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Periodontology > Spectrum of Perio Disease > Flashcards

Spectrum of Perio Disease Flashcards

1
Q

chronic periodontitis
what level in pedigree?
characterized by?

A

**II
infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss and bone loss

characterized by pocket formation and or gingival recession

variable in age and severity

most frequently occurring form of periodontitis

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2
Q

primary etological factor for periodontitis?

A

PLAQUE – initiator but HOST RESPONSE (inflammation mounted) are responsible for the MAJORITY of the loss we are seeing

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3
Q

clinical features and characteristics of chronic gingivitis?

what is a frequent finding in chronic periodontitis?

A

amount of destruction is consistent with the presence of local factors

slow to moderate rate of progression but can have periods of rapid progression

subgingival calculus is a common finding

most prevelant in adults, but can occur in children and adolescents

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4
Q

severity / destruction of perio is consitant with what?

A

the presence of local factors

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5
Q

how is chronic perio modified? what can it be associated with?

A

associated with – local predisposing factors (tooth -related or iatrogenic factors)

  • modified/associated with systemic diseases like diabetes or HIV infection
  • factors like smoking and emotional stress can also modify this
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6
Q

biggest environmetnal factor for perio?

A

SMOKING

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7
Q

Extent and severity in chronic perio characterized by what two things?

A

localized or generalized

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8
Q

localized?

A

if less than or equal to 30% of sites affected

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9
Q

generalized

A

if more than 30% of the sites are affected

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10
Q

refractory perio or recurrent perio?

A

cannot separate these but recurrent = represents a return of periodontitis and is NOT a separate disease entity

refractory = for identifiable and non-identifiable reasons, bot all cases of perio have successful tx outcomes

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11
Q

severity is categorized by?

A

basis of the amount of clinical attachment loss

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12
Q

levels of CAL

correlated to?

A

correlated to the CEJ

slight = 1- 2mm of CAL

moderate = 3-4 mm of CAL

severe = >or equal to 5mm CAL

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13
Q

aggressive perio AKA

A

early-onset perio

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14
Q

describe localized aggressive perio

A

*attachment loss usually in first molar and incisor

  1. circumpubertal onset
  2. robust serum antibody response to infecting agent s
  3. localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth, one of which is a first molar, and involving no more than two teeth other than first molars and incisors
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15
Q

generalized aggressive perio

A
  1. usually affecting persons under 30 yesrs of age, but patients may be older
  2. poor serum antibody response to infecting agents
  3. pronounced episodic nature of the destruction of attachment and alveolar bone
  4. generalized interproximal attachment loss affecting at least three permanentn teeth other than first molars and incisors
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16
Q

category of aggressive perio?

A

Category III

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17
Q

aggressive perio term replaces what?

A

early onset periodontal disease / localized juvenile/ generalized juvenile

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18
Q

what separates aggressive perio from chronic?

A
  1. except for presence of periodonitis; patients are otherwise clinically healthy in aggressive
  2. rapid attachment loss and bone destrcution
  3. familial aggregation
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19
Q

secondary aggressive perio features

A
  1. microbial deposits are inconsistent with severity of perio tissue destruction
  2. elevated levels of AGGREGATIBACTOR ACTINOMYCETEMCOMITANS and in some populations porphyromonas gingivalis may be elevated
  3. phagocyte abnormalities
  4. hyper-responsive macrophage phenotype including elevated levels of PGE2 and IL-1b
  5. progression of attachment loss and bone loss may be self-arresting
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20
Q

primary ‘culprite’ for localized aggressive perio?

A

elevated levels of AGGREGATIBACTOR ACTINOMYCETEMCOMITANS and in some populations porphyromonas gingivalis may be elevated

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21
Q

T/F all characterisitcs must be present to asign a diagnosis or classify the disease?

A

FALSE

- diagnosis may be based on clinical, radiographic, and historical data

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22
Q

category IV is?

A

periodontitis as a MANIFESTATION OF SYSTEMIC DISEASE

  • usually cannot mount a response to the bacteria present and destruction is due to bacteria having ‘free range’
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23
Q

3 characteristics/groups of perio as manifestation of systemic disease

A

A) associated with hemtological disorders

B) Associated with Genetic disorders

C) non-otherwise specified

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24
Q

Associated with hematological/ blood disorders in perio as manifestation of systemic disease

A
  1. acquired neutropenia
  2. leukemia
  3. other
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25
Q

acquired neutropenia

A

lower white blood cells so low levels of PMN’s and are first responders - so if do not have bacteria invade

rare and is an autoimmune against neutrophil-specific

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26
Q

Leukemia

A

white blood cells are immature

so immature cells cannot manifest response

ulceration and necrosis

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27
Q

what is common between all these?

A

all have or are characterized as severe periodontitis – manifestations same

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28
Q

perio associated with genetic disorders?

A

look at slide and know these manifest the same but causes are different

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29
Q

normal neutrophil cound

A

5000-10,000 cells/mm3

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30
Q

neutropenia level od wbc’s

A

less than 2,000 cells/mm3

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31
Q

agranulocytosis level

A

less than 500 cells/mm3

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32
Q

Leukpocyte Adhesion Deficinecy

A

not producing the adhesion but have plenty of white blood cells - cant deal with bacterial inection

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33
Q

Trisomy 21

A

associated with severe periodontitis

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34
Q

Papillon Lefevre syndorm

A

palmar/ plantar keratosis – LARGE calices that form on hands and feet and severe periodontal destruction and starts in primary and can effect the permanent

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35
Q

familial chronic benign neutropenia

A

disroder of inheretence in decreased neutrophul count, but overall low risk of infection

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36
Q

cyclic neutropenia

A

disease of unknown etilogy characterized by a regular 7-day period of depressed neutrophil count

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37
Q

oral manifestations of congenital neutropenias include?

A

oral mucosa ulceration, severe gingivitis, and periodontitis that can affect both primary and permanent dentitions, leading to premature exfoliation of teeth

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38
Q

Ehler’s danlos syndrome

types that are susceptible to perio?

A

connective tissue disorder that are characterized by defective collagen synthesis

articular hypermobility, dermal hyperplasticity, and widespread tissue fragility

types IV and VIII have increased

  • fragile oral mucosa and blood vessels
  • clinical appearance of generalized early-onset periodontitis, leading to premature loss of permanent teeth
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39
Q

category V?

A

necrotizing periodontal disease

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40
Q

breakdown of necrotizing periodontal disease?

A
  1. nectrotizing ulcerative gingivitis (NUG)
  2. Necrotizing ulcerative periodontitis (NUP)

decrease in host response
only difference is difference b/w gingivitis and perio
- loss of attachment levels differs

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41
Q

general description of necrotizing periodontal disease

A

acute, necrotizing (causing tissue death), ulcerating (causing open sores) form of gingivitis

also causes pain in the affected ares
fever and fatigue may be present

pain can become very bad and eating and swallowing become difficult - inflammation and infection can spread to nearby tissues of the face and neck

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42
Q

main cause of necrotizing periodontal disease

A 
1. frequent poor oral hygeine = main cause 
also
- stress
- unbalance diet
- lack of sleep
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43
Q

are NUG and NUP separate disease categories?

A

NO

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44
Q

only difference b/w NUG and NUP?

A

NUG - limited to gingiva

NUP- there is attachemnt apparatus loss

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45
Q

describe NUP

A

see attachment loss **

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46
Q

describe NUG

A
  1. gingival necrosis presenting as ‘punched-out’ papillae with gingival bleeding and pain

bad breathe and pseudomembrane formationo can be present

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47
Q

describe NUG

A
  1. gingival necrosis presenting as ‘punched-out’ papillae with gingival bleeding and pain

bad breathe and pseudomembrane formation can be present

fusiform bacteria, prevotella intermedia, and spirochetes have been associated with gingival lesions

predisposing factors = emotional stress, poor diet, cigarette smoking and HIV infection

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48
Q

describe NUP

A

see attachment loss **
necrosis of gingival tissues, periodontal ligament, and alveolar bone

these lesions are most commonly observed in individuals with systemic conditions like HIV infection, severe malnutrition, and immunonsupression

could be result or sequel of single or multiple episodes of NUG or may be result of the occurence of necrotizing disease at a previously periodontitis-affected site

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49
Q

category VI?

A

Periodontal Abscess

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50
Q

Periodontal Abscess

A
  1. primarily based on location of the infection
  2. can be associated with pain, swelling, color change, tooth mobility, extrusion, purulence, sinus tract formation, fever, radiolucency to affected bone, lymphadenopathy
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51
Q

classification of Periodontal Abscess and the three categories

A

primarily based on location of the infection

  1. gingival abscess
  2. periodontal abscess
  3. pericoronal abscess
52
Q

definition of abscess

A

localized purulent inflammation of the periodotnal tissues.
also known as lateral periodontal abscess or parietal abscess

can be acute or chronic

53
Q

acute abscesses

A

are painful, edematous, red, shiny, ovoid, with elevations on gingival margin and/or attached gingiva – after the purulent is partially exuded – become chronic

54
Q

chronic abscess

A

may produce dull pain and may at tImes can become acute again

55
Q

What would you call a localized purulent infection that involves the marginal gingiva or interdental papilla?

A

acute gingival abscess

56
Q

periodontal abscess
occur with?
more common in?

A

a localized purulent infection within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone

occur with pre-existing periodontitis – and the acute infection occurs in the walls of the periodontal pockets as a result of the invasion of bacteria into the periodontal tissues

more common in patients with systemic disease like diabeted, where there is already a reduced ability to combat infections

57
Q

T/F abscess can occur a few days after dental cleaning as a result of mechanical disruption of junctional epithelium, allowing the bacteria to gain entrance into the tissues

A

TRUE

58
Q

bacteria composition of periodontal abscess - general

A

bacteria in abscess are similar composition to what is found in periodontal pockets

they are termed ‘mixed anaerobic infections” due to the microbial findings

59
Q

tx of perio abscesses

importance

A
  1. purpose of acute = alleviate pain, control spread of infection and to establish drainage
  2. drainage – established through the pocket or by means of an incision from the outer surface

they are very destructive! so if not treated promptly = can result in irreversible damage to surrounding periodontium and can cause exfoliation of the tooth

remove pocket lining and thoroughly scale and root planing to remove plaque and calculus adhering to the root surface

antibiotics will be helpful

guided tissue regeneration / osseous surgery may be indicated as recurrence of abscess can occur

60
Q

tx of choice for chronic perio abscess

A

by a flap procedure

61
Q

pericoronal abscess

A

a localized purulent infection within the tissue surrounding the crown of a partially erupted tooth

62
Q

pericoronal abscess symptoms

A

painful, swollen, gingival tissue in the area of the affected tooth - can be difficult to bite down confortably without catching the swollen tissue between the teeth

bad smell
discharge of pus

63
Q

common cause/ location of pericoronal abscess

A

partial eruption of a 3rd molar can create a flap of soft tissue adjacent to the tooth

the flap can trap food particles and debris and can turn into a nidus of infection

64
Q

Pericoronal abscess treatment

A

usually surgically removed after a course of antibiotic therapy in order to prevent painful episodes

note the retromolar mass tissue granulation

65
Q

category VII?

A

Periodontitis in combination with endodontic lesions

66
Q

perio-endo lesions -general

A

lesions due to inflammatory products found in varying degrees in both periodontium and the pulpal tissues

both tissues are ectomesenchymal in origin and anatomical connections remain through development

NOT based on initial etiology - but just indicated there is BOTH periodontic and ann endodontic component

67
Q

explain how perio-endo lesions occur?

A

tubular communication between the pulp and periodontium may occur when dentinal tubules become exposed to the periodontium by the ABSENCE OF OVERLYING CEMENTUM

  • these are the pathways that provide pathological agents to pass between tghe pulp and periodontium
68
Q

clinical findings of perio in combination with endodontic lesions

A

infections of perio or endo origin may result in increased periodontal probing depths adjacent to the root surface, swelling, bleeding on probing, suppuration, fistular formation, tenderness to percussion, increased tooth mobility, angular bone loss, and pain

69
Q

symptoms in perio in combo with endo lesions usually due to what?

A

plaque-associated periodontitis which begins at the margin of the gingiva and spreads apically

70
Q

how does the endo lesion show the clinical signs of perio in combo with endo lesion?

A

by the endodontic infections that enter the periodontal ligament AT APICAL FORAMEN or through lateral or accessory CANALs and proceed CORONALLY

71
Q

treatment / resolution to perio in combo with endo lesion?

what does this not help?

A

endodontic therapy may lead to complete resolution UNLESS the signs and symptoms are due to root fracture

72
Q

prognosis of perio-endo lesions

A

usually poor/ hopeless if true combined lesion especially if perio lesions extensive with a lot of attachment loss

Pallative perio tx and RCT carried out – then root amputation, hemisection, or separation may allow root configuration to be changed for saving the tooth ; perio surgery

prognosis could be increased with bone grafts or guided tissue regeneration - but these decision based on tooth response to other conventional tx

73
Q

I-VIII classification of periodontal diseases

A 
I-
II- 
III-
IV
V
VI
VII
VIII
74
Q

category VIII

A

Development or Inherited Conditions

75
Q

Development or Inherited Conditions breakdown (4)

A

A- localized tooth-related factors that modify or predispose to plaque-induced gingival disease/periodontitis
B- Mucogingival deformities and conditions around teeth
C- Mucogingival deformities and conditions on Edentulous ridges
D- occlusal trauma

76
Q

localized tooth-related factors that modify or predispose to plaque-induced gingival disease/periodontitis

A

part of classification of VIII- development or inherited conditions

  1. tooth anatomic factors
  2. dental restorations or appliances
  3. root fractures
  4. cervical root resorption and cemental tears

tooth related factors (that can bea result of a tooth tx) may contribute to the initiation of periodontal disease

77
Q

what do localized tooth-related factors that modify or predispose to plaque-induced gingival disease/periodontitis etiology

A

etiology STILL BACTERIAL - factors that enhance bacterial accumulation or allow the ingress of bacteria into the periodontium should be considered in the classification of perio disease

more site specific problems that require tx in an otherwise intact periodontium

78
Q

localized tooth-related factors that modify or predispose to plaque-induced gingival disease/periodontitis seperate disease entitiy?

A

NO - but may serve as localized predisposing and/or modifying factors in the onset or progression of plaque-induced gingival diseases and periodontitis

CONDITIONS CAN BE RELEVANT TO ANYOF THE GINGIVAL OR PERIO CLASSIFICATIONS

79
Q

cervical enamel projections and enamel pearls are?

A

associated w/ tooth anatomy that have been associated with attachment loss in molar furcation areas

tooth anatomic factors associated with localized tooth-related factors that modify or predispose to plaque-induced gingival disease/periodontitis - which is classification of Category VII (Development or inhereted conditions)

80
Q

cervical enamel projections - describe

A

flat, ectopic deposits of enamel apical to the normal CEJ level in molar furcation areas

these enamel deposits usually have a triangular shape and a tapering form , extending apically into the furcation areas

81
Q

enamel pearls - describe

A

larger, spheroid -shaped ectopic deposits of enamel that can also located at furcation or other root surfaces of molars

82
Q

percentage and location of cervical enamel projections

A

approx. 15-24 % of mandibular molars and 9-25% of maxillary molars have cervical enamel projections

most likely to be found on buccal surfaces o second molars

83
Q

percentage and location of enamel pearls

A

between 1-5.7% among all molar teeth with maxillary third molars most frequently affected

mandibular third and maxillary seconf molars are next most common areas

less frequent = maxillary first and mandibular second

84
Q

what is strongly assocaited with cervical projections and enamel pearls?

A

presence of furcation involvement

  • due to the fact that when present in their locations- prevents connective tissue attachment - so predisposed to periodontal breakdown in these areas – a contributing etiologic factor in tissue breakdown at furcation sites
85
Q

furcation anatomy and location?

classification of perio disease?

A

extension of inflammation apically and horizontally

do NOT require special consideration in classification of periodontal diseases

86
Q

tooth position

A

position or inclination can be factors that predispose the periodontium to plaque accumulation and subsequent inflammation

** if meticulous oral hygein and maintaing good oral health is essential if do not want the increased effect

87
Q

root proximity? risk factor?

A

proximity of the roots of adjacent teeth is widely held as a risk factor for development of periodontal disease

impedes on professional and self-preforming plaque-removal – so enhances gingival inflammation

the volume of connective tissue and bone is reduced in these areas where root proximities are closer – so inflammtion can more easily cause destructive harm

no scientific evidence * but with ortho – showed no predisposition to more rapid peridontal breakdown

88
Q

bony septum in root proximity?

A

the bony septum between the teeth are VERY NARROW or absent – inflammation spreading into this area may rapidly produce a deep pocket

89
Q

open contacts? implication?

A

the contact provides for proper mastication and defelction of food AWAY from the interdental space – so when weak or absent - food impaction is likely

90
Q

etiologic factors for open contacts?

A

occlusal wear, interproximal bone and attachment loss, supereruption of teeth, tooth abnormalities, and poor restoration of interproximal contacts

91
Q

example of root abnormalities?

A

GROOVES

*palato-gingival

92
Q

palato-gingival grooves

A

developmental abnormalities seen primarily in maxillary incisor teeth

usually begin on the crown near central fossa and extend apically for varying distances and directions

can IMPEDE the removal of plaque and allow plaque microorganisms access to the subgingival area – many instances periodontal attachment and bone loss can be seen at these sites

93
Q

proximal root grooves

A

found on incisor and maxillary premolars –
associated with POORER PERIODONTAL HEALTH including loss of attachment and bone

*grooves can be on any tooth surface

94
Q

restorative resorations or appliances

A

subgingival margin discrepancy for onlays, crowns, fillings, and ortho bands can negatively influence the health of adjacent gingival tissues

95
Q

implications of restorations violating the biological width?

Reaction of periodontium?

A

can cause an inflammatory response that may result in loss of bone, connective tissue attachment, and migration of the epithelial attachment

Attempt in the periodontium to reestablish the normal dimensions of the dentogingival junction by a process of osseous resorption which leads to chronic inflammaiton and periodontitis

96
Q

severity of marginal discrepancy time present?

A

the time it is present influences the amount of damage to the periodontium and the ability of patients to maintain the areas free of plaque correlates

97
Q

effects of restorative material

A

hypersensativity reaction/ allergies common to some metals and acrylics which can cause damage to the periodontium from the hypersensativity reaction

98
Q

crown fractures implications on perio disease?

A

fractures of the tooth crown have NOT been shown to pose a risk for development of periodontal disease, unless the fracture enhances plaque accumulation

99
Q

root fractures implication

A

vertical root fracture exists = common spot for an accompanying periodontal lesion.

these lesions are often difficult to distinguish from other types of endodontic or periodontal lesions

100
Q

definition of cemental tears and relationship to perio

A

areas of the root surface cementum that have become either completely or partially detached

perio lesion that develops is a result of the growth f oral or sulcular bacteria within the cervical portion of a fracture line or cemental tear

inflammation from this causes loss in structures of the periodontium (PDL, alveolar bone, cementum - connective tissues

101
Q

external root resorption

A

problem for perio if it is located CORONALLY on the root. – get communication between oral environment and area of resoprtion and bacteria can penetrate

102
Q

Mucogingival deformities and conditions around teeth are part of what category?

A

Category VIII - Development or Inherited Conditions (part B)

103
Q

mucogingival

A

a term used to describe that portion of the oral mucosa that covers the alveolar process including the gingiva (keratinized) and the adjacent alveolar mucosa

104
Q

mucogingival deformity definition and implications

A

departure from the normal dimension and morphology of the interrelationship between gingiva and alveolar mucosa – deformity can be associated with a deformity in the underlying bone

implications on pt. esthetics and function and can be congenital, developmental, or acquired defects

105
Q

clinical appearance of the gingiva and thickness requirements exist?

A

previously it was believed that there had to be a certain width of attached gingiva for proper health - but today it is thought that there is no absolute minimum is required as long as hygeine practice is adequate

average thickness = 1.41mm

106
Q

perio ‘biotypes’ and what is the major factor that determines which

A
  1. thin/scalloped
  2. thick/flat

these refer to the actual consistency / thickness of he gingiva tissue and underlying bone as well as the forms of the surrounding tissues

shape of tooth is major determining factor

107
Q

triangular shaped tooth what perio biotype/form?
square tooth?
which is more susceptible to gingival recession?
which is more susceptible to periodontal pocketing?

A

trinagular – thin scalloped form

square – thick/flat form

*THIN TISSUE TYPE = more susceptible to gingival recession (especially on the anterior teeth)

**THICK TISSUE TYPE= more susceptible to perio pocketing

108
Q

defintion of gingival recession

A

location of the gingival margin apical to the cemento-enamel junciton

commonly seen on the buccal or lingual surfaces, but can be interproximal as well

109
Q

mucogingival therapy

A

non-surgical and surgical correction of defects in morphology, position, and/or amount of soft tissue and underlying bone

110
Q

periodontal plastic surgery

A

surgical procedures performed to prevent or correct anatomical, developmental, traumatical or plaque disease-induced defects of the gingiva, alveolar mucosa, or bone

111
Q

biological width compromised of? refers to?

A

this is the optimal distance between the free gingival margin to the osseous crest of bone, which with normal conditions should be 3MM

all is kerainized tissue
non-attached /free gingiva = SULCUS

EPITHELIAL ATTACHMENT - junctional epithelium (1mm) is second part

CONNECTIVE TISSUE ATTACHEMNT (1-2mm)

112
Q

proper width between CEJ and bone?

A

1mm – should always be this for proper gingival attachment – and this is altered when there is attachment loss

113
Q

non -attached space aka
called in health?
called in disease?
Measures?

A

less than equal to 3,, dimensions w/ sulcular epithelium
SULCUS = health
clinical X = 1.8

POCKET = DISEASE
if greater than or equal to 3mm

114
Q

Mucogingival deformities and conditions on edentulous ridges is part of what category?

A

Category VIII– Development or Inherited Conditions breakdown

third part of this category

115
Q

Trauma from Occlusion is part of what category?

A

Category VIII– Development or Inherited Conditions breakdown

fourth part of this category

116
Q

force is known as what type of quantity? definition

A

VECTOR quantity- associated with an interaction

push or pull acting upon an object as a result f its interaction with another object
*a force is an interaction that causes acceleration / or change

SI units is Newtons

117
Q

A force has? (4 components)

A
  1. Duration
  2. Intensity/ Magnitude
  3. Frequency
  4. Direction

can also thing about distribution – like how many teeth are receiving the force

118
Q

occlusal trauma

A

during function, OCCLUSAL FORCES are generated and transmitted to the attachement apparatus (PDL, bone, cementum) of the teeth which are capable of dissipating these forces

119
Q

traumatogenic occlusion>

A

forces are generated with EXCESSIVE duration, intensity, frequency or direction that exceed the adaptive capacity of the supporting structures of the teeth and pt’s can experience constant pain or discomfort upon biting

120
Q

primary occlusal trauma

A

an injury resulting from application of excessive occlusal forces acting upon a tooth or teeth with normal periodontal support

Under excessive occlusal load bt otherwise healthy intact periodontium so NO LOSS OF GINGIVAL CONNECTIVE TISSUE OR APICAL MIGRATION OF EPITHELIAL ATTACHMENT
NO POCKET
NO CA LOSS

121
Q

secondary occlusal trauma

A

effect of excessive OR NORMAL occlusal forced causing an injury to the attachment apparatus of a tooth or teeth with REDUCED PERIODONTAL SUPPORT

PRESENTS WITH INCREASING MOBILITY WITH BONE LOSS – with alreay reduced periodontal attachment levels and apical migration

remaining periodontium is no longer able to support the tooth without the presence of mobility, migration, or fremitus under normal occlusal loads

122
Q

radiographic changes consistent with occlusal trauma

A
  1. widening of the crestal portion of the PDL space
  2. irregular widening of the entire PDL space
  3. if periodontitits – vertical or angular bone resoprtion and radiolucencies in furcation areas

more extreme cases = resorption of alveolar bone or root resorption can be demonstrated

123
Q

funneling of crestal PDL space is radiographic sign of?

A

occlusal trauma

124
Q

widening of PDL is radigraphic sign of?

A

occlusal trauma

125
Q

occlusal trauma implication on periodontal disease?

A

does not cause any CAL or initiate gingivitis or convert gingivitits to periodontitis BUT OCCLUSION MAY PLAY A SECONDARY ROLE IN THE PROGRESSION OF PERIODONTAL DISEASE

Periodontology (20 decks)

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