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Interpretation of periodontal disease Flashcards

1
Q

What is the definition of periodontal disease?

A

Destructive inflammatory disease affecting supporting structures of the teeth

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2
Q

What is gingivitis?

A

only the soft tissues are involved

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3
Q

What is periodontitis?

A

soft tissues and supporting bone affected

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4
Q

Periodontal disease is the major cause of tooth loss in patients over ___ years old

A

35

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5
Q

Severity of periodontal disease increases with…

A
  • age
  • amount of plaque
  • amount of bacterial micro-flora
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6
Q

What are the different stages of periodontal disease?

A
  1. healthy teeth and gums
  2. gingivitis
  3. early periodontitis
  4. moderate periodontitis
  5. advanced periodontitis
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7
Q

What are the predisposing factors to periodontal disease?

A
  • plaque
  • salivary immune factors
  • cell mediated hypersensitivity in crevicular plaque
  • local dental factors (bad restorations, calculus, rotated teeth, thin bone)
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8
Q

What are local dental factors that can increase risk for periodontal disease?

A
  • poor restorations
  • Calculus (tartar)
  • Tilted/rotated tooth
  • Thin bone
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9
Q

What are the clinical signs of periodontal disease?

A
  • Edema, erythema of the tissues
  • Loss of epithelial attachment to tooth surface and pocket formation
  • Bleeding on probing
  • Purulence
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10
Q
A

early, mild periodontal changes

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11
Q
A

chronic periodontitis with favorable immune response

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12
Q
A

chronic advanced periodontal changes

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13
Q

What are the clinical signs of periodontal changes?

A

● Erythema
● Visible tissue recession
● Periodontal pocket depth (probing)

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14
Q

What do you examin on a radiograph if you suspect periodontal disease?

A

Bone
– quantity; relative to root length
- quantity; crestal evaluation
- quality; dense vs. sparse trabeculation
- furcation; susceptible to bone loss
- PDL space; widening

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15
Q

What do you look for when evaluating radiographic alveolar bone loss?

A
  • GENERALIZED
  • LOCALIZED
  • HORIZONTAL
  • VERTICAL
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16
Q

Generalized: > __% of existing dentition

A

75%

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17
Q

If bone loss is localized what should you do to diagnosing?

A

specifiy locations

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18
Q

What do you note when doing a radiographic examination on roots for periodontal disease?

A

● length
● shape – conical, diverging, curves, dilaceration, hypercementosis, etc…
● crown:root ratio
● Atypical multiple roots
● Proximity to adjacent roots

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19
Q

What is better for keeping teeth: long root or short roots?

A

long roots

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20
Q

What is better for retention of teeth: atypical multiple roots or normal amount?

A

atypical multiple roots

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21
Q

What is better for retention of teeth: crowding or normally spaced teeth?

A

normally spaced teeth
- crowding causes thin bone between roots

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22
Q

What is better for retention of teeth: diverging or converging?

A

diverging

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23
Q

What is dilaceration?

A

Abnormal angulation or bend in the root (and occasionally the crown) of a tooth

  • Some related to trauma during odontogenesis
  • idiopathic
24
Q

Is dilaceration good or bad for retention of teeth?

A

GOOD
- bad if you need to root canal or extract

25
What are local factors to look for when doing a radiographic examination for periodontal disease?
- restorations - calculus - tilted rotated teeth (ie, uneven marginal ridges)
26
You can see radiographic calculus best with ______ densities
bright
27
What are the radiographic changes to notice in periodontal disease?
1. Horizontal Bone Loss 2. Vertical Bone Loss 3. Furcation Involvement 4. Large crown:root Ratio
28
What is the definition of horizontal bone loss?
Even/uniform apical movement of the alveolar crestal bone height along adjacent root surfaces between affected tooth/teeth
29
The alveolar crest establishes itself apical to the...
CEJ - where the follicular sac attaches
30
physiologic bone height is <_____ mm from CEJs
2.0
31
What does the anterior alveolar bone look like in health?
- pointed, corticated crest
32
How long should the red line be?
2.0 mm
33
Incipient bone loss – slight crestal bone loss of <__________mm, but less than ____%
1.0 – 2.0 mm 20%
34
Moderate bone loss – evidence of ~_________% bone loss
20% up to 50%
35
Advanced bone loss – evidence of ___% or more of bone loss; evidence of vertical defects
50%
36
What is incipient bone loss?
- blunted, non-corticated crest - bone level is apical to physiologic height - <1.0 – 2.0mm, but less than 20%
37
What is moderate bone loss?
- blunted, non-corticated crest - prominent loss of alveolar bone height; ~20-50%
38
What is advanced (severe) bone loss?
- blunted, non-corticated crest - prominent loss of alveolar bone height; evidence of 50% or more of bone loss; evidence of vertical defects - crown:root ratio > 1:2
39
Advanced (severe) Bone Loss
40
Moderate Bone Loss
41
Incipient bone loss
42
Moderate Bone Loss
43
Nutrient canals
44
Initial Incipient Changes | loss of cortication but minimal loss of height
45
Loss of cortication Loss of bone height
46
What is vertical bone loss?
Angular bone loss along a root that more severely involves the affected tooth/teeth than the adjacent teeth
47
Vertical Bone Defects
48
Red - vertical bone loss Blue - horizontal bone loss
49
Furcation with HBL
50
Furcation with VBL
51
What do you look for when doing a radiographic examination of furcation defects?
* Loss of bone in the furcation area of a multirooted tooth * Can occur with HBL and VBL
52
What is the crown:root ratio?
* An index expressed as a ratio that gives an indication of a tooth’s prognosis
53
A crown:root ratio of more than ____ has a poor prognosis
1:2 (2:1 is bad) (1:3 is even better than 1:2)
54
What are the limitations of radiographic examinations for periodontal disease?
* Accuracy: 40 - 50% demineralization necessary for radiographic changes * 2-D Infra-bony defects difficult to observe * Soft-tissue Changes edema, color, plaque * No Information on relationship of soft tissue to hard tissue * Difficult to assess disease on B and Li bone plates adjacent B and Li tooth surfaces * Mobility
55
________% demineralization necessary for radiographic changes
40 - 50
56
What are the treatments for periodontal disease?
* Plaque control * Antimicrobial agents ––– Topical ––– systemic * Professional Cleaning (scaling, root planning, curretage) * Surgical techniques to re-establish physiologic contours

Radiology (25 decks)

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