Gingival and periodontal disease Flashcards
What is periodontology
The study of the periodontal tissues in health and disease; including the causes, prevention and treatment of diseases of the periodontal tissues.
What is the periodontium
Gingivae
Periodontal ligament
Root cementum
Alveolar bone
What are the two subsections of alveolar bone
Alveolar bone proper
Alveolar process
What is the name of the thin plate of bone immediately adjacent to the periodontal ligament
Alveolar bone proper
What does CEJ stand for
Cemnetoenamel junction
What determines periodontal health
The outcome of the bacteria of the dental plaque and the host immune system
What are periodontal diseases
A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque
What are two periodontal diseases
Gingivitis
Periodontitis
Does Gingivitis always progress to periodontitis
No
What is inflammation
A Biological response to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process.
What are cardinal signs of inflammation
Pain - dolor
Heat - calor
Redness - rubor
Swelling - tumor
Loss of function - functio laesa
What is the resolution of inflammation in periodontitis
There is none
In relation to internal vessels and cells what occurs to cause inflammation
-Dilatation of blood vessels
-Increased permeability of vessel walls
-Inflammatory exudate
-Emigration of white blood cells from blood vessels into the connective tissue
Periodontal disease is a multifactorial condition depending on general health conditions but what is the main factor at play
The function of the host immune system and its interplay with the bacteria of the plaque
How can general health lead to periodontal disease
Stress
Fatigue
Smoking
Diet
Medications
Hygienic habits
What are some local risk factors of developing periodontal disease
Acquired: plaque, calculus, overhanging and poorly contoured restorations
Anatomical: malpositioned teeth, root groves, concavities and furcations, enamel pearls
What are the systemic risk factors for periodontal disease
Non-modifiable: aging, genetic factors
Modifiable: smoking, poorly controlled diabetes, stress, medications, hormonal changes, poor nutrition, socioeconomic status
What were the multiple theories behind periodontal disease over the years
Non-specific plaque
Specific plaque
Ecological plaque
Polymicrobial dysbiosis
(Keystone-Pathogen hypothesis)
Who developed the non-specific plaque theory
1884 Black
1899 Miller
What does the specific plaque theory conclude
Few species of the total microflora are actively involved in disease
What is the ecological plaque theory
Combines key concepts of the earlier two hypotheses adding that changes in environment like pH, redox potentially lead to favourable growth certain species of bacteria
1994 Marsh
“everything is everywhere but environment selects”
Composition of the dental plaque depends on environment
What is a biofilm
An aggregate of microorganisms in which cells adhere to each other on a surface. These adherent cells are embedded within a self-produced matrix of extracellular polymeric substance (EPS) – DNA, proteins, polysaccharide.
Resistance to antibiotics, antibacterial agents, hidden from immune system of the host.
Where may biofilms form
Biofilms may form on living or non-living surfaces and can be prevalent in natural, industrial and hospital settings: Biofilms can form inside water and sewage pipes
Is dental plaque a type of biofilm
Yes
What are the steps to formation of biofilm
Pellicle
Association adhesion
Growth
Mature
What occurs during the growth stage of biofilm
Microcolonies - production of polysaccharide matrix
When do microcolonies transition into metaboli8c complexes in biofilm formation
Maturation stage
What is association adhesion
Trailblazing bacteria ‘streptococcus, actinomyces’ posses adhesion molecules
What is keystone bacteria theory
Certain low-abundance microbial pathogens can cause inflammatory disease by increasing the quantity of the normal microbiota and by changing its composition and by interfering with the host immune system
What bacterium is the keystone pathogen hypothesis based on
‘red complex’
Porphyromonas gingivalis
What disrupts the homeostasis between the bacteria of the biofilm and the immune system
1) Genetic conditions associated with the impairment of immune system:
Papillon-Lefevre syndrome, Chediak-Higashi syndrome, LAS syndrome, Down’s syndrome, chronic granulomatous disease
2) Diseases leading to impairment of immune system: Leukaemia, agranulocytosis, neutropenia, HIV infection
What produces calculus
Calcification of dental plaque
Signs of gingivitis
Erythema (redness)
Swelling
Bleeding on gentle probing
When might pain occur with periodontitis
Pain occurs very rarely mostly in necrotising ulcerative periodontal disease
What are clinical examination signs of periodontitis
Bleeding on gentle probing
Erythema, fibrosis, loss of Knife edge Margin
Halitosis
Swelling – falls pocket formation
Bone loss
Increase clinical probing depths - True pocket formation
Recession
Mobility
Purulence
What indicates a true pocket
Loss of attachment
What could produce a false pocket
Gingival swelling
Why cant antibiotics be prescribed to resolve periodontitis
Biofilm protects the bacteria from antibiotic and mouthwash and chemicals
What must be done before prescribing antibiotics or chemical agents to remove bacteria in biofilm
Disrupt the biofilm first before use of substance
What is the difference between biofilm and dental plaque
Dental plaque is a type of biofilm
