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Periodontics > Introduction > Flashcards

Introduction Flashcards

1
Q

how many americans suffer from periodontitis

A

Two in FIVE

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2
Q

—% Adults 30 years and older

A

42.2

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3
Q

—% Severe Form
—% Mild to Moderate Form

A

7.8
34.4

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4
Q

SKIPPED
Tx plans
Phase 1
(7)

A

*OHI with patient motivation
*Marijuana cessation
*Caries control
*Consult orthodontics for mandibular alignment
*Microbiological testing
*SRP 4 quadrants w/ antibiotic adjunctive therapy
*Re-evaluation after phase I

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5
Q

SKIPPED
Tx plans
Phase 2

A

Osseous recontouring and Guided Tissue Regeneration

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6
Q

SKIPPED
Tx plans
Phase 3

A

None

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7
Q

Tx plans
Phase 4
(3)

A

*Periodontal maintenance 1x/month (first 6 months)
*Bimonthly until 12 months
*Then keep 3 months follow-up

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8
Q

Court Dictated Role
(4)

A

Diagnose periodontal disease
Inform the patient of clinical findings
Refer patient to a Periodontist, or treat themselves
Treat to the current standard of care

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9
Q

Dentist’s Responsibilities
Professional
Legal
Ethical

A

To diagnose disease,
inform the patient of
existing disease, and
to refer or offer
appropriate treatment

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10
Q

Gingivitis

A

“Gingivitis is the inflammation of the
gingival tissues without loss of
connective tissue attachment.”

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11
Q

Periodontitis

A

“Periodontitis is the inflammation of
the gingival tissues with apical
migration of junctional epithelium
with concomitant loss of connective
tissue attachment and bone.”

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12
Q

Probing Depth

A

“Probing depth is the distance from
the soft tissue margin to the tip of
the periodontal probe.”

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13
Q

Pockets are classified as
Shallow (—mm);
Moderate (—mm);
Severe (—mm)

A

1-3
4-6
≥ 7

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14
Q

Clinical Attachment Level

A

“Clinical attachment level (CAL) is the
distance from the cementoenamel
junction (CEJ) to the tip of the
periodontal probe during normal
probing.”

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15
Q

Chronic Periodontitis
Mild (Incipient):
Moderate:
Severe:

A

1-2 mm CAL
3-4 mm CAL
≥ 5mm CAL

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16
Q

Chronic Periodontitis
Localized:
Generalized:

A

less than 30% teeth involved
more than 30% teeth involved

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17
Q

Aggressive Periodontitis
Not classified as mild/moderate/severe
Assumed all aggressive cases are severe due to
the (2)

A

rate of destruction and/or the age of onset

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18
Q

Aggressive Periodontitis
Localized:
Generalized:

A

1st molars and incisors
1st molars, incisors, and ≥ 3 other
teeth

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19
Q

STAGING
Based upon
(2)

A
  • Severity of the case
  • Complexity of the case
    management
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20
Q

STAGING
Consider
(7)

A
  • CAL
  • Amount and % of bone loss
  • PD
  • Presence/extent of ridge
    defects
  • Furcation involvement
  • Tooth mobility
  • Tooth loss due to periodontitis
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21
Q

GRADING
Consider biologic features
(3)

A
  • Rate of disease progression
  • Risk of further advancement
  • Potential threats to general
    health (eg. smoking, diabetes)
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22
Q

GRADING
Grade A, B, C

A
  • A: low risk of progression
  • B: moderate risk
  • C: high risk
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23
Q

Gingiva
Macroscopic (clinical features)
(4)

A
  • Marginal Gingiva
  • Gingival Sulcus
  • Attached Gingiva
  • Interdental Gingiva
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24
Q

Gingiva
Microscopic
(2)

A
  • Gingival Epithelium
  • Gingival Connective Tissue
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25
Q

Marginal Gingiva
(4)

A

Unattached or free
Sulcus epithelium adjacent to tooth
About 1 mm in depth
Up to 3 mm still considered normal

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26
Q

In —% of cases, marginal gingiva is demarcated from
the attached gingiva by a free gingival groove

A

50

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27
Q

Gingival Sulcus
(2)

A

Not attached to enamel or cementum
Bounded apically by the free gingival groove (50%
incidence) on the oral epithelium (if present)

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28
Q

If attachment loss occurs then referred to as a

A

PERIODONTAL POCKET

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29
Q

Attached Gingiva formula

A

KG – PD = attached gingiva

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30
Q

Attached Gingiva
(4)

A

Bordered apically by the mucogingival junction
Bound to underlying periosteum of alveolar bone
Firm, resilient
Varies in width: Maxillary and Mandibular

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31
Q

Interdental Gingiva
(3)

A

It occupies the embrasure
The interproximal space beneath the area of tooth
contact (Col)
Pyramidal or col shaped

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32
Q

Gingival Epithelium
* Predominately — in nature
* As a (4) barrier
* To protect

A

cellular
mechanical/chemical/water/microbial
the deep structures while allowing for a
selective interchange with the oral environment.

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33
Q

Gingival Connective Tissue
* Composed primarily of
* Also known as
* The gingival fibers are arranged in — groups

A

collagen fibers and
ground substances
“lamina propria”. It consists of
a papillary layer and a reticular layer.
3

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34
Q

3 different areas defined from the morphological
and functional characteristics

A
  • Oral Epithelium
  • Sulcular epithelium (~1 mm)
  • Junctional Epithelium (~ 1mm)
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35
Q
  • Oral Epithelium
    (2)
A
  • Keratinized stratified squamous epithelium
  • Turnover of 30 days
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36
Q
  • Oral Epithelium
    (2)
A
  • Keratinized stratified squamous epithelium
  • Turnover of 30 days
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37
Q
  • Sulcular epithelium (~1 mm)
    (3)
A
  • Unattached to enamel
  • Non-keratinized stratified squamous epithelium
  • Lacks stratum corneum and granulosum;
    Langerhans cells
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38
Q
  • Junctional Epithelium (~ 1mm)
    (3)
A
  • Attached by hemidesmosomes
  • Non-keratinized stratified squamous epithelium
  • High turnover rate (7-10 days)
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39
Q

Oral Epithelium
* Keratinized stratified squamous epithelium
(4)

A
  • Stratum corneum
  • Stratum granulosum
  • Stratum spinosum
  • Stratum basale
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40
Q
  • Sulcular epithelium (~1 mm)
    Importance
A

it is a semi-permeable membrane against
bacterial products passing into underlying tissue

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41
Q

Junctional Epithelium (~ 1mm)
* Attachment to the tooth surface via

A

hemidesmosomes and non-collagenous
proteins (proteoglycans & glysosaminoglycans)

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42
Q

Development of Gingival Sulcus
(4)

A
  • Once the enamel is fully developed,
    the ameloblasts (AB) reduce in height
    and form “reduced enamel epithelium
    (REE)” together with other cells.
  • Oral epithelium (OE) and REE show
    increased mitotic activity and form a
    joint epithelial mass.
  • When the tooth penetrates the oral
    mucosa, the mass transforms into the
    junction epithelium (JE).
  • In the later phase of the process, all
    cells of the REE were replaced by
    that of JE.
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43
Q

Gingival Connective
Tissue
* —% collagen fibers, —%
fibroblasts, —% matrix,
vessels and nerves.

A

60
5
35

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44
Q

Gingival Connective
Tissue
* —% collagen fibers, —%
fibroblasts, —% matrix,
vessels and nerves.

A

60
5
35

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45
Q

The gingival fibers are
oriented with functions
(3)

A
  • To brace the marginal gingiva against tooth
  • To provide rigidity,
  • To unite the marginal gingiva with the
    cementum and adjacent attached gingiva
46
Q

Gingivodental group
(Dentogingival)

A

Cementum → gingiva

47
Q

Circular group

A

Around the tooth in the gingiva

48
Q

Transeptal group

A

Connecting cementum of
two adjacent teeth

49
Q

Fibers that are in
close proximity to the
alveolar crest
contribute to the
connective tissue
attachment
component of the

A

“Biologic Width”

50
Q

Gingival Crevicular Fluid
Can be represented as either a

A

transudate
(healthy) or an exudate (inflamed) from the
gingival connective tissue and blood
vessels.

51
Q

GCF
* The main route:

A

basement membrane ->
JE intercellular space-> sulcus

52
Q

GCF
* The biochemical factors (cytokines,
enzymes, antibodies, etc.) in the GCF
could potentially serve as

A

diagnostic or
prognostic biomarkers.

53
Q

GCF
* Functions:
(3)

A
  • Cleanse materials
  • Improve adhesion of the epithelium to
    the tooth through plasma proteins
  • Possesses antimicrobial properties
54
Q

Correlation of Clinical and
Microscopic Features
(4)

A
  • Color
  • Contour
  • Consistency
  • Texture
55
Q
  • Color
A
  • Coral pink, melanin (variable)
56
Q
  • Contour
    (2)
A
  • Scalloped or flattened outline
  • Depends on location (ant./posterior)
57
Q
  • Consistency
A
  • Firm and resilient
58
Q
  • Texture
A
  • Stippling
59
Q

Stippling
* Represents the
* Is a form of adaptive
* ~ —% of population

A

microscopic depressions and elevations created by the connective tissue projections within the gingival tissue
specialization or reinforcement for function
40

60
Q

The gene of the underlying —
determines the covering epithelium

A

connective tissue

61
Q

PDL

A

A complex vascular and
highly cellular connective
tissue that surrounds the
tooth root and connecting
to the alveolar bone

62
Q

PDL
consists of (3)

A
  • Periodontal fibers
  • Cellular elements
  • Ground substances
63
Q

PDL Fibers
* Contains
(4)

A

Collagen I, III and IV
* Sharpey’s fibers

64
Q

Sharpey’s fibers:

A

the terminal portions of
the collagen fibers embedded in the root cementum
and the bundle bone

65
Q

PDL Fibers
(5)

A
  • Alveolar crest
  • Horizontal
  • Oblique
  • Apical
  • Interradicular
66
Q

PDL Fibers
* Alveolar crest
(2)

A
  • Cementum → crest alveolar bone
  • Prevents extrusion and lateral movements
67
Q

PDL Fibers
* Horizontal
(2)

A
  • Cementum → alveolar bone at 90º
  • Opposes lateral forces
68
Q

PDL Fibers
* Oblique
(3)

A

*Largest group
* Cementum → alveolar bone coronal direction
* Resists vertical masticatory forces

69
Q

PDL Fibers
* Apical
(2)

A
  • Cementum → apical alveolar bone
  • Resists tipping
70
Q

PDL Fibers
* Interradicular
(2)

A
  • Cementum → furcation bone
  • Resist luxation and tipping
71
Q

PDL Cells
* Connective tissue cells
(3)

A
  • Fibroblasts
  • Cementoblasts
  • Osteoblasts & osteoclasts
72
Q
  • Fibroblasts
    (2)
A
  • The most abundant one
  • Synthesize and degrade intracellular collagens
73
Q
  • Epithelial cells of Malassez
A
  • Remnants of Hertwig’s root sheath
74
Q
  • Immune system cells
A
  • Neutrophils, lymphocytes, macrophages, etc.
75
Q
  • Nerve fibers
A
  • Pain, pressure, tactile, stretch
76
Q

Functions of PDL
(3)

A
  • Physical functions
    Formative and remodeling functions
    Nutritional and sensory functions
77
Q
  • Physical functions
  • Contain (2)
  • Absorbs —
  • Suspensory mechanism attaching the —
  • Maintains — in the relationship to the teeth
A

blood vessels & nerves
occlusal forces and transmits occlusal force to the bone
teeth to the bone
gingival tissue

78
Q
  • Formative and remodeling functions
A
  • Cells could respond to occlusal force and participate in the formation
    and resorption of cementum/bone/collagens
79
Q
  • Nutritional and sensory functions
    (2)
A
  • Supplies nutrients to cementum/bone/gingiva
  • Transmits pressure and pain via trigeminal pathways
80
Q

PDL Space
The normal width of PDL is approximately

A

0.2 mm

81
Q

PDL Space
* — functions can affect
PDL space
* Within physiologic limits, PDL
accommodates increased force
with an
* When the force exceeds the
adaptive capacity ->

A

Occlusal
increased width,
thickened fiber bundles, and
increased numbers of Sharpey’s
fibers.
trauma
from occlusion.

82
Q

Cementum
* A specialized mineralized tissue
(2)

A
  • Inorganic content (45-50%) is mainly hydroxyapatite, < bone/dentin/enamel
  • Organic matrix (50-55%) is mainly composed of type I and type III collagen
83
Q

Cementum
* Contains no blood or lymph vessels, no nerves,
and grows by continuing deposition
* It’s different from —
* The highest rate of formation is in the —regions
* The greatest thickness is in —

A

bone
apical
apical third and the furcation areas

84
Q

Two main types of cementum
* Acellular (primary)
* Cellular (secondary)

A
  • Found in coronal portion of root
  • Found in apical portion of root
85
Q

Two major sources of collagen fibers

A
  • Sharpey’s fiber
  • Fibers that belong to cementum matrix
86
Q
  • Sharpey’s fiber
A
  • extrinsic - from fibroblasts
87
Q
  • Fibers that belong to cementum matrix
A
  • Intrinsic - from cementoblasts
88
Q

Functions of Cementum
(4)

A
  • Attaches the principal PDL
    fibers to the root (main function)
  • Contributes to the process
    of repair after damage to
    the root surfaces
  • Adjusts the tooth position
    to new requirements* It compensates for tooth eruption
  • Protects dental pulp/dentin
89
Q

CEJ
Gap between enamel
and cementum

A

5-10%

90
Q

CEJ
End-to-end

A

30%

91
Q

CEJ
Cementum
overlapping enamel

A

60-65%

92
Q

Exposed Cementum
(4)

A
  • Rough surface texture facilitates plaque adherence
  • Porosities facilitate attachment of calculus
  • Porosities facilitate absorption of bacterial enzymes
    (i.e. endotoxin)
  • Smear layer inhibits attachment of connective tissue
93
Q

Alveolar Process
* The portion of the maxilla and mandible that

A

forms
and supports the tooth sockets.

94
Q

Alveolar Process
* The portion of the maxilla and mandible that forms
and supports the tooth sockets.
* A tooth dependent structure:

A

It forms when the tooth erupts and disappears
gradually after tooth extraction

95
Q

Alveolar Process
* Contains blood or lymph vessels, and attachment
of PDL fibers (Sharpey’s fibers)
(2)

A
  • Nerves are not in the bone but in the periosteum
  • Vascular pathways from gingiva into supporting alveolar bone
96
Q

Alveolar Process
Shape
Depends on interdental
distance, tooth contours, root
contours
* Anterior:
* Posterior:

A

Scalloped
Flattened Scallop

97
Q

Distance from CEJ in health

A
  • 1 to 1.5 mm
  • 1.5-2 mm in adult (taking into
    account the biologic width
    concept)
98
Q

Alveolar Process
Components
(3)

A
  • External plate: cortical bone
  • Inner socket wall: thin cortical
    bone
  • Spongy bone: cancellous
    trabeculae
99
Q
  • Inner socket wall: thin cortical
    bone
    (3)
A
  • Alveolar bone proper
  • Bundle bone
  • Lamina dura:radiographic term
100
Q

*Basal bone is located — but unrelated to the teeth.

A

apically

101
Q

Cancellous bone is
found predominately in the

A

interdental & interradicular areas
(less in facially/lingually)

102
Q

In adult humans, more cancellous
bone in the — than in the
—.

A

maxilla, mandible

103
Q

Usually in the mandible, there is
thicker cortical bone and —
cancellous bone.

A

less

104
Q

Alveolar Process
* Thin — cortical
plates overlying root surfaces

A

facial and lingual

105
Q

Alveolar Process
* Lack of cancellous bone (so no
progenitor cells) overlying many
— root surfaces

A

facial

106
Q

Alveolar Process
* Increased

A

fibrosis and lipid cell
content in marrow spaces (results
in a decrease in progenitor cells)
in adults > 40 years old

107
Q
  • Dehiscence:
A

lack of bone on
the facial/lingual of the tooth
but with interproximal bone

108
Q

Fenestration:

A

lack of bone
on the facial/lingual of the
tooth resembling a “window”

109
Q
  • Predisposing factors:
A

prominent root
contours, malposition and roots with labial
protrusion in combination of thin bony plate

110
Q

Periosteum
(2)

A
  • The periosteum is a fibrous sheath that lines the outer surface of bone.
  • Bundles of periosteal collagen fibers penetrate the bone, binding the
    periosteum to the bone.
111
Q

Periosteum
Composed of two layers:

A

Fibrous layer: a dense, fibrous,
vascular layer
Osteogenic layer: a loose
connective tissue inner layer,
containing osteoprogenitor cells.

Periodontics (13 decks)

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