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periodontics > periodontal assessment and pathogenesis > Flashcards

periodontal assessment and pathogenesis Flashcards

1
Q

Why do we need a rationale for treatment?

A

To establish the underlying reason for treatment.

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2
Q

What is Webster’s definition of rationale?

A

“The underlying reason.”

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3
Q

Specific Knowledge

A
  • Understand the etiology of
    periodontal diseases
  • Determine therapeutic
    goals relative to etiology
  • Understand effects of therapies on the periodontium
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3
Q

What should a rationale for treatment be based on?

A
  • Etiology
  • Clinical evidence of efficacy
  • Long-term follow-up
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4
Q

Are all periodontal diseases caused by the same problem?

A

No

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5
Q

What are the key etiologic considerations for periodontal diseases?

A
  • Bacterial
  • Host factors
  • Systemic diseases
  • Genetic factors
  • Local factors
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6
Q

What is the primary therapeutic goal in periodontal treatment?

A

To alter or eliminate the microbial etiology and contributing risk factors.

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7
Q

What does achieving the therapeutic goal aim to do?

A

Arrest the progression of the disease.

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8
Q

What is the second therapeutic goal in periodontal treatment?

A

Preserve the dentition in a state of health, comfort, and function with appropriate esthetics.

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8
Q

What is the third therapeutic goal in periodontal treatment?

A

Prevent the recurrence of periodontitis.

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8
Q

What components are included in a periodontal assessment?

A
  • Medical/dental history
  • Clinical assessment
  • Radiographic assessment
  • Laboratory examinations
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9
Q

What are the patient-related factors influencing periodontal treatment goals?

A
  • Systemic health
  • Age
  • Compliance
  • Therapeutic preferences
  • Ability to control plaque
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9
Q

What is the fourth therapeutic goal in periodontal treatment?

A

Attempt regeneration of the periodontal attachment apparatus, where indicated.

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10
Q

What additional factors influence periodontal treatment goals?

A
  • Diagnosis
  • Prognosis
  • Clinician’s skill
  • Post-treatment responses
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11
Q

What does the clinical assessment include?

A
  • Visual exam
  • Periodontal charting
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12
Q

What are the key aspects of medical/dental history in periodontal assessment?

A

Identifying risk factors

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12
Q

What factors affect the accuracy of periodontal probing?

A
  • Degree of gingival inflammation
  • Probing force
  • Location of site and probe placement
  • Examiner variation
  • Repeatability varies with patient
  • More variation for deeper pockets
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13
Q

What are the components of clinical assessment in periodontal evaluation?

A
  • Plaque
  • Inflammation
  • Bleeding
  • Exudate
  • Pocket depth
  • Attachment loss
  • Recession
  • Mobility
  • Furcation involvement
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14
Q

What study assessed the reliability of attachment loss measurements in a longitudinal clinical trial?

A

Best, AM, Burmeister, JA, Gunsolley JC, Brooks, CN and
Schenkein, HA. Reliability of attachment loss measurements in
a longitudinal clinical trial. J Clin Periodontol. 1990;17:564-569.

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15
Q

What methods were used to assess the reliability of CAL measurements in the study by Best et al. (1990)?

A
  • 16 subjects
  • Calibration trials for examiners
  • Comparison of 2 or 3 examiners at a time
  • 52 separate occasions
  • Minimal time between calibration measures
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16
Q

What were the results for the reliability of CAL measurements in the study by Best et al. (1990)?

A
  • Exact agreement: 44.3%
  • Agreement within 1 mm: 40.9%
  • Agreement within 2 mm: 11.5%
  • Total agreement: 96.7%
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17
Q

What study evaluated the effects of plaque control and root debridement using subjective criteria and probing attachment loss?

A

Rik Vanooteghem, L. H. Hutchens, Gerald Bowers, et al. Subjective
criteria and probing attachment loss to evaluate the effects of plaque
control and root debridement. 1990; 17(8): 580-587.

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18
Q

What was the purpose of the study by Vanooteghem et al. (1990) on subjective criteria and attachment loss?

A

To determine if expert clinicians can predict which periodontal sites will respond to periodontal treatment.

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18
Q

What were the results of the study by Vanooteghem et al. (1990) on subjective criteria and attachment loss at 24 months?

A
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19
Q
  • Plaque score reduced from 72% to 30%
  • Bleeding reduced from 84% to 50%
  • Suppuration reduced from 10% to <1%
  • 60 sites (7% of the sites) with an initial PD of 4mm or more progressed (got worse).
A
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20
Q

What were the results for questionable sites at baseline in the study by Vanooteghem et al. (1990)?

A
  • 170 questionable sites
  • PPV: 15%
  • Sensitivity: 42%
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21
Q

What were the results for questionable sites at 3 months in the study by Vanooteghem et al. (1990)?

A
  • 145 questionable sites
  • PPV: 20%
  • Sensitivity: 48%
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21
Q

What were the results for questionable sites at 12 months in the study by Vanooteghem et al. (1990)?

A
  • 130 questionable sites
  • PPV: 22%
  • Sensitivity: 47%
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22
Q

What does PPV (Positive Predictive Value) refer to in the study by Vanooteghem et al. (1990)?

A

The proportion of sites identified by the expert clinician that actually lost attachment.

23
Q

What does Sensitivity refer to in the study by Vanooteghem et al. (1990)?

A

The proportion of sites with attachment loss that were correctly identified.

23
Q

What were the conclusions of the study by Vanooteghem et al. (1990) on subjective criteria and attachment loss?

A
  • Minimal agreement between the gold standard (actual attachment loss) and the examiners’ predictions.
  • Attachment loss may be caused by several factors, with microbial etiology being only one potential cause.
23
Q

What is a limitation of electronic probes in measuring?

A

stop at a certain force and are not very accurate.

24
Q

What does traditional radiography assess in periodontal health?

A
  • Changes in bone levels
  • Changes in bone density (though not very accurate)
  • Furcation changes
25
Q

What are the advantages of digital radiography in periodontal assessment?

A
  • Direct input to computer
  • Instant feedback
  • Much lower radiation exposure
  • Can alter radiograph directly on screen
  • Can measure lengths for endodontics, implants, etc.
26
Q

What is the disadvantage of digital radiography in periodontal assessment?

A

Expensive equipment

27
Q

What are the advantages of digital subtraction radiography in periodontal assessment?

A
  • Uses two radiographs to detect changes
  • Can correct for angulation and film variations
  • Can identify small changes
28
Q

What are the advantages of digital subtraction radiography in periodontal assessment?

A
  • Cannot identify attachment levels
  • Not very accurate
29
Q

What are the types of laboratory determinations used in periodontal assessment?

A
  • Biochemical Tests: e.g., collagenase
  • Immunologic Tests: e.g., antibodies
  • Microbiologic Identification: e.g., certain bacteria
  • Genetic Tests (PST): e.g., genetic susceptibility test for IL-1 production
30
Q

What are the main risk factors for periodontal disease?

A
  • Age
  • Bacteria (Oral Hygiene)
  • Genetics
  • Systemic diseases (Diabetes)
  • Smoking
31
Q

What are the bacterial risk factors for periodontal disease?

A
  • Porphyromonas gingivalis
  • Tannerella forsythia (Bacteroides forsythus)
  • Aggregatibacter actinomycetemcomitans (Actinobacillus)
  • Prevotella intermedia
  • Fusobacterium nucleatum
  • Campylobacter rectus
32
Q

What is the shape and motility of Aggregatibacter actinomycetemcomitans?

A

Small, non-motile, gram-negative rod.

32
Q

How many serotypes exist for Aggregatibacter actinomycetemcomitans?

A

5 serotypes (a-e), determined by surface antigens.

33
Q

What are some virulence factors of Aggregatibacter actinomycetemcomitans?

A

LPS, leukotoxin, collagenase, and protease.

33
Q

What is the frequency of isolation of Aggregatibacter actinomycetemcomitans in periodontal disease?

A

High frequency of isolation from aggressive periodontitis.

34
Q

What immune response is associated with Aggregatibacter actinomycetemcomitans?

A

Elevated antibody levels are seen in many patients.

35
Q

What tissue-related property does Aggregatibacter actinomycetemcomitans have?

A

It may invade tissue.

36
Q

Is Aggregatibacter actinomycetemcomitans transmissible within families?

A

Yes, it may be transmissible within families. In a study, members in 5 families had the same serotype and biotype (Zambon et al., 1983).

36
Q

Can Aggregatibacter actinomycetemcomitans be completely eradicated by scaling, root planing, or flap curettage?

A

It may not be completely eradicated by these treatments.

36
Q

What is the shape and motility of Tannerella forsythia?

A

Non-motile, gram-negative rod.

37
Q

What type of bacterium is Tannerella forsythia in terms of oxygen requirements?

A

Obligate anaerobe.

38
Q

What type of enzymes does Tannerella forsythia produce?

A

It produces multiple proteolytic enzymes.

39
Q

What is the effect of the enzymes produced by Tannerella forsythia?

A

The enzymes can destroy immunoglobulins and factors of the complement system.

40
Q

Which type of periodontitis is most affected by genetic factors?

A

Aggressive periodontitis (Grade C in young patients).

41
Q

What are the characteristics of aggressive periodontitis?

A
  • Onset may be localized or generalized
  • Aggressive periodontitis is familial
  • The localized form may progress to the generalized form
  • Both types may occur in the same family
41
Q

What genetic pattern does aggressive periodontitis appear to follow?

A

It appears to be an autosomal dominant trait.

41
Q

What is the prevalence of aggressive periodontitis in different populations?

A

Higher prevalence in those of African descent compared to white populations in the U.S. and other countries.

42
Q

What complex interactions contribute to the etiology of periodontitis in individuals with aggressive periodontitis?

A

A complex interaction between:

External environment
Oral environment
Genetically determined factors

42
Q

What are some systemic risk factors for periodontal disease?

A
  • HIV
  • Diabetes mellitus
  • Leukemia
  • Down’s syndrome
43
Q

What study assessed risk indicators for attachment loss in periodontal disease?

A

Grossi, S.G., J.J. Zambon, A.W. Ho, G. Koch, R.G. Dunford, E.E.
Machtei, O.M. Norderyd and R.J. Genco. Assessment of Risk
for Periodontal Disease. I. Risk indicators for Attachment
Loss. J Periodontol 1994; 65:260-267.

44
Q

Assessment of Risk
for Periodontal Disease. I. Risk indicators for Attachment
Loss: high risk

A

Age 65-74: 9.01 (High risk)
Heavy smoker: 4.75 (High risk)
Age 55-64: 4.14 (High risk)
Age 45-54: 3.01 (High risk)
Moderate smoker: 2.77
B. Forsythus: 2.45
Diabetes: 2.32

45
Q

Assessment of Risk
for Periodontal Disease. I. Risk indicators for Attachment
Loss: No significant risk

A

Light smoker:2.05
Age 35-44 1.72
P. gingivalis 1.59
Male 1.36

45
Q

Assessment of Risk
for Periodontal Disease. I. Risk indicators for Attachment
Loss: Protective

A

Allergy 0.7

46
Q

What was the hypothesis in the study by Genco et al. (1996) on hormonal influence on periodontal bone loss?

A

Hormonal influence on periodontal bone loss

47
Q

What was the method in the study by Genco et al. (1996) on hormonal influence on periodontal bone loss?

A

Compared post-menopausal women with and without hormone replacement therapy (HRT)

48
Q

What were the results for non-smoking females with hormone replacement therapy (HRT) in the study by Genco et al. (1996)?

A

No increased periodontitis.

49
Q

What were the results for non-smoking females without hormone replacement therapy (HRT) in the study by Genco et al. (1996)?

A

Increased periodontitis.

50
Q

What were the results for smokers with and without hormone replacement therapy (HRT) in the study by Genco et al. (1996)?

A

No difference in periodontitis between HRT and no HRT.

51
Q

What was the conclusion of the study by Genco et al. (1996) on hormonal influence and smoking?

A

Smoking negates the protective effects of estrogen on the periodontium.

52
Q

Payne, et al., J. Periodontol. 68:24, 1997 study on postmenopausal females?

A

Estrogen and alveolar bone density, comparing those with and without HRT, separated by smokers and non-smokers.

53
Q

What were the results of Payne et al. (1997) on estrogen and alveolar bone density?

A
  • Decreased bone density in non-smoking females without HRT (p<0.008).
  • No difference in bone density between smokers with and without HRT (p<0.04).
54
Q

How do the results of Payne et al. (1997) compare to Genco’s study?

A

Similar conclusions, but measured a different parameter.

55
Q

What did Moss et al. (1996) find about stress and periodontitis?

A
  • Financial stress (O.R. = 4.0 for income < $30K).
  • Being single (O.R. = 0.68).
  • Increased odds ratios of other stresses with high depression scores.

periodontics (2 decks)

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