Preventive Procedures - PP week 3 (2.1-2.6)

Question 1

Periodontal Disease

Answer 1

Periodontal disease is an infectious disease process that involves inflammation of the structures of the periodontium
* Causes a breakdown of the periodontium, resulting in loss of tissue attachment and destruction of the alveolar bone

Question 2

Prevalence of Periodontal Disease

Answer 2

1. Periodontal disease is the leading cause of tooth loss in adults
2. 47%+ of adults 30+ have a form or periodontal disease; 70%+ of adults 65+
3. Almost all adults and many children have calculus on their teeth
   Seven out of 10 Canadians will develop gum disease at some time in their
   lives. It is the most common dental problem, and it can progress quite painlessly until you have a real problem.
   That’s why it is so important to prevent gum disease before it becomes serious

Question 3

What is the periodontium?

Answer 3

The periodontium is made up of structures that surround, support, and are attached to the teeth

Question 4

Gingivae

Answer 4

commonly referred to as gums. This mucosa covers the alveolar process of the jaws and surrounds the necks of the teeth

Question 5

Epithelial attachment

Answer 5

Tissue at the base of the sulcus where the gingiva attaches to the tooth

Question 6

sulcus

Answer 6

space between the tooth and the free gingiva

Question 7

periodontal ligaments

Answer 7

dense connective fibers that connect the cementum covering the root of the tooth with the alveolar bone of the socket wall

Question 8

cementum

Answer 8

covers the root of the tooth. The primary function of the cementum is to anchor the tooth to the bony socket with the attachments of the periodontal ligaments.

Question 9

alveolar bone

Answer 9

bone that supports the tooth in its position within the jaw. The alveolar socket is the cavity in the bone that surrounds the tooth

Question 10

Is gingivitis reversible?

Answer 10

YES - it is reversible. If you do not treat gingivitis, then periodontitis follows.

Question 11

Causes of Periodontal Disease

Answer 11

1. Bacterial plaque (dental plaque, oral biofilm)
2. Calculus (tartar)
   ◦ Provides a surface to which biofilm can attach
   ◦ Two types:
   ▪ Supragingival calculus found above the margin of the gingiva
   ▪ Subgingival calculus on root surfaces below the gingival margin
   that can extend into periodontal pockets

Although biofilm is the primary factor causing periodontal disease, the type of
bacteria, length of time bacteria are left undisturbed on the teeth, and patient
response to bacteria are all critical factors in the risk for periodontal disease.
Biofilm cannot be removed simply by rinsing the mouth. Bacteria in biofilm cause
inflammation by producing enzymes and toxins that destroy periodontal tissues and
lower host defenses

Question 12

Signs and Symptoms of Periodontal Disease

Answer 12

1. Red, swollen, or tender gingiva
2. Bleeding gingiva while brushing or flossing
3. Loose or separating teeth
4. Pain or pressure when chewing
5. Pus around the teeth or gingival tissues

Question 13

Risk Factors for Periodontal disease

Answer 13

1. Smoking
2. Diabetes Mellitus
3. Poor Oral Hygiene
4. Osteoporosis
5. HIV/AIDS
6. Stress
7. Medications
8. Local Factors

Question 14

What helps neutralize sugary/sticky/acidic foods?

Answer 14

Cheese

Question 15

Risk Factor: Smoking

Answer 15

Smokers have greater loss of attachment, bone loss, periodontal pocket depths, calculus formation, and tooth loss. Periodontal treatments are less effective in smokers than in non-smokers.

Question 16

Risk Factors: Diabetes Mellitus

Answer 16

Diabetes is a strong risk factor for periodontal disease. Individuals with diabetes are 3 times more likely to have attachment and bone loss. Persons who have their diabetes under control have less attachment and bone loss than do those with poor control.

Question 17

Risk Factor: Poor Oral Hygiene

Answer 17

Lack of good oral hygiene increases the risk for periodontal disease in all age groups. Excellent oral hygiene greatly reduces the risk for severe periodontal disease.

Question 18

Osteoporosis

Answer 18

An association has been reported between alveolar bone and osteoprosis. Women with osteoporosis have increased alveolar bone resorption, attachment loss, and tooth loss compared with women without osteoporosis. Estrogen deficiency also has been linked to decreases in alveolar bone.

Question 19

Systemic Risk Factors: HIV/AIDS

Answer 19

Increased gingival inflammation is noted around the margins of all teeth. Often, patients with HIV/AIDS develop necrotizing ulcerative periodontitis.

Question 20

Systemic Risk Factor: Stress

Answer 20

Psychological stress is associated with depression of the immune system, and studies show a link between stress and periodontal attachment loss. Research is ongoing to identify the link between psychological stress and periodontal disease.

Question 21

Systemic Risk Factors: Medications

Answer 21

Some medications, such as tetracycline and nonsteroidal anti-inflammatory drugs, have a beneficial effect on the periodontium, and others have a negative effect.
Decreased salivary flow (xerostomia) can be caused by more than 400 medications. Antseizure drugs and hormones can cause gingival enlargement.

Question 22

Systemic Risk Factors: Local Factors

Answer 22

Overhanging restorations, subgingival placement of crown margins, orthodontic appliances, and removable partial dentures also may contribute to the progression of
periodontal disease.

Question 23

Oral conditions that increase an individual’s susceptibility to
periodontal disease:

Answer 23

1. Calculus
2. Tooth position
3. Tooth morphology
4. Occlusion
5. Poor oral hygiene
6. Habits
7. Food impaction
8. Faulty restorations and appliances

Question 24

• Periodontal disease is an inclusive term describing any disease of the
  periodontium and includes the following:

Answer 24

1. Gingivitis
2. Periodontitis

Question 25

Stages of Periodontal Disease

Answer 25

• Four stages:
  ◦ Gingivitis
  ◦ Early periodontitis
  ◦ Moderate periodontitis
  ◦ Advanced periodontitis

Question 26

Periodontal Disease Stage: Gingivitis

Answer 26

Gum tissue may
be inflamed,
swollen, and
bleeds easily
during brushing,
flossing, or
examination by
your dental
professional.

• Reversible & no bone loss

Question 27

Periodontal Disease Stage: Early Periodontitis

Answer 27

Continued
inflammation, loss
of gum
attachment and
bone support

Not reversible & bone loss

Question 28

Periodontal Disease Stage: Moderate Periodontitis

Answer 28

Supporting gum
and bone tissue
have
deteriorated, and
the tooth loosens.

-not reversible, bone loss

Question 29

Periodontal Disease Stage: Advanced Periodontitis

Answer 29

severe
destruction of
tissue and bone,
causing tooth loss

• not reversible, bone loss

Question 30

Healthy Gingiva tissue

Answer 30

Gum is firm, fits
tightly to the
teeth, and does
not bleed

Question 31

Modifiable Risk Factors

Answer 31

Tobacco use - Greater bone loss and calculus formation than non
smokers

Hyperglycemia (undiagnosed or uncontrolled
diabetes) - high blood glucose levels can increase susceptibility
to infections, including periodontitis or periodontal
abscesses

Bacterial plaque biofilm, clinical attachment loss,
and age - Age is also a factor because periodontal attachment loss is cumulative over time

Leukemia - significant bleeding attributable to clotting
deficiencies

Hyposalivation (Xerostomia) dry mouth - Xerostomia is associated with more than 500 medication
Malnutrition (vitamin C) deficiency, known as scurvy, primarily - found in populations without an adequate food
supply or on those on restricted diets

Drug-induced gingival enlargement - several categories of drugs, such as calcium channel blockers (e.g., nifedipine), immunosuppressive drugs (e.g., cyclosporine), and antiseizure drugs (e.g., phenytoin), can cause drug-influenced gingival enlargement

Question 32

Non-Modifiable Risk Factors

Answer 32

Past History of periodontal disease
Gender and Race
Age

Question 33

The Systemic Connection

Answer 33

1. Cardiovascular disease
   ◦ Individuals with periodontal disease have a greater
   incidence of coronary heart disease
2. Preterm/low birth weight (PLBW)
   ◦ Women with severe periodontal disease have seven
   times the risk of PLBW infants
3. Respiratory disease
   ◦ Individuals with periodontal disease may be at
   increased risk for respiratory infection

Question 34

Respiratory Disease

Answer 34

1. Individuals with periodontal disease may also be at increased risk
   for respiratory diseases.
2. Bacteria that have colonized in the mouth may alter the
   respiratory epithelium, leaving it more susceptible to pneumonia.
3. Individual’s that may already have chronic respiratory conditions
   may be further aggravated by the inhalation of bacteria from the
   oral cavity causing further infection.

Question 35

Dental Caries

Answer 35

1. Dental caries (tooth decay) is the most common chronic
   disease among children, teenagers, and adults over 65.
2. Emphasis is now on preventing future caries not just
   dealing with already present decay

Question 36

Bacterial Infection

Answer 36

• Two specific groups of bacteria found in the mouth are responsible for dental caries
  1. Mutans streptococci (MS) (Streptococcus mutans)
  2. Lactobacilli (LB)
• They are found in relatively large numbers in dental plaque
• The presence of lactobacilli in the mouth indicates a high sugar intake

The oral cavity of a newborn does not contain MS. However, these bacteria are transmitted through contact with saliva (most frequently the mother’s saliva) to
the infant.

Mothers are the most common source of disease-causing MS because of the close and frequent contact that takes place between mother and child during the first few years. (kissing, sharing a spoon)

Question 37

Oral biofilm

Answer 37

1. Oral biofilm is a colorless, soft, sticky coating that adheres to the teeth
2. Oral biofilm remains attached to the tooth despite movement of the tongue, water rinsing, water spray, and less-than-thorough brushing
3. Formation of oral biofilm on a tooth concentrates millions of microorganisms on that tooth

Question 38

For caries to develop, three factors must be present at the same time

Answer 38

1. A susceptible tooth
2. A diet rich in fermentable carbohydrates
3. Specific bacteria (regardless of other factors, caries
   cannot occur without bacteria)

Question 39

Areas for Development of Caries

Answer 39

1. Pit-and-fissure caries occurs primarily on the occlusal surfaces and the buccal and lingual grooves of posterior teeth, as well as in the lingual pits of the maxillary incisors
2. Smooth surface caries occurs on intact enamel other than pits and fissures
3. Root surface caries occurs on any surface of the root
4. Secondary, or recurrent, caries occurs on the tooth surrounding a restoration

Question 40

Stages of Caries Development

Answer 40

1. Caries is an active, ongoing process characterized
   by alternating periods of demineralization and
   remineralization
2. Stage 1: caries begins to demineralize the enamel
3. Stage 2: development of cavity or lesion

Question 41

Dental Caries Process Stage 1

Answer 41

Demineralization is the first step in the dental caries process
The tooth surface will appear opaque, dull, and chalky-white

Question 42

Secondary (Recurrent) Caries

Answer 42

1. Form in the spaces between the teeth and margins of a restoration
2. Not easily seen, thus diagnosis is difficult
3. New restorative materials may prevent recurrent
   decay

Question 43

Root Caries

Answer 43

1. Occurs on the root of teeth that have gingival recession that exposes root surfaces
2. Becoming more prevalent and is a concern for members of the elderly population, who often have gingival recession, exposing the root surfaces
3. Older people often take medications known to reduce saliva flow, which contributes to caries

Question 44

Prevention of Root Caries

Answer 44

1. Thorough plaque removal with brushing and flossing
2. Nutritional counseling
3. Patient Education
4. In-office and/or prescription fluoride products (containing
   5000 ppm)Remineralization products that contain calcium phosphate
5. For patients with xerostomia, stimulate saliva with use of sugarless chewing gum or sugarless candies, or apply saliva substitutes, such as gels, sprays, or liquids
6. No one method will be ideal for all patients, so recommendations should be based on the individual patient’s needs and caries risk assessment.

Question 45

Early Childhood Caries

Answer 45

1. An infectious disease that can happen in any family
2. Tooth decay is the single most prevalent disease of childhood
   Risk Factors:
   a) Lower socioeconomic status
   b) Particular ethnic groups
   c) Limited access to dental care
   d) Lack of water fluoridation

Question 46

How Children get ECC

Answer 46

ECC is a transmissible disease
◦ Bacteria in the parent’s or caregiver’s mouth are passed to
the child
It is important for parents to keep their own teeth healthy to keep their children’s teeth healthy
Baby bottle tooth decay is another term for ECC

Question 47

Contributing Factors to ECC

Answer 47

1. Mother to the child, important for parents to keep their
   teeth healthy.
2. Allowing a child to sleep with a bottle there is an
   increased risk.
3. Avoid sugary and starchy foods.

Question 48

Erosion

Answer 48

Loss of tooth structure by a chemical process that does not include bacterial involvement.
* Chemical dissolution of the tooth by:
◦ Chronic vomiting
◦ Diet
◦ Idiopathic
* Tooth surface appears smooth, shallow, hard and shiny.

Question 49

The Importance of Saliva

Answer 49

• Physical protection involves a cleansing effect
  ◦ Thick, or viscous, saliva is less effective than a more
  watery saliva in clearing carbohydrates
• Chemical protection contains calcium, phosphate, and
  fluoride
• Antibacterial substances in saliva work against the bacteria
• If salivary function is reduced for any reason, the teeth are
  at increased risk for decay

Question 50

Antibacterial protection from Saliva

Answer 50

1. Provides calcium and phosphate for remineralization
2. Carries topical fluoride around the mouth for remineralization
3. Neutralizes organic acids produced in plaque biofilm Discourages the
   growth of bacteria, inhibiting infection
4. Recycles ingested fluoride into the mouth
5. Protects hard and soft tissues from drying
6. Facilitates chewing and swallowing
7. Speeds oral clearance of food

Question 51

Caries Assessment Systems

Answer 51

1. Collecting data helps the dentist to determine the
   treatment protocol
2. A dental health professional assesses an individual’s
   risk factors and protective factors, then determines
   the level of risk for caries
3. Not all patients are equally at risk
   An individualized preventive plan is developed based on
   the determined level of risk

Caries Management by Risk Assessment (CAMBRA)
◦ An evidence-based strategy for preventive and
reparative care for early dental caries that can be used
in any dental office
* Caries Risk Tests

Question 52

How to Control Tooth Decay

Answer 52

1. Diet: Limit quantities of sugary and starchy foods, snacks, drinks, and candy (three snacks per day).
2. Fluorides: Fluorides help make the tooth resistant to being dissolved by acids.
3. Remove plaque: Perform thorough brushing and flossing to remove plaque from all tooth surfaces.
4. Saliva: Saliva neutralizes acids and provides minerals and proteins that protect the tooth. After you have had a snack, chew some sugar-free gum to increase the flow of saliva and neutralize acids.
5. Dental sealants: Sealants are an excellent preventive measure to be placed on children and young adults who are at risk for decay.

Question 53

Contributing Factors for Dental Caries

Answer 53

Risk factors:
1. Tooth position and morphology
2. Fluoride
3. Oral hygiene
4. Genetics
5. Diet
6. Socioeconomic status
7. Xerostomia
8. High counts of cariogenic bacteria

Question 54

The following methods are used to detect dental caries, and each has specific limitations:

Answer 54

1. Dental explorer
2. Radiographs
3. Visual appearance
4. Indicator dyes
5. Laser caries detector
6. Optical Coherence Tomography (type of x-ray that allows you to see inside)
   The laser caries detector does not detect interproximal caries, subgingival caries, or secondary caries under crowns, inlays, or restorations

Question 55

Caries Prevention

Answer 55

1. Fluoride
2. Antibacterial rinses
3. Decrease fermentable carbohydrates
4. Increase salivary flow
5. Oral hygiene

Question 56

Periodontium consists of

Answer 56

The periodontium consists of tissues that surround the teeth and attach them to the jawbone. These tissues include:

Gingiva
Periodontal Ligament
Cementum
Alveolar Bone
Each tissue plays a vital role in maintaining the health and function of the periodontium.

Question 57

Gingiva role

Answer 57

Gingiva provides a protective seal around the neck of the tooth.

Question 58

Periodontal Ligament

Answer 58

Suspends and holds the tooth in its socket.

Question 59

Cementum

Answer 59

Anchors the periodontal ligament fibers to the tooth, keeping it in the socket.
Protects the root dentin.

Question 60

Alveolar Bone

Answer 60

Surrounds and supports the tooth roots.

Question 61

What is Periodontal Disease?

Answer 61

Periodontal disease (PD) is an infection that causes inflammation in the tissues surrounding the teeth. It affects the gums and damages the connective tissue and bone that hold the teeth in place. The disease is triggered by harmful bacteria that cause an inflammatory response in the body.

Question 62

Prevelance of Periodontal disease

Answer 62

Most adults suffer from periodontal disease.
Severe periodontitis affects 10-15% of any population.
In Canada, 21% of adults with teeth have experienced moderate or severe periodontal disease.

Question 63

Current Theory on the Cause of Periodontal Disease:

Answer 63

The host-bacterial interaction theory explains that while bacteria are necessary for PD to occur, they alone are not enough to cause the disease. The body’s response to bacteria plays a crucial role. Not everyone is equally susceptible to PD; some people are more at risk due to their body’s response to bacteria.

Question 64

Periodontal Disease Process:

Answer 64

Dental Plaque (Biofilm):
Bacteria in plaque are necessary for PD to start.

Host Response:
The body’s reaction to bacteria, known as the host response, leads to tissue damage.
The interaction between bacteria and the host response causes tissue destruction.
Understanding the difference between health, gingivitis, and periodontitis is essential.

Question 65

Types of Periodontal Disease:

Answer 65

Gingivitis:
The mildest form of PD causes gum inflammation without attachment loss.
Symptoms include red, swollen gums that may bleed but usually cause little discomfort.
Gingivitis is reversible with professional care and good oral hygiene.

Periodontitis:
A severe bacterial infection affects the gums, periodontal ligament, bone, and cementum.
The damage is irreversible, leading to periodontal pockets and tooth loss if untreated.
It starts as gingivitis and progresses when toxins from plaque cause a chronic inflammatory response, destroying tissue and bone.

Question 66

Forms of Periodontitis:

Answer 66

Aggressive Periodontitis:
Occurs in otherwise healthy patients.
Characterized by rapid attachment loss and bone destruction, often seen in families.

Chronic Periodontitis:
The most common form, leading to inflammation, attachment loss, and bone loss.
Prevalent in adults but can occur at any age, with slow but sometimes rapid progression.

Necrotizing Periodontal Disease:
Causes tissue and bone death.
Common in individuals with systemic conditions like HIV, malnutrition, and immunosuppression.

Question 67

Factors Affecting Periodontal Disease

Answer 67

Periodontal disease (PD) affects people differently. While bacteria in dental plaque are the main cause of PD, several other factors can make someone more likely to develop gingivitis or periodontitis or worsen existing conditions. These factors include systemic diseases, local issues in the mouth, and how the body responds to bacterial infections.

Question 68

Systemic Contributing Factors to Periodontal Disease

Answer 68

These are conditions or habits that make a person more prone to periodontal disease:

Tobacco Use: Smoking or chewing tobacco increases the risk of periodontal disease.

Diabetes: People with diabetes are more susceptible to gum infections.

Osteoporosis: This condition weakens bones, which can affect the jawbone supporting the teeth.

Psychosocial Stress: High-stress levels can impact oral health.

AIDS: This condition weakens the immune system, making gum infections more likely.

Systemic Medications: Some medications can affect oral health.
Hormone Changes: Hormonal changes during puberty, pregnancy, and menopause can increase the risk of periodontal disease.

Genetics: Some people may be genetically predisposed to periodontal disease.

Nutritional Deficiencies: Lack of essential vitamins and minerals can weaken the immune system, making it harder to fight infections. Obesity may also be linked to an increased risk of periodontal disease.

Age: Older adults are more likely to have periodontal disease, often due to cumulative damage over time.

Question 69

Local Contributing Factors to PD

Answer 69

These are conditions within the mouth that increase the risk of periodontal disease:

Dental Calculus: Hardened plaque on teeth can make it harder to maintain good oral hygiene.

Tooth Shape and Surface: Irregularities on teeth can trap plaque.

Untreated Tooth Decay: Cavities can increase the risk of gum disease.

Poor Oral Hygiene: Not brushing and flossing regularly allows plaque to build up.

Trauma from Occlusion: Misaligned bites can cause damage to gums and teeth.

Food Impaction: Food stuck between teeth can contribute to plaque buildup.

Parafunctional Habits: Actions like clenching or grinding teeth can harm the gums and teeth.

Faulty Restorations and Appliances: Poorly fitted dental work can cause irritation and plaque accumulation.

Mouth Breathing: Breathing through the mouth can dry out the gums, making them more prone to infection.

Tongue Thrust: Pressing the tongue against teeth can damage the gums

Question 70

Connection Between Periodontal Disease and Systemic Conditions

Answer 70

It’s now understood that inflammation, not just bacteria, links periodontal disease with other health conditions. Treating periodontal disease might help manage or reduce the risk of other chronic conditions like:

Cardiovascular Disease
Premature or Low Birth Weight Babies
Diabetes
Respiratory Disease
Chronic Kidney Disease
Rheumatoid Arthritis
Obesity
Cognitive Impairment
Osteoporosis
Understanding these connections helps in managing both oral and overall health more effectively.

Question 71

What are dental caries?

Answer 71

Dental caries, or cavities, are areas of tooth decay caused by acids produced when bacteria break down sugars from food. This decay starts as invisible damage but can progress to visible tooth damage, pain, and even tooth loss.

Question 72

How common are dental caries?

Answer 72

Dental caries are very common and preventable. Despite this, they remain a major issue, especially among children. Around 60-90% of school children worldwide and nearly 100% of adults have cavities. In Canada, the rate of dental caries increases with age, and those from lower-income families or who haven’t seen a dentist recently are at higher risk. Most adults also have a history of cavities.