Perio etiology and therapy Flashcards
main etiologic bacteria for periodontal disease (aka chronic periodontitis)?
Porphyromonas gingivalis
etiologic pathogens for periodontitis are? Describe them
1) Porphyromonas gingivalis
- - virulence factors: fimbriae, hemaglutinin, capsular polysaccharide
2) Aggregatibacter actinomycetemomitans serotype B
- - fimbriae, PGA polysaccharide, serotype-specific carbohydrates, leukotoxin, proteases, cytolethal, GroEL-like protein
3) Tannerella forsythia
- - trypsin-like protease, sialidase, cysteine protease, apoptotic-inducing factor and lipoproteins
Streptococcus gordonii
early colonizers involved in plaque formation
streptococcus mutans
highly associated with caries
Lactobacillus casei
found in oral cavity (and intestines) and produces acid critical in enamel demineralization
main hormone associated with puberty and pregnancy associated gingivitis?
estrogen
sex hormones role in gingivitis?
sex hormones induce vasodilation and increases permeability along capillary walls. This allows more fluid to extravasate and cause severe inflammation
primary etiology of gingival inflammation?
plaque - bc bacterial aggregates from plaque initiate the inflammatory reaction
what is purulence composed of?
dead and dying neutrophils
streptococcus gordonii
- part of NORMAL oral flora
- in normal amounts it keeps balance between G- and G+ bacteria in mouth
- gram + cocci
- adheres to tooth pellicle
- considered one of the FIRST initial colonizers of dental biofilm by creating a site for bacteria to coaggregate
common causes of primary occlusal trauma?
over-filled dental restorations
crowns with high occlusion
heavy biting of hard substances
primary occlusal trauma VS secondary occlusal trauma
primary: trauma experienced by a tooth having NORMAL heathy periodontium
secondary: trauma experienced by a tooth with previous or COMPROMISED periodontium
* * MAY experience further trauma even if under normal occlusal loads
primary etiologic pathogen of localized aggressive periodontitis
Aggregatibacter actinomycetemomitans
1) first WBC to arrive at infected or injured tissue?
2) chronic infections include?
1) neutrophil
2) macrophages, lymphocytes and plasma cells
Treponema denticola
associated with necrotizing gingivitis/periodontits (ANUG/ANUP)
Actinomyces viscosus is associated with?
healthy gingiva
Most common viral oral infection?
Acute herpetic gingivostomatitis
Acute herpetic gingivostomatitis
commonly seen in children, viral
facultative anaerobes
can live with or without oxygen
- create their own energy source (ATP) via aerobic respiration through oxidative phosphorylation OR anaerobic respiration through fermentation
- require more energy to survive and make ATP fast
describe plaque after 48 hours
G+ cocci and rods (streptococcus and Actinomyces)
what two bacteria are associated with dental carries the most?
*streptococcus mutans** and Lactobacillus casei
Can you use ultrasonic instruments with active infectious disease pts?
No. aerosols created by instruments spread the disease (diabetes and deep pockets require ultrasonic)
What boney defects are goof candidates for bone grafting?
Defects with 2 or 3 walls
Full thickness flap includes stripping what off the bone?
all of the soft tissue (epithelium, connective tissue and periosteum)
Is a gingivectomy indicated to eliminate deep pockets?
No. Only indicated for pts having excessive gingival exposure
describe gingivectomy. what is it used for?
periodontal surgery that is used for excision of gingiva. How much is removed is determined by perio probe. the extent of gingivectomy may be equal or apical to teh bottom of the periodontal pocket AS LONG as the termination point is ABOVE the mucogingival junction
Used for:
1) treat supraboney periodontal pockets
2) gingival enlargement/hypertrophy
3) supraboney periodontal abscesses
4) provide visibility and accessibility for calculus removal/cleaning
Partila thickness flaps include? Used for what
include the epithelium and connective tissue, while the periosteum is left attached to the bone. Used for free gingival grafts and bone dehiscence or fenestration is present
name a magnetostrictive ultrasonic instrument?
Cavitron and Titin… used to remove heavy calc and stain via an elliptical motion
How do Cavitrons work?
1) Lavage - flushes the pocket, hard to reach areas
2) Cavitation -ultrasonic movement creates air bubbles that knock deposits off tooth
3) Vibration - mechanically removes deposits/debris
4) Acoustic turbulance - agitation observed in fluids by mechanical vibrations that disrupts bacterial cell walls
How are piezo instruments different from cavitons?
they use a linear motion to create a back and forth motion to create their ultrasonic movement (instead of an ovoid motion like cavitrons)
what is chlorhexidine?
an antiseptic rinse, it does NOT remove dead tissue
what is iodine 1% tincture used for? what is another name
aka Lugol solution. Great wide spectrum antiseptic agent that is used a rinse pre and post surgeries
Uses of low concentration hydrogen peroxide
3% hydrogen peroxide debrids intraoral lesions of dead tissue and infection, a mild concentration provides antimicrobial properties through the realease of oxygen as it is applied to the infected wound
Uses of high concentration hydrogen peroxide
used as a bleaching agent to disinfectant in hospitals and water waste management
why is prolonged hydrogen peroxide not advised?
harm and irritation of oral tissues
osseous VS resective VS regenerative surgeries
osseous: includes recontouring of both hard and soft tissues
resective: include gingivectomy and flap surgeries
regenerative: include grafting an use of barrier membranes
ultrasonic dental scalers vs ultrasonic cleaners
scalers use vibration and pulsation to break down mineralized plaque (calculus)
cleaners produce cavitation (movement creating tiny vacuum bubbles)
what is the main goal of resective or regenerative surgery for perio therapy?
reduce pocket depths
describe how free gingival grafts receive nutrients
from the recipient site through plasmatic diffusion from underlying connective tissue
- no vascular connection between recipient site and graft in first 24 hours. the forming of capillary anastomoses provides the source of nutrients for FGG 3 days post-surgery
- experience DEGENERATION in first few days due to lack of direct blood supply ** immobilization of graft will help with blood vessel formation
bacteria that are considered periodontal pathogens?
G- fusiform bacteria spirochetes anaerobic members of red complex
purpose of barrier or Teflon membranes?
placed to allow cultivation and growth of new attachments without any interference from the long junctional epithelium
relationship between pocket depth and oral hygiene?
indirect. wen pocket depth is decreased, effective oral hygiene measures increase
ostectomy VS osteoplasty
ostectomy: removes tooth SUPPORTING bone to help reduce or eliminate periodontal pockets
osteoplasty: removes NON-supporting bone
ostectomy or osteoplasty performed first?
osteoplasty. This allows for the most conservative removal of bundle bone (supporting bone) around teeth
guided tissue regeneration procedures require use of barrier membranes WHY? What do they do?
barrier membranes guide/direct the growth of newly forming bone and soft tissue. They stop the possible migration of epithelial calls toward the newly formed cementum layer, thus preventing the formation of long junctional epithelium (Ex: Teflon)
purpose of free gingival graft? harvested from where?
harvested from palatal area, purpose to increase keratinzised gingival tissue of an implant material or to cover up areas of gingival recession
3 types of bone allografts
1) fresh and fresh frozen bone
2) freeze dried bone allograft (FDBA) often this
3) Demineralized freeze dried bone allograft (DFDBA)
1) allograft
2) autograft
3) alloplasts
4) xenografts
5) isografts
1) allograft - person to ANOTHER different person
2) autograft - taken from one part of body and transferred to another area of same body
3) alloplasts or synthetic - inert or non-reactice foreign materials that are transplanted or implanted inside the body (hydroxyapatite or different polymers like polymethyl methacrylate (PMMA))
4) xenografts - one species to another species (bovine)
5) isografts - between two identical poeple (monozygotic twins)
What is a logical treatment for ANUG?
antibiotics such as penicillin and metronidazole… latest txt include SRP and topical chlorhexidine gluconate rinses
name for dry socket? How do you get it?
acute alveolar osteitis. Occurs after traumatic extraction and accidental early dislodgement of blood clot
treatment for acute alveolar osteitis?
rinsing the affected socket with warm saline solution and placement of a sponge with antiseptic dressing
NOT systemic antibiotics*****
how many walls does a crater defect have?
2
capillary inosculation
for a free gingival graft the formation of new capillaries from the recipient site to the donor site will only occurs within two to 3 days after the surgical procedure in the process known as capillary inosculaition
the incidence and severity of chronic inflammatory periodontal disease are easily lessened by?
regular proper oral hygiene
