Perio BSc Flashcards
what is reattachment?
the reunion of root and connective tissue serperated by incision/injury
is reattachment used in periodontal healing?
no. reattachment is not a term used in periodontal healing
what is new attachment?
union of connective tissue with previously pathogenically altered root surface
what is regeneration?
attachment of PDL cells and fibres to new cementum formation and coronal rewgrowth of alveolar bone
what happens following debridement within the following week?
- acute inflammation begins to subside 24-48 hrs after
- decrease vasodilation
- decrease GCF
- decrease PMN’s
- decrease ulceration of pocket
pocket epithelium begins to attach to root surface via what?
- via formation of basement membrane and hemidesmosome attachment
- these hold keratinocytes to the cementum(forming long junctional epithelium)
what does long epithelium result in?
long epithelium results in the gradual closure of a pocket and may continue for moths after treatments
junctional epithelium acts like what?
junctional epithelium acts as a zip
what is regeneration?
regeneration means attachment of PDL cells and fibres to new cementum formation and coronal regrowth of alveolar bone
if epithelium is allowed to grow into the wound space. What will happen?
- it will proliferate quickly
- it will prevent fibroblasts becoming attached to cementum and forming new attachment
what is guided tissue regeneration?
- most successful method of new attachment formation
- it promotes repopulation of cells derived from PDL and bone
What are some clinical features of NUG?
- sudden onset and very painful
- necrotic ulcers
- initially red swollen
- ulceration starts on tips of ID papillae and spreads laterally along gingival margin
- halitosis
- spontaneous bleeding
- metllic taste
- localised or generalised
how long do symptoms of NUG usually last?
acute symptoms last around 2-3 weeks leaving chronic periodontitis to occur
what can NUG develop into?
- cancrum oris
- orofacial necrosis
what bacteria are involved with NUG?
- anaerobic fuso-spirochaetal complex
- treponema vincentii&denticoli
- fusobacterium nucleatum
- prevotella intermedia
- porphyromonas gingivalis
what are some predisposing factors of NUG?
- smoking
- poor OH
- stress
- Immunodeficiency
what is the tx of NUG?
- OHI and explanation
- gentle USS
- antimicrobis (metronidazole 200mg for 3 days)
- review in 48 hrs
what are non-plaue induced gingival lesions?
BIVFGTSTF
- bacterial origin
- viral origin
- fungal
- genetic
- systemic
- traumatic
- foreign body
what are some examples of gingival diseases of viral origin?
- herpes virus infections
- primary herpatic gigivostomatitis
- varicella zoster infections
give some examples of gingival diseases of fungal origin?
- candida species infections
- linear gingival erythema
- hystoplasmosis
give an example of a gingival disease of genetic origin?
-hereditary gingival fibromatosis
what is recession?
-a seemingly inflammation free clinical condition characterised by the apical retreat of th periodontium
what is a fenestration?
window in bone
what is a dehiscence?
a lack of bone
what are some examples of recession?
- ortho tx
- frenum pulls
- excessive perio scaling
what is stillmans cleft?
‘v’ shape in gums
what is mcCalls festoon?
gum has rolled margin
what is a furcation plasty?
-surgical procedure used to remove tooth substance to widen entrance to furcation
what is guided tissue regeneration?
-procedure which enables bone and tissue to regenerate in defects around periodontally compromised teeth
what are 3 dentine hypersensitivity theories?
- dentinal receptor mechanism
- hydrodynamic mechanism(branhstroms theory)
- modulation of nerve impulses by poly peptides
what is it in toothpaste that helps sensitivity?
-pottasium ions
what do anti-epileptic drugs cause oraly?
-gingival hyperplasia
what anti-epileptic drug most commonly causes hyperplasia and where does it begin?
- phenytoin
- hyperplasia is worse anteriorly and begins interdentally and then grows
what type of drug is cyclosporin?
-immunosupressant
what does cyclosporin do oraly?
- gingival hyperplasia
- higher incidence in women and children
what are some commonly used corticosteriods?
-prednisalone, betlamethason, hydrocortisone
what do immunosupressants cause oraly?
- reduced inflammatory response/reaction to plaque
- decreased swelling/bleeding
- impaired wound healing
- increased susceptibility to infection
how do NSAIDs work?
-inhibit synthesis and release of prostaglandins
what oraly do NSAIDs cause?
- decreased bleeding
- decreased swelling
- decreased bone loss
how can oestrogen affect the periodontal tissues?
-oestrogen promotes keratinization and alters the composition of blood
how can progesterone affect the periodontal tissues?
-progesterone increases the permeability of gingival blood vessels
what is a pregnancy epulis?
soft, pedunculated granuloma arising from an inflammed gingival papilla
does the OCP affect periodontium if there is no pre-existing condition?
- No
- OCP only affect the periodontium if there is a pre existing condition
is the percentage of female smokers increasing or decreasing?
% of female smokers is increasing
smoking increases the prevelance of what?
- lung cancer
- cardiovascular disease
- GI disease
- low birth weight
is smoking an important risk factor in the development and progression of periodontal disease?
Yes. Smoking is now seen to be one of the most significant risk factors in the development and progression of periodontal disease
what are the constituents of a cigarette that cause the disease?
- nicotine
- napthalene
- phenols
- carboxylic acids
- aromatic amines
- tar
- many more…
what are some constituents of the gaseous phase?
- ammonia
- hydrogen sulphide
- hydrocarbons
- carboxylic acids
where can low doses of nicotine be stored and released?
-low doses of nicotine cane be stored and released by the periodontal fibroblasts
does nicotine act as a vasodilator or vasoconstrictor?
vasoconstrictor
list things that smokers are more likely to have :
big list
- spend less time brusing their teeth
- have more calc. deposits
- have more plaq. deposits
- deeper pockets
- greater alveolar bone loss
- lose more teeth than smokers
- gingivae have more keratinised cells
- perio. tx often fails
what are some things the perio tissued do in response to smoking?
- promotes vasoconstriction
- initial increase in GCF
- PMNs are impaired by smoking
is there any relationship between NUG and smoking?
yes. there is a clear relationship between NUG and smoking
tobacco may play a significant role in the development of a ……….. response to perio tx?
refractory response
there are clear links between smokeless tobacco products (snuff, betel nut) and what?
leukoplakia, and carcinoma
the periodontal pockets of smokers are more …….. than non smokers
the periodontal pockets of somkers are more ANAEROBIC than non-smokers
is smoking thought to alter the composition of plaque?
NO. smoking is not thought to alter the composition of plaque
with regards to ‘the effects on the response to periodontal treatment’ what do smokers have:
(another list)
- decreased salivary IgA antibodies to fusobacterium and P.intermedia
- decreased serum IgG antibodies to fusobacterium and P.intermedia
- decreased no. of T helper lymphocytes
- decreased neutrophil function
- tobacco smoke can impair the motility and chemotaxis of oral and peripheral PMNs
what can downs syndrome cause orally?
- class 3 occlusion
- anterior open bite
- large tongue
- lack of lip seal
- prone to infections
- prone to destructive periodontitis
- increased susceptiblity to NUG
- impaired chemotaxis and phagocytosis of PMNs
what can hypophosphatasia cause orally?
- premature exfoliation of premature teeth
- absence of gingival inflammation
- loss of alveolar bone
- prenament dentition does not appear infected
what can papillon lefevre syndrome cause?
- primary dentition prematurely lost and are shed in order of eruption
- pernament dentition erupts early
- aggressive periodontitis associated with permanent dentition
- perio tx is usually unsucessful
- accompanied with sever gingival inflammation
what can ehlers danlos syndrom cause orally?
- oral mucosa becomes fragile and susceptible to bruising
- gingival tissues bleed easily
- teeth become fragile and fracture easily
- perio. tx should be as atraumatic as possible
what are some features of hereditary gingival fibromatosis?
- condition does not manifest till after eruption of the teeth
- associated with pernament dentition
- gingival tissues are enlarged
- hyperplasia due to excessive production of collagen
- may delay eruption of the teeth
what is mucopolysacharidosis?
- group of inherited disorders
- teeth are small and widely spaced
what can a vitamin C deficiency cause?
scurvey
chemical antimicrobials may cause?
- sensitivity to the indvidual
- resistance
- super infections (mrsa, candidosis)
what do quaternary ammonium compounds do?
-have moderate plaque inhibitory activity but is not retained in mouth for long
give an example of a phenolic antiseptic?
listerine mouthwash
what are some possible uses of antiseptic mouthwashes?
- to replace mechanical toothbrushing when this is not possible
- after oral surgery
- during acute gingival conditions
- for mentally/physically handicapped people
can mouthwashes reach the subgingival area?
-no
what are agents used systemically for subgingival plaque control?
antibiotics
what are agents used topically/locally for subgingival plaque control?
antibiotics or antiseptics
what is the ‘perio chip’?
- contains 2.5mg chlorhexidine
- prolonged chlorhexidine release from single chip
- placed into pocket following RSD and arrest of haemorrhage
- chips swells on contact with moisture this retains it in the pocket
should antibiotics be the primary agent in the treatment of periodontal disease?
-No. Antibiotics should only be used as an adjunct in the tx of perio. disease
the development of ……. can be caused by frequent misuse of antibiotics.
-hypersensitivity reaction
what are the 5 phases of tx planning?
- initial examination and pain relief
- cause related therapy
- re-examination outcomes
- definitive tx
- maintenance
what is the goal of cause related therapy?
to render the roots biologically compatible with soft tisue by eliminating calculus and altered cementum and reducing periodontal pathogenic micro-organisms.
what is palliative care?
- not the same as maintenance
- palliative care recognises that the disease is not stable and it is not possible to achieve stability
- sc&p every 2-3 months
