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Perio Exam 2 > Sweep 2 > Flashcards

Sweep 2 Flashcards

1
Q

Gingival Disease Associated with Blood Dyscrasias

A

Leukemia-associated gingivitis

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2
Q

Leukemia-associated gingivitis

A

gingival lesions are primarily found in acute leukemia

reductions in dental plaque can limit the severity of lesion

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3
Q

Gingival Disease Modified by Nutrition

A

Ascorbic acid-deficiency gingivitis

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4
Q

Ascorbic acid-deficiency gingivitis

A

Malnourished individuals have a compromised host defense system which may make individuals susceptible to infectious diseases

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5
Q

Aggressive Periodontitis

secondary features

A

generally but may not be universally present

microbial deposits are inconsistent with the amount of periodontal destruction

elevated Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis
-As well as phagocyte abnormalities

phagocyte abnormalities

hyper-responsive macrophage phenotype (e.g., elevated levels of PGE2 and IL-1b

progression may be self-arresting

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6
Q

Localized Aggressive Periodontitis ——— onset

A

circumpubertal

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7
Q

LAP: ———– response to infecting agents

A

Robust serum antibody

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8
Q

LAP: Localized ————- presentation

A

first molar/incisor

interproximal attachment loss on at least 2 permanent teeth
one of which is a molar
involving no more than 2 teeth other than first molars and incisors

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9
Q

Generalized Aggressive Periodontitis:

Usually affects persons under —– but patients may be older

A

30

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10
Q

GAP: ———– response to infecting agents

A

Poor serum antibody

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11
Q

GAP: Pronounced

A

episodic nature of destruction of attachment and bone

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12
Q

GAP: Generalized interproximal attachment loss affecting at least

A

3 permanent teeth other than first molars and incisors.

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13
Q

Ehlers-Danlos syndrome (types IV & VIII)

autosomal dominant hereditary disorder

A

aggressive periodontitis (primary and permanent dentitions); fragility of gingiva, excessive hemorrhage

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14
Q

NPD early signs

A

Necrotic lesion of the papilla initially then progressing to gingival margin.
Punched-out appearance
Spontaneous bleeding
Pain

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15
Q

Advanced Lesion

A

Lack of deep pockets
Merging of papillary and marginal involvement
Characteristic foetor
Central necrosis results in crater formation
Involvement of periodontal ligament and alveolar bone (NUG  NUP)

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16
Q

Pericoronal

A

Localized, acute inflammation, vital pulp

Crown of partially erupted tooth

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17
Q

Ultrasonic perio probing

A

Ultrasonic periodontal probe uses a hollow tapered tip that is filled with water for coupling of the ultrasonic beam into the tissues (non-invasive)

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18
Q

Cone-beam Computed Tomography

A

CBCT is promising for periodontal applications, especially for intrabony defects, dehiscence and fenestration defects, periodontal cysts, furcation defects and thickness of palatal masticatory mucosa

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19
Q

Conventional radiographs (PA; Pano) are very

A

specific, but lack sensitivity

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20
Q

The sensitivity of a diagnostic test refers to the probability of the test being

A

positive when the disease is truly present

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21
Q

The specificity of a diagnostic test refers to the probability of the test being

A

negative when the disease is not present

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22
Q

Microbiologic testing:
Immunodiagnostic Methods
Use

A

Ab that targets specific
bacterial Ag
Direct and indirect

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23
Q

Immunodiagnostic methods:
immunofluorescent
microscopic assay (IFA)

A 
Able to identify pathogens 
   using a plaque smear
Used mainly to detect Aa and Pg
Comparable to bacterial culture
Does not require viable bacterial cells
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24
Q

IFA: used mainly to detect

25
Immunodiagnostic Methods: Cytofluorography (flow cytometry)
complexity and cost prevent its wide use
26
Immunodiagnostic Methods: | - Enzyme-linked immunosorbent assay (ELISA)
``` Used primarily to detect serum antibodies to periodontal pathogens Membrane immunoassay (EvalusiteTM): chairside use to detect Aa, Pg, and Pi (detection limit of 105 for Aa and 106 for Pg) ```
27
Immunodiagnostic Methods: | - Latex agglutination
Based on the binding of protein to latex: latex beads are coated with species-specific antibody Currently these assays only for research purposes
28
Enzymatic Methods | Several putative periodontal pathogens such as Pg, Tf, and Aa possess in common a
trypsin-like enzyme that hydrolyzes a substrate N-benzoyl-DL-arginine-2-naphthylamide (BANA).
29
Enzymatic methods Chair-side kit (PerioscanTM) was available in the 1990s Inability to distinguish between
individual bacteria - It may be positive at clinically healthy sites Negative result does not rule out the presence of other important periodontal pathogens
30
Molecular Biology Techniques | Analysis of
DNA, RNA, and structure or function of protein from target microorganisms
31
Nucleic acid probes
Synthesized and labeled DNA (20-30 nucleotides) Genomic DNA probe (whole DNA strand): significantly ↓ in sensitivity and specificity due to cross-reactivity to non-target microorganisms
32
16S rRNA –
oligonucleotide probes (high sensitivity and specificity) Checkerboard DNA-DNA hybridization Whole genomic digoxigenin-labeled DNA Up to 40 oral bacterial species in a single test Not been generalized for diagnostic purpose
33
PCR
High sensitivity and specificity for the identification of target pathogens PCR lower detection limit: 25-100 cells (Culture: 104-105 cells) Unable to quantify pathogens accurately in clinical samples
34
Real-time PCR
Real-time PCR: good correlation between the fluorescent signal measured and the number of bacterial cells been used Expensive and sophisticated technology in real-time PCR
35
Host-Derived Enzymes | Intracellular destruction enzymes
Possible markers of active periodontal destruction | Released from dead or dying PMN/Neutrophils from periodontium
36
Host-Derived Enzymes | Extracellular destruction enzymes
Associated with the activity of matrix metalloproteinases | Produced by inflammatory, epithelial and connective tissue cells
37
Aspartate aminotransferase (AST)
Periogard Periodontal Tissue MonitorsTM (chair-side test kit) A marked elevation in AST levels in GCF from sites with severe gingival inflammation Inability to discriminate between sites with severe inflammation with or without attachment loss - Aspartate amino-transferase: released during tissue destruction (cell death)
38
Alkaline phosphatase (ALP)
ALP in GCF are higher in diseased then healthy sites alkaline phosphate in disease. - Alkaline phosphatase: a membrane-bound glycoprotein involved in maintenance of alveolar bone
39
- β-glucuronidase:
a lysosomal enzyme degrades proteoglycans and ground substance β-glucuronidase (βG) Elevated βG in GCF from sites with severe periodontal disease High sensitivity and specificity when related to occurrence of clinical attachment loss Good predictor for future periodontal breakdown
40
- Elastase: a
proteolytic enzyme found in lysosomal granules of neutrophil Elastase Periocheck® (chair-side test kit) Positive correlation of elastase in GCF with clinical attachment loss
41
``` Matrix metalloproteinases (MMPs) Secreted by ```
fibroblasts and macrophages
42
MMPs: Responsible for
remodeling and degradation of ECM components
43
High MMP levels in GCF are at significantly greater risk for
progression of periodontitis
44
GCF MMPs level reduces in response to
treatment MMP-2 (gelatinase A), MMP-9 (gelatinase B), MMP-8 (collagenase 2), MMP-13 (collagenase 3), and MMP-3 (stromelysin-1) involve in the initial destruction of periodontal ECM
45
Destruction of collagen
The ECM of the periodontium is composed of collagen (predominant), proteoglycan (versican, decorin, biglycan, syndecan) and non-collagen proteins (elastin, fibronectin, laminin, osteocalcin, osteopontin, bone sialoprotein, osteonectin, and tenascin)
46
Elevated levels of =--------- can be found in the GCF from sites with periodontitis
hydroxyproline (breakdown from collagen), glycosaminoglycans (from matrix degradation) and osteocalcin & type I collagen (from alveolar bone destruction)
47
Bio-Plex Cytokine Assay
Incorporates novel technology using color-coded beads, permits the simultaneous detection of up to 100 cytokines in a single well of a 96-well microplate Are multiplex bead-based assays designed to quantitate multiple cytokines in tissue fluid including GCF
48
Salivary Occult Blood Test (SOBT) –
available in Japan A poor periodontal status: Subjects having ≥15% of teeth with BOP or ≥ 1 tooth with PD ≥ 4mm A paper strip containing gold-labeled anti-human hemoglobin monoclonal antibody was dipped into saliva sample (Positive: After swishing with three milliliters of distilled water for 10 seconds, the mixture is spit into a cup and the Perioscreen test strip is dipped into the saliva sample. The colloidal gold-labeled antibody dissolves in the salvia sample and if blood is present, an immune complex is formed and moves up the test strip by capillary action, resulting in a magenta line.
49
The SOBT may offer a simple screening method for periodontal status when a
thorough periodontal examination is not possible, although it is not sufficiently specific to be a reasonable substitute for a periodontal examination
50
Simplified Oral Hygiene Index (OHI-S): Purpose
To assess oral cleanlines by estimating the tooth surface covered with debris and/or calculus
51
Simplified Oral Hygiene Index (OHI-S): Components
Simplified Debris Index | Simplified Calculus Index
52
Simplified Oral Hygiene Index (OHI-S): Tooth selection
Facial surfaces of # 3, 8, 14, 24 | Lingual surface of # 19, 30
53
DI-S AND CI-S scores are calculated by
totaling the debris score of each surface and dividing by the number of surfaces examined
54
Plaque Index (PlI)
The PlI assesses the amount of plaque at the gingival margin, examining the same anatomical units as the GI Plaque scores range from {0} to {3} A probe is used to distinguish between scores {0} and {1}. Visible plaque is scored a {2} or a {3} The Pl-I is computed for a tooth, subject, or population It parallels the Gingival Index (GI) of Löe & Silness First published by Silness & Löe (1964)
55
Turesky Modification of Quigley-Hein Plaque Index
Score 0: No plaque Score 1: Spots of plaque at cervical margin Score 2: Thin, continuous band of plaque, £1 mm wide, at cervical margin Score 3: A plaque band >1 mm but <1/3 of crown height Score 4: Plaque covering ³ 1/3 but < 2/3 of crown height Score 5: Plaque covering ³ 2/3 of crown height
56
Turesky Modification of Quigley-Hein Plaque Index
In 1962 Quigley and Hein reported a plaque measurement that focused on the gingival third of the tooth surface. They examined only the facial surfaces of the anterior teeth, utilized a basic fuchsin mouthwash as a disclosing agent, and used a numerical scoring system of 0 to 5. Turesky and colleagues strengthened the objectivity of the Quigley-Hein criteria by redefining the scores of the gingival third area. Turesky-Gilmore-Glickman modification of the Quigley-Hein criteria is as following….
57
Turesky Modification of Quigley-Hein Plaque Index
The Quigley-Hein index is biased toward the gingival third of the tooth surface Facial and lingual surfaces are examined Plaque is made visible using a disclosing agent and scored using a {0} to {5} scoring system Scores are computed for subject, population It is the most frequently used plaque index in clinical trials Quigley & Hein (1962); Turesky et al. (1970) `
58
NIDR Calculus Index
0 Calculus is absent 1 Supragingival calculus, but no subgingival calculus is present 2 Supragingival and subgingival, or subgingival calculus only is present

Perio Exam 2 (20 decks)

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