Periodontics Exam III
When looking for premature occlusion of a specific tooth, you must guide the patient into _______. ______________ movements should also be evaluated to determine any interferences.
- Centric relation - Excursive movements
How does anemia present in the oral cavity (4)?
- Changes in tongue - Gingival pallor - *Yellowish* oral mucosa in Sickle Cell - Pale mucosal discoloration in aplastic anemia
What are the primary neutrophil disorders (3)? Secondary (3)?
- Chediak-Higashi, Lazy Leukocyte, and Leukocyte Adhesion Deficiency - Downs, Papillon-Lefevre, and IBD
What is an antiseptic?
- Chemical antimicrobial agent that can be applied *topically or subgingivally* to inhibit their reproduction or metabolism
What is an anti-infective agent? Antibiotic?
- Chemotherapeutic agent that acts by reducing the *number* of bacteria - Naturally occurring, semisynthetic, or synthetic type of anti-infective that destroys (cidal) or inhibits growth (static) of selective microorganisms
What two topical, antiginigivitis agents are accepted by the ADA?
- Chlorhexidine digluconate - Listerine (essential oils)
What 5 conditions will clinically manifest as desquamative gingivitis?
- Chronic bacterial, fungal and viral infections - Reactions to medications - Mouthwashes - Chewing gum - Crohn's disease, sarcoidosis, leukemias, factitious lesions
What is Bullous Pemphigoid? What percent have oral lesions? How do you treat it (2)? Bullous pemphigoid has no evidence of what?
- Chronic, sub-epidermal bullous disease with tense cutaneous bullae - 30% - Moderate dose of systemic prednisone and localized topical steroids - Acantholysis (loss of intercellular connections), so vesicles are subepithelial
What is the treatment for Linear A disease 3?
- Combination of *sulfones and Dapsone* with small amounts of *prednisone* added
How can we minimize antibiotic resistance when prescribing (6)?
- Combination therapy - Avoid *suboptimal* dosage - High dose over a short time (increase compliance) - Mechanical debridement *prior* to antibiotic use due to increased virulence of biofilms - Avoid when physical debridement can resolve the problem - Prophylactic use of antibiotics should be limited to *high risk* patients
Many "controlled" carrier materials release the active ingredient at a ________________ over time.
- Constant concentration (up to 14 days)
How is acute pericoronitis treated 3?
- Control of pain w/ analgesics & infection w/ antibiotics - Surgically remove operculum - Ext. involve tooth, *though careful evaluation should be done to rule out NUG before extraction*
What is pemphigoid? What are the two types and explain?
- Cutaneous, immune mediated lesion - Bullous: non-scarring and on the skin - Cicatrical: scarring, confined to mucous membranes
What is the treatment of NUG (8)?
- Debridement & cleanout under LA - Remove pseudomembrane w/ cotton pellet dipped in water or chlorhexidine - OH instructions such as rinsing w/ warm water or chlorhexidine - Analgesics for pain - Patient counseling - Antibiotic for immunocompromised or systemic involvement - Follow-up in 24 hours then every other day until resolved - Follow up w/ a comprehensive perio eval after resolution. (note get PT through acute phase 1st and then follow up w/ management)
Antibiotics may be used as adjuncts to SRP for patients with (6):
- Deep pockets - Aggressive forms of the disease - "Refractory" periodontitis - Acute or severe periodontal infections - "Active" sites or specific microbiologic profiles - Predisposing medical conditions (Note adjuncts doesn't mean they absolutely need it)
How does a Vitamin C deficiency present in the oral cavity (2)? T/F gingivitis is not caused by Vit C deficiency?
- Delayed wound healing, bleeding & swollen gingiva w/ loosened teeth (*scurvy*) - True: gingivitis is not caused by Vit. C deficiency but is increased in severity by it (does cause tooth loss b/c no collagen)
What are the two phases of GAP? Describe each.
- Destructive Phase: tissue is inflamed, ulcerated, and fiery red w/ *bleeding*, suppuration, and *active* attachment and bone loss - Non-Destructive Phase: tissues are pink with stippling (i.e. normal), lack overt inflammation, probing reveals deep pockets, bone & CAL are *stable* (but still deep from destructive phase)
What are the oral features of Primary Herpetic Gingivostomatitis (2)? Which parts of the oral cavity are involved?
- Diffuse erythematous gingival lesions showing edema and bleeding, usually the *entire gingiva* is involved (i.e. keratinized surfaces) - Primarily discrete ulcers that rupture and coalesce after 24 hours
Chronic *Cutaneous* Lupus Erythematosus presents with skin lesions called __________. These lesions present with ____________ 3.
- Discoid LE - Chronic scarring, hypopigmentation or hyperpigmentation of healing area
What are the 3 radiographic indications of Primary Occlusal Trauma?
- Discontinuity and thickening of lamina dura - *Widened* PDL space - Evidence of root resorption or bone loss
What are the signs of inflammation? What are the biological marks in the blood for an acute inflammation?
- Dolor, calor, tumor, rubor, and loss of function - C-Reactive Protein (CRP) increases (increases in CRP is a risk factor for several chronic inflammatory diseases)
How is aggressive periodontitis treated 6?
- Due to unpredictable course, consider referral to periodontist - Plaque control & patient education - Debridement & irrigation with CHX - Targeted antimicrobial therapy to eliminate A.a. - Periodontal surgery for regeneration & root resection - Ext. of hopeless teeth
What is Stephen's Johnson Syndrome (SJS)? What 2 causes it?
- EM Major - Most commonly caused by HSV or drug reactions *(sulfonamides, penicillins, quinolones, barbiturates, some NSAIDs, anticonvulsants, and allopurinol)*
What risk do oral contraceptives cause for periodontitis (3)?
- Early, high dose OCPs caused an increased risk for gingivitis; new, low dose OCPs cause a lower risk *- They may increase the risk for severe periodontitis* (probing depths and increased CAL both 5mm+)
What are the 3 common but not universal characteristics of Aggressive Periodontitis? Destruction of tissues caused by aggressive periodontitis is due to what?
- Elevated Aa levels - Phagocyte abnormalities (chemotaxis or phagocytosis) - Hyper-responsive macrophages/monocytes that produce PGE-2 and IL-1 beta in response to bacterial exotoxin - Hyper active macrophages
Why are antimicrobials needed to effectively treat periodontitis? T/F an ideal antibiotic would be specific for periodontal pathogens and in general use for txt of other diseases.
- Elimination of bacteria in non-dental areas (tongue or tonsils or dentinal tubules) is an important area of concern - False, not in general use for other diseases
GAP is _________ in nature with periods of inactivity that may last _________ (3).
- Episodic - Inactivity may last weeks, months, or years
How should an acute periodontal abscess be treated 5?
- Establish drainage through pocket retraction or external incision - Scaling and root planing - Systemic antibiotics if indicated - *Tooth removal* - Frequent rinsing with CHX
How strong is the evidence for causality between PD and CVD (2)? Which type of trials is needed to determine more data?
- Evidence of causal link between periodontitis and vascular disease doesn't exist - The AHA concluded that "periodontal disease is associated with atherosclerotic CVD independent of known confounders" *- Intervention trials are needed to make this determination*
What 6 conditions mimic desquamative gingivitis?
- Factitious lesions, candidiasis - GVHD - Wegner's granulomatosis - Foreign body gingivitis - Kindler syndrome - SCC
T/F there is no clear association of HIV infections w/ risk for necrotizing periodontal diseases? Declining CD4 counts can cause an increase in which 2?
- False - CAL & recession
T/F Periodontal diseases & certain systemic disorders share only genetic etiological factors. Ppl w/ genetic conditions that lead to syndromes such as Down syndrome will tend to have more severe perio disease.
- False, may share both genetic and environmental etiological factors - True
T/F Cementum is able to regenerate as fast as bone in the PDL. A tooth has a maximum amount of bone resorption after about 1 month following hyperloading.
- False: cementum takes a long time to regenerate compared to bone in the PDL - True
T/F Endo lesions are much less likely to spread to the periodontal tissues than the reverse. Residual periodontal lesions can be treated after completion of successful endodontic therapy.
- False: endo lesions are much more likely to spread - True
T/F Pregnancy can cause gingivitis. Pregnancy accentuates the response to plaque and may cause "pregnancy tumors" (pyogenic granulomas). Which organism has been associated with gingival disease in pregnancy?
- False: it doesn't cause gingivitis but accentuates the response to plaque - True - *Prevotella intermedia* (orange complex)
T/F Aggressive Periodontitis has a good response to periodontal therapy. There is episodic disease progression with lack of overt clinical signs of disease in *Aggressive* Periodontitis.
- False: it has a poor response to therapy - True
T/F Fibrinogen is considered a cytokine. IL-8 is a neutrophil attractant which initiates phagocytosis. The pro-inflammatory cytokines are IL-1, IL-6, and TNF-alpha. T/F Acute phase proteins may increase or decrease in response to inflammation.
- False: it is an acute phase protein like CRP (which increases) - True - True - True
T/F NS is a common disease, most likely stemming from a progression of NG or NP. NS is generally localized with very rapid destruction, starting in the mouth and spreading intra-orally. Many of the same bacteria are associated with NS as NG and NP. Predisposing factors like a compromised immune system are not the main factors facilitating bacterial pathogenecity.
- False: it is uncommon - True: it can perforate the facial skin causing Cancrum Oris or Noma - True, Fusobacterium, treponema denticola, and prevotella intermedia - False, they are the main factors
T/F The majority of periodontal bacteria live in the planktonic form. We are most concerned with the red, orange, and green complexes. A.a. lives in the red complex.
- False: majority live in bacterial *complexes* - True - False: A.a. is the outlier that is tissue invasive and highly aggressive but does *not* live in a complex (high risk pathogen non-red complex)
T/F Black males are less likely to get Aggressive Periodontitis than white males. There is both a localized and generalized form of *Aggressive* Periodontitis.
- False: more likely, black males > black females > white females > white males - True
T/F All people with neutrophil dysfunction have aggressive periodontitis. Not all people with aggressive periodontitis have a neutrophil dysfunction.
- False: not all people have this but it has an increased risk for aggressive periodontitis - True
T/F Nutritional deficiencies may cause gingivitis or periodontitis. Some nutritional deficiencies may cause changes in the oral cavity.
- False: nutritional deficiencies *alone* cannot cause gingivitis or periodontitis - True (may be related to inflammation)
T/F Periodontal lesions typically have an absent pocket. Primary periodontal/secondary endo lesions are rare and occur when the periodontal response reaches the apex and cuts off the blood supply from entering the tooth.
- False: primary pulpal lesions typically have little to no pocket associated with them - True
T/F The first bacteria that attach to teeth & form the biofilm are the most pathogenic. There is genetic exchange in the biofilm which increases drug resistance. What are the 6 steps in forming a biofilm (AAPMBG)?
- False: the more pathogenic bacteria come later - True - Association > Adhesion > Proliferation > Microcolonies > Biofilm formation > Growth/maturation
T/F Long-term studies of PD have shown a decrease in mortality generally associated with systemic inflammation. These studies show an association with PD, not a cause-and-effect relationship.
- False: they have shown an increase in mortality - True
T/F Traditional signs and symptoms of periodontitis reflect the systemic contribution. A growing amount of evidence indicates the presence of chronic gingival/periodontal inflammation possibly contributes to specific systemic diseases. Which type of studies and trials are needed before causative roles can be assigned?
- False: they may not reflect systemic contribution - True - Longitudinal studies and intervention trials
T/F Periodontal treatment is associated with an improvement in glycemic control in both Type I and II DM patients. When adjusted for other risk factors, PD played no risk in pre-term LBW cases.
- False: treatment only had a significant impact on glycemic control in *Type II* DM patients - False: when adjusted, the odds ratio was 7.5, being even greater than tobacco or alcohol use during pregnancy
T/F PD may be associated with adverse pregnancy outcomes with a strong level of evidence. PD therapy may reduce the risk of adverse outcomes. The risk of adverse outcomes appears to be related to the microbial bioload and the progression of PD during pregnancy.
- False; moderate level of evidence - True: limited level of evidence - True
The PDL is the tissue in the body with the ___________ turnover time, allowing rapid equilibration for shifts in occlusion.
- Fastest
Describe the 6 characteristics of A.a.
- Fastidious, *facultative* anaerobe, *non-motile*, non-hemolytic, non-sporing, small, *gram negative rod*
NG has a ________ odor and bleeds __________ with little provocation. Patients have a __________ saliva with a _________ taste in their mouth. T/F NG has no systemic signs and symptoms.
- Fetid odor - Bleeds profusely - *"Pasty"* saliva - Metallic taste (Note NG is painful) - False
How does DH present histologically? On IF?
- Focal aggregates of *eosinophils* among deposits of fibrin and neutrophils - IgA and C3 deposition at *dermal* papillary apices
What are the 4 requirements for occlusal stability?
- Forces on individual teeth don't exceed the support & resistance of that tooth's periodontium & are vertically oriented as much as possible - Even, simultaneous contacts of all posterior teeth in CR and MI - Little or no contact of anterior teeth in CR - Harmonious *excursive movement* of the mandible within the patient's envelope of function with complete absence of occlusal interference
What is GAP? What patient ages does it typically affect? How is it differentiated from LAP? T/F Camplyobacter rectus may be present in GAP?
- Generalized Aggressive Periodontitis - Usually 30 years or younger - Bone loss and CAL affects at least *3 teeth other than first molars and incisors* - True
The reaction between dental plaque and the host occurs where? How does this relate to occlusion?
- Gingival sulcus - With trauma from occlusion combined with bacterial infection, there is *increased destruction of the PDL*
How do Vitamin B deficiencies present in the oral cavity (GGGAI)? Why is gingivitis associated w/ Vit B deficiency non-specific?
- Gingivitis, glossitis, glossodynia, angular cheilitis, and inflammation of entire oral mucosa - Gingivitis is non-specific because it is *caused by plaque* rather than by the deficiency but it is *modified by the deficiency*
How do you treat Dermatitis Herpetiformis 2?
- Gluten-Free Diet - Oral *Dapsone* treatment
Chlorhexidine is the _______________ of all oral mouthrinses. It works by ______________. It exhibits the quality of ____________, adhering to soft and hard tissues and released over time.
- Gold standard - Rupturing cell membranes (cationic bisbiguanide) - Substantivity
Hyperparathyroidism has which 3 key features radiographically?
- Ground glass appearance - Absence of lamina dura - Brown tumors
What is the main differential diagnosis for NUG?
- Herpetic gingivostomatitis
What are the 2 proposed mechanisms of the influence of periodontal diseases on systemic diseases?
- Hunter (1900): oral microorganisms have access to the parts of the body distant from the oral cavity - Inflammation: periodontal bacterial infections induce an inflammatory response that can become locally destructive and contribute to systemic inflammation
What are the 4 main features of LP on histology?
- Hyper or parakeratosis - *Degeneration of basal cell layer* - *Dense band-like infiltrate of T-lymphocytes in lamina propria* - *Rete ridges with "saw-tooth" configuration*
What are drug eruptions? What is Stomatitis Medicamentosa? What is Stomatitis Venenata?
- Hypersensitivities to drugs leading to eruptions in the mouth (stomatitis medicamentosa) - Eruptions due to drugs taken PO or parentally - Also called *contact stomatitis*, the *local* reaction from the use of medicament in the mouth
How is a Gingival abscess treated 4?
- If fluctuant (movable), establish drainage - Debridement: remove foreign body if present - Rinse: saline or chlorhexidine - Follow-up
What is Diabetes Mellitus? What Type is most common?
- Imparied insulin secretion or function which results in increased blood glucose levels that characterized by metabolic *dysregulation* which primarily affects carbohydrate metabolism - Type II represents 90-95% of all cases
Why is a risk of peridontal disease increased in patients with DM (3)?
- Increased glucose in gingival crevicular fluid (hyperglycemia) - PMN leukocyte function is impaired w/ impaired healing - Collagen synthesis reduced due to *Advanced Glycation End products* accumulation causing increased susceptibility to *tissue destruction*
What are the 4 periodontal response to a leukocyte disorder?
- Increased infection, severe chronic periodontitis, aggressive periodontitis, or *rapid* alveolar bone *loss*
What 6 periodontal considerations need to be considered with Type II DM?
- Increased plaque due to xerostomia - Periodontal abscesses - Altered collagen metabolism - Impaired PMN functions - Increased bone resorption - Impaired wound healing (May even see increased diffuse gingival inflammation)
New research has shown that the common link between periodontal disease and cardiovascular disease is _______.
- Inflammation
What is acute pericoronitis? What 4 exacerbates it? How does it present 5?
- Inflammation of the gingiva covering an incompletely erupted tooth, most often a mandibular 3rd molar - Exacerbated by occlusal trauma, foreign body entrapment, plaque, or NUG - Erythematous, enlarged, suppurating lesion with pain that may *radiate to the ear, throat, or floor of mouth* with possible trismus and lymphadenitis
What is Lichen Planus, which cells play a role? What 5 forms does it present as? Which is most common form and describe the basic characteristics 3?
- Inflammatory, mucocutaneous disorder with *T-lymphocytes* playing a role - *Reticular*, patch/papular, atrophic, erosive, and bullous - Reticular is asymptomatic, bilateral, w/ interlacing white line (Wickham striae) most often on buccal mucosa
What is primary occlusal trauma? When does it occur (3)?
- Injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with *normal support* - Occurs in the presence of normal bone level with normal attachment and excessive occlusal forces
What is Secondary Occlusal Trauma? When does it occur (3)? T/F the center of rotation for secondary occlusal trauma is higher on individual teeth. PDLs in primary and secondary trauma have the same shape.
- Injury resulting in tissue changes from normal or excessive occlusal forces applied to *teeth with reduced support* - Occurs in the presence of bone loss, attachment loss, and normal/excessive occlusal forces (such as in severe PD) - False, lower due to loss of bone - True, thinner in the middle
Describe the process of determining your differential when classifying perio and endo lesions (4).
- Isolated bony defects with severe pain = endo lesion - Non-vital or irreversible pulpitis = endo or endo/perio lesions - Long-standing problem with little pain = perio lesion - Multiple bony defects = perio or endo/perio lesion
What else may be used to treat Recurrent Herpetic Stomatitis other than antivirals (2)?
- L-Lysine (b/c lysine competes w/ arginine to stop herpes replication) - Elimination diet of foods rich in arginine (almonds, walnuts, pecans, peanuts, dark chocolate, and red wine)
What are the 2 important effects of Macrolides?
- Less hypersensitivity than penicillins - Bacteriostatic or cidal, depending on the bug
How can leukemia cause periodontal problems (2)?
- Leukemia may cause gingival enlargement (*acute leukemia only*) leading to plaque accumulation and sponge-like gingiva that bleeds easily - The gingiva in these patients is very susceptible to bacterial infection which may lead to *necrosis and pseudomembrane formation*
A.a. produces a strong __________ which kills _____ (immune cell). How does this differ between strains? What strain are patients with the disease more likely to have?
- Leukotoxin, neutrophils - Different strains produce different levels of leukotoxin: highly virulent strains make increased leukotoxin - More likely to have highly virulent with strong leukotoxin
How does Linear IgA Disease appear on IF? How does this differ from dermatitis herpetiformis?
- Linear deposits of IgA at the epithelial-CT interface - Differs from dermatitis herpetiformis in that it is linear, not granular
Under immunoflorescence, how does LP appear 2? Describe the extraoral lesions of LP.
- Linear deposits of fibrin (shaggy appearance) in the BM with cytoid bodies in the upper Lamina Propria - Skin is purple, polygonal, pruritic, papules, and plaques
How does EM present histologically (5)? IF? How is it treated?
- Liquefaction of the upper epithelium, *intraepithelial* microvesicles, acanthosis, edema of lamina propria, and pseudoepitheliamatous hyperplasia - IF is negative - Systemic and local *antihistamines* together with topical anesthetics
What are some delivery methods of antimicrobial therapy specific for GAP? What is periostat (2)?
- Local antimicrobial therapy, including powder, chips, gels, and fibers for *direct application into the pocket* - Low dose doxycycline that can inhibit collagenase (antibiotic activity is gone)
What is LAP? What is characteristic of the bone loss associated with localized aggressive periodontitis (2)? What is elevated?
- Localized Aggressive Periodontitis: onset between puberty and 20 years with bone loss 3-4x faster than chronic periodontitis & CAL around 1st molar and incisors - Elevated Aa and P. gingivalis with little or no inflammation
What is a Gingival Abscess? What does it look like clinically 3?
- Localized purulent infection involving the *marginal gingiva and interdental papilla* - Red, smooth, & shiny surface - pointed - purulent exudate
What is a Periodontal Abscess?
- Localized purulent infection involving the periodontal tissues
What are the 4 systemic signs/symptoms?
- Lymphadenopathy, fever, malaise, loss of appetite - Usually minimal but are more severe in children
What are the 3 important effects of Penicillins?
- MOA: beta-lactam bactericidal - Drug of choice for many dental related infections - 15% of adults have hypersensitivity (1% anaphylactic)
What is necrotizing periodontitis 2?
- May be an extension of NUG into deeper periodontal structures, leading to CAL & bone loss - May be a different disease from NUG
What effect would neutropenia have on the periodontium?
- May result in severe infections with an *absence* of notable inflammatory reaction
What causes cells to differentiate from non-parenchymal cells to cells of the PDL?
- Mechanical forces on the PDL (masticatory forces)
What is the Van Winkelhoff Cocktail 2 (MA)?
- Metronidazole + Amoxicillin
What is necrotizing gingivitis? What are 4 other names for it?
- Microbial disease of the gingiva in presence of an *impaired host response* - Trench mouth, Vincent's gingivostomatitis, ANUG (acute), and NUG
What is the most common local drug delivery system? What is the % composition?
- Minocycline microspheres - 2% Minocycline
What is the first clinical indicator of occlusal trauma?
- Mobility of the tooth
What does EM look like clinically 2?
- Moderate cutaneous and mucosal involvement with multiple, large, shallow, *painful* ulcers in the mouth - *Hemorrhagic crusting of the vermillion border of the lips may occur*
Pemphigus vulgaris is the __________ common of the pemphigus diseases. How does this present?
- Most common - Epidermal and mucous membrane blisters occur when cell-to-cell adhesion structures are damaged
What are the 3 classic oral symptoms of Type II DM?
- Multiple periodontal abscesses - Severe bone loss (2.9x more likely to have severe periodontitis) - Poor response to treatment
What can an increase in stress be a *risk factor* for? How is long term stress coped with by the patient 3? How does the body respond to long-term stress?
- NUG; stress is implicated as Risk Indicators for some forms of periodontal disease (PD) - Stress is coped with by an increase in smoking, decrease in OH, and decreased visits to the dentist - Increased stress leads to cortisol (anti-inflammatory) production leading to a decreased immune response & resistance to infection
What is Necrotizing Stomatitis? Where are the 4 common locations?
- NUS occurs when necrosis progresses to deeper tissues beyond the *mucogingival junction* into soft tissues like the lip, buccal/labial mucosa, tongue, or palate
What is a biofilm? What is a glycocalyx? Quorum sensing? At which point does quorum sensing occur?
- Natural communal aggregation of microorganisms that become highly organized community w/ nutritional channels between colonies - Matrix produced by biofilm which *increases the virulence* of the bacteria by protecting it - "Communication" between bacteria of the biofilm which helps *increase virulence and growth* - When the biofilm is mature
What are the 3 necrotizing periodontal diseases we need to know?
- Necrotizing Gingivitis - Necrotizing Periodontitis - Necrotizing Stomatitis
How does a Vitamin E deficiency present in the oral cavity?
- No relationship between deficiency and oral disease, though systemic Vitamin E appears to accelerate gingival wound healing in the rat due to *antioxidant properties*
How does a Vitamin D deficiency present in the oral cavity (2)? What is Vit D essential for (2)?
- No studies have shown a relationship between deficiency and periodontal disease in humans - Dog studies have shown a decrease in alveolar bone similar to osteoporosis, however - Calcium absorption and calcium-phosphorus balance
What is the purpose of stabilization splints? T/F full mouth equilibration is not 1st line therapy.
- Occlusal appliances which provide a stabilizing influence for the incisors in particular - True
What causes Periodontal abscesses (5)?
- Occlusion of existing periodontal pocket - Extension from infected pocket - Incomplete removal of calculus - Root fracture - Systemic disorder: if there are multiple abscesses occurring in different locations
What is the epidemiology of NG (2)?
- Occurs in all ages with the highest incidence in those aged 15-30 years (college adds stress) - Mainly found in children in *developing* countries
Radiographically, how does LAP present 2?
- Often bilateral, *vertical* bone loss affecting the permanent first molars and incisors - Bone loss has an "arc-shape" extending from the distal of the 2nd premolar to the mesial of the 1st molar
What are 4 other clinical features of NP?
- Oral malodor, fever, malaise, and lymphadenopathy
What is the Focal Infection Theory (3)?
- Over 100 years ago, people belived dental infections were the *principle foci* of systemic diseases & had FMX's - this did not prevent systemic disease - Oral foci of infection are not the principle cause of most systemic diseases *- However, on occasion, oral pathogens may induce systemic infections (Infectious endocarditis, prosthetic joint infections)*
How is PD associated with an increased risk for CVD 5?
- PD stimulates host-immune system, increased inflammatory mediators, increased fibrinogen, and increased serum cholesterol leading to *vascular thickening* of the arteries and clot formation
What is parafunction, and how does it play a role in occlusion in periodontitis? How does the parafunction differ between day and night time?
- Parafunction, or bruxism, may cause occlusal forces on teeth that are susceptible to periodontitis & magnify the damage - Daytime: limited to clenching - Nighttime: clenching and grinding of teeth
Periodontal disease is caused by pathogenic ___________ and a susceptible ________.
- Pathogenic bacteria & a susceptible host
What are the 4 clinical features of LAP?
- Pathologic migration of the teeth (usually diastema) - Increased mobility of affected teeth - Periodontal abscess formation - Root surface sensitivity
What are the indications of local drug delivery? What are the side effects?
- Pockets *>5mm* non-responsive to SRP w/ BOP - Minimal side effects
How can DM be monitored? What is the best way? Give the normal values for each.
- Point in time fasting glucose levels: <100 mg/dL - 2 hour post-prandial glucose levels: <140 mg/dL - (10-12 weeks) Glycosylated HbA1c levels: <5.7% (best way)
What are 9 predisposing factors to NG?
- Pre-existing gingivitis, periodontitis, or pericoronitis, injury, malocclusion, poor OH, *inadequate rest, poor nutrition, smoking, stress, immune suppression,* & systemic disease
What effect do bisphosphonates have on the oral cavity (2)?
- Prescribed for osteoporosis & inhibit osteoclastic activity - Can cause BRONJ in patients: this is a non-healing exposure and necrosis of portions of the jaw bone in patients persisting for >8 weeks in patients on bisphosphonates who have *not been exposed to radiation*
How does heavy metal intoxication typically present in the oral cavity?
- Presents as a dark, horizontal line on the gingiva, such as Burton's Line in lead poisoning
According to Loesche, what are the 3 *constant* flora in NG? Variable flora?
- Prevotella intermedia, Fusobacteria, and Treponema - Heterogenous array of bacteria which varies among patients
What are the three most common associated organisms of NG (PFS)?
- Prevotella intermedia, Fusobacterium, & Spirochetes (Treponema)
What is Primary Herpetic Gingivostomatitis? What 7 causes recurrence? T/F primary Herpetic Gingivostomatitis occurs equally in M and F.
- Primary HSV-1 infection occurring mainly in infants and children younger than 6 (however may be seen in adults) and lasts 7-10 days, healing spontaneously *without scarring* - Dental treatment, respiratory infections, sun, stress, fever, trauma, or some chemicals. Recurrent herpes will be more localized - True
What are the 4 common characteristics of Aggressive Periodontitis?
- Rapid destruction of periodontal attachment & loss of supporting bone - *No signs of systemic disease* - Relatively *small* amounts of bacterial plaque & biofilm which is *disproportionate* to the amount of bone loss - Familial aggregation (possibly genetic)
What are the clinical features of NP 3? How is it distinguishable from NUG (2)?
- Rapid onset, soft tissue necrosis and ulceration of interdental papillae & marginal gingiva, bright red & *painful* gingiva that bleeds easily - Periodontal attachment and bone loss with deep interdental soft-tissue and osseous craters exposing bone (severe bone loss, mobility, and tooth loss)
What is the DD for Primary Herpetic Gingivostomatitis (4)?
- Recurrent apthous stomatitis, severe infective gingivitis, EM, bullous oral LP
How does a protein deficiency present in the oral cavity (2)?
- Results in *periodontal tissues* that lack integrity and are more vulnerable to breakdown in the presence of bacterial plaque
What is hypophosphatasia? What effect does hypophosphatasia have on the oral cavity 3? In adolescents, hypophosphatasia may resemble which disease?
- Rickets, poor cranial bone formation, craniosynostosis, & premature loss of primary teeth, esp. the *incisors* - Teeth are lost with *no clinical evidence of gingival inflammation*, reduced/absent cementum formation, premature loss of the deciduous teeth may be the only symptom in patients with minimal bone abnormalities - Localized aggressive periodontitis
The best clinical protocol for treating periodontitis (combo of SRP and antibiotics) is ____________ (3).
- SRP and antibiotics within 48 hours of each other, wait 6 months while doing maintenance, evaluate & do SRP and flap surgery if necessary
*Subacute* Cutaneous Lupus Erythematosus is similar to DLE without ______ & _______. ______% of patients present with *arthritis, arthralgias, fever, malaise, and myalgias.*
- Scarring and atrophy - 50%
Secondary Orofacial Herpes occurs b/c of which stimuli (4)? Secondary lesions manifest as what 5?
- Secondary herpes occurs in response to stimuli such as fever, sunlight, stress or trauma which manifest as H. labials, stomatitis, genitalis, encephalitis, or ocular herpes - These are the common cold sores
How does GAP appear radiographically 2?
- Severe bone loss affecting minimal number of teeth *OR* majority of teeth affected by advanced bone loss
How does SLE present in the oral cavity? How does it appear on IF? The patients have a positive serum ANA _______% of the time.
- Similar to LP with oral *ulcerations* and hyperkeratotic *plaques* - Ig and C3 deposition at the *dermal-epidermal* junction - 95% + ANA
What 5 tests can be performed to differentiate periodontal and periapical abscesses?
- Sinus tract: near the attached gingival indicates periodontal - Probing: Deep pockets indicate periodontal - Radiograph: periapical radiolucency indicates periapical - Fractured root indicates periodontal - Percussion: periapical/endo responds severely to pain, *periodontal is less severe*
What are the contributing factors for pre-term, low birth weight cases? T/F these contributing factors are involved in 90% of cases.
- Smoking & alcohol use - Inadequate prenatal care - HTN - Diabetes - False, *These factors are not present in 25% of preterm, LBW cases*
How does thrombocytopenia present in the oral cavity (3)?
- Soft, friable, and swollen gingiva - spontaneous bleeding - exaggerated response to local factors
What are the 3 side effects of chlorhexidine use? What percent solution is it available in?
- Staining, calculus formation, taste alteration - 0.12% in the U.S.
What 3 bacteria are associated with the *surface* exudate of NUG (CFS)? Between necrotic & living tissue (3)? Underlying tissue?
- Surface exudate: cocci, fusiform bacilli, and spirochetes - Between: huge numbers of *Fusiform bacilli and spirochetes*, leukocytes, and fibrin - Underlying tissue invaders: *spirochetes* (300 microns deep into tissue)
How can anti-infectives be delivered 2?
- Systemically (orally): arrives at site of action through circulatory system - Local: administration generally directly to pocket & can provide concentrations greater than systemic administration; reduces systemic side effects of the drug
What 3 antibiotics are given to kill A.a. (TDM)? Which type of AP will have a more unpredictable clinical course w/ response to txt?
- Tetracycline - Doxycycline - Metronidazole + amoxicillin - Generalized disease pattern
Tetracycline fibers (Actisite) is a polymer with 25% ________.
- Tetracycline hydrochloride
When treating combined perio and endo lesions, what should be treated first? In a primary periodontal/secondary pulpal lesion, prognosis is dependent more upon what?
- The endo lesion should be treated first with the perio lesion treated after - The success of treatment typically depends on the success of endo therapy - Perio txt after root canal txt
What effects does puberty have on the gingiva? How long does this last?
- The sex hormones associated with puberty cause an *exaggerated response* to local irritation, causing edema and gingival enlargement - As the patient leaves puberty, gingival reaction diminishes
What occurs when a tooth is underloaded during hypofunction? Where do teeth want to be?
- The tooth will supra-erupt with the force coming from the PDL pushing it up - Teeth want to be in a normal, physiologic state where little remodeling occurs - called the "Lazy Zone"
What occurs in a true combined endo-perio lesion?
- There is concomitant lesions of both perio and endo origins that form separately - Both must be treated concomitantly & depends on the removal of the individual causative factors and prevention of further factors that may affect the respective disease process
What did Loe et al. show in 1993 about the link between PD and DM? What effect does PD have on glycemic control levels?
- There is evidence that diabetes *increases the risk* for and severity of PD - Taylor et al. in 1996 showed that individuals with severe PD had a greater incidence of worsening glycemic control over a 2 to 4 year period compared to those without PD
The host response in periodontal therapy is responsible for the ____________ that occurs in PD. Host modulation therapy is used to *decrease* levels of what 3 modulators (ECP)? This can modulate __________ and __________ function.
- Tissue breakdown - Enzymes, cytokines, and prostanoids - Osteoclast and osteoblast function
What can cause Stomatitis Venenata (4)?
- Toothpaste, allergy to dental materials, cinnamon, lipstick, etc.
What is the treatment of CUS for moderate vs severe vs long lasting remission?
- Topical flucinonide or clobetasol for moderate cases - High dose systemic steroids for severe cases - *Hydroxychloroquine sulfate* for long-lasting remission
How is Subacute Cutaneous LE treated 3?
- Topical steroids & NSAIDs - Prednisone with immunosuppressive drugs - Systemic antimalarials for those resistant to topical therapy
What is the treatment for LP (3)?
- Topical steroids (fluocinonide) or immunosuppressants (tacrolimus) - also concomitant use of a topical antifungal agent- side effect of candidiasis
What is the treatment for BMMP (3)? What can systemic steroids be combined w/ (2) (AC)?
- Topical steroids: fluocinonide & clobetasol - Systemic steroids for *ocular* involvement - Dapsone if systemic lesions aren't responsive - *Systemics may be combined with azathioprine or cyclophosphamide*
What are the 2 important effects of Metronidazole (nitroimidazoles)?
- Treatment of necrotizing gingivitis - Causes severe antabuse reaction when ingested with alcohol
T/F Early signs of LAP may present in the primary dentition in the same region.
- True
T/F Adipose tissue dysfunction rather than obesity may result in increased number of cells which release proinflammatory cytokines & chemokines.
- True
T/F Defective neutrophil function is *common* for both forms of aggressive periodontitis.
- True
T/F Topical antigingivitis agents have little effect on periodontitis.
- True
T/F the new 2017 classification does not include the word aggressive w/ periodontitis.
- True
T/F Current evidence does NOT support the distinction between chronic & aggressive periodontitis as two separate diseases. What are the ways that aggressive and chronic periodontitis varies? In which 2 stages and in which grade would aggressive periodontitis fall under?
- True - Clinical presentation related to extent and severity - Stage 3 & 4 w/ a grade C
T/F Inflammation appears to be a common link between common diseases of aging, such as heart disease, arthritis, and periodontitis. Periodontitis starts as a microbial infection which leads to bacteria-mediated destruction of soft tissue if not treated.
- True - False, host-mediated destruction: caused by *hyperactivated* leukocytes w/ generation of cytokines, eicosanoids, & MMPs leading to bone loss
T/F Periodontal abscesses typically have broad-based pockets with soft tissue inflammation. Multiple periodontal abscesses is the typical clinical presentation.
- True - False: multiple abscesses is indicative of a systemic disorder
T/F No chemotherapeutic agent should be given as monotherapy but as an adjunct to mechanical therapy. Systemic antibiotics are necessary in most of gingivitis and periodontitis cases. The decision of when to use a chemotherapeutic agent can be generalized.
- True - False: they are not needed in most of these cases - False, individualized in each PT
T/F Primary pulpal lesions have no EPT response, typically have a sinus tract associated, and have tooth mobility. There is generalized bone loss, a wide pocket, and tenderness to percussion in these lesions. Endodontic treatment of primary pulpal lesions has an excellent prognosis.
- True - False: they typically have localized bone loss and a narrow & shallow pocket - True
T/F Systemic diseases do not cause periodontitis, but they may increase the progression of periodontitis. Type I DM causes insulin resistance at receptor and post-receptor levels.
- True - False: this is Type II DM; Type I DM is caused by the destruction of Beta cells in the pancreas
T/F Abnormal bleeding of the periodontium is an important clinical sign of a possible hematological disorder. Deficiencies in host response to insults of the periodontium can lead to severely destructive periodontal lesions.
- True - True
T/F Essential oils, like Listerine, contain alcohol to disrupt the cell wall. Local/controlled delivery systems are placed directly into the periodontally diseased pockets.
- True - True
T/F Infants with Primary Herpetic Gingivostomatitis may refuse food due to pain. They may also present with cervical lymphatdenitis and fever.
- True - True
T/F Patients with LAP have a consistently increased level of A.a. antibody titers. Lack of clinical improvement was found to correlate with a failure to significantly reduce the levels of A.a.
- True - True
T/F The association between PD and non-hemorrhagic stroke is stronger than for other types of CVD. PD and CVD both share many common risk factors. Evidence exists that states that treating PD reduces CVD risk. Recent studies show that PD is associated w/ risk of future CVD and increases in older individuals.
- True - True - False: there is no direct evidence of this; periodontal therapy cannot be ethically recommended solely to prevent CVD - True
T/F Invasive dental therapy for a patient on bisphosphonates may initiate the osteonecrotic process. Bisphosphonates suppress osteoclasts, angiogenesis, and result in dense and well nourished bone.
- True - False: poorly nourished bone
T/F Osteoporosis has no clear association w/ probing depth nor clinical attachment loss
- True (even though radiograph shows alveolar bone loss)
T/F Patients should be cautioned about the risk of self-transmission to the eye or other parts of the body.
- True: such as herpetic whitlow
T/F NUP is more common in patients with severe immunosuppression. NUP is associated with high CD4+ counts in HIV+ patients.
- True: these patients have more & faster destruction of tissues - False: associated with low CD4+ counts, a predictor of transition into AIDS
What's the difference between type 1 and type 2 diabetes?
- Type 1: destroys pancreatic B cells > leading to insulin deficiency - Type 2: *insulin resistance* at receptors. As demand increases pancreas reduces insulin production and completely stops
What is Linear IgA Disease? What drugs are known to trigger drug-induced LAD? What disease does Linear IgA Disease mimic histologically?
- Uncommon mucocutaneous disorder with characteristic plaques with an *annular* presentation surrounded by peripheral rim of blisters - *ACE inhibitors*; however etiology is unknown - Mimics LP - IF needed to establish diagnosis
What are the 3 important effects of Clindamycin (Lincosamides)?
- Used in patients who are allergic to penicillins - Bacteriostatic - Causes pseudomembranous colitis if taken in excess/too long
When does occlusal therapy commence in the treatment planning of periodontal therapy?
- Usually commences *following re-evaluation* (workup, OHI, SRP, re-eval 4-6 wks later)
How does Linear IgA disease present in the oral cavity and which 2 are most common sites?
- Vesicles, *painful* ulcerations, and erosive gingivitis or cheilitis - Hard and soft palate is more common - Seen on tonsillar pillars, buccal mucosa, tongue, and gingiva
Which test is most definitive for differentiating between a Periodontal abscess and a Periapical abcess?
- Vitality test - *Periodontal abscess: tooth is vital* - *Periapical* abscess: tooth is usually *not vital*
What 3 symptoms are associated with GAP? What 3 conditions may predispose to GAP?
- Weight loss, mental depression, general malaise - Chronic neutrophil defects, LAD, impaired chemotaxis/phagocytosis (most of the tissue destruction is due to monocytes and macrophages)
As the PDL is lost in periodontitis, what happens to the protective muscle modulation of occlusal forces?
- With a smaller PDL due to bone and CAL, there are fewer sensory fibers in the PDL which *limits* the protective muscle modulation of occlusal forces
Describe the evolution of traumatic lesions in a tooth.
- With hyperloading, peak bone resorption occurs at 1 month with remodeling beginning after 2 months - It takes several months to return to normal
How is the 1999 classification "Periodontitis as a manifestation of systemic disease" classified in the 2017 system?
- Within 2 subcategories of Periodontal diseases and conditions: Periodontitis as a manifestation of systemic disease (within the Periodontitis category) & Systemic diseases or conditions affecting the periodontal supporting tissues (within Other conditions affecting the periodontium)
Systemic Lupus Erythematosus has a prediliction for ________, affects the ________, ________, _______, and _________. It typically presents with a ________ rash in a butterfly distribution.
- Women (10 to 1) - Kidneys, heart, skin, and mucosa - Malar rash
_______ studies specifically demonstrate an increased risk of respiratory infections in patients with periodontal disease. T/F Good OH and frequent professional prophylaxes have been shown to be useful in reducing development of pneumonia in high risk elderly people
- Zero - True
What is guidance? T/F Response to occlusal forces is individualized for each PT. Tipping forces may lead to excessive forces over larger areas. Teeth are constantly moving, but the cusp-fossa relationship can hold them in place.
- pattern of opposing tooth contact during excursive movements of the mandible. - True - True - True
What is mandatory to begin the assessment of desquamative gingivitis?
- thorough clinical hx
How is Necrotizing periodontal diseases classified in the 2017 system?
1 of 3 groups w/ in the subclassification of Periodontitis which is 1 of the 3 groups sub classified in Periodontal Diseases and Conditions (part of Periodontal and peri-implant diseases and conditions
What 4 options do we have for Occlusal Therapy in Periodontitis?
*- Stabilization splints* - Limited orthodontic therapy - Equilibration - Splinting
A combination of antibiotics are used to achieve ___________. Bactericidal and bacteriostatic agents ___________ (should/shoud not) be used together. What do bactericidal antibiotics need to be effective?
*- Synergism (1 + 1 = 3)* - Should not - Organism replication
What 3 antibiotics are used for periodontal abscesses (ACA)? What is the antibiotic of choice?
- *Amoxicillin w/ 1g LD and 500mg TID for 3 days* - Clindamycin w/ 600mg LD and 300mg QID for 3 days - Azithromycin w/ 1g LD and 500mg QID for 3 days
What is desquamative gingivitis? What 6 conditions manifest as this (BPLDLC)?
- *Clinical term* which is a gingival response associated with a variety of conditions (NOT a specific disease) - Bullous pemphigoid, pemphigus vulgaris, linear IgA disease, dermatitis herpetiformis, lupus erythematosus, chronic ulcerative stomatitis
How does a Vitamin A deficiency present in the oral cavity? How might Vit A be protective?
- *Degenerative* changes occur in epithelial tissue, resulting in *keratinizing metaplasia* - Protecting against microbial invasion by *maintaining epithelial integrity*
List the 3 Acute Gingival diseases. List the Acute 3 Periodontal diseases
- *Gingiva*: Necrotizing gingivitis, acute herpetic gingivostomatitis, acute pericoronitis - *Periodontal*: gingival abscess, periodontal abscess, and pericoronal abscess - Note that periodontal-endodontic lesions are considered acute
PV has a distinct histopathology. Describe it (3).
- *Intra-epithelial* separation above the basal cell layer ("tombstone" appearance) - Acantholysis is present (separation of epithelial cells from lower stratum spinosum) - Antibodies to Desmoglein-3, a desmosome between epithelial cells; *chicken-wire appearance* on IF
How does CUS present on histopathology 3? Which other disease is CUS similar to?
- *Similar to erosive LP* w/ hyperkeratosis, acanthosis, & liquefaction of basal cell layer - Lamina propria has lymphocytic chronic infiltrate with band-like configuration - On IF, there are deposits of IgG with a speckled pattern & fibrin deposits at the epithelia CT interface
How does BMMP present histologically and under IF?
- *Subepithelial* vesiculation with an intact basal cell layer - IgG and C3a confined to mucous membrane, antibodies against the *hemidesmosomes* in BM
What is the treatment for PV? How should the maintenance phase be treated?
- *Systemic steroids with or without immunosuppressives*. Primary txt is prednisone - Control the disease with the lowest dose of medication needed
In the 2017 classification, Periodontal abscesses and endo-perio lesions fit into which category?
- *other* conditions affecting the periodontium (recall necrotizing periodontal diseases lies within "periodontitis" subclass)
Following biopsy, H&E specimens should be stored in ________. Immunoflorescence specimens should be stored in _________.
- 10% buffered formalin - Michel's Buffer (*ammonium sulfate* buffer)
______% of U.S. adults are diabetic, with _____% not knowing it. ______% are pre-diabetic. What may be the first clinical sign of DM?
- 14.3% (28 million) - 36.4% don't know it - 38.0% are prediabetic - Oral effects
The Chlorhexidine Chip has ______ mg in a biodegradable film of hydrolyzed gelatin, lasting about __________. How much doxycycline in doxycycline gel (Atridox)?
- 2.5mg - 7-10 days - 10% = 42.5 mg
What is Periostat, how is it administered and what are the effects? Periostat has no _____ activity.
- 20mg of doxycyline 2x daily over 6-9 months leading to downregulation of *MMPs, cytokines, and ostoclasts* *- No antibacterial activity at this dosage*
What eye lesions are seen with pemphigoid?
- 25% of patients have adhesions of eyelid to eyeball (*symblepharon*) which lead to corneal damage and *blindness*
In _____% of patients, *oral lesions are the first sign* of disease with pemphigus vulgaris. The soft palate is involved _____% of the time.
- 60% - 80%
What is the prevalence of aggressive periodontitis? What ethnicity is it higher in? T/F AP is higher in males.
- <1% - African Americans - False, gender predilection varies
According to Jeffcoat et al. in 2011, what was the conclusion on PD treatment and pre-term birth risks?
- A beneficial effect on pre-term birth may be dependent on the *success* of periodontal treatment *- This is a key paper*
What is Dermatitis Herpetiformis? This can be a presentation of what disease? How does it initially present? How does it present in the oral cavity 2?
- A chronic condition presenting in 20-30 year olds (more men) - May present as a *cutaneous manifestation of celiac disease in 25% of these patients* - *Initial presentation has clusters of vesicles arising on the skin though has nothing to do with Herpes* - Oral lesions range from painful ulcerations preceded by collapse of vesicles of bullae to erythematous lesions
What relationship exists between COPD and PD?
- A two year RCT showed a *decreased frequency* of COPD exacerbation after successful PD therapy (Zhou et al. 2014)
What bacteria is associated with LAP? Younger patients experience __________ destruction in a shorter period of time.
- A.a. (more found in younger compared to older patients) - More (so important to diagnose condition in early stages)
Why does A.a. affect certain teeth (4)?
- A.a. colonizes the first permanent teeth to erupt, evades host defenses, and antibodies are produced which improve phagocytosis of bacteria which may prevent colonization of other sites - A.a. may lose its ability to produce *leukotoxin* which may slow or arrest the disease process - *A.a. competes* with other bacteria at new colonization sites, localizing the infection & tissue destruction - A.a colonizes altered root surfaces which may *lack cementum*, allowing penetration into the root and colonization of the site
What are the 4 clinical features of a Periodontal abscess?
- Acute abscess is often acute exacerbation of a chronic inflammatory periodontal lesion - Dull, *constant pain*, recent in origin - Surface of tissue is edematous, erythematous, smooth, and/or shiny - Tooth may be sensitive to percussion and be *elevated* in socket
What is Erythema Multiforme? What is the hallmark lesions of EM (2)? What 2 forms are there?
- Acute, bullous and macular inflammatory mucocutaneous disease mainly in young adults from 20-40 years old - Hallmark "target" or "iris" lesions - EM Minor and EM Major/(SJS)
What evidence exists to show a bacterial infection etiology in NG 3? What evidence shows immune system etiology?
- Administration of metronidazole causes resolution of the clinical symptoms & increased titers for IgG and IgM to medium-sized spirochetes. Also, spirochetes and fusiform are ALWAYS found in NG - NUG is seen more in AIDs patients & those malnourished, fusiform-spirochetes are found in normal oral cavity, depression of PMN leukocyte responsiveness
What are 6 contraindications and adverse side effects seen with antibiotic use?
- Allergic reactions - GI disturbances - Hepatotoxicity - Photosensitivity reactions - Fungal infections - Inactivation of OCPs by inhibiting oestrogen breakdown in stomach
Necrotizing gingivitis has a _______ onset with ___________ of the papillary & marginal gingiva. What other characteristics are associated with it?
- An acute onset - Ulceration & necrosis of papillary/marginal gingiva (*Pseudomembranous* covering) - Punched out, crater-like depressions at the crest of the interdental papillae - Gingival margins are hemorrhagic and red
What are the 5 important effects of Tetracyclines?
- Anti-collagenase activity - Anti-inflammatory - High concentration in *gingival crevicular fluid* - May cause tooth discoloration & photosensitivity - Decreased absorption with food or milk (chelation effects)
What is Recurrent Herpetic Stomatitis 2?
- Attenuated form of primary herpes infection affecting tissues firmly bound down (to bone i.e. keratinized) - Vesicles burst to form ulcers, coalesce, and heal in 7-10 days
What causes a Gingival abscess 2?
- Bacteria carried into the gingival tissue - Often a foreign body, such as a popcorn hull, toothbrush bristle, fingernail, dental materials (ex. retraction cord)
What are the 4 Zones of Destruction in NG according to Listgarten (BNNS)? Describe the composition of each.
- Bacterial Zone which is a superficial fibrous mesh made of degenerated epithelial cells, leukocytes, & wide variety of bacterial cells - Neutrophil Rich Zone: high # of leukocytes, esp. neutrophils & numerous spirochetes - Necrotic Zone: disintegrated cells with medium & large size spirochetes & fusiform bacteria - Spirochetal Infiltration Zone: *tissue components preserved* but are infiltrated w/ ONLY large & medium sized *spirochetes* (no other bacteria)
What is the primary etiological factor of perio disease? T/F Presence of specific bacterial pathogens invariably causes disease.
- Bacterial plaque - False; presence does not cause disease; however, absence appears consistent w/ health (host response is what makes the difference)
What are the important effects of Quinolones 2?
- Bactericidal - May cause tendon rupture, tendonitis, or CNS toxicity
What is seen on histopathology of the *primary* infection HSV1? How is it diagnosed (3)? what is the most specific way to dx? Dx is usually based on what 2?
- Balooning of epithelial cells with formation of Tzanck cells leading to ulcer formation from rupture - History, clinical features, *viral culture*, and Tzanck smear usually on keratinized surfaces - Viral culture however we don't wait for results bc that takes too long - clinical features and PT hx
What is another name for Cicatricial Pemphigoid? What is it? Where is it seen? What are the oral lesions seen?
- Benign Mucous Membrane Pemphigoid - Chronic, vesiculobullous autoimmune disorder - Mucous membranes: oral cavity, conjunctiva, mucosa of nose, vagina, rectum, esophagus, and urethra - Erythema, desquamation, ulceration, and vesiculation of *attached gingiva*
What is a common differential for LP?
- Benign pemphigoid or Pemphigus vulgaris - Less common: linear IgA disease or chronic ulcerative stomatitis
What is the important effect of Cephalosporins?
- Beta-lactam antibiotics with cross allergies with penicillins (rashes, urticaria, fever, & GI upset)
What is the treatment for PHGS (3)? When is it infective?
- Bland mouthrinses, soft diet (no pizza), NSAIDs, topicals - Antivirals (acyclovir, valacyclovir, famciclovir) which must be given within 3 days of initial presentation to be effective - Palliative Mouthrinse (1-2-3): diphenhydramine (40 mL), loperamide (80 mL), and distilled water (120 mL) - Patient is contagious while vesicles are present
Is NG due to bacterial infection or immune dysfunction?
- Both: organisms are normal commensals that become pathogenic when local resistance becomes reduced
What is the most common cause of Primary Occlusal Trauma?
- Bruxism: this causes *non-axial* loading of a tooth, leading to expansion of the PDL in one area and narrowing in another area
What is Chronic Ulcerative Stomatitis? CUS is seen in which demographic?
- CUS presents with painful, *solitary* small blisters and erosions with surrounding erythema on the buccal mucosa or hard palate - Seen in women in the 4th decade of life
In Monik Jimeniz, SM, et al. 2009, Periodontal bone loss was significantly associated with what 2 Pt histories?
- CVA (stroke) and transient ischemic attack (TIA)
Primary Pulpal lesions are typically caused by _________ leading to a _______ pulp. How can primary pulpal lesions result in secondary peridontitis?
- Caries or trauma - Necrotic pulp - Lateral & accessory canals may allow for lateral, furcal, or apical periodontitis
What effect do corticosteroids have on the oral cavity?
- Cause less gingival inflammation
What are the 5 indications for systemic *antibiotic* therapy with periodontal *abscesses*?
- Cellulitis - Deep, inaccessible pockets - Fever or swollen glands - Regional lymphadenopathy - Immunocompromised patient