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1st year > plaque related diseases - perio > Flashcards

plaque related diseases - perio Flashcards

1
Q

how do metal ions control plaque?

A

zinc, copper, tin, plaque inhibitory
copper and tin cause intrinsic staining
zinc retained by plaque and inhibits growth

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2
Q

what is new attachment?

A

union of CT with previously pathogenically altered root surface

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3
Q

describe the initial lesion?

A 
24-48 hours after plaque accumulation
gm +ve bacteria, aerobic, saccharolytic
vasodilation, increased omns, gcf
minimal tissue damage
immune response provoked
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4
Q

what is mild perio?
mod
severe

A

1-2mm bone loss
3-4mm bone loss
>5mm bone loss

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5
Q

where does gingival attachment happen in health?

A

begins coronal to the ACJ

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6
Q

what are some oral features of downs syndrome?

A 
prone to destructive perio disease
class III occ
ant open bite
lack of lip seal
large tongue
infection prone
w
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7
Q

what are types of periodontitis as a manifestation of systemic disease?

A

haematological
genetic
NOS

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8
Q

what is the tx of a grade 3 furcation?

A

tunnel prep
root resection
XLA

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9
Q

describe the oral epithelium?

A

stratified squamous epithelium
90% keratinocytes
10% - non k cells - langerhans, melanocytes, lymphocuyes, merkel cells

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10
Q

how do you monitor recession?

A

LOA/ppf charts
photographs
study models

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11
Q

enzymes can be used for what control?

A

supragingival plaque control
can interfere with bacterial attachment
host defences can inhibit bacteria

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12
Q

what is the aim of NS therapy?

A

render roots biologically compatible with ST by eliminating calculus/altered cementum and reducing pathogenic microorganisms

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13
Q

what slow release gels are available to use?

A

dentomycin gel

elyzol gel

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14
Q

what do calcium channel blockers do to the gums?

A

nifedipine, gingival hyperplasia in 30% of cases

amlodipine

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15
Q

what are some clinical signs of healing?

A 
reduced redness and swelling
reduced BOP
healing of ulceration
pinker and firmer gums
shrinkage
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16
Q

for regeneration to occur in perio what is needed?

A

epithelium and CT must be excluded from wound space and not allowed to proliferate and
adequate RSD
repopulation by progenitor cells to form a PDL

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17
Q

what are gingival fibres?

A

circular
dentogingival
dentoperiosteal
alveolgingival

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18
Q

what are NUG risks?

A

poor oh
smoking - vasoconstricts - anaerobic
stress
immunodefiency

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19
Q

what is a furcationplasty?

A 
reflection of flap
removal of deposit and ST from furcation
widen furcation
replace flap 
- can lead to RSC, danger to pulp, hypersensitivity
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20
Q

what happens initially after RSD?

A

initial acute inflammation 24-48 hours after

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21
Q

what are the types of chronic periodontitis?

A

localised

generalised

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22
Q

what is triclosan?

A

non ionic antiseptic
mod inhibition with zinc
anti inflammatory

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23
Q

what fungal infections present orally?

A

gen ging candidosis
linear g erythema
histoplasmosis

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24
Q

what does RSD remove?

A

endotoxins
plaque biofilm
subg calc
outtermost nectrotic cementum

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25
how do immunosuppressants affect the gums?
reduced inflammatory response = gngivitis appearance may reduce
26
what is the junctional epithelium?
epithelial attachment to tooth | hemi desomosones anchor basal keratinocytes to basement membrane
27
what theory expains disease progression?
socransky burst theory
28
what is GTR?
``` allows bone tissue to regenerate in bony defects nonresorbable/bioresorbable membrane - flap resected - RSD - membrane over defect - sutured in place for 6 weeks = new attachment = 3-6mm gain in attachment levels ```
29
what are two types of antimicrobials? | what may they cause?
antibiotics and antiseptics | sensitivity, resistance, super infections
30
when would antiseptic MW's be used?
replace toothbrush when not poss | adjunct to normal mechanical cleaning
31
what is a tunnel prep?
exposes entire furcation - only for mandibular RSD inter radicular removed
32
what is a pregnancy epulis?
soft pedunculated granuloma from inflammed papilla deep red and bleeds easy anteriors and 3rd month of pregnancy common plaque and one of - cavity, poor contact, overhang
33
what happens if NUG is not treated?
acute for 2-3 weeks, heals as chronic gingivitis | reoccurs with further ID papillae loss
34
what bacteria are present in NUG?
treponema vincentii fusobacterium prevotella
35
how do you prevent sensitivity?
- occlude dentinal tubules - topical - potassium ions e.g sensodyne, potassium oxalate precipirates calcium oxalate crystals - by insulative restoration - devitalise tooth - rct
36
what is perio chip?
adjunct for pockets not responding to tx 2.5mg chx in gelatin and water biodegradable bisphasic release over 7 days - initially 40% released, 60% released over 7 days
37
pockets of 4-6mm should see what after RSD?
reduced ppd of 0.5mm. 1mm attachment gain
38
how does cyclosporin affect the gums?
hyperplasia in 30% of cases increased change in women and children change to tacrimolus
39
what are the types of plaque induced gingival diseases?
- systemic factors - pregnancy/diabetes - medication - hyperplasia - malnutrition - plaque only
40
how is perio chip used?
placed into pocket after RSD/haemorhage arrest chip swells and contact with moisture and is retained eliminates pathogenic bacteria >100days use 3/12
41
what are the type of aggressive periodontitis?
ocalised | generalised
42
what does the OCP do to the gums?
increased gcf/inflammation | only exacerbates a pre existing condition
43
what are quaternary ammonium compounds?
cetly pyridium chloride | mod plaque inhibitory
44
what is dentomycin gel?
semi synthetic tetracyline 2& minocycline ppd >5mm 2-3 times with 2 weeks inbetween
45
in health what is the volume of gcf?
low volume
46
what is NUG caused by?
anaerobic fusospirochaetal complex treponema vincentii fusobacterium nucleatum p intermedia
47
signs of PHgingivostomatits?
acuute stomatitis ulcers gen malaise
48
what bacteria are present in: localised aggressive perio? generalised aggressive perio?
A.a | p.gingivalis
49
what is hereditary gingival fibromatosis?
autosmal dominant - secondary dentition excess collagen - hyperplastic gingivae localised/generalised gingivae can delay eruption of the teeth
50
what are phenolics?
listerine | poor oral retention
51
what does vasoconstriction cause in the mouth?
decreased serum IgG levels decreased T helper cells imapired mobility and chemotaxis of pmns
52
what happens if epithelium enters the wound space? how can it be fixed?
fast proliferation and blocks fibroblast attachment - bone graft conditioning root surface membranes - GTR
53
how do NSAIDs affect the gums?
inhibit synthesis and release of PG = reduced bleeding and swelling cant use in tx = GI effects and asthmatics
54
what do you use to vitality test?
ethyl chloride | electric pulp tester
55
what is the conditions of the perio pocket of a smoker?
more anaerobic
56
what is shrinkage?
happens due to factitious injury/perio tx
57
what are the divisions of risk factors for perio?
local | systemic
58
what is seal/protect?
fluoride and triclosan mechanical blockage of tubules on root surface resin or light cured
59
what do snuff, chewing tobacco and betel nut all cause?
carcinoma and oral leukoplakia where tobacco is placed
60
what is GTR?
mechanical barrier eliminates ep wound space and repopulated by cells from the PDL and bone - good for bony defects and furcations
61
what is chronic granulomatous disease?
defect in cell killing ability of phagocytes
62
what is NaF used in?
duraphat - encourages secondary dentine - more resistant to decalcification
63
what is the actions of nicotine?
- lipid sol - enters blood and passes through blood brain barrier - vasoconstrictor = reduced blood flow = ischameic tissue and impaired healing - increases platelet adhesiveness and thrombosis risk - reduced proliferation of RBC/fibroblast/macrophages
64
what is recession?
inflammation free condition characterised by apical retreat of the periodontium and ID papillae remain at normal level
65
what is the composition of dentine?
70% inorganic HA 20% organic - collagen 10% water and processes of odontoblasts - lying at periphery of pulp and extends into ADJ
66
what is tertiary/reparative dentine?
dentine and a noxious stimulus - NCTSL/caries | odontoblasts lay down more dentine
67
what is stontium chloride/potassium chloride?
strontium ions = strong affinity for calcified tissues/obliterates tubules sensodyne - 10% StCl , 3.75% KCl
68
what affect does pregnancy have on the gums?
exacerbation of any pre exisiting plaque induced inflammation
69
what are the colours and bacteria present in each bacteria complex?
purple - gm +ve, aerobic, non motile - actinomyces yellow - strep green - actinobacillus orange - fusobacterium, prevotella red - gm -ve, motile, anaerobic - p gingivalis, treponema
70
where is nicotine stored in the mouth?
stored and released by perio fibroblasts
71
what is a furcation?
horizontal loss of support in areas where roots multi rooted teeth converge
72
describe the established lesion?
CT = all inflammatory exudate JE = ulcertaed and deeper crevice = true pocket increased pmns, ig, complement bac = damage/indirect
73
what are the blood vessels in the PDL?
apical gingival perforating
74
what is shrinkage?
orientation of healthy gingival collagen fibres and long junctional epithelium formation
75
what are some perio risk factors?
``` uncontrolled diabetes smoking poor oh genetic predisposition immunodeficiency virulent bacteria in flora local factors alcohol stress ```
76
how do the cells of the JE sit? what is the JE turnover? how do cells turnover? why is it readily permeable?
sit parallel to tooth 4-11 day cell turnover cell div throughout JE and shed into sulcus no MCG's and large intercellular spaces
77
what are oxytalin fibres?
elastic and insert into cementum run oblique and parallel to root surface maintain potency of blood vessels
78
what is lichen planus?
inflammatory disease of skin/mucous membranes with oral lesions and skin lesions reticulated form of interlacing white network erosive - can occur on gingivae most common cause of desquamative gingivitis
79
why does reduced ppd happen?
shrinkage of g tissues, long JE, shrinkage
80
what is neutropenia?
oral ulceration severe gingivitis and profuse bleeding rapid perio bone loss
81
describe oral sulcular epithelium?
lines sulcus | non k
82
what is periostat?
subantimicrobial dose doxycycline | collagenase inhibitor
83
new attachment involves formation of...?
long junctional epithelium and gradual closure of the pocket
84
when diagnosing perio consider what?
``` severity/extent of disease severity and pattern of pockets/loa pts age at onset of disease signs and symptoms local irritants ```
85
what are causes of recession?
``` fenestration - window in bone dehisence - complete lack of bone chronic minor trauma and inflammation frenum pull ortho tx excessive scaling parafunction ```
86
what type of bone makes up the tooth socket/lamina dura?
bundle bone
87
what are mucotaneous disorders that present in the mouth?
``` lichen planus pemphigus vulgaris lupus erythematous pemphigoid erythema multiforme ```
88
highly susceptible pts have bursts of what type of attachment loss?
rapid
89
what does an inflammed pulp cause to the sensitivity?
increased sensitivity
90
how do bisbiguanide antiseptics work?
broad spec of killing | damage to cell wall
91
what are types of developmental or acquired deformitites and conditions?
local factors mucogingival deformities and conditions around the tooth or edentulous ridge occlusal trauma
92
oral signs of crohns?
``` apthous ulcers cobblestone mucosa mucosal tag gingivae are diffuse erythematous enlargement of attached gingivae severe periodontitis possible ```
93
what problems can recession cause?
sensitivity root surface caries TB abrasion
94
what is leukaemia?
``` oral ulceration petechiae gingival enlargement - infiltration of leukaemia cells gingival bleeding infection susceptibility ```
95
what are types of abscesses of the periodontium?
gingival periodontal periocoronal
96
what are the types of antibiotics?
1. bacteriocidal - kills bac - penicillin/metronidazole | 2. bacteriostatic - inhibits multiplication
97
what is NUG tx?
OHI gentle fm USS systemic symptoms - metronidazole 200mg 3 days rev 48hours
98
what antiepileptics can cause gingival problems?
``` phenytoin causes gingival hyperplasia in 50% of cases, interferes with fibroblast activity, improved OH = reduced hyperplasia side effects start at 3 months worse at anteriors and begins ID related to serum conc of blood ```
99
how is alveolar bone resorbed?
immune response - cytokines, igs and leukotrienes
100
what are the principle fibres of the PDL?
``` attachment of cementum to bone oblique fibres alveolar crest horizontal fibres apical fibres inter radicular ```
101
what is the treatment of aggressive perio?
tetracycline, RSD
102
what affect does puberty have on the gums?
increased prevalence and severity of gingivitis | increased host response to plaque
103
what are local perio risk factors?
anatomical iatrogenic trauma from occlusion
104
what are mucopolysaccharide disorders?
disturbance of mucopolysaccharide metabolism - hurlers/hunters wide spread, small teeth, delayed eruption with or without gingival enlargement
105
what is perio disease commonly treated with?
tetracycline | metronidazole
106
what bacteria are present in gingivitis?
fusobacterium | porphyromonas
107
why do smokes exhibit less inflammation than younger smokers?
more vasoconstriction and keratinisation
108
what does rsd cause/what changes in the microflora?
reduced total no.of organisms | = residual bacteria are gm +ve aerobic
109
what are risk markers of perio disease?
mobility | BOP
110
what types of attachment loss occur?
rapid progressive attachment loss RAL | gradual progressive attachment loss GAL
111
what are the types of gingiva?
free - coronal to ep attachment | attached - tightly bound to underlying bone
112
what is periodontitis associated with scurvy?
vit c needed for collagen | scurvy = vit c deficiency
113
how does new attachment occur?
pocket epithelium attaches to root surface by formation of a basement membrane and hemidesomosomal attachment, keratinocytes are held to cementum by formation of a long junctional epithelium
114
what is ehlers danlos syndrome?
excessive joint mobility skin hyperflexibility easy bruising and abnormal scarring fragile oral mucosa, gingiva bleed easy, fragile teeth that fracture easy, type VIII linked with aggressive perio
115
what is hypophosphatasia?
``` premature exfoliation of deciduous teeth bone and cementum changes inflammation free shell teeth perm dentition not affected ```
116
what do dentinal tubules allow?
passage of fluid, chemicals and bacteria
117
what is the tx of a grade 1 furcation?
s/p, ohi, furcationplasty
118
what is the aim of treating a furcation?
exposure to ease cleaning and induce bone regeneration
119
when is USS not used?
pts with pacemaker - EM interferes | contagious diseases - aerosol
120
what isc chediak higashi syndrome?
lymphoma like condition with neutropenia, anaemia, thrombocytopenia severe g + p premature loss of primary and secondary dentition
121
in health changing to disease what changes?
increased crevicular fluid increased inflammatory and immune cellular infiltrate less fibroblasts reduced collagen content
122
what is the correct tx plan order?
1. initial exam and pain relief 2. intitial NS therapy 3. re exam and definitive tx plan 4. correct tx 5. maintenance
123
what is the tx of a grade 2 furcation?
``` furcationplasty tunnel prep GTR root resection XLA ```
124
what is elyzol?
25% metronidazole - kills A.a active for 24 hours ppd >5mm
125
what are perio prognostic factors?
``` systemic health hereditary factors aetiology age related to LOA smoking status attitude and co op ```
126
what is type 1 collagen? and what fibres does it make up?
attaches g tissue to bone | circular, trans septal, dento gingival, dento periosteal, crestal
127
caution with what antibiotics if pt has liver disease?
clindamycin | metronidazole
128
what does hypogammaglobulinaemia cause?
high suscpetibility to infection
129
what cellular changes does smoking cause orally?
reduced salivary IgA and serum IgG antibodies to fusobacterium and P intermedia T helper lymphs neutrophil function
130
what is sarcoidosis?
granulomatous condition swelling of parotid gland and lymph nodes gingivae can be hyperplastic or granulomatous
131
what is NUG/ANUG?
endogenous infection | systemic changes predispose the gingiva to invasion by bacteria in intraoral flora
132
what is stannous F?
enzyme poison - inactivates enzymes in process | induces mineralisation in tubules = calcific barrier on surface
133
what is dentine receptor mechanism?
odontoblasts have a sensory function | when stimulated will communicate with nerve plexus and cause pain
134
why might recession happen at lower ants?
thin buccal bone | frenum pull
135
what are some side effects of chx?
``` unpleasant taste/taste alteration staining increased calc formation redness/burning/erosion of mucosa parotid gland enlargement ```
136
what is root amputation?
remove compromised root whilst conserving crown
137
where is dentine more sensitive?
adj and pulp
138
what are clinical signs of recession?
stillmans cleft - v shape in gum | mccalls festoon - gum has rolled margin
139
what is : modulation of nerve impulses by polypeptides?
pulpal tissue has bradykinin etc which regualates neural transmission and can alter permeability of odontoblast cell membrane = increased sensitivity
140
what is aplastic anaemia? | what is fanconis anaemia?
- caused by drugs/chemotherapy/radiation - gingival bleeding and infections - rare form, associated with perio and premature tooth loss
141
what is the PDL?
specialzed vascular tissue derived from dental follicle fibrous attachment of toth cementum to bone attachment
142
if pt has kidney failure, caution with what antibiotics?
acyclovir amoxicillin erythromycin
143
what is pemphigus vulgaris?
oral lesions before skin lesions bullae anywhere on OM corticosteroid tx
144
when would you use anti plaque mouthwashes?
after surgery acute mucosal infections/gingival infections disabled pts primary herpetic gingivostomatitis
145
what are clinical signs of NUG?
``` necrotic ulcers starting ID and spreading laterally grey pseudomembranous slough halitosis spont bleeding metallic taste local or generalised ```
146
how do cytokines regulate healing?
attract fibroblasts
147
what do haematological conditions do to the gingivae?
conditions cant cause gingivitis but tissue changes cause an altered tissue response to plaque
148
how is formaldehyde used in sensitivity tx?
formalin in toothpaste | precipitates protein in tubules
149
what is hereditary gingival fibromatosis?
autosmal dominant gen g enlargement can be associated with epilepsy and mental retardation
150
what is the hydrodynamic mechanism?
tubules have more fluid and stimuli causes rapid movement in the tubules = deformation in process and pain explains why LA does not block sensitivity
151
why does a furcation cause loss of vitality?
hard to clean | loss of vitality bc accessory canals
152
describe the oral gingival epithelium?
stratified sqaumous orthokeratinised junction with underlying gingivae tissue is wavy - connective tissue papila rete pegs
153
describe the advanced lesion?
fibrosis in ct ulceration and migration of JE pdl fibres breakdown bone loss and osteoclasts present
154
how does the junctional epitherlium form?
fusion of REE with oral ep on tooth eruption | as tooth reaches occlusal attachment, moves apically down the crown and stabilises near ACJ
155
what does short use of systemic and topical tetracycline and metronidazole cause?
reduced gm negative, anaerobes, spirochates, improved clinical condition, reduced pocket depth, reduced bop
156
how does perio destruction progress?
site specific episodic manner and bursts of destructive activity alternating with periods of quiesence and poss repair = socransky burst theory
157
what is the histopathology of NUG?
``` bac zone - surface slough pmn rich zone - superficial ct necrotic zone deeper tissues bact infiltrate ```
158
what is benign mucous membrane pemphigoid?
disease of mucous membranes caused by an immunological disorder lesion = bula = ulcer = heals with scarring diffuse erythema and areas of desquamation
159
describe the ealry lesion?
after 1 week of plaque accumulation antibody/cytokine release increased size of CT = gingival inflammation loss of fibroblasts/collagen = loss of stippling increased gcf and pmns swelling = deeper crevice = false pocket bac = gm -ve, anaerobic, endotoxins produced
160
what is the aim of NS tx?
create an environment biollogically compatible with healing = decon of root surface, disruption and elimination of plaque biofilm removal of bulk of subg calc
161
what is secondary dentine?
forms slowly throughout life and deposited at floor and roof of pulp chamber
162
describe gingival connective tissue?
highly vascular CT - collagen fibres and extracellular matrix fibroblasts, macrophage, polymorphs, lymphocytes
163
oral signs of aneamia?
om pallor smooth tongue with or without apthous ulceration
164
how can enzymes be involved in perio disease?
- break down plaque structure - interfere with plaque attachment D - resistant strains develop, sensitivity, superinfection
165
what is actisite?
25% tetracycline active for 10 days left in situ for 10 days
166
what are MCG's?
formed in prickle and granular layers contain lipids that are discharged into intercellular layers barrier to permeability of water
167
what is papillon leverfe syndrome?
rare autosmal recessive disorder palmer planter keratosis premature loss of both dentitions skin lesions - diffuse erythematous keratotic areas on palms and soles of feet primary lost early in order of eruption secondary erupts early with aggressive perio edentulous by 16 years
168
what are the 2 types of gingival disease?
plaque induced | non plaque induced
169
what would you see on a radiograph in an area of a furcation?
arrow head lesion
170
what kind of reponse to perio tx do smokers have?
refractory response despite good oh and peristant bop
171
how does limited remodelling of the alveolar crest happen?
collagen laid down by migration of fibroblasts
172
why is dentine highly sensitive?
richly innervated
173
what is regeneration?
attachment of pdl cells and fibres to new cementum and coronal regrowth of the alveolar bone
174
what are the layers of non keratinised epithelium?
basal prickle intermediate surface
175
how does calc contribute to perio disease?
coating of plaque impedes cleaning absorbs endotoxins false ppd/impedes
176
what do chemotheraputic agents do to the gums?
reduced WBC count = increased susceptibility to perio
177
smokes have what things?
- more calc - more plaque - deeper pockets - brush for less time - increased bone loss - loose more teeth - increased keratinisation - tx often fails
178
what is a perio pocket?
pathogenically altered gingiva crevice | pocket = ulcerated epithelial lining of pocket wall, JE, diseased root surface - pathogenic and sub calc
179
what is periodontitis associated with endodontic lesions?
combined perio endo lesions
180
what is the ideal aim of perio tx?
regeneration | attachment of pdl cells and fibres to new cementum and coronal regrowth of the alveolar bone
181
what bacteria are present in chronic perio disease?
p ging f nucelatum p intermedia
182
what are gingivae?
fibrous tissue covered by epithelium
183
what is the area covered by odontoblasts at ADJ/pulp?
20 000mm squared | 65 000mm squared
184
how does the PDL breakdown?
loss of collagen fibres in cementum | fibroblast damage
185
what is the components of the periodontium and what is its function?
gingiva, pdl, alveolar bone, cementum | attachment of teeth to jaws, effective support during masticatory function
186
what are types of non plaque induced gingival diseases?
``` vira fungal specific bacteria genetic systemic - mucotaneous/alergic traumatic lesions ```
187
how do you manage/review a furcation?
regrade - 6/12 | vitality test - 12/12
188
what is cervitec?
1% chx, 1% thymol reduced bacterial levels mechanical blockage
189
how do oxygenating agents work?
inhibit obligate anaerobes
190
how do sex hormones affect the gums?
oestrogen - increased keratinisation, altered CT composition | prgesterone - increased gingival vessel permeability
191
what is gcf and what does it contain?
produced by dentogingival plexus post capillary cells blood cells various plasma proteins defence cells/proteins - pmns, abs, complement
192
what changes in tissue response happen when smoking?
vasoconstriction transient increase in gingival crevicular fluid passes through OM and causes >50% inhibition of function of neutrophils - motility and chemotaxis
193
what happens 1 week post RSD?
reduced vasodilation, gcf, pmns, ulceration
194
what are systemic perio risk factors?
``` genetic environmental behavioural lifestyle metabolic haematological ```
195
what are the advantages of local administration?
higher conc in pocket lower total dose of antibiotic lower systemic spillover
196
what is a root resection/hemisection?
removal of one or more roots | retained root - RCT
197
what are types of necrotizing periodontal diseases?
NUG | NUP
198
what is hypersensitivity?
pain with thermal, chemical or osmotic stimuli or pathology
199
what is reattachment?
union of root and CT after incision or injury
200
what should you tell pts to avoid when using chx?
avoid smoking, tea,coffee, red wine
201
sensitive dentine has how many more x tubules of what x the diameter?
8x no of tubules | 2x diameter
202
what happens during healing?
long JE shrinkage tightening and formation of g cuff
203
what bacteria are present in gingival health?
strep and actinomyces
204
deep pockets should see what after RSD?
reduced ppd 2mm | +1mm attachment
205
what are the layers of keratinised epithelium>?
basal cell prickle cell granular cell keratinized
206
why are downs syndrome pts more at risk of perio disease and in what part of the mouth is it more common in? what is there an extra increased risk of having?
related to immune system abnormalities - impaired chemotaxis and phagocytosis of pmns - lower ants, NUG
207
why does tooth mobility happen?
trauma periapical disease periodontal disease
208
how do corticosteroids affect the gums?
reduced response to plaque reduced swelling increased infection susceptibility

1st year (8 decks)

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