Perio I Flashcards
3 Lesions of Gingivitis:
The Lesion of Periodontitis:
Initial, Early, Established
Advanced
The Initial Lesion in Gingivitis develops in ___ to ___ days.
Inflammatory cell infiltrate is primarily ______
2 to 4 days
Neutrophils
In the Initial Lesion of Gingivitis there is Vasculitis, increase in GCF, no bone loss, no clinical attachment loss, but a loss of Perivascular ___
CT
collagen
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…
4-7
lymphocytes, macrophages
T-cell
What stage of Gingivitis sees the beginnings of a pseudopocket, loss of gingival stippling, and BOP?
Early Lesion (4-7 days)
Classic “gingivitis,” or a transition to periodontitis, aka…
Established Lesion
The Established Lesion of Gingivitis establishes itself at _____
2-3 weeks
At 2-3 weeks in the Established Lesion, _____ persist but ______, _____, and ______ dominate
neutrophils
lymphocytes, macrophages, plasma cells
chronic infiltrate
What stages of Gingivitis is there BOP?
Early lesion (4-7 days)
Established lesion (2-3 weeks)
T/F
The established lesion can last for years, and the mechanisms that proceed to periodontitis is not well understood
True
What stage of Gingivitis is characterized by Rete Pegs in the Junctional Epithelium and Erythema?
Early
An Advanced Lesion, aka
Periodontitis
What defines an Advanced Lesion?
Activation of Osteoclasts
alveolar bone resorption
Aggressive periodontitis refers to:
Severe refers to:
Adolescents
Adults
Name 3 Endocrine conditions that can create Gingival Disease:
Puberty
Pregnancy
Diabetes
What bacteria thrive in the endocrine conditions created by Puberty, Pregnancy, and Diabetes?
P. intermedia
A blood dyscrasia that can lead to gingival disease:
Is there bone loss with Dyscrasias?
Leukemia
no
Name 3 drugs that can elicit Gingival Enlargement:
Phenytoin sodium (Dilantin)
Cyclosporine (Sandimmune)
Ca Channel Blockers (Nifedipine)
Name 3 bacteria that don’t produce plaque but can induce gingival disease:
Neisseria gonorrhea
Treponema pallidum
beta-hemolytic Strep
Name 2 Viruses that can induce gingival disease:
Herpes I and II
Varicella-zoster
Name 3 Fungi that can induce gingival disease:
Candida albicans
Histoplasmosis
Linear gingival erythema
Localized vs. Generalized periodontitis happens at ____ % of teeth involved.
30
What are the 4 components of the Periodontium?
Gingiva
Periodontal Ligament
Cementum
Alveolar Bone proper
What periodontal tissue has the capacity to become keratinized?
What does not?
Oral sulcular epithelium
Junctional epithelium
T/F
Stippling is present in 40% of the population
True
Gingival Margin to MGJ (mucogingival junction) - sulcus depth =
Attached Gingiva
Normal probing depth:
0-3 mm
CAL is measured from the…
CEJ
What is the Gold Standard for monitoring the trends of perio disease?
BOP
If BOP is negative, there is…
no active disease
On average, the Biological Width is ___ mm
2 mm
T/F
Biological width is made of the Junctional Epithelium, the CT attachment to the alveolar bone, and the sulcular epithelium
False
*not the sulcular epithelium
What is the Biological Width made up of? (2 components)
Junctional epithelium
Attached epithelium to the bone
What is the average width of the PDL in an Adult?
0.17 mm
What are the 3 classes of Tooth Mobility?
Class I: 0.2 to 1 mm
Class II: greater than 1 mm
Class III: greater than 1 mm + Axial displacement
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?
Clinical diagnosis of Perio disease
ANUG has an age of onset between ____ and ____ years
it is commonly associated with stress and ______
15 and 30
smoking
What 2 systemic antibiotics are used to address ANUG?
Amoxicillin
Metronidazole
What are the 4 microscopic zones of ANUG?
Bacterial zone
Neutrophil rich zone
zone of Necrosis
zone of Spirochete Infiltration
What 2 conditions can result in multiple Acute Periodontal Abscess formation?
Diabetes (uncrontrolled)
AIDS
What % of flora is G- in an Acute Periodontal Abscess?
65%
What are 2 Important bacteria in Acute Periodontal Abscess?
Why?
P. gingivalis and P. intermedia
Proteinases increase nutrients
Unlike Acute Periodontal Abscess (which is caused by blockage of a periodontal pocket), what causes Acute Gingival Abscess?
impaction of foreign body
What type of Periodontitis sees furcation invasion?
Chronic perio
T/F
Chronic Periodontitis can be treated with Systemic Antibiotics
False
T/F
Chronic Periodontiti is painfule
False
*painless except w/ abscess
Chronic Periodontitis - classification by Severity:
Slight: 1-2 mm CAL
Moderate: 3-4 mm CAL
Advanced: 5 (or greater) CAL
What is Excessive PD without the loss of clinical attachment?
(an increase bulk of the gingiva)
Pseudopocket
What is excessive PD with loss of clinical attachment?
Periodontal Pocket
What are the 2 types of Periodontal Pockets?
Suprabony
Intrabony
How are Intrabony pockets classified?
Walls (1-3)
Circumferential
Interdental Craters
Suprabony pockets tend to be associated with ____ alveolar bone loss
Intrabony pockets tend to be associated with ____ alveolar bone loss
Horizontal
Vertical
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
True
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.
True
What is the Red Complex
*Aggressive Periodontitis
Porphyromonas gingivalis
Tannerella forsythia
Treponema denticola
Aggregatibacter actinomycetemcomitans
(A.a. = adolescent)
How does NUP differ from ANUG?
clinical attachment loss and alveolar bone loss
both consistent in NUP
T/F
NUP is associated with AIDS, and 73% of pts die within 24 months of NUP diagnosis
True
Low grade fever, lymphadenopathy, moderate/severe pain, periodontal abscesses, aggressive necrosis, aggressive loss of alveolar bone, exposure of interproximal alveolar bone (necrotizing stomatitis):
Necrotizing Ulcerative Periodontitis (NUP)
NUP has all the microbes as Advanced Chronic Periodontitis, plus what 3 more species?
Clostridium
Klebsiella
Enterococcus
(also Candida and EBV)
Tx for NUP is soft tissue debridement, scaling/root planing, CHX, and what 2 drugs?
Metronidazole
Fluconazole (Diflucan)
Cytoplasmic granules (Basophils/Mast Cells) contain what 5 important factors?
Histamine
Platelet activating factor
Heparin
TNF-alpha
SRS-As
What 3 SRS-As (slow reacting substances of anaphylaxis) are in Basophils/Mast cells?
Leukotriene C4, D4, and E4
Monocyte/Macrophage (along with phagocytosis/antigen recognition), synthesizes what 5 cytokines/lymphokines?
IL-1
IL-6
TNF-alpha
INF
Lipid mediators (prostaglandin, leukotriene, Platelet Activating Factor)
Function, IL-1:
IL-6:
TNF-alpha:
INF:
activates - osteoclasts, B-lymphocytes, CD8 lymphocytes
activates osteoclasts
endothelium/inflammatory mediator
interferes with viral replication
What lymphocyte activates macrophage, CD8 (cytotoxic) T cells, and B-lymphocytes that secrete IG’s
CD4
The CD8 Lymphocyte (cytotoxic) destroys cells with Cytotoxins (lymphokines) and synthesizes what other 3 factors?
INF-gamma
TNF-alpha
TNF-beta
Cell population, inflammation, Initial Stage:
PMN’s
Cell population, inflammation, Acute Stage:
PMN’s, Macrophage, a few Lymphocytes (B and T-cells)
Cell population, inflammation, Chronic Stage:
few PMN’s/Macrophage
mostly Lymphocytes and Plasma Cells (B-lymphocytes)
A dense collection of inflammatory cells, primarily neutrophils, combined with tissue necrosis and walled off by immature connective tissue:
Abscess
T/F
Periodontitis is always accompanied by inflammation
False
T/F
Gingivitis differs from Periodontitis b/c it lacks Bone Loss, PDL destruction, and apical migration of the JE
True
T/F
Everyone with poor plaque control eventually develops gingivitis
True
T/F
Plaque is necessary but not sufficient to initiate pariodontitis
True
T/F
Perio disease theory includes the Continuous model and an asynchronous multiple burst model, the latter of which is the more probable
True
What are soluble, locally active plypeptides that regulate cell growth, differentiation and/or function?
Cytokines
IL-1 functions (3):
IL-6 function:
IL-8 function:
osteoclast, fibroblast, macrophage
B and T cells
PMN’s
**all pro-inflammatory
TNF-alpha activates…
osteoclasts
4 functions of PGE2
Vasodilation
Pyrogenic
Mast cell mediator release
cell-mediated cytotoxicity
T/F
Neutrophils always come through the JE, even in healthy gingiva
True
Acute =
Chronic =
Increase in chronicity =
PMN’s
Lymphocytes
Plasma cells
In an Early Lesion there is a ___ % loss of collagen in the gingival lamina propria
There is also Vascular ______
70
Hyperemia
What class of endopeptidase is active against most extracellular matrix macromolecules?
MMP’s
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)
Interstitial, Fibroblast
Type IV, Fibroblast
Neutrophil
Neutrophil, Type IV
Macrophage
Fibroblast
Junctional Epithelium - Initial
Early
Established
PMN infiltration
Rete pegs
Rete pegs with microulcers
Advanced Lesion (periodontitis) cell profile:
PMN’s
plasma cells (cytopathlogically altered), lymphocytes, macrophagess
When does loss of epithelial intermediate, tight, and gap junctions occur?
In the Established Lesion
How much bone volume/density needs to be lost before radiographic detection?
30-50%
Significant attachment loss precedes bone loss by ____ to ____ months
6 to 8
Puberty sees an increase in Estrogen/Progesterone and levels of what microbe?
P. intermedia
What is the essential nutrient for P. intermedia?
What is a substitute for this in progesterone?
Menadione (methyl-naphthanlenedione)
naphthoquinone
Name 5 primary Periodontal Pathogens:
this is pregnancy related
P. gingivalis
Tannerela forsythia
Campylobacter rectus
Prevotella intermedia
Treponema denticola
Stage 1 Hypertension:
140-159 / 90-99
Stage 2 Hypertension:
(greater than) 160 / 100
At what BP would there be an immediate referral and the performance of emergency dental care only?
180/100
How long should Tx be deferred following an MI?
6 months
In Congestive Heart Failure, treat the patient in what position?
Upright
What are 3 Periodontal pathogens that may be involved in Infectious Endocarditis
*Alpha-hemolytic strep is most common etiological agent
Eikenella corrodens
A.a.
Capnocytophaga spp.
Following a CVA (cerebrovascular accident) wait ___ months before initiating perio Tx
*CVA = stroke
6 months
Pts with CVA require an M.D. consult regarding ______
anticoagulants
Periodontitis from Type I diabetes is usually the result of _______
Cellular starvation
T/F
The link between obesity and Perio disease is an inflammatory association
*think cytokines
True
HbA1c above ____%, don’t do electives
6.5%
T/F
Xerostomia and Candidiasis are some signs of Diabetes
True
What increases with age?
Cementum
T/F
There are more older adults with Advanced Disease
False
*fewer - probably b/c problem teeth have been removed
What drug used for bone cancer and osteoporosis causes jaw necrosis?
Bisphosphonates
*BIONJ - bisphosphonate induced osteonecrosis
NUP is treated with soft tissue debridement, scaling/root planing, _____, _____, and ______
CHX
Fluconazole (Diflucan)
Metronidazole
