Unit 308/315 Periodontal Disease

Question 1

Name the 4 supporting structures of the teeth

Answer 1

Gingivae
Periodontal ligament
Cementum
Alveolar bone

Question 2

What is the first stage of periodontal disease called?

Answer 2

Chronic gingivitis

Question 3

What is dental plaque made up of?

Answer 3

Saliva, micro-organisms and food debris

Question 4

What has a passive role in periodontal disease?

Answer 4

Calculus

Question 5

What has an active role in periodontal disease?

Answer 5

Micro-organisms

Question 6

What does iatrogenic factors mean in dentistry?

Answer 6

Poor quality dentistry e.g loose contact points on restorations, overhanging margins, ill-fitting prosthesis

Question 7

What do bacteria produce as a by-product of digesting food?

Answer 7

Toxins (poisons). Accumulate at the gingival crevice where gingiva in direct contact with these toxins become irritated and inflamed.

Question 8

What are false pockets?

Answer 8

False pockets occur during chronic gingivitis. The toxins produced by bacteria cause the gingiva to swell as a result of inflammation. This swelling creates what’s known as a false pocket, however there’s no actual loss of attachment between the junctional epithelium and the tooth.

Question 9

Name the two anaerobic bacteria associated with periodontal disease.

Answer 9

Actinomyces and Porphyromonas Gingivalis

These bacteria colonise subgingival where the initial bacteria cannot survive due to the lack of oxygen.

Question 10

What causes plaque to form calculus?

Answer 10

The inorganic ions within saliva mineralise plaque, causing it to harden and form calculus.

Question 11

During chronic gingivitis, why do the gingiva bleed on brushing and gentle probing?

Answer 11

Rough calculus and bacterial toxins cause painless micro-ulcers to develop within the gingiva. These bleed when touched.

Question 12

What are the symptoms of chronic gingivitis?

Answer 12

Shiny red swollen gingiva
No stippling texture on gingiva
Bleed on brushing and gentle probing
Visible plaque at gingival margin
Halitosis

Question 13

Following chronic gingivitis, what is the next stage of periodontal disease?

Answer 13

Chronic periodontitis

Question 14

What do the toxins gradually destroy during chronic periodontitis?

Answer 14

Periodontal ligament. They do this by building up toxins within false pockets and begin soaking into the gingival tissues through the micro-ulcers present from chronic gingivitis.

Question 15

What is a true pocket?

Answer 15

A true pocket is formed when bacterial toxins destroy the periodontal ligament and the attachment of the tooth to its supporting tissues. This loss of attachment continues to deepen pockets, allowing more calculus and plaque to form in them.

Question 16

What happens if chronic periodontitis is allowed to continue?

Answer 16

The bacterial toxins will eventually attack the alveolar bone and destroy the walls of the tooth socket so that the tooth becomes mobile.

Question 17

What are the symptoms of chronic periodontitis?

Answer 17

Periodontal probing pockets deeper than 3mm
Supragingival and subgingival calculus present
Some teeth may be mobile
Radiographs will show destruction of the alveolar bone in longstanding cases

Question 18

Which two areas in the oral cavity is calculus most likely to form?

Answer 18

Buccal surface of upper molars and lingual surface of lower incisors. This is because they are opposite the orifices salivary gland ducts.

Question 19

What factors worsen periodontal disease? (But don’t cause it)

Answer 19

Smoking
Excessive masticatory stress
Hormonal changes (pregnancy, puberty)
Open lip posture
Immune-compromised patients e.g diabetes, AIDS
Epilepsy treated with phenytoin (Epanutin)
Vitamin C deficiency
Immune-suppressant drugs

Question 20

Name plaque retention factors (factors which exacerbate plaque accumulation)

Answer 20

Poor OH due to patient apathy
Poorly aligned teeth which increase stagnation areas
Incompetent lip seal which dries out soft tissues
Small oral aperture which makes effective tooth brushing difficult
Iatrogenic causes

Question 21

What is the percentage make up of dental plaque?

Answer 21

30% micro-organisms

70% inter-bacterial substances including protein, blood cells, acids, carbohydrates

Question 22

Briefly explain the process of plaque and calculus accumulation.

Answer 22

3-4 hours - colonisation of rods and cocci
24 hours - visible layer of aerobic cocci
3 days - greater prominence
7 days - full growth
14 days - plaque calcifies to form calculus due to inorganic ions in saliva which mineralise it

Question 23

What is gingival hyperplasia?

Answer 23

Gum overgrowth. Involves an abnormal increase in the number of tissue cells which causes the enlargement.

Question 24

What can cause gingival hyperplasia?

Answer 24

Poor OH (gum inflammation/swelling)
Medication induced including:
Phenytoin - anti-epileptic
Cyclosporine - immunosuppressant to prevent organ rejection after transplant
Nifedipine and Amlodopine - calcium channel blockers used to manage hypertension and irregular heartbeats

Question 25

What is a gingivectomy?

Answer 25

Surgical procedure involving removing a strip of the gingival margin where overgrowth has occurred or a false pocket itself.

Question 26

What is gingivoplasty?

Answer 26

Another form of gum surgery which focuses on contouring and reshaping. Often used after surgical periodontal treatment or to shape healthy gum tissue so it can support teeth better.

Question 27

What is sub-acute pericoronitis?

Answer 27

Infection of the gingival flap (operculum) lying over partially erupted wisdom teeth (3rd molar).

Question 28

What causes pericoronitis?

Answer 28

Partially erupted 3rd molars are notoriously difficult to clean due to poor access, especially if combined with a patient with generally poor OH. Therefore plaque and bacteria can quickly accumulate.
As well as this, the operculum is often traumatised by the opposing tooth.

Question 29

How can pericoronitis be treated?

Answer 29

Irrigation of debris using chlorhexidine

OHI e.g warm salty mouthwash, disinfectant mouthwash or peroxyl mouthwash (oxygen releasing to remove anaerobic bacteria)

Abc if patient has a raised temperature

Operculectomy (surgical removal of the operculum covering the tooth)

Opposing tooth could be extracted to break the cycle of trauma and inflammation

Question 30

What is an operculectomy?

Answer 30

Surgical removal of gingival flap, operculum, covering a partially erupted 3rd molar (a localised gingivectomy).

Question 31

What is acute herpetic gingivitis and who does it commonly affect?

Answer 31

Acute inflammation with tiny blisters/ulcers present. Caused by heres simplex virus and commonly affects infants.

Question 32

How is acute herpetic gingivitis treated?

Answer 32

No treatment needed as it soon resolves on its own. Short-lived but uncomfortable.

Question 33

What happens to the herpes simplex virus after acute herpetic gingivitis?

Answer 33

Lies dormant in the body and can later be reactivated by the common cold to produce a cold sore.

Question 34

What is acute necrotising ulcerative gingivitis and how is it identified? (ANUG)

Answer 34

(Formerly known as AUG or Vincent’s disease)

Characterised by pain, swollen gingiva and halitosis.

Gingiva will be red with a layer of yellow/grey sloughing membrane where gum margin has been destroyed by bacteria.

Question 35

What are the two bacteria involved in ANUG?

Answer 35

Bacillus fusiformis

Treponema vincenti

Question 36

What causes ANUG?

Answer 36

Usually affects young adults who already have chronic gingivitis present. Stress, heavy smoking and low general resistance are causes. Can be a first indication of AIDS.

Question 37

How is ANUG treated?

Answer 37

Antibiotics if patient has a raised temperature. Metronidazole is preferred to target anaerobic bacteria.

Disinfectant mouthwash containing chlorhexidine.

When symptoms have settled, thorough scale and polish with OHI.

Smoking cessation advice if relevant.

Question 38

What is an acute lateral periodontal abscess?

Answer 38

Complication of chronic periodontitis in which pus formation in a deep pocket is unable to drain through the gingival crevice. This pus instead accumulates at the base of the pocket and forma an abscess. Occurs on a vital tooth at the side of the root.

NOT TO BE CONFUSED WITH ACUTE ALVEOLAR ABSCESS which involves pulp death and occurs at the root apex.

Question 39

What are the treatment options for a periodontal abscess?

Answer 39

Drainage of pus
Thorough subgingival scaling of the affected tooth
Local administration of antibiotic into the pocket itself (metronidazole)
OHI
If all the above fail, an XLA may be the only option

Question 40

Explain non-surgical methods of controlling periodontal disease involving professional debridement.

Answer 40

Removal of subgingival calculus at base of pockets
Scraping tooth root surfaces to dislodge contaminated cementum
Irrigate pockets with chlorhexidine to fight anaerobic bacteria
Subgingival scaling instruments used

Question 41

What is root planing?

Answer 41

Provides a deeper clean subgingival compared to scaling alone. Involves smoothing the root surfaces, removing any infected tooth structure and calculus deposits from deepened pockets.

Question 42

Explain gingival flap surgery as a method for controlling periodontal disease.

Answer 42

Involves raising the gingival flap to expose root surface and alveolar bone. All hidden subgingival calculus is removed. The alveolar bone may then need to be contoured. A local delivery of antibiotic is placed which aids healing. The flap is then sutured back.