Periodontology Flashcards
What are the 4 periodontal tissues?
- gingiva
- periodontal ligament
- alveolar bone (socket)
- cementum
What is the periodontal ligament (PDL)? What is it’s role?
- shock absorbing elastic fibres that insert into alveolar bone and onto cementum of tooth root
- contain the tooth within the socket
Why do we see periodontal dz so often?
- under constant attack
- limited regeneration capacity
2 types of periodontal disease?
- gingivitis
- periodontitis
What do periodontal tissues (gingiva & sulcus mainly) break down in the presence of?
- plaque
Why is plaque difficult to get rid of?
- biofilm
– can’t be rinsed away
– must be mechanically broken down
After 48h of being undisturbed, what does the bacterial population of plaque biofilm shit to?
- initial gram positive aerobes -> predominance of gram negative anaerobes
– worse for tissues as release toxins
– bacteria start to become mineralisation and calculus forms
What is the host response to plaque?
- gingivitis
– response to the toxins produced from stagnant bacteria
Why is the inflammatory response of the gingiva not effective at getting rid of plaque bacteria?
- the bacteria are on the tooth next to the tissue
– can’t be phagocytosed
How to reverse gingivitis
- plaque removal
– BRUSH TEETH
What is the irreversible sequel to gingivitis due to the damage caused by the immune response?
- periodontitis which progresses to involve gingiva, alveolar bone, PDL + cementum -> breaking down of attachment
What is the main aim of tx of periodontitis?
- slowing progression
How can you arrest the progression of periodontitis?
- brush daily
– bacteria change over 24h
– can’t get periodontitis without gingivitis
What are the predisposing factors for periodontitis?
- plaque
- genetics
- immune system
- salivary contents
- overcrowding of teeth
- systemic underlying disease e.g. diabetes
- stress
What local factors may increase risk of periodontitis due to plaque retention & stagnation?
- calculus
- overcrowding
- gingival abnormalities (hyperplasia = more pockets)
- FB
- trauma
What can cause gingival hyperplasia?
- drugs
- hereditary
- inflammation of gingiva
Local implications of periodontal dz
- impacts adjacent teeth
- abscesses
- osteitis
- osteomyelitis (lytic response of bone -> jaw breaks down)
- stomatitis
- ulceration (kissing ulcers = tissues overlying surface of tooth covered in bacteria)
- faucets (inflammation further back in mouth like tonsils)
Systemic complications of periodontal dz
- bacteraemia
– increased vascularity in mouth as big surface area inflamed
– bacteria enter blood vessels more easily
– can disseminate to compromised organs + seed (liver, kidney, heart) - can lead to bacterial endocarditis
- can cause issues relating to pregnancy + performance
Prevention of periodontitis
- brush daily once mouth clean
- if O can’t, teeth need to be extracted
Tools to debulk calculus to tx periodontal dz
- hand scale
- ultrasonic scale
Why shouldn’t you put the scaler subgingival?
- it is pointy & sharp
-> breaks down attachments/epithelial seal below sulcus
Which hand scaler can you put supra + sub gingival?
- curette
Homecare
- brushing daily
– soft-medium bristle brush - mouthwash with chlorhexidine 0.12%
- chews for 5 mins +
- dental diets that promote plaque removal
Pros & cons of scaling
- calculus removal (but will leave tiny bits behind)
- plaque biofilm removal
- but leaves rough, plaque retentive surface
