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Perio Exam 2 > Perio sweep 1.2 > Flashcards

Perio sweep 1.2 Flashcards

1
Q

Gingivitis around implants =

A

Peri-mucositis

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2
Q

Characteristics common to all gingival diseases:

A

1- Signs and symptoms limited to the gingiva.

2- The presence of dental plaque.

3- Clinical signs of inflammation.

4- Clinical signs and symptoms associated on a periodontium with no attachment loss or on a stable but reduced periodontium.

5- Reversibility of the disease by removing the etiology.

6- Possible role as a precursor to attachment loss.

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3
Q

Near Infrared (NIR) Spectroscopy

A

Measure of oxygen saturation of the tissues
The wavelength region 500 to 600 nm is dominated by the absorption from oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (Hb)
Tissue oxygenation at periodontitis sites significantly ↓ as compared to gingivitis and healthy control sites

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4
Q

Saliva test:

A

Type and concentration of specific periodontal pathogens
- Apply DNA PCR – identify specific periodontal pathogens
Genetic susceptibility to periodontitis in individuals
- Test genetic variation: over-expression of IL-1α and IL-1β

These tests identify general risk factors for the development of periodontal diseases, but fail to determine when periodontal destruction will occur
NOT being able to specifically predict periods of disease activity

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5
Q

Salivary Occult Blood Test (SOBT) –

A

available in Japan
A poor periodontal status: Subjects having ≥15% of teeth with BOP or ≥ 1 tooth with PD ≥ 4mm
A paper strip containing gold-labeled anti-human hemoglobin monoclonal antibody was dipped into saliva sample (Positive: ≥ 2 μg/ml human hemoglobin)
Sensitivity:0.72; Specificity: 0.52

After swishing with three milliliters of distilled water for 10 seconds, the mixture is spit into a cup and the Perioscreen test strip is dipped into the saliva sample. The colloidal gold-labeled antibody dissolves in the salvia sample and if blood is present, an immune complex is formed and moves up the test strip by capillary action, resulting in a magenta line.

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6
Q

The SOBT may offer a simple screening method for periodontal status when a

A

thorough periodontal examination is not possible, although it is not sufficiently specific to be a reasonable substitute for a periodontal examination

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7
Q

Gingivitis associated with dental plaque only

A

w/o other local contributing factors

w/ other local contributing factors

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8
Q

> Gingival diseases modified by systemic factors

A 
Associated w/ endocrine system
-Puberty associated gingivitis
-Menstrual cycle associated gingivitis
-Pregnancy associated gingivitis
-Diabetes mellitus associated gingivitis
Associated w/ blood dyscrasias
-Leukemia associated gingivitis
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9
Q

> Gingival diseases modified by medications

A

Gingival enlargements

Oral contraceptive associated gingivitis

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10
Q

> Gingival diseases modified by malnutrition

A

Ascorbic acid deficiency gingivitis

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11
Q

Normal gingival color:

A

“coral pink”+ pigmentation

[tissue’s vascularity and overlying epithelial layers]

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12
Q

Inflammed gingiva:

A

red

[increased vascularization and decreased epithelial keratinization]

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13
Q

Severly inflammed gingiva:

A

red and cyanotic
[vascular proliferation and reduction in keratinization +
venous stasis]

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14
Q

Changes start at

A

interdental papillae and gingival margin and spread to the attached gingiva.

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15
Q

Gingival bleeding: With increasing inflammation:

A

Dilation and engorgement of the capillaries

Thinning or ulceration of the sulcular epithelium

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16
Q

Chronic or recurrent bleeding,

A

provoked by trauma.

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17
Q

Spontaneous bleeding occurs in

A

acute/severe gingival disease and may be related to systemic health problems.

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18
Q

With inflammation:

A
  • Increase in extracellular fluid and exudate,
    • Degeneration of connective tissue and epithelium,
    • Engorged connective tissue and thinning of epithelium.
      Soft, swollen (edema), friable.
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19
Q

In severe gingival disease:

A

Sloughing with grayish flake-like debris (necrosis)

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20
Q

Chronic inflammation can induce

A

fibrosis and epithelial proliferation….

firm leathery consistency.

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21
Q

Healthy gingiva…

A

Dull surface texture with stippling present in some cases.

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22
Q

With inflammation:

loss of

A

stippling,

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23
Q

smooth and shiny …if

A

exudative changes occur,

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24
Q

firm and nodular …if

A

fibrotic changes occur.

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25
shape healthy gingiva….
- Scalloped with gingiva filling interdental spaces ( presence of papilla).
26
Shape of gingiva With inflammation…
- Knife edge gingival adaptation or loose gingival margins | - In some cases, clefts (Stillman’s) or festoons (McCall’s) may develop
27
Perio Primary etiologic factor =
Bacterial plaque
28
Secondary etiological factors =
local factors * Calculus * Marginal deficiencies in restorations and rough surfaces * Malocclusion * Tooth/root anomalies
29
Bio width
“A minimum dimension of 3 mm coronal to the alveolar crest … to permit healing and proper restoration.”
30
Bio width: “Intracrevicular restorative margins” at sites of
insufficient gingival (or marginal tissue) width and/or thickness ….
31
Periodontitis starts with
gingivitis
32
The return of inflammation to sites treated for | periodontitis is .
common
33
The recurrent inflammation may be confined to the
gingival tissues and may not cause further attachment | loss. This is still diagnosed as “recurrent periodontitis
34
Gingival diseases modified by endocrine factors
Need to have dental plaque !!! Pregnancy associated gingivitis Puberty associated gingivitis Menstrual cycle associated gingivitis
35
Pregnancy associated gingivitis:
Microbiota …. Characteristic of gingivitis. Exaggerated localized host response modulated by levels of endogenous hormones (androgens, estrogens and progesterone). Changes often appear during 2nd trimester and regress upon parturition.
36
Puberty associated gingivitis-
Localized host response mediated by high levels of hormones | (estrogens,testosterone
37
Puberty associated gingiviits: ------- can be a secondary factor
mouth-breathing.
38
Menstrual cycle associated gingivitis-
Clinically detectable changes do not seem to be associated with the menstrual cycle. An increase in GCF (Gingival Crevicular Fluid) by 20% has been described.
39
Pyogenic granuloma of pregnancy-
Commonly arises from the proximal gingival tissues and has a pedunculated base. The usual presentation is in the second or third trimester of pregnancy. A highly vascularized mass of granulation tissue.
40
Gingival diseases modified by systemic conditions-
Diabetes mellitus …Type I and II Leukemias and other blood dysplasias. Acute myeloid leukemia associated with gingival changes. Persistent unexplained gingival bleeding may indicate underlying thrombocytopenia. Cyclic neutropenia (14-36 days cycle) ... Ulcerations
41
Gingival diseases modified by medications- 3 commonly used drug types that are associated with gingival overgrowth:
Anticonvulsants (Phenytoin sodium or epinutin) Immunosuppressant (Cyclosporin A) Calcium channel blocking agents (Nifedipine).
42
Necrotizing Ulcerative Gingivitis (NUG)
Adolescents or young adults, may be smokers and individuals often with psychological stress. Pain, ulceration and necrosis of the interdental papillae, bleeding. Differential diagnosis with primary herpetic gingivostomatitis. The resolution of the disease is often required systemic antibiotic.
43
NUG: | Predisposing factors:
* Systemic diseases like ulcerative colitis, blood dyscrasias and nutritional deficiency states. * Abnormalities of white blood cell function. * Patients suffering from AIDS Associated with periodontal attachment loss. May progress to Noma or cancrum oris.
44
Differential diagnosis of NUG and primary herpetic | gingivostomatitis (PHS).
* Etiology….. Bacteria (NUG), Herpes simplex virus (PHS) * Symptoms… Ulceration and necrotic tissue, yellowish white plaque (NUG) Multiple vesicles which burst leaving small round fibrin covered ulcers (PHS) * Duration…. 1-2 days if treated (NUG) 1-2 weeks (PHS) * Contagious… No (NUG) Yes (PHS)
45
Necrotizing Periodontal Diseases (NPD)
Necrotizing Ulcerative Gingivitis (NUG) | Necrotizing Ulcerative Periodontitis (NUP)
46
Necrotizing Ulcerative Gingivitis
Confined in interdental papillae and marginal gingiva. Characterized by rapid onset of gingival pain, interdental gingival necrosis , and bleeding. Affected young adults, associated with cigarettes smoking and stress.
47
Clinical signs of NUG
Severe Pain is the chief complaint of the pt. Ulceration covered by a yellowish – white or grayish slough which is termed “Pseudo membrane”. Necrotic interdental papillae: Punched out appearance. Bleeding either spontaneously or upon gentle manipulation.
48
Necrotizing Ulcerative Periodontitis (NUP) | signs
``` Necrosis of papilla (“punched-out”) Pain (chief complaint) Bleeding -Other --“pseudomembrane” (=sloughed material) ---Halitosis (foetor ex ore) Attachment loss ```
49
Other findings of NPD
Oral hygiene usually poor, painful when brushing. Swelling of regional lymph nodes may occur. Usually confined to the submandibular lymph nodes Cervical lymph nodes may also be involved. Fever and malaise are not consistent characteristics. Increased salivation.
50
Epidemiology of NPD | young adults
``` Industrialized countries Prevalence between 2% and 7% (1960) Higher under certain conditions: smoking and stress. Developing countries Much higher prevalence ```
51
Epidemiology of NPD | immunocompromised patients
Prevalence between 1% and 28%. | Significantly decreased after anti-retroviral therapy.
52
Etiology & Pathogenesis of NPD
``` Bacteria Spirochetes (Treponema) Fusobacterium P. intermedia Virus Human cytomegalovirus(CMV) HIV ```
53
NPD: Host factors
``` Immunosuppression -Systemic disease (HIV) -Malnutrition Pre-existing gingivitis, poor oral hygiene, history of NPD Psychological stress, lack of sleep Smoking ```
54
Histopath of NPD
Necrosis of epithelium and superficial layers of the connective tissue. Hyperemic CT with engorged capillaries and dense infiltrations of PMNs. ``` Listgarten 1965: Bacterial zone Neutrophil rich zone Necrotic zone Spirochetal infiltration zone ```
55
NPD: Clinical presentation
Ulceration and necrosis of interproximal papillae Painful gingiva Bleeding (spontaneous, on slight provocation)
56
NPD: | Differential Diagnosis
Primary Herpetic Gingivostomatitis | Oral mucosal diseases
57
NPD: Acute Treatment
Debridement Oral rinses (0.12% CHX) Antibiotics: metronidazole (250mg TID)
58
Periodontal Abscesses
localized collection of pus within the tissues of the periodontium. 3rd most Common emergency condition (8-14%)
59
Gingival Abscess
Etiology: irritation from foreign bodies forcefully embedded into previously healthy tissues. Localized, painful, rapidly expanding lesion with sudden onset. Generally limited to the marginal gingiva or interdental papillae.
60
Periodontal Abscess
A localized purulent inflammation in the periodontal tissues. Often occur in molar sites. Associated with preexisting periodontitis Localization occurs when drainage through pocket is impaired.
61
Periodontitis-related Abscess
``` Exacerbation of chronic lesion Untreated patients Maintenance patients (recurrent infection) Post-therapy Abscess Following SRP (calculus) Following surgical therapy (calculus, foreign bodies) Post-antibiotic Abscess Super-infection ```
62
Non-Periodontitis-related Abscess
``` Foreign body impaction Oral hygiene devices Food particles Root morphology alterations Iatrogenic (endodontic perforation) External root resorption Cemental tears ```
63
development of a periodontal abscess, the first step is
the bacterial invasion of the soft tissues surrounding the periodontal pocket, all periodntitis relted bacteria can be involved. but P.g has been detected with high frequency in the periodontal abscess. The invision of the bacteria attracts pmn to the site, which kill and encapsulate he bacteria.
64
Periodontal Abscess Diagnosis
``` Pain Swelling Redness Suppuration Spontaneous or occur after pressure Gingival tenderness Associated with deep pocket, BOP, mobility. Radiographic: widened PDL, bone loss Fever, malaise, lymphadenopathy ```
65
Differential Diagnosis
``` Periapical (endodontic) abscess Vertical root fracture Endo-perio abscess Other Osteomyelitis Periodontal cyst Manifestation of systemic diseases ```
66
Periodontal Abscess - Therapy
``` Acute lesion management -Irrigation with antiseptics -Drainage -When present, removal of foreign body -Debridement -OHI -Antibiotics -Review after 24-48 hours; a week later, the definitive treatment should be carried out. Definitive treatment ```
67
Simplified Oral Hygiene Index (OHI-S) | purpose
To assess oral cleanlines by estimating the tooth surface covered with debris and/or calculus
68
OHI-S: Components
Simplified Debris Index | Simplified Calculus Index
69
OHI-S: Tooth selection
Facial surfaces of # 3, 8, 14, 24 | Lingual surface of # 19, 30
70
Plaque Index (PlI)
The PlI assesses the amount of plaque at the gingival margin, examining the same anatomical units as the GI Plaque scores range from {0} to {3} A probe is used to distinguish between scores {0} and {1}. Visible plaque is scored a {2} or a {3} The Pl-I is computed for a tooth, subject, or population It parallels the Gingival Index (GI) of Löe & Silness First published by Silness & Löe (1964)
71
Turesky Modification of Quigley-Hein Plaque Index
Score 0: No plaque Score 1: Spots of plaque at cervical margin Score 2: Thin, continuous band of plaque, £1 mm wide, at cervical margin Score 3: A plaque band >1 mm but <1/3 of crown height Score 4: Plaque covering ³ 1/3 but < 2/3 of crown height Score 5: Plaque covering ³ 2/3 of crown height
72
Turesky Modification of Quigley-Hein Plaque Index
The Quigley-Hein index is biased toward the gingival third of the tooth surface Facial and lingual surfaces are examined Plaque is made visible using a disclosing agent and scored using a {0} to {5} scoring system Scores are computed for subject, population It is the most frequently used plaque index in clinical trials Quigley & Hein (1962); Turesky et al. (1970)
73
Calculus Indices
``` Simplified Oral Hygiene Index (OHI-S) Periodontal Disease Index (PDI) Probe Method (Volpe-Manhold) Calculus Surface (Severity) Index (CSI) Marginal Line Calculus Index (MLCI) NIDR Calculus Index ```
74
NIDR Calculus Index
0 Calculus is absent 1 Supragingival calculus, but no subgingival calculus is present 2 Supragingival and subgingival, or subgingival calculus only is present
75
Volpe-Manhold Index
Determines the quantity of supragingival calculus Lingual surfaces of lower anteriors (#22-27) Quantity is determined in mm of calculus along the 2 diagonal and the central lines drawn over the lingual surface of each tooth Index, expressed in mm, is computed for tooth, subject, population Most frequently used calculus index in longitudinal studies Published by Volpe & Manhold (1962) *High inter-examiner and intra-examiner reproductivity

Perio Exam 2 (20 decks)

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