MD PERIO Flashcards
1
Q
what are 4 components make up periodontium?
A
alveolar bone
PDL
cementum
gingiva
( what surrounds tooth)
2
Q
what is the initating factor of periodontal disease?
A
microbial plaque ( biofilm)
3
Q
probing depth is from where to where?
A
gingival margin -> base of pocket
4
Q
clinical attachment loss CAL is measured where to where?
A
CEJ -> base of pocket
5
Q
what is the best way to measure inflammation in period disease?
A
BOP
6
Q
during a perio exam. a patient had a PPD of 4 mm with 2 mm of recession. what was the patients CAL?
A
4 + 2 = 6 mm
CAL= PPD + recession
7
Q
patient had a PPD of 9 mm but tissue grew 3 mm. what was the cal
A
(9- 3 = 6 mm
8
Q
gingival recession is measured from ___ to __
A
CEJ to gingival margin
9
Q
miller classification of mobility for tooth moving more or equal to 1 mm is what class?
A
class 2
10
Q
miller classification of mobility for tooth moving more than 1 mm and can be vertically displaced in socket
A
class 3
0, 1 ,2 ,3
11
Q
what are the hamp classification furcation classes and what do they tell you?
A
0- none
1- horizontal involvement <3 mm
2- horizontal involvement > 3 mm
3- through and through involvement
YOU KNOW THIS FROM CLINIC!!
12
Q
normal distance from CEJ to alveolar crest is how many mm?
A
2 mm
13
Q
when this defect is surrounded by 3 walls what bone defect is it? 1 wall 2 wall 3 wall 4 wall
A
3 wall defect
14
Q
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
A
1 wall defect
15
Q
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
A
1 wall
16
Q
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
A
2 wall (MOST COMMON)
17
Q
hemiseptal is what wall defect?
1 wall
2 wall
3 wall
4 wall
A
1 wall defect
18
Q
trough is what wall defect?
1 wall
2 wall
3 wall
4 wall
A
3 wall
19
Q
easiest wall defect to graft?
1 wall
2 wall
3 wall
4 wall
A
3 wall b/c already 3 walls present
20
Q
what is 4 wall defect?
A
extraction socket
21
Q
millers classification of recession. which one has no likelihood of root coverage?
class 1, 2, 3, 4
A
class 3 wont have total root coverage but class 4 has no chance
22
Q
most common gingival disease? **
A
plaque induced
23
Q
plaque induced gingival disease is modified by what 3 things?
A
SYSTEMIC FACTORS: endocrine changes (puberty, pregnancy, diabetes)
MEDICATION
MALNUTRITION (vitamin C deficiency aka scyurvy)
24
Q
what is a modification in nutrtition that contributes to plaque induced gingival diseases?
A
VITAMIN C DEFICIENCY
scurvy
25
what is systemic factor that contributes to plaque induced gingival disease?
endocrien changes ( puberty, pregnancy, diabetes)
leukeumoia
26
what is medication that contributes to plaque induced gingival disease?
C - ca+
D- dilantin
C- cyclosporin
27
patient walks in with inflammed gums that are non-hemmorrhagic and firm, what does patient have?
hereditary gingival fibromatosis
28
mm of call for moderat Perio disases?
3-4 mm
severe more than 5
slight 1-2
29
periodontal disease distrubution is what percent generalized?
> 30% ( more than or equal)
30
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
31
4 clinical features of necrotizing perio disease ( ANUG, ANUP)
pseudomembrane
fetid breathe
blunted papillae
fever
32
predisposing factors of necrotizing perio disease
stress
smoking
immunosuppression
33
patient walks in with fever, rancid breathe, what is the diagnosis?
ANUG or ANUP ( necrotizing perio disaese)
34
type of bacteria in subgingival tissue?
anaerobic G(-)
35
type of bacteria in supragingival tissue?
aerobic ( g +)
36
describe the type of bacteria in supra and sub gingival tissue>
bacteria goes from g+ to G-
coronal -> apical
37
where does supra and subgingival bacteria accumulate from
supra: saliva
sub: GCF
38
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
39
communication among bacteria to encourage growth of beneficial species and discourage competing species is called
quorum sensing
40
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)
41
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
42
aggressive periodontitis is caused by what bacteria?
A. Actinomycetemcomitans (G-)
A-gressive caused by AA
43
```
which bacteria found in ANUG, ANUP?
P.Gingivalis
T. Denticola
Prevotella Intermedia
T. Forsythia
A. Actinomycetemcomitans
```
TDenticola ( red)
44
```
which bacteria found in chronic periodontitis?
P.Gingivalis
T. Denticola
T. Forsythia
Prevotella Intermedia
A. Actinomycetemcomitans
```
P. Gingivalis (red complex)
45
```
which bacteria found found in preganncy gingivitis ?
P.Gingivalis
T. Denticola
Prevotella Intermedia
T. Forsythia
A. Actinomycetemcomitans
```
P. Intermedia (orange compelx)
46
most common oral bacteria residing on tongue?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
S. Salivarius
| saliva = tongue
47
oral bacteria on root caries?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
actinomyces
48
coronal caries?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
s. mutans
49
bacteria found in implants?
most common oral bacteria residing on tongue?
S. Mutans
Actinomyces
S. Salivarius
Pseudomonas
pseudomonas (staph)
50
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)
51
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
52
soft cheeselike accumulation of bacteria easily displaced by water spray?
materia alba
53
Orange extrinsic staining usually where and due to what? **
anterior teeth, poor hygiene
54
brown extrinsic staining usually where and due to what? **
dark beverages, poor hygiene
55
yellow-brown extrinsic staining usually where and due to what? **
CHX and stannous fluoride
56
black extrinsic staining on cervical third usually where and due to what? **
iron
57
green and yelow extrinsic staining usually where and due to what? **
ant teeth, poor OH
| chromogenic bacteria
58
bluish green extrinsic staining due to what
occupational exposure of metallic dust
59
t or F undercountoured restorations worse than over contoured
F : overcontoured b/c forms plaque
60
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
61
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
62
antigen presenting cells like moncytes and dendritic cells regulate immune response via how?
cytokines such as IL-8
63
this cell causes vascular permeability and dilation?
mast cell
64
histamine releasing cell? what antibody does it have?
mast cell
| IgE
65
what cell makes antibodies?
B cells become PLASMA CELLS and make antibodies
66
which cells kill intracellular antigens?
T cytotoxic cells (CD8)
67
CD4 vs CD8 cells
CD4- T helper cells : communicate
CD8: kill intracellular antigens
lppk at slide 64
68
these cells recognize and kill tumor and cirally infected cells
NK cells
69
T cytotoxic cells vs NK cells
```
TCyto cells ( CD8): kill intracellular antigens
NK: recognize and kill tumor and virally infected cells
```
70
this cytokine causes bone absorption
IL-1
71
A member of a group of enzymes that can break down proteins, such as collagen, released by neutrophils
MMP
72
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
73
what are 5 proinflammatory mediators?
```
IL-1
iL-6
PGE2
TNFa
MMP
```
74
what are antiinflammatory mediators
IL-4
Il-10
TIMPs
75
```
which one are anti and pro inflammatories
IL-4
Il-10
TIMPs
IL-1
iL-6
PGE2
TNFa
MMP
```
anti: IL4, IL10, TIMPS
76
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)
77
what is the most important factor determining prognosis of a tooth?
CAL !!
78
scaling vs root planing
scaling: remove supra and sub gingival plaque and calculus
root planning: remove embedded calculus and rough cementum
79
sickle scalers remove what type of calculus>
supragingival
80
curettes remove what type of calculus>
subgingival calculus
81
ultrasonic scalers remove what type of calculus>
tenacious calculus
82
the magnetostrictive ultrasonic vibrate in what type of pattern?
(cavitron) elliptical
83
the piezoelectric ultrasonic vibrate in what type of pattern?
linear
84
this type of stroke is for light feeling used with probes and explorers
exploratory
85
this stroke is a short strong pull to remove hard deposits
scaling
86
light intermitten strokes with tip parallell to tooth surface in constant motion
utrasonic
87
when inserting curette into pocket, angulation of blade to tooth should be ___ and is changed to ____
0 (closed angle)
| 45-90 ( open angle)
88
what type of bone should flap design incision be?
intact bone not defects or eminences !!!
89
want sharp or round incision corners?
round
90
WHAT IS THE MOST IMPORTANT PROCEDURE AFTER PERIO SURGERY?
post-op plaque control
91
this flap thickness retract gingiva, submucosa and even periosteum?
full thickness flap ( mucoperiosteal)
92
this type of flap is for mucogingival surgery where exposing bone not necessary?
split or partial thickness ( mucosal) flap
93
this thickness flap used for osseous surgery and periodntal regeneration
full thickness flap
94
whnwver alveolar bone is exposed during full thickness flaps, how much bone resoprtion is expected?
1 mm
95
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
96
difference between gingivectomy and gingivoplasty?
ectomy: excision of gingiva to elimante suprabony pockets or enlargement
plasty: excision of gingiva to reshape tissue deformities
97
maxillary distal wedge?
full thickness flap with parallel incision
98
mandibular distal wedge
full thickness flap with V-Shape incision
99
what happens during free gingival graft?
widen band of keratinized tissue
100
connective tissue graft?
root coverage
take palatal tissue and suture over root surface
101
frenectomy?
complete removal of frenum
102
vestiibuloplasty
deepening of vestibule
103
what is a free gingival graft?
transplanted WITHOUT nourishing blood supply so undregoes revascularization from recipient bed
104
what is most common donor site for connective tissue graft and what is it for?
PALATe
root coverage
105
ostectomy ?
removal of SUPPORTING bone
106
osteotomy?
removal of NON SUPPORTING bone
107
guided tissue regeneration regenerates what 3 things?
bone
cementum
PDL
108
```
CT cells
PDL Cells
Bone Cells
EPithelial cells
which one heal fastest to slowest?
```
epi
ct
PDL
bone
109
```
what cells cause long JE when healing?
CT cells
PDL Cells
Bone Cells
EPithelial cells
```
Epithelial cells
| CT cells
110
2 examples of chelating agents and use?
EDTA and CITRIC acid
root surface treatment ?
111
what is an allograft?
another human, usually cadaver
112
what is an autograft?
bone graft from yourself
113
what is an alloplast?
synthetic or onorganic bone graft
114
```
which is the best and worst?
autograft
allograft
xenograft
alloplast>
```
best: AUTOGRAFT
worst: ALLOPLAST
115
what does osteoconductive mean?
bone forming cells move across scaffold and replace with new bone
116
osteoinductive ?
convert neighboring progenitor cells into osteoblasts
117
additive periodontal surgery?
periodontal regernaration
free gingival graft ( transplant w/out blood supply)
connective tissuse graft ( harvest inner CT)
coronally advanced flap
118
substractive periodontal surgery summary
resective osseous surgery
gingivectomy
apically positioned flap
119
when have 1 and 2 wall defect how do we fix?
RESECTION (ostectomy)
recontour bone to restore positive architecutre
120
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)
121
when do you resection and when do you regenerate ( which bone wall defects)?
resection: 1 and 2
Regeneratgion: 3 and 4
122
which Hamp classification is ideal for regenerating furcation defects?
```
class 1
class 2
class 3
class 4
```
class 2
123
which miller class is ideal for regenerating recessive defects?
Class 1 ( nearly 100%)
124
which phase should antibiotics be used?
phase 1 : non surgical procedures
125
what type of periodontitis uses ANTIBIOTICS
agressive perio
126
where is tetracycline concentrated at ?
GCF
127
which tetracycline drug is best to take and why?
doxycycline only one dose per day
128
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 !!!
129
Local delivery Antiobiotics are used when?
when localized recurrent PD pockets > 5 mm with inflammation are still present after therapies
130
what are local delivery antibiotics and 3 examples?
MINOCYCLINE: arrestin
DOXYCYCLINE: atridox
CHX: periochip ( non antibiotic)
131
host modulation therapy is used for what type of perio?
Reduces tissue destruction and stabilizes and regenerates inflammatory tissue
chronic periodontitis
132
what do NSAIDS inhibit?
PROSTOGLANDIS ( cause inflammation)
133
what do bisphosophonates inhibit? side effect?
osteoCLASTS
BRONJ ( bisphophonate related osteonecrosis of the jaw)
134
subantimicrobial dose doxycycline inhibits what>
MMP ( collagenases)
135
primary occlusal trauma caused by?
excessive forces on NORMAL periodontium
136
secondary occlusal trauma caused by?
normal occlusal forces on reduced periodontium
137
this occlusal trauma is vibration of tooth upon closing?
fremitus
138
waterpik function is what?
reduce BACTERIAL LOAD ON GINGIVA
NOT biofilm on tooth surface !!
139
chronic periodontitis is most prevalent in what demographic?
black males
140
re- evaluation of perio should be when ?
after phase 1 non surgical : 4-8 weeks
141
in osseous surgery what is positive architecture?
interproximal bone coronal to radicular bone ( what we want)
142
in osseuous surgery what is flat architecture/
interproximal and radicular bone same height
143
in osseous surgery what is negative architecture ?
interproximal bone apical to radicular bone ( not healthy)
