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Periodontics > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Colonization of the
Oral Cavity:

what happens on day 1?

A

Starts at birth with facultative and aerobic bacteria

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2
Q

what are potential outcomes of interaction between host and microbe?

A

infection

colonization

commensalism

disease

death

persistance

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3
Q

what are the 6 major ecosystems in the oral cavity?

A

hard surfaces : intraoral, supragingival (teeth, restorations)

pocket: periodontal/peri implant pocket
epithelium: buccal epithelium, palatal epithelium, floor of mouth

dorsum of tongue

tonsils

saliva

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4
Q

definition of dental plaque

A

A structured, resilient, yellow-grayish substance that adheres tenaciously to the intraoral hard surfaces, including removable and fixed restorations

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5
Q

plaque is differentiated from _______ and ______

A

materia alba

calculus

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6
Q

what does dental plaque look like?

it is primarily composed of:

it is considered to be a ______

it is imposible to remove by:

A

resilient clear to yellow greyish substance

bacteria in a matrix of salivary glycoproteins and extracellular polysaccharides

biofilm

rinsing or with the use of sprays

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7
Q

3 major phases of plaque formation

A
  1. Formation of pellicle on tooth surface
  2. Initial adhesion and attachment of bacteria
  3. Colonization and plaque maturation
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8
Q

what are the risk factors for perio disease?

A

smoking

diabetes

pathogenic bacteria and microbial tooth deposits

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9
Q

what is disease risk?

A

the probability that an individual will develop a specific disease in a given period

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10
Q

colonization of the oral cavity:

what happens on day 2?

A

anaerobic bacteria can be detected

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11
Q

colonization of the oral cavity:

what happens on day 14?

A

mature microbiota is

established in gut of newborn

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12
Q

colonization of the oral cavity:

what happens at age 2?

A

human microbiota is formed. By this time 1014

microorganisms populate body

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13
Q

after tooth eruption, there is more complex what?

A

oral flora

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14
Q

are most bacteria commensal and beneficial or harmful?

A

commensal and beneficial

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15
Q

what does materia alba look like?

it is a soft accumulation of _______, ______, ________, and ________

Is it an organized or disorganized structure?

easily displaced with:

A

white, cheese like accumulation

salivary proteins, some bacteria, many desquamated epithelial cells, and occasional disintegrating food debris

it is organized and is not as complex as dental plaque

water spray

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16
Q

calculus is a hard deposit that forms via:

generally covered by:

A

the mineralization of dental plaque

a layer of unmineralized dental plaque

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17
Q

All surfaces of oral cavity are coated with a

_______

A

pellicle

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18
Q

Within nanoseconds after polishing teeth they

are covered with:

A

saliva-derived layer =derived

pellicle

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19
Q

Pellicle consists of glycoproteins, proline-rich

proteins, phosphoproteins, histidine-rich proteins, enzymes . . . ______ sites for bacteria

A

adhesion

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20
Q

initial adhesion and attachment of bacteria:

phase 1:

phase 2:

phase 3:

A

phase 1: transport to surface/random contact

phase 2: initial adhesion - reversible

phase 3: attachment - firm anchorage

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21
Q

phase 1 and 2 of initial adhesion of bacteria are non ________

A

specific

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22
Q

phase 3 of initial adhesion and attachment of bacteria depends on specific interactions between _______ cell adhesion molecules and ________ in pellicle

A

microbial

receptors

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23
Q

what provides hard, non-shedding surface that allows development of extensive structured bacterial deposits

A

teeth and implants

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24
Q

Teeth are “___________” for

periopathogens

A

port of entry

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25
Q

Key periodontal pathogens will disappear after:

A

full mouth extractions

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26
Q

definition of supragingival plaque

A

marginal plaque when in contact with gingival margin

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27
Q

supra gingival plaque

Gram ________ cocci and _______ predominate at the tooth surface

Gram ______ rods and filaments, spirochetes
predominate at outer surface

A

positive, short rods

negative

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28
Q

Topography of
supragingival plaque:

Initial growth along _______ and from ______ space

Further extension in ________ direction

Changes with surface _______

A

gingival margin, interdental

coronal

irregularities

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29
Q

Factors Affecting
Supragingival Dental
Plaque Formation:

rough/smooth surfaces* accumulate and retain more plaque

thicker/thinner plaque has more pathogenicity, more motile organisms, spirochetes, denser packing

Smoothing surface decreases:

A

rough

thicker

rate of formation

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30
Q

Plaque Formation
Within Dentition:

Forms faster in lower/upper jaw

Forms faster in ______ areas

Forms faster on lingual/buccal surfaces of teeth

Forms faster _______
compared to strict buccal or lingual

A

lower

molar

buccal

inter proximally

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31
Q

Individual Variables Influencing Plaque Formation:

Rate of formation differs significantly between:

__________ and ________ explain 90% of variation

A

individuals

Saliva-induced aggregation and relative salivary flow conditions

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32
Q

____ does NOT influence de novo plaque formation

A

age

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33
Q

plaque in younger/older people led to more gingivitis

A

older

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34
Q

plaque forms faster adjacent to inflamed or healthy gingiva?

A

inflamed

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35
Q

plaque is or is not removed spontaneously during eating

A

is NOT

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36
Q

sub-gingival plaque differs due to:

A

availability of blood products and anaerobic environment

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37
Q

periodontal pathogens that are strict _____ may contribute little to no initiation of disease

A

anaerobes

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38
Q

is de novo subgingival plaque formation easy or difficult to completely remove?

A

difficult

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39
Q

what is the source for recolonization of de novo subgingival plaque formation?

A

remaining bacteria

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40
Q

some pathogens penetrate _____ tissue and ______

A

soft

dental tubules

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41
Q

how fast is regrowth of bacteria to pre treatment levels?

A

within 7 days

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42
Q

Tooth-associated Subgingival
Plaque:

Tooth-associated cervical plaque similar to
_______ plaque

Deeper parts of pocket less _______

Apical portion dominated by smaller/larger organisms without particular _______

A

supragingival

filamentous

small, orientation

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43
Q

biofilms have an organized/disorganized structure?

A

organized

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44
Q

in lower layers, the biofilm is bound together by:

A

polysaccharide

matrix and organic and inorganic materials

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45
Q

_______ run through fluid channels in plaque mass (plaque as biofilm)

A

nutrients

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46
Q

in plaque as a biofilm, bacterial cells ______ with each other, known as?

A

communicate

quorum sensing

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47
Q

Bacterial transmission
and translocation:

Are periodontal pathogens and cariogenic bacteria transmissible?

Vertical/horizontal transmission more
frequent than vertical/horizontal in
families

Translocation occurs from 1 niche to another, ie by:

A

yes

vertical, horizontal

oral hygiene device

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48
Q

non bacterial inhabitants of the oral cavity (4)

A

viruses

fungi

protozoa

archaea

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49
Q

non specific plaque hypothesis

A

accumulation of
plaque over time

diminished host response and host susceptibility with age

Plaque control is key to disease control

hypothesis has been discarded, but most therapy is still based on this principle

50
Q

specific plaque hypothesis

A

only certain plaque
is pathogenic and this
depends on specific
microorganisms

Major advances in
techniques used to isolate,
identify and sample increased the power of association studies

Unknown whether specific
bacteria cause or correlate

51
Q

ecological plaque hypothesis

A

Attempt to unify theories on
plaque and disease.

Both total amount of plaque and specific microbes may contribute to disease.

Site may impact
microbiome.

Host response
may be affected by excessive plaque or host factors (ie smoking, diabetes, diet)

52
Q

keystone pathogen hypothesis

A

A specific pathogen present in low abundance that is able to disrupt the periodontal microbiota and lead to dysbiosis

May provide basis for targeted treatment

53
Q

in health, there is more _________ organisms

in periodontitis there is more _________ organisms

A

gram +/facultative

gram -/anaerobic

54
Q

Experimental
gingivitis model:

Early undisturbed plaque
formation follows
___________ growth rate

During first 24 hours, plaque growth is _________- (<3% of vestibular surface)

Next 3 days follow ______ rate

After 4 days growth slows but composition shifts toward _______ and gram ____

A

exponential

negligible

rapid

anaerobic, gram -

55
Q

Initial bacteria types associated with gingivitis are: (3)

A

gram positive rods

gram positive cocci

gram-negative cocci

56
Q

what are the microorganism types associated with chronic periodontitis? (3)

A

Spirochetes

anaerobic (90%)

gram – bacteria
(75%)

57
Q

microorganisms associated with severe periodontitis occurring at an early age:

A

Bone destruction is extensive in
relation to patient’s age

Almost all localized aggressive harbor A. actinomycetemcomitans

  • A.a. may comprise as much as 90% of microbiota
  • A.a is primary etiologic agent
58
Q

what periodontal disease is associated with the stress of HIV infection?

A

necrotizing periodontal disease

59
Q

what bacteria are in high levels with necrotizing perio disease?

A

P intermedia

spirochetes

60
Q

what is the treatment for necrotizing perio disease?

A

debridement

OHI

mouth rinse and pain medication

antibiotics as an adjunct if not responsive

61
Q

what can often occur in untreated periodontitis but can also occur after SRP or during maintenance?

A

abscesses of the periodontum

62
Q

can an abscess occur in the absence of periodontitis?

A

yes (popcorn stuck)

63
Q

what can occur with an abscess?

A

pain

swelling

suppuration

BOP

mobility

64
Q

Microorganisms associated
with periodontitis as a
manifestations of systemic
disease:

Severe destruction may be
associated with mutation of
__________ receptor

_________ and _______ defects

NOT specific ______

A

Cathepsin C

neutrophil and leukocyte adhesion

microbes

65
Q

what are the roles of beneficial species of bacteria? (5)

A

Passively occupy niche

Limit a pathogen’s ability to
adhere to tissue surfaces

Adversely affect growth or
vitality of pathogen

Affect ability of pathogen to
produce virulence factor

Degrade virulence factor

66
Q

which is more resistant to antibiotics, biofilms or planktonic bacteria?

A

biofilms

67
Q

how many more times are biofilms more resistant to antibiotics that planktonic bacteria?

A

1000-1500

68
Q

why are biofilms more resistant to antibiotics?

A

slower growth rate

variations in nutritional
status

pH

prior exposure to antibiotic

resistance to diffusion of antibiotic

69
Q

what is calculus?

A

Mineralized bacterial plaque that forms on the surfaces of natural teeth and dental prostheses

70
Q

Composition of calculus:

______% inorganic:
• 76% _______ _______
• 3% _______ ______
• 4% _______ _________ and other metals

2/3 of inorganic are crystaline (4):

A

70-90%

calcium phosphate
calcium carbonate
magnesium phosphate

  • Hydroxyapatite
  • Magnesium whitlockite
  • Octocalcium phosphate
  • Brushite
71
Q

Formation of calculus:

Precipitation of mineral salts starts between ____ and ____ day of _______ formation

Calcification can start in as little as __-____ hours

Calcification begins on:

Forms in _____

Initiation and rate vary in _________

A

1st
14th
plaque

4-8

inner surface of plaque

layers

individuals

72
Q

what are the 2 theories of mineralization of calculus?

A

mineral precipitation from local rise in saturation of calcium and phosphate ions

crystal formation of a compound through seeding

73
Q

what are the 4 modes of attachment to a tooth surface?

A

1) Via organic pellicle on enamel or cementum
2) Mechanical locking into surface irregularities
3) Close adaptation of calculus undersurface depressions to cementum surface
4) Penetration of calculus bacteria into cementum

74
Q

where is supragingival calculus located?

A

located above the gingival margin

75
Q

where is supragingival calculus heaviest?

A

near major salivary ducts

76
Q

where does the mineral source for supragingival calculus come from?

A

from saliva

77
Q

what color is supragingival calculus?

A

white/yellowish

78
Q

how fast can supragingival calculus from?

A

less than 24 hours

79
Q

subgingival calculus is not ______ specific

A

site

80
Q

what is the mineral source for subgingival calculus?

A

GCF and inflammatory infiltrate

81
Q

where is the highest incidence of subgingival calculus?

A

proximal surfaces

82
Q

what color is subgingival calculus?

A

brown to black

83
Q

what is the texture of subgingival calculus?

A

dense, hard, tenacious

84
Q

is the formation rate of subgingival calculus slower or faster than supragingival calculus?

A

slower rate

85
Q

etiological significance of calculus:

Distinguishing between effect of plaque and calculus is easy/difficult

Calculus is always covered with ______

Positive correlation exists between ______ and _______

what is the cornerstone of periodontal therapy?

A

difficult

plaque

calculus, gingivitis

removal of plaque and calculus

86
Q

what is disease risk?

A

the probability that an individual will develop a specific disease in a given period

87
Q

to be considered a risk factor for periodontitis, the exposure must occur:

exposure can be single point, over multiple points, or continuous

A

before the disease onset

88
Q

risk factors for periodontitis may be ______, ______, or _______

A

environmental

behavioral

biologic

89
Q

tobacco smoke contains more than ____ known carcinogens

A

60

90
Q

what are the 3 main risk factors for periodontitis

A

tobacco smoking

diabetes

pathogenic bacteria

91
Q

current smokers are ___ times more likely to have severe periodontitis vs non smokers

A

3

92
Q

there is a _____ response relationship between smoking and the prevalence and severity of periodontitis

A

dose

93
Q

are the negative effects of smoking on the host reversible or irreversible?

A

reversible

94
Q

former smokers respond to periodontal therapy differently or similarly to non smokers?

A

similarly

95
Q

how does smoking affect gingival inflammation and bleeding on probing?

A

it decreases it

  • due to decreased gingival blood vessels with increased inflammation
  • decreased cervicular fluid flow
96
Q

to decrease the risk for periodontitis, ______ the number of years since quitting smoking

A

increase

97
Q

what are the 5 As when talking to a patient about tobacco?

A

Ask the patient about smoking status

Advise smokers of the associations between oral disease and smoking

Assess the patient’s interest to attempt to quit

Assist the patient in the attempt

Arrange for referral or follow up visit

98
Q

what kind of relationship is there between diabetes and periodontitis?

A

direct relationship

99
Q

there is/is not a difference between type 1 and 2 diabetes and periodontitis

A

not a difference

100
Q

periodontal disease is the ____ complication of diabetes

A

6th

101
Q

complications of diabetes

A

microvascular and macrovascular diseases

102
Q

Diabetes: level of
glycemic control is
important:

Poorly controlled diabetics:
- Altered _______ function
(PMNs)

  • Qualitative changes in
    ________
  • Altered ______ structure
    and function
  • Severe ______ inflammation,
    deep _____, rapid _____
    loss, and periodontal
    ______
A

immune

bacteria

collagen

gingival, pockets, bone, abscesses

103
Q

Periodontitis in type 1
teenagers ___-fold increased
prevalence in periodontitis

Poorly controlled adult
diabetic ____ times higher
prevalence

OR for smokers with poorly
controlled diabetes: ___ times

Uncontrolled diabetics good/ poor response to therapy relative
to well-controlled and non diabetics

A

5

  1. 9
  2. 6

poor

104
Q

does the quantity of plaque indicate risk for periodontitis?

A

it may not indicate risk

105
Q

the ______ of plaque is important in the risk for periodontitis

A

composition (quality)

106
Q

what are some anatomic factors in the mouth that harbor bacterial plaque

A

furcations

root concavities

grooves

cervical enamel projections

enamel pearls

overhanging margins

calculus

107
Q

what are the risk determinants/background characteristics for periodontitis? (5)

A

genetics

age

gender

socioeconomic status

stress

108
Q

genetic factors for periodontitis:

what alterations are associated with severe periodontitis?

Alterations in ____ genes are one of several
involved in periodontitis

A

neutrophils and monocytic
hyperresponsiveness

IL-1

109
Q

Age

Prevalence and severity increase/decrease with age

__________ changes related to aging process

Prolonged _________ over life lead to
cumulative destruction rather than increased rate of destruction

Young/old individuals with periodontal disease are at greater risk for continued disease

A

increase

degenerative

exposure to other risks

young

110
Q

who have more attachment loss, men or women?

A

men

111
Q

who have higher level of plaque and calculus, men or women?

A

men

112
Q

gender differences in prevalence and severity appear to be related to?

A

preventative practice vs genetic

113
Q

how does socioeconomic status lead to increased risk of periodontitis?

does socioeconomic status alone lead to increased risk for periodontitis?

A

decreased dental awareness and decreased frequency of dental visits

no

114
Q

how does stress lead to increased risk for periodontitis?

increased incidence of ________ during periods of high stress

A

emotional stress may interfere with normal immune function

necrotizing ulcerative gingivitis

115
Q

what are 3 risk indicators for periodontitis?

A

HIV/Aids

osteoporosis

infrequent dental visits

116
Q

risk indicator: HIV/AIDS

Higher degree of
___________ in
adults with AIDS

Increased periodontal
______ formation and loss of _________

__________ prominent
diagnostic feature

A

immunosuppression

pocket, attachment

oral lesions

117
Q

what are oral and periodontal manifestations of HIV infection?

A

Oral candidiasis

Linear gingival erythema

Oral hairy leukoplakia

Kaposi Sarcoma and other malignancies

Acute necrotizing ulcerative gingivitis
(ANUG)

Necrotizing ulcerative gingivitis and
periodontitis

Chronic periodontitis

118
Q

how does osteoporosis lead to increased risk for periodontitis?

does osteoporosis initiate periodontitis?

A

reduced bone mass aggravates periodontal disease progression

no

119
Q

Risk indicator:
infrequent dental visits

Increased risk for severe periodontitis in patients
who had not visited the dentist for ___ years or more

versus

No more loss of attachment or bone loss in
individuals who did not seek dental care for over ___ years

A

3

6

120
Q

what are risk markers/predictors associated with?

do they cause the disease themselves?

examples

A

associated with increased risk for disease but do not cause the disease

examples: previous history of perio disease

bleeding on probing

121
Q

previous history of periodontal disease:

severe existing loss of attachment is a predictor for:

no attachment loss of a predictor for:

A

future loss of attachment

decreased risk for future loss of attachment

122
Q

Bleeding on probing:

In healthy subjects, % BOP sites has a ______ relationship with probing force

what is a reason for bleeding on probing in the absence of disease?

Reproducibility can be improved by
either ______ or _____

A

linear

trauma

increasing or decreasing force

Periodontics (5 decks)

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