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NBDHE May 2022 > Periodontology > Flashcards

Periodontology Flashcards

1
Q

Biological Width

A

Distance from the alveolar crest to the junctional epithelium and connective tissue attachment of the root surface

  • at least 2mm of vertical space is needed for a restoration to be successful without damage to periodontium
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2
Q

Free Gingiva

A

Located at the crest of alveolus, not attached, outer boundary of sulcus

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3
Q

Free Gingival Groove

A

Slight depression that separates free and attached gingiva

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4
Q

Attached Gingiva

A

Located below free gingival groove, lies over underlying bone

Connected to cementum and periosteum

Keratinized tissues

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5
Q

Mucogingival Junction

A

Apical boundary where the attached gingiva (keratinized) meets the alveolar mucosa (non-keratinized)

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6
Q

Alveolar Mucosa

A

Located below mucogingival junction

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7
Q

Sulcular Epithelium

A

Non-Keratinized

lining of free gingival sulcus

extends from crest of gingival margin to junctional epithelium

Permeability allows GCF to flow through

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8
Q

Junctional Epithelium

A

forms the base of the sulcus and provides a seal between gingiva and tooth surface

Non-keratinized

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9
Q

Alveolar Crest Fibers

A

from cementum at apex to base of socket

PDL

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10
Q

Circular Fibers

A

encircles tooth like a ring, not attached to cementum or bone

gingival

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11
Q

Horizontal Fibers

A

extend at right angles to long axis of tooth

PDL

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12
Q

Oblique Fibers

A

from cementum in a coronal direction to bone

withstands masticatory stress in a vertical direction, largest and most significant fiber group*

PDL

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13
Q

Intergingival Fibers

A

extends in a mesiodistal direction

links adjacent teeth in arch

gingival

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14
Q

Interradicular Fibers

A

ONLY in multirooted teeth

extend from cementum at furcation to bone in furcation area

PDL

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15
Q

Interpapillary Fibers

A

connects interdental papillae of posterior teeth

gingival fiber

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16
Q

Transgingival Fibers

A

from the cementum near the CEJ and runs horizontally

links adjacent teeth in arch

gingival fiber

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17
Q

Transseptal Fibers

A

from cementum of one tooth over crest of alveolar bone to the cementum of adjacent tooth

connects adjacent teeth

fibers adjusted during orthodontic tx*

gingival fiber

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18
Q

Col

A

nonkeratinized tissue located between lingual and facial papillae

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19
Q

Epithelial Attachment

A

located at base of the sulcus where epithelium attaches to tooth

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20
Q

Functions of the Periodontal Ligament

A

Supportive - resist the impact of occlusal forces, shock absorber*

Sensory

Nutritive

Formative

Resorptive

Attach cementum to bone by Sharpeys Fibers

NOTE: PDL has nerve endings but no blood vessles

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21
Q

Most prominent cell type in PDL?

A

Fibroblasts

responsible for collagen synthesis and degradation

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22
Q

Cementum Formation

A

Arranged in layers (lamellae)

made up of hydroxyapatite crystals

frequently overlaps enamel

Receives nutrients from PDL, has no blood vessles or nerves

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23
Q

Acellular Cementum

A

Coronal

no cells present

contain calcified Sharpeys fibers

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24
Q

Cellular Cementum

A

Apical

contains cells

less calcification and fewer sharpeys fibers

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25
Q

CEJ Orientations

A

Overlap: cementum overlaps enamel in 60-65% of cases

Meets: Cementum meets enamel in 30% of cases

Gap: cementum and enamel dont meet - dentin is exposed in 5-10%

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26
Q

Alveolar Bone

A

Bone that surrounds and supports roots of the teeth

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27
Q

Alveolar Bone Proper

A

thin layer of bone lining the tooth socket

radiographically called lamina dura

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28
Q

Alveolus

A

hole in bone containing the tooth root

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29
Q

Cortical Bone

A

Compact hard bone

thicker in the mandible

comprises the facial and lingual aspects of alveolar bone

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30
Q

Cancellous Bone

A

Porous spongy bone

fills interior of alveolar process

contains many holes allowing blood vessels to travel

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31
Q

Alveolar Crest

A

most coronal portion of alveolar process

2mm apical to CEJ in health

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32
Q

Periosteum

A

connective soft tissue covering outer bone surface

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33
Q

Endosteum

A

Connective tissue covering inner bone surface

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34
Q

Osteoblasts

A

Build/make bone

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35
Q

Osteoclasts

A

Crush/resorb bone

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36
Q

Clinical Signs of Acute Gingivitis

A

Bleeding

Erythema (red. inflammed)

soft, stippled gingiva

Edematous consistency

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37
Q

Clinical Signs of Chronic Gingivitis

A

Bleeding

Fibrotic

stippled, hard gingiva

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38
Q

Suprabony Pocket

A

base of pocket is coronal to alveolar bone

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39
Q

Infrabony Pocket

A

Base of the pocket is apical to the crest of alveolar bone

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40
Q

What is the Cause of Gingivitis?

A

ulceration of the sulcular lining/base of the sulcus

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41
Q

Clinical Signs of Periodontitis

A

dark blue/purple

edamatous, smooth tissue

swollen gingival margin

BOP

4mm+ pocket depths

loss of CAL

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42
Q

Bacteria Associated with Periodontitis

A

P. gingivalis

T. forsythia

T. denticola

P. intermedia (pregnancy perio)

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43
Q

Which Medications are Used to Control Periodontitis?

A

tetracycline

chlorohexadine

metrondiazole

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44
Q

Microbes Necrotizing Periodontal Disease?

(NUG and NUP)

A

Spirochetes

Vibrios

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45
Q

Medications for Necrotizing Periodontal Disease?

(NUG and NUP)

A

Tetracycline

Antibiotic therapy

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46
Q

Necrotizing Ulcerative Gingivitis

(NUG)

  • characteristic, symptoms
A

Primary sign: punched out papillae

affects interdental gingiva

strong odor

Symptoms: pain, fever, swollen lymph nodes, malaise

*in clients with no known systemic disease or immune dysfunction

47
Q

Necrotizing Ulcerative Periodontitis

A

Similar to NUG

rapid loss of bone and soft tissue

occurs in immunocompromised patients

48
Q

AAP Classification Periodontal Health

A

pink, firm, stippled gingiva

no BOP

1-3mm pockets

alveolar crest 2-3mm apical to base of CEJ

49
Q

Gingivitis Modifying Factors

(5)

A

Sex steroid hormone

Puberty

Menstrual cycle

pregnancy

oral contraceptive

50
Q

Plaque-Induced Gingivitis Exacerbating Conditions

(4)

A

hyperglycemia (T1 diabetes)

Leukemia

Smoking

Malnutrition

51
Q

Infections/Disease Affecting Non-Plaque Induced Gingivitis

(5)

A

NUP

Cocksakie Virus

HPV

Herpetic Gingivostomitis

Candidiasis

Squamous Cell Carcinoma

52
Q

Stage 1 Periodontitis

A

MILD DISEASE

Probe depth ≤4mm

CAL ≤1-2mm

horizontal bone loss

Non-surgical tx

53
Q

Stage 2 Periodontitis

A

MODERATE DISEASE

Probe Depths ≤5mm

CAL ≤3-4mm

horizontal bone loss

non-surgical and surgical tx

54
Q

Stage 3 Periodontitis

A

SEVERE DISEASE

Probe depths ≥6mm

CAL ≥5

Vertical bone loss

May be Class 1 or 2 furcations

≤4 teeth lost

Surgical tx

55
Q

Stage 4 Periodontitis

A

VERY SEVERE DISEASE

Probe depths ≥6mm

CAL ≥5mm

5+ teeth lost

surgical and multi-specialty tx

*remains a stage 4 for life, S1-3 can become stable on a reduced periodontium

56
Q

Grade A Periodontitis

A

No bone loss over 5 yrs

<0.25% bone loss/age

heavy biofilm, low destruction

Non-Smoker

No diagnosis of diabetes

57
Q

Grade B Periodontitis

A

<2mm over 5 years

0.25%-1.0% bone loss/age

<10 cigarettes/day

Hb1c <7.0% in patients with diabetes

58
Q

Grade C Periodontitis

A

≥2mm over 5 years

1.0%+ bone loss/age

≥10 cigarettes/day

Hb1c ≥7.0% in patients with diabetes

59
Q

Periodontitis as a Manifestation of Systemic Disease (AAP)

A

*Down syndrome: higher prevalence and severity

*Papillon-Lefevre Syndrome: early onset, early loss of dentition

Congenital Neutropenia: severe

Systemic Lupus Erythematous: oral ulcers and increased prevalence

60
Q

Primary Occlusal Trauma

A

injury resulting in tissue changes from excessive occlusal force on a tooth/teeth with normal periodontal support

61
Q

Secondary Occlusal Trauma

A

injury resulting in tissue changes from excessive occlusal force on a tooth/teeth with reduced periodontal support

62
Q

Systemic Diseases Affecting Periodontal Supporting tissues

A

Diabetes

Obesity

HIV

Arthritis

Tobacco

63
Q

Peri-Implant Health

A

Absence of bleeding and inflammation

no tx

64
Q

Peri-Implant Mucositis

A

Bleeding and Inflammation

caused by plaque

can be reversed

65
Q

Peri-Implantitis

A

plaque-associated

inflammation, loss of supporting bone

irreversible if left untreated for too long

66
Q

Primary Factor in Reduction of Gingival/Periodontal Diseases?

A

Plaque Control

67
Q

Mineralization of Sub vs Supra Calculus

A

Supra: mineralized by saliva

Sub: mineralized by GCF

68
Q

Tobacco Use

A

most significant risk factor of periodontal disease

gingiva can appear healthy

smoking does not increase risk of caries

not associated with hairy leukoplakia

69
Q

Medications Causing Gingival Enlargement (3)

A

Phenytoin

Cyclosporin

Nifedipine

70
Q

Type 1 Embrasure

A

Interdental papillae fills the space

can be cleaned with floss

71
Q

Type 2 Embrasures

A

interdental papillae does not fill space

can be cleaned with tufted floss, interdental brush, wooden wedge, end tuft brush, toothpick

72
Q

Type 3 Embrassures

A

interdental papillae is missing

cleaned with tufted floss, interdental brush, wooden wedge, end tuft brush, toothpick

73
Q

Pseudopocket

A

Caused by gingival inflammation without loss of attachment

tx: gingivectomy

74
Q

Grade 1 Mobility

A

<1mm in a buccolingual direction

75
Q

Grade 2 Mobility

A

>1mm buccolingual but <2mm in a horizontal direction

76
Q

Grade 3 Mobility

A

>2mm horizontal or vertical, can depress tooth in socket

77
Q

Fremitus

A

Visible movement or vibration of tooth when in function, assessed by tapping instrument or placing finger while pt bites together

78
Q

Class 1 Furcation

A

curvature of concavity can be detected with probe tip, but cannot enter the space

79
Q

Class 2 Furcation

A

Probe enters furcation >1mm but does not pass through other side

80
Q

Class 3 Furcation

A

Probe tip enters furcation and passes through other side

81
Q

Class 4 Furcation

A

Visible entry of probe completely passing through furcation due to recession

82
Q

How to Measure CAL

A

In recession ⇒ probe depth + measurement between gingival margin and CEJ

In tissue overgrowth ⇒ probe depth - measurement between gingival margin and CEJ

83
Q

Dehiscence

A

loss of alveolar bone on the facial aspect of a tooth that leaves a root exposed defect from the CEJ apically

can be 1 or 2mm long, or the length of entire root

84
Q

Fenestration

A

“window” of bone loss on the facial or lingual aspect of a tooth that places the exposed root surface directly in contact with the gingiva or alveolar mucosa

bordered by alveolar bone along its coronal aspect

85
Q

Gingival Abscess

A

abscess limited to the gingival margin or interdental papilla

results from the injury to or infection of surface gingival tissue

86
Q

Periodontal Abscess

A

usually occurs with pre existing periodontal disease

results when infection spreads deep into the periodontal pockets and drainage is blocked

may develop due to incomplete scaling

87
Q

Pericoronal Abscess

A

flap of tissue called operculum, usually on distal of 8’s

Streptococci milleri are usually involved

develops and inflammed dental follicular tissue overlying the crown of a partially erupted tooth

88
Q

Non-Surgical Periodontal Therapy

A

Patients with periodontal disease

Goals: reduce pathogens, address risk factors, arrest disease

  • scaling and root planning
  • periodontal debridement
  • full mouth disinfection
89
Q

Periostat

A

delivery of a 20mg capsule of doxycycline hyclate (oral administration)

90
Q

Arestin

A

microspheres of minocycline are directed into pocket by cannula tip

91
Q

Atridox

A

doxycycline gel inserted in pocket by cannula tip

gel dissolves

do not brush or floss site for 7 days

92
Q

Periochip

A

chlorohexadine chip is inserted into pocket

pocket must be at least 5mm

chip dissolves

do not floss site for 10 days

93
Q

Tetracycline HCL Fibers

A

tetracycline soaked cord is packed inside the pocket and retained with adhesive

time consuming, can be uncomfortable for patient

94
Q

Osseous Flap Surgery

A

gums are lifted away from the tooth to allow access to deep clean the root surface

gum tissue is replaced to minimize pocket depth

95
Q

Gum / Connective Tissue Graft

A

tissue is harvested from a donor site such as the palate, then placed on the desired area to provide strength and cover exposed root surfaces

can reduce sensitivity

96
Q

Gingival Currettage

A

removes soft tissue lining of the periodontal pockets in order to eliminate bacteria and diseased tissue

can be used with scaling and root planning

97
Q

Gingivectomy

A

pocket reduction by excision of the soft tissue pocket wall

98
Q

Gingivoplasty

A

reshaping of gingiva to obtain better contours

99
Q

Osseous Surgery

A

reshape alveolar bone for better contour

flap surgery may be used in conjunction

100
Q

Allograft

A

from human cadaver

101
Q

Alloplastic

A

synthetic material

102
Q

Xenograft

A

from another species (usually cow)

103
Q

Guided Tissue Regeneration

A

fabric is sewn into bone

gingiva is then sewn into fabric to prevent gum tissue from growing down

104
Q

Crown Lengthening

A

excess gum and bone tissue are reshaped to expose more of the natural tooth

105
Q

Fibrosis

A

results in an increase in cellular components, a hallmark sign of chronic inflammation

106
Q

Hypertrophy

A

gingival enlargement due to an increase in cell size

107
Q

Hyperplasia

A

gingival enlargement due to an increase in cell number

108
Q

Endodontic Periodontal Lesions Treatment

A

DO NOT SCALE

refer to periodontist

109
Q

Sulcular Fluid

A

cleanses the sulcus

a source of nutrients for subgingival bacteria

flow is minimum to absent in health

110
Q

Rete Pegs

A

epithelial extensions that project into underlying connective tissue

increase strength between epithelium and connective tissue

NOTE: marginal tissue is not stippled

111
Q

Masticatory Mucosa

A

KERATINIZED tissue

protect gingiva and hard palate

112
Q

Lining Mucosa

A

NONKERATINIZED tissue

alveolar mucosa, soft palate, vestibule, buccal mucosa, sublingual area, sulcular and junctional epithelium

typically supports a removable partial denture

113
Q

Specialized Mucosa

A

dorsum of the tongue

114
Q

Connective Tissue

A

vascular, has nerve tissue

fibroblasts produce collagen and elastic fibers

encircles tooth

NBDHE May 2022 (12 decks)

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