Periodontics Flashcards
1
Q
What does the periodontium consist of?
A
- Alveolar Bone
- PDL
- Cementum
- Gingiva
2
Q
Gingival Sulcus
A
- Aka Gingival Crevice
- Natural space b/w the tooth and gingiva
3
Q
Gingival Margin
A
- Aka Free Gingival Margin/ Gingival Crest
- Peak of the gingiva
- Used in Periodontal pocket depth (PPD) measurement
4
Q
Free Gingival Groove
A
- Shallow linear depressino on the gingival surface
- border b/w free gingiva and attached gingiva
5
Q
Mucogingival Junction
A
- Border b/w the attached gingiva and alveolar mucosa
6
Q
Free Gingiva vs Attached Gingiva vs Alveolar Mucosa
A
Free Gingiva:
* Not bound
* Keratinized
Attached Gingiva:
* Bound
* Keratinized
Alveolar Mucosa:
* Not Bound
* Non-keratinized
7
Q
What is the initiating factor for gingivitis and periodontitis?
A
- Microbial Plaque (BIofilm)
8
Q
Biofilm
A
- Microbial plaque
- Thin layer of bacteria on the tooth surface
9
Q
What are the 3 states of the periodontium? Describe each
A
Periodontal Health:
* No inflammation
* No PDL and Bone destruction
Gingivitis:
Inflammation
* No PDL and Bone Destruction
Periodontitis:
* Inflammation
* PDL and Bone Destruction (CAL)
10
Q
What is the Pathogenesis of Periodontal Disease?
A
- Microbial challenge (LPS, antigens) subgingival plaque bacteria
- Upregulated host immune inflammatory response (Cytokines, prostaglandins, MMPs)=gingivitis (inflammation, no PDL or bone destruction)
- Tissue Destruction=Periodontitis (Inflammation w/PDL and bone destruction
11
Q
Erosion
A
- caused by acidic foods/beverages or gastric acid
12
Q
Abrasion
A
- Loss of tooth structure by mechanical wear
- ex: Aggressive w/Hard Bristled tooth brush
13
Q
Attrition
A
- occlusal wear from functional contacts w/opposing teeth
- Bruxism and clenching
14
Q
Abfraction
A
- Loss of tooth structure in cervical areas
- due to tooth flexure
15
Q
Hypersensitivity
A
Result of exposed dentinal tubules in root surface
16
Q
What are the 3 objective findings in a Periodontal Exam?
A
- Probing Pocket Depth (PPD)
- Clinical Attachment Loss (CAL)
- Bleeding on Probing (BOP)
17
Q
How do you measure Probing Pocket Depth
A
- Gingival magin to base of pocket
18
Q
How do you measure clinical attachment loss (CAL)?
A
- CEJ to base of pocket
- CAL=PPD + Recession (CEJ to gingival margin)
19
Q
Bleeding on Probing (BOP)
A
- best measure of inflammation in periodontal tissues
19
Q
Bleeding on Probing (BOP)
A
- best measure of inflammation in periodontal tissues
20
Q
Gingival Recession
A
- From CEJ to gingival margin
- Apical shift of gingival margin
- exposes root surface
21
Q
Suppuration
A
- Indicates large number of neutrophils in pocket
- Puss
22
Q
Mobility is due to
A
- due to loss of periodontal support, traumatic occlusion, or combo
23
Q
Define Furcation vs Furcation involvement
A
Furcation:
* branching point of a tooth root
Furcation Involvement:
* area of bone loss at the furcation
24
What does An oral exam consists of?
Home Care:
* measure w/local factors-plaque & calculus
* How much they are brushing and flossing? Proper technique?
Inflammation-> redness, swelling, BOP
Destruction of Periodontal tissues-->PPD, CAL, Alveolar bone loss, mobility, furcation involvement
25
Miller Classification of Mobility
26
Furcation involvement factors:
* Short root trunk (measured from CEJ to furcation)
* Short roots
* Narrow interradicular dimension (Distance b/w roots)
* Cervical enamel projection (Enamel dips down into furcation area, should be cementum)
27
Hamp Classification of Furcation
Use NABERs Probe (3mm increments)
Class 0:
* no furcation involvement
Class 1:
* horizontal furcation invovlement
* < 3mm
Class 2:
* Horizontal furcation involvement
* > 3 mm
Class 3:
* through-and-through furcation involvement
* Nabers probe sticks out the other side-can see clinically
28
Glickman Classification of Furcation
Class 1
* pocket formation in the FLUTE (only have 1 flute)
* incipient furcation involvement
Class 2:
* Pocket formation into the FURCA (Furcation areabranching b/w your 2 fingers)
* Cul-de-sace furcation involvement
Class 3:
* Through-and-Through Lesion
* same as Hamp classification
Class 4:
* Through-and-Through Lesion
* YOU CAN SEE THROUGH
29
What is the normal distance from the CEJ to Alveolar Crest in a healthy patient?
2 mm
30
Alveolar Bone Loss
* Crest should be PARALLEL to line connecting CEJs of adjacent teeth
Horizontal Bone loss:
* Stays parallel to line connecting CEJs
Vertical or angular Bone Loss:
* classified by # of bony walls remaining
* not parallel to line connecting CEJs
31
What is the best radiograph to assess bone height?
Bite Wings (Horizontal or vertical)
32
Classification of Vertical/Infrabony Defects
1 wall= Hemiseptal
2 wall: Crater
* most common
* occurs b/w two teeth (lose interseptal bone)
3 Wall: Trough
4 Wall: Circumferential (Extraction socket)
33
Millers Classification of Recession
34
Gingivitis
Inflammation of Gingiva
Measured by 3 C's:
**Color**
* from Increased Blood Flow=Red
**Contour**
* Inflammatory exudate and edema (Swelling)
**Consistency**
* Chronic gingivitis leads to fibrosis
* Ideal=Stippling (Like an orange peel)
35
Plaque-Induced Gingival Diseases
* Most common
Result of an interaction b/w plaque bacteria and inlammatory cells of host
Modified by: (Not Caused by!)
**Systemic Factors**
* endocrine changes (Puberty pregnancy, diabetes)
* Blood dyscrasias (Leukemia)
**Medications**
** Drug induced gingival enlargement w/CCB (Nifedipine), dilantin, cyclosporine*
* Oral contraceptives*
**Malnutrition**
* Vitamin C Deficiency (Scurvy)
36
Non-Plaque-induced Gingival Diseases
* Less common than plaque induced
In response to:
* Infections
* allergy
* Trauma
**Hereditary Gingival Fibromatosis**
* non-hemorrhagic
* firm
37
Periodontal Disease: Classification System (OLD)
1. Severity (CAL)
2. Distribution
3. Type
38
Periodontal Disease: Severity
Based on CAL
* Slight: 1-2 mm CAL
* Moderate: 3-4 mm CAL
* Severe: >/= 5 mm CAL
39
Periodontal Disease: Distribution
How many sites in mouth with the CAL
* Localized: < 30%
* Generalized: >/= 30%
40
Periodontal Disease: Types
* Chronic
* Aggressive (opposite of chronic)
* Necrotizing
41
Chronic vs Aggressive Periodontitis
CHronic:
* Clinically not Healthy (Smoker, diabetes)
* Slower, progressive bone destruction
* Microbial deposits CONSISTENT w/extent of destruction
* Modied by systemic Issues (Smoking, diabetes)
* Older
Aggressive (Opposite):
* Clinically Healthy
* Rapid Bone destruction
* Familial aggregation
* Microbial deposits NOT consistent w/extent of destruction
* Localized version has first MOLAR/INSOR presentation (Deeper pockets ONLY aroudn molars and inciros)
* Younger
42
Necrotizing Periodontal Disease
ANUG: Acute Necrotizing Ulcerative Gingivitis
ANUP: Acute Necrotizing Ulcerative Periodontitis
* Pseudomembrane
* Fetid breath (Bad breath)
* Blunted Papillae
* Fever
Predisposing factors:
* stress
* smoking
* immunosuppresion
