Periodontology Flashcards
what does sulcus bleeding index measure?
records the long term effectiveness of a pt’s OH
why is bleeding on probing the most effective method?
- the technique is the same as when probing pocket depths (so not only superficial bleeding)
- adapts side of probe tip to tooth surface
Know the 2 surfaces the probe touches the tooth…
- side of the tip in contact w/ the tooth
2. probe parallel to the tooth long axis
The removal of plaque & calculus during periodontal Tx results in the healing of the sulcular epith & elim of BOP w/i _____ days when plaque control is sufficient.
7-10
Inadequate OH & new plaque accumulation will result in sulcular epithelial ulceration and bleeding w/i _____ days, indicating current inflamm activity.
a couple of
Bleeding on probing has a low positive predictive value for future periodontal destruction, BUT absence of bleeding on probing has a high negative predictive value indicating _____.
periodontal stability
*all periodontal pts will exhibit bleeding, but all pts exhibiting bleeding don’t necessarily have periodontal disease
indices to detect inflamm at the base vs the coronal part of the sulcus?
gingival sweep index
which index gives usually higher scores, the “gingival sweep” or the “BOP” score?
BOP
what info we get from the gingival bleeding indices?
shows long-term effectiveness of pt’s OH; absence in consecutive visits shows stability
O’Leary Plaque Score?
- use disclosing tablet
- records the effectiveness of the pt’s OH just BEFORE that visit
what info we get from the plaque indices (plaque vs bleeding indices)?
shows most recent hygiene; snapshot of OH
which index is more meaningful? BOP or O’Leary?
Define “meaningful”
- long term effect = BOP
- snapshot of OH = O’Leary
do we record the plaque or the bleeding scores first?
probably plaque first in order; not to remove the plaque during the bleeding score.
mucogingival exam?
examine the relationship betw keratinized & nonkeratinized mucosal tissues
- gingiva = free + attached (all keratinized)
- alveolar mucosa is nonkeratinized
Gingiva is more pink, and the alveolar mucosa more red. Why?
alveolar mucosa is not as keratinized; fewer layers; more vasculature
factors that predispose for recessions?
- trauma to gingival tissues
- thin tissue complex
- thin cortical bone
- presence of narrow zone of attached gingiva
- labioverted/prominent roots
- previous orthodontic tx
probing depth technique: record measurements at ___ sites/tooth
6
tip of the probe is in contact w/ the _____ & the side of the probe touches the _____
root at the middle of the interprox surface; contact pt betw the teeth
is probing depth enough to make a periodontal diagnosis?
no, you need CAL
at the interproximals, angle or not angle the probe, touch or don’t touch the contact point?
at the interproximals, slightly angle the probe tip while retaining contact w/ the contact pt
which factors affect the PD assessment?
factors affecting PD assessment: probe size, angle, inflammation, calculus, tooth anatomy
what do you need to determine the periodontal Dx?
PD w/ CAL & BOP
what is the CAL?
distance from the CEJ to the base of the probeable sulcus or pocket (junctional epith)
- represents the CT fiber attachment level
how do you detect the CEJ?
- angle probe 45 deg & use tactile sense to detect CEJ
- slide probe from crown to root (usu feel a drop at CEJ–bc enamel is bulkier & usu overlaps cementum)
- indirect: ht of anatomical vs clinical crown; digital radiograph; relative attachment level
**DIFFERENCES in Probing Depth vs CEJ Technique
- angle: parallel to tooth axis for PD, 45 deg for CEJ
- contact pts: 2 for PD, 1 for CEJ
- movement: circumferential step-like movt for PD, sliding movt coronal-apical for CEJ
- tactile sense: gentle resistance (rubber feeling) at base of sulcus for PD, drop or bump for the CEJ
___ offers the most valid estimate of past disease & of the treatment outcome.
CAL
mesial furcation on a MX molar is best detected from the ?
palate
distal furcation entrace is usu best detected from the ______ aspect
facial
class 1: horizontal loss of attachment ____?
< 3mm w/i furcation area
class 2: horizontal loss of attachment ___?
> 3 mm but not encompassing the total width of the furcation area
class 3: horizontal loss of attachment ___?
through and through destruction of the periodontal tissues of the furcation area
highest frequency of furcation?
distal furcation of MX 1st molar
3 zones of oral mucosa?
- masticatory - ex. palatal tissue
- specialized
- lining (i.e. alveolar–nonkeratinized)
main structural element of rugae = ?
GAG
boundaries of the sulcus?
- enamel
- sulcular epithelium
- junctional epithelium
gingivo-dental group?
originate from cementum to the rest to gingiva, to outer surf & periosteum.
dento-alveolar group?
from crest of bone to gingiva
circular group?
fibers that are not attached to the tooth
transeptal group?
located inter-proximally & connects the cementum of 2 adjacent teeth
dento-periostal?
cementum to periosteum
width of attached gingiva increases w/ age. t/f?
TRUE
what has the least buccal width of attached gingiva?
cuspid and bicuspids
width of attached gingiva is ____ anterior to posterior teeth
increased
Patient has 6 mm keratinized mucosa and 2 mm free, how much attached gingiva?
4mm
blood supply to gingiva?
- from PDL
- from alveolar process
- supra-periosteal blood supply (MAIN)
lamina densa?
1 layer of junctional epith; adjacent to enamel
lamina lucida?
1 layer of junctional epith; adjacent to epithelial cells; provides attachment for hemidesmosomes
col?
connects the F/L interdental papillae and conforms to the shape of the interprox contact areas; what connects the papillas!!!
what are the sites of locus minoris resistentiae in peridontium?
sulcular epith & col
biologic width?
soft tissue attachment to the tooth, coronal to the alveolar crest (2.04mm); junctional epith & CT attachment
epithelial rest cells of malassez?
remnants of hertwig’s root sheath
avg width of PDL?
0.2 mm
transeptal group of PDL?
extends interproximally, over alveolar crest, & imbedded in cementum of 2 adjacent teeth just below CEJ; NOT attached to bone
alveolar crest fibers of PDL?
apical to CEJ; extends obliquely from cementum of alveolar crest & from cementum over alveolar crest & into periosteum; resist extrusion of tooth
horizontal fibers of PDL?
extend at right angle to long axis of tooth; from cementum to alveolar bone; resist lateral movts
oblique fibers of the PDL?
majority of PDL fibers; prevent intrusion into the socket
apical fibers of PDL?
radiate from apex to the bone
interradicular fibers of PDL?
found in furcation of the multi-rooted teeth
sharpey’s fibers?
terminal ends of principal fibers that are inserted into the cementum or to the bone (ends are partly calcified)
what enables the eruption process if the tooth is attached to the bone by the PDL?
intermediate plexus (splicing/unsplicing of collagen fibers that permits tooth eruption & migration)
hammock ligament concept?
eruption begins only after crown formation is complete
