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Dentistry Module 6 > Periodontology > Flashcards

Periodontology Flashcards

1
Q

What accounts for the possible link between periodontal disease and systemic chronic disease?

A

The leaking of pro-inflammatory mediators and/or the periodontal bacteria into the systemic bloodstream

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2
Q

In regards to periodontal manifestations of systemic diseases, what’s are the 3 groups systemic diseases are classified into?

A

Group 1. Systemic disorders that have a major impact on the loss of periodontal tissues by influencing periodontal inflammation.
Group 2. Other systemic disorders that influence the pathogenesis of periodontal diseases
Group 3. Systemic disorders that can result in loss of periodontal tissues independent of periodontitis

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3
Q

Name 4 genetic disorders where periodontitis is a manifestation.

A

Down’s syndrome
Papillon-lefevre
Chediak-higashi syndrome
Cyclic neutropenia

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4
Q

What genetic disorder is characterised by palmar planter hyperkeratosis (of hands and feet) and has associated severe periodontitis soon after eruption, with early loss of primary and secondary teeth?

A

Papillon-lefevre syndrome

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5
Q

What sub-type of ehlers danlos syndrome is associated with a bleeding tendency?

A

Type IV

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6
Q

What sub-type of ehlers danlos syndrome is associated with aggressive-like (Grade C) periodontitis?

A

Type VIII

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7
Q

What are common signs of ehlers danlos syndrome?

A
  1. excessive joint mobility
  2. Skin hyper-extensibility
  3. Cardiac valve defects
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8
Q

What is hypophosphotasia?

A

Deficiency in enzyme alkaline phosphotase which results in abnormal mineralisation of bones and teeth (and cementum)

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9
Q

What are the two periodontal conditions associated with HIV?

A

Necrotising gingivitis and necrotising periodontitis

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10
Q

What are the features of necrotising gingivitis?

A
  • painful red swollen gingivae
  • yellowish-greyish marginal necrosis with loss of interdental papillae
  • gingival bleeding
  • halitosis
  • anterior gingivae mostly affected
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11
Q

What is an important feature to recognise of necrotising periodontitis?

A

Severe deep pain localised to the jaw bone

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12
Q

What is the suggested antimicrobial treatment for necrotising gingivitis?

A
  1. Oral metronidazole 200-400mg three times a day for 7 days
  2. Chlorohexidine mouthwash 2x daily
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13
Q

Why is it so important to not use broad-spectrum antibiotics such a amoxicillin to treat necrotising gingivitis?

A

Due to the risk of untreatable fungal infections (especially in someone with HIV)

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14
Q

Name 5 most common systemic diseases/conditions which are risk factors/disease modifiers for periodontitis.

A
  1. Diabetes mellitus
  2. Obesity
  3. Osteoperosis
  4. Arthritis
  5. Emotional stress and depression
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15
Q

What systemic disease has increased prevalence of periodontitis, radiographically increased width of PDL and gradual obliteration of the lamina dura?

A

Systemic sclerosis (scleroderma)

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16
Q

Diabetes is characterised in the 2017 periodontal classification under “periodontitis as a manifestation of systemic disease”. True or false?

A

False. It is classed under “other systemic disorders that influence the pathogenesis of periodontal disease”.

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17
Q

A squamous cell carcinoma on the gingiva is categorised in the 2017 periodontal classification under “systemic disease or conditions affecting the periodontal supporting tissues.” True or false?

A

False. It is classified under “ systemic disorders that can result in loss of periodontal tissues independent of periodontitis.”

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18
Q

Clinically, necrotising periodontal disease associated with HIV infection have identical clinical features to necrotising periodontal diseases in non-HIV patients. True or false?

A

True

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19
Q

Ehlers danlos syndrome is categorised in the 2017 periodontal classification under “periodontitis as a manifestation of systemic disease.” True or false?

A

True

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20
Q

Define, a non-plaque induced condition where the gingiva is red, glazed with ulcerations.

A

Desquamative gingivitis

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21
Q

Name 5 diseases that can present as Desquamative gingivitis.

A
  1. Lichen planus
  2. Benign mucous membrane pemphigoid
  3. Pemphigus vulgaris
  4. Plasma cell gingivitis
  5. Erythema multiforme
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22
Q

In the 2017 classification, the disease which cause Desquamative gingivitis are classified under what title?

A

“ gingival diseases: Non-Dental Biofilm-Induced inflammatory conditions & lesions”

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23
Q

What medication used to treat hypertension can induce gingival hyperplasia?

A

Calcium channel blockers

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24
Q

What difficulties can drug-induced gingival enlargement cause?

A
  1. Creates difficulties for patient to maintain OH which increases risk of periodontitis
  2. Can cause functional and aesthetic problems
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25
Q

What three main groups of drugs are associated with gingival enlargement?

A
  1. Antiepileptics (phenytoin & sodium valproate)
  2. Calcium channel blockers
  3. Immune regulators (cyclosporine)
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26
Q

What cells are targeted in drug-influenced gingival enlargements? what is the mechanism affected?

A

Gingival fibroblasts
Increased production of extracellular matrix proteins and reduced collagenase production leading to reduced tissue turnover.

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27
Q

What are the clinical signs of Drug-influenced gingival enlargement (DIGE)?

A
  1. Affects anterior regions
  2. Usually papilla affecting within 3 months of starting medication
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28
Q

What drug is associated with more fibrotic enlargements of DIGE?

A

Phenytoin

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29
Q

What drug is associated with high levels of inflammation with little fibrosis in DIGE?

A

Cyclosporine

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30
Q

What reduces severity of DIGE?

A

Good plaque control

31
Q

What supplement may be affective for phenytoin-related gingival enlargement where plasma and red blood cell levels if folate are demonstrated to be low?

A

Folic acid

32
Q

What is the management of DIGE?

A
  1. Stop medication that is inducing it if possible
    OR
  2. Open wound gingivectomy
33
Q

What is Wegeners granulomatosis?

A

Rare autoimmune disease resulting in disseminated granulomatous vasculitis of small vessels.

34
Q

What is the characteristic feature of Wegeners granulomatosis and why is it potentially fatal?

A

Feature = “Strawberry gums”
Potentially fatal as it is often due to respiratory disease and renal failure

35
Q

What does “fictitious injury” mean?

A

Self-harm

36
Q

What are clinical signs of fictitious injury to the gingivae?

A

Typically localised lesions on gingiva of young people which may be ulcerated or have marginal keratosis from chronic trauma.

37
Q

What group of medication results in the highest incidence of DIGE & what percentage of patients taking this medication have gingival enlargement?

A

Antiepileptics drugs (phenytoin), 50% of patients taking medication have DIGE.

38
Q

In terms of 2017 periodontal classification, under what heading is DIGE classified?

A

“Gingivitis: dental biofilm-induced : (c) drug- influenced gingival enlargements”

39
Q

What is the most common cause of gingival enlargement in general?

A

Gingivitis

40
Q

Which connective tissue cell is thought to be directly involved in the development of DIGE?

A

Gingival fibroblasts

41
Q

State 4 conditions which can result in Desquamative gingivitis.

A
  1. Pregnancy epulis
  2. Acute leukaemia
  3. Hereditary gingival fibromatosis
  4. Wegner’s granulomatosis
42
Q

Are plaque bacteria directly involved in the pathogenesis of Desquamative gingivitis?

A

No, this condition is non-plaque induced. Although plaque build up will worsen/exacerbate the condition.

43
Q

What is 90% of cases of halitosis caused by? And what is the other 10% caused by?

A

90% = Internal factors within the mouth
10% = underlying systemic disease

44
Q

What groups of individuals are at increased risk of halitosis?

A
  1. Increased age
  2. Males
  3. Individuals who fast
  4. Individuals who have a high protein diet.
45
Q

Why has the presence of halitosis been worse since COVID-19?

A

Many people wear masks.

46
Q

What are the two broad groups of halitosis?

A
  1. Genuine halitosis
  2. Psychogenic halitosis
47
Q

What is meant by pseudo-halitosis?

A

No objective evidence of malodour, but the patient thinks they have it.

48
Q

What is meant by halitophobia?

A

The patinet persists in believing they have halitosis despite firm evidence for the absence of halitosis.

49
Q

What are the two subgroup classifications of genuine halitosis?

A
  1. Physiological halitosis
  2. Pathologic halitosis
50
Q

What is physiological halitosis?

A

Morning breath

51
Q

What is the cause of physiological halitosis?

A
  • increased microbial activity during sleep
  • reduced saliva flow during sleep
  • fasting and starvation
52
Q

What is the management of physiological halitosis?

A
  1. Eating
  2. Routine OH
  3. Rinsing with fresh water
  4. Tongue brushing/scraping
53
Q

What foods tend to induce physiological halitosis? Name 8.

A
  1. Garlic
  2. Onion
  3. Cabbage
  4. Cauliflower
  5. Radish
  6. Spicy foods
  7. Coffee
  8. Alcohol
54
Q

What is pathologic halitosis?

A

Halitosis often associated with oral sepsis/disease (e.g. gingivitis, periodontitis, NG)

55
Q

Other than oral sepsis/disease, what other intra-oral causes are there for pathologic halitosis?

A
  1. Poor oral appliance hygiene (e.g. dentures)
  2. Mouth breathing
  3. Tongue coating
56
Q

What is the primary cause of halitosis?

A

The production of volatile sulphur compounds (VSC) by oral bacteria, which produce these compounds as a result of the breakdown of epithelial cells, salivary proteins, serum proteins and food debris.

57
Q

There is no single bacterial species responsible for halitosis, however, what is a key group of bacteria involved?

A

Gram-ve proteolytic anaerobes (e.g. porphyramonas gingivalis)

58
Q

What are three malodourous volatile sulphur compounds often produced in halitosis and what is each of their smells?

A
  1. Methyl mercaptan : pungent and smells of rotten cabbage
  2. Hydrogen sulphide : rotten eggs
  3. Dimethyl sulphide : unpleasantly sweet smell
59
Q

What type of VSC does evidence suggest is the primary compound responsible for intra-oral halitosis?

A

Methyl mercaptan

60
Q

What type of mouthwash can be effective in neutralisation of VSC that cause halitosis?

A

Chlorine dioxide (ultraDEX) and zinc containing mouthwashes

61
Q

What are the various general aetiological extra-oral factors of halitosis?

A
  1. Drug induced
  2. Systemic disease
  3. Habits such as smoking and alcohol intake
62
Q

Why is GIT problems a rare cause of halitosis, even though it is believed to be more common?

A

As the oesophagus is usually collapsed so unlikely to be cause of halitosis in mouth

63
Q

What are the two principle methods of assessment of halitosis?

A
  1. Organoleptic assessment
  2. Laboratory methods (e.g. hallimeter and gas chromotography)
64
Q

Organoleptic assessment is the most common method used for assessing halitosis. Describe this test.

A
  1. Patient closes their mouth for 1 minute
  2. The clincian sits approx 10cm from patients mouth
  3. Clinician smells the patients exhaled breath and subjectively assesses it for odour.
65
Q

What are the requirements prior to undergoing organoleptic assessment?

A
  1. Both patient and clinician avoid smoking, drinking coffee/tea/juice and wearing perfumes/aftershaves.
  2. Patient should avoid eating foods associated with halitosis for 48 hours prior to test.
66
Q

What is the downside to the hallimeter (portable gas monitor) as a test for halitosis?

A

It cannot differentiate between different VSC’s and is also more sensitive to hydrogen sulphide than the more common methyl mercaptan.

67
Q

Why must alcohol or any alcohol mouthwashes be avoided 12 hours prior to hallimeter testing?

A

Hallimeter is very sensitive to alcohol so this could mess up the results

68
Q

Why is the hallimeter rarely used in clinical practice?

A

Very expensive equipment

69
Q

What is the gold standard test for assessing halitosis? And why?

A

Gas chromatography, because it is useful for differentiating and quantifying specific compounds.

70
Q

What are the three VSC’s that the portable gas chromatography machines (OralChromaTM) are very sensitive to?

A
  1. Hydrogen sulphide
  2. Methyl mercaptan
  3. Dimethyl sulphide
71
Q

Why might persistent halitosis be referred onto an ENT specialist?

A

Halitosis can be a result of associated nasopharyngeal conditions.

72
Q

Gastro-intestinal probelms are a common cause to halitosis, true or false?

A

False

73
Q

A patient attends your clinic complaining of bad breath first thing in the morning, what simple measures could you suggest to the patient to manage this?

A
  1. Eat food
  2. Carry out OH
  3. Ensure to drink lots of fluids
74
Q

When should you refer a patient to a GMP or an oral medicine department?

A

Once all causes have been investigated and management attempted, but halitosis continues despite this.

Dentistry Module 6 (15 decks)

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