Perio Quizlet
Be able to compare and contrast the coral pink tissue of the attached gingiva with the darker, shiny tissue of the alveolar mucosa
*look up images*
Be able to identify the following boundaries of the gingiva; gingival margin, free gingival groove and mucogingival junction
*look up images*
*look at chart on Ch 4 slide 7-12*
*powerpoint*
what are the two periodontal classifications?
-1999 disease classification subdivided into two subgroups: chronic and aggressive -2017 disease classification eliminated two subdivisions: little evidence that suggested it two different diseases
intitial
-2 to 4 days -acute inflammation, PMNS, macrophages -subclinical, no signs of ging, increase gcf flow
established
-2-3 weeks -b cell lesion, plasma cell, chronic gingivitis (blue gingiva)
what stage in pregnancy can gingivitis increase?
-2nd trimester of pregnancy
early
-4 to 7 days -t cell lesion -clinical signs of gingivitis first seen (BOP, redness, edema)
how many periodontal disease are there?
-7 -dental plaque induced gingival disease or nonplaque induced -•Chronic Periodontitis •Aggressive Periodontitis •Periodontitis as a Manifestation of Systemic Disease •Necrotizing Periodontal Diseases •Abscesses of the Periodontium •Periodontitis Associated with Endodontic Lesions •Developmental or Acquired Deformities & Conditions
who classified periodontitis?
-AAP (american academy of periodontology)
what can deficiency in vitamin c cause?
-Although rare, vitamin C deficiency can cause scurvy, a condition resulting in defective collagen formation and maintenance.
what sets threshold for gingivitis?
-BOP -can revert to a state of health
what can estrogen regulate?
-Cellular proliferation -Keratinization -Vascular proliferation -Fragility in the gingival tissues
what is loss of attachment?
-Clinical attachment is the measurement of the amount of destruction affecting tooth-supporting structures that have been destroyed around a tooth. -Clinical attachment loss of 1-2 mm at one or several sites can be found in nearly all members of the adult population
gingivitis classified into various categories due to?
-Clinical manifestations of the disease -Cause -Association with systemic diseases -Association with medications -Other causes
Describe the progressive destruction of alveolar bone loss that occurs in periodontitis
-Crest of alveolar bone is more than 2 mm apical to CEJ -bone loss (horizontal or vertical)
what cardiac medications cause overgrowth of gingival tissue?
-Dihydropyridine (Nifedipine, Amlodipine, -dipines) -Phenalkylamine (Verapamil) -Benzothiazepine (Diltiazem)
nomenclature to describe gingivitis?
-Extent of involvement: localized, generalized -Tissues affected: marginal, papillary -Degree of inflammation: slight, moderate, severe
NUG, NUP, NPD
-Necrotizing Gingivitis: (NUG)Tissue necrosis that is limited to the gingival tissues -Necrotizing Gingivitis: (NUP)Tissue necrosis of the gingival tissues combined with loss of attachment and alveolar bone loss -Necrotizing Stomatitis: (NPD) Severe tissue necrosis that extends beyond the gingiva to other parts of the oral cavity, such as tongue, cheek, and palate
what is the main pathogen associated with periodontal disease?
-Porphyromonas gingivalis -Treponema forsythia •Treponema denticola •Prevotella and Fusobacterium species •Actinomyces actinomycetemcomitans
what is NUG?
-Rapid onset of pain -Development of necrotic ulcerative lesions of the gingiva -Can occur with no bone loss but -With a specific identifiable bacterial component. -Related to excessive stress. -Pseudomembrane Distinctive breath odor that has been termed fetor oris(fetid odor) is
If periodontal disease is left untreated what can happen?
-Results in loss of connective tissue attachment to the cementum on the tooth root. ◦Junctional epithelium migrates along the root surface ◦Deepening the gingival sulcus and forming a periodontal pocket. ◦Mobile teeth that are susceptible to abscess formation ◦Premature tooth loss
how can endocrine influenced gingival disease be caused?
-Steroid-type hormones produced by the endocrine glands influence gingivitis. -Hormones associated with puberty and pregnancy also affect gingival disease. -Estrogen receptors in the gingival tissues -Serum concentrations of female sex hormones during pregnancy
what is cyclosporine?
-The major drug used for immunosuppression in patients who have undergone organ transplantation -This medication may also be used to treat multiple sclerosis. -May cause gingival overgrowth.
what is a pregnancy tumor?
-This gingival lesion is not a tumor but a localized area of pyogenic granulation tissue. -The tissues are highly inflamed, easily bleed, and may cause the teeth to be mobile and possibly migrate out of the way.
Periodontitis is?
-a term describing any disease of the tissues surrounding the teeth including gingival diseases and diseases of the supporting structures.
prevalence? what variables are taken into consideration?
-all cases 1. gender 2. Race/ethnicity 3. Education and socioeconomic status 4. Age 5. Behavior 6. Access to dental care
what is phenytoin?
-an antiseizure medication not used commonly today -associated with gingival hyperplasia (overgrowth) -Normal tissue becomes fibrotic and enlarged. Fibroblasts that create a denser connective tissue cause the enlargement
conditions in peri-implant hard and soft tissue deficiencies
-bone loss, trauma, endodontic infections, root fractures, thin bony plates, poor tooth positions, sinus injury, medications, tooth agenesis, prosthetic pressures
conditions in peri-implant mucositis
-bop -visual signs of inflammation -reversible if you remove biofilm
Be able to discuss some differences between the 2017 and 1999 classification systems
-chronic and aggressive periodontitis are grouped in 2017 as periodontitis. 2017 has a new classification for peri-implant diseases and conditions. 2017 is based on a multidimensional staging and grading system. The clinician can individualize patient-specific treatment modalities and treatment sequences using the staging and grading system.
what is cicatricial pemphigoid?
-chronic vesiculobullous disease -seen as Blistering -sloughing of the surface of gingival epithelium -cause is not known -considered an autoimmune reaction. -more common in older individuals -significantly more common in women than in men. -Lesions may appear on oral tissues other than the gingiva including the buccal mucosa and inner surface of the lips.
why do pocket depths increase?
-coronal movement of gingiva -perio pockets reflecting tissue destruction -collagen fibers in connective tissue are broken down by enzymes
Describe how clinical dental hygiene practice can be affected by epidemiological research
-current methods and behaviors that are successful in the treatment or prevention of periodontal disease - define the level of risk a patient may have for periodontal disease. -can be used to look at disparities or inequities of disease patterns.
most common form of gingivitis?
-dental plaque induced
what occurs when pemphigoid lesions are limited to gingival tissues?
-desquamative gingivitis
what is osseointegration?
-direct contact of bone with implant surface -successful if: -No mobility -Absence of inflammation of tissues -No discomfort or pain when functioning -No increased bone loss or radiolucency
what is a biologic seal?
-epithelium adapting to titanium abutment post -barrier between implant and oral cavity -periodontal pathogens can destroy bone faster along a dental implant
what heals the gingiva?
-fibroblasts laying down extracellular matrix of collage -replace inflammatory cells -produce dense subgingival connective tissue -no pentration of probe by this tissue
in NUG, what are vincents 2 microorganisms?
-fusiform bacillus -spirochete
bacteria changes from what to what?
-gram positive to gram negative
*pull up classification of pockets image*
-in powerpoint slide 22
conditions in peri-mplantitis
-inflammation of peri-implant mucosa -progressive bone loss
what is gingivitis?
-inflammation of the gingival tissues -no attachment loss -or non progressive loss
how does NUG start?
-interdental papillae -tips of the papillae are pinched out covered by white pseudomembrane -pseudomembrane is a collection of PMNs trapped in fibrin clot -attached gingival tissues are also inflammed
common systemic diseases revealed as dermatologic coniditions?
-lichen planus -benign mucous membrane pemphigoid
clnical probing depth increases for 2 reasons
-loss of collagen -edema moving the gingival margin coronally
periodontal patients can stop treatment when?
-never, once diagnosed its for life to stop regression
incidence?
-new cases
conditions in peri-implant health
-no inflammation -no bop -normal or reduced bone support
abscess around the third molar? and the flap of tissue partially covering the tooth?
-pericoronal abscess -operculum
.Explain why clinicians need to be familiar with terminology from the 1999 disease classification, such as chronic periodontitis an aggressive periodontitis
-periodontal journals and textbooks is based on the earlier 1999 disease classification.
Explain why there is a band of intact transseptal fibers even in the presence of severe bone loss
-separates the site of inflammation from the remaining alveolar bone -regenerated
where does perio occur?
-site specific
2 types of perio pockets
-suprabony (horizontal) -infrabony (vertical bone loss)
how to bacteria migrate in the gingiva?
-the junctional epithelium into the gingival crevice and out the oral cavity
what is inflammation?
-thickening of the sulcular epithelium and infiltration into underlying connective tissues
advanced
-undetermined -alveolar bone loss -perio pocket formation -b cell lesion -periodontitis
what are the endpoints of periodontal treatment?
1. Elimination of the microbial etiology and contributing factors that perpeturate periodontal inflammation 2. Preservation of the state of teeth and periodontium in a state of health, function, and stability and prevention of disease reoccurrence 3. Prevention of disease reoccurrence
inflammation in horizontal bone loss
1. Inflammation spreads into the tissues in those order: (1)Within the gingival connective tissue along the connective tissue sheaths surrounding the blood vessels, (2)into the alveolar bone and (3)finally into the periodontal ligament space 2. Inflammation usually spreads in this manor because it is the path of least resistance. The pdl ligament fiber bundles act as n effective barrier of the spread of inflammation
inflammation in vertical bone loss
1.In vertical bone loss, inflammation spreads into the tissues in the order (1) within the gingival connective tissue, (2) directly into the periodontal ligament space, and (3) finally, into the alveolar bone 2. Inflammation spreads in the manner whenever the crestal periodontal ligament fiber bundles are weakened and no longer present an effective barrier. Prior events such as occlusal trauma can be responsible for the weakend condition of fiber bundles
the development of gingival inflammation is separated into four stages:
1.Initial 2.Early 3.Established 4.Advanced -once it extends into the bone it is considered periodontal disease
what aren the 4 levels of periodontal health?
1.Pristine Periodontal Health •With a structurally sound & uninflamed periodontium 2.Well-Maintained Clinical Periodontal Health •With a structurally sound & clinically sound intact periodontium 3.Periodontal Disease Stability •With a reduced periodontium 4.Periodontal Disease Remission/Control •With a reduced periodontium
Define the term disease progression
A change in the way an illness affects a patient as it moves from its earliest stages to its peak and then to its resolution.
Describe the nerve and blood supply to the periodontium
Anterior and posterior superior alveolar arteries, infraorbital artery, and greater palatine artery.
The miller classification system for recession
Class I Class II Class II Class IV
what two phases of periodontal disease exist?
During the active phase ◦Bone and other periodontal tissues are lost & ◦Pockets deepen. During the periods of quiescence (remission), ◦Disease is static & ◦Pockets do not deepen
*know the terms*
Page 51
Define the term periodontal disease and contrast it with the term periodontitis
Periodontal diseases are mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed.
Name the three major categories of periodontal disease and conditions
Periodontal health, gingival diseases and conditionsPeriodontitisOther conditions affecting the periodontium
Explain the role of the lymphatic system in the health of the periodontium
The lymphatic system is our body's 'sewerage system'. It maintains fluid levels in our body tissues by removing all fluids that leak out of our blood vessels. The lymphatic system is important for the optimal functioning of our general and specific immune responses
The cairo classification system for recession
Type 1 (RT1) Type 2 (RT2) Type 3 (RT3)
Explain the difference in color between acute and chronic inflammation
acute: Gingivitis of a sudden onset and short duration, after which professional care and patient self care returns the gingiva to a healthy state chronic: Long lasting gingivitis; gingivitis may exist for years without ever progressing to periodontitis, typically painless and is more common than acute
Describe the position and contour of the alveolar crest of bone in health
cervical rim of the alveolar bone proper.
what is between the bone and the implant?
chondroitin sulfate glycosaminoglycans
Identify the alveolar process on a human skull
hold the roots of the teeth
Compare and contrast the etiologic factors associated with dental biofilm-induced gingivitis and non-plaque induced gingival diseases
induced: -most common noninduced: -less common
Define periodontal health and be able to describe the clinical features that are consistent with signs of periodontal health
intact periodontium: Clinical signs characteristic of perio health coupled with an intact periodontium reduced periodontium on a non perio patient: Clinical signs of perio health on a periodontium with a pre-existing loss of connective tissue and/or loss of alveolar bone which is attributed to non-perio reasons reduced periodontium on a successfully stable perio patient: Clinical signs of perio health on a periodontium with a pre-existing loss of connective tissue and alveolar bone which is attributed to perio but, has been treated and is currently stable
what endotoxins from the organisms in the biofilm penetrate the cementum?
lipopolysaccarides
periodontitis vs. periodontal disease
peridontitis: gingivitis/periodontal disease periodontal disease: bone loss
Contrast the characteristics of gingiva and periodontal pockets
perio: Pathologic deepening of the gingival sulcus as a result of apical migration of the JE, destruction of PDL fibers, and destruction of alveolar bone. In periodontitis, the JE cells attach to the cementum of the tooth root. ging: A deepening of the gingival sulcus as a result of swelling or enlargement of the ginigival tissue. They can also be known as pseudo-pockets or false pockets because there's NO apical migration of the JE. Although the coronal portion of the JE detaches from the tooth resulting in a slight increase in probing depth. Increase in probing depth can also be caused by swelling of the tissue.
*review stages of gingivitis on week 3 powerpoint*
pp
Define the term disease progression
sequence of events that occur during the development of a disease and abnormal conditions Health (green lights) Gingivitis (yellow light) Periodontitis (red light)
Be able to identify the presence or absence of stippling of attached gingiva
with a gauze
Clinical attachment loss?
•Early •CAL 1-2 mm •Moderate •CAL 3-4 mm •Advanced & Severe •CAL ≥ 5 mm
4 parts of an implant?
•Implant body •Abutment •Cylinder •Crown • **The crown is usually already attached to the cylinder prior to placement
subperiosteal implants?
•Placed below the periodontium & rest on the bone -maxilla or mandible -frame rests on jaw bone -post protrude through soft tissue for anchorage for a denture
endosseous implants?
•Placed into the bone •majority of implants •based on the principle of osseointegration.
Transosteal implants (rare)?
•Placed through the bone like a staple -pass through the mandible -stabilization plate is placed under the mandible
2 stage techniue surgical procedure
•Stage 1: -Implant body is placed in the bone followed by a healing period •Stage 2: -After the healing period, the implant site is surgically exposed to prepare the implant for a final restoration
2 types of endosseous implants?
•root-form implants -either screw or cylindrically shaped -with different lengths, diameters, and design characteristics. •blade implants -is no longer used today; it had a high incidence of complications and failures.
what type of cells are present in periodontal tissues when disease is established?
◦both plasma cells and lymphocytes are present in the periodontal tissues. ◦Plasma cells are important in antigen-antibody reactions. ◦Antigen-antibody reactions activate events that attract additional inflammatory cells to the periodontal tissues.
Periodontal disease mostly affects?
◦inflammation of the supporting tissues of the teeth, specifically the ◦Periodontal ligament ◦Cementum ◦Alveolar bone
PERIODONTITIS: Describe and contrast the (1) position of the junctional epithelium, (2) characteristics of the epithelial-connective tissue junction, and (3) position of the crest of the alveolar bone in health, gingivitis and periodontitis
Clinical Picture: Color: Tissue shows visible alternations color, contour and consistency ◦1. Edematous tissue (spongy) bluish or purplish red with smooth shiny appearance ◦2. Fibrotic tissue (firm, nodular tissue) light pink with leathery consistency (beginning clinicians often mistakenly interpret this light pink color as a sign of health Gingival Margin: may be swollen or fibrotic and does not have a close knife edged adaption to the neck of the tooth Interdental papillae: The interdental papillae may not fill the interdental embrasure spaces There often is bleeding upon probing, and suppuration (a discharge of pus) may be visible Pocket: Probing depths are 4mm or grater in depth because the junctional epithelium is attached to the root surface
Describe the function that each tissue serves in the periodontium, including the gingiva, free gingiva, gingival sulcus, interdental gingiva and attached gingiva
Clinical Picture: Color: pink, may be pigmented and is resilient in consistency Gingival Margin: Scalloped outline, located coronal to the CEJ Interdental papillae: firm, occupies embrasure space Absence of bleeding Sulcus: probing depths range from1-3mm Microscopic Picture: Junction epithelium: firmly attached by hemidesmosomes to the enamel slightly coronal to the CEJ Epithelial connective tissue junction: in health the junctional epithelium has no epithelial ridges Gingival fibers: Intact supragingival fiber bundles support the JE Alveolar bone" crest of the bone is intact and located 2-3mm apical from the base of the JE Cementum: Cementum is normal
HEALTHY: Describe and contrast the (1) position of the junctional epithelium, (2) characteristics of the epithelial-connective tissue junction, and (3) position of the crest of the alveolar bone in health, gingivitis and periodontitis
Clinical Picture: Color: pink, may be pigmented and is resilient in consistency Gingival Margin: Scalloped outline, located coronal to the CEJ Interdental papillae: firm, occupies embrasure space Absence of bleeding Sulcus: probing depths range from1-3mm Microscopic Picture: Junction epithelium: firmly attached by hemidesmosomes to the enamel slightly coronal to the CEJ Epithelial connective tissue junction: in health the junctional epithelium has no epithelial ridges Gingival fibers: Intact supragingival fiber bundles support the JE Alveolar bone" crest of the bone is intact and located 2-3mm apical from the base of the JE Cementum: Cementum is normal
GINGIVITIS: Describe and contrast the (1) position of the junctional epithelium, (2) characteristics of the epithelial-connective tissue junction, and (3) position of the crest of the alveolar bone in health, gingivitis and periodontitis
Clinical Picture: Color: red or reddish-blue in color Gingival Margin: swollen and loses its knife edge adaptation to the tooth, may cover more crown of the tooth due to swelling or fibrosis Interdental papillae: bulbous and swollen Bleeding upon gentle probing Sulcus: probing depths may be greater than 3mm due to swelling of the tissues (there is NO apical migration of the junctional epithelium) Microscopic Picture: Junction epithelium: the hemidesmosomes still attach to the enamel coronal to the CEJ Epithelial connective tissue junction: the junctional epithelium extends epithelial ridges down into the connective tissue Gingival fibers: Damage has occurred to the supragingival fiber bundles. This damage is reversible if the bacterial infection is brought under control Alveolar bone" crest of bone still in tact, no destruction of the bone Cementum: Cementum is normal
