Perio Lesion 5: Perio Pocket Flashcards
What is the “gingival pocket” or “pseudopocket”
Gingival enlargement without the destruction of supporting tissues
What is the periodontal pocket (Supra-, and infrabony)
Results from the destruction of periodontal supporting tissues including the tooth wall and gingival wall
What is the tooth wall of the periodontal pocket?
The cementum that has been exposed
What causes the destruction of the tooth wall during periodontitis?
Bacterial invasion and penetrating endotoxins Embedded remnants of Sharpey's fibers Demineralized cementum (Root Caries) Necrotic cementum (Similar to Caries)
What are the two reasons for root planing?
Get rid of:
Bacterial invasion of the perio pocket
Necrotic cementum
What is going on in the gingival wall of the periodontal pocket?
There are areas of health and areas of bacterial accumulation and emerging leukocytes
Areas of ulceration
Areas of epithelial desquamation
Areas of hemorrhage
What is the route to inflammation interproximally?
Gingiva to Bone to PDL
Gingiva straight to PDL
What are the routes of inflammation facial/lingually?
Gingiva to Outer Periosteum
Periosteum to bone
Gingiva to PDL
Histologically what structures does the inflammation follow?
Inflammation follows blood vessels and collagen bundles to the crestal bone surface
What cell response does the inflammation cause?
Increase in osteoclasts and mononuclear phagocytes
What are the first structural changes in the bone following the inflammation pathway?
Howship lacunae
Enlargement of marrow spaces
Thinning of trabeculae
What changes to bone marrow are observed?
Fatty bone marrow is replaced by fibrous marrow
What are the two models of periodontal disease activity?
- Slow but continuous
2. Episodic burst
What marks the quiescent phase of the episodic burst model?
Periods of reduced inflammation with little or no bone loss/attachment loss
What marks the exacerbation/active phase of the episodic burst model
Increased inflammation/bone loss/attachment loss
Plasma cells and PMNs
High proportions of gram negative bacteria
Inflamatory mediators
What does “Site Specificity” mean in terms of perio disease?
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.
What two factors can contribute to a patients susceptibility to periodontitis?
Genetic and Environmental
What does the type of bacteria present have to do with susceptibility?
Specific bacteria are needed that can cause an imbalance between host protective and destructive response mechanisms
Do probing depth, attachment loss, bleeding, plaque scores, and radiographs measure the severity or activity of periodontal disease?
Severity
Pathogenesis Models
Practice Drawing out the models
If different periodontal diseases like Chronic, Aggressive, NUP, etc all share the same histopathological features how do they differ?
Etiology
Natural History
Progression
Response to Therapy
