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Periodontology > Intro to perio > Flashcards

Intro to perio Flashcards

1
Q

What year are the new periodontal classifications from?

A

2017

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2
Q

What are the two states in healthy periodontium?

A

Intact periodontium

Reduced periodontium

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3
Q

What are the types of reduced periodontium?

A
  • Reduced periodontium in a non-periodontitis patient

- Reduced periodontium in a successfully treated stable periodontitis patient

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4
Q

What is a reduced periodontium in a non-periodontitis patient?

A
  • Clinical signs of periodontal health on a periodontium with pre-existing loss of connective tissue and/or loss of bone due to non-periodontitis (e.g. traumatic toothbrushing or crown lengthening)
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5
Q

What is reduced periodontium in a successfully treated periodontitis patient?

A
  • Clinical signs of periodontal health on a periodontium with pre-existing loss of connective tissue and alveolar bone due to periodontitis, but had been successfully treated and is currently stable
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6
Q

Define periodontal health

A
  • State free from inflammatory periodontal disease that allows an individual to function normally and avoid consequences due to current or past disease.
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7
Q

What are the clinical features of gingival health?

A

Absence of BOP (<10% of sites), erythema, edema and patient symptoms

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8
Q

What are the clinical INDICIES for gingivitis

A

> 10% bleeding sites

Probing depths <3mm

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9
Q

What are the two main categories of gingivitis

A
  • Dental plaque biofilm induced gingivitis

- Non-dental plaque biofilm induced gingivitis

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10
Q

What is plaque biofilm induced gingivitis

A

An inflammatory lesion resulting from interactions between dental plaque biofilm and the hosts immune-inflammatory response

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11
Q

What is the treatment for plaque biofilm induced gingivitis

A

Removal of plaque

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12
Q

What are the local plaque retentive factors resulting in gingivitis?

A
  • Overhangs
  • Subgingival margins
  • Surface irregularities
  • Caries
  • Intraoral appliance (ortho or dentures/clasps)
  • Crowding
  • Erupting teeth
  • Calculus
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13
Q

How do systemic factors increase the risk of periodontal disease?

A

They alter the immune response, resulting in an exaggerated inflammatory response to plaque

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14
Q

List the main systemic risk factors for periodontal disease?

A
  • Smoking
  • Diabetes
  • Drugs
  • Vitamin C deficiency
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15
Q

What are the clinical signs of inflammation?

A
  • Erythema, edema, pain, heat and loss of function
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16
Q

How do the clinical signs of inflammation manifest in gingivitis?

A
  • Swelling (loss of knife edge appearance)
  • BOP
  • Redness
  • Discomfort (brushing or probing)
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17
Q

List symptoms of gingivitis

A
  • Bleeding gums
  • Metallic taste
  • Soreness
  • Halitosis
  • Difficulty eating
  • Aesthetics
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18
Q

What are non-dental plaque biofilm induced gingival conditions?

A

Gingival abnormalities that are not caused by plaque and do not resolve following plaque removal, but likely a gingival manifestation of a systemic condition

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19
Q

List some causes of non-dental plaque biofilm induced gingivitis

A
  • Genetics - hereditary gingival fibromatosis
  • Infections - gonorrhea, tuberculosis, herpes
  • Inflammatory - contact allaery, plasma cell gingivitis
  • Pemphigus vulgaris, pemphigoid, LP, LE, crohns
  • Vitamin C deficiency
  • Neoplasms
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20
Q

What is the main marker for progression from gingivitis to periodontitis?

A
  • Pathological apical migration of the junctional epithelium (indicates destruction of alveolar bone)
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21
Q

What are the signs of periodontitis?

A
  • Continued inflammation (gingivitis signs BUT pockets >4mm are true and irreversible)
  • CAL
  • Migration of JE
  • Destruction of bone and PDL
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22
Q

Staging criteria for periodontitis

A

Stage I = <15% or 1-2mm CAL
Stage II - 16-33% or 3-4mm CAL
Stage III - 34-66% or middle/apical third of root
Stage IV - >66% or middle/apical third of root

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23
Q

What does the staging and grading tell us about periodontits?

A

Stage - the severity

Grade - rate of progression

24
Q

How to calculate the grade of periodontitis

A

Bone loss / age

25
Q

What are the grades for periodontitis

A

Grade A - <0.5% bone loss/age or no evidence of bone loss over 5 years
Grade B - 0.5-1% bone loss/age or <2mm over 5 years
Grade C - >1% bone loss/age or >2mm over 5 years

26
Q

What is the criteria for the extent and distribution of periodontitis

A

Localised - <30%
Generalise - >30%
Molar-incisor pattern

27
Q

List the radiographic features of healthy bone levels

A
  • At the CEJ (can be higher or lower with physiological bone loss)
  • Good quality bone and stable lamina dura
  • Crestal bone 2-3mm from CEJ
  • Bone in the furcations
28
Q

What is periodontal stability?

A

Successful treatment of local/systemic risk factors resulting in minimal bop (<10%), stable probing depths and lack of further periodontal destruction

29
Q

What is the main indicator for periodontal stability?

A

Absence of inflammation/BOP

30
Q

What makes up the periodontium?

A 
Gingiva (free and attached) 
Alveolar mucosa 
Cementum 
Periodontal ligament 
Alveolar bone
31
Q

What is the junctional epithelium?

A

Epithelial attachment between the connective tissue and tooth surface

32
Q

Where is the junctional epithelium located?

A

Below the gingival sulcus (sucular epitheium)

33
Q

How is JE attached to the enamel?

A

Via a basal lamina and intercellular hemidesmosome

34
Q

What is the turnover of the JE?

A

4-6 days - this is rapid in comparison to the oral epithelium (6-12 days)

35
Q

Difference between oral epithelium and JE/SE?

A

Oral epithelium is keratinised (resist mechanical forces)

JE and SE are non-keratinised

36
Q

What is the periodontal ligament?

A

A group of specialised connective tissue fibres, which connects the tooth to the alveolar bone

37
Q

What are the components of the pdl

A 
Principal fibres 
Loose connective tissue 
Blasts and blast cells 
Oxytalan fibres 
Cell rests of Malassez
38
Q

What are the three categories of principal fibres?

A 
Dentoalveolar (around roots) 
Gingival fibres (around cervical portion of the tooth)
39
Q

List the gingival principal fibres

A

Transseptal
Attached gingival
Free gingival
Circular

40
Q

What are the roles of the gingival fibres?

A

Transseptal - resist tooth separation mesial and distally

The rest - resist gingival displacement

41
Q

List the dentoalveolar principal fibres

A 
Apical 
Oblique 
Horizontal 
Alveolar crest 
Interradicular
42
Q

What are the two components of the alveolar bone?

A
  • Alveolar process

- Alveolar bone proper

43
Q

What is the role of the alveolar process

A

Provide structural support to the teeth

44
Q

What is the role of the alveolar bone proper

A

Provide an attachment site for the PDL and the tooth

45
Q

Where is the alveolar bone proper?

A

In the portion of bone lining the tooth socket

46
Q

What are the histological lesions of periodontal disease?

A

Initial lesion
Early lesion
Established lesion
Advanced lesion

47
Q

What occurs in the initial lesion?

A
  • Vasodilation results in neutrophil migration, IGG, complement and fibrin
  • Increase in permeability (increased GCF)
  • Localised to gingival sulcus
48
Q

What occurs in the early lesion?

A
  • Localised epithelial proliferation of JE and SE
  • Further vascular changes occur with increased GCF - Neutrophils dominate but there is local accumulation of lymphocytes (T cells)
49
Q

What are the signs of epithelial proliferation in the early lesion?

A
  • Rete peg hyperplasia

- Microulceration of the sucular epithelium (why it bleeds on probing)

50
Q

What occurs in the established lesion?

A
  • Further proliferation of JE and SE with some loss of collagen (no attachment loss)
  • T cells dominate and plasma cells are found (mainly IgG and IgA)
  • Maximum GCF
  • Neutrophils persist
51
Q

What occurs in the advanced lesion?

A
  • Pocket formation, LOA, collagen and bone loss
  • IgG, IgA and IgM present
  • Dense infiltrate of lymphocytes, plasma cells and macrophages
  • Bystander damage
  • Neutrophils persist
52
Q

What is bystander damae?

A

Breakdown of the epithelial barrier (pocket lining) allowing antigens direct access to periodontal tissues to activate immune cells

53
Q

What is the key point of chronic inflammation?

A

There is persistent inflammation with attempts of repair

54
Q

What are the roles of the B cells in periodontitis?

A
  • Differentiate into plasma cells to form antibodies (neutralise, aggregate and opsonisation)
55
Q

What are the roles of T cells in periodontitis?

A
  • CD4 secrete cytokines to activate immune cells
56
Q

What are the main cytokines?

A
  • IL1 (pro-inflammatory)

Periodontology (6 decks)

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