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Periodontics > Periodontal Health, Gingival Disease:Conditions > Flashcards

Periodontal Health, Gingival Disease:Conditions Flashcards

1
Q

Periodontal Health

A

Absence of clinically
detectable inflammation A state free from inflammatory periodontal disease

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2
Q

Periodontal Health

A

“A state free from inflammatory
periodontal disease that allows an
individual to function normally and
avoid consequences (mental and
physical) due to current or past
disease.”

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3
Q

Impact
(5)

A

Cardiovascular diesases
Respiratory disease
Diabetes
Pregnancy complications
Others: Dementia, Cancers

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4
Q

Importance
To find the common —
for assessing disease and determining
the meaningful treatment outcomes.

A

reference point

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5
Q

Periodontium
(4)

A
  • Gingiva
  • PDL
  • Cementum
  • Alveolar process
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6
Q

Macroscopic (clinical features)
(4)

A
  • Marginal Gingiva
  • Gingival Sulcus
  • Attached Gingiva
  • Interdental Gingiva
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7
Q

Microscopic
(2)

A
  • Gingival Epithelium
  • Gingival Connective Tissue
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8
Q

Oral epithelium

A

*Keratinized, turnover rate 30
days

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9
Q

Sulcular epithelium

A

*Non-keratinized, no rete pegs,
semipermeable membrane

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10
Q

Junctional epithelium

A

*Non-keratinized, attached via
hemidesmosomes, infiltrate by
PMN, turnover rate 7-10 days

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11
Q

Microscopic
* Gingival Connective Tissue
(2)

A

Connective tissue presents a
diffuse, amorphous ground
substance and collagen fibers.
Blood vessels stand out clearly in
the papillary projections of the
connective tissue.

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12
Q

Biologic width

A

2.04 mm

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13
Q

Replaced “Biologic Width”

A

Supracrestal Tissue Attachment

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14
Q

Color:
(3)

A
  • Coral pink on marginal/attached gingiva
  • Red smooth shiny on alveolar mucosa
  • physiologic pigmentation
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15
Q

Size:

A

Should corresponds
with the sum total of the bulk
of cellular and intercellular
elements and vascular
supply

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16
Q

Consistency:

A

Firm and
resilient (gingival fibers)

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17
Q

Surface texture:

A

Stippled on
the attached gingiva

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18
Q

Contour:

A

Scalloped and collar-like fashion

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19
Q

Shape:

A

Pyramidal towards the anterior,
flattened towards the posterior

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20
Q

Position:

A

the level at which the gingival margin
is attached to the tooth

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21
Q

Continuous tooth eruption-

A

active and passive
eruption- altered passive eruption

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22
Q

Microbiological
Determinants
(2)

A

Supragingival plaque
Subgingival plaque

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23
Q

Host
Determinants
Local predisposing factors
(4)

A

Periodontal pockets
Restorations
Root anatomy
Tooth position and crowding

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24
Q

Environmental
Determinants
(4)

A

Smoking
Medication
Stress
Nutrition

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25
Q

Systemic modifying factors
(3)

A

Host immune function
Systemic health
Genetics

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26
Q

Indicators
Bleeding on Probing
(BOP):
Periodontal Probing:
Radiographic Features:
Tooth Mobility:

A

light pressure 0.25N
Inadequate for diagnosis when used alone
Lamina dura, The distance of 2mm from the most
coronal part of the alveolar crest to CEJ
Not recommended

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27
Q

Clinical Gingival
Health on an Intact Periodontium
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

** Physiological bone levels range
from

A

<10%
≤3mm
No
No

1-3 mm (average 2mm) apical
to the CEJ

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28
Q

Clinical Gingival
Health on a Reduced
Periodontium: Stable Periodontitis Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

<10%
≤4mm
(no site ≥4mm with BOP)
Yes
Yes
I.e., a patient with a history of periodontitis
who is currently periodontally stable

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29
Q

Clinical Gingival
Health on a Reduced
Periodontium:
Non-periodontitis
Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

<10%
≤3mm
Yes
Possible
I.e., recession; crown lengthening.

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30
Q

Pristine periodontal health

A

Total absence of of clinical inflammation and physiological immune surveillance with no attachment or
bone loss
Not likely to be observed clinically

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31
Q

Clinical periodontal health

A

Absence or minimal levels of clinical inflammation in a periodontist with no attachment or bone loss

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32
Q

Periodontal disease stability

A

In a reduced periodontium

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33
Q

Periodontal disease remission/control

A

In a reduced periodontium
Control modifying factors and therapeutic response

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34
Q

Clinical gingival health can be restored following treatment. However,

A

the treated and stable periodontitis patient with
current gingival health remains at increased risk of
recurrent periodontitis, and must be closely monitored.

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35
Q

Gingivitis

A

“Gingivitis is the inflammation of the
gingival tissues without loss of
connective tissue attachment.”

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36
Q

Bleeding on Probing
(4)

A
  • One of the early signs
  • Prior to color change or other visual signs of inflammation
  • Excellent negative predictor (absence of BOP) of future
    attachment loss
  • Smoking masks BOP by suppressing inflammatory response
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37
Q

Early sign: bleeding on probing Under microscope

A
  • Dilation and engorgement of the
    capillaries and thinning or ulceration
    of the sulcular epithelium
  • Vasculitis of blood vessels adjacent to
    the junctional epithelium
  • Progressive destruction of the
    collagen fiber network (collagen-poor)
  • Cytopathologic alterations of resident
    fibroblasts (cell-rich)
  • Progressive infiammatory immune
    cellular infiltrate (predominantly
    lymphocytic)
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38
Q

Change in Gingival Features
* Color:
* Patterns:

A

important clinical sign of gingival disease
marginal, diffuse or patchlike

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39
Q

Change in Gingival Features
Consistency:

Acute Forms
(2)
Chronic Forms
(3)

A

result from the predominance of the
destructive (edematous) and reparative (fibrotic)
changes

• Sloughing with grayish,
desquamative debris
• Vesicle formation

• Soggy puffiness
• Softness and friability
• Firm, leathery consistency

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40
Q

Change in Gingival Features
Surface texture:

A

loss of stippling is an early sign of
gingivitis ( 40% patients have stippling)

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41
Q

Surface texture Indication
Smooth, Shiny
Peeling
Leathery
Nodular

A

Epithelial atrophy in atrophic gingivitis
Chronic desquamative gingivitis
Hyperkeratosis
Drug-induced gingival overgrowth

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42
Q

Change in Gingival Features
* Position:

  • Prevalence, extent and
    severity increase with —
  • More prevalent in —
  • The gingival margin shifts
    —, resulting in the
A

gingival recession is a common finding

age
male
apically, root surface exposure

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43
Q

Type of recession
Visible

A

Clinically observable

44
Q

Type of recession
Hidden

A

Covered by gingiva,
can be measured by
probing to the level of
epithelial attachment

45
Q

Position of gingiva
Apparent position

A

The level of the crest of the
gingival margin

46
Q

Position of gingiva
Actual position

A

severity

The level of the coronal
end of the epithelial
attachment on the tooth

47
Q

Change in Gingival Features
Clinical significance
Exposed roots are susceptible to (4)

A

caries,
hypersensitivity, pulp symptoms, plaque accumulation

48
Q

Change in Gingival Features
* Contour:
(2)

A
  • Primarily associated with gingival enlargement
  • Stillman’s clefts, McCall festoons
49
Q

Change in Gingival Features
* Size/Contour:

A

gingival enlargement/overgrowth

50
Q

Localized

A

Limited to the
gingiva adjacent to
one tooth or a
group of teeth

51
Q

Papillary

A

Confined to the
interdental papilla

51
Q

Generalized

A

Involving the gingiva
throughout the
mouth

52
Q

Diffuse

A

Involve marginal,
attached gingiva
and papilla

53
Q

Discrete

A

An isolated sessile or
pedunculate, tumor
like enlargement

54
Q

Marginal

A

Confined to the
marginal gingiva

55
Q

Grade 0

A

No signs of gingival
enlargement

56
Q

Grade I

A

Confined to the
interdental papilla

57
Q

Grade II

A

Involves papillae
and marginal
gingiva

58
Q

Grade III

A

Enlargement covers
>3/4 crown

59
Q

Gingivitis
Dental plaque-induced
An inflammatory response of

A

gingiva resulting
from plaque biofilm accumulation located and
below the gingival margin

60
Q

Characteristics
— to initiate the inflammation
Clinical signs and symptoms are
confined in the —
— modifying factors
— attachment may or may not
experience —
Reversible?

A

Plaque
gingival unit
Systemic
Stable
further attachment loss
Reversibility

61
Q

Systemic conditions
(5)

A

Steroid Hormones
-Puberty, menstrual cycle, pregnancy,
oral contraceptives
Smoking
Hyperglycemia
Leukemia
Malnutrition

62
Q

Local/predisposing factors
(2)

A

Prominent subgingival
restoration margins
Hyposalivation

63
Q

Drug-induced gingival enlargements
(4)

A

Antiepileptic drugs
Calcium channel-blocking drugs
Immunoregulating drugs
High-dose oral contraceptives

64
Q

Calcium channel-blocking drugs
(5)

A

Nifedipine, verapamil, diltiazem, amlodipine, felodipine

65
Q

Antiepileptic drugs (1)

66
Q

Immunoregulating drugs (1)

A

Cyclosporine

67
Q

The clinical signs of inflammation are (5)

A

erythema,
edema, pain (soreness), heat, and loss of function.

68
Q

These may manifest clinically in gingivitis as:
(4)

A

a. Swelling, seen as loss of knife-edged gingival
margin and blunting of papillae
b. Bleeding on gentle probing
c. Redness
d. Discomfort on gentle probing

69
Q

— is not helpful in diagnosing gingivitis

A

Radiograph

70
Q

Based on available methods to assess gingival
inflammation, gingivitis case could be simply,
objectively and accurately identified and graded using

A

Bleeding on Probing
Score (BOP%)

71
Q

A case of dental plaque-induced gingivitis is defined
as

A

≥10% bleeding sites with probing depths ≤3 mm

72
Q

Localized gingivitis:
Generalized gingivitis:

A

10%-30% bleeding sites
> 30% bleeding sites

73
Q

For epidemiological purposes alone, a patient with a
history of periodontitis, with gingival inflammation is
still a

A

periodontitis case

74
Q

Biofilm-induced Gingivitis
Intact Periodontium:

Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

≥10%
≤3mm
No
No

75
Q

Biofilm-induced Gingivitis
Reduced
Periodontium:
Stable Periodontitis
Patient:

Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

≥10%
≤4mm*
(no site ≥4mm with BOP)
Yes
Yes

76
Q

Biofilm-induced Gingivitis
Reduced
Periodontium:
Non-periodontitis
Patient

Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

≥10%
≤3mm
Yes
Possible

77
Q

Localized gingivitis is — BOP
Generalized Gingivitis is — BOP

A

> 10% and <30%
30%

78
Q

Gingivitis
Non-plaque-induced
The oral conditions resulted from the

A

manifestations of systemic conditions which
may be further exacerbated by local factors
such as plaque or oral dryness. These conditions
may persist even after plaque removal.

79
Q

skipped
Non-Biofilm-induced Gingivitis
Genetic abnormalities

A

Hereditary gingival fibromatosis
(Son of the Sevenless gene)

80
Q

skipped
Specific infection

A

Bacteria (Necrotizing Periodontal Disease), Viral,
Fungal

81
Q

skipped
Inflammatory and
immune conditions

A

Contact allergy, pemphigus vulgaris, pemphigoid,
lichen planus

82
Q

skipped
Neoplasms

A

Leukoplakia, erythroplakia, squamous cell
carcinoma, leukemia, lymphoma

83
Q

skipped
Endocrine, nutritional,
metabolic disease

A

Scurvy (Vit C deficiency), toothbrushing trauma,
etching, burning

84
Q

skipped
Gingival pigmentation

A

Melanoplakia (smoker’s melanosis, drug-induced
pigmentation, amalgam tattoo)

85
Q

Management
(2)

A

Interdisciplinary consultation: know when to refer
Remove etiology: plaque control (OHI, dental prophylaxis, scaling in the presence
of gingival inflammation with re-evaluation), routine recall/maintenance

86
Q

Desquamative
Gingivitis
Gingival Disease/Conditions
A gingival response is a peculiar condition
associated with a variety of conditions, characterized
by

A

intense erythema, desquamation, and ulceration
of both the free and attached gingiva.

87
Q

Desquamative gingivitis is
a clinical term
NOT a

88
Q

Desquamative Gingivitis
Need a series of laboratory result for final
diagnosis and corresponding treatment

A

Clinical
history Clinical
examination Biopsy Microscopic
examination
Immuno-
fluorescence

89
Q

Lichen Planus
(3)

A
  • A immunologically-mediated mucocutaneous disorder
  • T lymphocytes play a central role
  • Prevalent in middle aged and older females
90
Q

Lichen Planus
Five subtypes:

A

Reticular,
erosive,
patch,
atrophic,
bullous

91
Q

Lichen Planus
* Oral lesion:
* Gingival lesion:

A

more than gingiva is involved
restricted in gingiva

92
Q

Pemphigoid
(2)

A
  • A cutaneous, immune-mediated subepithelial disease
  • Separation of the basement membrane zone
93
Q

Pemphigoid
Three conditions:

A
  • Pemphigoid gestationis, bullous pemphigoid,
    mucous membrane pemphigoid
94
Q

Pemphigus
Vulgaris
(2)

A
  • Pemphigus disease is a group of autoimmune disorders
  • Produces cutaneous and mucous membrane blisters
95
Q

Pemphigus vulgaris is the most common of all.
(2)

A
  • Lethal chronic condition (10% mortality rate)
  • Predilection in women (after 4th decade of life)
96
Q

Pemphigus vulgaris
Soft palate (–%)
Lower labial mucosa (–%)
Buccal mucosa (–%)
Tongue (–%)
Gingival tissue

97
Q

Lupus
Erythematosus
(2)

A

An autoimmune disease with three clinical presentations:
* Systemic/Chronic cutaneous/Subacute cutaneous

98
Q

Lupus Erythematosus
* Cutaneous lesion
(3)
* Oral lesion:

A
  • Butterfly pattern
  • Discoid lesion
  • Scar and atrophy production

ulcerative or lichen planus-like

99
Q

Lupus Erythematosus
Clinical Presentation

A

Gingival discoid lupus erythematosus lesion
Ulcerative or lichen planus-like

100
Q

Erythema Multiforme
* Reactive acute – disease
* – inflammatory disease
* Broad spectrum from –
* Predominant in –

A

vesiculobullous
Mucocutaneous
self-limiting to severe progression
young individuals

101
Q

Erythema
Multiforme
Clinical Presentation
(3)

A

Oral lesion
Swollen lip
Crust formation
Ruptured Bullae
Extensive ulcers
Pseudomembranes
Skin lesions
Iris appearance

102
Q

Necrotizing
Periodontal
Disease
(3)

A
  • An inflammatory, destructive gingival condition
  • Young adults, (HIV)‐infected individuals
  • Mild to severe, may develop fever and malaise
103
Q

Necrotizing
Periodontal
Disease
* Characteristics of gingival lesion
(2)

A
  • Punched‐out appearance
  • Pseudomembrane
104
Q

Necrotizing
Periodontal
Disease
Clinical Presentation
Pseudomembrane
(2)

A

Leukocytes, fibrin and necrotic tissue
Masses of bacteria

105
Q

Diagnosis criteria: health
Bleeding on probing
Probing depth
Intact periodontium
Reduced periodontium

A

<10%
≤3mm
No
Possible

106
Q

Diagnosis criteria: gingivitis
Bleeding on probing
Probing depth
Intact periodontium
Reduced periodontium

A

≥10%
≤3mm
No
Possible

Periodontics (13 decks)

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