Periodontics Flashcards
In Rodrigues’s 2013 survey, “A clinical survey on the prevalence and types of cheek teeth disorders present in 400 Zamorano-Leones and 400 Mirandes donkeys (Equus asinus),” what was found to be the major cause of periodontal disease in the study?
Diastemata (97.4% of CT adjacent to diastemata had periodontal disease)
In Jackson’s 2016 study “A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth,” what treatments showed stat sig reductions in periodontal pocket depth?
JVD 2016
Chlorhexidine
Metronidazole
PVS
In Jackson’s 2016 study “A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth,” what treatment group did not show a significant reduction after adjusting for multiple testing?
JVD 2016
Diastema widening
In Jackson’s 2016 study “A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth,” what was the relationship between pocket depth and improvement following treatment?
JVD 2016
Deeper pockets tended to experience greater improvement following treatment
In Jackson’s 2016 study “A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth,” what were the two main inclusion criteria?
JVD 2016
At least one cheek tooth periodontal pocket with a depth of 5mm or more
Second treatment/exam performed within 6 months
In Schrock’s 2013 paper, “Finite element analysis of equine incisor teeth. Part 1: Determination of the material parameters of the periodontal ligament,” what two properties describe the elastic behavior of materials?
Young’s modulus, Poisson’s ratio
Describe the properties of the periodontal ligament as presented in Schrock’s 2013 paper, “Finite element analysis of equine incisor teeth. Part 1: Determination of the material parameters of the periodontal ligament.”
Anisotropic with viscoelastic and non-linear behavior
In Schrock’s 2013 paper, “Finite element analysis of equine incisor teeth. Part 1: Determination of the material parameters of the periodontal ligament,” what was the calculated Young’s moduli of equine incisor periodontal ligaments?
1.3- 8.0 Mpa
In Schrock’s 2013 paper, “Finite element analysis of equine incisor teeth. Part 2: Investigation of stresses and strain energy densities in the periodontal ligament and surrounding bone during tooth movement,” what were the two principal directions of tooth movements observed in all jaws?
Intrusive movement in an apical direction along the longitudinal axis of the tooth into its alveolus
Tilting movement in a labial direction
Describe the predominant areas of the tooth responsive to compressive and tensile stresses and the associated bone reaction as described in Schrock’s 2013 paper, “Finite element analysis of equine incisor teeth. Part 2: Investigation of stresses and strain energy densities in the periodontal ligament and surrounding bone during tooth movement.”
Compressive stresses predominant on the labial side of the alveolar crest
palatal/ lingual side of the root tip –> loss of bone
Tensile stresses predominant on the
palatal/ lingual side near the alveolar crest
–> deposition of bone
Distribution pattern of high SEDs within the PDL coincides with the position of initial resorptive lesions in EOTRH affected teeth
What were the top 3 phyla identifies in Wenling’s 2015 study on the equine subgingival microbiome?
Microb Path 2015
Proteobacteria (41%)
Firmicutes (28%)
Bacteroidetes (25%)
In Kennedy’s 2017 paper, Gingival Toll-like receptor and cytokine messenger RNA
levels in equine periodontitis and oral health (EVJ (49); 294-299), was there a difference in mRNA of TLRs and cytokines when comparing diseased and normal gingiva?
EVJ 2017
Yes
Significant increases in mRNA levels of TLR2, TLR9, IL-4, IL-10, IL-12 (P≤0.05) and IFN-c (P≤0.01) were observed for both unweighted and age-weighted analyses of diseased gingival tissue samples compared with healthy gingival samples
In Turner’s 2021 study on perio in horses related to tooth elongations, what tooth pairs were signficantly associated with PD1?
a. 106/107, 206/207
b. 106/107, 410/411
c. 310/311, 410/411
d. 206/207, 310/311
JVD 2021, issue 3
a. 106/107, 206/207
In Turner’s 2021 study on perio in horses related to tooth elongations, what PD grade(s) were associated with all four tooth pairs?
106/107, 206/207, 310/311, 410/411 were the pairs
JVD 2021, issue 3
PD2 and PD4
In Zapf’s study “Periodontal structures in horses with pituitary pars intermedia dysfunction: A histological evaluation” what differences between the PPID and control groups may predispose PPID horses to periodontal disease?
Frontiers 2023
The changes in leukocyte infiltration of the PDL and the irregular cementum in inter-dental and non inter-dental locations might point to a disproportionate inflammation in PPID affected horses and a structural weakening of the periodontal tissue predisposing for the development of diastemata.
Clarifier: when they controlled for age, then any significant differences of the tissues went away – corroborates that age is a determinant of perio, not PPID
In Walker’s 2012 paper, “Prevalence and some clinical characteristics of equine
cheek teeth diastemata in 471 horses examined in a UK first-opinion equine
practice (Veterinary Record),” what % of horses had at least 1 diastema and which teeth were most affected?
Walker Vet Record 2012
49.9% of horses examined had at least one diastemata
83.5% of diastemata involved mandibular cheek teeth.
The most common mandibular diastema site was 07/08 position.
In Simhofer’s paper “The use of oral endoscopy for detection of cheek teeth abnormalities in 300 horses,” what was the % of horses had at least 1 diastema noted on exam?
Simhofer TVJ 2008
24.3% of horses
In Borkent’s 2019 study “A microbiome analysis of equine peripheral dental caries using next generation sequencing” what was the most common genus associated with the healthy samples vs the peripheral caries samples?
EVJ 2019
Streptococcus species was the genus most commonly associated with equine PC
Gemella species was the genus most associated with the control group.
Corynebacterium also associated with control
In Borkent’s 2019 study “A microbiome analysis of equine peripheral dental caries using next generation sequencing” what was the most common genus associated with rostral vs caudal peripheral caries?
EVJ 2019
Veillonella species was the most commonly associated genus with PC of the rostral cheek teeth
Streptococcus species was the most associated genus with the PC of caudal cheek teeth
In Walker’s 2012 paper, “Prevalence and some clinical characteristics of equine
cheek teeth diastemata in 471 horses examined in a UK first-opinion equine
practice (Veterinary Record),” what was the prevalence of diastema, and what teeth were most affected by them?
Walker 2012 Vet Rec
49.9% of horses examined had at least one diastemata
83.5% of diastemata involved mandibular cheek teeth.
The most common mandibular diastema site was 07/08 position.
In Ramzan’s 2011 paper, “The incidence and distribution of peripheral caries in the cheek teeth of horses and its association with diastemata and gingival recession,” out of 108 horses, what % had at least 1 diastema?
Ramzan 2011 The Vet Journal
75%
80% of diastemas were on the mandible
10-11 Triadan position most affected (27%)
In Nuttall’s paper “Prevalence and analysis of equine periodontal disease, diastemata and
peripheral caries in a first-opinion horse population in the UK,” what factors were significantly associated with diastemas?
Nuttall 2019 The Vet Journal
Diastema more common in mandibular than maxillary arcades
Periodontal disease assoc. with diastemas
Increasing age was a significant risk factor for periodontal disease and diastemata
Sex was not stat sig as a risk factor
In Cox’s study “Histopathological lesions associated with equine periodontal disease” what was the conclusion about gingival hyperplasia and equine periodontitis lesions?
Cox 2012 The Vet Journal
Present in some degree in all horses
Only weakly associated with stage of periodontitis
Many histo features had a lot of overlap from healthy and diseased gingiva
In Cox’s study “Histopathological lesions associated with equine periodontal disease” what was the association between gingival recession and periodontitis and how many horses had GR?
Cox 2012 The vet journal
Present in 13/21 horses
Sig assoc with higher periodontal status
What are the arrows indicating in this sulcular sample from a horse?
Cox 2012 TVJ
Gingival epithelial hyperplasia in a periodontal pocket
What are the arrws indicating in this sulcular epithelial sample from a horse?
Cox 2012 TVJ
Spirochaetal bacteria (arrows) within the sulcular epithelium (Modified Young’s stain).
Which of the following has the correctly paired definition?
A. Bacterial Adhesions - biofilm adhering to the teeth
B. Dental Plaque - proteinaceous layer that is between 0.5-1µm thick
C. Acquired pellicle - proteinaceous layer that is between 0.5-1µm thick
D. Acquired pellicle - proteinaceous layer that is thicker than 10µm
Ch 8
C. Acquired pellicle - proteinaceous layer that is between 0.5-1µm thick
What are the criteria for PD stage in Easley’s Ch 10?
Ch 10
Grade 0 - Normal
Grade 1 -gingivitis only (no interdental pocket or attachment loss)
Grade 2 - Gingivitis +interdental periodontal pocket < 10 mm depth with minor periodontal attachment loss at buccal or lingual/palatal margins
Grade 3 - Gingivitis + interdental periodontal pocket > 10 mm depth with moderate periodontal attachment loss at buccal or lingual/palatal margins
Grade 4 - Gingivitis + extensive periodontal pocket(s) > 10 mm with major periodontal attachment loss at buccal or lingual/palatal margins
What pathology is indicated by the star and arrows?
Kennedy 2016 EVE “The aetiopathogenesis of equine periodontal disease a fresh perspective”
Rotated 208, diastemas secondary to rotation
What pathology is denoted by the arrow? P is plaque, C is cementum (peripheral crown cementum)
Kennedy 2016 EVE “The aetiopathogenesis of equine periodontal disease a fresh perspective”
Cemental clefts secondary to periodontitis. Plaque will infill them
What does the red arrow, white asterisk, and red arrowhead indicate anatomically?
Staszyk 2015 EVE “Equine dental and periodontal anatomy A tutorial review”
Red arrow: gingival crest
Asterisk: Oral epithelium, showing the transition from free gingiva to attached gingiva
Red arrowhead: gingival sulcus
In Dixon’s 2014 paper “A long-term study on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of periodontitis in 202 horses (2008-2011),” what cheek teeth were most likely to be tx with diastema widening?
Dixon 2014 EVJ
Triadan 09-10 highest prev in mand
89.8% of tx diastemas were between mandibular cheek teeth
09-10 lowest prev in max; 10% of tx diastemas were between max CT (06-08 most common in max)
In Dixon’s 2014 paper “A long-term study on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of periodontitis in 202 horses (2008-2011),” how many horses were tx with diastema widening, and what was the mean # of tx diastema per horse?
Dixon 2014 EVJ
Mean 1.5 tx diastema per case
202/302 horses with diastema were tx with diastema widening
In Dixon’s 2014 paper “A long-term study on the clinical effects of mechanical widening of cheek teeth diastemata for treatment of periodontitis in 202 horses (2008-2011),” what was the outcome summary of the cases tx with diastema widening?
Dixon EVJ 2014
72.6% had complete remission of clinical signs that was permanent (for the duration of this study) in 50.5% and temporary in 22%
A partial response was obtained in 17.2%
No response was obtained in 4.3%
The clinical signs that recurred in horses (n = 73) with temporary or partial resolution of clinical signs included quidding in 84.9% (62/73), weight loss in 24.7% (18/73), halitosis in 17.8%(13/73) and bitting problems in 15.1% (11/73)
In Dixon’s 2008 paper “Treatment of equine cheek teeth by mechanical widening of
diastemata in 60 horses (2000–2006)” what were the clinical signs noted in these cases?
Dixon EVJ 2008
Quidding was present in 82% (49/60 cases)
35% (21/60) had weight loss
17% (10/60) had halitosis
12% (7/60) had bitting and/or behavioural problems
5% (3/60) had external bony swellings
5% (3/60) had buccal food packing
3% (2/60) asymptomatic
What type of bur was recommended for diastema widening in Dixon’s 2008 paper?
Dixon 2008 EVJ
Diamond tipped, conical diastema bur (max width 6mm)
What is a major complication that can result from diastema widening procedures?
Dixon 2008 EVJ
Pulp exposure (most likely caudal pulp horns of rostral tooth) and subsequent apical infection, requiring extraction of the tooth
In Bettiol’s and Dixon’s 2011 paper, “An anatomical study to evaluate the risk of pulpar exposure during mechanical widening of equine cheek teeth diastemata and ‘bit seating’” (EVJ 2011, 43 (2) 163-169), which of the following is correct:
A. Subocclusal dentinal thickness significantly increases with age
B. The most caudo-medial pulp horns had consistently lower Interproximal Space - Pulp horn distance compared to cranial-medial pulp horns
C. Interproximal Space - Pulp horn distance had no significant correlation to Triadian position
D. Many currently used diastema burrs are 4.5-6.5 mm in diameter, which is narrow enough to completely avoid any risk of exposing sensitive pulp
Bettiol and Dixon EVJ 2011
B. The most caudo-medial pulp horns had consistently lower Interproximal Space - Pulp horn distance compared to cranial-medial pulp horns
In Bettiol’s and Dixon’s 2011 paper, “An anatomical study to evaluate the risk of pulpar exposure during mechanical widening of equine cheek teeth diastemata and ‘bit seating’” what were the minimum distances found for inerproximal space-PH (IPS-PH) and occlusal surface-PH (OS-PH)?
Bettiol and Dixon 2011 EVJ
Minimum value of IPS-PH and IPS-PH15 was 1.3 mm → risk of exposure from diastema widening
Minimum value of occlusal surface to pulp (OS-PH) was 1.6 mm → risk of exposure or thermal injury from bit seating
In Bettiol’s and Dixon’s 2011 paper, “An anatomical study to evaluate the risk of pulpar exposure during mechanical widening of equine cheek teeth diastemata and ‘bit seating’” what Triadan position(s) had the lowest distance from IPS-PH? Which had the highest?
Which had the thickest and thinnest subocclusal dentine?
Bettiol and Dixon 2011 EVJ
Triadan 09s had the closest distance IPS-PH (mean 5.35 mm) than other Triadan positions
Triadan 07 (mean 5.54mm) and 08 (mean 5.64mm) positions having significantly higher values (i.e. pulp horns further from the interproximal space) than the 4 other Triadan positions.
Highest subocclusal dentine thickness were at mandibular 07s and 08s positions
Lowest subocclusal dentine thickness at mandibular 06s and 11s
In Bettiol’s and Dixon’s 2011 paper, “An anatomical study to evaluate the risk of pulpar exposure during mechanical widening of equine cheek teeth diastemata and ‘bit seating’” what were the relative thickness findings for pulp horns?
Bettiol and Dixon 2011 EVJ
IPS-PH: The most caudo-medial pulp horns (i.e. PH 4 and 5, mandibular) consistently had significantly lower values
IPS-PH15: PH 4 and 5 (mandible) (mean 5.19mm) consistently having significantly lower value
OS-PH: thinnest subocclusal secondary dentine was found over the caudal located pulp horns, i.e. PH 2, 4 and 5
The thickest secondary dentine was above PH 6 (mean 10.79mm) although the Triadan 06s overall had the thinnest subocclusal secondary dentine…
What does partial diastema widening entail?
Easley ch 26
only the occlusal 4 – 6 mm of the interdental space is widened (~40-50% of the clinical crown height)
What is normal equine dental drift, and which type of diastema should it prevent?
Easley ch 26
Normal equine cheek teeth have significant dental drift i.e. > 25 mm, in particular mesial (rostral) drift of the Triadan 11s over 10 years (2.83 cm in Luiti 2017)
Should prevent secondary diastemas
What instrument is shown here?
Easley ch 26
Equine periodontal (“diastema”) forceps
Which of the following epithelial layers is composed of flat squamous cells (orthokeratinized):
a. stratum basale
b. stratum spinosum
c. stratum granulosum
d. stratum corneum
Carranza Ch 3
stratum corneum - flat squamous eosinophilic cells without nuclei (orthokeratinization)
all distinct keratinized epithelial strata in process of keratinization
What types of epithelium are reported to have Langerhans cells important for the local immune response?
Carranza Ch 3
Gingival epithelium and sulcular epithelium
not found in junctional epithelium
What layer connects the epithelium to underlying connective tissue, and what collegen type predominates?
Carranza Ch 3
basal lamina, type IV collagen
What type of epithelial cells make up sulcular epithelium?
Carranza Ch 3
Non keratinized
How many layers thick can junctional epithelium be?
Carranza Ch 3
20 layers stratified squamous nonkeratinizing epithelium
How is junctional epithelium formed?
Carranza Ch 3
formed by the confluence of the oral epithelium and the reduced enamel epithelium during tooth eruption
REE not essential for its formation; in fact, the junctional epithelium is completely restored after pocket instrumentation or surgery, and it forms around an implant
What are the turnover rates for palate/tongue/cheek oral epithelium and gingival epithelium?
Carranza Ch 3
5-6 days; 10-12 days respectively
The turnover of the junctional epithelium is 1 -6 days
What cells produce sulcular (crevicular) fluid?
Carranza Ch 3
The main route of the gingival fluid diffusion is through the basement membrane, through the relatively wide intercellular spaces of the junctional epithelium, and then into the sulcus
What are the 4 functions of crevicular/gingival fluid?
Carranza Ch 3
(1) cleanse material from the sulcus; (2) contain plasma proteins that may improve adhesion of the epithelium to the tooth; (3) possess antimicrobial properties; and (4) exert antibody activity to defend the gingiva.
What are the two main sources of collagen fibers in cementum?
Carranza Ch 3
(1) Sharpey fibers (extrinsic, from fibroblasts) – Type III collagen appears to coat the type I collagen of the Sharpey fibers
(2) Intrinsic fibers of cementum
What is the alveolar process?
Carranza CH 3
the portion of the maxilla and mandible that forms and supports the tooth sockets (alveoli)
What are the histologic layers of the alveolar process?
Carranza CH 3
- An external plate of cortical bone is formed by haversian bone and compacted bone lamellae.
- The inner socket wall of thin, compact bone called the alveolar bone proper is seen as the lamina dura in radiographs.
- Cancellous trabeculae between these two compact layers act as supporting alveolar bone
What are the 4 events in bone resorption?
Carranza Ch 3
- Attachment of osteoclasts to the mineralized surface of bone
- Creation of a sealed acidic environment through the action of the proton pump, which demineralizes bone and exposes the organic matrix
- Degradation of the exposed organic matrix to its constituent amino acids via the action of released enzymes (e.g., acid phosphatase, cathepsin)
- Sequestering of mineral ions and amino acids within the osteoclast
What is bundle bone?
Carranza Ch 3
Bundle bone is the term given to bone adjacent to the periodontal ligament that contains a great number of Sharpey fibers. Localized within the alveolar bone proper
How does plaque biolfilm adhere to teeth?
Carranza Ch 8
Binding of the bacterial species to receptors of the pellicle, then creating a nascent surface and acting as a bridge for additional species
There are primary and secondary colonizing species – Biofilm maturation is a highly specific event that involves a nonrandom aggregation of different bacteria.
How much more resistant to ABX are biolfilm bacteria?
Carranza Ch 8
Almost without exception, organisms in a biofilm are 1000 to 1500 times more resistant as compared with antibiotics in their planktonic state