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
