MD PERIO Flashcards
what are 4 components make up periodontium?
alveolar bone
PDL
cementum
gingiva
( what surrounds tooth)
what is the initating factor of periodontal disease?
microbial plaque ( biofilm)
probing depth is from where to where?
gingival margin -> base of pocket
clinical attachment loss CAL is measured where to where?
CEJ -> base of pocket
what is the best way to measure inflammation in period disease?
BOP
during a perio exam. a patient had a PPD of 4 mm with 2 mm of recession. what was the patients CAL?
4 + 2 = 6 mm
CAL= PPD + recession
patient had a PPD of 9 mm but tissue grew 3 mm. what was the cal
(9- 3 = 6 mm
gingival recession is measured from ___ to __
CEJ to gingival margin
miller classification of mobility for tooth moving more or equal to 1 mm is what class?
class 2
miller classification of mobility for tooth moving more than 1 mm and can be vertically displaced in socket
class 3
0, 1 ,2 ,3
what are the hamp classification furcation classes and what do they tell you?
0- none
1- horizontal involvement <3 mm
2- horizontal involvement > 3 mm
3- through and through involvement
YOU KNOW THIS FROM CLINIC!!
normal distance from CEJ to alveolar crest is how many mm?
2 mm
when this defect is surrounded by 3 walls what bone defect is it? 1 wall 2 wall 3 wall 4 wall
3 wall defect
when defect is surrounded by 1 wall what is the defect?
when this defect is surrounded by 3 walls what bone defect is it?
1 wall
2 wall
3 wall
4 wall
1 wall defect
when the D,F,L wall of a defect is missing what wall is it?
when this defect is surrounded by 3 walls what bone defect is it?
1 wall
2 wall
3 wall
4 wall
1 wall
crater is what defect? when this defect is surrounded by 3 walls what bone defect is it? 1 wall 2 wall 3 wall 4 wall
2 wall (MOST COMMON)
hemiseptal is what wall defect?
1 wall
2 wall
3 wall
4 wall
1 wall defect
trough is what wall defect?
1 wall
2 wall
3 wall
4 wall
3 wall
easiest wall defect to graft?
1 wall
2 wall
3 wall
4 wall
3 wall b/c already 3 walls present
what is 4 wall defect?
extraction socket
millers classification of recession. which one has no likelihood of root coverage?
class 1, 2, 3, 4
class 3 wont have total root coverage but class 4 has no chance
most common gingival disease? **
plaque induced
plaque induced gingival disease is modified by what 3 things?
SYSTEMIC FACTORS: endocrine changes (puberty, pregnancy, diabetes)
MEDICATION
MALNUTRITION (vitamin C deficiency aka scyurvy)
what is a modification in nutrtition that contributes to plaque induced gingival diseases?
VITAMIN C DEFICIENCY
scurvy
what is systemic factor that contributes to plaque induced gingival disease?
endocrien changes ( puberty, pregnancy, diabetes)
leukeumoia
what is medication that contributes to plaque induced gingival disease?
C - ca+
D- dilantin
C- cyclosporin
patient walks in with inflammed gums that are non-hemmorrhagic and firm, what does patient have?
hereditary gingival fibromatosis
mm of call for moderat Perio disases?
3-4 mm
severe more than 5
slight 1-2
periodontal disease distrubution is what percent generalized?
> 30% ( more than or equal)
chronic vs agressive perio in terms of :
- are they clinically healthy?
slower or rapid progression>
are microbial deposits consistent with destruction?
chronic: clinically not healthy
agressive: clinically healthy
rapid bone : aggressive
slow: chronic
chronic: deposits consistent
aggressive: not consistent
4 clinical features of necrotizing perio disease ( ANUG, ANUP)
pseudomembrane
fetid breathe
blunted papillae
fever
predisposing factors of necrotizing perio disease
stress
smoking
immunosuppression
patient walks in with fever, rancid breathe, what is the diagnosis?
ANUG or ANUP ( necrotizing perio disaese)
type of bacteria in subgingival tissue?
anaerobic G(-)
type of bacteria in supragingival tissue?
aerobic ( g +)
describe the type of bacteria in supra and sub gingival tissue>
bacteria goes from g+ to G-
coronal -> apical
where does supra and subgingival bacteria accumulate from
supra: saliva
sub: GCF
what are the 3 steps and times of dental plaque formation?
pellicle (saliva outside teeth) : seconds
adhesion and attachment of bacteria: within minutes
Colonization/ plaque formation: 24-48 hrs
communication among bacteria to encourage growth of beneficial species and discourage competing species is called
quorum sensing
what is red complex bacteria associated with and the types? **
BOP and deep pockets:
P.Gingivalis
T. Denticola
T. Forsythia
TF/ TD/ PG (TF? touchdown Paul georgs)
what is orange complex bacteria associated with and the types? **
preceeeds presence of red complex supporting sequential nature plaque formation
Fusobacterium
Prevotella Intermedia
Campylobacter Rectus
FB, CR, PI
aggressive periodontitis is caused by what bacteria?
A. Actinomycetemcomitans (G-)
A-gressive caused by AA
which bacteria found in ANUG, ANUP? P.Gingivalis T. Denticola Prevotella Intermedia T. Forsythia A. Actinomycetemcomitans
TDenticola ( red)
which bacteria found in chronic periodontitis? P.Gingivalis T. Denticola T. Forsythia Prevotella Intermedia A. Actinomycetemcomitans
P. Gingivalis (red complex)
which bacteria found found in preganncy gingivitis ? P.Gingivalis T. Denticola Prevotella Intermedia T. Forsythia A. Actinomycetemcomitans
P. Intermedia (orange compelx)
most common oral bacteria residing on tongue?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
S. Salivarius
saliva = tongue
oral bacteria on root caries?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
actinomyces
coronal caries?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
s. mutans
bacteria found in implants?
most common oral bacteria residing on tongue?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
pseudomonas (staph)
describe how calculus affects gingival tissue ?
calculus does not serve as the irritant ! but the plauqe it accumulates is what irritated the tissue
(calculus does not contribute to caries it is a natural seal)
describe supragingival and subgingival calculus?
- color, what causes it?
supra: white/yellowish ; mineralization due to saliva near salivary duct openings
subgingival: dark, mineralization due to GCF
soft cheeselike accumulation of bacteria easily displaced by water spray?
materia alba
Orange extrinsic staining usually where and due to what? **
anterior teeth, poor hygiene
brown extrinsic staining usually where and due to what? **
dark beverages, poor hygiene
yellow-brown extrinsic staining usually where and due to what? **
CHX and stannous fluoride
black extrinsic staining on cervical third usually where and due to what? **
iron
green and yelow extrinsic staining usually where and due to what? **
ant teeth, poor OH
chromogenic bacteria
bluish green extrinsic staining due to what
occupational exposure of metallic dust
t or F undercountoured restorations worse than over contoured
F : overcontoured b/c forms plaque
what is the first line of defense for fighting infection?
how do they move?
how does it kill bacteria?
NEUTROPHILS !
- move via CHEMOTAXIS
- kill via PHAGOCYTOSIS
what is the most important enzyme involved in the destruction of periodontal tissues? **
how is it treated?
MMP- 8 ( neutrophil collagenase)
- causes periodontitis, kills neutrophils
tetracycline
antigen presenting cells like moncytes and dendritic cells regulate immune response via how?
cytokines such as IL-8
this cell causes vascular permeability and dilation?
mast cell
histamine releasing cell? what antibody does it have?
mast cell
IgE
what cell makes antibodies?
B cells become PLASMA CELLS and make antibodies
which cells kill intracellular antigens?
T cytotoxic cells (CD8)
CD4 vs CD8 cells
CD4- T helper cells : communicate
CD8: kill intracellular antigens
lppk at slide 64
these cells recognize and kill tumor and cirally infected cells
NK cells
T cytotoxic cells vs NK cells
TCyto cells ( CD8): kill intracellular antigens NK: recognize and kill tumor and virally infected cells
this cytokine causes bone absorption
IL-1
A member of a group of enzymes that can break down proteins, such as collagen, released by neutrophils
MMP
this is a cytokine secreated by macrophages, NK cells,and lymphocytes used for necrosis or apoptosis
TNFa (tumor necrosis factor alpha)
protein important for necrosis and apoptosis and resistance to cancer
what are 5 proinflammatory mediators?
IL-1 iL-6 PGE2 TNFa MMP
what are antiinflammatory mediators
IL-4
Il-10
TIMPs
which one are anti and pro inflammatories IL-4 Il-10 TIMPs IL-1 iL-6 PGE2 TNFa MMP
anti: IL4, IL10, TIMPS
4 stages of gingivitis?
1) 2-4 days : NEUTROPHILS infiltrate, Inc GCF
2) 4-7 days; T LYMPHOCYTES infiltrate, inc collagen loss, BOP
3) 14-21 B LYMPHOCYTES , mature plasma cells infiltrate, collagen loss, change in collar
4) PERIODONTITIS ( IRREVERSIBLE)
what is the most important factor determining prognosis of a tooth?
CAL !!
scaling vs root planing
scaling: remove supra and sub gingival plaque and calculus
root planning: remove embedded calculus and rough cementum
sickle scalers remove what type of calculus>
supragingival
curettes remove what type of calculus>
subgingival calculus
ultrasonic scalers remove what type of calculus>
tenacious calculus
the magnetostrictive ultrasonic vibrate in what type of pattern?
(cavitron) elliptical
the piezoelectric ultrasonic vibrate in what type of pattern?
linear
this type of stroke is for light feeling used with probes and explorers
exploratory
this stroke is a short strong pull to remove hard deposits
scaling
light intermitten strokes with tip parallell to tooth surface in constant motion
utrasonic
when inserting curette into pocket, angulation of blade to tooth should be ___ and is changed to ____
0 (closed angle)
45-90 ( open angle)
what type of bone should flap design incision be?
intact bone not defects or eminences !!!
want sharp or round incision corners?
round
WHAT IS THE MOST IMPORTANT PROCEDURE AFTER PERIO SURGERY?
post-op plaque control
this flap thickness retract gingiva, submucosa and even periosteum?
full thickness flap ( mucoperiosteal)
this type of flap is for mucogingival surgery where exposing bone not necessary?
split or partial thickness ( mucosal) flap
this thickness flap used for osseous surgery and periodntal regeneration
full thickness flap
whnwver alveolar bone is exposed during full thickness flaps, how much bone resoprtion is expected?
1 mm
periodontal pack used for what and what is it made of how long to keep it on ? ?
ZOE
protects surgical wound and stops bleeding
PACK DONT ENHANCE healing ( ZOE SOOTHES)
1 week
difference between gingivectomy and gingivoplasty?
ectomy: excision of gingiva to elimante suprabony pockets or enlargement
plasty: excision of gingiva to reshape tissue deformities
maxillary distal wedge?
full thickness flap with parallel incision
mandibular distal wedge
full thickness flap with V-Shape incision
what happens during free gingival graft?
widen band of keratinized tissue
connective tissue graft?
root coverage
take palatal tissue and suture over root surface
frenectomy?
complete removal of frenum
vestiibuloplasty
deepening of vestibule
what is a free gingival graft?
transplanted WITHOUT nourishing blood supply so undregoes revascularization from recipient bed
what is most common donor site for connective tissue graft and what is it for?
PALATe
root coverage
ostectomy ?
removal of SUPPORTING bone
osteotomy?
removal of NON SUPPORTING bone
guided tissue regeneration regenerates what 3 things?
bone
cementum
PDL
CT cells PDL Cells Bone Cells EPithelial cells which one heal fastest to slowest?
epi
ct
PDL
bone
what cells cause long JE when healing? CT cells PDL Cells Bone Cells EPithelial cells
Epithelial cells
CT cells
2 examples of chelating agents and use?
EDTA and CITRIC acid
root surface treatment ?
what is an allograft?
another human, usually cadaver
what is an autograft?
bone graft from yourself
what is an alloplast?
synthetic or onorganic bone graft
which is the best and worst? autograft allograft xenograft alloplast>
best: AUTOGRAFT
worst: ALLOPLAST
what does osteoconductive mean?
bone forming cells move across scaffold and replace with new bone
osteoinductive ?
convert neighboring progenitor cells into osteoblasts
additive periodontal surgery?
periodontal regernaration
free gingival graft ( transplant w/out blood supply)
connective tissuse graft ( harvest inner CT)
coronally advanced flap
substractive periodontal surgery summary
resective osseous surgery
gingivectomy
apically positioned flap
when have 1 and 2 wall defect how do we fix?
RESECTION (ostectomy)
recontour bone to restore positive architecutre
when have 3 and 4 wall defect how do we fix>
REGENERATION,
better blood supply and cell source proximity
REGENERATION better than RESECTION ( wall 1 and 2)
when do you resection and when do you regenerate ( which bone wall defects)?
resection: 1 and 2
Regeneratgion: 3 and 4
which Hamp classification is ideal for regenerating furcation defects?
class 1 class 2 class 3 class 4
class 2
which miller class is ideal for regenerating recessive defects?
Class 1 ( nearly 100%)
which phase should antibiotics be used?
phase 1 : non surgical procedures
what type of periodontitis uses ANTIBIOTICS
agressive perio
where is tetracycline concentrated at ?
GCF
which tetracycline drug is best to take and why?
doxycycline only one dose per day
most important combination drug for perio disease ? ***
amoxicillin (500mg TID) and Metronidazole ( 250 mg TID) for 14 days
AMX+ MTZ
TID+ 3x a day
duration more important than dose !!!
Local delivery Antiobiotics are used when?
when localized recurrent PD pockets > 5 mm with inflammation are still present after therapies
what are local delivery antibiotics and 3 examples?
MINOCYCLINE: arrestin
DOXYCYCLINE: atridox
CHX: periochip ( non antibiotic)
host modulation therapy is used for what type of perio?
Reduces tissue destruction and stabilizes and regenerates inflammatory tissue
chronic periodontitis
what do NSAIDS inhibit?
PROSTOGLANDIS ( cause inflammation)
what do bisphosophonates inhibit? side effect?
osteoCLASTS
BRONJ ( bisphophonate related osteonecrosis of the jaw)
subantimicrobial dose doxycycline inhibits what>
MMP ( collagenases)
primary occlusal trauma caused by?
excessive forces on NORMAL periodontium
secondary occlusal trauma caused by?
normal occlusal forces on reduced periodontium
this occlusal trauma is vibration of tooth upon closing?
fremitus
waterpik function is what?
reduce BACTERIAL LOAD ON GINGIVA
NOT biofilm on tooth surface !!
chronic periodontitis is most prevalent in what demographic?
black males
re- evaluation of perio should be when ?
after phase 1 non surgical : 4-8 weeks
in osseous surgery what is positive architecture?
interproximal bone coronal to radicular bone ( what we want)
in osseuous surgery what is flat architecture/
interproximal and radicular bone same height
in osseous surgery what is negative architecture ?
interproximal bone apical to radicular bone ( not healthy)
