Perio exam 1

What is the clinical significance of GCF?

-It is Collected from sulcus in small amounts -Analyzed -May be used to help detect or diagnose active periodontal disease -May help predict patients at risk for periodontal disease

what are the clinical features of necrotizing periodontal diseases?

-Ulcerated and necrotic papillary and marginal gingiva -Gray pseudomembrane -Blunting and cratering of papillae -Bleeding -Pain & Fetid breath -Fever, malaise, lymphadenopathy

What is periodontitis?

inflammatory disease caused by Non-Specific microorganisms, results in progressive destruction of the PDL, alveolar bone with pocket formation, recession or both. CAL is often accompanied by pocket formation & alveolar bone loss.

what is the concept of biologic width?

it is the physiologic width dimension of JE & CT attachment. Allow 3-4 mm between crown margin & bone crest to allow for Biologic width and sulcus depth

what is the free gingival groove?

junction between unattached and attached gingiva. Found in 50% of patients.

what forms the attachment between the gingiva and the tooth?

junctional epithelium. COnfluence between oral epithelium and reduced enamel epithelium at tooth eruption. contains 2 strata: external basal lamina and internal basal lamina. It is coronal to or at level of CEJ prior to disease

what are the cell types in oral epithelium?

keratinocytes *predominate cell in epithelium melanocyte-produces melanin langerhan cells-dendritic cells, important in immune response

what form of periodontits is this? why?

localized aggressive periodontitis -have vertical bone loss, localized to 1st molar

how is the extent of chronic periodontitis characterized as?

localized id <30% of sites involved generalized if >30% of sites involved

what is a circumpubertal onset of aggressive periodontics a form of?

localized, it is localized to 1st molars or incisor teeth

what are the 8 medications related to lichenoid mucositis?

1. Allopurinol 2. Antimalarials 3. ACE Inhibitors (lisinopril, Enalapril) 4. Beta blockers (propranolol) 5. Ketokonazole 6. Lithium 7. NSAIDS 8. Penicillins, sulfonamides, streptomycin & tetracyclin

What are the componentd of the GCF?

1. Cells: Bacteria Desquamated epithelial cells Leukocytes (PMN, Lymphocytes, Macrophages) 2. Organic Compounds: Cytokines (IL-1β) Prostaglandin E2 Immunoglobulins (IgG, IgA, IgM)

what is periodontitis associated with endodontic lesions?

1. Endodontic-Periodontal Lesions -Pulpal necrosis -Infection drainage through PDL 2. Periodontal-Endodontic Lesions -Pulpal involvement due to advancement of periodontal disease 3. Combined lesions -Pulpal necrosis and periapical lesions begin separately and join.

what are the 3 defense mechanisms of the gingiva?

1. Gingival crevicular fluid (GCF) 2. Leukocytes 3. Saliva

what is periodontitis as a manifestation of systemic diseases?

1. Hematologic diseases- Acquired Neutropenia & Leukemias 2. Genetic disorders: Familial & cyclic Neutropenia, Down syndrome, Leukocyte adhesion deficiency syndrome (LAD), Papillon-Lefevre syndrome (PLS), Chediak-Higashi syndrome, Agranulocytosi & Hypophosphatasia-defect in cementum

what is the etiology of developmental or acquired conditions?

1. Localized tooth-related factors- CEP (Cervical enamel projection *common in mandibular molars; enamel pearls, palatogingival grooves-*maxillary incisors; tooth malalignment, & open contacts 2. Dental restorations-subgingival margins, encroaching on biologic width or appliances 3. Root fractures- apical migration of plauqe along fracture 4. Cervical root resorption & cemental tears

what are the predisposing factors of necrotizing periodontal diseases?

1. Psychological stress 2. Smoking 3. Immunosuppression- NUP may be observed among patients with HIV infection Usually indicative of CD4+ counts <200 cells/mm3.

what are the Gingival Diseases of non-plaque induced?

1. bacterial-neisseria gonorrhoea, treponema palladum 2. viral-herpes simplex virus & herpes zoster 3. fungal-candida albicans & histoplasmosis 4. Genetic-hereditary gingival fibromatosis 5. gingival manifestations of systemic conditions/drug-7 6. traumatic lesions

what are the non-plaque induced gingival diseases caused by traumatic lesions? (4)

1. chemical injury 2. Iatrogenic 3. thermal injury 4. toothbrush & flossing clefts

periodontitis is further categorized into what 3 types?

1. chronic 2. aggressive 3. periodontitis as a manifestation of systemic disease

what are the 6 classification of periodontal diseases?

1. gingival diseases 2. periodontitis 3. necrotizing periodontal diseases 4. abscesses of the periodontium 5. periodontitis associated with endo lesions 6. developmental/acquired deformities & conditions

What are the 4 Mucogingival deformities as a subcategory of developmental/acquired deformities and conditions?

1. gingival recession 2. mucogingival defect-*lack of attached gingiva (0 mm), PD penetrates to or beyond the MGJ & PD+width of KG, so lacks keratinized gingiva 3. aberrant frenum 4. gingival excess

what are the effects of aging on the periodontium?

1. gingival recession-cumulative effect over many years of inflammation & toothbrush trauma, passive eruption, not an inevitable physiologic process of aging 2. root surface caries-increased risk due to recession and xerostomia related to medications 3. alveolar bone-osteoporosis 4. wound healing after surgery-delayed 5. periodontitis-more prevalent with increased age, due to cumulative exposure of plaque, not due to increased risk for disease.

What are the Gingival Diseases of plaque induced?

1. gingivitis-most common form & no attachment loss 2. "GD" modified by systemic factors-PPDL-puberty, pregnacy, diabetes & leukemia 3. GD modified by medications-drug-induced gingival enlargment-dilantin, cyclosporing & Ca+ channel blockers 4. GD modified by malnutrition-vitamin C deficiency

list the 7 non-plaque induced gingival diseases that are gingival manifestations of systemic conditions?

1. lichen planus 2. cicatricial pemphigoid (aka benign mucous membrane pemphigoid) 3. pemphigoid vulgaris 4. erythema multiforme 5. lupus erythemactosus 6. drug induced-lichenoid mucositis 7. allergic reactions-restorative materials, toothpastes, gum & additives

What are the 3 regions of the gingiva?

1. oral (outer) epithelium 2. sulcular epithelium 3. junctional epithelium

what are the 3 sources of gingival blood supply?

1. vessels from PDL 2. supracrestal arterioles from alveolar process 3. arterioles from interdental septa

the inorganic content of cementum is?

45-50% ydroxyapatite

what are causes of gingival recession?

Aggressive toothbrushing Tooth malposition Aberrant frenum attachments Iatrogenic factors (restorations, orthodontics) Root planing shallow sites Periodontitis

what is the portion of the maxilla and mandible which supports the tooth socket?

Alveolar process, which dissappears after tooth is lost. consists of: alveolar bone proper, cancellous trabeculae and cortical bone plate

what happens in loss of attachment in periodontitis?

CT fibers are lost apical migration of JE pocket formation

what is the most common form of periodontitis?

Chronic periodontitis -prevalent in adults, **but can be found in young adults -amount of attachement loss if consistent with amount of plaque & calculus -slow to moderate rate of progression

what is the difference between keratinized gingiva and attached gingiva?

KG is bigger, whereas attached gingiva is smaller because of probe depth

this extends from the gingival margin to the MGJ?

KG, also known as width of KG

how do you measure attached gingiva?

KG-PD

what are the 2 necrotizing periodontal diseases?

NUG & NUP-**clinical attachement loss & bone loss

what decreases in width with loss of function?

PDL, which is hour-glass shaped. But PDL increases in width with increased forces such as trauma from occlusion. Average width is 0.2 mm. Radiographically, the PDL appears as the radiolucent area between the radiopaque lamina dura of the alveolar bone proper and the radiopaque cementum on the tooth surface.

what tooth supporting structure functions in transmission of occlusal forces to bone?

PDL. other functions include: ASSN attachment of teeth to bone shock absorption sensory nutrition

what cells take part in primary defense?

PMNs. Inflammatory infiltrate is always present in CT adjacent to sulcular epithelium. An increase in biofilm, lymphocytes appear (2nd defense). Theres no defense at this point because the host is containing the microbial challenge.

Hos is chronic periodontitis modified?

Systemic diseases-diabetes & HIV Smoking, Stress, Nutrition, Genetics

what drugs can get in the GCF in high concentrations and what is the clinical implication?

Tetraclycline & Metronidazole, used an an adjunct to treat Aggressive Periodontitis

True or false: The endodontic infection should be controlled before definitive management of the periodontal lesion.

True

Is a pyogenic granuloma modified by pregnacy considered plaque or non-plaque induced?

a plaque inducedd, gingival disease modified by systemic factors

what is a mucogingival defect?

absence of attached gingiva (0 mm) probe depth penetrates to or beyond the MGJ PD=KG

what type of cementum covers the cervical 1/3 of the root?

acellular (primary). also contains mainly sharpeys fibers

what are the 2 types of cementum?

acellular and cellular

what contains the bundle bone?

alveolar bone proper

what PDL fibers resist extrusion and lateral forces?

alveolar crest

The MGJ is the coronal extent of this?

alveolar mucosa. has non-keratinized epithelium, not bound to bone, it is mobile. more red in color due to lack of keratinization & visibility of underlying blood vessels.

what keratinized gingiva is bound tightly to tooth and bone?

attached gingiva. Extends from the base of the sulcus to the MGJ. Can be ortho or parakeratinized.

How is gingivitis classified?

based on extent on where it is present -papillary-papilla -margina-papilla & margina (free) gingiva -diffuse-papillary, marginal & attached gingiva

what lines the tooth socket wall?

bundle bone, within the alveolar bone. *only present when the tooth is present.

what type of cementm contains cementocytes in lacunae?

cellular (secondary). formed after tooth reaches occlusal plane. thinnest in the coronal half and thickest at the apical third. it increases in thickness with age.

epithelial cells in the PDL can develop into?

cementicles, lateral periodontal cysts or periapical cysts

what is the gingival CT (lamina propia) composed of?

collagen fibers, fibroblasts, vessels, nerves, matrix & inflammatory cells.

What are the characteristics of the gingiva?

color, consistency, contour

How do you treat an excessive gingival display, with indequate clinical crown height and poor esthetics?

crown lengthening

what involves the loss of bone and and crestal bone?

dehiscense

what interdigitates with the papillary layer?

epithelial rete pegs

what is passive eruption?

exposure of teeth via apical migration of gingiva (recession).

what are 2 sources of collagen fibers in cementum?

extrinsic-sharpeys fibers from the PDL intrinsic- produced from cementoblasts within the cementum

Where do you find the smallest amount of keratinized gingiva?

facial premolars has the thinnest amount of KG. most likely location for MG defect

what involves the loss of bone overlying the root with the crestal bone still intact?

fenestration

what are primary cells of the PDL?

fibroblasts. Other cells of the PDL include: cementoblasts, osteoblasts, epithelial elements-epithelial rests of malassez & remnants of HERS (lateral periodontal cysts, periapical cysts & cementicles), immune cells-Neutrophils, lymphocytes, macrophages, mast cells, Eosinophils and Neurovascular cells

if there is a loss of at least 3 teeth other than 1st molars and incisors, this is a form of?

generalized aggressive periodontitis. usually affects <35 years of age but can be older

what are the 2 types of abscesses of the periodontium?

gingival & periodontal

What contains leukocytes?

gingival crevicular fluid. other functions of the GCF include: cleanse material from the sulcus, improves adhesion of epithelium to tooth & contains antibodies

what are the 3 gingival collagen fibers?

gingivaldental group circular group transeptal group

what type of bacteria are the early colonizers of plaque?

gram positive aerobic bacteria or biofilm. Streptococci sanguis, actinomyces viscosus. Late colonizers are gram negative anaerobic. Gingivitis or inflammation develops in response to plaque.

how does the JE attach to the tooth?

hemidesmosomes, which regulates gene expression, cell differentiation & proliferation. (signal transduction). Other functions include: permeable barrier against bacteria (allows diffusion of fluid & inflammatory cells to sulcus as host defense mechanism), Rapid cell turnover= rapid repair of damaged tissue 1-6 days.

a gingival abscess is confined to?

marginal gingiva & often occurs in previously disease-free states. -Whereas a periodontal abscess is a Localized accumulation of pus within the wall of a periodontal pocket & Affects supporting structures of periodontium (PDL, bone).

what is the junction between KG and alveolar mucosa?

mucogingival junction

If a patient has gingival recession (mucogingival deformity), does the patient have a mucogingival defect on #5 if KG=5 mm and PD=2mm?

no, because patient has 3 mm of attached gingiva (keratinized gingiva), so only has a mucogingival deformity

what is the largest fiber group of the PDL, that bears the brunt of vertical masticatory forces?

oblique fibers

How does aggressive periodontitis occur?

occurs in an otherwise clinically healthy patient, have rapid attachment loss & bone destruction. *have no plaque & calculus (unlike chronic periodontitis), often infected with Aggregatibacter actinomycetemcomitans-invades CT. -familial aggregation -most commonat an early age <35 years -hyper or hypo-responsive PMN & macrophage function

What are the cells of the alveolar process?

osteoblasts, osteoclasts, osteocytes and osteoids

what are the symptoms of a periodontal abscess?

pain swelling suppuration bleeding on probing mobility (have pocket formation)

in most cases, gingival epithelium is?

parakeratinized

what do incremental lines represent?

period of rest in deposition

If a patient presents with swelling and pain on maxillary right canine, 9mm pocket, suppuration, what is your diagnosis?

periodontal abcess

what is the primary factor of gingivitis?

plaque

gingival diseases are further classified into what 2 categories?

plaque-induced or non-plaque induced

what are 2 forms of gingival excess as a type of mucogingival deformity?

pseudopocket excessive gingival display

what are the terminal ends of the principle PDL fiber which insert into cementum & bone (bundle bone)?

sharpery's fibers

how is the severity of chronic periodontitis characterized as?

slight- 1-2 mm CAL (3-4mm PD) moderate=3-4 mm CAL (5-6mm PD) severe- >or =5 CAL (7+ mm PD)

what epithelium is semi-permeable?

sulcular epithelium.

this extends from the inner surface of the oral epithelium to the junctional epithelium

sulcular epithelium. normal depth is 1-2 mm, non-keratinized (potential to keratinize), semi-permeable

what is the clinical significance of COL?

the COL is non-keratinized, it is more permeable, and less resistant to bacterial ingress.

what is the CT that surrounds the root and connects it to the alveolar bone?

the periodontal ligament, which is continous with the gingival collagen fibers of the gingival CT

which fibers are somtimes classified as the principle fibers of the periodontal ligament?

transeptal fibers

what are the 6 groups of principle collagen fibers of the PDL?

transseptal alveolar crest horizontal oblique apical interradicular

when can you use the diagnosis "Periodontitis as a manifestation of systenic diseases"?

when the systemic condition if the major predisposing factor and you have no plaque and calculus (local factors)

is gingival connective tissue attachment apical to epithelial attachement?

yes

is the severity of aggressive periodontitis the same as chronic periodontitis?

yes

Is gingival recession a mucogingival deformity?

yes, have severe recession, loss of attachment, bone loss but NO Inflammation & Attachment levels are Stable!

Is a primary herpetic gingivostomatitis a gingival disease?

yes, it is a non-plaque induced viral gingival disease

if a patient PD=1 mm and KG=0 mm, does the patient have a mucogingival defect?

yes, the PD is greater than the width of the KG