Chapters 5-8 Review

The dental clinician notes the following clinical signs during the periodontal assessment of an young female teenager: • A small amount plaque biofilm present at the gingival margin • Gingival tissues appear bright red and soft • Bleeding upon gentle probing • Gingival margin slightly coronal to the CEJ • Probing depths of 2 to 3 mm • An inflammatory response that seems exaggerated given the small amount of plaque biofilm Which of the following types of periodontal disease should the hygienist suspect for this patient?

Gingival disease associated with endocrine system and fluctuations in sex hormones

Signs and symptoms of periodontitis include:

-Changes in color, contour, consistency, and texture -Bleeding - either during brushing or bleeding on probing Crevicular fluid - increased flow in pockets -Plaque and calculus deposits - mature supra and sub deposits -Loss of clinical attachment (CAL) - a. Apical migration of the junctional epithelium b. Destruction of the gingival and PDL fibers c. Alveolar bone destruction/loss

Healthy gingival tissue

-Color: shade of pink - may be pigmented -Contour - papilla will be knife-like and fill the interproximal spaces -Consistency - firm, flat; NO bleeding on gentle probing -Texture - stippled

Inflamed gingival tissue

-Color: shade of red -Contour - papilla may be bulbous -Consistency - edematous, spongy -Texture - smooth, shiny

The disease process of periodontitis includes:

-Direct destruction by bacteria -Indirect destruction by the host inflammatory response

Therapeutic Endpoints for Periodontal Therapy

-Elimination of the microbial etiology and contributing factors -Preservation of health, function, and stability of the teeth and periodontium -Prevention of disease recurrence

Healthy gingival tissue in the human population:

-May be pigmented -May be various shades of pink -Will have papilla that comes to a point and fill the space between teeth

Oral signs and symptoms of Necrotizing Periodontal Disease include:

-Pain -Ulcerated and necrotic papilla and gingival margins giving the appearance of papilla being "punched out" -Necrotic areas of gingiva are yellowish white or grayish with tissue sloughing called "pseudomembrane"

Predisposing factors for Necrotizing Periodontal Diseases include:

-Poor self-care/plaque control -Emotional stress -Alcohol used. Smokinge. Poor nutrition

Modifying factors that increase plaque retention capabilities can include:

-Poorly contoured restorations -Hyposalivation (xerostomia)

Goals for Periodontal Therapy

-Reinforcing daily self-care -instrumentation to remove microbial etiology -elimination of local intraoral factors -periodontal surgery (if needed)e. periodontal maintenance

Modifying factors that exacerbate the host response can include

-Sex/steriod hormones-puberty, pregnancy, menstrual cycle, oral contraceptives -Hyperglycemia-abnormally high blood glucose levels -Leukemia-exaggerated inflammatory response to the amount of plaque biofilm -Smoking-smokers have fewer clinical symptoms than non-smokers -Malnutrition-vitamin deficiencies, seen in infants, institutionalized elderly, addicts

Risk factors for developing recession of the gingival margin include:

-Thin periodontal biotype - individual differences in gingival anatomy and morphology -An absence of attached gingiva - approx. 1mm of attached gingiva is desirable to maintain periodontal health -Reduced thickness of alveolar bone

All forms of Necrotizing Periodontal Diseases are characterized by

-Tissue ulceration and necrosis -Pain -Swelling and sloughing of necrotic (dead) tissues -Fetid oral odor

As long as stippling is clinically present in maxillary anterior teeth, tissues are considered healthy even with slight bleeding upon probing. If there is no tissue stippling, tissues are unhealthy.

Both statements are false

Dental clinicians may be the first to suspect a patient may have leukemia because of an unusual odor emanating from the oral cavity. In leukemia, gingival tissues become keratinized and appear pale pink and very thick.

Both statements are false

One critical component of NPD is advanced age. NPD is more commonly found in the 40 year and older age group.

Both statements are false

Gingival recession is the most common mucogingival deformity. Absence of attached gingiva predisposes a person to gingival recession.

Both statements are true

Refractory periodontitis occurs despite good self-care and appropriate therapy and regular maintenance visits. Recurrent periodontitis occurs because the patient did not control the bacterial plaque biofilm and/or the periodontal disease was not adequately treated.

Both statements are true

Gingival papillae that are enlarged and expand out of the interproximal spaces are described as:

Bulbous papilla

A patient who presents with marginal tissue recession which does not extend to the mucogingival junction is said to have which of the following Miller Classifications?

Class I

Three months ago, a patient with periodontitis was seen for a maintenance visit. Three months ago clinical attachment loss ranged from 4 to 6 mm. Today, he returns for a maintenance visit and the hygienist notes that there is no additional attachment loss in most areas of the mouth. The one exception is a 2 mm increase in clinical attachment loss on the distal proximal surface of tooth #20. How would you characterize the periodontal disease progression in this patient's mouth?

Disease progression is slow

A GENERALIZED, pronounced overgrowth of the gingival tissue, first seen in the papillae of the anterior sextants is a common clinical characteristic of which of the following periodontal diseases?

Drug-influenced gingival enlargement

A disorder of the mucous membranes due to an allergic reaction or infection that includes swollen lips with extensive crust formation is termed:

Erythema multiforme

All of the following statements are considerations of healthy gingiva EXCEPT:

Flaccid gingival margin

All of the following are common sources for intraoral allergic reactions EXCEPT:

Fluoride embedded in dental floss

By far the most common type of periodontal disease is:

Generalized periodontitis

Gingival disease characterized by a bacterial infection of the gingiva by a specific bacterium that is NOT commonly found in bacterial plaque biofilm is known as a:

Gingival disease of specific bacterial origin

All of the following statements about NG are FALSE EXCEPT:

NG is seen more in people with high levels of emotional and personal stress

Necrotizing periodontal diseases include all of the following EXCEPT:

Necrotizing mucogingiva

A patient presents with: • Pink gingival tissues • CEJ slightly coronal to the JE • No visible change in tissue contour • No visible change in tissue consistency The hygienist classifies this periodontal disease as gingivitis associated with plaque only. Does she have enough information to make this decision?

No, because the tissues can have these characteristics in periodontitis

All of the following are typical warning signs of periodontitis EXCEPT:

Pain

The most frequently occurring form of periodontitis is:

Periodontitis

Associated symptoms of NPD include all of the following EXCEPT:

Pigmented gingiva

Most common type of periodontal disease

Plaque induced gingivitis

The dental clinician notes the following clinical signs during the periodontal assessment of an young male teenager: • Moderate plaque biofilm present at the gingival margin • Gingival redness and tenderness • Bleeding on gentle probing • Gingival margin slightly coronal to the CEJ • Probing depths of 2 to 3 mm • An inflammatory response that seems appropriate given the amount of plaque biofilm. Which of the following types of periodontal disease should the hygienist suspect for this patient?

Plaque-induced gingivitis by bacteria only

A LOCALIZED, mushroom-shaped gingival mass projecting from the gingival papilla is a common clinical characteristic of which of the following periodontal diseases?

Pregnancy-associated gingivitis

A patient who exhibits loss of interproximal attachment associated with horizontal bone loss is said to have which Cairo Classification?

RT2

A patient has undergone repeated, appropriate periodontal therapy over the past 5 years. Today, the hygienist notes additional attachment loss at several sites. The patient practices satisfactory self-care and follows the recommended program of periodontal maintenance visits. Which of the following is the most likely disease classification for this patient?

Refractory periodontitis

Three months ago, a patient with periodontitis was seen for a maintenance visit. Today, he returns for another maintenance visit and the hygienist notes that there is no additional attachment loss in most areas of the mouth. The one exception is a 2 mm increase in clinical attachment loss on the distal proximal surface of tooth #20. The area on tooth #20 is described as:

Site-specific disease

Increased fluid in inflamed gingival tissue can cause the tissue to be characterized by:

Soft, spongy, and nonelastic tissue

Acute Gingivitis has a brief duration that is improved with good self-care. Chronic gingivitis lasts a long time and always develops into periodontitis.

The first statement is true; the second is false

A palatolingual groove can enhance plaque retention thereby contributing to initiation of periodontal disease. Poorly fitting orthodontic appliances have been known to initiate periodontal disease.

The first statement is true; the second statement is false

Necrotizing periodontal diseases is characterized by papillae that appear cratered. Although tissues in NPD appear fiery red, they are not painful.

The first statement is true; the second statement is false

A patient who presents with clear, thin delicate gingiva is said to have which periodontal biotype?

Thin scalloped

Necrotizing Periodontal Diseases

a broad category of inflammatory destructive infection of the periodontal tissues characterized by tissue necrosis.

Periodontitis

a complex microbial infection that triggers a host-mediated inflammatory response resulting in progressive destruction of the periodontal ligament and supporting alveolar bone; irreversible, a periodontal patient is ALWAYS a periodontal patient!

Bleeding on probing is seen clinically

before changes in tissue color.

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Acute gingivitis

has a sudden onset and short duration, professional care and good patient self-care returns the gingiva to health.

Gingivitis

inflammation of the gingiva causes the papilla to be enlarged (bulbous) and the gingival margin to be more coronal because of the swelling/enlargement

Chronic gingivitis

long-lasting gingivitis; may last for years without ever progressing to periodontitis, typically painless and more common than acute gingivitis.

Refractory Periodontitis

patient exhibits continued attachment loss after professional care and has good home care practices**Disease sites that have not responded to treatment are characterized by continuing to have clinical attachment loss

Gingival inflammation

the body's reaction to bacterial infection of the gingival tissues from periodontal pathogens. The reaction results in clinical changes of the free gingiva, attached gingiva, and papilla. GINGIVITIS- confined to the gingival tissue and has no effect on attachment level.

Recurrent Periodontitis

the return of destructive periodontitis after the disease was affectively halted - patient was treated for periodontitis, got a good result from treatment and stopped the disease process, then destruction occurs again

Gingivitis may cause tissue margins to move in what direction?

Coronal

Gingival papillae with a concave appearance are described as:

Cratered papilla

Which of the following statements is correct regarding gingival tissues for a patient who has received treatment for periodontitis and presents with generalized 4 mm of recession, blunted papillae, tissue pink in color and no bleeding on probing?

In spite of the periodontal treatment, gingival tissues are healthy

Chronic gingival inflammation includes all of the following EXCEPT:

Increased bone loss

All of the following bacterial species are associated with increased intensity of gingivitis in adolescents, EXCEPT:

Leptotrichia

When describing distribution of gingivitis, all of the following may be applied EXCEPT:

Lingual