Perio OHI and Miyasaki

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Perio OHI and Miyasaki
2012-06-12 12:46:47
Perio OHI Miyasaki

Perio OHI and Miyasaki
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  1. Assuming that it fits the embrasure, the use of a cylindrical traveler (or Go Between or Go Between Ultra or Soft Picks) does a better job of cleaning an interproximal surface than dental floss.
  2. What are the many uses of rubber tip?
    Gentle way to clean along tooth-gingival sulcus area, mesial and distal surfaces adjacent to extraction site, following periodontal surgery, along molar banded teeth,
  3. How is a rubber tip held to clean along the gingival margin of a molar that is orthodontically banded?
    Parallel if can't get 45 degree angle
  4. Which of the following is an example of a safe wooden interdental cleaner?
  5. What are the best applications for using the “sulcus brush”?
    • ideal for inflamed or sensitive gums.
    • narrow bristle head for cleaning along your gum line.
    • Helps you reach back teeth
    • Provides comfortable cleaning
    • Gives you great control
  6. What are suitable alternatives to flossing for a young adult (e.g. 21 years old)?
    • Wooden cleaners, soft-picks, floss threader
    • Type II embrasure- interdental cylindrical brush, superfloss, go-between
    • Type III embrasure- interdental tapering brush, superfloss
  7. The method of brushing advocated in the UCLA Dental Clinic is called the
  8. One of the best uses of the rubber tip stimulator is
    remove sulcus plaque
  9. Which of the following is the most important consideration in deciding on an appropriate interproximal cleaning aid for a patient?
    Size of embrasures
  10. How are the bristles of the toothbrush placed in using the Bass technique?
    45 deg angle
  11. The use of a toothpick found at a restaurant or super market to clean interpoximally may produce damage to the tooth and gingival embrasure because it is made of hard wood.
  12. Is a Stimudent is made of compressible wood?
  13. In giving instruction on the use of a cylindrical Traveler or Go Between or Go Between Ultra, the most important rules are??
    • PretestInstruction (demonstration on model)
    • Clinical instruction (demonstrate in patient’s mouth using HAND MIRROR patient demonstrates skill
  14. In giving instruction on the use of a cylindrical Traveler or Go Between or Go Between Ultra, the basic rule is to always hold the brush parallel to the occulsal biting plane.
  15. How do you minimize pressure on the gingival tissues when using the rubber tip stimulator?
  16. What are the indications for using the tapering end-tufted brush?
    Excellent for distal surface of most posterior tooth, endentulous side of abutment tooth or isolated single tooth, used for applying antimicrobial rinse or paste to tooth surface
  17. In comparing the use(s) of the “tapering end tufted brush” to the “rubber tip,” the term that best describes the rubber tip is
  18. The attributes of the Braun Oral-B Triumph power brush that makes it so effective in minimizing pressure on the gingival tissues are??
    Rotation oscillation and two speeds
  19. What does a better job of cleaning the interproximal?
    something that fits embrasure
  20. 1. Where does the blood originate if we go back to embryonic and fetal stages of human development?
    Mesenchyme of yolk sac
  21. 2. The progenitors of what two cell types form the blood islands (best, most encompassing answer)?
    Angioblasts, and hematoblasts (comes from hemangioblast)
  22. 3. Swelling is a sign of inflammation. There is both fluctuant swelling and indurated swelling. Indurated swelling is most likely a result of stimulation of what?
    Cellular infiltration
  23. 4. What has been shown when blood is functioning in the absence of disease or
    • inflammation?
    • Rolling adhesion (using L-selectin binding to sialomucin CD34)
  24. 5. In the absence of inflammation, leukocytes will bind the endothelium, roll due to the flow of blood, and eventually, release the endothelium and float away. What is the leukocyte molecule most important in this brief, temporary rolling process?
    L-selectin (CD62L)
  25. 6. Endothelium, when stimulated by inflammation (eg., Mast Cell-derived TumorNecrosis Factor alpha; TNFα) will rapidly display several signals to leukocytes within the blood vessel lumen. What are the two signals important to transendothelial migration.
    P (CD62P) & E selectin
  26. 7. In transendothelial migration, the chemokine such as IL-8, will cause the leukocyte to do what two things?
    Shed L-selectin & activate LFA-1 (CD11a/CD18)
  27. 8. In transendothelial migration, the endothelial constitutively expresses what two molecules (or types of molecules) on it’s lumenal surface (the surface that faces inward into the blood vessel)?
    LFA-1 (on neutrophil) will bind to ICAM-2 or JAM-1 (on endothelium)
  28. 9. In transendothelial migration, when does the rolling of the leukocyte along the endothelium cease?
    When LFA-1 binds to ICAM-2 (tight binding)
  29. 10. In the natural history of inflammation, neutrophilic polymorphonuclear leukocytes(neutrophils, PMN) are important in what phase of inflammation?
    Acute inflammation
  30. 11. In the natural history of inflammation, chronic inflammation usually begins to dominate the site of inflammation after what period of time?
  31. 12. Roy Page and Hubert Schroeder (University Washington) studied experimental gingivitis in the beagle dog model. They described four phases/stages of periodontal inflammation based upon histology. What was the stage that occurred 2-4 days after cessation of oral hygiene and hard chow called?
    Initial lesion
  32. 13. What was the dominant cell type found in the connective tissues in advanced lesion of Page and Schroeder?
    B cells (activated, plasma, or dying [via caspase 1 which activates IL-1B])
  33. 14. In the periodontium during periodontitis, two arenas of inflammation are identified: (1) junctional epithelium/gingival crevice (JE-GC) and (2) non-calcified gingival connective tissue (CT). What dominates JE-GC and CT?
    • Neutrophils for JE-GC
    • B cells (chronic inflammatory cells) for CT
  34. 15. By the early 1990s, a theory (paradigm) for periodontal disease and inflammation arose which was consistent with histological studies, experimental animal models, and the clinical observation of primary and secondary (iatrogenic, infectious, habitual, pathogenic) immune defects. What was this paradigm?
    Acute inflammation protects periodontium & chronic inflammation protects the host and may sacrifice the periodontium
  35. 16. The gingival crevicular environment is hypoxic (low pO2). Why can the neutrophil function under hypoxic conditions? Note: The oxygen that we breathe is a diradical (two electron orbitals that can each take one more electron with an opposite spin), sometimes referred to as “molecular oxygen” and for precision retentives, “dioxygen.” “Cellzombie” is a term I just made-up.
    98% of energy comes from glycolysis
  36. 17. The microbial flora shifts to anaerobic as plaque ‘ripens’ in periodontitis. Why may this shift impair the function of the neutrophil NADPH oxidase (NOX2)?
    Neutrophil uses oxygen to make superoxide anion  hydrogen peroxide; no oxygen = no hydrogen peroxide
  37. 18. In the Page and Schroeder experimental gingivitis model, T-cells predominate the cellular infiltration of the gingival connective tissue (CT) throughout what stage?
    Initial lesion
  38. 19. Neutropenia has been associated with severe periodontitis. How is Neutropenia defined?
    <1500/mm3 Low blood neutrophil levels, can’t get neutrophil into blood
  39. 20. Leukocyte adhesion deficiency, type 1 (LAD-1) was associated with severe periodontitis by the Waldrop group (actually, Stuart Anderson’s group) in Texas, in 1987. This was the first time anyone associated a genetic/cellular/molecular defect with a form of severe periodontitis (so it is historic). In LAD-1, the defect appears to be a failure to express what molecule?
    CD18 deficiency
  40. 21. Although LAD-1 may be associated with defective immune synapse formation (LFA-1 required) and defective phagocytosis (iC3b receptors CR3 and CR4 – aka Mac1 and p150/95 are required), what appears to be the foremost problem in LAD- 1 which leads to severe periodontitis?
    Transepithelial migration
  41. 22. In LAD-1, what was observed in the gingival connective tissues at periodontal lesional sites?
    • B-cell lesion  shows that chronic leukocytes can get out of blood
    • Plasma infiltrate w/o PMN
    • Russell bodies
  42. 23. The X-chromosome encodes the gene for p91[phox]. Defects in this gene usually result in early death (mid-20s); severe recurrent infections -- usually by catalase positive bacteria; occasionally, severe periodontitis; and neutrophils that cannot do what properly?
    Defect in NOX system  can’t form NADP by reducing oxygen
  43. 24. Smoking has been associated with cases of periodontitis that are hard to treat and given the fancy name, “refractory” periodontitis. What has smoking been shown to cause?
    Patients cannot respond to periodontal treatment, smoking affects PMN phagocytosis
  44. 25. Aggressive Periodontitis, Localized (APL, LAP: aka Localized Juvenile Periodontitis, LJP) has been associated with infection by Agregatibacter actinomycetemcomitans. The following is true about this organism
    • a. It cannot survive in the presence of dioxygen (it is a strict anaerobe)
    • b. It can be killed by the complement membrane attack complex
    • c. It can be killed by IgM, complement, and neutrophils
    • d. It can be killed by IgG, complement, neutrophils
    • e. It can never be killed
    • D
  45. 26. What does about 3/4 of patients with APL have?
    Agreg actinomyc
  46. 27. Classic studies from the early 1980s revealed that APL neutrophils had what functional defect 75% of the time?
    Diminished PMN chemotaxis educed chemotaxin receptors on neutrophils
  47. 28. What drugs have been recommended by the American Academy of Periodontology to be considered for use following periodontal surgery?