient (health or disease?)
Periodontal Screening (PSRs)
What kind of pocket is shown in the image?
suprabony
A ____ is performed on all patients over age 12 using 5 teeth and a UNC probe by swiping approx. 1mm into sulcus to detect plaque.
This score would be a % of these areas WITHOUT PLAQUE. Must be 75% or greater.
PASS Score
Which cytokine stimulates connective tissue destruction and stimulates bone resorption?
IL-8
__________ are the terminal endings of periodontal ligaments attached to cementum, they are embedded in bone and cementum.
Sharpey’s Fibers
An increase in plaque biofilm retention and biofilm pathogeenicity as well as damage to the periodontium are all considered _______ factors.
local contributing
What are the characteristics of chronic gingivitis?
- May exist for years without ever progressing to periodontitis; resolves upon professional and good self-care
- Tissues can appear bluish red to purplish red
What are the clinical and histological characteristics of gingivitis?
Clinical: red, swollen, bleeding likely
Histological: JE at CEJ and supragingival fiber destruction are present. The alveolar bone and periodontal ligament are still intact
*reversible damage*
Which cytokine stimulates bone resorption and induces breakdown of collagen matrix in gingiva, pdl, and alveolar bone?
THF-a
What type of periodontal pocketing tshown in the image?
Infrabony
**Double check question**
A. Tooth morphology, calculus formation, and trauma are all considered ____ contributing factors
calculus formation
_____ of disease include features of a disease that are noticed by the patient.
Symptoms
The zone of soft tissue occupied by the junctional epithelium and connective attachment tissue fibers, approx. 2mm is called the _____. When violated, the body attempts to re-establish this zone through the inflammatory process
biologic width
When determiningthe periodontal dianosis, Confirmation that a patient is a periodontal case should include the _______ at two nonadjacent teeth, and whether it is necrotizing periodontitis, a manifestation of systemic disease, or periodontitis
A description of aggressiveness of disease should also be included by providing the Stage and Grade.
CAL
__________ produced by immune cells are largely responsible for the tissue destruction seen in periodontitis.
Biochemical mediators
Which cytokine stimulates osteoclast activity resulting in bone resorption and induces breakdown of collagen matrix in gingiva,
pdl and alveolar bone
IL-1
Who is responsible for the treatment of the patient?
the provider who performs the treatment
What is the prime purpose of the human immune system?
to defend the life of the individual (host).
________ are conditions or diseases that increase an individual’s susceptibility to periodontal infection by modifying or amplifying the host response to microbial infection.
Systemic risk factors
What sis Phase II of periodontal therapy?
Surgical Therapy
What are the clinical and histological presentations of a healthy periodontium?
Clinical: pink, firm, no bleeding
Histological: JE coronal to CEJ, supragingival fibers intact, alveolar bone intact, PDL intact.
Which biomediators are powerful inflammatory mediators that work to increase permeability and dilation of blood vessels, trigger osteoclasts to destroy alveolar bone, promote overproduction of MMP enzymes and play an important role in bone destruction in periodontitis.
Prostoglandins
___________ may play a role in the etiology of some systemic diseases/conditions
Systemic risk factors
The _____ is a valley-like depression apical to the contact area of 2 adjacent teeth. It connects facial and lingual papillae, and will not be present if there is a large space between 2 teeth or there is notable gingival recession
gingival col
_______ is the body’s protective response to pathogens, foreign bodies, or an injury. It concentrates host defense components at the site of an infection or injury to eliminate microorganisms and heal damaged tissue.
Inflammation
____________ is the proces by which epithelial cells on the surface of the skin become stronger and waterproof.
Keratinization
What surrounds the cells of a tissue and is comprised of fibers and a gel-like substance?
extracellular matrix
The ______ is the body’s response to bacteria and the immune system strives to defend the body against bacteria present in plaque biofilm.
host response
Smokers are ___ times more likely to develop periodontal disease than non-smokers.
7 times
Where is the junctional epithelium (JE) located?
at the base of the sulcus
Which cellular defender is characterized by the following?
- Capture and destroy bacterial invaders.
- Short-lived cells that die when they become engorged with bacteria.
- Attracted to bacteria by a process called chemotaxis.
- PMN contains many strong bactericidal and digestive enzymes, called lysosomes.
- Periodontal pathogens are most effectively destroyed by PMNs.
- Essential for the control of bacterial infections.
*Rapid Responders, providing the 1st line of defense*
PMNs (Polymorphonuclear Leukocytes)
Where is the oral epithelium (OE)?
it covers the free and attached gingiva
Complete the following sentences to identify the various types of ginigval distribution:
_____ gingivitis affects the interdental ginigva.
______ gingivitis affects the margins and papillary gingiva.
______ gingivitis pertains to the gingival margin, papilla, AND the attached gingiva.
- Papillary
- Marginal
- Diffuse
______ defines the sequence of events that occur during the development of a disease or an abnormal condition.
Pathogenesis
¨A _________ is a gray layer of tissue that covers the necrotic areas of the gingiva.
pseudomembrane
Findings from studies indicate that diabetes mellitus leads to a ______ response to oral microbial biofilms and ______ resolution of inflammation and repair.
hyperinflammatory response
______ seal the ends of open dentinal tubules, compensates for occlusal attrition to maintain tooth length.
Sharpey’s Fibers
Direct visual examination, visual examination using compressed air, tactile examination using explorer, and radiographic evaluation are all ways to evaluate the presence and amount of ______ deposit.
calculus deposit
What is the CAL in the first image?
3mm probe depth
Attachment at CEJ
Negative recession
0 mm CAL
Gingivitis
A specialized cell junction that connects two neighboring epithelial cells and their cytoskeletons together is called a _________.
It is a cell-to-cell connection that is found in gingival epithelium.
desmosome
Use understandable language, provide oppurtunities tof patient questions and assess patient understanding are all guidelines for ___________.
obtaining informed consent
Which enzymes act together to break down the connective tissue matrix and with increased levels cause the collagen destruction that occurs in the periodontal tissues.
MMPs
What drives tissue destruction?
uncontrolled host infalmmatory and immune responses
The ______ surrounds and supports the roots of the tooth
alveolar bone
In regards to periodontal health, a(n) _______ periodontium presents with no loss of periodontal tissue (past or present).
*Non-periodontal patient*
intact periodontium
Periodontal biotype, gingival/soft tissue recession, lack of keratinized gingica, decreased vestibular depth, aberrant frenum postition, gingival excess, and abnormal color are all types of mucogingival _____ and conditions around teeth.
deformities
Provide health promotion education that contributes to overall systemic and periodontal health and _______ with medical team for joint patient management.
health promotion, collaborate
What is the network of ropelike collagen fiber bundles located coronal to (above) the crest of the alveolar bone called?
supragingival fiber bundles
C = Circular
AG = Alveologingival
DG = dentogingival
PG = periosteogingival
_______epithelial cells have no nuclei and form a tough, resistant layer on the surface of the skin
Keratinized
In regards to periodontal health, a(n) _______ periodontium exhibits pre-existing loss of periodontal tissue with NO current activity or loss of connective tissue and/or alveolar bone.
reduced periodontium
Attachment loss CANNOT be due to ______ causes such as, dental caries extending to or apical to CEJ, the presence of CAL on the distal aspect of a second molar associated with extraction of a third molar or a vertical root fracture.
non periodontitis
_______ is a living film containinga WELL ORGANIZED community of bacteria that grows on a surface
Biofilm
What type ofcementum covers the apical half of the root, is continuously deposited throughout the life of the tooth, and increases in thickness with age?
cellular
________ leads to a hyperinflammatory response to the microbial challenge in periodontitis. These effects are at lest partly mediated by the signaling mechanisms of the ________ interaction.
Diabetes mellitus; AGE-RAGE
What are the three different medications that can lead to gingival enlargment?
Phenytoin, Cyclosporine, Nifedipine
The _____ is a layer of yellow, hard, mineralized tissue attached to the dentin. It anchors the ends of the periodontal ligament fibers to the tooth, protects dentin and compensates for tooth wear.
cementum
_________ are regenerated continuously across the crest of bone separate the site of inflammation from the remaining alveolar bone.
Transeptal fibers
_________ is an established risk factor for periodontitis.
Diabetes mellitus
Cytokines, Matrix Metallo Proteinases (MMP’s), and Prostoglandins are all ____________.
biochemical mediators
____ levels of cytokines, RANKL, MMPs and PGE2 characterize periodontitis.
High levels
______ are more likely to have more colonization by periodontal pathogens. These individuals also experience effects on both the human system and inflammatory response.
Smokers
In _______ (disease) the crest of the alveolar bone is located more than 2mm apical to the CEJ
periodontitis
______________ are large leukocytes with one kidney-shaped nucleus and some granules. They are highly phagocytic cells that actively engulf and destroy microorganisms.
They are slower to arrive at the infection site than PMNs, but are long-lived cells.
*Most numerous cells in chronic inflammation*
monocytes (when in bloodstream)
macrophages (when in tissue)
When uncontrolled, the prevalence of periodontitis is ______ and symptoms more severe in individuals with diabetes mellitus compared with nondiabetics
higher
Systemic disease, periodontal pathogens, social atmosphere nad habit are all _____ for periodontal disease.
risk factors
Explain why there is a band of intact transseptal fibers even in the presence of severe bone loss.
because a band of intact transseptal fibers ALWAYS seperate the site of inflammationfrom the remaining alveolar bone.
What is the CAL determination in the last image?
4mm probe depth
Gingival margin below CEJ 3 mm recession
7 mm CAL
Stage 3 or 4 Periodontitis
_________ cells work by secreting antibodies that neutralize microorganisms. They can further differentiate into plasma B-cells or memory B-cells. Once activated, they makes millions of antibodies and pours them into the bloodstream
B-cells, B-lymphocytes, Plasma cells
_______ is a fibrous protein found in skin and nails.
Keratin
In_____ and ____ the crest of the alveolar bone is located approximately 2 mm apical to the CEJ
health
A specialized cell junction that connects the epithelial cells to the basal lamina is called a ________.
It is a cell-to-basal lamina connection also found in gingival epithelium
hemidesmosome
What are the 3 possible arrangements of enamel & cementum?
(OMG)
- Overlap
- Meet the enamel
- Doesn’t meet, leaving a gap between the cementum and enamel
It is theroized that ______ has an impact on bone metabolism
smoking
_____are regulatory proteins released by host immune cells that influence behavior of other cells, initiate tissue destruction and bone loss
Cytokines
Where is the sulcular epithelium (SE) located and what does it line?
•lines the sulcus
Which medication is used for paients who are immunosuppresive, mediacally compromised, and similar in appearance to phenytoin-associated gingival enlargement?
A. Cyclosporine
B. Nifedipine
C. Phenytoin
A. Cyclosporine
_________ are regulatory proteins released by host immune cells that influence behavior of other cells. They initiate tissue destruction and bone loss
Cytokines
_______ also known as the (spongy bone) that fills the interior portion of the alveolar process is found mostly in the interproximal areas.
Cancellous bone
Progressive alveolar bone loss is present is ______. This bone destruction may eventually lead to tooth mobility or loss
periodontitis
_______ is a layer of compact bone that forms the outer wall on facial and lingual.
cortical bone
Development of a fiery red gingiva with spontaneous gingival bleeding, intense oral pain, fetid oral odor (bad breath), and excessive salivation are all clinical symptoms of _________.
necrotizing diseases
What are the three basic states of the periodontium?
- Health
- Gingivitis
- Periodintitis
The extracellular protective layer more commonly referred to as the _____ is a dense protective barrier that protects from antibiotics, antimicrobials,
and the body’s immune system.
slime layer
_______removes or disrupts the dental plaque biofilm and is best achieved by brushing, interproximal plaque removal,
and periodontal instrumentation. This is the most effective way to control dental plaque biofilms.
Mechanical cleaning
_________ is tissue death resulting in partial loss of interdental papillae. It gives the appearance that the papillae have been punched-out or cratered
Gingival necrosis
What type of cementum covers approximately the cervical third or half of the root, and is normally not produced after the tooth has reached its occlusal plane?
acellular
What is the CAL determination in the second picture?
4mm probe depth
Gingival margin at CEJ
No recession
4mm CAL
Stage II Periodontitis
