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Perio Exam 2 > Sweep 2.3 > Flashcards

Sweep 2.3 Flashcards

1
Q

Chronic perio Symptoms

A
  • Mostly painless
  • Localized dull pain
  • Gingival tenderness, ‘itching’ gums
  • Loose teeth
  • Food impaction
  • Drifted teeth/ increased spacing • Root sensitivity
  • Bleeding gums
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2
Q

Chronic perio severity

A 
Slight
• 1-2mm Aloss
• Moderate
• 3-4 mm Aloss
• Severe
• 5mm or more of Aloss
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3
Q

• Risk determinant: non-modifiable factors •

A

Age

• Gender

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4
Q

Risk indicators:

A

putative risk factors that have been identified in cross sectional studies but not confirmed longitudinally
• HIV/AIDS
• Osteoporosis
• Infrequent dental visits

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5
Q

Risk markers/predictors:

A

a characteristic associated with elevated risk for disease but may not be part of the causal chain
• Furcation involvement
• Calculus
• History of attachment loss

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6
Q

gingivitis and CP are

A

different aspects of the same disease

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7
Q

Severe Periodontitis =

A

6th most prevalent disease in the world

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8
Q

CP treatment: Sites with initially shallow pockets tend to

A 
lose CAL (possible trauma)
• Critical probing depth (Lindhe) - probe depths less than which root planing will cause attachment loss (2.9mm
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9
Q

Greater risk for additional attachment loss if presenting multiple sites with residual probing depth

A

6 mm after active treatment

• Bottomline - You cannot maintain 6 mm pockets; surgical therapy recommended

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10
Q

Mucocutaneous disorders:

A 
1- Lichen planus
2- Pemphigoid
3- Pemphigus vulgaris
4- Erythema multiforme
5- Lupus erythematosus
6- Drug-induced mucocutaneous disorders
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11
Q

Lichen planus

A

Oral involvement alone is common.
Prevalence=0.1-4%; any age but rare in children > a premalignant potential (0.5-2%).
> Characteristic skin lesions (Wickham striae).

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12
Q

Lichen planus clinical appearance

A

[papular, reticular, plaque-like, atrophic, ulcerative, bullous]

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13
Q

Papula=

A

a small, inflammatory, congested spot on the skin; a pimple

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14
Q

Reticular=

A

Mesh; in the form of network

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15
Q

Plaque=

A

A patch on the skin or on a mucous surface Atrophy= A wasting; a decrease in size of tissue

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16
Q

Ulcerative=

A

Affected with an ulcer; open sore or lesion of the skin or mucosa accompanied by sloughing of inflamed necrotic tissue

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17
Q

Bulla=

A

A large blister or skin vesicle filled with fluid

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18
Q

Papular, reticular, plaque-like forms… generally

A

asymptomatic

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19
Q

Atrophic, ulcerative, bullous forms… generally

A

symptomatic

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20
Q
  • subepithelial,band-like accumulation of
A

lymphocytes and macrophages characteristic of a type IV hypersensitivity reaction.

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21
Q

Oral Lichenoid Lesions

A

An uncertain background
Examples: lesions in contact with dental restorations
lesions associated with various types of medications (NSAIDs, diuretics, beta-blockers etc)
a group of systemic diseases (liver disease)
Treatment:
Take biopsy (handling is different than regular biopsy) Take sample for culture if questioning candida inf
(about 38% of OLP cases have secondary inf)
A traumatic dental plaque control
Topical corticosteroids to control pain, discomfort

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22
Q

Pemphigoid

A group of disorders in which

A

autoantibodies towards components of the basement membrane result in detachment of the epithelium from the connective tissue

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23
Q

Pemphigoid: Histology:

A

Autoantibody reactions against hemidesmosome and

lamina lucida components.

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24
Q

Pemphigoid: ————– may be involved in the pathogenesis.

A

Complement-mediated cell destructive processes

25
Q

Nicholsky sign

A

[Rubbing of the gingiva creates bulla formation]

26
Q

Pemphigoid: Three types:

-

A

Bullous

- Benign Mucous Membrane - Cicatricial (Scar formation)

27
Q

Pemphigus vulgaris

A

Formation of intraepithelial bullae in skin and
mucous membranes.
Strong genetic background (Jewish and Mediterranean)
Painful desquamative lesions, erosions or ulcerations. Chronic course with recurrent bulla formation. Typically in middle age or elderly

28
Q

Pemphigus vulgaris: Histo:

Acantholysis

A

(due to destruction of desmosomes)

Pericellular epithelial deposits of IgG and C3.
Circulating autoantibodies against interepithelial adhesion molecules

29
Q

Erythema multiforme

A

Acute, sometimes recurrent, vesiculobullous disease affecting both mucous membranes and skin.
Oral involvement occurs as much as 25-60% of cases. Swollen lips often with extensive crust formation of the
vermilion border.
Bullae that rupture and leave extensive ulcers.
Characteristic skin lesions (iris appearance+bullae). Extensive necrosis: Stevens-Johnson syndrome
(oral, ocular, genital, skin) May occur at any age but mostly young individuals.

30
Q

Erythema multiforme of palatal mucosa

A

appears to be a cytotoxic immune reaction towards keratinocytes precipitating by a wide range of factors including herpes simplex virus and various drugs.
Histopathology is not specific.

31
Q

Erythema multiform treatment

A

Treatment: Plaque control, Local/systemic

32
Q

Lupus erythematosus-

A

Autoimmune connective tissue disorders in which autoantibodies form to various cellular constituents.
Central atrophic area with small white dots surrounded by irradiating fine white striae with a periphery of telangiectasia
(vascular lesion formed by dilatation of a group of small blood vessels).
Lesions can be ulcerated and cannot be differentiated from leukoplakia or atrophic oral lichen planus.
Together with characteristic skin lesions (butterfly).

33
Q

Lupus erythematosus- histo

A

Histology:
Degeneration of basal cells and increased width of the basement membrane.
Deposits of various Ig.s, C3 and fibrin along the basement
membrane.

34
Q

Atrophic gingival discoid lupus erythematosus

A

Degeneration of basal cells and increased width of the basement membrane.
Deposits of various Ig.s, C3 and fibrin along the basement membrane.

35
Q

Drug-induced

mucocutaneous disorders

A

Gingival hyperplasia (enlargement) Erythema multiforme
Oral ulceration
Epithelial atrophy, superficial sloughing Intense erythema

36
Q

Gastro-intestinal diseases

A

Crohn’s disease: Chronic granulomatous infiltrates
of the wall of gastrointestinal tract.
[Mucosal folding/ defective neutrophil functions]

37
Q

Hematological disorders

Leukemia

A

Leukemia: A malignant hematological disorder with abnormal proliferation and development of leukocytes and their precursors in the blood and bone marrow.

Swelling, ulceration, petecchia and erythema of
gingiva.
69% of patients with acute leukemia had oral signs of leukemia.

38
Q

PERIODONTAL TUMORS AND CYSTS

Different tumors/cysts may have the appearance of

A

gingivitis/periodontitis

39
Q

Reactive processes of periodontal soft tissues:

Fibroma/ focal fibrous hyperplasia:

A

► A focal fibrous hyperplasia caused by irritation. ► Sessile, well-circumscribed smooth-surfaced
nodules.
► Cell-poor, hyperplastic collagenous tissue. ► May show hyperkeratinization.
► Differential diagnosis: Giant cell fibroma.

40
Q

Reactive processes of periodontal soft tissues

Calcified fibroblastic granuloma:

A

► Often reddish and ulcerated reactive lesion.
► Fibrous proliferation in which bone- or cementum-like hard tissue is formed.
► Highly cell-rich areas below ulcerated sites.
►Differentialdiagnosis: Pyogenicgranuloma

41
Q

Reactive processes of periodontal soft tissues: Pyogenic granuloma:

A

► Ulcerated (may resemble purulence).
► gingival margin.
► Reddish or bluish, sometimes lobulated, sessile or pedunculated. Bleeding is common.
► Highly vascular with chronic inflammatory cells. ► Differential diagnosis: Pregnancy tumor.

42
Q

Reactive processes of periodontal soft tissues:

Peripheral giant cell granuloma

A
  • Anywhere on the gingival mucosa.
  • Pedunculated (has a stalk), sessile (broad base),
    red or purple, commonly ulcerated.
  • Focal collection of multi-nucleated osteoclast-like
    giant cells with a richly cellular and vascular stroma separated by collageneous septa.
  • Probably originated from periodontal ligament. Differential diagnosis: focal fibrous hyperplasia.
43
Q

Reactive processes of periodontal hard tissues

Periapical cemental dysplasia:

A

► Fibrous-osseous cemental lesions.
► Tooth is usually vital.
► Usually no symptoms.
► Periapical bone is replaced by cellular fibroblastic tissue through a cementoblastic phase.
►Differentialdiagnosis: Cemento-ossifying fibroma and fibrous dysplasia.

44
Q

Benign neoplasms of periodontal soft tissues:

Hemangioma-

A
  • Rather frequent tumors of oral mucosa.
  • Flat or raised, sometimes lobulated, soft lesions of blue to red color.
  • Asymptomatic but may bleed. - They blanch on pressure.
  • Capillary and cavernous types.
    Differential diagnosis: Mucous cysts, pyogenic granuloma.
45
Q

Benign neoplasms of periodontal soft tissues:

Nevus:

A

► Pigmented lesion containing melanocytes in CT. ► rare in the oral mucosa, mostly seen in palate. ► Flat, slightly raised lesions or a tumor.
► Brown or black or no pigmentation.
► Nevocellular or brown nevus located along the basal layer of epithelium.
Differential diagnosis: Amalgam tattoo.

46
Q

Benign neoplasms of periodontal soft tissues:

Papilloma:

A

► Four or five different types of papilloma are present.
► Exophytic, pedunculated or sessile lesions. Reddish/normal or whitish/gray color.
► A granular/moruloid or filiform/digitated surface. ► Human Papilloma Virus is commonly found.

47
Q

Benign neoplasms of periodontal soft tissues: Verruca vulgaris (one type of papilloma):

A
  • Is less common in oral mucosa compared to skin.
  • Lips and palate are main locations.
  • Sessile, exophytic or raised lesion with a whitish surface. - Papillomatous surface with hyperkeratinization
    and elongated rete ridges.
  • Associated with HPV type 2 and 4.
48
Q

Benign neoplasms of periodontal soft tissues

Peripheral odontogenic tumors:

A

► Non-ulcerated sessile or pedunculated gingival lesions.
► Generally detected in the soft tissue around unerupted
teeth.
► Histopathology is similar to intraosseous forms of the tumors.

49
Q

Benign neoplasms of periodontal hard tissues:

Ameloblastoma:

A

► Derived from odontogenic epithelium. ► Well-circumscribed radiolucency.

50
Q

Benign neoplasms of periodontal hard tissues:

Squamous odontogenic tumor:

A

► Derived from pdl, presumably from epithelial rests of Malassez.
► Often associated with lateral root surface. ► Rarely seen.

51
Q

Benign neoplasms of periodontal hard tissues:

Benign cementoblastoma:

A

► Slow-growing neoplasm forming hard tissue around the apex of a tooth.
► Radiopacity typically surrounded by a radiolucent margin.

52
Q

Malignant neoplasms of periodontal soft tissues

Squamous cell carcinoma:

A

► Mandible
► posterior to the premolars
► nodular lesions, often with ulceration and surrounding leukoplakia.
► Regional lymph-node metastasis is common.

53
Q

Malignant neoplasms of periodontal soft tissues:

Metastasis to the gingiva:

A

► The majority are intraosseous.
► Soft tissue metastasis from lung cancer.
► Most of the metastasis cases are carcinoma and not sarcoma.

54
Q

Malignant neoplasms of periodontal soft tissues:

Kaposi’s sarcoma:

A

► Skin lesion followed by oral lesions.
► Gingiva is the second mostly detected site after
palate.
► Re-occurrence with AIDS

55
Q

Malignant neoplasms of periodontal soft tissues:

Malignant lymphoma:

A

► Primary malignant lymphoma is rare in the oral cavity.

► It occurs among HIV-infected patients frequently.

56
Q

Malignant neoplasms of periodontal hard tissues:

Osteosarcoma:

A

► 7% of all osteosarcomas occur in the jaws.
► Clinical and radiographic examinations are required.
► Widening of pdl is common

57
Q

Malignant neoplasms of periodontal hard tissues:

Langerhans cell disease (Histiocytosis X):

A
  • Originated from Langerhans cells.
  • Manifestations in the jaws are seen in 10-20% of all cases.
  • Swelling, tenderness, pain and loosening of teeth are frequent symptoms.
58
Q

Cysts of the periodontium-

A 
1- Gingival cyst
2- Lateral periodontal cyst
3- Inflammatory paradental cyst 
4- Odontogenic keratocyst
5- Radicular cyst

Perio Exam 2 (20 decks)

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