Perio Lesion 5: Perio Pocket

Question 1

What is the “gingival pocket” or “pseudopocket”

Answer 1

Gingival enlargement without the destruction of supporting tissues

Question 2

What is the periodontal pocket (Supra-, and infrabony)

Answer 2

Results from the destruction of periodontal supporting tissues including the tooth wall and gingival wall

Question 3

What is the tooth wall of the periodontal pocket?

Answer 3

The cementum that has been exposed

Question 4

What causes the destruction of the tooth wall during periodontitis?

Answer 4

Bacterial invasion and penetrating endotoxins
Embedded remnants of Sharpey's fibers
Demineralized cementum (Root Caries)
Necrotic cementum (Similar to Caries)

Question 5

What are the two reasons for root planing?

Answer 5

Get rid of:
Bacterial invasion of the perio pocket
Necrotic cementum

Question 6

What is going on in the gingival wall of the periodontal pocket?

Answer 6

There are areas of health and areas of bacterial accumulation and emerging leukocytes
Areas of ulceration
Areas of epithelial desquamation
Areas of hemorrhage

Question 7

What is the route to inflammation interproximally?

Answer 7

Gingiva to Bone to PDL

Gingiva straight to PDL

Question 8

What are the routes of inflammation facial/lingually?

Answer 8

Gingiva to Outer Periosteum
Periosteum to bone
Gingiva to PDL

Question 9

Histologically what structures does the inflammation follow?

Answer 9

Inflammation follows blood vessels and collagen bundles to the crestal bone surface

Question 10

What cell response does the inflammation cause?

Answer 10

Increase in osteoclasts and mononuclear phagocytes

Question 11

What are the first structural changes in the bone following the inflammation pathway?

Answer 11

Howship lacunae
Enlargement of marrow spaces
Thinning of trabeculae

Question 12

What changes to bone marrow are observed?

Answer 12

Fatty bone marrow is replaced by fibrous marrow

Question 13

What are the two models of periodontal disease activity?

Answer 13

1. Slow but continuous

2. Episodic burst

Question 14

What marks the quiescent phase of the episodic burst model?

Answer 14

Periods of reduced inflammation with little or no bone loss/attachment loss

Question 15

What marks the exacerbation/active phase of the episodic burst model

Answer 15

Increased inflammation/bone loss/attachment loss
Plasma cells and PMNs
High proportions of gram negative bacteria
Inflamatory mediators

Question 16

What does “Site Specificity” mean in terms of perio disease?

Answer 16

Periodontal tissue destruction does not happen in all parts of the mouth at the same time. It is a more localized (even to different parts of the same tooth) event.

Question 17

What two factors can contribute to a patients susceptibility to periodontitis?

Answer 17

Genetic and Environmental

Question 18

What does the type of bacteria present have to do with susceptibility?

Answer 18

Specific bacteria are needed that can cause an imbalance between host protective and destructive response mechanisms

Question 19

Do probing depth, attachment loss, bleeding, plaque scores, and radiographs measure the severity or activity of periodontal disease?

Answer 19

Severity

Question 20

Pathogenesis Models

Answer 20

Practice Drawing out the models

Question 21

If different periodontal diseases like Chronic, Aggressive, NUP, etc all share the same histopathological features how do they differ?

Answer 21

Etiology
Natural History
Progression
Response to Therapy