Perio Flashcards
What are the three parts of the oral epithelium
oral epithelium; Keri
Sulcular: non keri
Junctional; non keri
What is the name of the GCF once inflammation has occurred
inflammatory exudate
I contains a higher level of serum proteins and leukocytes
What is the epithelial attachment
Special part of the junctional epithelium.
consists of lamina lucida, lamina densa and hemidesmosomes.
What is the alveolar bone proper
immediately surrounds the roots of the tooth and to which PDL fibers are attached to.
Perforated cribiform plate
What is the origin of the PDL and what is it primarily made up of
Dental sac collagen fibers (connective tissue fibers)
What are the three specialized cells found in the PDL area
cementoblast/cementoclast
Fibroblasts ( Most abundant) /Fibroclasts
Osteoblasts/Osteoclasts
What is the terminal portion of the gingival fibers called
Sharpey’s fibers
What are the components of the free gingva
gingival margin
Free gingival groove
gingival sulcus
interdental gingiva
What does pathological mobility depend on
quantity of remaining bony support
degree of inflammation
magnitude of occlusal forces
What are the most common medications that cause hyperplasia
Phenytoin (Dilantin)
Cyclosporine A
Nifedipine
What is present in dilantin-induced hyperplasia
Increased accumulation of inflammatory cells
What is pseudo pocketing
pocketing occurs without attachment loss
What are RG signs of O trauma
Widening of PDL Thickening of lamina dura Angular bone loss and infrabony pocket defect root resorption Hypercementosis
What’s necessary for apical shift of the attachment
local irritant and inflamation
What is secondary O trauma
excessive force applied to a tooth or teeth with inadequate bone support (periodontal disease)
What RG changes can be seen in teeth that are no longer in function
reduced trabeculation of bone
narrowing of the PDL space.
What is gingivitis
form of perio disease associated with PLAQUE
No loss of attachment or bone loss
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.
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
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
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
