Perio Flashcards
What does a BPE score 0 mean
No pockets
No calculus/overhangs
No BOP
What does a BPE score 1 mean
No pockets
No calculus/overhangs
BOP
What does a BPE score 2 mean
No pockets
Supra or subgingival calculus/overhangs
What does a BPE score 3 mean
Probing depth 3.5-5.5 mm
What does a BPE score 4 mean
Probing depth above 5.5 mm
What does * mean for perio
Furcation involvement meaning you can see where the roots diverge
Which teeth are assessed in sillness and loe
UR6, UR2, UL4, LR4, LL2, LL6
How does sillness and Loe score the teeth examined
They are added and divided by 4 then divided by 6 (the number of teeth’s examined)
What does a score of 0 in sillness and loe mean
No plaque
What does a score of 1 mean in sillness and loe
Film visible only by removal with probe
What does a score of 2 mean in sillness and loe
Moderate accumulation of plaque at the gingival margin visible to the naked eye
What does a score 3 mean in sillness and loe
Heavy accumulations of plaque easily visible in the gingival crevice and interdentally
How does the modified turesky technique measure perio
0 to 5 is assigned to buccal and lingual non restored surface of all the teeth expect third molars
How is an index determined for the modified turesky technique
By dividing the total score by the number of surfaces (max 56)
How do you calculate the index with the O’Leary technique
Total number of tooth surfaces with stained plaque recorded DIVIDED BY the total number of surfaces present TIMES 100 = %
What does a mobility score 0 mean
No detectable movement above 0.2mm
What does a mobility score 1 mean
Horizontal mobility between 0.2 and 0.5 mm
What does a mobility score 2 mean
Movement 0.5 - 1 mm
What does a mobility score 3 mean
Above 1 mm or vertical displacement
What does furcation grading 1 mean
Less than 3mm horizontal probing
What does furcation grading 2 mean
Grater than 3mm but not through
What does furcation grading 3 mean
Through and through involvement
What is gingivitis
Reversible inflammation of gingival with no accompanying destruction of periodontal tissues
Why does gingivitis occur
Most commonly develops in response to plaque adherent to tooth surfaces or adjacent restorations
May occur in relation to hormonal disturbances
How long can it take for gingivitis to occur
21 days
What is periodontitis
Bacterially induced, immune mediated inflammatory diseases of tissues supporting teeth
What does periodontitis destroy
PDL and alveolar bone
How many bacterial species are there in the human oral microbiome
Nearly 800
What make up the 60% pioneer bacteria
Streptococcus species
What are 3 other pioneer bacteria
Actinomyces
Veillonella
Neisseria
List 5 examples of host susceptibility to perio
Gene polymorphism
PMN defects
Smoking
Diabetes
Immunosuppression
What does plaque consist of
Diverse population of micro organisms embedded in extracellular matrix polymers
What is calculus
Calcified deposit found on surfaces of teeth covered by biofilm of plaque calcium and phosphate crystals appear
What are the 4 different types of calcium phosphate crystal
Octacalcium phosphate
Hydroxyapatite
Whitlockite
Brushite
How long does it take for supragingival calculus to form
Within 12 days
What is supragingival calculus
About gingavae
Builds in creamy amorphous layers particularly lingually around lower incisors and buccal on maxillary molars near salivary duct openings
Where is the mineral content derived from in supragingival calculus
Saliva
Where is mineral content derived from in subgingival calculus
GCF
Which calculus build up is commonly anaerobic
Subgingival
What is non specific plaque hypothesis
Disease due to volume of plaque not type of microbes
Microbes produce virulence factors that lead to inflammation and tissue destruction
What is specific plaque hypothesis
Microbial analysis revealed bacteria that are more often associated with disease than with health
Focuses on periodontal disease that have specific microflora associated
What is ecological plaque theory
Accumulation of plaque results in inflammation which changes local environment
Facilitates shift in microflora causing more inflammation
What is polymicrobial synergy and dysbiosis
All plaque biofilms have potential to stimulate disease and although toxic and proinflammatory usually tolerated
Where are red complex bacteria most frequently found
In deep periodontal pockets
What are 3 red complex’s
P gingivalis
T forsythia
T denticola
What are 4 orange complex’s
P intermedia
P nigrescens
P micros
F nucleatum
What are 3 yellow complex’s
S oralis
S mitis
E corrodens
What type of bacteria is periodontitis largely associated with
Gram negative bacteria
What are 3 species of designated periodontal pathogens
Aggregatibacter actinomycetemcomitans
Porphyromonas gingivalis
Tannerella forsythia
What does aggregatibacter actinomycetemcomitans do
Multiple adhesion molecules allow strong binding to various surfaces
Invades epithelial cells and fibroblasts
Blocks T cell proliferation and has immunosuppressive functions
What does porphyromonas gingivalis do
Inhibits neutrophil function - cannot phagocytose
Uses gingipains to produce inflammatory state in neutrophils and release pro inflammatory cytokines
Suppresses antigen presenting function of epithelial cells
What are 5 virulence factors
Fimbriae from adherence
Proteases
Bone resorbing factors
Toxins - leukotoxin, cytotoxic metabolites
Capsule
What effect does interlukin 1 have
Osteoclast activation
Margination of neutrophils
TNF production/release
Prostaglandin IL 6 release from fibroblasts
What effect does interleukin 6 have
Increase bone resorption
Activates T cells and differentiation of B cells
B cells and IG production
What effect does interlukin 8 have
Chemotaxis (strong) of neutrophils
What effect does interleukin 10 have
Anti inflammatory suppression
When does an initial lesion occur
2-4 days
When do early lesions occur
4-7 days
When do established lesions occur
2-3 weeks
When do advanced lesions occur
More than 3 weeks
What is the shape of bacilli
Rods
What are 3 bacilli
Bacillus
Fusiform
Vibrio
What shape are cocci
Round
What are 3 cocci species
Diplococci
Streptococci
Staphylococci
What shape are spirochetes
Spiral
What are the 2 types of spirochetes
Loosely spiralled
Tightly spiralled
What are oxygen loving bacteria called
Obligate aerobes
What are oxygen hating bacteria called
Obligate anaerobes
What are the 2 neither loving or hating bacteria called
Facultative anaerobes
Aerotolerant anaerobes
What are 5 gram positive bacteria
Streptococcus sanguinis
Streptococcus oralis
Actinomyces naesludii
Actinomyces viscosus
Veilonella species
What type of bacteria are present in healthy gingival sulcus
Gram positive cocci
What 2 adhesions attach to bacteria on the tooth
Fimbri
Pilli
What does inflammation increase the flow of
GCF
List 3 bacteria present in periodontitis
Porphyromonas gingivalis
Tanerella forsythia
Treponema denticola
What is the main bridging species
Fusobacterium nucleatum
What happens during the initial lesion stage
Increased GCF flow
Neutrophil accumulation
Early loss of perivascular collagen
Increased permeability
What activates the complement during the initial lesion stage
Lipopolysaccharides and peptidoglycans in bacterial cell walls via alternative pathway
Enter tissue causing mast cells to release vasoactive amines - vasodilation
During the initial lesion stage how much of connective tissue does the lesion occupy
5-10%
At what stage does plaque biofilm begin to extend subgingivally
Early lesion stage 4-7 days
What is the vascular change during the early lesion stage
Opening of dormant capillary beds increasing permeability
What is the change in GCF at the early lesion stage
Increased GCF and changes from interstitial fluid to inflammatory exudate escalation of inflammation
What percentage of lymphocytes infiltrate around 21 days
70%
At the early lesion stage what mainly infiltrates
T cells along with antigen presenting cells and macrophages
At what stage does a false pocket begin
Established lesion stage
What is a false pocket
Deepened gingival sulcus but stable and attached
At what stage can gingivitis progress to periodontitis
Established lesion stage due to deepening of gingival sulcus
What is the defining feature of the established lesion stage
Predominance of plasma cells in connective tissues
What causes the periodontal pocket to form
B cell lesion progression
Connective tissue breakdown leads to loss of attachment
Early proliferation apical migration and lateral extension of junctional epithelium
What happens during the established lesion stage
Increased permeability and ulceration of pocket epithelium
Ingress bacterial products - continued production of inflammatory cytokines - perpetuation of pro inflammatory process
At what stage does early bone loss occur
Established lesion stage
What is the main difference in the advanced lesion stage
Overt loss of attachment
