Perio I Flashcards by Tim Agee

3 Lesions of Gingivitis:

The Lesion of Periodontitis:

Initial, Early, Established

Advanced

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

Inflammatory cell infiltrate is primarily ______

2 to 4 days

Neutrophils

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

collagen

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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

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

Early Lesion (4-7 days)

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

Established Lesion

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The Established Lesion of Gingivitis establishes itself at _____

2-3 weeks

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

neutrophils

lymphocytes, macrophages, plasma cells
chronic infiltrate

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What stages of Gingivitis is there BOP?

Early lesion (4-7 days)

Established lesion (2-3 weeks)

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T/F

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

True

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

Early

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An Advanced Lesion, aka

Periodontitis

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What defines an Advanced Lesion?

Activation of Osteoclasts

alveolar bone resorption

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Aggressive periodontitis refers to:

Severe refers to:

Adolescents

Adults

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Name 3 Endocrine conditions that can create Gingival Disease:

Puberty

Pregnancy

Diabetes

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

P. intermedia

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A blood dyscrasia that can lead to gingival disease:

Is there bone loss with Dyscrasias?

Leukemia

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Name 3 drugs that can elicit Gingival Enlargement:

Phenytoin sodium (Dilantin)

Cyclosporine (Sandimmune)

Ca Channel Blockers (Nifedipine)

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

Neisseria gonorrhea

Treponema pallidum

beta-hemolytic Strep

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Name 2 Viruses that can induce gingival disease:

Herpes I and II

Varicella-zoster

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Name 3 Fungi that can induce gingival disease:

Candida albicans

Histoplasmosis

Linear gingival erythema

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

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What are the 4 components of the Periodontium?

Gingiva

Periodontal Ligament

Cementum

Alveolar Bone proper

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What periodontal tissue has the capacity to become keratinized?

What does not?

Oral sulcular epithelium

Junctional epithelium

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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