Periodontics Flashcards
1
Q
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?
A
Diastemata (97.4% of CT adjacent to diastemata had periodontal disease)
2
Q
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
A
Chlorhexidine
Metronidazole
PVS
3
Q
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
A
Diastema widening
4
Q
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
A
Deeper pockets tended to experience greater improvement following treatment
5
Q
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
A
At least one cheek tooth periodontal pocket with a depth of 5mm or more
Second treatment/exam performed within 6 months
6
Q
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?
A
Young’s modulus, Poisson’s ratio
7
Q
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.”
A
Anisotropic with viscoelastic and non-linear behavior
8
Q
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?
A
1.3- 8.0 Mpa
9
Q
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?
A
Intrusive movement in an apical direction along the longitudinal axis of the tooth into its alveolus
Tilting movement in a labial direction
10
Q
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.”
A
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
11
Q
What were the top 3 phyla identifies in Wenling’s 2015 study on the equine subgingival microbiome?
Microb Path 2015
A
Proteobacteria (41%)
Firmicutes (28%)
Bacteroidetes (25%)
12
Q
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
A
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
13
Q
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
a. 106/107, 206/207
14
Q
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
A
PD2 and PD4
15
Q
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
A
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
16
Q
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
A
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.
17
Q
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
A
24.3% of horses
18
Q
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
A
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
19
Q
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
A
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
20
Q
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
A
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.
21
Q
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
A
75%
80% of diastemas were on the mandible
10-11 Triadan position most affected (27%)
22
Q
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
A
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
23
Q
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
A
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
24
Q
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
A
Present in 13/21 horses
Sig assoc with higher periodontal status
25
What are the arrows indicating in this sulcular sample from a horse?
## Footnote
Cox 2012 TVJ
Gingival epithelial hyperplasia in a periodontal pocket
26
What are the arrws indicating in this sulcular epithelial sample from a horse?
## Footnote
Cox 2012 TVJ
Spirochaetal bacteria (arrows) within the sulcular epithelium (Modified Young’s stain).
27
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
## Footnote
Ch 8
C. Acquired pellicle - proteinaceous layer that is between 0.5-1µm thick
28
What are the criteria for PD stage in Easley's Ch 10?
## Footnote
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
29
What pathology is indicated by the star and arrows?
## Footnote
Kennedy 2016 EVE "The aetiopathogenesis of equine periodontal disease a fresh perspective"
Rotated 208, diastemas secondary to rotation
30
What pathology is denoted by the arrow? P is plaque, C is cementum (peripheral crown cementum)
## Footnote
Kennedy 2016 EVE "The aetiopathogenesis of equine periodontal disease a fresh perspective"
Cemental clefts secondary to periodontitis. Plaque will infill them
31
What does the red arrow, white asterisk, and red arrowhead indicate anatomically?
## Footnote
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
32
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?
## Footnote
Dixon 2014 EVJ
Triadan 09-10 highest prev in mand
89.8% of tx diastemas were between mandibular cheek teeth
## Footnote
09-10 lowest prev in max; 10% of tx diastemas were between max CT (06-08 most common in max)
33
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?
## Footnote
Dixon 2014 EVJ
Mean 1.5 tx diastema per case
202/302 horses with diastema were tx with diastema widening
34
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?
## Footnote
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%
## Footnote
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)
35
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?
## Footnote
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
## Footnote
3% (2/60) asymptomatic
36
What type of bur was recommended for diastema widening in Dixon's 2008 paper?
## Footnote
Dixon 2008 EVJ
Diamond tipped, conical diastema bur (max width 6mm)
37
What is a major complication that can result from diastema widening procedures?
## Footnote
Dixon 2008 EVJ
Pulp exposure (most likely caudal pulp horns of rostral tooth) and subsequent apical infection, requiring extraction of the tooth
38
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
## Footnote
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
39
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)?
## Footnote
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
40
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?
## Footnote
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
41
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?
## Footnote
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...
42
What does partial diastema widening entail?
## Footnote
Easley ch 26
only the occlusal 4 – 6 mm of the interdental space is widened (~40-50% of the clinical crown height)
43
What is normal equine dental drift, and which type of diastema should it prevent?
## Footnote
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
44
What instrument is shown here?
## Footnote
Easley ch 26
Equine periodontal (“diastema”) forceps
45
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
## Footnote
Carranza Ch 3
stratum corneum - flat squamous eosinophilic cells without nuclei (orthokeratinization)
| all distinct keratinized epithelial strata in process of keratinization
46
What types of epithelium are reported to have Langerhans cells important for the local immune response?
## Footnote
Carranza Ch 3
Gingival epithelium and sulcular epithelium
| not found in junctional epithelium
47
What layer connects the epithelium to underlying connective tissue, and what collegen type predominates?
## Footnote
Carranza Ch 3
basal lamina, type IV collagen
48
What type of epithelial cells make up sulcular epithelium?
## Footnote
Carranza Ch 3
Non keratinized
49
How many layers thick can junctional epithelium be?
## Footnote
Carranza Ch 3
20 layers stratified squamous nonkeratinizing epithelium
50
How is junctional epithelium formed?
## Footnote
Carranza Ch 3
formed by the confluence of the oral epithelium and the reduced enamel epithelium during tooth eruption
## Footnote
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
51
What are the turnover rates for palate/tongue/cheek oral epithelium and gingival epithelium?
## Footnote
Carranza Ch 3
5-6 days; 10-12 days respectively
## Footnote
The turnover of the junctional epithelium is 1 -6 days
52
What cells produce sulcular (crevicular) fluid?
## Footnote
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
53
What are the 4 functions of crevicular/gingival fluid?
## Footnote
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.
54
What are the two main sources of collagen fibers in cementum?
## Footnote
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
55
What is the alveolar process?
## Footnote
Carranza CH 3
the portion of the maxilla and mandible that forms and supports the tooth sockets (alveoli)
56
What are the histologic layers of the alveolar process?
## Footnote
Carranza CH 3
1. An external plate of cortical bone is formed by haversian bone and compacted bone lamellae.
2. The inner socket wall of thin, compact bone called the alveolar bone proper is seen as the lamina dura in radiographs.
3. Cancellous trabeculae between these two compact layers act as supporting alveolar bone
57
What are the 4 events in bone resorption?
## Footnote
Carranza Ch 3
1. Attachment of osteoclasts to the mineralized surface of bone
2. Creation of a sealed acidic environment through the action of the proton pump, which demineralizes bone and exposes the organic matrix
3. Degradation of the exposed organic matrix to its constituent amino acids via the action of released enzymes (e.g., acid phosphatase, cathepsin)
4. Sequestering of mineral ions and amino acids within the osteoclast
58
What is bundle bone?
## Footnote
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
59
How does plaque biolfilm adhere to teeth?
## Footnote
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
## Footnote
There are primary and secondary colonizing species -- Biofilm maturation is a highly specific event that involves a nonrandom aggregation of different bacteria.
60
How much more resistant to ABX are biolfilm bacteria?
## Footnote
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
61
Saliva contains many components of the oral cavity's innate immune response. What do the follow components do?
Mucin
Histatins
Lactoferrin
## Footnote
Carranza Ch 7
Mucin - inhibits agglutination and therefore adherence of bacteria to form biofilm
Histatins - inhibit virulence factors, neutrolizes LPS
Lactoferrin - inhibit bacterial cell growth
## Footnote
Saliva also contains specific immunoglobulin A antibodies to periodontal pathogens
62
What antibody is largely present in saliva?
## Footnote
Carranza Ch 7
IgA
63
What produces gingival crevicular fluid? And what does it contribute to the immune system in the mouth?
## Footnote
Carranza Ch 7
postcapillary venules of the gingival plexus
brings in PMNs, Abs, and compelement (innate)
flow increases with inflammation
64
How does RANK/RANKL/OPG regulate bone resorption?
## Footnote
Carranza Ch 7
RANKL binds to RANK and stimulates osteoclast differentiation and activation. OPG antagonizes this action by binding to RANKL and preventing it from binding to RANK.
## Footnote
The ratio of RANKL to OPG is important, with studies reporting higher levels of RANKL and lower levels of OPG in patients with advanced periodontitis compared with healthy controls
65
What bacteria make up the red complex of the microbiome?
## Footnote
Carranza Ch 8
P. gingivalis, T. forsythia, and T. denticola
## Footnote
These are secondary colonizers
66
What are the components of calculus?
## Footnote
Carranza Ch 13
Inorganic: 70-90%
76% calcium phosphate
3% calcium carbonate
4% magnesium phosphate
2% carbon dioxide
Organic content: 10-30%
protein– polysaccharide complexes, desquamated epithelial cells, leukocytes, and various types of microorganisms
## Footnote
Calculus consists of mineralized bacterial plaque that forms on the surfaces of natural teeth and dental prostheses
67
What % of volume of the junctional epithelium do PMNs (neutrophils) reach to cause detachment?
## Footnote
Carranza CH 23
60%
## Footnote
The degree of leukocyte infiltration of the junctional epithelium is independent of the volume of inflamed connective tissue; thus this process may occur in gingiva with only slight signs of clinical inflammation.
68
What is the main antibody to periodontal pathogens?
## Footnote
Carranza Ch 7
IgG
69
What role does RANK and RANKL play in periodontal disease?
## Footnote
Carranza Ch 7
Binding of RANKL to RANK results in osteoclast differentiation and activation and thus bone resorption
70
Which of the following drugs has been shown to have higher concentrations in GCF than serum?
A. Tetracyclines
B. Aminoglycosides
C. Cephalosporins
D. NSAIDs
## Footnote
Carranza Ch 16
A. Tetracyclines
71
What % of calculus is inorganic?
## Footnote
Carranza CH 13
70-90%
72
What are the most to least keratinized oral mucosal structures?
## Footnote
Carranza Chp 3
Palate > gingiva > ventral aspect of tongue > cheek
73
This histo image depicts what type of gingival epithelium?
## Footnote
Carranza Chp 3
Keratinized
74
This histo image depicts what type of gingival epithelium?
## Footnote
Carranza Ch 3
Nonkeratinized
75
This histo image depicts what type of gingival epithelium?
## Footnote
Carranza Chp 3
Parakeratinized
76
What is sulcular epithelium composed of?
## Footnote
Carranza Ch 3
thin, nonkeratinized stratified sqaumous epithelium without rete pegs
77
What is the dentogingival unit?
## Footnote
Carranza Chp 3
The junctional epithelium and gingival fibers that attach the gingiva to the tooth
78
What does gingival innervation derive from?
## Footnote
Carranza Chp 3
Fibers that arise from nerves in the PDL and the labial, buccal and palatal nerves
79
Principal fibers of the periodontal ligament are composed of what type of collagen?
## Footnote
Carranza Chp 3
Type 1 Collagen
80
Sharpey fibers are composed of what type of collagen?
## Footnote
Carranza Chp 3
Type I (90%)
Type III (~ 5%)
## Footnote
Type III thought to coat Type I fibers
81
What are the key MMPs in periodontitis produced by neutrophils?
## Footnote
Carranza Ch 7
MMP-8 and MMP-9
82
What is the role of IL-1alpha in periodontal disease
## Footnote
Carranza Ch 7
Expressed intracellularlly normally --> becomes an alarmin when released from necrotic cells --> signaling cytokine for tissue damage
83
What is the role of IL-6 in periodontal pathogenesis?
## Footnote
Carranza Ch 7
Secretion stimulated by IL-1Beta and TNF-alpha, stimulates bone resorption and development of osteoclasts
## Footnote
plays an important role but less than IL-1Beta or TNF-alpha
84
Bone resorbs to maintain a width of how much noninfiltrated connective tissue over the bone?
## Footnote
Carranza Ch 7
0.5 to 1.0mm
85
Bone resorption ceases when how many mm of distance is present between bacteria in the pocket and the bone?
## Footnote
Carranza Ch 7
2.5mm distance
86
What is the nonspecific plaque hypothesis?
## Footnote
Carranza Ch 8
QUANTITATIVE
Periodontal disease results from elaboration of noxious products by the entire plaque flora.
Less plaque, less periodontal disease
## Footnote
Discarded in favor of other hypotheses. Treatment of perio still based on these principles
87
What is the Specific Plaque Hypothesis?
## Footnote
Carranza Ch 8
QUALITATIVE
The pathogenicity of dental plaque depends on the presence of or an incrase in specific microorganisms
Concept of red complex bacteria supported this hypothesis
88
What is the Ecologic Plaque Hypothesis?
## Footnote
Carranza Ch 8
COMBINATION
Both the total amount of dental plaque and the specific microbial composition of plaque may contribute to the transition from health to disease.
89
What is the Keystone Pathogen Hypothesis?
## Footnote
Carranza Ch 8
Certain low-abundance microbial pathogens can orchestrate inflammatory disease by remodeling a normally benign microbiota into a dysbiotic one.
## Footnote
P. gingivalis labeled keystone pathogen
90
What are the key mediators of wound healing?
## Footnote
Verstraete Ch 1
Platelet derived growth factors (PDGFs)
Transforming growth factor beta (TGF-Beta)
91
What cell type regulates formation of granulation tissue?
## Footnote
Verstraete Ch 1
Macrophages
92
What is the primary difference between oral and extraoral re-epithelialization?
## Footnote
Verstraete Ch 1
Oral epithelial cells migrate directly onto the moist, exposed surface of the fibrin clot instead of under dry exudate of dermis
93
Which forms first in fracture healing, woven or lamellar bone?
## Footnote
Verstraete Ch 2
Woven bone
94
How much bone can osteoclasts resorb per day?
## Footnote
Verstraete Ch 2
50-100µm
95
According to Warhonowicz's 2006 study "The equine periodontium as a continuously remodeling system: morphometrical analysis of cell proliferation," how do equine teeth compensate for loss of surface area as they become shorter with age to maintain the strength of the periodontal ligament?
## Footnote
Staszyk, Archives of Oral Biology, 2006. Cited in Easley 2022
Age related increase in bundling and thickness of the collagen fibre apparatus plus adjustment of the attachment angle between collagen fibres and cementum
96
In Cordes' 2012 study "Finite element analysis in 3-D models of equine cheek teeth," what was the relationship of the biomechanical behavior of the equine PDL with age?
## Footnote
Staszyk, The Vet J 2012.
Increase in intrusion with increasing age
The general stress level in the PDL and surrounding bone increased with age
## Footnote
In aged (> 15 years) horses, simulated loads on the periodontal ligament near the alveolar crest reached levels that would cause collagen fibre disruption and local inflammation in the human periodontal ligament
97
What microscopic anatomy feature of the junctional epithelium allows high permeability permitting transmigration of cells and immunoglobulins from the subepithelial connective tissue through the junctional epithelium?
## Footnote
Easley 2022
Junctional epithelial cells are interconnected by limited numbers of widely spaced desmosomes
98
What equine teeth have distinct interdental papillae?
## Footnote
Easley 2022
Incisors
Palatal gingiva maxillary cheek teeth
99
What are the names of the gingival papilla of the buccal maxillary cheek teeth?
## Footnote
Easley 2022, Steinfort 2019
Pre and post-mesostyle papillae
100
What is the reported normal depth of the equine gingival sulcus according to Easley et al 2022?
1mm
101
What do A, B and C stand for in the histologic image below?
## Footnote
Easley 2022
A. Gingival margin
B. Sulcular epithelium
C. Junctional epithelium
102
What do the blue and white asterisks represent?
## Footnote
Easley 2022
White asterisk: Pre-mesostyle papilla
Blue asterisk: Post-mesostyle papilla
103
What does IP stand for in the image below?
## Footnote
Easley 2022
Interdental papilla
104
Erridge's 2012 study "A histological study of peripheral dental caries of equine cheek teeth," what thickness of a biofilm was termed dental plaque instead of a pellicle?
## Footnote
JVD 2012
> 10 micrometers
105
What bacteria in humans has been shown to have a key role in both early and late oral biofilms and plays a bridging role in the formation of dental plaque
## Footnote
Easley 2022
Fusobacteria nucleatum
106
Where does plaque formation in the healthy equine oral cavity typically occur?
## Footnote
Easley 2022
Interproximal spaces of cheek teeth
Canine teeth
107
In Easley's 2022 textbook what bacteria is described as a well studied keystone pathogen for periodontal disease in humans?
Porphyromonas gingvalis
108
What components of the innate immune system are responsible for recognition of periodontal pathogenic bacteria and initiate cytokine production?
## Footnote
Easley 2022
Toll-like receptors (TLRs)
109
Studies of oral microbiota in other species have estimated that what percent of oral cavity bacteria cannot be cultured by traditional techniques?
## Footnote
Easley 2022
50%
110
High throughput sequencing of what gene has been used to characterize the equine oral microbiome with culture-independent molecular methods?
## Footnote
Easley 2022
The gene that encodes the 16s subunit of the bacterial ribosome (16s rRNA)
111
Why is the 16s rRNA gene so useful for analyzing the oral microbiome?
## Footnote
Easley 2022
It is not found in mammalian cells
Can identify anaerobes
112
In Zhu's 2020 study "Investigation of Oral Microbiome in Donkeys and the Effect of Dental Care on Oral Microbial Composition," what relationship was found between bacterial taxa relative abundance before and 20 days after basic dental treatment?
## Footnote
Animals 2020
Relative abundance at the phylum and genus levels differed between the time points
No stat sig differences observed in richness and diversity between the time points
113
In Gao's 2016 study "In-depth snapshot of the equine subgingival microbiome," how were samples obtained and how was periodontal health determined?
## Footnote
Microb Path 2016
Pooled subgingival plaque samples were collected from approximately 200 sulcus sites using sterile curettes from two horses
2 horses post mortem 1-2 hours – assessed for PD health by human dentists
114
In Gao's 2016 study "In-depth snapshot of the equine subgingival microbiome," what were the 3 most commonly identified phyla?
## Footnote
Microb Path 2016
Gammaprotebacteria
Firmicutes
Bacteroidetes
115
In Sykora's 2014 study "Isolation of Treponema and Tannerella spp. from equine odontoclastic tooth resorption and hypercementosis related periodontal disease," Treponema and/or Tannerella DNA was detected in what percent of periodontitis related samples vs healthy horse samples?
## Footnote
Eq Vet J 2014
periodontitis 100% samples
healthy horse crevicular fluid 52%
116
In Sykora's 2014 study "Isolation of Treponema and Tannerella spp. from equine odontoclastic tooth resorption and hypercementosis related periodontal disease," Porphyromonas gingivalis was found in how many horses with EOTRH?
## Footnote
Eq Vet J 2014
3/23
117
In Kennedy's 2016 study "The microbiome associated with equine periodontitis and oral health," how did the gingival swab samples diversity from healthy horses differ from the subgingival plaque samples of horses with periodontitis?
## Footnote
Vet Research 2016
Samples from healthy horses were significantly less diverse
Periodontitis samples had sig higher diversity
118
In Kennedy's 2016 study "The microbiome associated with equine periodontitis and oral health," what genera dominated the samples from healthy horses and those with periodontitis respectively?
## Footnote
Vet Research 2016
Healthy horses: Gemella, Actinobacillus
Periodontitis: Prevotella, Veillonella
119
What 3 factors influence the characteristics of plaque microbiota?
## Footnote
Easley 2022
(1) oxygen concentration
(2) nutrient availability
(3) pH
120
What is the normal equine sulcus depth according to Klugh's 2009 paper "Periodontal disease. In: Current Therapy in Equine Medicine?"
## Footnote
Easley 2022
1-5mm
121
Luiti's 2017 study "Computed tomographic assessment of equine maxillary cheek teeth anatomical
relationships, and paranasal sinus volumes," showed how much mean rostral/mesial drift of 11s over a 10 year period?
## Footnote
Luiti, Dixon, Vet Rec 2017
2.48cm - 2.83 cm
122
In Easley's 2022 textbook what minimum length of forage will become entrapped between cheek teeth?
2cm
## Footnote
feeding finely chopped (i.e. a few mm long) forage (e.g. soaked high fibre cubes, “geriatric or senior diets”) is an effective method of managing diastemata following removal of impacted long food fibres that are causing periodontal inflammation.
123
For partial diastema widening how much of the occlusal interdental space is removed?
## Footnote
Easley 2022
4-6mm
## Footnote
40-50% of clinical crown height
124
When performing diastema widening, more tooth structure should be removed from the tooth mesial or distal to the diastema and why?
## Footnote
Easley 2022
Remove more from the mesial aspect of the tooth distal to the diastema because Bettiol and Dixon 2011 showed that the distal pulp horns (particularly PH 5) are closest to the distal aspect of the tooth
125
Diastema widening is most effective for what type of diastema?
## Footnote
Easley 2022
Valve diastema
126
What follow up intervals are recommended in Easley's 2022 textbook for treatment of severe vs mild cases of diastemata/periodontal disease?
Milder cases: 6-8 weeks
Severe cases: 2-4 weeks
127
What materials are listed as potential interdental bridging materials for treatment of diastemata in Easley's 2022 textbook?
Vinyl polysiloxane with application gun
Eugenol free human periodontal dressing (Coe-Pak)
Temporary luting cement with calcium hydroxide (Provicol QM)
Self curing dental composite material (Structur-2 QM)
128
In Nuttall's 2019 paper "Prevalence and analysis of equine periodontal disease, diastemata and peripheral caries in a first opinion horse population in the UK," how were grades 0 and 1 periodontal disease defined as modifications of the Cox 2012 system?
## Footnote
The Vet J 2019
0: Presence of static food material in gingival sulcus < 5mm in depth
1: Gingival sulcus depth 5-9mm
129
In Nuttall's 2019 paper "Prevalence and analysis of equine periodontal disease, diastemata and peripheral caries in a first opinion horse population in the UK," how were grades 2 and 3 periodontal disease defined as modifications of the Cox 2012 system?
## Footnote
The Vet J 2019
2: Gingival sulcus depth 10-14mm
3: Gingival sulcus depth > 15mm
130
In Cox's 2012 study "Histopathological lesions associated with equine periodontal disease," what findings were stat sig associated with higher degrees of periodontal disease?
## Footnote
Dixon Vet J 2012
Neutrophil transmigration
Gingival erosion and ulceration
Spirochetes in gingiva
131
In Dixon's 2008 paper "Treatment of equine cheek teeth by mechanical widening of diastemata in 60 horses (2000–2006)," what percent of cases were mandibular?
## Footnote
EVJ 2008
85%
132
In Dixon's 2008 paper "Treatment of equine cheek teeth by mechanical widening of diastemata in 60 horses (2000–2006)," what percent of primary vs secondary diastemata cases had complete improvement?
## Footnote
EVJ 2008
Primary 72% with mean of 1.3 treatments
Secondary 48% with mean of 2.2 and ongoing treatments
133
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 risk factors/variables were stat sig associated with outcome?
| Eq Vet J 2014
None
134
In Cox's 2012 study "Histopathological lesions associated with equine periodontal disease," what findings were NOT stat sig associated with higher degrees of periodontal disease?
## Footnote
Dixon, The Vet J 2012
Presence of mononuclear cells in gingival lamina propria and submucosa
Presence of eosinophils
Gingival hyperplasia present to some degree in all horses and not stat sig associated with periodontal disease status
135
In Poschke's 2018 study "Molecular Characteristics of the Equine Periodontal Ligament," what tendon molecular components were significantly higher in mature PDL tissue vs mature tendon tissue?
## Footnote
Staszyk, Frontiers 2018
COL1, COL3
136
In Poschke's 2018 study "Molecular Characteristics of the Equine Periodontal Ligament," what was the ratio between mean relative COL1 and COL3 gene expression for mature equine PDL?
## Footnote
Staszyk, Frontiers 2018
3.3:1
137
In Poschke's 2018 study "Molecular Characteristics of the Equine Periodontal Ligament," what was the main conclusion regarding mature equine PDL collagen production and turnover vs mature tendon?
## Footnote
Staszyk, Frontiers 2018
Sig higher expression levels of COL1 and COL3 in the mature equine PDL indicates higher levels of collagen production and turnover than mature tendon
138
What do the black arrows in the image below indicate?
## Footnote
Steinfort, Staszyk. The equine gingiva: a gross anatomical evaluation. Frontiers 2019
Mesostyle
139
What is the name of the structure indicated by the blue arrow below?
Linguaflexid
140
In Steinfort's 2019 study "The equine gingiva: a gross anatomical evaluation," what percent of gingival sulcus depths were less than 1mm overall?
## Footnote
Staszyk. Frontiers 2019
90%
141
In Steinfort's 2019 study "The equine gingiva: a gross anatomical evaluation," what factors were stat sig associated periodontal pockets?
## Footnote
Staszyk. Frontiers 2019
Location: Cheek teeth, increased with age
142
In Steinfort's 2019 study "The equine gingiva: a gross anatomical evaluation," where were diastemata most commonly found?
## Footnote
Staszyk. Frontiers 2019
Maxillary cheek teeth
143
In Steinfort's 2019 study "The equine gingiva: a gross anatomical evaluation," what was the difference in shape and contour of the gingiva for the buccal vs palatal upper CT?
## Footnote
Staszyk. Frontiers 2019
Palatal: slightly undulatory single waved contour
Buccal: regularly undulating double waved contour
## Footnote
buccal interdental papilla present 98%, palatal interdental papilla prsent 59%
144
In Steinfort's 2019 study "The equine gingiva: a histological evaluation," what histomorphological differences were noted between tooth type, between upper and lower jaw, and different locations around the tooth?
## Footnote
Staszyk Frontiers 2019
None
## Footnote
The histomorphological characteristics of the equine gingiva appear to be quite similar to humans and dogs despite the differences of brachydont and hypsodont teeth and very different diets
145
In Steinfort's 2019 study "The equine gingiva: a histological evaluation," what was the average depth and range of the gingival sulcus?
## Footnote
Staszyk Frontiers 2019
Average depth 0.8mm
Range 0.1-2.7mm
146
In Steinfort's 2019 study "The equine gingiva: a histological evaluation," what was the association between amount of leukocyte infiltrates in the lamina propria near sites of periodontal disease vs other sites?
## Footnote
Staszyk Frontiers 2019
no sig difference in leukocyte infiltrates near diastemata or perio pockets vs normal sites
## Footnote
Lamina propria always contained leukocyte infiltrates dominated by lymphocytes
147
In Nitzsche's 2022 study "The gingiva of horses with pituitary pars intermedia dysfunction: a macroscopic anatomical evaluation," what factors were stat sig more associated with PPID horses than controls?
## Footnote
Staszyk Frontiers 2022
Gingival sulci greater than or equal to 1mm and gingival texture alterations
148
In Nitzsche's 2022 study "The gingiva of horses with pituitary pars intermedia dysfunction: a macroscopic anatomical evaluation," what factors were stat sig found more commonly in controls than PPID horses?
## Footnote
Staszyk Frontiers 2022
Peripheral caries, plaque, periodontal pockets
149
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 percent of diastemata had periodontal pockets?
## Footnote
Vet Rec 2012
44%
150
In Ringeisen's 2018 paper "Influence of dental materials on cells of the equine periodontium" what materials were deemed safe and which had adverse effects on PDL fibroblasts?
## Footnote
Ringeisen 2018 EVJ
Pericare (oily CaOH suspension) and Provicol (temporary luting cement with CaOH used to affix crowns) had no adverse effects
Calyxl (barium sulphate pulp capping paste) and Honigum (impression material with monophase silicone base and VPS) had severe cytotoxic effects
## Footnote
Calyxl - immediate loss of cell viability
Honigum - increase IL-6 and COX-2 at 24 hrs and decreased viability then
