Periodontal Disease

Question 1

What is periodontology

Answer 1

The study of periodontal tissue in health and disease

Question 2

What does the periodontal tissue consist of

Answer 2

Gingiva
Periodontal ligament
Root cementum
Alveolar bone

Question 3

What is the gingival crevice

Answer 3

Normal space located between the wall of the unattached gum tissue and the enamel/cementum of the tooth

Question 4

Why can the seal be described as a protective measure

Answer 4

Bacteria cannot easily enter

Question 5

What does gingival crevice fluid provide

Answer 5

A flushing action and an isolation effect by rapidly washing out substances put into the crevice

Question 6

What are signs of healthy gingiva

Answer 6

No bleeding

Pink

Question 7

Why should dark gums not automatically be assumed as unhealthy gums

Answer 7

In some regions of the world, gingiva can have melanin pigmentation

Question 8

What is present in diseased gingiva

Answer 8

Pockets

Question 9

How can pockets be clinically assessed

Answer 9

Between the free gingiva and the surface of the tooth there is a crevice where the probe can be inserted and the probe can help determine if the gingiva is healthy

Question 10

What is the probe measurement for healthy gingiva

Answer 10

1 - 3mm

Question 11

What is the probe measurement for a warning

Answer 11

4mm

Question 12

What is the probe measurement for urgent

Answer 12

5 - 9mm

Question 13

What is periodontal disease

Answer 13

A group of diseases affecting the periodontal tissues, representing an immune reaction to adjacent microbial plaque

Question 14

What is periodontitis characterised by

Answer 14

Irreversible, recessed gums and bone loss

Question 15

Is gingivitis reversible

Answer 15

Yes

Question 16

What is the treatment for periodontitis

Answer 16

It is irreversible so aim is to decrease inflammation and encourage patients to reach a non active state of disease

Question 17

What are retention factors

Answer 17

Calculus
Dental restorations
Various cavities
Partial dentures
Orthodontic appliances 
Mal positioned teeth

Question 18

What is the main goal of treatment

Answer 18

Plaque control
Removal of plaque
Retention factors

Question 19

What does inflammation result in

Answer 19

Dilation of blood vessels
Increased permeability of vessel walls
Inflammatory exudate
Emigration of white blood cells from blood vessels into the connective tissue

Question 20

What are cardinal signs of inflammation

Answer 20

Pain
Heat
Redness
Swelling
Loss of function

Question 21

What factors increase gingivitis

Answer 21

Neutrophil emigration

Leukocytic infiltrate

Question 22

What are factors that contribute to periodontal disease

Answer 22

General health
Additional pathological conditions
Genetics
Functions of the immune system

Question 23

What is a false pocket

Answer 23

Gingival swelling
No bone loss
Junctional epithelium still intact

Question 24

What is a true pocket

Answer 24

Loss of attachment
Tissue is destroyed
Bone loss

Question 25

What does the keystones pathogen hypothesis indicate

Answer 25

That commensal microbiota is essential in the disease process as certain microorganisms cannot colonise without their presence

Question 26

Describe how the immune system organises itself in healthy periodontal tissue

Answer 26

The periodontal tissue contains a wall of neutrophils between the plaque and the epithelial surface The array of different TLRs in combination with the multitude of bacterial species lead to a large variety of cytokines that are expressed at health

Question 27

Why is periodontal disease so difficult to treat

Answer 27

The bacteria form a biofilm

Question 28

What is a biofilm

Answer 28

An aggregate of microorganisms in which the cells adhere to each other on a surface These adherent cells are embedded within a self produced matrix

Question 29

What does the self produced matrix consist of

Answer 29

Extracellular polimetric substances - DNA, proteins and polysaccharides

Question 30

Why does the biofilm cause a problem when treating periodontal disease

Answer 30

It means that microorganisms in the mouth are resistant to antibiotics and they are hidden from the immune system of the host

Question 31

How is the biofilm formed

Answer 31

Pellicle is made of proteins and glycoproteins Association and adhesion occurs Growth of microorganisms results in micro colonies and this results in the production of the polysaccharide matrix Mature biofilm micro colonies transition into metabolic complexes

Question 32

What are the strategies for treatment

Answer 32

Mechanical disruption - reducing the bacterial challenge by scaling and root surface debridement Host modulation therapy

Question 33

What are the oral hygiene instructions given for treatment

Answer 33

Modified brushing techniques Flossing when patient has good papillae Interdental brushes for interdental space

Question 34

What are the different adhesion molecules that create the wall of neutrophils between the plaque and epithelial surface

Answer 34

E-selectin IL-8 ICAM

Question 35

What does E-selectin do

Answer 35

Allows neutrophil migration from the highly vascularised gingival tissue

Question 36

What does IL-8 do

Answer 36

It is a key neutrophil chemo-attractant produced by epithelial cells

Question 37

What does ICAM do

Answer 37

Facilitates adhesion of neutrophils to the tissue allowing formation of this wall

Question 38

What is the seal

Answer 38

Junctional epithelium attaches the gingiva to the tooth surface preventing bacteria from getting through