Periodontics Flashcards
What does the periodontium consist of?
- Alveolar Bone
- PDL
- Cementum
- Gingiva
Gingival Sulcus
- Aka Gingival Crevice
- Natural space b/w the tooth and gingiva
Gingival Margin
- Aka Free Gingival Margin/ Gingival Crest
- Peak of the gingiva
- Used in Periodontal pocket depth (PPD) measurement
Free Gingival Groove
- Shallow linear depressino on the gingival surface
- border b/w free gingiva and attached gingiva
Mucogingival Junction
- Border b/w the attached gingiva and alveolar mucosa
Free Gingiva vs Attached Gingiva vs Alveolar Mucosa
Free Gingiva:
* Not bound
* Keratinized
Attached Gingiva:
* Bound
* Keratinized
Alveolar Mucosa:
* Not Bound
* Non-keratinized
What is the initiating factor for gingivitis and periodontitis?
- Microbial Plaque (BIofilm)
Biofilm
- Microbial plaque
- Thin layer of bacteria on the tooth surface
What are the 3 states of the periodontium? Describe each
Periodontal Health:
* No inflammation
* No PDL and Bone destruction
Gingivitis:
Inflammation
* No PDL and Bone Destruction
Periodontitis:
* Inflammation
* PDL and Bone Destruction (CAL)
What is the Pathogenesis of Periodontal Disease?
- 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
Erosion
- caused by acidic foods/beverages or gastric acid
Abrasion
- Loss of tooth structure by mechanical wear
- ex: Aggressive w/Hard Bristled tooth brush
Attrition
- occlusal wear from functional contacts w/opposing teeth
- Bruxism and clenching
Abfraction
- Loss of tooth structure in cervical areas
- due to tooth flexure
Hypersensitivity
Result of exposed dentinal tubules in root surface
What are the 3 objective findings in a Periodontal Exam?
- Probing Pocket Depth (PPD)
- Clinical Attachment Loss (CAL)
- Bleeding on Probing (BOP)
How do you measure Probing Pocket Depth
- Gingival magin to base of pocket
How do you measure clinical attachment loss (CAL)?
- CEJ to base of pocket
- CAL=PPD + Recession (CEJ to gingival margin)
Bleeding on Probing (BOP)
- best measure of inflammation in periodontal tissues
Bleeding on Probing (BOP)
- best measure of inflammation in periodontal tissues
Gingival Recession
- From CEJ to gingival margin
- Apical shift of gingival margin
- exposes root surface
Suppuration
- Indicates large number of neutrophils in pocket
- Puss
Mobility is due to
- due to loss of periodontal support, traumatic occlusion, or combo
Define Furcation vs Furcation involvement
Furcation:
* branching point of a tooth root
Furcation Involvement:
* area of bone loss at the furcation
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
Miller Classification of Mobility
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)
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
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
What is the normal distance from the CEJ to Alveolar Crest in a healthy patient?
2 mm
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
What is the best radiograph to assess bone height?
Bite Wings (Horizontal or vertical)
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)
Millers Classification of Recession
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)
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)
Non-Plaque-induced Gingival Diseases
- Less common than plaque induced
In response to:
* Infections
* allergy
* Trauma
Hereditary Gingival Fibromatosis
* non-hemorrhagic
* firm
Periodontal Disease: Classification System (OLD)
- Severity (CAL)
- Distribution
- Type
Periodontal Disease: Severity
Based on CAL
* Slight: 1-2 mm CAL
* Moderate: 3-4 mm CAL
* Severe: >/= 5 mm CAL
Periodontal Disease: Distribution
How many sites in mouth with the CAL
* Localized: < 30%
* Generalized: >/= 30%
Periodontal Disease: Types
- Chronic
- Aggressive (opposite of chronic)
- Necrotizing
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
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
