Quiz 6

Question 1

What is the structure of an MMP?

Answer 1

Similar to that of Hemoglobin, has a metal cation center.

Question 2

What is the role of MMPs?

Answer 2

They degrade extracellular matrix molecules, neutralize bacteria, they participate in tissue destruction and alveolar bone loss.

Question 3

What are considered inhibitors of MMPs?

Answer 3

Tetracycline, Doxycycline

Question 4

What are the main products founds in crevicular fluid during periodontal disease process?

Answer 4

Alkaline phosphatase, IL-1 beta (genotype positive of this are at increased risk), beta-glucoronidase, IgG4, elastase, AAT, PGE2

Question 5

Where are arachidonic acid metabolites found in cells and when are they released?

Answer 5

They are found in the lipid bilayer membrane of cells and are released when the cells are damaged. Inflamed periodontal tissues posses high levels of PGE2 capable of inducing gingival inflammation and bone resorption. It is broken down by C3 convertase as well.

Question 6

What are some of the main activities involved with arachidonic acid metabolites?

Answer 6

Induces increased vasopermeability and
vasodilation leading to redness and edema.
Potent inducer of MMP secretion by monocytes and fibroblasts to trigger connective tissue destruction.
Osteoclast bone resorption is triggered by a synergistic action with IL-1 and TNF alpha to enhance the effects of these molecules.

Question 7

How are arachidonic acid metabolites markers for disease activity?

Answer 7

There is a 2-3 fold increase in gingivitis and periodontitis as compared to healthy. There is a 5-6 fold increase during active disease progression and attachment loss. GCF - PGE2 levels increase prior to attachment level changes and can be used as a screening test to predict future attachment loss.

Question 8

What are the two models that exist for hyperresponsiveness to PGE2?

Answer 8

1. Chronic infection and LPS exposure might lead to systemic elevations of TNF α, IL-1β and GM-CSF which are all capable of up- regulating monocyte PGE2 secretion
2. Alternatively there is extensive data which establish a genetic basis in the region of the HLA-DR region of chromosome 5 in the area of the TNFβ genes.

Question 9

What are lipoxins and are they pro or anti inflammatory?

Answer 9

They are arachidonic acids and they are anti inflammatory, don’t let neutrophils enter tissue. Omega 3 fatty acids and DHA can help with these.

Question 10

Which type of stress is the most important stress when it comes to periodontal disease?

Answer 10

Environmental Stress

Question 11

What are the 4 systemic modifications of periodontal disease status?

Answer 11

1. Host Stress
2. Physical Stress
3. Social Effectors
4. Environmental Stress

Question 12

What is Host Stress and which factors are involved?

Answer 12

These effects are mediated by the central nervous system (CNS) neuropeptides (eg, corticotropin releasing factor (CRF). CRF depresses lymphocyte function leading to inhibition of antibody secretion, and it also neutrophil action. CRF also up-regulates the release of IL-1 and TNF alpha by monocytes, so maybe both pro and anti inflammatory?

Question 13

What are the main cells that are actively getting into periodontal pocket space?

Answer 13

Neutrophils. Lymphocytes and macrophages should mainly stay in connective tissue. Fibroblast is #1 cell involved in destruction of connective tissue.

Question 14

What causes green pus to be green?

Answer 14

It is the myeloperoxidase.

Question 15

Why do mouth breathers usually have the most erythema and redness?

Answer 15

Because of lack of saliva, and lack of IgA which is found in saliva, and helps protect mucosal surfaces.

Question 16

What is the best way to preserve a ridge from where a tooth was?

Answer 16

Perform a debridement and go in and chemically clean it out.

Question 17

How far is it on average from the CEJ to the apex of the root?

Answer 17

About 12 mm

Question 18

What should the distance be between the crest of the bone and the CEJ (or most apical part of crown if there)?

Answer 18

Between 1 to 2 mm

Question 19

What is pemphigoid?

Answer 19

Pemphigoid is a rare autoimmune disorder that can develop at any age, but that most often affects the elderly. Pemphigoid is caused by a malfunction of the immune system and results in skin rashes and blistering on the legs, arms, and abdomen. Pemphigoid can also cause blistering on the mucous membranes of the eyes, nose, mouth, and vagina, and can occur during pregnancy in some women. There is no cure for pemphigoid, but there are many treatment options. It is seen by separation of epithelium from basement membrane. Stratum spinosum split from basement membrane.

Question 20

What is lichen planus?

Answer 20

Lichen planus (LP) is a disease of the skin and/or mucous membranes that resembles lichen. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. On an H&E stain, there is liquefaction and loss of basement membrane.

Question 21

What is a periodontal abscess?

Answer 21

A Periodontal abscess (also termed lateral abscess,[1] or parietal abscess),[1] is a localized collection of pus (i.e. an abscess) within the tissues of the periodontium. It is a type of dental abscess. A periodontal abscess occurs alongside a tooth, and is different from the more common[2] periapical abscess, which represents the spread of infection from a dead tooth (i.e. which has undergone pulpal necrosis). To reflect this, sometimes the term “lateral (periodontal) abscess” is used. In contrast to a periapical abscess, periodontal abscesses are usually associated with a vital (living) tooth. Abscesses of the periodontium are acute bacterial infections[3] classified primarily by location.
Odontogenic keratocysts look similar to these as well.
Definition: an acute, destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp.

Question 22

What is necrotizing ulcerative periodontal disease?

Answer 22

Necrotizing ulcerative periodontitis (NUP, or simply necrotizing periodontitis, NP) is where the infection leads to attachment loss (destruction of the ligaments anchoring teeth in their sockets), but involves only the gingiva, periodontal ligament and alveolar ligament. Usually this spectrum of diseases result in loss of attachment, and therefore many ANUG diagnoses may be technically termed NUP, although ANUG is the term in most common use. NUP may be an extension of NUG into the periodontal ligaments, although this is not completely proven. In the mean time, NUG and NUP are classified together under the term necrotizing periodontal diseases.

Question 23

When it comes to tools in periodontology, radiographs aid in the following 4 things:

Answer 23

1) Diagnosis in periodontal disease
2) Determination of the prognosis?
3) Treatment options
4) Evaluation of the outcome of treatment
They are an adjunct to the clinical examination, not a substitute for it.

Question 24

Without radiographic images, the clinician could not effectively evaluate the following 4 things:

Answer 24

1) Alveolar crestal bone architecture
2) Crown-to-root ratio/calculus presence
3) Possible vertical or furcation defects
4) Amount of horizontal bone loss

Question 25

What are the three basic intraoral radiographs to consider for assessment of bone status in patients with periodontitis?

Answer 25

1) Vertical bitewing
2) Horizontal bitewing
3) Periapical

Question 26

What type of suspected bone loss would be good to take horizontal bitewings?

Answer 26

Mild to Moderate horizontal bone loss. When properly positioned, the clinician should expect to see:

1. Superimposition of the buccal and lingual/palatal cusps 2. A sharp or well-defined alveolar crestal margin,
2. No horizontal “overlap” between adjacent teeth.
   - The bony crest is visible in both arches, but with a properly fitted horizontal bitewing, the crest is getting close to the bottom with the mandibular premolars.

Question 27

When are vertical bitewings useful?

Answer 27

Vertical bitewings are useful if the patient has demonstrated deep probing depths on clinical examination and the clinician expects the patient to have “moderate to severe” horizontal bone loss.

Question 28

With which is the osseous crest not visible? Horizontal or Vertical bitewing?

Answer 28

Horizontal bitewing

Question 29

What is the tendency that periapical radiographs have?

Answer 29

They tend to distort the distance between the alveolar osseous crest and CEJ compared to a bitewing.

Question 30

With a periapical radiograph, which technique is used to get the most realistic image to evaluate level of alveolar bone?

Answer 30

The long-cone paralleling technique.

Question 31

What types of measurements or things are periapical radiographs critical for?

Answer 31

Crown-to-root ratio, root morphology, periodontal ligament spaces, and periapical status.

Question 32

What does normal interdental septa look like radiographically?

Answer 32

It is a thin, radiopaque border at alveolar crest. The radiopaque line continues apically as alveolar bone proper and is termed “Lamina dura”. The shape of the interdental septum is a function of the morphology of the contiguous teeth. It appears angulated rather than horizontal when the crest of interdental bone is different than level of CEJ.

Question 33

What is the PDL space important in diagnosing?

Answer 33

Widening of the periodontal ligament (PDL) space is seen with occlusal trauma as well as vertical root fractures and progressive systemic sclerosis (scleroderma).

Question 34

True or False. Bone loss is usually greater than it appears on radiograph?

Answer 34

True. 30% of bone mineral density is lost before it is detected radiographically. Radiographs show amount of bone remaining rather than
amount lost. Radiographs do not indicate internal morphology / depth of crater-like defects (angular / vertical). Does not show extent of Facial / Lingual involvement

Question 35

What are the characteristics of furcation defects?

Answer 35

Loss of bone in the furcation areas of molar teeth may occur as a result of periodontitis, endodontic infection, root perforation during dental procedures, or occlusal trauma.
These changes are most readily seen in the mandibular molar region (because most mandibular molars have only two roots.
Note also the appearance of heavy calculus deposits. The roots of the first molar are relatively divergent, whereas the roots of the second molar are in close proximity.
Because most maxillary molars have three roots, early change in their furcation areas are more difficult to assess.
Loss of bone in the mesial and distal furcations of maxillary molars may present as a “furcation arrow”

Question 36

Where are cervical enamel pearls usually found and what can they lead to?

Answer 36

More common on maxillary third molars, then second molars, then first molars, and they can lead to bone loss.

Question 37

What does the radiography of a periodontal abscess look like?

Answer 37

The radiographic appearance of the periodontal abscess is generally a discrete area of radiolucency along the lateral aspect of the root.