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NBDE Pt 2 Flash Cards > Perio > Flashcards

Perio Flashcards

1
Q

True or false… streptococcus gordonii is part of the normal oral flora

A

True. It is gram-positive cocci. It is one of the initial colonizers of the dental biofilm. It creates a binding site for other bacteria to adhere in the process known as congregation

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2
Q

Name 3 bacterial species that are well-known pathogens responsible for causing periodontitis.

A

Aggregatibacter actinomycetemcomitans, pophyromonas gingivalis, tannerella forsynthia

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3
Q

Name three medications that can cause gingival hyperplasia.

A

Calcium channel blockers

Phenytoin (Dilantin)

Cyclosporine

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4
Q

During the first 48 hours of plaque formation the majority of the bacteria present are…

A

Gram-positive cocci and rods like streptococcus and actinomyces species

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5
Q

What bacterial species is most associated with localized aggressive periodontitis?

A

Aggregatibacter actinomycetemcomitans

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6
Q

The mechanism of action that influences the severity of localized aggressive periodontitis is ___

A

Defects in neutrophil chemotaxis

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7
Q

What are the most common associated symptoms/signs with acute herpetic gingivostomatitis?

A

Self limiting disease that lasts 10 days

Caused by herpes simplex virus

Fever and lymphadenopathy - vesicles appear two days later

Recurrent gingivostomatitis has a clear preference for keratinized tissues

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8
Q

Hermetic gingivostomatitis is typically treated with ___

A

Valacyclovir

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9
Q

What bacteria is most commonly associated with acute necrotizing ulcerative periodontitis (ANUP)?

A

Treponema denticola

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10
Q

What are the signs/symptoms of acute necrotizing gingivitis?

A

Pain
Interproximal necrosis of papilla

Bleeding gingiva

Fetid odor

Low-grade fever

Pseudomembrane

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11
Q

What are the risk factors for acute necrotizing gingivitis?

A

Poor oral hygiene

Smoking

Malnutrition

Fatigue

Stress

Immunocompromised pts

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12
Q

___ and ___ are most commonly associated with chronic periodontitis

A

Porphyromonas gingivalis*

Tannerella forsythia

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13
Q

What is the difference between primary and secondary occlusal trauma?

A

Primary - trauma that is experienced by a tooth having a normal healthy periodontium

Secondary - condition where a tooth with a compromised periodontium may experience further trauma under normal occlusal loads

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14
Q

What are 3 common causes of primary occlusal trauma?

A

Over-filled restorations

Crowns with high occlusion

Heavy biting of hard substances

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15
Q

What is the most common cause of gingival recession?

A

Toothbrush abrasion

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16
Q

True or false.. calculus on its own does not cause gingivitis

A

True. It provides a hard and rough surface for plaque to grow

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17
Q

True or false… sex hormones in puberty can influence inflammation of gingiva

A

True it causes an exaggerated reaction over plaque build up

Estrogen is the primary hormone associated with puberty and pregnancy assocaited gingivitis

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18
Q

Name three calcium channel blockers

A

Amlodipine

Verapamil

Diltiazem

All can cause gingival hyperplasia

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19
Q

Which periodontal fibers are most likely to cause orthodontic relapse?

A

Supracrestal fibers

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20
Q

True or false… the inflammatory response is conducive to healing in a bone graft

A

False. A good bone grating should be biocompatible and should not produce any immune response

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21
Q

Aggressive periodontitis is rapidly progressing disease that can be better managed with ___ and ___

A

Complete root debridement

Antibiotic therapy

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22
Q

True or false… systemic antibiotics are considered to ensure that the antibiotic molecule reaches the site better than locally placed antibiotics because with locally placed antibiotics, it may not reach the deep pockets.

A

True

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23
Q

The ___ is the most important variable when determining the periodontal prognosis of a tooth

A

CAL (clinical attachment loss)

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24
Q

What periodontal defect has the worst prognosis for bone grafting?

A

Class 4 furcation

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25
Q

____ is an essential factor that increases the success of a free gingival graft

A

Immobilization of the graft at the recipient site

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26
Q

Regeneration of junction all epithelium takes about ___ days to complete after surgery

A

10-14

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27
Q

Debridement of intraoral lesions are performed to remove dead and infected surfaces through the use of ___

A

3% hydrogen peroxide solution

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28
Q

____ also known as lugol’s solution, is a great antiseptic agent that has a wide spectrum of antimicrobial activity and is used to….

A

1% tincture of iodine

Pre-and post-surgical mouth rinse to reduce chances of bacterial infection over the surgical site

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29
Q

True or false… chlorhexidine is an antiseptic rinse that helps remove dead tissues

A

False

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30
Q

An apically repositioned flap usually requires displacement of the gingiva to a more apical position, requireing ____ except when the flap is made on the ___.

A

Vertical releasing incisions

Palate

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31
Q

True or false… the palatal mucosa is firmly attached to the palatal bone and due to its thick nature cannot be displaced apically

A

True

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32
Q

Ultrasonic cleaners produce ___, where rapid movement creates tiny vacuum bubbles in the liquid which burst once they come into contact with contaminants. This reaction is able to scrub particles of bacteria and calculus off of tooth surfaces

A

Cavitation

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33
Q

Ultrasonic ___ action is used for hard-to-reach areas like endodontic canals

A

Lavage

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34
Q

___ Movement differs from ultrasonic mechanism of action. Piezo Movement is in a ___ fashion. ultrasonic Movement is in a ___ fasion .

A

Piezo

Forward and backward linear

Ovoid

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35
Q

A gingivectomy may be used for what 4 things?

A

Treat suprabony periodontal pockets

Treat gingival enlargement/hypertrophy

Treat suprabony periodontal abscesses

Provide visibility and accessibility for calculus removal and cleaning

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36
Q

The apical extent of a gingivectomy may be ___ to the bottom of the periodontal pocket as long as the termination point is ___ the mucogingival junction

A

Equal or apical

Above

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37
Q

Bone defects with ___ walls in the alveolar bone and teeth that exhibit ___ bone loss are good candidates for bone grafting

A

2-3

Angular

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38
Q

True or false… gingivectomies can be performed to reduce pocket depths

A

False

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39
Q

Ultrasonic instruments should NOT be used for patients with ___ because ____

A

Active infectious diseases

Of the aerosol created by the instruments

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40
Q

The technical term for dry socket is ____

A

Localized alveolar osteitis

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41
Q

True or false… systemic antibiotics are indicated in the extraction of mandibular 3rd molars with acute pericornitis

A

True

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42
Q

True or false… systemic antibiotics are needed in a full mouth extraction case with a patient with severe periodontal disease

A

True

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43
Q

Cavitrons work by what 4 mechanisms?

A

Lavage (flushes the pocket)

Cavitation

Vibration

Acoustic turbulence (agitation observed in fluids by mechanical vibrations that disrupts bacterial cell walls.

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44
Q

A partial thickness flap may be used to…

A

Cover up the dehiscence or fenestration of a root

Or free gingival grafts

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45
Q

What is an isograft?

A

Tissue grafts between two genetically identical people (monozygotic twins)

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46
Q

What is the difference between an ostectomy and an osteoplasty?

A

Ostectomy - surgical procedure that removes supporting bone to reduce/eliminate periodontal pockets

Osteoplasty - surgical procedure that removes non-supported bone.

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47
Q

Which is completed first, the ostectomy or the osteoplasty?

A

Osteoplasty is completed before the ostectomy to allow for the most conservative removal of supporting bone (bundle bone) around the teeth

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48
Q

What is the first line of treatment for HIV-associated ANUG?

A

Debridement with prescription of chlorhexidine 0.12%

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49
Q

ANUG and ANUP usually occurs because of the predominance of what bacteria?

A

Anaerobic fusobacteria and/or spirochetes within the oral cavity, specifically underneath the gingiva

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50
Q

A partial thickness flap is indicated when there is less than __mm of attached gingiva

A

2mm

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51
Q

A partial thickness flap is raised with a ___ incision

A

Internal bevel

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52
Q

What are three objectives of the internal bevel incision?

A

Allows for better adaptation of the gingiva to the junction of the alveolar bone to the tooth

Conserves gingival tissue

Removes the epithelial lining of the periodontal pocket

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53
Q

The forming capillary anastomoses of gingival grafts provide the source of nutrients for the free gingival graft after __ days postsurgically

A

3

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54
Q

A barrier such as teflon membrane is placed during a guided tissue regenerative procedure in order to ___

A

Prevent the formation of long junction all epithelium

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55
Q

What is the best way to manage postsurgical root sensitivity? Why?

A

Plaque control

Acidic metabolites from plaque may cause sensitivity to the exposed root surface

Desensitizing dentrifice may provide temporary relief but it takes up to two weeks to take effect.

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56
Q

What are the three types of gingival embrasures?

A

Type 1 - no loss of interdental papilla

Type 2 - partial loss of interdental papilla

Type 3 - complete loss of interdental papilla

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57
Q

The ___ surface of the ___ typically has a type 2 or 3 gingival embrasure resulting in moderate to severe recession with exposure of the root concavitiy. Interdental brushes clean the root concavity much better than floss.

A

Mesial

Maxillary first premolar

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58
Q

What is the intended function a home dental water-irrigation system?

A

Reduce gingival bacterial load (not bacterial load on tooth surface)

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59
Q

___ wound healing involves the approximation of the flaps using the surgical sutures. While the new junctional epithelium will form in approximately ___ weeks, formation and maturation of the ___ takes considerably longer.

A

Primary

2 weeks

Underlying connective tissue attachment

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60
Q

____, is the most common sign of occlusal trauma

A

Mobility

Another sign of occlusal trauma is a widened PDL

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61
Q

What antibody is the most prevalent in saliva? Which antibody is more associate with sulcular fluid?

A

IgA

IgG

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62
Q

What is the purpose of IgA?

A

To prevent adhesion of the bacteria to the oral tissues because it is bound it IgA instead.

IgA is known as the agglutinizing antibody because it clumps or “glues” bacteria together

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63
Q

___ arise from the ___, a remnant of odontogenesis that is more common in middle-aged adult males. ___ are usually not associated with pain, and they usually appear as a unilocular radiolucency on the side of the canines or premolar roots. They are most commonly seen in the mandibular bicuspid area. The involved tooth is usually vital and presents no indication for RCT unless the signs of non-vital or necrotic pulp tissue wer confirmed. They are typically treated by surgical ____

A

Lateral periodontal cysts

Epithelial rest of malassez

Lateral periodontal cysts

Enucleation

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64
Q

Early exfoliation of primary teeth as a result of defective bone mineralization, due to an enzyme deficiency is a characteristic of ____. It is a hereditary disease where there is a marked deficiency in the ____ enzyme.

A

Hypophosphatasia

Tissue non-specific alkaline phosphatase

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65
Q

True or false… calculus rubbing against the gingival tissues causes severe gingival irritation.

A

False.

The main deleterious effect of calculus is that bacteria attaches to the calculus and releases irritants

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66
Q

What does pain upon lateral percussion indicate?

A

Pressure on an inflamed PDL, not an apical infection

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67
Q

Junctional epithelium reattaches to cementum and dentin after an apically repositioned flap by re-establishing ___. Regeneration of junctional epithelium takes about ___ [days/weeks] to complete after the surgery.

A

Tight junctions

10-14 days

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68
Q

Describe the fours stages of pathogenesis of periodontitis

A

Initial - characterized by the presence of an acute inflammatory reaction as the normal healthy gingiva reacts to plaque accumulation

Early lesion - occurs when an infiltrate of lymphoid cells, particularly T lymphocytes appear on the site of inflammation

Established lesion - B lymphocytes and plasma cells suddenly predominate the site

Advanced lesion - manifests itself as periodontitis and physiologically irreversible loss of bone

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69
Q

The severity of ___ is directly related to the amount of plaque accumulation. When ___ are released by the plaque, the gingiva becomes irritated, initiating a defensive reaction through an inflammatory response

A

Gingival inflammation

Bacterial toxins

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70
Q

____ is defined as a white blood cell count above the normal range and is a sign of an inflammatory response that is most commonly the result of infection. It is also observed with __, __, ___ ___, ___, ___, __, and ___

A

Leukocystosis (neutrophilia is the most common form)

Certain parasitic infections

Cancer

After strenuous exercise

Emotional stress

Pregnancy

Anesthesia

Steroid

Epinephrine administration

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71
Q

The epithelium of the free gingival graft experiences ___ a few days after the transplant takes place due to the lack of direct blood supply. The FGG is able to survive through… ___. FGG procedures are performed to ___ . It is usually harvested in which location?

A

Degeneration

The help of the underlying connective tissue bed that provides nutrition to its surviving epithelial cells.

Increase the keratinized gingival tissue support of an implant material or to cover up areas of gingival recession

Palatal area

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72
Q

Wha this the most common reason for maxillary incisors to harbor chromogenic plaque?

A

Poor oral hygiene

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73
Q

What are Miller classifications?

A

Assess the degree of recession and the amount of interdental bone loss. Class 1 and class 2 recessions do not involve interproximal bone loss.

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74
Q

Describe miller classifications 1-4.

A

Class 1 recession - does not extend to the mucogingival junction

Class 2 recession - extends to or beyond the mucogingival junction, but demonstrates no loss of interproximal clinical attachment

Class 3 recession - extends to or beyond the mucogingival junction, with loss of interproximal clinical attachment or tooth rotation

Class 4 recession - extends to or beyond the mucogingival junction, with severe loss of interproximal bone or tooth rotation

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75
Q

True or false.. the presence of fremitis always indicates splinting.

A

False. Unstable teeth that cannot maintain normal position during centric occlusion need additional support to maintain their position. Splinting to the adjacent teeth provides support for unstable teeth that are experieincing discomfort.

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76
Q

Which furcation class has the best prognosis with guided tissue regeneration procedures?

A

Class 2 - because they are the least severe of pathosis.

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77
Q

___ is the most important variable when determining the prognosis of a tooth.

A

Clinical attachment loss

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78
Q

The experimental gingivitis model does not prove that gingivitis always evolves to periodontitis. What 4 things does it accomplish?

A

Supports the non-specific plaque hypothesis

Demonstrates that the bacterial ecology changes as plaque accumulates

Demonstrates the relationship between plaque formation and gingivitis

Demonstrates that gingivitis is a reversible disease

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79
Q

What is the maximum distance between the contact point of two restorations and the crest of the bone in order to achieve 100% complete interproximal papilla to fill?

A

5mm

6mm, the papilla was present 56% of the time

7mm, the papilla was present 27% of the time or less

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80
Q

What is the expected rate of infection after periodontal surgeries? What should the patient do to avoid infection?

What is the most common complication of esthetic crown lengthening?

A

2%

Avoid any trauma or tooth brushing in the treated area for 2 weeks. 0.12% chlorhexidine rinses are usually prescribed.

Recession, if excessive bone resection has been done.

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81
Q

When fabricating a complete mandibular denture for a patient with severe ridge resorption and persistent tissue inflammation, what should the clinician due?

A

Maximize the extension of the denture distally to distribute the masticatory forces over a broader area

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82
Q

When casting gold, shrinkage porosity is associated with ___. Wha happens if the sprue is too narrow? Where should the sprue be placed?

A

Sprue diameter

The sprue is the channel that allows the molten alloy to reach the mould within the investing material of the wax out procedure.

If the sprue is too narrow, it will prevent the smooth flow of the molten material into the mould, allowing the molten alloy to harden without flowing into all areas of the mould, resulting in shrinkage porosities

Placement of sprue is also important to prevent shrinkage porosities. The sprue must be placed ideally where the wax pattern has its greatest bulk, which is approximately 45 degrees perpendicular to the flat surface of the wax pattern.

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83
Q

The pterygomandibular raphe acts as a tendon between which two muscles? It is a landmark used for the ___ when performing ___.

A

Buccinator and superior constrictor

Pterygomandibular space when performing an IA block.

The injecting needle pierces the buccinator muscle to inject the local anesthetic solution in the pterygomandibular space

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84
Q

What is the only property of a base metal alloy that is numerically lower than gold?

A

Specific gravity.

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85
Q

What is the purpose of using a liner when casting gold with a casting ring?

A

It allows for uniform setting of the casting

Liners are placed along the internal aspect of the casting ring and provide space for uniform investment expansion, allowing for the uniform setting of the casting.

Allowing investment expansion prevents distortion of the wax pattern during investment

The liner acts as a spacer that prevents pressure from building up betwen the investment material and the casting ring during the expansion of the investment

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86
Q

Liners are usually placed __ shorter than the casting ring and demos to a thickness of ___

A

3mm

1mm

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87
Q

The ___ major connector is the best RPD connector option for patients with a shallow lingual vestibule

A

Lingual plate

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88
Q

Patients with a ___ total vestibular depth with respect to the free gingival margins must be restored with the lingual plate major connector.

A

6mm

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89
Q

The free gingival margin must be about ___ away form the major connector. The bar itself must be ___ thick for strength. Because this distance is not possible with a shallow vestibule, the placement of a lingual plate is indicated.

A

3mm

5mm

Interruptions in major connectors are supposed to prevent plaque deposition and facilitate cleaning

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90
Q

___ is the ability of a material to resist fracture while bending and is also known as a modulus of rupture, bend strength, or fracture strength. The ___ test is the most frequently employed to evaluate the ___ of a material using a 3-point flexural test technique

A

Flexural strength

Transverse bending

Flexural strength

The significance of flexural strengh is commonly expressed in class V cervical restorations

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91
Q

___% of platinum, palladium, or gold is required for an alloy to be considered a noble metal. High noble alloys have ___% noble metals with ___% or more being gold

A

25%

> 60%

40%

Note that silver is not considered a noble metal although it does improve castability

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92
Q

____ release alcohol as a by-product during their setting reaction

A

Condensation silicones (not addition silicones)

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93
Q

When extra water is added to gypsum-bonded casting investments, you should expect [more/less] setting expansion.

A

Less

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94
Q

What type of RPD direct retainers is considered the most esthetic?

A

Intracoronal attachment

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95
Q

When soldering a FPD before porcelain application, the greatest risk of failure is in ___ resulting in ___

A

Overheating

Surface pitting, internal porosity, other microstructural changes resulting in a weak joint

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96
Q

Which problem can occur when a custom tray without occlusal stops is used to make a polysulfide final impression?

A

An inaccurate final impression occurs due to permanent distortion incurred during the setting reaction

Occlusal stops prevent overheating of the impression on insertion as well as removal

Both condensation silicones and polysulfide impression materials undergo polymerization shrinkage during setting

Polyethers are also known to readily absorb water, making them less dimensionally stable if the impression is not poured within 24 hours

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97
Q

A stiffer or a rigid substance will have a [higher/lower] modulus of elasticity and vice versa

A

Higher

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98
Q

Elastic modulus is also defined as a measure of ___/___.

A

Stress/strain

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99
Q

What is the most probable explanation for the margins of a metal framework for a PFM crown being sealed during the framework try-in, then NOT being sealed after the porcelain is applied two days later?

A

The porcelain proximal contacts were overcontoured

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100
Q

When comparing high-noble alloys to base-metal alloys. Base metal alloys have a higher ___

A

Melting point

High-noble metals also have a lower modulus of elasticity since they are less rigid

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101
Q

True or false… high-noble metals resist oxidation

A

True

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102
Q

True or false.. high-noble alloys are more difficult to case because of their lower melting point.

A

False. It is easier

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103
Q

True or false… base-metal alloys are harder and stronger than high-noble alloys

A

True

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104
Q

___ interferences are the most destructive types of interferences

A

Non-working

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105
Q

A lingual bar major connector requires a minimum of __mm in cervicoocclusal height and should be approximately ___mm away from the marginal gingiva

A

4

4

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106
Q

After packing acrylic resin into the denture flasks, one should wait to cure the resin to…

A

Make sure temperature equilibrium exists between the flask and acrylic

Allowing the dental flask packed with acrylic to remain under the bench press until equilibrium in temperature is achieved will give enough time for the acrylic to achieve better monomer-polymer interaction and create a stronger chemical bond

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107
Q

Relining a RPD is indicated when ____.

A

The distal extensions are depressed due to loss of support along the distal alveolar ridge

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108
Q

The thinnest/weakest portion of the wax pattern should be placed ___. Sprue formers should be attached to the __ part of the wax pattern to ensure the smooth flow of alloy

A

In the deepest part of the ring or farthest from the sprue base to ensure that the margins of the wax pattern will not be insufficient when contraction occurs

Bulkiest

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109
Q

The path of insertion of the key into the key way should be parallel to the path of insertion of the retainer [carrying/NOT carrying] the key way.

A

NOT carrying

110
Q

Brittle materials can be hard solid material that can withstand heavy compression but not ___.

They exhibit low ___ strength and may fracture or break instead of ring deformed.

A

Tension

They exhibit low tensile stress

111
Q

A retainer tooth for an FPD is severely tipped mesially. A short ___ axial wall most diminished the long-term prognosis.

A

Distal

112
Q

Name 5 uses for surveyors.

A

Measuring the depth of an undercut

Determine the best path of draw for an RPD

Identifying bony areas to be removed with alveoloplasty

Identifying undercuts for survey crowns

Blocking out master casts when fabricating RPDs

113
Q

___ is the impression material most prone to fracture when forcibly removed from the mouth due to its stiffness

A

Polyether

114
Q

___ is a non-aqueous hydrophilic elastomeric impression material that is considered the most rigid impression material. It is the stiffest among the elastomeric impression materials and will fracture when forcefully removed when it is engaged in an undercut. It is a stable impression material and can be used in a moist environment since its hydrophilic.

A

Polyether

115
Q

Increasing the ___ (which includes the ___) helps establish a more balanced occlusion during lateral excursive and protrusive movements when fabricating a denture.

A

Compensating curve

Curve of spee, curve of monson, curve of Wilson

116
Q

___mm is the minimum distance between the major connector of a maxillary RPD and the free gingival margin of a tooth. Having a space this large between the framework and the gingival margin prevents ___. The border of the mandibular RPD framework should be at least ___mm from the gingival margin and ___-___mm from the floor of the mouth

A

6mm

Irritation of the gingiva

3mm

6-8mm

117
Q

Clasped teeth in RPDs must have more than ___ degrees encirclement so that the prosthodontic device doesn’t have any ___ effect.

A

180

Orthodontic

118
Q

True or false… reciprocation clasp arms do not need to be flexible, because they are placed above the height of contour and not in the undercuts

A

True

119
Q

What is the name for a 1 wall, 2 wall, 3 wall, and 4 wall infrabony defect? Which is the most common?

A

1 wall = hemiseptal

2 wall = crater (most common)

3 wall = trough

4 wall = circumferential (extraction site)

120
Q

In a 2 wall defect, which bony walls remain?

A

Buccal and lingual

121
Q

What does miller classification classify?

A

Recession

Determines likelihood of regaining root coverage

122
Q

Define miller classification 1-4.

A

Class 1 = marginal tissue recession not extending to the mucogingival junction. No loss of interdental bone or soft tissue

Class 2 = mariginal tissue recession extends to or beyond the mucogingival junciton. No loss of interdental bone or soft tissue

Class 3 = marginal tissue recession extends to or beyond the mucogingival junction. Interproximal bone or soft tissue loss present or tooth malpositioning prevents total root coverage.

Class 4 = marginal tissue recession extends to or beyond the mucogingival junction. Interdental bone or soft tissue loss or tooth malpositioning is so severe that root coverage is not anticipated

123
Q

What is hereditary gingival fibromatosis?

A

Hereditary condition in which gingiva is enlarged, non-hemorrhagic and firm

124
Q

Localized aggressive periodontitis has a predilection for which sites?

A

Molars and incisors

125
Q

Bacteria in the plaque that are closest to the tooth structure tend to be gram ___. Bacteria in the plaque that are furthest away from the tooth (closer to the epithelium) tend to be gram ___.

A

+

-

126
Q

Supragingival components of plaque are derived from ___. Subgingival components are derived from ___.

A

Saliva

GCF

127
Q

The dental pellicle forms within ___. It consists of what things?

A

Seconds

Glycoproteins

Proline-rich proteins

Other molecules that serve as attachment sites for bacteria

128
Q

Adhesion and attachment of bacteria occurs within ___. Initial adhesion is due to what kind of forces? Firm attachment is due to what kinds of forces?

A

Minutes

Van der waals electrostatic forces

Strong, irreversible interactions between specific bacterial adhesion molecules and host pellicle receptors

129
Q

What is the third step of dental plaque formation? How long does it take for this step to occur?

A

Colonization and plaque maturation

24-48 hours

130
Q

In the colonization and plaque maturation step of dental plaque formation, firmly attached ___ provide newreceptors for attachment of other bacteria in a process called ___. As bacteria grow and the biofilm matures, there is a shift from ___ to __.

A

Primary colonizers

Coadhesion

Facultative gram-positive to anaerobic gram-negative

131
Q

Secondary (late) colonizers tend to feed on ___ rather than ___ like primary (early colonizers)

A

Amino acids

Sugars

132
Q

What is the role of fusobacterium nucleatum in dental plaque?

A

It serves as a bridge between primary and secondary colonizers. It “glues” the bacteria together.

At this point the plaque is living and active

133
Q

What is quorum sensing?

A

Referees to communication among bacteria in a biofilm to encourage growth of beneficial species and discourage growth of competing species.

Note that biofilm bacteria are more restitant to antimicrobial than plankonic (free-swimming bacteria )

134
Q

The red complex is associated with __ and __. Name the three bacteria species that are in this complex.

A

BOP and deeper pockets

p. Gingivalis

T. Denticola

T. Forsythia

135
Q

The orange complex precedes the presence of red complex supporting sequential nature of plaque maturation. Name the three bacteria species that make up the orange complex.

A

Fusobacterium

Prevotella intermedia

Campylobacter rectus

136
Q

A. Actinomycetemcomitans is involved in ___ periodontitis. It a ___, ___ rod. It is capnophilic (meaning… )

A

Aggressive

Nonmotile, gram negative

Grows well in carbon dioxide environment

137
Q

A. A. Have what 4 toxins? What do they do?

A

Leukotoxin - kills human neutrophils, monocytes, and lymphocytes

LPS (endotoxin) - component of all gram-negative outer membranes

Collegenase

Protease that cleaves IgG

138
Q

P. gingivalis is involved in ___ Periodonttis. It is a nonmotile, gram ___ rod. It has ___ which are important in adherence. It has a capsule. It has what 3 toxins/proteins?

A

Chronic

Negative

Fibriae

Gingipain - protease that cleaves host proteins

Collegenase

Hemolysin

139
Q

T. Denticola is involved in what type of periodontitis/gingivitis? It is a motile, gram ___ ____. It penetrates epithelium and connective tissue. It has protease that can degrade collagen, immunoglobulins, and complement factors.

A

ANUG/ANUP

Negative, spirochete

140
Q

_____ is in the orange complex and is involved in pregnancy gingivitis. It is a nonmotile, gram-negative rod. It becomes darkly pigmented when grown on blood agar plates

A

P. Intermedia

141
Q

C. Rectus is part of the ___ complex. It is a [motile/nonmotile] gram ____ rod and has ____

A

Orange

Motile

Negative

Polar flagellum

142
Q

F. Nucleatum is part of the ___ complex. It is a nonmotile, gram negative rod that induces apoptosis of leukocytes and release of tissue-damaging substances from leukocytes. What else is important about this bacteira?

A

Orange

It is the “bridge” bacteria that “glues” the plaque together.

143
Q

What two types of bacteria tend to associated with implants?

A

Pseudomonas

Staph

144
Q

Precipitation of mineral salts into plaque usually occurs within __-___ days.

A

1-14

145
Q

Subgingival calculus is mineralized via ___

A

GCF

146
Q

Describe orange stains

A

Usually on anterior teeth

Due to poor oral hygiene

147
Q

Describe brown stains

A

Due to drinking dark-colored beverages and poor oral hygiene

148
Q

Describe dark brown and black stains

A

Due to tobacco

149
Q

Describe yellow-brown stains

A

Due to chlorhexidine and stannous fluoride

150
Q

Describe black stains.

A

Thin lines on cervical third. Found in healthy mouths, due to consumption of iron

151
Q

Describe green and yellow stains.

A

Usually on anterior teeth, due to poor oral hygiene and chromogenic bacteria

152
Q

Describe bluish-green stains

A

Occupational exposure to metallic dust.

153
Q

True or false… green/yellow stains on teeth due to poor oral hygiene and chromogenic bacteria are easily removed by brushing

A

False. They are nearly impossible to remove.

154
Q

___ and ___ associated with missing teeth can lead to food impaction and plaque retention

A

Mesial drift

Extrusion

155
Q

True or false… overcontoured restorations are worse for gingival health than undercontoured restorations

A

True

156
Q

Even when not faulty, subgingival crown margins are associated with __, ___, and __.

A

Plaque accumulation

Gingival inflammation

Deeper pockets

157
Q

True or false… periodontal health must always be established before initiating orthodontic therapy

A

True

158
Q

___ are the first line of defense in controlling the bacterial challenge and inconsequently destroy the periodontal tissue via release of destructive molecules

A

Neutrophils

159
Q

How do neutrophils get to the periodontal pocket?

A

Migrate from subepithelial vascular plexus into the periodontal pocket by directed locomotion called chemotaxis where they form a barrier to protect the body from periodontal bacteria

160
Q

Neutrophils internalize bacteria via ___ and kill them using “biological bleach” which consists of __ and ___

A

Phagocytosis

Myeloperoxidase

Oxygen radicals

161
Q

What is the most important proteinase involved in the destruction of periodontal tissues by neutrophils. It is inhibited by ___

A

MMP-8 (neutrophil collegenase)

Tetracyclines

162
Q

Defective neutrophil chemotaxis leads to ___

A

Aggressive periodontitis

Too much neutrophil activity leads to self-inflicted tissue destruction. Too little neutrophil activity leads to unchecked microbial challenge which also leads to tissue destruction

163
Q

Name 4 neutrophil abnormalities

A

Neutropenia

Chediak-Higashi syndrome

Papillon-lefevre syndrome

LAD-1 and LAD-2

164
Q

Macrophages regulate the immune response via cytokines like ___

A

IL-8

165
Q

Mast cells are responsible for causing vascular [constriction/permeability] . What antibody do they release?

A

Permeability (and dilation)

IgE

166
Q

Name 5 important proinflammatory mediators

A 
IL-1
IL-6
PGE2
TNF-alpha
MMPs
167
Q

IL-1 is associated with ___

A

Bone resorption

168
Q

TNF-alpha is associated with ___

A

Macrophage activation

169
Q

MMPs are involved in ___

A

Collagen destruction

170
Q

Name 3 important anti-inflammatory mediators

A

IL-4
IL-10
TIMPs

171
Q

In stage 1 gingivitis, the ___ lesion, occurs in __-__ days. What occurs in this stage?

A

Initial

2-4 days

Neutrophil infiltration, increased GCF

172
Q

In stage 2 of gingivitis, the ___ lesion, occurs in __-___ days. What occurs in this stage?

A

Early

4-7 days

T lymphocyte infiltration

Increased collagen loss

BOP

173
Q

In stage 3 of gingivitis, the ___ lesion, occurs in __-___ days. What occurs in this stage?

A

Established

14-21 days

B lymphocyte infiltration including mature plasma cells

Collagen loss

Clinical changes in color, contour, consistency

174
Q

In stage 4 of gingivitis, the ___ lesion, what occurs?

A

Advanced

Transition to irreversible damage of periodontitis

175
Q

What is the short term goal of periodontal therapy?

A

Reduce gingival inflammation by correcting conditions that cause it

176
Q

What are the long-term goals of periodontal therapy?

A

Eliminate pain

Arrest hard and soft tissue destruction (CAL)

Establish occlusal stability and function

Reduce tooth loss - NOT designed to save all teeth

Prevent disease recurrence

177
Q

How many phases are in periodontal treatment planning?

A

5

178
Q

What is the purpose of the 0 stage (preliminary phase) of periodontal therapy?

A

Treat emergencies

Extract hopeless teeth***

179
Q

What is the first phase of periodontal therapy? What occurs in this phase?

A

Non-surgical phase

Plaque control and patient education

Diet control

Caries control

Prophylaxis, SRP, OHI to remove local factors

Correct restorative irritational factors

Local or systemic antibiotics

periodontal re-evaluation after 4-8 weeks***

180
Q

Periodontal re-evaluation should occur __-___ weeks after the completion of phase 1 therapy to allow for healing and formation of the ___

A

4-8 weeks

Junctional epithelium

181
Q

What is the second phase of periodontal therapy? What does it involve?

A

Surgical phase

Reduce or eliminate pocket depths***, correct soft and hard tissue defects, regenerate periodontal tissues, or place implants

Periodontal therapy, including placement of implants

Endodontic therapy

182
Q

What occurs in the third phase of periodontal therapy? What is it called?

A

Restorative phase

Final restorations

Fixed and removable prosthodontics

183
Q

What is the 4th phase of periodontal therapy? What does it involve?

A

Maintenance phase

Also called supportive periodontal therapy, involves Periodic ongoing evaluation of OHI and condition of periodontal tissues

Periodontal maintenance performed in a continuum with phase 2 and phase 3 therapy every 3 months for the first year

184
Q

Define risk factor

A

Casually associated with the disease (smoking leads to periodontal disease)

185
Q

Define risk determinant

A

Unchangeable background characteristics, increases likelihood of disease (gender, genetics)

186
Q

Define risk indicator

A

Not casually associated with the disease (stress, osteoporosis may influence periodontal disease)

187
Q

Define risk marker or predictor

A

Quantitative association with disease (previous history, attachment level)

188
Q

Name 4 risk factors of periodontal disease

A

Smoking

Diabetes

Pathogenic bacteria

Microbial tooth deposits

189
Q

Name 4 risk determinants of periodontal disease

A

Genetic factors - periodontitis may be heritable, polymorphisms in IL-1 genes may contribute to severe chronic periodontitis

Age - due to prolonged exposure to etiologic factors rather than the actual aging process

Gender - males have more CAL than females

Socioeconomic status - decreased dental awareness, frequency of dental visits, and more smoking

190
Q

And 4 risk indicators of periodontal disease

A

HIV/AIDS - ANUG/ANUP is more often seen in immunocompromised individuals

Osteoporosis - reduced bone mass may have an impact on progression of periodontal disease

Infrequent dental visits

Stress - emotional stress may interfere with normal immunologic function

191
Q

Name 3 risk markers

A

BOP

CAL***

Previous history of disease

192
Q

Define prognosis

A

Prediction of the outcome of a disease

Prognosis for individual teeth must be considered in the context of the entire dentition

193
Q

True or false.. a younger patient with the same level of disease as an older patient has a worse prognosis

A

True

194
Q

True or false… PPD is more important than CAL in determining prognosis

A

False. CAL is more important

195
Q

Name 5 clinical factors that affect prognosis

A

Age

Disease severity

Plaque control

Patient compliance

Type of bone loss

196
Q

Which has a better prognosis, vertical or horizontal bone loss?

A

Vertical bone loss has a better prognosis than horizontal bone loss because it can potentially be treated with regenerative therapy (especially in 3-wall defect)

197
Q

Name 3 systemic factors that affect the prognosis

A

Smoking - smokers have increased prevalence and severity of periodontal disease and decreased healing response to both nonsurgical and surgical therapy

Diabetes - poorly controlled diabetes has worse prognosis than well-controlled diabetes

Parkinson’s - compromise the pts ability to perform oral hygiene

198
Q

What is the most important fact in determining prognosis?

A

CAL

199
Q

Define exploratory stroke

A

Light feeling stroke used with probes and explorers

200
Q

Define scaling stroke

A

Short, strong pull stroke to remove hard deposits

201
Q

Define root planing stroke

A

Light to moderate pull stroke for final smoothing

202
Q

Describe the strokes used for ultrasonics

A

Light intermittent strokes with tip parallel to the tooth surface and in constant motion

203
Q

When initially inserting a curette into the pocket, angulation between the blade and the tooth should be ___ degrees (___-angle). when scaling and root planing, the angulation is changed to __-___ degrees (___-angle)

A

0

Closed

45-90

Open

204
Q

What is a prophy jet?

A

Delivers slurry of water and sodium bicarbonate to remove extrinsic stains and soft deposits

205
Q

Gingival flap designs should have a [narrower/wider] base to ensure adequate blood supply. Incisions should be over ___ bone, not over ___. The corners of the flaps should be [rounded/sharp]. Vertical releases should be made at ____. Make sure to avoid vital structures. What is the most important post-operative consideration after periodontal surgery?

A

Wider

Intact. (Not over bony defects or eminences)

Rounded

Line angles of teeth

Plaque control

206
Q

What are some areas to avoid when making incisions?

A

Canine eminence

Piriform ridge

Lingual of mandible

Bony defects

Be careful in the labial maxilla (infraorbital region) and lingual of mandible

207
Q

What kinds of flaps are indicated for mucogingival surgery? Why?

A

Split thickness (AKA partial thickness, AKA mucosal) flaps

Exposing the bone is unnecessary

208
Q

What type of flap is indicated for osseous surgery, apically repositioned flaps, and periodontal regeneration? Why?

A

Full thickness (AKA mucoperiosteal) flaps

The bone is necessary to access

209
Q

Whenever alveolar bone is exposed, like in full thickness flaps, expect about ___mm of bone resorption and remodeling.

A

1mm

210
Q

A full thickness flap involves three horizontal incisions. Describe them.

A

Internal (reverse) bevel - about 1mm from the gingival margin, removes pocket lining yet conserves outer gingiva

Sulcular (crevicular) - through the base of the pocket to the alveolar crest

Interdental (interproximal) removes the collar of tissue around the tooth you created with the first two incision.

211
Q

What is the modified widman flap? What is its goal?

A

Involves three incisions (internal bevel, sulcular, and interdental) and provides access to subgingival areas for debridement with the goal of new attachement

212
Q

What is an internal bevel incision?

A

About 1mm from the gingival margin, removes pocket lining yet conserves outer gingiva

213
Q

What is an apically repostitioned flap?

A

Modified widman flap with additional vertical releasing incisions made beyond the mucogingival junction in order to attain pocket reduction.

214
Q

The periodontal pack consists of ___. It is left in place for ___. Packs are placed. To protect the surgical wound, minimize discomfort, maintain tissue placement, and help prevent post-op bleeding. They [do/do not] enhance healing.

A

ZOE

1 week

Do not

215
Q

True or false… periodontal packs enhance healing

A

False

216
Q

What are the two types of gingival surgery?

A

Gingivectomy

Gingivoplasy

217
Q

What is the difference between gingivectomy and gingivoplasty?

A

Gingivectomy = excision of gingiva to eliminate suprabony pockets or gingival enlargements. More aggressive.

Gingivoplasty = excision of gingiva to reshape tissue deformities. Less aggressive, more for esthetics.

218
Q

In gingival surgery, healing is by ___ intension because…

A

Secondary

There is no tissue to approximate

219
Q

What is the purpose of distal wedge surgeries ( a type of gingival surgery)?

A

Pocket reduction distal to terminal molars

220
Q

What is the difference between maxillary and mandibular distal wedge procedures?

A

Maxillary = full thickness flap with parallel incisions

Mandibular = full thickness flap with V-shaped incisions

221
Q

The second category of periodontal surgery is mucogingival surgery. This includes both the gingiva and the mucosa below and above the mucogingival line. What is the purpose of a free gingival graft? What is the purpose of a connective tissue graft?

A

Free gingival graft = widen band of keratinized tissue

Connective tissue graft = increase root coverage

222
Q

Name 5 different types of mucogingival surgeries. Describe them.

A

Free gingival graft - widen band of keratinized tissue. (Occurs at or apical to the gingival margin)

Connective tissue graft - increase root coverage (occurs at or above the gingival margin

Frenecotmy - complete removal of frenum

Frenotomy - incision of frenum

Vestibuloplasty - deepen the vestibule

223
Q

Why is a free gingival graft considered “free”?

A

A free graft by definition is transplanted without a nourishing blood supply so it must undergo revasularization from the recipient bed.

224
Q

What is the ideal thickness of a free gingival graft?

A

1-1.5mm

225
Q

No minimum width of attached gingiva has been established, but at least ___ is a good amount.

A

2mm

226
Q

Why is keratinized tissue so great?

A

Attached gingiva helps enhance plaque removal (less painful brushing), improves esthetics, and reduces inflammation around abutment teeth and implants.

227
Q

Why is connective tissue grafting less painful than free gingival grafts?

A

Harvest the inner connective tissue and not the epithelium

Donor sites should always have tough attached gingiva

228
Q

Where is the most common donor site for both free gingival grafts and connective tissue grafts?

A

Hard palate

229
Q

The third category of periodontal surgery is osseous surgery. Visualization of bony architecture allows clinician to determine the types of bony defects that are present and the extent of those defects. What are the three different types of bony architecture?

A

Positive architecture

Flat architecture

Negative architecture

230
Q

Describe the three different types of bony architecture.

A

Positive architecture - interproximal bone is coronal to radicular bone, (normal ideal alveolar bone morphology)

Flat architecture - interproximal and radicular bone are at same height

Negative architecture - interproximal bone is apical to radicular bone

231
Q

What is the difference between ostectomy and osteotomy?

A

Ostectomy - removal of supporting bone

Osteotomy - removal of non-supporting bone

232
Q

After ostectomy, peaks of bone often remain at the line angles called ____ which predispose to periodontal pockets in these area.

A

Widow’s peaks

233
Q

Define regeneration, repair, reattachment, and new attachment

A

Regeneration - completely restore architecture and function

Repair - not completely restore architecture and function, involving healing by scar or formation of long JE

Reattachment - reunion of epithelial and connective tissue with root surface after incision or injury

New attachment - embedding of new PDL fibers into new cementum that has been previously deprived of its original attachment

234
Q

The fourth category of periodontal surgery is periodontal regeneration. It seeks to regenerate bone, cementum, and PDL. This is called GTR (____)

A

Guided tissue regeneration

235
Q

What are the three “B’s” of periodontal regeneration? What are their roles?

A

Barrier membrane - the “tank” - it prevents soft tissue downgrowth and permits hard tissue ingrowth

Bone graft - the “damage” - osteoconductive, osteoinductive, and/or osteogenic

Biological agent - the “healer” - creates an environment conducive to tissue formation

236
Q

Name the cells that populate a wound area during the healing process from fastest to slowest.

A

1 - epithelial cells

2 - CT cells

3 - PDL cells

4 - bone cells

237
Q

Why do we need a barrier in GTR?

A

Because bone cells are the slowest to populate a wound area. We want to prevent soft tissue to populate the wound area, we want bone and PDL cells

238
Q

Root surface treatment involves the use of chelating agents such as ___ and ___ which can expose the ___- through demineralization and may improve new attachment

A

EDTA and citric acid

Collagen fibrils

239
Q

What is an alloplast bone graft?

A

Synthetic or inorganic bone graft material

240
Q

What is the difference between osteoconductive, osteoinductive, and osteogenic?

A

Osteoconductive = scaffold

Osteoinductive = convert neighboring progenitor cells into osteoblasts

Osteogenic = make bone directly

241
Q

An autograft has which regeneration quantities? What about allograft, xenografts and alloplast?

A

Autograft = osteoconductive, osteoinductive, and osteogenic

Allograft = osteoconductive, osteoinductive (not osteogenic)

Xenografts and alloplasts are osteoconductive only

242
Q

What is the treatment for 1 and 2 wall bony defects?

A

Resection (ostectomy), recontour bone to restore positive architecture

243
Q

What is the treatment for 3 and 4 wall bony defects?

A

Regeneration, better blood supply and cell source proximity

244
Q

____ is the ideal for regenerating infrabony defects

A

Deep narrow 3 wall

Because it provides protection to the graft and allows more room for healing cells to populate

245
Q

___ is ideal for regenerating furcation defects.

A

Hamp class 2 (buccal upper or either buccal or lingual of lower)

246
Q

___ is ideal for regenerating recession defects

A

Miller class 1 with thick gingival biotype and wide band of keratinized tissue

247
Q

Antibiotics are most often used for ___ and ___ perio cases during phase ___ treatment.

A

Aggressive

Refractory periodontitis

1

248
Q

Tetracyclines concentrate in the ___ which make it helpful for perio. ___ only requires one dose per day which may improve patient compliance

A

GCF

Doxycycline

249
Q

What is the most powerful combination for periodontal disease?

A

Amoxicillin and metronidazole for 14 days

Duration is more important than dose - the longer the better

Avoid alcohol with metronidazole

250
Q

When are local delivered antibiotics used?

A

When localized recurrent and/or residual PD of 5 or greater with inflammation still present following conventional therapies

251
Q

Name three local delivery antibiotics? (Brand name and drug type)

A

Arrestin - Minocycline

Atridox- Doxycycline

PerioChip = Chlorhexidine gluconate

252
Q

Host modulation therapy aims to ____. When should/can it be used?

A

Downregulate the destructive aspects of the host response

Should only be used as an adjunct to mechanical debridement during phase 1

Chronic periodontitis

253
Q

What are three different types of medicaments used for host modulation therapy systemically? What are their purposes?

A

NSAIDS - inhibit prostaglandins thus inhibiting inflammation

Bisphosphantes - inhibit osteoclasts (BRONJ is a significant side effect)

Subantimicrobial dose doxycycline - inhibits MMPs (collagenases) 20mg twice daily for 3-9 months (periostat). Only one of these three that is currently approved by the FDA and accepted by ADA

254
Q

Name 2 locally administered host-modifying agents

A

Emdogain = enamel matrix proteins

PDGF = GEM 21S

These surgical adjuncts may also influence periodontal regeneration

255
Q

Define traumatic occlusion

A

Injury to the periodontium resulting from occlusal forces that exceeds the reparative capacity of the attachment apparatus

256
Q

Define teh two types of traumatic occlusion

A

Primary = caused by excessive forces on a normal periodontium

Secondary = caused by normal occlusal forces on a reduced periodontium

257
Q

True or false… in regards to traumatic occlusion, occlusal therapy should be delayed until after inflammation is resolved

A

True

258
Q

What is a furcation plasty?

A

Smooth the furcation and enlarge it so the patient can easily clean it

259
Q

What is furcation tunneling?

A

Move the tissues and bone apically to create a grade 4 furcation so the furcation is easy to clean

260
Q

How is root amputation helpful for furcation involvements?

A

Leaves an open area so the furcation is easier to clean (DB root of maxillary molars are most common because it is the smallest root)

261
Q

How is a hemisection useful for furcation correction?

A

Cutting the molar in two, leaving room to easily clean the furcation area.

262
Q

Name 4 ways to correct furcation involvements

A

Furcation plasty

Tunneling

Root amputation/root resection

Hemisection/premolarization

263
Q

What is the best method of toothbrushing?

A

Bass method

Bristles at 45 degrees and extend about 0.5mm subgingival to effectively disrupt plaque buildup

264
Q

Periodontitis is most prevalent in what population?

A

Males of African descent

265
Q

The distance from the CEJ to the base of the pocket is a measure of…

A

Clinical attachment level

266
Q

What is the primary treatment objective of guided tissue regeneration?

A

Coronal movement of the PDL

267
Q

Which type of bacteria is routinely involved in cases of chronic periodontitis?

P. Gingivalis 
T. Forsythia
P intermedia
C rectors 
A.A
A

P gingivalis

268
Q

Which of the following is not a feature of the modified Widman flap?

Full thickness flap
Reduction of osseous defect
Precise horizontal incisions

Provides improved visual access to periodontally involved tissues

A

Reduction of osseous defects (no ostectomy with the modified widman flap, ostectomy IS performed with the normal widman flap)

269
Q

The best indication of success of periodontal therapy is ___

The best indication of for determining prognosis is ___

A

Lack of BOP

CAL

270
Q

What is the mechanism of action as used in host modulation therapy?

A

Prevents further breakdown of periodontal tissues by blocking collegenase**

(Host modulation therapy = less than the usual dose, it is not being used as an antibiotic)

271
Q

The predominant inflammatory cellsin the periodontal pocket are which of the following?

Lymphocytes
Plasma cells
Neutrophils
Macrophages

A

Neutrophils

NBDE Pt 2 Flash Cards (23 decks)

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