Perio Flashcards by Luis Franco

What are the three parts of the oral epithelium

oral epithelium; Keri
Sulcular: non keri
Junctional; non keri

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What is the name of the GCF once inflammation has occurred

inflammatory exudate

I contains a higher level of serum proteins and leukocytes

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What is the epithelial attachment

Special part of the junctional epithelium.

consists of lamina lucida, lamina densa and hemidesmosomes.

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What is the alveolar bone proper

immediately surrounds the roots of the tooth and to which PDL fibers are attached to.
Perforated cribiform plate

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What is the origin of the PDL and what is it primarily made up of

Dental sac
collagen fibers (connective tissue fibers)

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What are the three specialized cells found in the PDL area

cementoblast/cementoclast
Fibroblasts ( Most abundant) /Fibroclasts
Osteoblasts/Osteoclasts

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What is the terminal portion of the gingival fibers called

Sharpey’s fibers

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What are the components of the free gingva

gingival margin
Free gingival groove
gingival sulcus
interdental gingiva

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What does pathological mobility depend on

quantity of remaining bony support
degree of inflammation
magnitude of occlusal forces

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What are the most common medications that cause hyperplasia

Phenytoin (Dilantin)
Cyclosporine A
Nifedipine

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What is present in dilantin-induced hyperplasia

Increased accumulation of inflammatory cells

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What is pseudo pocketing

pocketing occurs without attachment loss

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What are RG signs of O trauma

Widening of PDL
Thickening of lamina dura
Angular bone loss and infrabony pocket defect
root resorption 
Hypercementosis

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What’s necessary for apical shift of the attachment

local irritant and inflamation

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What is secondary O trauma

excessive force applied to a tooth or teeth with inadequate bone support (periodontal disease)

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What RG changes can be seen in teeth that are no longer in function

reduced trabeculation of bone

narrowing of the PDL space.

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What is gingivitis

form of perio disease associated with PLAQUE

No loss of attachment or bone loss

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What is the first stage of gingivitis

Transient (incipient) stage; within 2-4 days after cessation of OH.
Margination of PMN’s in vessels close to JE.

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What is the second stage of gingivitis

Developing stage; Area of collagen destruction becomes larger and is occupied by fluid containing: Fibrin, immunoglobulin (IgG), complement, inflammatory cells (B or T lymphocytes, macrophages.
LYMPHOCYTES are the predominant cell

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What is the third stage of gingivitis

Chronic stage; cytologic characteristics of the inflammatory infiltrate in the gingival lamina propria are changed.
PLASMA cells predominate
IgG is produced by most the plasma cells
Few cells containing IgA are present, mostly in saliva
IgM containing cells are rarely seen

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What are cytokines

Infection-fighting factors involved in healing.

In excess they can cause inflammation and severe damage.

T-cells are important in

Cell mediated immunity.
Type IV hypersinsitivity reactions (contact dermatitis)
Modulation of antibody-mediated immunity.

What are the major classes of T-cells

Helper T-cells
Suppressor T-cells
Cytotoxic T-cells

What is neutropenia

Abnormal decrease in the number of PMNs in the blood

Associated with: Acute leukemia, infection, RA, vit B12 def, chronic splenomegaly.

What is leukemia

malignant neoplasm of immature WBC Pt's with acute leukemia have more oral complications than those with chronic leukemias. Gingiva; grosly enlarged, bluish-red in color, soft spongy consistency and blunted papilla

What is pregnancy gingivitis

bleeding is the most common complaint severity increases from second to eighth month. Similar increase seen at or around puberty and with long term use of oral contraceptives. Tx; OHI and scaling

What are the four local signs of acute inflammation

Rubor calor; dilation of blood vessels and high metabolic rate of PMNs and macrophages. Tumor; from increased cellular permeability Dolor; due to lysis of cells triggers production of Bradykinin and prostaglandins

What does a mast cell release

heparin and histamine due to injury or inflammation.

What is the purpose of histamine

causes vasodilation and increased vascular permeability

Where histamine stored

Mast cells Platelets basophils

What is the extent of localized perio

<30% of sites involved

What is the extent of generalized perio

>3O%

What is the severity of 1-2 mm of CAL

Slight

What is the severity of 3-4 mm of CAL

Moderate

What is the severity of >5 mm of CAL

Severe

What are the two bacteria associated with Generalized Aggressive perio and occurs at what age

``` prevotella intermedia Eikenella corrodens 12 to 25 yo Episodic, rapid and severe attachment loss Weak serum response ```

what are the two bacteria that dominate on Local aggressive perio and occurs at what age

``` Gram negative anaerobes: Actinobacillus Actinomycetemcomitans Capnocytophaga 8-22 y/o Strong serum response Confined to incisors and first molars. relative lack of local factors to explain it, possible genetic predespostion or dysfunction of PMNs (chemotactic defect) ```

What are the characteristics of ANUG

Interproximal necrosis and pseudomembrane formation on marginal tissues. History of : Soreness, bleeding gums, fetor otis, low grade fever, malaise. Age; 18-30

What are the predisposing factors to ANUG

``` 18-30 y/o Smoking gingivitis poor OH fatigue stress poor nutrition immune-compromised pts ```

Wha is the tx for ANUG

debriment Hydrogen peroxide rinses Abx therapy

What are the characteristics of HIV gingivitis

defined linear marginal gingival erythema | resistant to conventional therapy

What are the characteristics of HIV periodontitis

rapid progression of destruction of gingiva with ulceration and cratering. Necrosis leading to sequestration of alveolar bone. Extremely painful

Where does an endotoxin comes from and where is it found

Cell wall of gram negative bacteria. | Free endotoxin found in dental plaque and inflamed gingiva.

What do endotoxins promote

bone resorption inhibit osteogenesis chemotaxis of PMNs

What are the three methods for treating a periodontal abscess

cuettage via the sulcus Flap surgery I and D

What is the bacterial count on plaque

10^10 bacteria per milligram

What material contributes to the ability of plaque to adhere to teeth

Dextrans

What inorganic compounds are found in plaque

Ca and phosphate

What two species are early tooth colonizers

neisseria and streptococci

What are the O components of calculus

microorganisms, desquamated epithelial cells, leukocytes and mucin

What are the objectives of perio surgery

``` pocket reduction promotion of gingival reattachment tx the etiology remove or eliminate lesion restore form and function ```

modified Widman flap

new attachment at a more coronal level | Preserves adequate zone of attached gingiva