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Tim's Cards > Perio I > Flashcards

Perio I Flashcards

1
Q

3 Lesions of Gingivitis:

The Lesion of Periodontitis:

A

Initial, Early, Established

Advanced

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2
Q

The Initial Lesion in Gingivitis develops in ___ to ___ days.

Inflammatory cell infiltrate is primarily ______

A

2 to 4 days

Neutrophils

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3
Q

In the Initial Lesion of Gingivitis there is Vasculitis, increase in GCF, no bone loss, no clinical attachment loss, but a loss of Perivascular ___

A

CT

collagen

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4
Q

The Early Lesion of Gingivitis evolves at ____ days

Along with neutrophils, the chronic cell infiltrate begins to appear and is made up of _____ and ______

The dominant infiltrate cell is…

A

4-7

lymphocytes, macrophages

T-cell

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5
Q

What stage of Gingivitis sees the beginnings of a pseudopocket, loss of gingival stippling, and BOP?

A

Early Lesion (4-7 days)

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6
Q

Classic “gingivitis,” or a transition to periodontitis, aka…

A

Established Lesion

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7
Q

The Established Lesion of Gingivitis establishes itself at _____

A

2-3 weeks

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8
Q

At 2-3 weeks in the Established Lesion, _____ persist but ______, _____, and ______ dominate

A

neutrophils

lymphocytes, macrophages, plasma cells
chronic infiltrate

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9
Q

What stages of Gingivitis is there BOP?

A

Early lesion (4-7 days)

Established lesion (2-3 weeks)

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10
Q

T/F

The established lesion can last for years, and the mechanisms that proceed to periodontitis is not well understood

A

True

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11
Q

What stage of Gingivitis is characterized by Rete Pegs in the Junctional Epithelium and Erythema?

A

Early

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12
Q

An Advanced Lesion, aka

A

Periodontitis

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13
Q

What defines an Advanced Lesion?

A

Activation of Osteoclasts

alveolar bone resorption

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14
Q

Aggressive periodontitis refers to:

Severe refers to:

A

Adolescents

Adults

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15
Q

Name 3 Endocrine conditions that can create Gingival Disease:

A

Puberty

Pregnancy

Diabetes

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16
Q

What bacteria thrive in the endocrine conditions created by Puberty, Pregnancy, and Diabetes?

A

P. intermedia

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17
Q

A blood dyscrasia that can lead to gingival disease:

Is there bone loss with Dyscrasias?

A

Leukemia

no

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18
Q

Name 3 drugs that can elicit Gingival Enlargement:

A

Phenytoin sodium (Dilantin)

Cyclosporine (Sandimmune)

Ca Channel Blockers (Nifedipine)

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19
Q

Name 3 bacteria that don’t produce plaque but can induce gingival disease:

A

Neisseria gonorrhea

Treponema pallidum

beta-hemolytic Strep

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20
Q

Name 2 Viruses that can induce gingival disease:

A

Herpes I and II

Varicella-zoster

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21
Q

Name 3 Fungi that can induce gingival disease:

A

Candida albicans

Histoplasmosis

Linear gingival erythema

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22
Q

Localized vs. Generalized periodontitis happens at ____ % of teeth involved.

A

30

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23
Q

What are the 4 components of the Periodontium?

A

Gingiva

Periodontal Ligament

Cementum

Alveolar Bone proper

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24
Q

What periodontal tissue has the capacity to become keratinized?

What does not?

A

Oral sulcular epithelium

Junctional epithelium

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25
Q

T/F

Stippling is present in 40% of the population

A

True

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26
Q

Gingival Margin to MGJ (mucogingival junction) - sulcus depth =

A

Attached Gingiva

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27
Q

Normal probing depth:

A

0-3 mm

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28
Q

CAL is measured from the…

A

CEJ

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29
Q

What is the Gold Standard for monitoring the trends of perio disease?

A

BOP

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30
Q

If BOP is negative, there is…

A

no active disease

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31
Q

On average, the Biological Width is ___ mm

A

2 mm

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32
Q

T/F
Biological width is made of the Junctional Epithelium, the CT attachment to the alveolar bone, and the sulcular epithelium

A

False

*not the sulcular epithelium

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33
Q

What is the Biological Width made up of? (2 components)

A

Junctional epithelium

Attached epithelium to the bone

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34
Q

What is the average width of the PDL in an Adult?

A

0.17 mm

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35
Q

What are the 3 classes of Tooth Mobility?

A

Class I: 0.2 to 1 mm

Class II: greater than 1 mm

Class III: greater than 1 mm + Axial displacement

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36
Q

Probing depth, BOP, CAL, width of attached gingiva, recession, furcation involvements, Mobility, Radiographic evidence of bone loss, and plaque/calculus are all used for what?

A

Clinical diagnosis of Perio disease

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37
Q

ANUG has an age of onset between ____ and ____ years

it is commonly associated with stress and ______

A

15 and 30

smoking

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38
Q

What 2 systemic antibiotics are used to address ANUG?

A

Amoxicillin

Metronidazole

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39
Q

What are the 4 microscopic zones of ANUG?

A

Bacterial zone

Neutrophil rich zone

zone of Necrosis

zone of Spirochete Infiltration

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40
Q

What 2 conditions can result in multiple Acute Periodontal Abscess formation?

A

Diabetes (uncrontrolled)

AIDS

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41
Q

What % of flora is G- in an Acute Periodontal Abscess?

A

65%

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42
Q

What are 2 Important bacteria in Acute Periodontal Abscess?

Why?

A

P. gingivalis and P. intermedia

Proteinases increase nutrients

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43
Q

Unlike Acute Periodontal Abscess (which is caused by blockage of a periodontal pocket), what causes Acute Gingival Abscess?

A

impaction of foreign body

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44
Q

What type of Periodontitis sees furcation invasion?

A

Chronic perio

45
Q

T/F

Chronic Periodontitis can be treated with Systemic Antibiotics

A

False

46
Q

T/F

Chronic Periodontiti is painfule

A

False

*painless except w/ abscess

47
Q

Chronic Periodontitis - classification by Severity:

A

Slight: 1-2 mm CAL

Moderate: 3-4 mm CAL

Advanced: 5 (or greater) CAL

48
Q

What is Excessive PD without the loss of clinical attachment?
(an increase bulk of the gingiva)

A

Pseudopocket

49
Q

What is excessive PD with loss of clinical attachment?

A

Periodontal Pocket

50
Q

What are the 2 types of Periodontal Pockets?

A

Suprabony

Intrabony

51
Q

How are Intrabony pockets classified?

A

Walls (1-3)

Circumferential

Interdental Craters

52
Q

Suprabony pockets tend to be associated with ____ alveolar bone loss

Intrabony pockets tend to be associated with ____ alveolar bone loss

A

Horizontal

Vertical

53
Q

T/F
Untreated Chronic periodontitis progresses at 0.1-0.3 mm/yr for facial/lingual surfaces and 0.3 mm/yr for interproximal areas

A

True

54
Q

In a 10 year period, untreated Chronic periodontitis pts will lose 3.5-4.0 teeth while pts that are treated will only lose 1 tooth.

A

True

55
Q

What is the Red Complex

*Aggressive Periodontitis

A

Porphyromonas gingivalis

Tannerella forsythia

Treponema denticola

Aggregatibacter actinomycetemcomitans

(A.a. = adolescent)

56
Q

How does NUP differ from ANUG?

A

clinical attachment loss and alveolar bone loss

both consistent in NUP

57
Q

T/F

NUP is associated with AIDS, and 73% of pts die within 24 months of NUP diagnosis

A

True

58
Q

Low grade fever, lymphadenopathy, moderate/severe pain, periodontal abscesses, aggressive necrosis, aggressive loss of alveolar bone, exposure of interproximal alveolar bone (necrotizing stomatitis):

A

Necrotizing Ulcerative Periodontitis (NUP)

59
Q

NUP has all the microbes as Advanced Chronic Periodontitis, plus what 3 more species?

A

Clostridium

Klebsiella

Enterococcus

(also Candida and EBV)

60
Q

Tx for NUP is soft tissue debridement, scaling/root planing, CHX, and what 2 drugs?

A

Metronidazole

Fluconazole (Diflucan)

61
Q

Cytoplasmic granules (Basophils/Mast Cells) contain what 5 important factors?

A

Histamine

Platelet activating factor

Heparin

TNF-alpha

SRS-As

62
Q

What 3 SRS-As (slow reacting substances of anaphylaxis) are in Basophils/Mast cells?

A

Leukotriene C4, D4, and E4

63
Q

Monocyte/Macrophage (along with phagocytosis/antigen recognition), synthesizes what 5 cytokines/lymphokines?

A

IL-1

IL-6

TNF-alpha

INF

Lipid mediators (prostaglandin, leukotriene, Platelet Activating Factor)

64
Q

Function, IL-1:

IL-6:

TNF-alpha:

INF:

A

activates - osteoclasts, B-lymphocytes, CD8 lymphocytes

activates osteoclasts

endothelium/inflammatory mediator

interferes with viral replication

65
Q

What lymphocyte activates macrophage, CD8 (cytotoxic) T cells, and B-lymphocytes that secrete IG’s

A

CD4

66
Q

The CD8 Lymphocyte (cytotoxic) destroys cells with Cytotoxins (lymphokines) and synthesizes what other 3 factors?

A

INF-gamma

TNF-alpha

TNF-beta

67
Q

Cell population, inflammation, Initial Stage:

A

PMN’s

68
Q

Cell population, inflammation, Acute Stage:

A

PMN’s, Macrophage, a few Lymphocytes (B and T-cells)

69
Q

Cell population, inflammation, Chronic Stage:

A

few PMN’s/Macrophage

mostly Lymphocytes and Plasma Cells (B-lymphocytes)

70
Q

A dense collection of inflammatory cells, primarily neutrophils, combined with tissue necrosis and walled off by immature connective tissue:

A

Abscess

71
Q

T/F

Periodontitis is always accompanied by inflammation

A

False

72
Q

T/F

Gingivitis differs from Periodontitis b/c it lacks Bone Loss, PDL destruction, and apical migration of the JE

A

True

73
Q

T/F

Everyone with poor plaque control eventually develops gingivitis

A

True

74
Q

T/F

Plaque is necessary but not sufficient to initiate pariodontitis

A

True

75
Q

T/F
Perio disease theory includes the Continuous model and an asynchronous multiple burst model, the latter of which is the more probable

A

True

76
Q

What are soluble, locally active plypeptides that regulate cell growth, differentiation and/or function?

A

Cytokines

77
Q

IL-1 functions (3):

IL-6 function:

IL-8 function:

A

osteoclast, fibroblast, macrophage

B and T cells

PMN’s

**all pro-inflammatory

78
Q

TNF-alpha activates…

A

osteoclasts

79
Q

4 functions of PGE2

A

Vasodilation

Pyrogenic

Mast cell mediator release

cell-mediated cytotoxicity

80
Q

T/F

Neutrophils always come through the JE, even in healthy gingiva

A

True

81
Q

Acute =

Chronic =

Increase in chronicity =

A

PMN’s

Lymphocytes

Plasma cells

82
Q

In an Early Lesion there is a ___ % loss of collagen in the gingival lamina propria

There is also Vascular ______

A

70

Hyperemia

83
Q

What class of endopeptidase is active against most extracellular matrix macromolecules?

A

MMP’s

84
Q

MMP 1 (2 types of collagenase)

MMP 2 (1 collagenase, 1 gelatinase)

MMP 8 (1 collagenase)

MMP 9 (gelatinase, collagenase)

MMP 12 (elastase)

MMP 13 (collagenase)

A

Interstitial, Fibroblast

Type IV, Fibroblast

Neutrophil

Neutrophil, Type IV

Macrophage

Fibroblast

85
Q

Junctional Epithelium - Initial

Early

Established

A

PMN infiltration

Rete pegs

Rete pegs with microulcers

86
Q

Advanced Lesion (periodontitis) cell profile:

A

PMN’s

plasma cells (cytopathlogically altered), lymphocytes, macrophagess

87
Q

When does loss of epithelial intermediate, tight, and gap junctions occur?

A

In the Established Lesion

88
Q

How much bone volume/density needs to be lost before radiographic detection?

A

30-50%

89
Q

Significant attachment loss precedes bone loss by ____ to ____ months

A

6 to 8

90
Q

Puberty sees an increase in Estrogen/Progesterone and levels of what microbe?

A

P. intermedia

91
Q

What is the essential nutrient for P. intermedia?

What is a substitute for this in progesterone?

A

Menadione (methyl-naphthanlenedione)

naphthoquinone

92
Q

Name 5 primary Periodontal Pathogens:

this is pregnancy related

A

P. gingivalis

Tannerela forsythia

Campylobacter rectus

Prevotella intermedia

Treponema denticola

93
Q

Stage 1 Hypertension:

A

140-159 / 90-99

94
Q

Stage 2 Hypertension:

A

(greater than) 160 / 100

95
Q

At what BP would there be an immediate referral and the performance of emergency dental care only?

A

180/100

96
Q

How long should Tx be deferred following an MI?

A

6 months

97
Q

In Congestive Heart Failure, treat the patient in what position?

A

Upright

98
Q

What are 3 Periodontal pathogens that may be involved in Infectious Endocarditis

*Alpha-hemolytic strep is most common etiological agent

A

Eikenella corrodens

A.a.

Capnocytophaga spp.

99
Q

Following a CVA (cerebrovascular accident) wait ___ months before initiating perio Tx

*CVA = stroke

A

6 months

100
Q

Pts with CVA require an M.D. consult regarding ______

A

anticoagulants

101
Q

Periodontitis from Type I diabetes is usually the result of _______

A

Cellular starvation

102
Q

T/F
The link between obesity and Perio disease is an inflammatory association

*think cytokines

A

True

103
Q

HbA1c above ____%, don’t do electives

A

6.5%

104
Q

T/F

Xerostomia and Candidiasis are some signs of Diabetes

A

True

105
Q

What increases with age?

A

Cementum

106
Q

T/F

There are more older adults with Advanced Disease

A

False

*fewer - probably b/c problem teeth have been removed

107
Q

What drug used for bone cancer and osteoporosis causes jaw necrosis?

A

Bisphosphonates

*BIONJ - bisphosphonate induced osteonecrosis

108
Q

NUP is treated with soft tissue debridement, scaling/root planing, _____, _____, and ______

A

CHX

Fluconazole (Diflucan)

Metronidazole

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