Things to learn Flashcards
List the gingival descriptors
Color
- Healthy pink
- Uniform colour
- Erythemic
Consistency
- Firm and Resilient Gingiva
- Spongy Gingiva
Contour
- Scalloped outline
- Pointed Pyramidal Gingiva
- Blunted Gingiva
- Bulbous Gingiva
Gingival Margin:
* Located near or 1-2 mm above CEJ
Bleeding / Exudate:
- None
- Some
Size
* Fits snugly around tooth, no unusual bumps/ swelling
Texture:
- Normal or stippled
- Shiny (sign of dry mouth)
Interdental Papillae
* Firm; occupy interdental spaces apical to contact areas
Recognize the bacteria most commonly associated with gingival health, gingivitis and periodontitis
- P gingivalis
- T forsythia
- A. actinomycetemcomitans
Explain how fatty acids serve as a virulence mechanism for bacteria
- Fatty acids are short organic acids produced by anaerobic fermentation
• They inhibit T- and B- cell proliferation & cytokines IL-2, IL-4, IL-5, IL-6, and IL-10
Describe the pathogenesis of periodontitis
Periodontal disease starts when the bacteria in plaque releases a substance called “lipopolysaccharides”.
These LPS binds to macrophages and simultaneously stimulates PMNS.
The macrophages and PMNs release MMP’s = tissue destruction.
In addition, the macrophage is also prompted to release the following cytokines:
- IL- 1B
- TNF- a
- PGE2
These cytokines activates fibroblasts which then:
- Releases more MMPS = tissue destruction
- Releases more PGE2 = bone resorption
The PGE2 stimulates macrophages to turn into osteoclasts.
In addition, the stimulate osteoblasts to releases RANKL which binds with RANK receptors in pre- osteoclasts.
T cells releases pro- inflammatory cytokines and RANKL, while B cells releases the antibody IGE-2 to cause the clumping and killing of bacteria.
As a side not, LPS have the ability to cause direct bone resorption.
Describe stage 2 of periodontitis
- Damage to tooth supporting structures
- Established periodontitis
Management:
* Remove biofilm
Describe stage 3 and 4 of periodontitis
- Significant LOA
- Deep PD Lesions extending to middle portion of root
Stage 3:
Complicated by infra- boney defects and furcations
Stage 4:
Complicated by tooth hypermobility
Explain the goals of non-surgical periodontal therapy
- Return the periodontium to health
- Eliminate inflammation
- Minimize bacterial challenges
- Eliminate or control local risk factors
- Stabilize attachment level
Describe the role of periodontal instrumentation in non-surgical periodontal therapy
- Instrument pockets to disrupt bacterial colonies that cannot be reached by traditional brushing or flossing
- Arrest periodontal disease
- Induce symbiosis
- Eliminate inflammation
- Increase patient self- care
Explain new attachment and repair
New attachment:
• When periodontal ligament fibres attach into the cementum in a tooth surface previously denuded by disease
Repair:
• Healing of periodontal tissues that do not replicate the original lost periodontium, like scar tissue
• Re- establishes a normal gingival sulcus at the base of the pocket
• Arrests destruction
• Does NOT result in gain of gingival attachment or bone height
Discuss the effects of systemic disease on the periodontium
Obesity
* High obesity = poorer metabolism = poorer glycaemic control
Osteoporosis
* Bone resorption, especially in post- menopausal women
Rheumatoid arthritis
* Periodontitis may contribute to pathogenesis of RA
What is peri-implant mucositis?
- Gum inflammation is found only in soft tissues around dental implant
- No sign of bone loss
- Bleeding, redness, exudate
- Reversible
Causes:
- Biofilm
- Diabetes/ smoking
- Host response
What is peri-implantitis?
List histological changes, causes and treatments.
- Inflammation
- Bone loss
Histology:
- Lesions extend beyond JE
- Large numbers of PMNS
Causes
- Peri mucositis
- Smoking/ diabetes
Treatment
* Mechanical debridement combined with antibiotic therapy and/or regenerative surgery
What is peri- implant soft and hard tissue deficiencies?
What are risk factors?
- After tooth loss, the healing process involved reduced alveolar bone height which presents as deficiencies in soft and hard tissues
- Can present as recession around implant
Occurs due to: • Mispositioning of implants • Lack of bone • Thin soft tissue • Surgical trauma
What are the stages of disease involved in the pathogenic mechanisms of periodontal pathogens?
- Attachment to hosts
- Evasion of hosts defences
- Replication
- Tissue damage
List examples for the following:
1. Attachment to hosts
- Evasion of hosts defences
- Replication
- Tissue damage
- Attachment to hosts
* Adhesions
* Fimbriae - Evasion of hosts defences
* Capsules
* Fatty acids
* Proteases: gingipains - Replication
* Acquiring nutrients to live; ability to steal iron and porphyrin - Tissue damage
* MMPs
* Bone resorption inducers LPS
* Cytotoxins eg. ammonia
