Midterm 1 (AAP Classifications and Questions)

Question 1

A. Plaque Induced Gingival Disease

Answer 1

• Gingival disease
• 4 subtypes:
  1. Caused sole by plaque, most common type of gingival disease
  2. Modified by systemic factors, plaque still plays a central role but systemic factors also play a role (ex: hormone fluctuations promote the growth of certain types of bacteria in the biofilm)
  3. Modified by medications: certain meds like phenytoin and cyclosporin can promote gingival enlargement in the presence PBF formation
  4. Modified by malnutrition: deficiencies in nutrients can contribute to gingival disease (ex: deficiency is ascorbic acid can lead to increase in gingival inflammation and bleeding

Question 2

B. Non-Plaque Induced Gingival Lesions

Answer 2

• Gingival disease
• PBF does not have an etiological role in non-plaque induced lesions
  1. Bacterial infections: inflammation or lesions caused by bacteria
  2. Viral infections: inflammation or lesions caused by viruses
  3. Fungal infections: inflammation or lesions caused by fungi
  4. Genetic origin: inflammation or lesions associated with inherited conditions
  5. Systemically related: gingival lesions as a manifestation of systemic disease. Can involes mucocutaneous disorders and/or allergic reactions
  6. Traumatic lesions involving chemcial physcial and thermal injury
  7. Reactions to foreign bodies like piercing
  8. Other: things not otherwise specified in the classification system

Question 3

C. Chronic Periodontitis

Answer 3

• Most common form
• Bacterial infection within the supporting tissues of the teeth
• Initiated and sustained by PBF but the body’s host response is responsible for most of the tissue destruction
• Progresses at slow to moderate rate but there may be instances of rapid disease progression
• PBF and sub-g calculus are frequent finding with the amount of tissue destruction consistent with the presence of local etiologic factors

Question 4

D. Aggressive Periodontitis

Answer 4

• Bacterial infections characterized by rapid loss of attachment and a less predictable response to perio therapy
• Less common than C and may occur in both healthy adults and children
• The amount of tissue destruction is less consistent with local etiologic factors
• A family history of aggressive periodontitis can exists. It can be modified by systemic disease or associated with immune deficiencies

Question 5

E. Periodontitis as Manifestations of Systemic Disease

Answer 5

• This category is used when the systemic condition is the major predisposing factor and the bacterial infection is considered secondary feature of the systemic disease
• Associated with blood disorder or genetic disorder
• A severely decreased host resistance associated with the systemic condition is the major etiologic factor

Question 6

F. Necrotizing Perio DX

Answer 6

• This involes tissue necrosis or localized tissue death
• Necrotizing ulcerative gingivitis is confined to the gingiva and does not involve clinical attachment loss
• Necrotizing ulcerative periodontitis involes the gingiva and results in attachment and bone loss
• Usually characterized by a diminished resistance to bacterial infection of the period tissues
• Necrotic papillary and marginal covered by a yellowish or greyish coating
• Blunted or cratered papillae
• Spontaneous bleeding, fetid breath and pain

Question 7

G. Abscesses of the Periodontium

Answer 7

• An abscess is a localized collection of pus that forms in a circumscribed area of the periodontal tissues
• Ginginval abscess is caused by infection from bacteria that enter the gums following injury from aggressive tooth brushing, toothpick punctures, or from food that is forced into the gumline. This infection may spread into surrounding tissue and if left untreated it can progress, damaging the support structure of the tooth and becomes a period abscess
• The pus is a collection of neutrophils which is not able to drain collects in the soft tissue walk to form the abscess
• Periocoronal abscesses occur around the tissue partially erupted teeth

Question 8

H. Periodontitis Associated with Endodontic Lesions

Answer 8

• This involves infection or death of the tissues of the dental pulp
• A tooth can be affected by perio dx and plural disease at the same time. They can combine into one lesion and is refereed to as a combined perio-endo lesion
• Perio infection can leaf to an infection of the pulp: if the periodontitis is so severe it can affect the apex of the tooth which can lead to infection of the pulp
• An infection of the pulp can lead to the destruction of the periodontium: severe infection can spread from the pulp to the periodontium
• A combined perio-endo lesion requires both perio and endodontic treatment to save the tooth

Question 9

I. Deformities and Conditions

Answer 9

• These are conditions that exist around teeth that predispose the periodontal to disease (gingivitis or periodontitis)
• Can be tooth related as in malpositioning and malocclusion
• Can be related to mucogingival conditions: these are conditions associated with gingiva and or alveolar mucosa that predispose to disease
• Can be mucogingival deformities which involve abnormal shapes of the gingiva or alveolar mucosa predisposing to disease
• Primary occlusal trauma occurs when greater than normal occlusal forces are placed on the teeth (para-functional habits like bruxism, clenching, biting) resulting in damage to periodontium
• Secondary occlusal trauma occurs when normal occlusal forces are placed on a compromised periodontium contributing harm to an already damaged system