Perio - Exam 1

Question 1

What does the modified plaque index measure….

Answer 1

Modified plaque index allows you to determine if that patient is being compliant. Instead of checking every tooth, we just check Ramfjord’s teeth- 3, 9, 12, 19, 25, 28. We measure the buccal of the maxillary teeth and lingual of the mandibular teeth. Note, if a Ramfjord tooth is missing, use adjacent tooth.

Question 2

What are Ramfjord’s teeth?

Answer 2

3, 9, 12, 19, 25, 28

Instead of checking every tooth, we check Ramfjord’s teeth for the modified plaque index.

Note: if a Ramfjord’s tooth is missing, use adjacent tooth.

Question 3

Which surface do we measure on the maxillary teeth for the modified plaque index? For the mandibular teeth?

Answer 3

Maxillary = buccal
Mandibular = lingual

Question 4

The gingival index was introduced by whom?

Answer 4

Loe and Silness

Question 5

What is the purpose of the gingival index?

Answer 5

• It can be used to describe qualitative changes in gingival soft tissues.
• It can be used on all or selected teeth.
• It does NOT consider pocket depth, bone loss, or any quantitative periodontium change- only the gingiva.

Question 6

Scoring of the gingival index.

Answer 6

• It does NOT consider pocket depth, bone loss, or any quantitative periodontium change- only the gingiva.
• Each of the 4 gingival areas of a tooth is scored as:
0 = normal
1 = mild inflammation
2 = moderate
3 = severe-spontaneous bleeding

Question 7

Fiber systems includes…

Answer 7

1) Gingival collagen fiber
2) Alveolar mucosa fiber (fibers are elastic)
3) Periosteum fiber (innermost connective tissue layer, which is attached to the bone)

Question 8

What are the gingival fibers made of?

Answer 8

Collagen

Question 9

Groups within gingival fiber…

Answer 9

• Gingivodental group
• Circular group
• Transseptal

Question 10

Gingivodental group…

Answer 10

• Part of gingival collagen fiber

* Attached to bone and cementum

Question 11

Transseptal fibers…

Answer 11

• Part of gingival collagen fiber

* Cementum of one tooth to another tooth’s cementum

Question 12

What are the periosteum fibers?

Answer 12

Innermost connective tissue layer, which is attached to the bone.

Question 13

Epithelial and connective tissue differences between gingival and alveolar mucosa…

Answer 13

• Epithelial: free and attached gingival are keratinized, whereas alveolar mucosa is not
• Connective tissue: free and attached gingiva have collagen fibers, whereas alveolar mucosa has elastic fibers (making it looser)

Question 14

Free and attached gingiva are ________, and have ________ fibers.

Answer 14

Keratinized, collagen

Question 15

Alveolar mucosa is not ________, and has ________ fibers.

Answer 15

Not keratinized, elastic

Question 16

The biological width consists of…

Answer 16

1) junctional epithelium - connected by hemidesmosomes

2) connective tissue fibers (Sharpy’s), collagen fibers attaching the attached gingiva to the cementum

Question 17

What is the biologic width?

Answer 17

• The soft tissue attached to the tooth, but before the alveolar bone.
•

Question 18

2 mm, from base of sulcus, to the crest of the alveolar bone, is what??

Answer 18

The biologic width

Question 19

Measurement of biologic width

Answer 19

2 mm (0.97 JE, 1.07 CT)

Question 20

What violates the biologic width?

Answer 20

• Often caused by crown prepping (done badly).

* Others: overhang, vertical root fracture 10-12 mm deep, etc.

Question 21

If patient has thin biotype and biologic width is violated, what results?

Answer 21

Patient will have recession of gingiva.

Question 23

If patient has thick biotype and the biologic width is violated, what results?

Answer 23

Patient will have erythema

Question 24

What type of epithelium makes up the gingival sulcus?

Answer 24

Sulcular epithelium, which is thin, non-keratinized, and has no rete pegs.

Question 25

The sulcus, made of the ____ gingiva, should be __ to __ mm, __ mm tops.

Answer 25

Free gingiva, 1-2mm, 3mm tops

Question 26

Why does the gingiva bleed?

Answer 26

• Connective tissue is below the sulcular epithelium (thin, non-keratinized).
• Connective tissue contains blood vessels, so if the epithelium is ulcerated, bleeding comes from here.
• In short, sulcular epithelium is tissue which breaks down – bleeds – easily upon probing.

Question 27

What is periodontitis?

Answer 27

• An inflammatory disease of supporting tissues of teeth, caused by infection of specific microorganisms.
• Result is destruction of the periodontal ligament and bone - seen as increased probing depth and/or recession.

Question 28

Etiologic factor for chronic periodontitis.

Answer 28

• The etiological factor is the bacteria in plaque, specifically bacteria of the red complex.
• Age is not an etiological factor, so it is age-associated, not age-related, because you accumulate the etiological factors over time.

Question 29

Rate of progression of chronic periodontitis.

Answer 29

• Progresses at a slow to moderate rate.
• There may be periods of more rapid destruction of there are changes in plaque accumulation or host response (due to smoking, stress, systemic health).
  
  • These periods of rapid destruction do not necessarily mean patient has aggressive periodontitis.

Question 30

Risk factors for chronic periodontitis.

Answer 30

1) Local factors
2) Systemic disease
3) Environmental factors

Question 31

Symptoms of chronic periodontitis.

Answer 31

1) Usually painless, so patient is unaware and needs dentist to inform them.
2) Bleeding while brushing/eating
3) Pathologic migration. Teeth move due to loss of support by periodontal tissue and being pushed by cheek/tongue/mastication.
4) Teeth mobility. Teeth become loose
5) Root sensitivity due to exposed roots after gingiva recessed.
6) Dull localized discomfort or gingival itchiness.
7) Discomfort if interproximal spaces are exposed and get food impacted more easily.

Key point. For a disease that can lead to tooth loss and even affect systemic health, the symptoms are relatively mild.

Question 32

Clinical feature that distinguishes periodontitis from gingivitis is…

Answer 32

• Clinical attachment loss, related to the presence of plaque.
• We will always see clinical attachment loss in a patient with chronic periodontitis.

Question 33

How to measure clinical attachment loss?

Answer 33

Probe for the distance between the CEJ and the base of the sulcus.

Question 34

Clinical features for chronic periodontitis…

Answer 34

1) Variable pocket depths (some areas not 3mm)
2) Bone loss
3) Furcation defects
4) Plaque, calculus
5) Tooth mobility and pathologic migration
6) Gingival recession and inflammation (changes in color, contour, consistency)
a) Erythema or cyanosis
b) Blunted/rolled gingival margin, flattened/cratered papilla
c) Fibrotic in smokers, or fragile
d) Volume increase because of edema
e) Loss of gingival stippling because of edema (though sometimes no stippling in health)
f) Bleeding - spontaneous or upon probing
g) Exudate of gingival crevicular fluid
h) Suppuration - discharging pusq

Question 35

__________ must be used in conjunction with clinical assessment.

Answer 35

Radiographs (bite-wings or periapicals most diagnostic)

Question 36

Radiographs ________ the level of bone loss.

Answer 36

Underestimate

Note:
• Mild cases may not show radiographic change.
• Radiographs shows loss that has already happened, not current cellular activity.