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3rd year - module 6 > Perio > Flashcards

Perio Flashcards

1
Q

What causes pocketing in periodontal disease?

A

the pocket is filled with pathogenic anaerobes resulting in an inflammatory reaction in the adjacent gingival tissues, resulting in the pocket wall becoming ulcerated and leaky

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2
Q

What is the surface area of the exposed ulcerated periodontal pockets estimated to be in a subject with deep periodontal pocketing?

A

20-30cm squared
equivalent to SA of palm

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3
Q

How do periodontal bacteria and inflammatory mediators enter the systemic bloodstream?

A

periodontal tissues are very vascular and the blood vessels within the inflamed tissue are very leaky, allowing the baceraemia and mediators to spill over into the systemic circulation

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4
Q

What accounts for the possible link between periodontal disease and systemic disease?

A

the spilling over of periodontal bacteria and inflammatory mediators into the systemic bloodstream
- raising systemic inflammation
- direct effects of periodontal bacteria
- combination of both

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5
Q

What are 8 examples of systemic diseases that have possible links to periodontal disease?

A

1) diabetes - good evidence of bi-directional relationship
2) cardiovascular disease
3) adverse pregnancy outcomes
4) respiratory disease
5) kidney disease
6) osteoporosis
7) Alzheimer’s disease
8) inflammatory bowel disease

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6
Q

What are the three classifications of periodontal manifestations of systemic diseases and conditions?

A

1) systemic disorders that have a MAJOR impact on loss of perio tissues by influencing periodontal inflammation
2) other systemic disorders that INFLUENCE the pathogenesis of periodontal diseases
3) systemic disorders that result in a loss of periodontal tissues INDEPENDENT of periodontitis

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7
Q

What is a group 1 disease in the 2017 classification?

A

Periodontitis as a manifestation of systemic disease

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8
Q

What are the sub-groups of group 1 diseases influencing periodontitis?

A

Periodontitis as a manifestation of systemic disease
1.1 Genetic disorders
1.2 acquired immunodeficiency diseases
1.3 diseases affecting the connective tissues
1.4 metabolic and endocrine disorders

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9
Q

What kind of classification does Down Syndrome come under in the perio classifications and what are the risks?

A

Classification group 1: 1.1 genetic disorders
- increased prevalence and severity of periodontitis with evidence of high risk of loss of attachment starting in adolescence
- abnormal collagen biosynthesis

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10
Q

What does Down Syndrome occur as a result of?

A

trisomy chromosome 21
causes learning difficulties and tendency for inadequate OH

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11
Q

What immune defects do people with down syndrome suffer from?

A
  • neutrophil (PMN) defects - chemotaxis, phagocytosis, killing defects
  • association with T-cell migration to periodontal tissues and increased release of matrix metalloproteinases leading to tissue damage
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12
Q

What group does Papillon-Lefevre come under in the perio classifications?

A

classification group 1 ; 1.1 genetic disorders

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13
Q

What kind of syndome is papillon lefevre syndrome?

A

autosomal recessive - defect chromosome II
- reduced function of neutrophils

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14
Q

What are the classical signs of Papillon-Lefevre syndrome?

A

seen between 2-4yrs:
- palmar (hands) plantar (feet) hyperkeratosis
- associated with severe periodontitis soon after eruption and early loss of teeth, primary and secondary

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15
Q

What group does Chediak-Higashi syndrome come under in the perio classifications?

A

classification group 1; 1.1 genetic disorders

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16
Q

What kind of genetic disorder is Chediak-Higashi syndrome?

A
  • rare autosomal recessive condition
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17
Q

What are the features of Chediak-Higashi syndrome?

A

defects in neutrophil and monocyte chemotaxis, phagocytosis and reduced intracellular killing
- severe periodontitis with high risk of early loss of primary and secondary teeth - responds poorly to perio treatment

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18
Q

What group does Cyclic neutropenia (reduced numbers of leukocytes) come under in the perio classifications?

A

classification group 1; 1.1 genetic disorders

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19
Q

What kind of genetic disorder is cyclic neutropenia?

A

rare autosomal dominant condition

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20
Q

What are the features of cyclic neutropenia?

A
  • cyclical depression of neutrophils (PMNs)
  • oral ulceration and rapid periodontal destruction associated with periods of low neutrophil numbers
  • ulceration/necrosis of gingival margin
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21
Q

What group does Ehlers Danlos syndrome come under in the perio classifications?

A

classification group 1; 1.3 diseases affecting connective tissues

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22
Q

What are the features of Ehlers Danlos syndrome?

A
  • various genetic defects resulting in defects of collagen synthesis - excessive joint mobility, skin hyper-extendability, cardiac valve defects
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23
Q

What are the IO subtypes of Ehlers Danlos syndrome?

A

type IV - associated with bleeding tendency
type VIII - associated with aggressive-like (grade C) periodontitis

24
Q

What group does hypophosphatasia come under in the perio classifications?

A

Classification 1: 1.4 metabolic and endocrine disorders

25
Q

What kind of condition in hypophosphatasia?

A

rare - autosomal recessive condition

26
Q

What are the features of hypophosphatasia?

A
  • deficiency in enzyme alkaline phosphatase
  • abnormal mineralisation of bones and teeth; abnormal cementum
  • premature loss of deciduous teeth
  • permanent teeth appear not to be affected
27
Q

What group does HIV infection come under in the perio classifications?

A

Classification group 1; 1.2 acquired immunodeficiency diseases

28
Q

What are the two periodontal conditions associated with HIV infection?

A

1) necrotising gingivitis
2) necrotising periodontitis - (necrotising stomatitis)

29
Q

Which is more severe necrotising gingivitis or necrotising stomatitis?

A

necrotising stomatitis

30
Q

HIV associated necrotising periodontal disease has higher risks of what when compared to the same condition in non-HIV patients?

A
  • higher risk of progression to more severe lesions i.e. from NG to NP/NS
  • Higher risk of recurrence and poorer response to treatment
31
Q

What is the microbiological difference in HIV infected patients?

A

they have similar perio bacteria to non-HIV patients but candida species often associated, which could explain resistance to perio treatment

32
Q

What is the presentation of necrotising gingivitis?

A

same in HIV and non-HIV pts
- painful, red, swollen gingivae
- yellow-ish, grey-ish marginal necrosis with loss of interdental papillae
- gingival bleeding
- halitosis
- no LOA
- anterior gingivae mostly affected
- localised or generalised
can progress to NUP leading to severe damage

33
Q

What is the presentation of necrotising periodontitis (NP)?

A

same in HIV and non-HIV pts
- ulceration/necrosis leading to soft tissue loss
- exposure, destruction or sequestration of bone, especially in severely immunocompromised
- not always assoc with deep pockets due to rapid hard and soft tissue loss (rapid increase in mobility)
- severe deep pain/localised to jaw bone (important feature)
- widespread BOP - >50% spontaneously
- halitosis
- usually several independent localised lesions
- can be chronic in nature with acute phases of ulceration and quiescent phases without ulceration

34
Q

What are the treatment options for HIV infected patients?

A
  • conventional debridement - OHI, PMPR etc
  • remove necrotic tissue/bone sequestrae under LA
  • antimicrobial treatment - oral metronidazole (200-400mg, 3x daily for 7days)
  • twice daily chlorhexidine mouthwash useful in active treatment and maintenance
35
Q

What are group 2 periodontal classifications and give examples?

A

other systemic disorders that INFLUENCE the pathogenesis of perio disease
essentially conditions which are risk factors/disease modifiers for perio
e.g. diabetes, osteoporosis, obesity, arthritis, emotional stress and depression

36
Q

What are group 3 periodontal classifications?

A

systemic disorders that can result in loss of periodontal tissues INDEPENDENT of periodontitis (i.e. cause damage to the perio tissues)
2017 classification; systemic diseases or conditions affecting the periodontal supporting tissues

37
Q

What are the two sub-types of group 3 periodontal classification?

A

3.1 neoplasms - oral SCC, odontogenic tumours
3.2 other disorders that may affect perio tissues - giant cell granulomas, systemic sclerosis (scleroderma)

38
Q

What group does systemic sclerosis (scleroderma) come under in the perio classifications?

A

classification group 3; 3.2 other disorders that may affect perio tissues

39
Q

What is systemic sclerosis (scleroderma)?

A
  • tight inflexible skin due to fibrosis: mask-like face, restricted oral opening (microstomia)
  • autoimmune disease affecting connective tissues
40
Q

What are the dental aspects of systemic sclerosis (scleroderma)?

A
  • tight skin, mask-like face, restricted oral opening
  • gingival recession common and increased prevalence of periodontitis
  • radiographically increased width of PDL and gradual obliteration of lamina dura - increased tooth mobility
41
Q

What are three conditions classified under the other systemic conditions which may appear on the periodontium?

A

1) desquamative gingivitis
2) drug-influenced gingival enlargements
3) factitious injury (self-harm)

42
Q

What is desquamative gingivitis?

A

when the gingivae is red, glazed with ulceration and there is desquamation of the attached gingivae (not plaque induced)

43
Q

What other diseases can present as desquamative gingivitis?

A
  • lichen planus
  • benign mucous membrane pemphigoid
  • pemphigus vulgaris
  • plasma cell gingivitis
  • erythema multiforme
44
Q

What does drug -influenced gingival enlargements result from?

A

aberrant (abnormal) effects not expected from known pharmacological actions of the drug when given in normal therapeutic doses

45
Q

How variable are drug influenced gingival enlargements?

A

very - can range from being very minor to covering the entire teeth in extreme cases

46
Q

What difficulties can drug influenced gingival enlargements cause?

A
  • difficulty with OH (perio risk)
  • aesthetic and functional problems (occluding onto excessive gingival tissues)
47
Q

What main three groups of drugs are associated with gingival enlargements?

A

1) anti-epileptic drugs - phenytoin and sodium valproate
2) calcium channel blockers - used for hypertension, nifedipine, amlodipine, verapamil
3) immune regulators - cyclosporin (typically organ transplant pts)

48
Q

What is needed in conjunction with a drug to cause drug influenced gingival enlargement (DIGE)?

A

a plaque biofilm

49
Q

What are the target cells that are affected in DIGE?

A

gingival fibroblasts
- increased production of ECM proteins
- reduced collagenase production leading to reduced tissue turnover

50
Q

Where and who do DIGE lesions appear in?

A
  • higher prevalence in younger age groups
  • tends to affect anterior regions, affecting papilla first within 3 months of starting medication
  • no associated LOA due to medication
51
Q

What is the approximate incidence of DIGE in pts taking phenytoin, cyclosporin and calcium channel blockers?

A

phenytoin - 50%
cyclosporin - 30%
calcium channel blockers - 15%

52
Q

What preventative measures can be put in place to prevent DIGE?

A
  • good plaque control will not prevent overgrowth but may reduce severity
  • folic acid supplementation may be effective for phenyoin-related gingival enlargement where plasma and RBC level of folate are low
  • can request GMP to change medications
  • traditionally managed with gingivectomy
53
Q

What are some rarer causes of gingival enlargements? excluding drugs

A
  • hormonal - pregnancy epulis, puberty
  • neoplasia - leukaemia
  • hereditary gingival fibromatosis
  • granulomatosis with polyanglitis (Wegener’s granulomatosis)
54
Q

What is Wegener’s granulomatosis?

A
  • Granulomatosis with polyangiitis
  • rare autoimmune disease resulting in disseminated granulomatous vasculitis of small vessels
  • characteristic “strawberry gums”
  • potentially fatal, often due to respiratory disease and renal failure
55
Q

What is a factitious injury?

A

self harm

56
Q

What are some examples of factitious injury concerning the periodontium?

A
  • self mutilation (rare)
  • typically localised lesions on gingiva of young people which may be ulcerated or have marginal keratosis from chronic trauma - notched recession defects caused by finger nails, pencils, knives etc
  • habitual behaviours - attention seeking, psychiatric disorder

3rd year - module 6 (14 decks)

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