Oral Soft Tissues II Flashcards
T/F
The normal periodontium has little to none Sulcular/Gingival Crevicular Fluid
True
How much Gingival Crevicular Fluid (sulcular fluid) is there without gingivitis?
0.42 - 1.56 microliters
What type of Antibodies are in sulcular fluid?
IgG
What are 3 defense mechanisms of the Gingiva?
Sulcular fluid
Leukocytes
Saliva
What antibodies are found in Sulcular Fluid?
IgG
T/F
Smoking increases Sulcular Fluid
True
T/F
More than 90% of Leukocytes in the gingival sulcus are PMN’s
True
T/F
Glycoproteins and mucoids are serve as lubrication and physical protection in the saliva
True
What is the major antibody of the Saliva?
Of sulcular fluid?
IgA
IgG
What are 2 antibacterial components of Saliva?
Lysozyme
Lactoperoxidase (oxidize susceptible bacteria)
Gingival Inflammation:
How many days for Initial lesion?
Early lesion?
Established lesion?
2-4 Days
4-7 Days
14-21 Days
The initial lesion (2-4 days) sees a rise of what?
Increase in Gingival Cervicular Fluid
T/F
Gingival Bleeding is Cell rich and Collagen poor and is defined by a sulcular ulceration
True
What are 3 types of Generalized gingivitis?
GM - gingival margin
AG - atached gingiva
Papillae
T/F
Chronic inflammation of the Gingiva progresses from Papilla to Gingival Margin to Attached Gingiva
True
What can cause a local color change of the gingiva?
Systemic?
Amalgam
Heavy metals
T/F
The consistency of gingival tissue from health to chronic inflammation proceeds from Firm > Edematous > Fibrotic
True
T/F
Two types of Chronic Inflammation are Plaque associated and Mouth breathing
True
T/F
Two types of Acute Inflammation of the gingiva are Gingival Abscess and Periodontal Abscess
True
T/F
Drug-induced Enlargement of the gingiva is a type of Hyperplasia
False
*just enlargement
Where does Drug-Induced enlargement of the gingiva begin?
Interdental papilla
*extends to facial/lingual margins
3 features of Pathogenesis of Anticonvulsant gingival enlargement:
Fibroblast proliferation
Collegenase deactivation
Plaque-induced inflammation
T/F
The dose of Anticonvulsant is responsible for amount of gingival enlargement
False
*dose response doesn’t seem to matter
What is more vascular in nature, an enlargement caused by Phynytoin (anticonvulsant), or one cause by Cycolsporine/Tacrolimus (immunosuppressants)>
Cyclosporine/Tacrolimus
*Also appears to be dose related
**Expressed in 20-70% of pts taking drug - wow
What has less overgrowth, Cyclosporine or Tacrolimus
(immunosuppressants)?
Tacrolimus
Name 3 Calcium channel blockers:
Nifedipine
Diltiazem
Verapamil
T/F
Kidney transplant pts can be on Verapamil + Cyclosporine (Ca blocker and immunosuppressant)
True
What are the 3 categories of gingival enlargements associated with systemic conditions?
Conditioned
Neoplastic
False
What are 3 types of Conditioned gingival enlargements?
Hormonal
Nutritional
Allergic
T/F
Pregnancy causes gingivitis
T/F
Prevotella intermedia has been associated with pregnancy
False
True
*only predisposes - accentuates response to plaque
**begins in 2nd-3rd month
The pregnancy tumor that needs to be treated is called what?
From whence does it come?
Pyogenic Granuloma
Interdental papilla
Name the 4 nutritional influences of Gingiva:
Ascorbic acid - (collagen production)
Folic acid
Vitamin B12
Protein Deficiency
T/F
No nutritional deficiencies by themselves cause gingivitis or periodontitis
True
T/F
The Perio treatment phases consist of:
Phase 1 Initial (soft tissue)
Re-evaluation (4-6 weeks)
Phase 2 surgical (hard tissue)
Maintenance
True
Describe the 1st Phase of Perio treatment:
SRP - Scaling and Root Planing
OHI - Oral Hygiene Instruction
When is Scaling and Root planing done in Perio treatment?
Phase 1: Initial (soft tissue) therapy
Attached Gingiva =
Keratinized Gingiva - Probing Depth
or
Gingival Margin to MGJ minus Probing Depth
T/F
If the GM is above the CEJ, the value is negative
True
CAL =
GM to CEJ (+ or -) + Probing Depth
Name 3 cell types found in the gingiva:
Squamous Epithelium
Keratinocytes
Nonkeratinocytes
What are the 3 Nonkeratinocytes found in the gingiva?
Melanocytes
Langerhan’s cells (antigen presenting)
Merkel cells (free nerve endings)
5 Gingival Fibers:
Circular
Dentogingival
Dentoperiosteal
Alveologingival
Transseptal
5 Perio Fiber:
Alveolar Crest
Horizontal
Oblique (occlusal forces - largest group)
Apical
Interradicular
T/F
The MGJ does not change throughout a lifetime
True
What is the line of demarcation of the MGJ?
Alveolar Mucosa
Attached gingiva
*keratinized to non-keratinized
What is the effect of smoking on the Gingival Crevicular Fluid?
Immediate transient increase in GCF
*smoking event = increase in crevicular fluid
Gingival Crevicular Fluid’s other name:
Sulcular fluid
T/F
Periotron analyzes sulcular/GCF after tested with filter paper (threads or micropipette)
True
GCF is present in _____ amount in healthy people and _____ amount in people with gingivitis
Small
Larger
GCF is composed of proteins, Antigen, enzymes, epithelial cells, leukocytes, electrolyte, organic compounds, and ______
Antibody - IgG
T/F
GCF increases with circadian rhythm (6 AM to 10 PM), sex hormones, chewing, smoking (immediate), and initial pathogenesis
True
What are the 2 names for the Anti-convulsants?
Mechanism of gingival enlargement?
Dose dependent?
Dilantin/Phenytoin
Fibroblast proliferation/collagenase inhibition
no/questionable
Name 3 Ca channel blockers:
Nifedipine
Diltiazem
Verapamil
Name 2 Immunosuppressants:
Compare to Phenytoin:
Dose dependent?
Cyclosporine/Tacrolimus
More vascular
yes
Describe the Initial, acute, 2-4 day gingival inflammation:
PMN’s, macrophage, increased crevicular flow, no gingivitis
Describe the Early, 4-7 day gingival inflammation:
T-cell
gingivitis - red, bleeding, edema
Describe the Established, 2-3 week gingival inflammation:
B-cell
Plasma cells
chronic
Describe the Advanced stage of gingival inflammation:
Periodontitis (alveolar bone loss and pocket formation)
B-cell lesion
Name 3 categories of Plaque-Induced disease:
Systemic factors (puberty, blood dyscrasias)
Drugs
Malnutrition
Non-plaque induced disease includes E. coli, Strep, Neisseria, Treponema, Dandidiasis, Histoplasmosis, and ______.
Herpes
*also trauma, genetic, systemic disease
What is the most prevalent form of Periodintitis in adults?
Chronic
Localized chronic periodintitis means
30
*also Generalized and Diffuse (GM + papilla)
CAL severity:
Slight:
Moderate:
Severe:
1-2 mm
3-4 mm
5+ mm
Localized Aggressive Periodontitis occurs at what sites?
Molars and Incisors
Aggressiv Periodontitis is more common in African Americans and is associated with what bug?
What 2 cytokines are elevated?
A.a.
PGE2 and IL-1b
T/F
Periodontal abscesses has pocket association and PMN accumulation.
T/F
Gingival abscesses have pocket formation and bone loss
True
False
*no bone loss or pocket
**Gingival abscess NOT a cyst, but bacteria have been carried into gingival tissue
T/F
Periodontitis associated with Pregnancy sees an increase in GCF, and complications can see preterm labor and low birthweight.
True
4 General risk factors for Periodontal Disease?
Microbial
Systemic
Behavioral
Local
What are the bugs involved in NUG and NUP?
P. intermedia
Spirochetes
Fusiform bacteria
T/F
NUG proceeds by: forming pseudomembrane, replacing epithelium with meshwork of fibrin, necrotic epithelial cells, PMN’s, etc.
True
What forms an interdental crater by punching out papilla?
NUG
Describe the treatment for NUG:
1st - debridement, Oral Hygiene Instruction
2nd - 1-2 weeks, OH
3rd - 4-6 weeks, possible gingivectomy
*Amoxicillin/Metronidazole (clindamycin if allergic)
How does NUP differ from NUG?
Bone loss
*Systemic signs usually immunosuppression
** very painful
Where can primary herpes (HSV-1) occur?
Bound and Unbound tissue
*attached keratinized and alveolar
All sexes and races are equally affected by HSV
True
What are 3 drugs used to treat HSV?
Other than topicals Acyclovir (zovirax), Penciclovir (Denavir), Docosanol (Abreva)
Acyclovir
Cibraadine
Valacyclovir
4 Phases of HSV infection
Prodromal (gingival inflammation, fever, etc)
Active (vesicles, shedding, etc)
Latency (back to ganglia)
Reactivation (stress, sun, etc)
What is the term for extra-oral Herpes?
Herpes labialis
Recurrent herpes occurs where in the mouth?
Bound down tissue (attached gingiva)
*grape cluster presentation
What is hand herpes?
Whitlow
*acyclovir
T/F
Aphtous ulcer is not herpes although it looks similar (has a different etiology)
True
T/F
Stippling is found in 35% of children between 5-13
True
What is the mean gingival sulcus depth in pediatric pts?
1 mm
*also no papilla due to wide spacing
Describe the PDL in pediatric pts?
Wider than adults
Name 4 diseases that alter the oral mucosa/gingiva in pediatric pts:
Varicella
Rubella (measles)
Scarlatina (scarlet fever)
Diphtheria
What is the most prevalent gingival disease in childhood?
Chronic marginal gingivitis
(looks like chronic)
*associated with tooth eruption
If the base of the pocket is coronal to underlying bone it is ______, it the pocket is apical to adjacent bone it is _____.
What type of bone loss occurs with each?
Suprabony - Horizontal bone loss
Intra/infrabony - Vertical bone loss
T/F
Elimination of plaque is the rationale behind pocket reduction therapy
True
A “window” into a bone is a _______
Further loss of facial Alveolar bone is ______
Fenestration
Dehiscence
Fenestrations are a development flaw, not active PD
True
What are the 4 Patterns of Bone Loss?
Horizontal
Vertical
Osseous crater
Reverse architecture
What is the most common destructive pattern of bone loss?
Horizontal
What pattern of bone loss has the best chance of regeneration?
3 wall defect
T/F
A 4 wall defect resembles a tooth extraction and doesn’t exist in natural dentition
True
T/F
1 wall defects and horizontal bone loss can’t be grafted
True
Angular or U-shaped defects are known as ______ architecture.
Reverse
Concavities in the crest of the Alveolar bone that are confined within facial and lingual walls are know as…
Osseous craters
Primary Occlusal Trauma occurs when excessive forces are applied to tooth with ______
Secondary Occlusal Trauma occurs when normal/excessive forces are applies to a tooth with ______
Normal periodontium
Reduced periodontium
T/F
Occlusal trauma can cause periodontal pockets and attachment loss
False
Describe consequences of Hypofunction:
4 things
PDL atrophy
PDL space narrows
Cementum increases thickness
Alveolar bone thins
T/F
The difference between Localized Aggressive Periodontitis and Generalized Aggressive Periodontitis is based on location and number of teeth involve, NOT on percentage of sites.
True
5 common PD pathogens:
P.g.
Tannerella forsythia
Treponema denticola
A.a.
Prevotella Intermedia
Red Complex:
P.g.
T.f.
T.d.
What oral manifestation of HIV usually presents at the lateral border of the tongue, is corrugated, and may appear shaggy?
Hairy leukoplakia
***doesn’t wipe off
*take biopsy
Aside from Hairy Leukoplakia and Oral Candidiasis, name 3 oral manifestations of HIV:
Bacillary angiomatosis (red, purple, blue soft lesion)
Kaposi sarcoma (HHV8)
Hyperpigmentation (typically from meds)
T/F
NUS - necrotizing ulcerative stomatitis, is common periodontal disease in AIDS pts
True
NUS, NUG, NUP, and _______ are Perio diseases in HIV pts.
Linear Gingival Erythema
- diffuse gingivitis
- Fiery red
**doesn’t reflect CD4 count
5 Oral signs/symptoms of Diabetes:
Xerostomia
Burning Mouth
Periodontal abscesses
Dental caries
Candidiasis
T/F
Diabetes pts have impaired wound healing, increased plaque from xerostomia, abscesses, altered PMN chemotaxis, and increased bone resorption.
True
Glycosylated Hb Assay (HbA1c)
Normal:
Moderate control:
Needs improvement:
5-6%
6-7%
> 8%
*each 1% change = 25-35 mg/dl glc
T/F
Proper diagnosis is the most important factor in treating PD
True
Primary bacteria associated with gingivitis is balance between G+ and G-
True
Tetracycline/Doxycycline is given in low doses to treat/regulat MMP
True
*NOT as a replacement to Perio Treatment
Biological width =
2-3 mm
Allergic Gingival Enlargments are Plasma Cell associated
True
*changing toothpastes, etc
4 Zones of NUG
Zone 1: Bacterial
Zone 2: Neutrophil
Zone 3: Necrotic
Zone 4: Spirochete infiltration
Acute herpetic gingivostmatitis usually has primary infection early in life and has a viral shedding active phase of _____ days
12 days
*only occurs on attached after reactivation
Primary herpetic gingivostmomatitis shows “balloning degeneration” including Acantholysis - which is separtation of the prickle cells of the stratum spinosum - then nuclear enlargement.
Infected cells fuse, forming multinucleated cells.
This leads to vesicle formation surrounded by zone rich in engorged blood vessels
True
*diagnosed with Tzanck smear, serum Ab titer - ELISA or PCR
3 Systemic meds for Herpes:
Valcyclovir
Vibaradine
Acyclovir
3 Topical meds for Herpes:
Acyclovir
Penciclovir
Docosanol
What is the most important cause of Localized Marginal Recession?
Tooth position in arch
