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Tim's Cards > Oral Soft Tissues II > Flashcards

Oral Soft Tissues II Flashcards

1
Q

T/F

The normal periodontium has little to none Sulcular/Gingival Crevicular Fluid

A

True

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2
Q

How much Gingival Crevicular Fluid (sulcular fluid) is there without gingivitis?

A

0.42 - 1.56 microliters

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3
Q

What type of Antibodies are in sulcular fluid?

A

IgG

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4
Q

What are 3 defense mechanisms of the Gingiva?

A

Sulcular fluid

Leukocytes

Saliva

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5
Q

What antibodies are found in Sulcular Fluid?

A

IgG

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6
Q

T/F

Smoking increases Sulcular Fluid

A

True

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7
Q

T/F

More than 90% of Leukocytes in the gingival sulcus are PMN’s

A

True

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8
Q

T/F

Glycoproteins and mucoids are serve as lubrication and physical protection in the saliva

A

True

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9
Q

What is the major antibody of the Saliva?

Of sulcular fluid?

A

IgA

IgG

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10
Q

What are 2 antibacterial components of Saliva?

A

Lysozyme

Lactoperoxidase (oxidize susceptible bacteria)

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11
Q

Gingival Inflammation:
How many days for Initial lesion?

Early lesion?

Established lesion?

A

2-4 Days

4-7 Days

14-21 Days

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12
Q

The initial lesion (2-4 days) sees a rise of what?

A

Increase in Gingival Cervicular Fluid

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13
Q

T/F

Gingival Bleeding is Cell rich and Collagen poor and is defined by a sulcular ulceration

A

True

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14
Q

What are 3 types of Generalized gingivitis?

A

GM - gingival margin

AG - atached gingiva

Papillae

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15
Q

T/F

Chronic inflammation of the Gingiva progresses from Papilla to Gingival Margin to Attached Gingiva

A

True

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16
Q

What can cause a local color change of the gingiva?

Systemic?

A

Amalgam

Heavy metals

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17
Q

T/F

The consistency of gingival tissue from health to chronic inflammation proceeds from Firm > Edematous > Fibrotic

A

True

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18
Q

T/F

Two types of Chronic Inflammation are Plaque associated and Mouth breathing

A

True

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19
Q

T/F

Two types of Acute Inflammation of the gingiva are Gingival Abscess and Periodontal Abscess

A

True

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20
Q

T/F

Drug-induced Enlargement of the gingiva is a type of Hyperplasia

A

False

*just enlargement

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21
Q

Where does Drug-Induced enlargement of the gingiva begin?

A

Interdental papilla

*extends to facial/lingual margins

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22
Q

3 features of Pathogenesis of Anticonvulsant gingival enlargement:

A

Fibroblast proliferation

Collegenase deactivation

Plaque-induced inflammation

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23
Q

T/F

The dose of Anticonvulsant is responsible for amount of gingival enlargement

A

False

*dose response doesn’t seem to matter

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24
Q

What is more vascular in nature, an enlargement caused by Phynytoin (anticonvulsant), or one cause by Cycolsporine/Tacrolimus (immunosuppressants)>

A

Cyclosporine/Tacrolimus

*Also appears to be dose related

**Expressed in 20-70% of pts taking drug - wow

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25
Q

What has less overgrowth, Cyclosporine or Tacrolimus

(immunosuppressants)?

A

Tacrolimus

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26
Q

Name 3 Calcium channel blockers:

A

Nifedipine

Diltiazem

Verapamil

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27
Q

T/F

Kidney transplant pts can be on Verapamil + Cyclosporine (Ca blocker and immunosuppressant)

A

True

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28
Q

What are the 3 categories of gingival enlargements associated with systemic conditions?

A

Conditioned

Neoplastic

False

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29
Q

What are 3 types of Conditioned gingival enlargements?

A

Hormonal

Nutritional

Allergic

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30
Q

T/F
Pregnancy causes gingivitis

T/F
Prevotella intermedia has been associated with pregnancy

A

False

True

*only predisposes - accentuates response to plaque

**begins in 2nd-3rd month

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31
Q

The pregnancy tumor that needs to be treated is called what?

From whence does it come?

A

Pyogenic Granuloma

Interdental papilla

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32
Q

Name the 4 nutritional influences of Gingiva:

A

Ascorbic acid - (collagen production)

Folic acid

Vitamin B12

Protein Deficiency

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33
Q

T/F

No nutritional deficiencies by themselves cause gingivitis or periodontitis

A

True

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34
Q

T/F
The Perio treatment phases consist of:

Phase 1 Initial (soft tissue)

Re-evaluation (4-6 weeks)

Phase 2 surgical (hard tissue)

Maintenance

A

True

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35
Q

Describe the 1st Phase of Perio treatment:

A

SRP - Scaling and Root Planing

OHI - Oral Hygiene Instruction

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36
Q

When is Scaling and Root planing done in Perio treatment?

A

Phase 1: Initial (soft tissue) therapy

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37
Q

Attached Gingiva =

A

Keratinized Gingiva - Probing Depth

or

Gingival Margin to MGJ minus Probing Depth

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38
Q

T/F

If the GM is above the CEJ, the value is negative

A

True

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39
Q

CAL =

A

GM to CEJ (+ or -) + Probing Depth

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40
Q

Name 3 cell types found in the gingiva:

A

Squamous Epithelium

Keratinocytes

Nonkeratinocytes

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41
Q

What are the 3 Nonkeratinocytes found in the gingiva?

A

Melanocytes

Langerhan’s cells (antigen presenting)

Merkel cells (free nerve endings)

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42
Q

5 Gingival Fibers:

A

Circular

Dentogingival

Dentoperiosteal

Alveologingival

Transseptal

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43
Q

5 Perio Fiber:

A

Alveolar Crest

Horizontal

Oblique (occlusal forces - largest group)

Apical

Interradicular

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44
Q

T/F

The MGJ does not change throughout a lifetime

A

True

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45
Q

What is the line of demarcation of the MGJ?

A

Alveolar Mucosa

Attached gingiva

*keratinized to non-keratinized

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46
Q

What is the effect of smoking on the Gingival Crevicular Fluid?

A

Immediate transient increase in GCF

*smoking event = increase in crevicular fluid

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47
Q

Gingival Crevicular Fluid’s other name:

A

Sulcular fluid

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48
Q

T/F

Periotron analyzes sulcular/GCF after tested with filter paper (threads or micropipette)

A

True

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49
Q

GCF is present in _____ amount in healthy people and _____ amount in people with gingivitis

A

Small

Larger

50
Q

GCF is composed of proteins, Antigen, enzymes, epithelial cells, leukocytes, electrolyte, organic compounds, and ______

A

Antibody - IgG

51
Q

T/F
GCF increases with circadian rhythm (6 AM to 10 PM), sex hormones, chewing, smoking (immediate), and initial pathogenesis

A

True

52
Q

What are the 2 names for the Anti-convulsants?

Mechanism of gingival enlargement?

Dose dependent?

A

Dilantin/Phenytoin

Fibroblast proliferation/collagenase inhibition

no/questionable

53
Q

Name 3 Ca channel blockers:

A

Nifedipine

Diltiazem

Verapamil

54
Q

Name 2 Immunosuppressants:

Compare to Phenytoin:

Dose dependent?

A

Cyclosporine/Tacrolimus

More vascular

yes

55
Q

Describe the Initial, acute, 2-4 day gingival inflammation:

A

PMN’s, macrophage, increased crevicular flow, no gingivitis

56
Q

Describe the Early, 4-7 day gingival inflammation:

A

T-cell

gingivitis - red, bleeding, edema

57
Q

Describe the Established, 2-3 week gingival inflammation:

A

B-cell

Plasma cells

chronic

58
Q

Describe the Advanced stage of gingival inflammation:

A

Periodontitis (alveolar bone loss and pocket formation)

B-cell lesion

59
Q

Name 3 categories of Plaque-Induced disease:

A

Systemic factors (puberty, blood dyscrasias)

Drugs

Malnutrition

60
Q

Non-plaque induced disease includes E. coli, Strep, Neisseria, Treponema, Dandidiasis, Histoplasmosis, and ______.

A

Herpes

*also trauma, genetic, systemic disease

61
Q

What is the most prevalent form of Periodintitis in adults?

A

Chronic

62
Q

Localized chronic periodintitis means

A

30

*also Generalized and Diffuse (GM + papilla)

63
Q

CAL severity:
Slight:

Moderate:

Severe:

A

1-2 mm

3-4 mm

5+ mm

64
Q

Localized Aggressive Periodontitis occurs at what sites?

A

Molars and Incisors

65
Q

Aggressiv Periodontitis is more common in African Americans and is associated with what bug?

What 2 cytokines are elevated?

A

A.a.

PGE2 and IL-1b

66
Q

T/F
Periodontal abscesses has pocket association and PMN accumulation.

T/F
Gingival abscesses have pocket formation and bone loss

A

True

False

*no bone loss or pocket

**Gingival abscess NOT a cyst, but bacteria have been carried into gingival tissue

67
Q

T/F
Periodontitis associated with Pregnancy sees an increase in GCF, and complications can see preterm labor and low birthweight.

A

True

68
Q

4 General risk factors for Periodontal Disease?

A

Microbial

Systemic

Behavioral

Local

69
Q

What are the bugs involved in NUG and NUP?

A

P. intermedia

Spirochetes

Fusiform bacteria

70
Q

T/F
NUG proceeds by: forming pseudomembrane, replacing epithelium with meshwork of fibrin, necrotic epithelial cells, PMN’s, etc.

A

True

71
Q

What forms an interdental crater by punching out papilla?

A

NUG

72
Q

Describe the treatment for NUG:

A

1st - debridement, Oral Hygiene Instruction

2nd - 1-2 weeks, OH

3rd - 4-6 weeks, possible gingivectomy

*Amoxicillin/Metronidazole (clindamycin if allergic)

73
Q

How does NUP differ from NUG?

A

Bone loss

*Systemic signs usually immunosuppression

** very painful

74
Q

Where can primary herpes (HSV-1) occur?

A

Bound and Unbound tissue

*attached keratinized and alveolar

75
Q

All sexes and races are equally affected by HSV

A

True

76
Q

What are 3 drugs used to treat HSV?

Other than topicals Acyclovir (zovirax), Penciclovir (Denavir), Docosanol (Abreva)

A

Acyclovir

Cibraadine

Valacyclovir

77
Q

4 Phases of HSV infection

A

Prodromal (gingival inflammation, fever, etc)

Active (vesicles, shedding, etc)

Latency (back to ganglia)

Reactivation (stress, sun, etc)

78
Q

What is the term for extra-oral Herpes?

A

Herpes labialis

79
Q

Recurrent herpes occurs where in the mouth?

A

Bound down tissue (attached gingiva)

*grape cluster presentation

80
Q

What is hand herpes?

A

Whitlow

*acyclovir

81
Q

T/F

Aphtous ulcer is not herpes although it looks similar (has a different etiology)

A

True

82
Q

T/F

Stippling is found in 35% of children between 5-13

A

True

83
Q

What is the mean gingival sulcus depth in pediatric pts?

A

1 mm

*also no papilla due to wide spacing

84
Q

Describe the PDL in pediatric pts?

A

Wider than adults

85
Q

Name 4 diseases that alter the oral mucosa/gingiva in pediatric pts:

A

Varicella

Rubella (measles)

Scarlatina (scarlet fever)

Diphtheria

86
Q

What is the most prevalent gingival disease in childhood?

A

Chronic marginal gingivitis

(looks like chronic)

*associated with tooth eruption

87
Q

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?

A

Suprabony - Horizontal bone loss

Intra/infrabony - Vertical bone loss

88
Q

T/F

Elimination of plaque is the rationale behind pocket reduction therapy

A

True

89
Q

A “window” into a bone is a _______

Further loss of facial Alveolar bone is ______

A

Fenestration

Dehiscence

90
Q

Fenestrations are a development flaw, not active PD

A

True

91
Q

What are the 4 Patterns of Bone Loss?

A

Horizontal

Vertical

Osseous crater

Reverse architecture

92
Q

What is the most common destructive pattern of bone loss?

A

Horizontal

93
Q

What pattern of bone loss has the best chance of regeneration?

A

3 wall defect

94
Q

T/F

A 4 wall defect resembles a tooth extraction and doesn’t exist in natural dentition

A

True

95
Q

T/F

1 wall defects and horizontal bone loss can’t be grafted

A

True

96
Q

Angular or U-shaped defects are known as ______ architecture.

A

Reverse

97
Q

Concavities in the crest of the Alveolar bone that are confined within facial and lingual walls are know as…

A

Osseous craters

98
Q

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 ______

A

Normal periodontium

Reduced periodontium

99
Q

T/F

Occlusal trauma can cause periodontal pockets and attachment loss

A

False

100
Q

Describe consequences of Hypofunction:

4 things

A

PDL atrophy

PDL space narrows

Cementum increases thickness

Alveolar bone thins

101
Q

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.

A

True

102
Q

5 common PD pathogens:

A

P.g.

Tannerella forsythia

Treponema denticola

A.a.

Prevotella Intermedia

103
Q

Red Complex:

A

P.g.

T.f.

T.d.

104
Q

What oral manifestation of HIV usually presents at the lateral border of the tongue, is corrugated, and may appear shaggy?

A

Hairy leukoplakia

***doesn’t wipe off

*take biopsy

105
Q

Aside from Hairy Leukoplakia and Oral Candidiasis, name 3 oral manifestations of HIV:

A

Bacillary angiomatosis (red, purple, blue soft lesion)

Kaposi sarcoma (HHV8)

Hyperpigmentation (typically from meds)

106
Q

T/F

NUS - necrotizing ulcerative stomatitis, is common periodontal disease in AIDS pts

A

True

107
Q

NUS, NUG, NUP, and _______ are Perio diseases in HIV pts.

A

Linear Gingival Erythema

  • diffuse gingivitis
  • Fiery red

**doesn’t reflect CD4 count

108
Q

5 Oral signs/symptoms of Diabetes:

A

Xerostomia

Burning Mouth

Periodontal abscesses

Dental caries

Candidiasis

109
Q

T/F
Diabetes pts have impaired wound healing, increased plaque from xerostomia, abscesses, altered PMN chemotaxis, and increased bone resorption.

A

True

110
Q

Glycosylated Hb Assay (HbA1c)
Normal:

Moderate control:

Needs improvement:

A

5-6%

6-7%

> 8%

*each 1% change = 25-35 mg/dl glc

111
Q

T/F

Proper diagnosis is the most important factor in treating PD

A

True

112
Q

Primary bacteria associated with gingivitis is balance between G+ and G-

A

True

113
Q

Tetracycline/Doxycycline is given in low doses to treat/regulat MMP

A

True

*NOT as a replacement to Perio Treatment

114
Q

Biological width =

A

2-3 mm

115
Q

Allergic Gingival Enlargments are Plasma Cell associated

A

True

*changing toothpastes, etc

116
Q

4 Zones of NUG

A

Zone 1: Bacterial

Zone 2: Neutrophil

Zone 3: Necrotic

Zone 4: Spirochete infiltration

117
Q

Acute herpetic gingivostmatitis usually has primary infection early in life and has a viral shedding active phase of _____ days

A

12 days

*only occurs on attached after reactivation

118
Q

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

A

True

*diagnosed with Tzanck smear, serum Ab titer - ELISA or PCR

119
Q

3 Systemic meds for Herpes:

A

Valcyclovir

Vibaradine

Acyclovir

120
Q

3 Topical meds for Herpes:

A

Acyclovir

Penciclovir

Docosanol

121
Q

What is the most important cause of Localized Marginal Recession?

A

Tooth position in arch

Tim's Cards (140 decks)

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