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Introduction to Periodontics and Prevention > Lecture 13, 14, and 15 > Flashcards

Lecture 13, 14, and 15 Flashcards

1
Q

TF? Tartar is another name for plaque.

A

F. tartar = calculus

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2
Q

TF? Dental plaque can form in the absence of bacteria.

A

T

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3
Q

What is dental calculus?

A

mineralized bacterial plaque

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4
Q

Where can dental calculus form?

A

teeth, restorations, prostheses

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5
Q

What can dental calculus absorb, leading to damage of the gingiva?

A

endotoxin and other toxins

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6
Q

TF? Toxins are located within root surfaces.

A

F. on, not within

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7
Q

TF? Extensive removal of cementum is not necessary to remove dental calculus.

A

T

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8
Q

a heat-stable toxin associated with the outer membranes of certain gram-negative bacteria, including Brucella, Neisseria, and Vibrio species:

A

endotoxin

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9
Q

2 classifications of dental calculus:

A

supra- or subgingival

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10
Q

TF? Supragingival dental calculus is easily detached.

A

T.

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11
Q

TF? Supragingival dental calculus recurs slowly.

A

F. rapidly

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12
Q

Supragingival dental calculus recurs rapidly, esp around these teeth.

A

Lingual mandibular incisors

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13
Q

Extremely heavy calculus buildup can lead to the formation of a calculus:

A

bridge

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14
Q

What color is supragingival calculus?

A

White or whitish yellow

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15
Q

Most common location of supragingival dental calculus:

A

lingual of mandibular anterior teeth

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16
Q

Wharton’s duct is the ___ gland

A

submandibular

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17
Q

Bartholin’s duct is the ___ gland.

A

sublingual

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18
Q

2nd Most common location of supragingival dental calculus:

A

buccal maxillary molars

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19
Q

Stensen’s duct is __ gland

A

parotid

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20
Q

TF? Subgingival dental calculus is usually visible.

A

F.

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21
Q

What color is subgingival dental calculus?

A

dark brown or greenish black

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22
Q

TF? Subgingival dental calculus is easy to remove.

A

F. Firmly attached, tough to remove

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23
Q

How far apically does subgingival calculus typically extend?

A

nearly to bottom of periodontal pocket but not to JE

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24
Q

What will happen to a pt with heavy subgingival dental calculus after initial scaling and wo effective subgingival scaling?

A

gingival “shrinkage” and very visible, dark calculus that was previously below the gingiva

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25
Q

What is calculus?

A

mineralized dental plaque,calculus: minerals, caries: bacteria

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26
Q

Calculus formation occurs days ___-___ of plaque formation.

A

1-14 (ask, what about after?)

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27
Q

Minerals for supragingival calculus come from:

A

saliva

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28
Q

Why does calculus form more near salivary gland ducts?

A

saliva and plaque fluid supersaturated with calcium phosphates

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29
Q

Where do the minerals for subgingival calculus come from?

A

gingival crevicular fluid, serum transudate, esp. inflamed gingiva

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30
Q

TF? All plaque becomes calculus.

A

F.

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31
Q

What is calculus always covered by?

A

plaque

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32
Q

What causes gingival inflammation?

A

plaque covering calculus, not calculus itself

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33
Q

Evidence demonstrating that calculus does not cause inflammation:

A

autoclave calculus, no inflammation

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34
Q

Can calculus form in the absence of microorganisms?

A

Yes, (ask, how -> You were getting calculus confused with caries!. All calculus needs to form is minerals from saliva)

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35
Q

2 theories as to how plaque mineralizes:

A

Saliva supersaturated with calcium and phosphate ions AND heterogeneous nucleation

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36
Q

What happen to pH, CO2, and ammonia formation if saliva becomes supersaturated with calcium and phosphate ions?

A

increase pH (these minerals are basic), decrease CO2 and increase ammonia formation by plaque bacteria

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37
Q

What does phosphatase precipitate?

A

calcium phosphate, increases phosphate ions (possible therapeutic target?)

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38
Q

Explain Heterogeneous Nucleation:

A

Seeding agents induce small foci of calcification that enlarge and coalesce to form a calcified mass

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39
Q

Composition of Calculus:

A

70%–90% Inorganic, similar to calcified tissues - bone, dentin cementum

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40
Q

The inorganic portion of calculus is mainly:

A 
calcium phosphate (76%) - Ca3(PO4)
some calcium carbonate - CaCO3 - and magnesium phosphate - Mg3(PO4)2
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41
Q

What are the main crystals in calculus?

A

hydroxyapatite, octacalcium phosphate

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42
Q

What determines ease / difficulty in removal of caclulus?

A

How it attaches to teeth (I asssume this is why calculus is harder to remove subgingivally)

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43
Q

4 ways Calculus Attaches to Teeth:

A

Enamel: pellicle, Cementum: mechanical locking, close adaptation, or penetration of calculus

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44
Q

Is calculus attachment to enamel via pellicle easy or difficult to remove with scalers and curettes?

A

easy

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45
Q

Is calculus interlocked to cementum easy or difficult to remove?

A

difficult

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46
Q

What type of calculus adherence necessitates SRP?

A

Calculus interlocked to cementum

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47
Q

Scaling is the removal of ____ from teeth.

A

deposits

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48
Q

Root Planing is aka:

A

root debridement

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49
Q

What is being removed during root debridement?

A

cementum or dentin that is rough, contaminated, or permeated with calculus

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50
Q

How to remove cementum or dentin that is rough, contaminated, or permeated with calculus:

A

hand, sonic and/or ultrasonic instruments

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51
Q

Goal of root planing:

A

Create a glasslike feel to the surface

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52
Q

This is one of the most difficult clinical skills to master:

A

Root planing

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53
Q

% of calculus removed in pockets less than 5mm:

A

90%

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54
Q

% of calculus removed in pockets greater than 6mm:

A

65%

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55
Q

Is calculus removal more difficult on multirooted or single rooted teeth?

A

multirooted

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56
Q

This surgery facilitates calculus removal:

A

flap, open vs closed procedure

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57
Q

TF? Flap surgery is a closed procedure.

A

F. open

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58
Q

Supragingival calculus detection:

A

visual, dry tooth surface, “chalky” appearance

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59
Q

Subgingival calculus detection:

A

dark shadow at the gingival margin, feel roughness with an explorer

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60
Q

Appearance of calculus on RG:

A

radiodense spicules

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61
Q

Explorer used primarily for calculus detection:

A

11/12, (board exam)

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62
Q

Does subgingival calculus reach the junctional epithelium?

A

no, but nearly to the bottom of the pocket

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63
Q

Where is there a zone free of calculus in sulcus?

A

base of pocket

64
Q

Which type of calculus can you see on a RG?

A

both supra- and subgingival

65
Q

Main type of calculus visible on RG’s:

A

interproximal

66
Q

TF? The location of calculus indicates the bottom of the periodontal pocket.

A

F.

67
Q

Is the sensitivity of RG calculus high or low?

A

low

68
Q

Why is the Sensitivity of Radiographs for the Detection of Calculus Low?

A

only interproximal calculus visible

69
Q

Additional methods for calculus detection:

A

(A, E, L, O, U) Fiberoptic endoscopy, spectro-optical technology, ultrasound, autofluorescence, laser and autofluorescence

70
Q

Device used for fiberoptic endoscopy:

A

perioscopy

71
Q

Device used for spectro-optical technology:

A

detectar

72
Q

Device used for autofluorescence:

A

diagnodent

73
Q

Device used for ultrasound:

A

perioscan

74
Q

Device used for laser and autofluorescence:

A

Keylaser3

75
Q

Is calculus a primary or secondary factor for PD?

A

secondary etiology

76
Q

plaque accumulation leads to:

A

Inflammation, difficulty in plaque removal

77
Q

Can tissue healing occurs in the presence of calculus?

A

as long as plaque is removed

78
Q

Basis for all periodontal therapy:

A

plaque and calculus removal

79
Q

Increased difficulty of calculus removal with:

A

Deeper pockets, tooth anatomy (furcations), less operator experience

80
Q

Common ingredients in anti-tartar dentrifice formulations:

A

zinc citrate, sodium, phosphate, fluoride, pyrophosphate, triclosan,

81
Q

% of ppl bwb 9-18 with calculus:

A

37%-70%

82
Q

TF? Prevalence of calculus increases with age.

A

T

83
Q

% of ppl with calculus after the age of 40:

A

86-100%

84
Q

90% of all calculus is found here:

A

mandibular anteriors

85
Q

4 Types of Calculus Formers:

A

non, low, mod, heavy

86
Q

Why Different Calculus Formers?

A

Differences in pyrophosphate concentration in plaque. Non-formers had high concentrations

87
Q

How Does Pyrophosphate Decrease Calculus Formation?

A

prevents calcification

88
Q

Components of Pyrophosphate:

A

sodium, tetrasodium, tetrapotassium

89
Q

Pyrophosphate is a structural analog of:

A

orthophosphate

90
Q

Pyrophosphate inhibits:

A

calcium phosphate crystal growth, conversion of calcium phosphate to hydroxyapatite, bacterial growth (lower concentrations)

91
Q

How Does Pyrophosphate Decrease Calculus Formation?

A

binds to Ca2+ ions in hydroxyapeptite

92
Q

Agents to Control Calculus:

A

Plaque or crystal growth inhibitors

93
Q

Ex of Plaque inhibitor:

A

triclosan

94
Q

What type of agent is triclosan?

A

broad-spectrum antimicrobial

95
Q

Fxn of triclosan:

A

destroys bacterial cell membrane (cidal then, R?)

96
Q

Examples of Crystal growth inhibitors:

A

pyrophosphate, zinc salts, bisphosphonates

97
Q

TF? Crystal growth inhibitors inhibit the formation of new calculus.

A

T

98
Q

TF? Crystal growth inhibitors reduce existing calculus.

A

F

99
Q

TF? Pockets resolve after calculus removal.

A

T

100
Q

Pyrophosphates inhibits:

A

plaque mineralization

101
Q

Should X-rays be reviewed before or after charting?

A

Before

102
Q

This should be continuous with lamina dura of adjacent teeth:

A

interdental crestal bone

103
Q

What to look for in healthy bone:

A

normal trabeculation and density

104
Q

Where should the alveolar crest be?

A

1-2mmm from CEJ and roughly parallel to a line bw CEJ’s

105
Q

Healthy features of interdental crestal bone margins in anterior region:

A

thin, even, pointed

106
Q

Healthy features of interdental crestal bone margins in posterior region:

A

thin, smooth, evenly corticated, sharp angle bw crestal bone and lamina dura

107
Q

Features of healthy perio ligament space:

A

thin even width

108
Q

Factors that can result in the absence of ‘normal features’ of bone:

A

technique error, overexposure, normal variation in alveolar bone shape and density

109
Q

Why is the cortication at the crest not always evident?

A

small amt of bone, beam angulation

110
Q

What might be visible in RG’s following perio therapy?

A

healthy perio tissues with earlier bone loss

111
Q

TF? RG bone loss alone is an indicator of current periodontal inflammation.

A

F

112
Q

RG features of chronic PD:

A

Loss of corticated interdental crestal margin (irregular or blunted), bone in furcation areas (from widening of PDL space in furcation to large areas of bone loss), hori or vert bone loss (loss or formation of complex bony defects), widening of interdental PLS’s, widened perio lig spaces at crestal margin, normally sharp angle bw crestal bone and lamina dura bcm rounded or irregular

113
Q

order of tissues from cementum out:

A

cementum, PDL, then lamina dura

114
Q

Are the categorizations of mild, moderate and severe bone loss based on distance from where it should be or based on percent loss in relation to length of roots?

A

ask, same with furcation involvement

115
Q

How do we quantify bone loss?

A

as a percentage

116
Q

What affects the relative height of alveolar crest in RG’s?

A

beam angulation

117
Q

If the beam is angled in this manner, the alveolar crest will appear more coronal than it is:

A

angled from above (think more coronal) patient at a down angle

118
Q

How to get X-ray of severe bone loss:

A

vertical placement of film

119
Q

Etiology of vertical bone loss:

A

Local factors, endo/perio lesions, localized aggresive PD, immunosuppression

120
Q

Local factors that can cause vertical bone loss:

A

open contact, overhanging restorations, cracked tooth (post and core restorations)

121
Q

This is important in determining prognosis and in prosthetic tx plans:

A

RG crown to root ratio (clinical crown? Anatomical crown? Area of tooth not covered with bone?)

122
Q

Overhanging restos can lead to:

A

loss of LD at alveolar crest and hori bone loss

123
Q

Other factors in local bone levels:

A

root and sinus proximity

124
Q

Factor in treatment planning of teeth with bone loss:

A

number of osseous walls

125
Q

Example of 1-wall osseous defect:

A

hori bone loss (check)

126
Q

Example of 2-wall osseous defect:

A

Oseous crater

127
Q

What is the most common type of osseous defect in PD?

A

2-wall

128
Q

Limitations of standard RG’s:

A

don’t show perio pockets, early bone loss, early furcation involvement, all calculus, tooth mobility, widened PDL, detailed morphology of osseous defects

129
Q

Supragingival, usually use:

A

McCall’s instrument

130
Q

These are instruments to reach root surfaces in deep pockets without trauma:

A

Gracey curettes

131
Q

Blade in relation to the shank, Gracey curettes:

A

offset, face beveled at 60d angle to shank

132
Q

TF? Gracey curettes are site-specific.

A

T

133
Q

In how many planes are Gracey curettes curved?

A

2, up and to the side

134
Q

These Gracey curettes are used for all surfaces of anterior teeth only:

A

Gracey 1-4

135
Q

These Gracey curettes are used for all surfaces of anterior teeth, all surface of premolars, and all surfaces of molars except distals:

A

Gracey 5 and 6

136
Q

lower numbers work well on:

A

B,L, and M

137
Q

Gracey’s 13, 14, 15:

A

posterior teeth and distals of posteriors (check)

138
Q

These Gracey curettes are used for all surfaces of anteriors, all surface of premolars, and facial and lingual of posteriors:

A

Gracey 7 - 10

139
Q

These Gracey curettes are used for all surfaces of all teeth except distals of posteriors:

A

Gracey 11 and 12

140
Q

These Gracey curettes are used for all surfaces of all teeth except mesials of posteriors:

A

Gracey 13 and 14

141
Q

Gracey 5 and 6 are never for:

A

distal surfaces

142
Q

Angle of blade face to lower shank for sickle scaler:

A

90d

143
Q

How should site specific curettes be held in relation to the tooth surface?

A

parallel to root surface

144
Q

If an instruments lower shank is perpendicular to the flor, where is the workign-end?

A

the lower edge is the cutting edge

145
Q

What are the 1st, 2nd, and 3rd strokes in scaling?

A

vertical, oblique, then hori

146
Q

For which stroke is the lower shank parallel (to the long axis of tooth?)?

A

mainly for vertical stroke

147
Q

Which instruments are thinnest in Xsection?

A

curettes

148
Q

Where should finger rest be for scaling mandibular premolars?

A

mandibular anteriors

149
Q

Where should finger rest be for scaling distal mandibular posteriors?

A

cross arch, from upper arch (finger rest in different arch?)

150
Q

Where should finger rest be for scaling maxillary molars?

A

mandibular premolars or double finger rest on the maxillary arch

151
Q

What is the least stable finger rest?

A

chin rest

152
Q

TF? Distal curettes can also be used on B and L.

A

F. Mesial curettes can be (check)

153
Q

Angulation for calculus removal should be bw:

A

45 and 90d

154
Q

Ideal angulation for calculus removal should be bw:

A

60-80d

155
Q

What will happen if you use a 90d angle in calculus removal?

A

jump over caclulus, missing a lot and cutting gingival of pt

Introduction to Periodontics and Prevention (8 decks)

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