periodontal diseases Intoduction

Question 1

what is periodontology?

Answer 1

The study of the periodontal tissues in health and disease; including the causes, prevention and treatment of diseases of the periodontal tissues.

Question 2

what are the periodontal tissues?

Answer 2

Gingivae
Periodontal Ligament
Root Cementum
Alveolar Bone

Question 3

where is the amelo-cemental junction/cemento-enamel junction?

Answer 3

junction between the enamel and cementum
- seal of tissue closing entrance to periodontal tissue
- junctional epithelium

Question 4

what is the sulcus depth in healthy patients?

Answer 4

1-2 mm

Question 5

what is periodontal health?

Answer 5

the outcome of the balance between bacteria of the dental plaque and the host Immune system

Question 6

what is periodontal disease?

Answer 6

A group of diseases affecting the periodontal tissues, representing an immune reaction (innate and adaptive) to adjacent microbial plaque.

Question 7

what is affected in gingivitis?

Answer 7

soft tissues only

Question 8

what is affected in periodontitis?

Answer 8

soft tissues AND bone/ attachment

Question 9

what can affect the progression of periodontitis?

Answer 9

• person
• location in mouth

Question 10

what is inflammation?

Answer 10

biological response to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process

Question 11

what are the cardinal signs of inflammation?

Answer 11

• pain
• heat
• redness
• swelling
• loss of function

Question 12

what is important going into the future of periodontitis?

Answer 12

• awareness
• prevention

Question 13

is there resolution of inflammation in periodontitis?

Answer 13

NO- because of continuous presence of bacteria

Question 14

what is present in inflamed tissues?

Answer 14

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

Question 15

what type of disease is periodontitis?

Answer 15

multifactorial with complex etiopathogenesis

Question 16

what are risk factors involved in periodontitis?

Answer 16

general health:
- stress,
- fatigue,
- smoking
- diet
- medications
- hygienic habits
Function of immune system
Genetics
Additional pathological conditions:
- viral infections
- bacterial infections
- diabetes mellitus
- hypoxia
- liver diseases

Question 17

what are acquired local risk factors for periodontitis?

Answer 17

• plaque
• calculus
• overhanging
• poorly restored restorations

Question 18

what are systemic risk factors for periodontitis?

Answer 18

NON-MODIFIABLE
- ageing
- genetics
MODIFIABLE
- smoking
- diabetes
- stress
- medications
- hormones
- nutrition
- socioeconomic status

Question 19

what are the three varying factors in bacteria?

Answer 19

• number
• virulence
• formation of the biofilm

Question 20

what is a biofilm?

Answer 20

an aggregate of microorganisms in which cells adhere to each other on a surface and embedded within a self-produced matrix of extracellular polymeric substance
- they have resistance to antibiotics, antibacterial agents, and are hidden from immune system of the host
- they may form on living or non-living surfaces and can be prevalent in natural, industrial and hospital settings

Question 21

what is dental plaque?

Answer 21

a type of biofilm
- sibgingival and supragingival
- polymicrobial

Question 22

how does biofilm form?

Answer 22

• pellicle
• adhesion- trailblazing bacteria
• growth and matrix production
• mature biofilm microcolonies transition into metabolic complexes

Question 23

what are keystone bacteria?

Answer 23

certain low-abundance microbial pathogens which can cause inflammatory disease by increasing the quantity of the normal microbiota and by changing its composition and by interfering with the host immune system

Question 24

what is the keystone-pathogen hypothesis of gingivitis?

Answer 24

P. gingivalis impairs the host immune system in ways that alter the growth and development of the entire biofilm, triggering a destructive change in the normally homeostatic host-microbial interplay in the periodontium

Question 25

how does p. gingvalis manipulate the host’s immune system?

Answer 25

toll-like receptor response manipulation

Question 26

what is the key to disruption of homeostasis between bacteria of biofilm and immune system?

Answer 26

susceptible host

Question 27

what two things can disrupt the homeostasis between bacteria and the immune system?

Answer 27

• genetic conditions eg down syndrome
• diseases which impair the immune system eg leukaemia

Question 28

why is the immune system key to periodontitis?

Answer 28

• homeostasis
• loss of protection from immune system

Question 29

what is dental calculus?

Answer 29

hardened dental plaque

Question 30

what are clinical signs of gingivitis?

Answer 30

• redness (erythema)
• swelling
• bleeding on gentle probing

Question 31

what are examples of symptoms of periodontitis experienced by patients?

Answer 31

Bleeding on Brushing
Bad breath (Halitosis) and taste
sensitivity
Drifting teeth
Mobility
Discomfort, pain occurs very rarely mostly in necrotising ulcerative periodontal disease

Question 32

what are clinical signs of periodontitis?

Answer 32

Bleeding on gentle probing
Erythema, fibrosis, loss of Knife edge Margin
Halitosis
Swelling – falls pocket formation
Bone loss
Increase clinical probing depths - True pocket formation
Recession
Mobility
Purulence

Question 33

what is a false pocket?

Answer 33

gingival swelling (no loss of attachment)
- gingivitis

Question 34

what is a true pocket?

Answer 34

loss of attachment (junctional epithelium destroyed)
- periodontitis

Question 35

what are the bacteria associated with the red complex?

Answer 35

• porphyromonas gingivalis
• bacteroides forsythus
• treponema denticola

Question 36

What are anatomical local risk factors of periodontitis?

Answer 36

• malpositioned teeth
• root grooves
• concavities and furcations
• enamel pearls

Question 37

What is a Pellicle?

Answer 37

Made up of proteins and glycoproteins of saliva

Question 38

What is halitosis?

Answer 38

Bad breath

Question 39

What are the anatomical local risk factors for periodontitis?

Answer 39

• malpositioned teeth
• root grooves
• concavities
• furcations
• enamel pearls