Periodontal Q&A Flashcards
Q: What is attached gingiva ?
Q1: ____ to ____. There’s fiber attaching this that’s why it’s called “attached gingiva”
Q: What is keratinized attached gingiva ?
Q2: No keratinized tissue below ____ junction.
Is all the attached gingiva keratinized? No the ____ epithelium is NOT keratinized. It is pocket epithelium.
• If you call it pocket = ____
• Sucular epithelium = health gingiva
Q: What is alveolar mucosa ?
free gingival margin
muco-gingival junction
muco-gingival
periodontitis
What are four layers of the oral epithelium? Q: What is dental gingival UNIT? Stratum \_\_\_\_ Stratum \_\_\_\_ Stratum \_\_\_\_ Stratum \_\_\_\_
What is the difference between junctional epithelium & non-junctional epithelium?
• Biological width = ____
◦ Only 2.04 mm
Gingival unit = ____ width
basal spinosum granulosum corneum epithelial attachment biologic
Q: What is clinical attachment loss?
If the marginal gingiva is below the cementoenamel junction (CEJ):
CAL =____
If the marginal gingiva is above the CEJ:
CAL = ____
Gingivitis is now considered kinda healthy because it is impossible to find someone without gingivitis. Most of the time CEJ is detectable, maybe it is not visible but you can use the perio probe to detect the CEJ. Sometimes you can’t because the CEJ is invading the bone level (?).
Why do we use CEJ as the landmark? The CEJ is the only landmark that will remain the same in the presence of ____ & can be used to accurately understand the progression of the disease.
pocket depth + [CEJ to marginal gingiva]
[marginal gingiva to CEJ] - [maginal gingiva to bottom of pocket]
inflammation
Q: What is the composition of the connective tissue?
Connective tissue is fibrous, consisting of mostly ____, ground substances, and mucopolysaccharides. It also contains ____, blood vessels, lymphatics, and nerves.
BOARD Q: CT is composed of type I collagen.
type I collagen
white blood cells
Q: What are five types of gingival fibers ?
Dentogingival group:
• Fibers extending ____ toward the gingival crest
• Fibers extending ____ to the facial gingival surface
• Fibers extending ____ beyond the alveolar crest height and then apically along the alveolar
bone cortex
Alveologingival group:
Fibers in this group run ____ into the lamina propria from the periosteum at the alveolar crest.
Dentoperiosteal fibers:
These fibers insert into the ____ of the alveolar crest and fan out to the adjacent cementum.
Circular group:
These are the only fibers that are confined to the ____ and do not attach to the ____.
Transseptal group:
These fibers bridge the ____ tissue between adjacent teeth and insert into the cementum.”
Circular group is the ONLY group that does not attach to the teeth.
coronally
laterally
horizontally
coronally periosteum gingiva teeth interproximal
Q: What are the functions of PDL? • Protect \_\_\_\_ and nerves • \_\_\_\_ occlusal forces • Attach the tooth to \_\_\_\_ • Perform formative and \_\_\_\_ functions • \_\_\_\_ and Sensory
Q: What is ankylosis?
Ankylosis is the fusion of the ____ and alveolar bone with obliteration of the ____. It develops after chronic periapical ____, tooth re- implantation, and ____ trauma.
Among these fibers, which occupies the most space? ____ because it takes on the most forces.
Reads bullets. One important function of the PDL is the protection from occlusial forces. When you chew - there is not just forces up & down - the tooth distributes the force side to side & in all different directions - the PDL protects from this.
• Implants do not have ____ - there is no sensation. The forces might be too much & you won’t feel it (bc no PDL) & the implant will break.
Anklylosis is kinda a bad thing for the tooth but for implants it’s ____ since there is no PDL.
vessels transmit bone remodeling nutritive
cementum
PDL
inflammation
occlusal
oblique
PDL
necessary
Q: What are acelluar and cellular cementum?
(A) Acellular cementum is located on the ____ at the CEJ. It does not contain ____ and forms slowly.
(B) Cellular cementum is located at the ____ of the root. It is more irregular and forms ____. With age, there is an ____ in width of the cellular cementum.
Inorganic component: 45-50 %
Bone: 65%
Enamel: 97 %
Dentin: 70%
BOARD Q: Which forms first? ____.
BOARDS Q: Gets thicker as you age? ____.
• More potential to heal
• Thicker and thicker as you age
____ is the hardest part of your body because the % inorganic component.
enamel cementocytes apical third rapidly increase
acellular cementum
cellular cementum
enamel
Q: What are acelluar and cellular cementum?
• ____% of the cementum and enamel overlap.
• ____% of the cementum and enamel form a butt joint.
• ____% of the cementum and enamel are separated by a gap.
60
30
10
Q: Discuss 4 different types of collagen :
• ____: Skin, tendon, vascular ligature, organs, bone (main component of the organic part of bone)
• ____: Cartilage (main component of cartilage)
• ____: Comprised of reticular fibers, commonly found alongside type I collagen, found in smooth muscle
• ____: Forms basis of cell basement membrane
type I
type II
type III
type IV
Glickman classification of furcation involvement (1953)
• Grade I: Pocket formation into the furcation, but intact ____ bone
• Grade II: Loss of ____ bone and pocket formation but not extending through to the ____ side
• Grade III: ____ lesion
• Grade IV: Through-and-through lesion with gingival recession, leading to a clearly ____ furcation area
interradicular interradicular opposite through-and-through visible
Q: What’s the difference of Periodontitis and Gingivitis?
Clinical attachment loss? -\_\_\_\_ Periodontal pocket > 3 mm? -\_\_\_\_ Gingival recession? -\_\_\_\_ Bleeding on probing? -\_\_\_\_
Before 2017: Clinical attachment loss is the ONLY differentiating factor.
After 2017: these are all used to describe periodontitis (??)
• You can use bleeding on ____ to detect inflammation - you can but it is not a sensitive test because other things can cause inflammation, such as trauma. Probing can cause trauma, depending on the skill/ force of the clinician + the design (diameter) of the probe. Probing is considered a dull instrument - because it wouldn’t injure the back of your hand. However, when you walk your probe it can easily cut through the CT tissue, causing bleeding because the junctional epithelium is not healthy & this is why the patient complains of discomfort.
yes no no no probing
Q: What’s the pathogenesis of Periodontitis?
These are all factors that can cause periodontitis.
• NOW we believe that the host ____ response has the biggest role in causing
periodontitis.
• In the past, antibiotics were used much more to treat periodontitis because the microbial role was thought to be the main cause - however, periodontitis still exists so clearly it’s not mainly the ____.
immune-inflammatory
microbes
Two types of immune responses
- Innate Responds (Non-Specific Responds)
- ____ Responds
- Created ____ for specific responds happened
- Not ____
BOARD Q: Difference between innate & delayed response.
Innate = moat around the castle but when you have an intruder, they cannot get in - but some pathogens can bypass the innate response …. So the adaptive immune system comes into play after some time.
rapid
time
selective
Two types of immune responses
- AdaptiveResponds (Specific Responds)
- ____ responds
- High ____
- ____ Mediated
slow
selective
antibody
____ are FIRST in an adaptive response.
Part 2 NBDE questions:
Important in:
Parasitic infection & allergic response = ____
Viral infection = ____
Are monocytes & macrophages the same thing? No. Monocyte = ____ cell
Macrophage is ____
neutrophils eosinophil lymphocyte precursor differentiated
Q: PMN are the predominant immune cells in which stage of gingivitis?
Neutrophils are FIRST in an ____ response.
Then the rest come depending on the type of infection -> reads the picture.
adaptive
Q: Select from the following cell type that are part of the innate immune responds • T cell ? • B cell ? • \_\_\_\_ ? • \_\_\_\_ ? • \_\_\_\_ Cell ? • Lymphocyte
Dendritic cell should be categorized in the innate response but they ARE involved in the ____ response.
neutrophil
monocyte
mast
adaptive
(MOST) ____ > ____ > ____ > ____ > ____
neutrophil lymphocyte monocyte eosinophil basophil
Q: Which of the following are cells of the innate immune system? a. Neutrophils and monocytes/macrophages b. T cells and B cells c. Mast cells and dendritic cells • a and b • a and c • b and d • b and c
Q: Which of the following are antigen-presenting cells? • Neutrophils • T-lymphocytes • Macrophages • Plasma cells
1) a and c
2) macrophages
Modified Gingival Index
0: Absence of ____
1: ____ inflammation, slight color change, and slight edema but not ____ the entire marginal or papillary unit and no bleeding
on probing
2: ____ inflammation, slight color change, and slight edema ____ the entire marginal or papillary unit and no bleeding on probing
3: ____ inflammation, redness, edema, glazing, bleeding on probing, and hypertrophy of the entire marginal unit
4: ____ inflammation
inflammation mild involving mild involving moderate severe
Periodontal Disease Index
• G0: ____ of disease
• G1: Mild to moderate inflammation not ____ around the tooth
• G2: Mild to moderate inflammation ____ around the tooth
• G3: ____ gingivitis and redness
absence
extending
extending
severe
Plaque Index
• 0: No ____
• 1: ____ of plaque
• 2: ____ accumulation of plaque within the gingival pocket or on the tooth and gingival margin that can be seen with the naked
• 3: ____ of plaque within the gingival pocket or on the tooth and gingival margin.
plaque
film
moderate
abundance
Q: What percentage of the population has aggressive, chronic, and severe periodontitis?
• Localized aggressive periodontitis: ____% (greater prevalence in blacks many studies have proposed that there may be a defect in neutrophil function)
• Generalized aggressive periodontitis: ____%
The 2009 and 2010 National Health and Nutrition Examination Survey found the following data on the prevalence of periodontitis among adults in the United States:
- 47.2% have periodontitis
- 8.7% have ____ periodontitis
- 30% have ____ periodontitis
- 8.5% have ____ periodontitis”
Which race is most likely to have aggressive periodontitis? ____»_space; Hispanics > Asians > Caucasian
• ____/____ pattern because these are the first teeth erupting in your mouth so they are most impacted by periodontitis.
0.53
0.13
mild
moderate
severe
african americans
molar
incisal
Q: Is there anything between periodontist and preterm birth ?
This is an exercise just believe me: the people who like to eat ice cream are more likely to die from drowning.
If you take this funny statement to be true - why could it be true? Confounding factors. You usually eat ice cream in the summer, you also swim in the summer.
Very strong associations = ____ & diabetes
Risk factors = ____ & socioeconomic factors
• very strong association but not causation
THERE ARE studies that show a correlation between pre-term baby and periodontitis but this is very debated - it’s probably somewhat a risk factor but not huge.
smoking
age
MASKED INFLAMMATION: Smokers have LESS ____ on probing but the disease is MORE ____.
bleeding
severe
Effect of Smoking on etiology and Pathogenesis of Periodontal Disease
Microbiology
Increased ____ pathogens
Immune inflammatory responds
• Altered neutrophil ____, phagocytosis, and oxidative burst
• Increased ____
• Increased the ____
Physiology
• Decreased ____
• Decreased ____
periodontal chemotaxis collagenases PGE2 blood vessel GCF
Q: Which bacteria are associated with refractory periodontal disease? HIV/AIDS?
Refractory periodontitis
____
____
____
HIV/AIDS
____
____
Necrotizing periodontal diseaes
____
____
t. forsynthia
p intermedia
p gingivalis
AA
p gingivalis
spirochetes
(t denticola & p intermedia)
Q: Neutrophil Abnormalities and Periodontits
- ____ syndrome
- ____ syndrome
papillon lefevere
chediak-higashi
Systems and Conditions Possibly Influenced by Periodontal Condition • \_\_\_\_ • Endocrine • \_\_\_\_ • Respiratory
cardiovascular
reproductive
Q: Which medication can cause gingival hyperplasia?
____
-____
____
-____
____
-____
anticonvulsants
dilantin (phenytoin)
calcium channel blockers
nifedipine
immunosuppressants
cyclosporine
Patient is a: • Smoker! • Hypertension • Arthritis - inflammatory disease that relates to your immune system • Diabetes - relates to inflammation
If a patient comes to you sweating & hungry … be careful! What if she’s diabetic & took her medication but DID NOT eat? She’ll ____ on the floor!
faint
Pathogenesis of Periodontitis
- ____ smoking
- Smokeless tobacco
- ____
- Diabetes
- ____ changes
- Down Syndrome
- ____
- Nutrition
- Heavy ____
- Medication
Reads the environmental & acquired risk factors that DO HAVE A CONTRIBUTION in the change of the immune response.
cigarette radiation hormone stress metals
Erosion: can be ____
- usually lingual palate because of acid reflux and soda
Abrasion: ____
Attrition: ____
Abfraction: from normal ____ surfaces (inside the tooth) that causes destruction
When I see this clinical presentation - you cannot make a diagnosis you have to figure it out from ____.
chemical brushing bruxism occlusion patient history
Facial & Lingual Probing
- parallel to ____ axis
- walking the ____
vertical
probe
Interproximal probing
✓ To detect ____ point of interdental crater
✓ Probe should be placed ____
deepest
obliquely
Q: Gingivitis is most often caused by:
a. Hormonal imbalance
b. Inadequate oral hygiene
c. Occlusal trauma
d. Vitamin deficiency
e. Aging
B
Etiology of gingivitis
- ____
- host ____
11% of patients do not have good oral hygiene control but they do not proceed to periodontitis - this is from the Sri Lankan worker study
- Proof that there IS a ____ component
Norwegian study
• Most people have ____ periodontitis
• Only 10% had severe
• & the rest had mild
The difference in these studies is that in Sri Lanka they had no concept of ____ whereas in Norwegian study they did (so Sri Lankan was based on people who straight up didn’t know how to brush)
plaque response genetic moderate oral hygiene
Most important pathogens to remember: ____, PG, ____, TD, ____
BOARD QUESTION - which bacteria is most related to…
• Pyogenic granuloma? ____
• Localized aggressive periodontitis? ____
• Generalized periodontitis? ____
AA
PI
TF
PI
AA
PG
Criteria for Defining Pathogenic Microorganisms
• Koch’s postulates (1882)
- A bacteria should be able to be ____ from diseased tissues
- ____ cultures of that bacteria can be obtained
- Bacteria inoculated in experimental animals should cause the ____
- The bacteria should then be ____ in the diseased tissues of the animal
isolated
pure
disease
isolated
Microbiologic Etiologic Factors
- Health- and disease-associated bacteria reside in loosely or tightly structured tooth-associated biofilm
- Health-related bacteria
- Predominantly gram-____ ____
- Aerobic or facultative anaerobic species
- ____
- ____, purple complex (Socranky 1998)
• Disease-related bacteria
- Predominantly gram-____
- Strict or facultative anaerobic species
- Maybe be ____ or motile
- ____, red complex (Socranky 1998)
However - in health, there is MORE ____ complex. In disease there is MORE red.
positive
filamentous rods and cocci
nonmotile
yellow
negative
nonmotile
orange
green
Q: In a clinically healthy periodontium, the microbial flora is largely composed of:
• gram-negative obligate microorganisms
• gram-negative facultative microorganisms
• gram-positive obligate microorganisms
• gram-positive facultative microorganisms
Q: In a healthy sulcus, which of the bacteria below are most abundant?
• Actinobacillus actinomycetemcomitans and Tannerella forsythus
• Streptococcus and Actinomyces species
• Treponema and Capnocytophaga species
• Prevotella intermedia and Porphyromonas gingivalis
Q: Early microbiologic studies of localized aggressive periodontitis (LAP) provided clear evidence of a strong association between disease and a unique bacterial microbiota dominated by:
• Tannerella forsythia
• Prevotella intermedia
• Porphyromonas gingivalis
• Actinobacillus actinomycetemcomitans (aa)
- gram-positive facultative microorganisms
- Streptococcus and Actinomyces species
- Actinobacillus actinomycetemcomitans (aa)
Virulence factor of Periodontopathogens
Some bacteria can…
Promote colonization
- ____
Promote host tissue destruction
- ____
Help bacterium to evade the host immune response
- ____
Degrade host immune cell
- ____
fimbriae or pilli
Pg, Aa collagenase
capsule
Aa leukotoxin
Alternative Criteria for Defining Key Bacteria in Periodontal Infections
•Socransky’s alternative criteria (1997)
- The presence of the putative pathogen in proximity to the periodontal lesions and in ____ numbers compared to either the absence of the bacteria or presence in much smaller numbers in healthy subjects
- Patients infected with these periodontal pathogens often develop high levels of ____ in serum, saliva, and gingival crevicular fluid and may also develop a cell-mediated immune response to the putative pathogen
- These bacteria can often demonstrate in vivo production of virulence factors that can be correlated with clinical ____
- Experimental implantation of the organism into an animal model should lead to at least some characteristics of naturally occurring ____ disease
- Clinical treatment that eliminates these bacteria from periodontal lesions should result in clinical ____
high high histopathology periodontal improvement
Characteristics of biofilms
• ____ communities
• Metabolic ____
• ____ circulatory system
• Resist host ____
• Resist systemic or local ____ and antimicrobial agents
• Bacteria grown in biofilms communicate with each other through ____. Quorum sensing is important in the regulation of expression of specific genes.
dynamic cooperation primitive defenses antibiotics quorum sensing
Dental plaque formation
• ____ phase (Formation of the pellicle)
• ____ phase (Initial adhesion and attachment of bacteria(Rapid grow phase
• ____ maturation (Steady phase)
adherence
lag
colonization
Plaque Hypotheses in the Initiation of Periodontal Disease
• Nonspecific plaque hypothesis (1960s)
- Periodontal disease results from the elaboration of noxious products by the plaque biomass, indicating that the ____ of plaque is of most importance in the initiation of disease. This hypothesis is contradicted by the finding that some patients with ____ plaque have severe periodontitis.
• Specific plaque hypothesis (1970s)
- The pathogenic potential of plaque is dependent on the presence of, or increasing ____ of, specific microorganisms. As a result, many years have been spent trying to identify the specific pathogens associated with disease.
• Ecological plaque hypothesis
- Putative periodontal pathogens are present in both ____ and diseased sites. A change in the pocket ____ (e.g., a change in the nutrient status) is the primary cause for the overgrowth of the putative pathogens.
number little numbers healthy environment
Pathogenic Role of Calculus
• By itself, does not initiate or cause progression of periodontal disease - acts as a local ____ factor
• Acts as a biologic ____ for the development of biofilm
• May also have food and tissue debris - ____ - associated with the biofilm communities
• Materia alba is a concentration of microorganisms, ____ proteins and lipids, desquamated ____ cells, and leukocytes that is ____ adherent than dental plaque. The presence of bacteria may lead to materia alba serving as an irritant to gingival tissues.
• Why not calculus? Calculus is calcified. It is a ____ of plaque.
contributing material alba salivary epithelial less product
Q:How much pressure should be applied when measuring the BOP?
According to Gerber, false-positive BOP results around teeth could be minimized by using a probing pressure of ____ N, and around implants a threshold pressure of ____ N could reduce false positives.
- 25
0. 15
Q: Is probing depth a good predictor of periodontal disease?
Armitage concluded the following from studies in beagle dogs:
• Periodontal probes do not ____ measure connective tissue attachment levels.
• ____ has a significant influence on the degree of probe penetration.
• Histologic and clinical sulcus depths ____ significantly.
____ but we have to use it because it does give an idea.
precisely
inflammation
differ
no
Q:Are radiographs an accurate method of diagnosing periodontal disease?
Ortman found that the unaided eye is able to detect radiographic changes when approximately ____% of the bone has been lost.
This is a tricky question that will be on an exam during your time at Penn - are radiographs a
good method to diagnose periodontitis? Furcation involvement?
- NO - you ____ to have radiographs but it is not 100% because you ____ detect early
periodontal disease.
For furcation involvement:
- for grade 1 - use a ____ probe because radiograph won’t see it bc no bone
involvement
- grade 2 - radiograph might detect it but not 100%
- grade 3 is through & through so it is easy to see a ____ on the radiograph
50
have
cannot
naber’s
through and through
Q: How is periodontal abscess different from plural abscess?
Tx:
• ____ the abscess
• ____
• Possible ____
Depending on how they write the question - be careful. ANTIBIOTICS are NOT GIVEN ____.
drain
pain killers
antibiotics
first
Q:What is the prognosis of a tooth that has been diagnosed with a furcation lesion?
Cobb reported that over a 15-year period, ____% of teeth with furcation lesions and only ____% of teeth without furcation lesions were lost.
Ramfjord discovered that 16 of 17 teeth extracted in 5 years during maintenance and following active treatment initially presented with ____ involvement.
19-57
5-10
furcation
Q: Which of the following presents the most difficulty in performing a scaling and root planing ?
a. medial surface of maxillary premolar b. proximal surface of mandibular incisor
c. trifurcation of maxillary molars
d. distal surface of mandibular molars
Key: The anatomic features of teeth frequently limit the effectiveness and efficiency of calculus removal.
c. trifurcation of maxillary molars
Q:What are the indication and contraindication for occlusal adjustment?
Indications: \_\_\_\_ Tx Primary Tx of Bruxism Sever extrusion of \_\_\_\_ teeth \_\_\_\_ state of the patient treatment precludes a satisfied result
Contraindications: In conjunction with \_\_\_\_ tx. Orate tx, OGS..etc when indicate Parafunction Habbit Increased \_\_\_\_ Traumatic Injury
prophylactic
malpositioned
emotional
restorative
mobility
Q: How does orthodontics help a periodontal patient?
• ____ the teeth and helps the patient with oral hygiene
• Can improve ____ defects (decrease amount of resective surgery)
• Can force eruption to ____ the gingiva
• Can force eruption of a ____ tooth (at least 1:1 crown-to-root ratio)
• Closes open ____
• Improves adjacent tooth ____ before implant placemen
Q: What are the risks of orthodontic treatment? • \_\_\_\_ • Root \_\_\_\_ (shortened root length) • Loss of attachment • Loss of tooth \_\_\_\_ • Tooth relapse • \_\_\_\_
aligns osseous align cracked embrasures position
recession
resorption
vitality
caries
Q:What is SRP?
Scaling is instrumentation of the crown and root surfaces of the teeth to remove ____, calculus, and staining from the teeth.
Root planing is a treatment procedure to remove ____ or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.”
What is the difference between scaling and root planing? A lot of people get this confused.
• Scaling we remove the plaque & biofilm
• Root planing… planing refers to making a smooth surface…
We can’t do this 100% but we want to remove as much as possible to allow tissue to heal and for healthy tissue to reattach to the bone.
plaque
cementum
Q: What are some factors can limit the effectiveness of SRP?
Many anatomical factors can limit the effectiveness of root instrumentation:
• ____ probing depths
• Root ____
• ____
Host response may also limit the effectiveness of root instrumentation: • \_\_\_\_ • Pregnancy • \_\_\_\_ • AIDS • \_\_\_\_ • Blood dyscrasias
deep
concavities
furcations
diabetes
stress
immunodeficiencies
Q:Is root debridement equally effective in molars and nonmolars?
Loos found that, following full-mouth root debridement, more ____ furcation sites (25%) lost probing attachment compared with ____ sites (7%) and ____ sites (10%).
Non-molars are more predictable because they only have single roots.
molar
non-molar
molar flat-surface
Q: What are the consequences to patients with periodontitis who do not receive treatment?
Löe did a study on Sri Lankan laborers, who, in the absence of oral hygiene practices, presented with large amounts of plaque, calculus, and staining and widespread gingival inflammation. Using interproximal loss of attachment and rates of tooth loss, the authors identified three subpopulations:
• Individuals (approximately 8%) with ____ progression of periodontal disease
• Individuals with ____ progression of periodontal disease (approximately 81%)
• Individuals with no ____ (approximately 11%) of periodontal disease beyond gingivitis
rapid
moderate
progression
Q: What are the critical probing depth?
Using a split-mouth design, Lindhe et al treated 15 patients with moderately advanced periodontal disease using SRP in combination with a modified Widman flap procedure on one side and SRP only on the contralateral side. The study found the following critical probing depths:
- 2.9 mm: Attachment loss occurred in pockets < 2.9 mm when ____ was performed
- 4.2 mm: Attachment loss occurred in pockets < 4.2 mm if ____ were performed”
When pocket is <3mm we DO NOT DO ____ because you will cause attachment loss and traumatize the tissue.
When the pocket is only 4 - you do not do ____ for the same reason.
When the pocket is >5mm it’s safe to do ____.
SRP SRP and surgery SRP surgery surgery
Q: What is done during the maintenance visit?
What is the difference between prophy & maintenance?
• Prophy = ____ patient
• Maintenance = patient previously had ____, treated, cured and now you are
maintaining the results
◦ These patients CANNOT return to a diagnosis of “____”
◦ You cannot be cured from periodontitis - you can be treated & the disease is
____.
‣ Similar to diabetes… you can’t cure diabetes but you can be well maintained.
healthy
disease
gingivitis
maintained
Side Effect of the Antibiotics
Tetracycline (Minocycline, Doxycycline) Type: \_\_\_\_ Spectrum: \_\_\_\_ Drug interaction/side effect: • Should not take with \_\_\_\_ • \_\_\_\_ pill will be less effective • Not for \_\_\_\_ dysfunction patient
Metronidazole Type: \_\_\_\_ Spectrum: \_\_\_\_ Drug interaction/side effect: • No \_\_\_\_ • Increase the effect of the \_\_\_\_
bacteriostatic broad. gram (+) and gram (-) warfarin birth control renal
bactericidal
obligate anaerobes
alcohol
warfarin
Side Effect of the Antibiotics Amoxicillin Type: \_\_\_\_ Spectrum: \_\_\_\_ Drug interaction/side effect: Can make \_\_\_\_ less effective
Clindamycin Type: \_\_\_\_ Spectrum: \_\_\_\_ Drug interaction/side effect: • \_\_\_\_ • Do not use in \_\_\_\_ transplant patient
bactericidal
broad. anaerobic gram (+) and gram (-)
effective
bacteriostatic
gram (+) and gram (-)
pseudomembranous colitis
kidney
____: inhibits
____: kills bacteria
bacteriostatic
bactericidal
The difference between doxycycline & tetracycline
• Doxy belongs to ____, which is a big family.
• Doxy is a ____ generation of tetracycline which doesn’t have the same side effects.
◦ Can take doxy while ____ … meanwhile tetra will cause ____ of teeth? Baby teeth?
◦ Both have ____ (his discussion of this was unclear but google says both)
tetracycline new pregnant staining photosensitivity
Sequencing of Antibiotic Therapy
- Initial periodontal therapy should include thorough ____ root debridement followed by ____ access if needed
- ____ may be prescribed on the basis of the clinical need for further treatment, the findings of microbiological testing, and the medical status and current medications of the patient.
- The clinical response should be evaluated ____ months after completion of the ____ therapy.
- After resolution of the periodontal infection, the patient should be placed on an individually tailored maintenance program. ____ plaque control in the supportive periodontal therapy phase may help prevent recolonization by putative periodontal pathogens.
mechanical sugrical antibiotics 1 to 3 mechanical supragingival
Q: When should systemic antibiotics be prescribed ?
• When there is an active ____
• As antibiotic ____
• ____ grafting procedure
• To treat aggressive ____
• ____ surgery can’t be proceed for any reason
• Recurrent or refractory periodontitis due to the persistent ____
pathogens and possibly weakened host resistant
infection prophlyaxis perio periodontitis perio sub gingival
Q: Which patients would benefit the most from systemic antibiotics?
A: Irrespective of the diagnosis, patients with severe forms of periodontitis seem to
benefit from adjunctive systemic ____.
Q: Which antibiotics should be used?
A: Given the consistency of results of dozens of randomized clinical trials conducted across the globe, the combination ____ should be the antibiotics of choice to treat periodontal diseases.
However, the literature lacks studies with head-to-head comparisons between different antibiotics.
MTZ + AMX
amoxicillin and metronidazole
Questions • What are the risks of systemic antibiotics uses? Answer: • \_\_\_\_ reactions • Superinfection • \_\_\_\_ effects • Drug interactions • Patient \_\_\_\_ • BacterialResistance
allergic
toxicity/side
compliance
Q: When extensive SRP must be performed, the best approach would be:
a. Perform everything in a ____ appointment
b. A ____ of appointment set up
single
series
Q: To date, the ADA has accepted two agents for treatment of gingivitis, these are:
• Prescription solution of ____ digluconate oral rinse
• Prescription solution of ____ rinse
• ____ essential rinse
• nonprescription solution of ____ oral rinse
Substantivity: The ability of drugs to ____ onto and bind to soft and hard tissue
SUBSTANTIVITY IS SEEN ON BOARDS EVERY YEAR.
• ____ has a very good substantivity.
◦ Patients should rinse 2x day. It stays a long time in your mouth.
‣ INHIBITS THE ____ OF BACTERIA does not kill.
‣ ^so its ____, not bactericidal
chlorhexidine tetracycline nonprescription penicillin absorb
chlorohexidine
growth
bacteriostatic
Maintenance
Phase I -> ____ -> phase ____ (maintenance) phase ____ (perio) or phase ____ (restorative)
phase II -> phase ____
reevaluation
IV
II
III
III
Q: If there are residual pocket, what option do I have?
Re-evaluate every ____ weeks to see if more SRP is required.
Can do ____, surgical approach or nothing.
• We will talk about surgical approach in a couple of months.
6
SRP
Arrestin (Minocycline) is used at Penn.
• Studies show that it is very helpful in decreasing ____ - even in smokers.
• We don’t use it all the time because Arrestin can increase bacterial ____.
TAKE A LOOK AT THE CHARTS
inflammation
resistance
Host Modulation Therapy
We sometimes use bisphosphonates to inhibit osteoclasts but ____ is an issue.
MRONJ
Q: What is cascade of leading bone loss
- ____-stimulated lymphocytes (B/T cells)
- Receptor activation of ____ axis
- Increase in the ____ ratio and protein production
- ____ are stimulated to osteoclasts and maturation of the osteoclasts
- ____ loss
antigen NFkB (RANK)-RANKL-OPG RANKL-OPG macrophages bone
Q: Describe the relationship between diabetes and inflammation.
C reacting protein is looked at to quantify ____. When it is elevated, it means that some part of your body has uncontrolled inflammation.
inflammation
Periodontal infection ->
Cardiovascular disease ->
- ____ (cytokine)
- CRP
- ____ responses
- bacteremia
inflammation
immune
