Periodontics Part 1 Flashcards
The periodontium consists of:
- Alveolar Bone
- PDL
- Cementum
- Gingiva
Gingival Sulcus
Aka: Gingival Crevice
* natural space b/w tooth and gingiva
PERIODONTAL POCKET: Pathologically Deepened
* > 3 mm
Free Gingival Margin
- Peak of gingiva
- Base periodontal Measurements off of
Free Gingiva
- unbound
- Keratinized
- b/w Free gingival margin and Free Gingival Groove
Free Gingival Groove
- Shallow, linear depression on gingival surface
- border b/w free gingival and attached gingiva
Attached Gingiva
- Bound (attached to bone)
- keratinized
- extends from gingival groove to mucogingival junction
Mucogingival Junction
- border b/w attached gingiva and alveolar mucosa
Alveolar Mucosa
- Unbound
- Non-Keratinized
- b/w mucogingival jxn and vestibular fold
Vestibular Fold
Transition b/w alveolar mucosa and labial/buccal mucosa
Initiating Factor for Periodontal Disease
Microbial Plaque
Periodontal Health vs Gingivitis vs Periodontitis
Periodontal Health:
* No inflammation + No PDL & Bone Destruction
Gingivitis:
* Inflammation + No PDL & Bone Destruction
Periodontitis:
* Inflammation + PDL & Bone Destruction (CAL)
Periodontitis: Pathogenesis
- subgingival plaque bacteria=Microbial Challenge (LPS, antigens)
- inflmmatory response (Cytokines, prostaglandins, MMPs)
- Tissue Destruction
Erosion
Caused by acidic foods/beverages or gastric acid
Abrasion
- Loss of tooth structure by mechanical wear
- ex: aggressive tooth brushing
Attrition
Occlusal wear due to functional contacts w/opposing teeth
Hypersensitivity
- due to exposed dentin tubules on root surface
Periodontal Exam consists of:
Objective:
* Probing Pocket Depth (PPD)
* Clinical Attachment Loss (CAL)
* Bleeding on Probing (BOP)
Additional:
* Gingival Recession
* Alveolar Bone Loss
* Suppuration
* Mobility
* Furcation
Probing Pocket Depth (PPD)
- from gingival margin to base of pocket
Clinical Attachment Loss (CAL)
- From CEJ to base of pocket
- CAL=PPD + Recession
Bleeding on Probing (BOP)
- Best measure of inflammation
Gingival Recession
- from CEJ to gingival margin
- apical shift of gingival margin
- exposes root surface
Alveolar Bone Loss
- Radiographic measure-not realiable
- BWs=Best
Suppuration
Pus
* Large number of neutrophils in pocket
Mobility is due to?
Due to:
* loss of periodontal support
* traumatic occlusion
* Both
Furcation vs Furcation involvement
Furcation:
* branching point of tooth root
Furcation involvement:
* area of bone loss at furcation
Oral Exam consists of
Home Care:
* Plaque
* calculus
Inflammation:
* redness
* swelling
* BOP
Destruction of Periodontal tissues:
* PPD
* CAL
* Alveolar BOne Loss
* Mobility
* Furcation involvement
Miller Classification (MOBILITY)
Mobility
Class 0:
* Normal physiologic mobility
Class 1:
* Slightly more than normal
Class 2:
* moderately more than normal (</= 1mm)
Class 3:
* severely more than normal (> 1mm) & Vertically depressable
What are some factors that predispose a tooth to furcation involvement?
- Short root trunk
- Short Roots
- Narrow interradicular dimensions (B/w roots)
- Cervical enamel projections
Hamp Classifiction:Furcation involvement
Furcation
Class 0:
* No furcation involvement
Class 1:
* Horizontal furcation involvement < 3mm
Class 2:
* Horizontal furcation involvement > 3mm
Class 3:
Through-and-through furcation invovlement
Glickman Classification
Furcation
Class 1:
* Pocket formation into the FLUTE
* incipient furcation involvement
* one 1 FLUTE
Class 2:
* Pocket formation into the FURCA (Furcation area)
* cull-de-sac furcation involvement
Class 3:
* Through-and-Through furcation lesion
Class 4:
Throgh and-through furcation lesion THAT YOU CAN SEE THROUGH
What is the normal distance b/w CEJ and Alveolar Crest?
2mm
Alveolar Bone Loss
Radiographic Measure: not reliable
* BWs=Best
Normal: 2mm from CEJ to alveolar
* parallel to lines connecting CEJs of adjacent teeth
Horizontal Bone Loss: > 2mm; parallel
Vertical Bone Loss
* Aka Angular
* classified by number of bony walls
* Not Parallel
Vertical Bone Loss/Infrabony defects: Classification
1 wall:
* hemiseptal (horizontal defect)
2 wall:
* Crater
* most common
3 Wall:
* trough
* best prognosis
4 wall:
* circumferential
* extraction socket
Miller Classification (Recession)
Regain Root Coverage w/Connective Tissue Graft (CTG)
Class 1:
* recession does not extend to mucogingival junction
* no loss of interdental bone or soft tissue
* 100% to regain
Class 2:
* to or beyond mucogingival junction
* no loss of interdental bone or soft tissue
* 100% to regain
Class 3:
* to or beyond the mucogingival jxn
* Interproximal bone or soft tissue loss, or tooth malpositiioning
* Partial root coverage
Class 4:
* to or beyond the mucogingival jxn
* Severe interdental bone, soft tissue loss, or tooth malpositioning
* 0%
Gingivitis:
3 C’s:
Color
* Normal: Coral Pink
* Diseased: Red; Increased Blood Flow
Contour:
* inflammatory exudate and edema (swelling)
* Normal: Knife Edged
* Diseased: Blunted
Consistency:
* Chronic Gingivitis leads to fibrosis
* Normal=stippled
Gingivitis:
3 C’s:
Color
* Increased Blood Flow (redness)
* Normal: Coral Pink
* Diseased: Red
Contour:
* inflammatory exudate and edema (swelling)
* Normal: Knife Edged
* Diseased: Blunted
Consistency:
* Chronic Gingivitis leads to fibrosis
* Normal=stippled
Plaque Induced Gingival Diseases
Most common
* due to plaque bacteria & inflammatory response
Modified By: (not caused by)
Systemic Factor
* Endocrine changes (Puberty, prgenancy, diabetes)
* Blood dyscrasias (leukemia)
Medications:
* Drug-induced gingival enlargement w/CCB (Calcium channel blockers-nifedipine), dilantin, and cyclosporine (CDC)
* oral contraceptives
Malnutrition:
* Vit C Deficiency (Scurvy)
Non-Plaque-Induced Gingival Diseases
Less Common
Due to
* Infections
* allergy
* trauma
Hereditary Gingival Fibromatosis:
* non-hemorrhagic and firm
Periodontal Disease: Old Classification
- Severity (Based on CAL)
* Slight: 1-2 mm CAL
* Moderate: 3-4mm CAL
* Severe: 5+ CAL - Distribution
* Localized: < 30%
* Generalized: >/= 30% - Type
* Chronic Periodontitis
* Aggressive Periodontitis
* Necrotizing (ANUG or ANUP-Acute NEcrotizing Ulcerative Periodontitis)
Chronic vs Aggressive Periodontitis
Chronic
* common
* Clinically Not healthy
* Slow progressive bone loss
* Microbial depositss consistent w/extent of destruction
* Modified by systemic issues (Smoking, diabetes)
Aggressive:
* rare
* Clinically Healthy
* Rapid Bone loss
* Familial aggregation
* Microbial deposits NOT CONSISTENT w/extend of destruction
* Localized version has first molar/incisor presentation(deeper poickets only around molars and incisor)
Necrotizing (ANUG, ANUP)
Acute Necrotizing Ulcerative Gingivitis/Periodontitis
**
* Pseudomembrane
* Fetid Breath (Bad smalling)
* Blunted Papillae
* Fever**
Predisposing factors:
* stress
* smoking
* immunocompromised
Supragingival vs Subgingival plaque bacteria species
Supragingival: Aerobic
* Tooth=Gram +
* Outer surface of plaque: Gram -
Subgingival: Anaerobic
* Tooth: G+ Coronal and G- apical
* Epithelium: G-
Where is supragingival & subgingival components of plaque derived from
Supra gingival: Saliva
Sub gingival: GCF
Steps in Dental Plaque Formation
Plaque Composition: Organic vs Inorganic
Organic:
* polysaccharides
* proteins
* glycoproteins
* lipids
Inorganic:
* Calcium
* Phosphorus
* Sodium
* Potassium Fluoride
