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Theoretical Perio > Midterm > Flashcards

Midterm Flashcards

1
Q

Mandibular Anterior and Middle Buccal arterial supply

A

External: Inferior Labial Artery/Mental Artery

Internal: Incisive Artery

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2
Q

Mandibular Posterior Buccal arterial supply

A

External: Inferior Labial Artery

Internal: Inferior Alveolar Artery

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3
Q

Mandibular Lingual arterial supply

A

External: Sublingual Artery

Internal: Inferior Alveolar Artery

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4
Q

Maxillary Anterior and Middle Buccal arterial supply

A

External: Superior Labial Artery

Internal: ASA (anterior teeth), MSA (middle teeth)

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5
Q

Maxillary Posterior Buccal arterial supply

A

External: External branch of the PSA

Internal: PSA

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6
Q

Maxillary Lingual arterial supply

A

External: Greater Palatine Artery

Internal: ASA, MSA, PSA

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7
Q

Buccal gingiva of Maxillary Incisors, Canines, and Premolars nerve supply

A

Superior Labial branches from the Infraorbital Nerve

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8
Q

Buccal Gingiva of Maxillary Molars Nerve Supply

A

PSA Nerve

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9
Q

Posterior (Molars) Palatal Gingiva Nerve Supply

A

Greater Palatine Nerve

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10
Q

Anterior (Incisors and Premolars) Palatal Gingiva Nerve Supply

A

Nasopalatine Nerve

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11
Q

Buccal Gingiva of Mandibular Incisors and Premolars Nerve Supply

A

Mental Nerve

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12
Q

Buccal Gingiva of Mandibular Molars Nerve Supply

A

Long Buccal Nerve

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13
Q

Lingual Gingiva of Mandible Nerve Supply

A

Lingual Nerve

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14
Q

What does the submental lymph node drain?

A
  1. Mandibular Incisors

2. Labial and lingual gingiva over mandibular incisor region

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15
Q

What does the submandibular lymph node drain?

A
  1. Palatal and Buccal gingiva of maxilla
  2. Mandibular Posterior region
  3. All teeth and adjacent periodontal tissue
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16
Q

What does the jugulodigastic lymph node drain?

A

Tonsils and posterior tongue

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17
Q

Progression of lymph nodes from mandibular incisors

A
  1. Submental lymph nodes
  2. Submandibular lymph nodes
  3. Superior Deep Cervical lymph nodes
  4. Inferior Deep Cervical lymph nodes
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18
Q

What is the mucogingival junction?

A

Point at which the alveolar mucosa (non-keratinized) meets the attached gingiva (keratininzed)

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19
Q

Dimensions of Maxillary AG, Facial Aspect

A

Widest: Incisor region (3.5-4.5 mm)

Narrowest: Premolars region (1.9 mm)

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20
Q

Dimensions of Mandibular AG, Lingual Aspect

A

Widest: Molar region

Narrowest: Incisor Region

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21
Q

Dimensions of Mandibular AG, Facial Aspect

A

Widest: Incisor region (3.3-3.9 mm)

Narrowest: Canines and premolar region (1.8 mm)

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22
Q

General dimensions of the Attached Gingiva

A

1-9 mm

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23
Q

Order of Junction between tooth, epithelium, and Connective tissue (inside to outside)

A
  1. Tooth
  2. Internal Basal Lamina (Lamina Densa and Lamina Lucida)
  3. Junctional Epithelium
  4. External Basal Lamina
  5. Connective tissue
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24
Q

What is the Biologic Width?

A

Connective tissue attachment and junctional epithelium attachment (usually 2 mm)

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25
Q

What PDL fibers are the most numerous and provide the main support to the tooth?

A

Oblique Fibers

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26
Q

What is the first type of cementum to be formed?

A

Acellular cementum

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27
Q

When is cellular cementum formed?

A

After the tooth has reached the occlusal plane

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28
Q

How are the Sharpey’s fibers arranged in cellular cementum?

A

Parallel to the PDL or randomly

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29
Q

How are the Sharpey’s fibers arranged in acellular cementum?

A

Perpendicular to the tooth (Right angles)

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30
Q

What is the composition of cementum?

A

Inorganic (40-50%): Hydroxyapatite

Organic: Type I (90%) and Type III (5%) Collagen

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31
Q

What is the relative mineralization of the Periodontal structures?

A
  • Enamel (97%)
  • Dentin (70%)
  • Bone (65%)
  • Cementum (40-50%)
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32
Q

What is the most common CEJ configuration?

A

Cementum overlapping enamel (60-65% of cases)

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33
Q

How is alveolar bone formed?

A

Intramembranous ossification

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34
Q

What is the hydroxyapatite composition of alveolar bone?

A

60-65% Hydroxyapatite

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35
Q

What is the function of Osteoblasts, Osteoclasts, and Osteocytes in alveolar bone?

A
  • Osteoblasts: Form Osteoid/bone
  • Osteoblasts: Resorb and remodel bone
  • Osteocytes: Form networks of bone (in lacunae)
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36
Q

What makes up the attachment apparatus?

A
  1. PDL
  2. Cementum
  3. Alveolar Bone
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37
Q

What is the physiologic Architecture of the Alveolar Bone?

A

Bone more coronal interproximally than on the lingual or facial side

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38
Q

What is the Reverse Architecture of the Alveolar Bone?

A

Bone more apical interproximally than on lingual or facial side (opposite of physiologic architecture)

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39
Q

What is dehiscence?

A

V-shaped defect with the marginal bone gone

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40
Q

What is Fenestration?

A

“window” defect in bone with marginal bone still intact

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41
Q

What is mesial drift?

A

Distal = Bone formation

Mesial = Bone resorption

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42
Q

What is the cranial nerve supplying the periodontium?

A

The trigeminal nerve (CN 5)

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43
Q

What happens to keratinization of the periodontium when aging?

A

It decreases

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44
Q

What happens to the CT cellularity of the periodontium when aging?

A

It decreases

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45
Q

What happens to the Epithelium of the periodotium when aging?

A

It thins

46
Q

What happens to the Intercellular substance of the periodontium when aging?

A

It increases

47
Q

What happens to the Rate of Collagen Synthesis of the Periodontium while aging?

A

It decreases

48
Q

What happens to the cementum thickness of the periodontium while aging?

A

It thickens (usually apically 5-10X)

49
Q

What happens to the width of the PDL during aging?

A

It narrows due to cementum thickening

50
Q

What is Abrasion?

A

Wearing away of tooth structure by forces other than mastication (e.g. tooth brushing)

51
Q

What is Erosion?

A

Loss of tooth structure via a chemical process (e.g. anorexia/bulimia, acid reflux, soda)

52
Q

What is Attrition?

A

Loss of vertical dimension due to tooth-to-tooth contact or wearing away of structure

53
Q

What happens to periodontitis prevalence as people age?

A

It increases in both prevalence and severity

54
Q

What is the main differentiation between gingivitis and periodontitis?

A

Gingivitis is reversible and does not exhibit attachment loss and Periodontitis is irreversible and does exhibit attachment loss

55
Q

Characteristics of Stage IV Periodontitis Lesion

A
  1. Plasma cells predominate (not PMNs)

2. Extension of lesion into alveolar bone and PDL

56
Q

Where do the earliest signs of gingivitis occur?

A

In the interdental papillae (Papillary gingivitis)

57
Q

What is the most common cause of gingival bleeding?

A

Plaque/caries

58
Q

What are examples of mechanical trauma that cause gingival bleeding?

A

Tooth brushing, toothpicks, and food impaction (may cause recession too)

59
Q

What Systemic Factors are related to Gingival Bleeding?

A
  1. Hemorrhagic diseases
  2. Vascular Abnormalities
  3. Platelet disorders
  4. Hypothrmobinpenia (Vit. K def)
  5. Coagulation defects
  6. Multiple Myeloma
  7. Postrubella Purpura
  8. Use of ASA and Anticoagulants
60
Q

Color changes in the gingiva in gingivitis

A

Becomes redder due to increased vascularity or decreased keratinization

61
Q

Systemic Diseases associated with Periodontitis

A
  1. AIDS
  2. Diabetes
  3. Down’s Syndrome
  4. Cyclic Neutropenia
  5. Papillon Lefevre
  6. LAD
62
Q

What are the clinical manifestations of NUG?

A

“PIG”

  • Pain
  • Interdental Cratering
  • Gingival Bleeding
63
Q

What is Leukemia associated with?

A

Bleeding gums (Coagulation defect)

64
Q

What drugs may cause gingival overgrowth?

A
  1. Dilantin (anti-seizure)
  2. Nifedipine (CCB)
  3. Cyclosporin
65
Q

Classification of Calculus

A

Supragingival (C1) Calculus: Salivary source of mineral ions

Subgingival (C2) Calculus: Serum source of mineral ions

66
Q

Components of Calculus

A
  • 80% inorganic salts (calcium and phosphorus)
  • Hydroxyapatite
  • Brushite
67
Q

What is the Primary etiology of periodontitis?

A

Plaque

68
Q

Characteristic of Periodontitis

A
  • Destruction of gingival and periodontal fibers
  • Cyclic in nature
  • Rate of progression related to mass and composition of flora
  • Not all teeth/tooth surfaces equally susceptible
69
Q

Calculations of Clinical Probing Attachment Level

A

w/o recession: probing depth (mm) - distance from free gingival margin to CEJ (mm)

w/recession: probing depth (mm) + gingival recession (mm)

70
Q

Golden rule of periodontitis

A

Attachment loss

71
Q

Clinical signs of periodontal pocket

A
  • Enlarged bluish/red marginal gingiva
  • Edema
  • Bleeding
72
Q

What is the difference between suprabony and infra/intrabony pockets?

A

Suprabony: Base of pocket is coronal to alveolar crest; Horizontal pattern of bone destruction

Infrabony: Base of pocket is apical to alveolar crest; Vertical/Angular pattern of bone destruction

73
Q

Differential Diagnosis between endo and perio

A

Pulp Test:
Endo: Nonvital
Perio: Vital

Periodontal Pocket:
Endo: Narrow
Perio: Wide coronally, narrow apically

74
Q

Causative relationship between gingivitis and periodontitis

A

Periodontitis is always preceded by gingivitis, but not all gingivitis progresses to periodontitis

75
Q

What resorption/formation conditions may result in bone loss?

A
  1. Normal resorption and decreased formation
  2. Normal formation and increased resorption
  3. Increased resorption and decreased formation
76
Q

What are the characteristics of bone destruction?

A
  • Cyclic nature

- Demineralization followed by degradation of organic matrix

77
Q

What will most likely occur with thinning of the periodontium?

A

Dehiscence or fenestration

78
Q

Classifications of Vertical bone loss

A

Based on number of osseous walls remaining

  • 1 wall
  • 2 wall
  • 3 wall
  • Combination defects
79
Q

What is an Osseous crater?

A

Special 2-wall vertical bone loss where the Lingual and facial plates still remain, but two walls against adjacent teeth are missing

80
Q

What is the most common vertical defect and where is it commonly located?

A

Osseous Crater

In the mandible

81
Q

What is incidence?

A

Number of defects that occur over a period of time

82
Q

What is prevalence?

A

Number of defects that occur in a population at one point in time

83
Q

What is attachment loss?

A

Apical migration of the JE and CT attachments

84
Q

What is the mean attachment loss for males and females?

A

Males: 2.04 mm
Females: 1.80 mm

85
Q

What Percentage of US adults have gingival bleeding?

A

50%

86
Q

What Percentage of US adults (30+) have periodontitis?

A

47%

87
Q

What Percentage of the population is at risk for severe periodontitis?

A

10-20%

88
Q

O’Leary Plaque Record

A

Score = Number of sites with plaque/(number of teeth x 4)

Goal = 10% in hygiene clinic

89
Q

Gingival Index

A

0: Normal Gingiva
1: Mild inflammation, slight change in color, slight edema (NO BLEEDING)
2: Moderate inflammation, redness, edema, glazing (BOP)
3: Severe inflammation, marked redness and edema, ulcerations (spontaneous bleeding)

90
Q

Miller Mobility Index

A

0: No movement
1: Barely any movement
2: crown moves up to 1mm in any direction
3: Crown moves >1mm in any direction or is depressible

91
Q

What is the predominant Ig in GCF?

A

IgG

92
Q

What is GCF?

A

An inflammatory exudate derived from the serum

93
Q

What are the functions of Macrophages?

A
  1. Process and Present Ag to Lymphocytes
  2. Produce Collagenase, IL-1, PGE2, IL-6, IL-8, IL-10, IL-13, etc.
  3. Phagocytosis
94
Q

What are the functions of IL-1?

A
  1. Promote T-cell helper function
  2. Inhibit T-cell suppressor function
  3. Promote B-cell maturation
  4. Activate Macrophages to produce PGE2
  5. *Activate Osteoclasts
95
Q

What are the functions of PGE2?

A
  1. Vasoactive
  2. Edema, pain, fever
  3. Neutrophil and monocyte chemotaxis
  4. *Activates osteoclasts
96
Q

Functions of C3b

A
  1. Induce macrophage secretion and cytokine production
  2. *Opsonization
  3. Stimulate leukocyte oxidative metabolism
97
Q

Functions of C5a

A
  1. Leukocyte Chemotaxis
  2. Stimulate leukocyte oxidative metabolism
  3. Activate neutrophil and mast cell degranulation
  4. *Increase Vascular permeability
98
Q

Functions of C3a

A

Increase vascular permeability via Histamine

99
Q

Function of C5b-9

A

Membrane attack complex

100
Q

What are in vitro bone resorption factors?

A
  1. LPS
  2. Lipoteichoic Acid and muramyl dipeptides of gram +ve organisms
  3. PGE2
  4. IL-1
  5. IL-6
  6. TNF
101
Q

Role of GCF

A
  1. Cleansing
  2. Antimicrobial properties
  3. Adhesive properties
102
Q

Functions of saliva

A
  1. Lubrication
  2. Physical protection
  3. Cleansing
  4. Buffering
  5. Maintain tooth integrity
103
Q

Antibody functions

A
  1. Ag/Ab complexes inactivate toxins
  2. Ag/Ab complexes activate classical complement pathway
  3. Ab (w/C3b) opsonizes bacteria
104
Q

T-cell functions

A
  1. Cytotoxic
  2. Helper
  3. Suppressor
  4. Lymphokines
105
Q

Antibacterial Neutrophil Factors

A
  1. Reactive Oxygen Species
  2. Myeloperoxidase
  3. Lactoferrin
  4. Lysozyme
  5. Neutral Proteases (Cathepsin G, Elastase, Collagenase)
106
Q

What do Macrophages secrete?

A
  1. IL-1, IL-6, TNF
  2. Collagenase and elastase
  3. PGE2
  4. Complement components
  5. Fibroblast and endothelial mitogens
107
Q

What are the components of the periodontium?

A
  1. Alveolar bone
  2. Gingiva
  3. PDL
  4. Cementum
108
Q

Bacteria with strong evidence for periodontitis etiology

A
  1. Aggrebacter actinomycetemcomitans
  2. Porphyromonas gingivalis
  3. Tannerella forsythia
109
Q

What bacteria make up the “red complex?”

A
  1. Porphyromonas gingivalis
  2. Tannerella forsythia
  3. Treponema denticola
110
Q

What bacteria is LAP associated with?

A

Aggrebacter actinomycetemcomitans

111
Q

What bacteria is GAP associated with?

A

Porphyromonas gingivalis

Theoretical Perio (1 decks)

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