IntroToPerio - Final Review

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  1. Gingival collagen fiber system
    • Gingivodental – attached gingiva to bone and cementum
    • Circular – like a turtleneck
    • Transseptal – cementum to cementum
  2. Epithelium
    • Masticatory Mucosa – keratnized
    • Alveolar mucosa – non-kerratinized
    • Sulcular epithelium - non-keratinized
  3. Connective Tissue
    • Masticatory Mucosa – Collagen fibers
    • Alveloar Mucosa - Elastic fibers
  4. Periosteum
    Inner most layer of the connective tissue - Bound Down (2 layers)
  5. Attachment Apparatus
    • Cementum
    • Periodontal ligament - .25mm; if thicker than .25mm, might be trauma from occlusion.
    • Alveolar bone
  6. PERIODONTAL LIGAMENT
    • .25 mm wide
    • Functions: supportive, sensory, nutritive & remolding
    • 70% water composition
    • Consists of fibroblasts, epithelial cells, mesenchymal cells, bone and cementum cells
    • Consists of collagen fibers and are called principal fibers
    • Proprioceptors – for touch, pain & pressure
  7. ________ is the most common cause of tooth loss.
    Chronic periodontitis
  8. Localized periodontitis: < __% of sites involved.
    30
  9. AGGRESSIVE PERIODONTITIS
    • Localized – 1st molars & incisors
    • Generalized – >=3 teeth + 1st molars & incisors
  10. Chronic Periodontitis is not linear, nor does it occur at the same rate in all areas of the mouth. It is a slow progressing disease with active and quiet periods of activity.
  11. Red complex
    • P. gingivalis
    • T. forsythia
    • T. denticola
    • Associated w/ bleeding on probing, CLINICAL PARAMETER OF DESTRUCTIVE PERIODONTAL DISEASES
  12. Green complex
    • E. corrodens
    • A. actino.
    • C. gingivalis
    • C. sputigena
    • C. ochracea
    • C. concisus
  13. Yellow complex
    • S. mitis
    • S. oralis
    • S. sanguis
  14. GINGIVITIS AND PREGNANCY GINGIVITIS - _______;
    ANUG - _____________;
    CHRONIC PERIODONTITIS - _____________;
    AGGRESSIVE PERIODONTITIS - _____________.
    • P. INTERMEDIA
    • P. INTERMEDIA, SPIROCHETES
    • P. GINGIVALIS
    • Aa, CAPNOCYTOPHAGA
  15. Histopathology of Gingival Disease (Page & Schroeder, 1977)
    • Stage 1 – Initial Lesion
    • Stage 2 – Early Lesion
    • Stage 3 – Established Lesion
    • Stage 4 – Advanced Lesion
  16. Initial Lesion (2-4 days)
    • Histologic picture of clinically healthy tissue
    • Microorganisms in the sulcus activate resident leukocytes
    • Vascular changes:
    • - Dilation of capillaries
    • - Increased blood flow
    • - Stimulation of endothelial cells
    • - Increased vascular permeability allows PMN and monocytes to migrate through CT to bacteria
    • Migration of leukocytes into sulcus via chemotaxis
  17. Early Lesion (4-7 days)
    • Lymphocyte predominate inflammatory cell
    • Bleeding upon probing
    • First clinical signs of erythema, edema
    • Epithelium proliferates into collagen depleted areas of connective tissue forming rete pegs
    • Less collagen formation near the inflammatory infiltrate
  18. Established Lesion (14-21 Days)
    • Plasma cell is the predominant immune cell present
    • NO attachment loss
    • Changes in early lesion worsen
    • Continued breakdown of collagen, vascular proliferation, formation of rete pegs
    • Moderately to severely inflamed gingiva
    • Changes in color, size, texture, consistency, contour of gingiva
    • Gingival lesion is reversible
  19. Advanced Lesion
    • Extension of the lesion into alveolar bone
    • Apical migration of junctional epithelium
    • Bone loss
    • Loss of attachment
    • Clinical signs of acute and/or chronic inflammation may be present
  20. PROGNOSIS w/ periodontal treatment and maintenance (Caton & Kwok, 2007)
    • Favorable -> likely periodontal stability
    • Questionable; local and/or systemic factors controlled or not -> maybe periodontal stability
    • Unfavorable; local and/or systemic factors can't be controlled -> unlikely periodontal stability
    • Hopeless -> extraction needed
  21. Probe with force up to ___, because the tip of the probe does not penetrate the junctional epithelium. Forces up to ___ are used to reach the bone level and do bone sounding or mapping.
    • 30g
    • 50g
  22. The radicular bone should be approximately _____ to the CEJ to make room for ________, which is the space for ______________.
    • 2 mm apical
    • the biologic width
    • the junctional epithelium plus the collagen fibers of the attached gingiva that are in cementum
  23. Facial/lingual defects are classified as:
    inconsistent margins, reverse architecture (radicular bone higher than interproximal bone), dehiscences, furcations, etc.
  24. Mucogingival defects
    • No keratinized gingival tissue – alveolar margin
    • No keratinized attached gingiva
    • Aberrant frenum
    • Shallow vestibule
  25. Necrotizing Ulcerative Gingivitis – NUG
    Necrotizing Ulcerative Periodontitis – NUP
  26. ANUG
    • Referred to as Trench Mouth
    • Marginal gingiva is affected
    • Punched out gingival margins
    • Painful – odor
    • Pseudomembrane
    • Fusospirochetes predominant
  27. HIV - AIDS
    • CD-4 Lymphocytes affected.
    • Normal CD4 Th count = 500 cells/mm(3) to 1200
    • CD-4 < 200 cells/mm(3) is HIV to AIDS
    • Viral load – how much virus is present
    • Present medication to control the viral load - ART, Antiretroviral Therapy
  28. ORAL MANIFESTATIONS OF HIV - AIDS
    • Opportunistic infections
    • Oral Candidiasis - can wipe off
    • Kaposi’s Scarcoma - lesions on skin, palate, etc.
    • HIV-G – Linear Gingival Erythema
    • HIV-P - NUP
    • Oral Hairy Leukoplakia - side of tongue
  29. HSV–1
    Herpes Simplex Type 1- oral
  30. HSV–2
    Herpes Simplex Type 2 – genital
  31. Epstein Barr Virus
    Mono + Oral hairy leukoplakia; Herpes virus
  32. Varicella – Zoster
    Chickenpox & Shingles; Herpes virus
  33. Cytomegalovirus
    possible association with Karposi’s Sarcoma – common oral lesion on the palate in HIV infected individuals; Herpes virus
  34. Causes of gingival enlargement/hyperplasia
    • Chronic Inflammation
    • Puberty Gingivitis
    • Pregnancy Gingivitis
    • Drug Induced - Ca chan blocker (Nifedipine); Phenytoin (Anticonvulsant; Dialin); immuno-suppressing
    • Hereditary – Gingival Fibromatosis
    • Blood Dyscrasias
    • Neoplasm
  35. Gingival manifestations of systemic conditions
    • Mucocutaneous disorders
    • 1. Erosive Lichen Planus
    • 2. Pemphigoid
    • 3. Pemphigus Vulgaris
    • Allergic reactions
    • 1. Dental restorative materials
    • 2. Toothpastes - Mouthrinses
  36. Histology of desquamative diseases
    • Nikolsky’s Sign – Lifting off of the epithelium; present in bullous diseases & autoimmune diseases
    • Separation of epithelium at the basement membrane – Erosive Lichen Planus or BMMP
    • Separation of epithelium at the spinous layer of the (within) epithelium – Pemphigus Vulgaris
    • Immunofluoresence – Basement membrane
    • a. Shaggy appearance & T - cell mediated – ELP
    • b. Linear appearance & Humoral (B antibodies) - BMMP
  37. Biopsy types
    • Excisional - whole lesion (small) + normal tissue
    • Incisional - part of big lesion + normal tissue
  38. Abscesses of periodontium
    • Gingival
    • Periodontal
    • Pericoronal
  39. ATTACHMENT APPARATUS POSSIBLE RELATIONSHIPS
    • Normal relationship – Cementum + Periodontal Ligament + Bone
    • Ankylosis – Cementum + Bone; No ligament; fused cementum and bone
    • External Root Resorption – Normal relationship, but the cementum is resorbed and the tooth structure is destroyed. Etiology is unknown
  40. Socransky’s criteria for defining perio pathogens
    • Associated With Disease, Increases At Diseased Sites
    • Clinical Resolution With Elimination Or Decrease
    • Elicit Host Response
    • Capable Of Causing Disease In Animal Models
    • Demonstrate Virulence Factors
  41. What is the innate immune response?
    • Intact epithelial barrier (junctional and sulcular epithelium)
    • Outflow of Gingival Crevicular Fluid (GCF) from the sulcus - dilution and flushing
    • neutrophil & macrophage in the sulcus - phagocytosis
    • Antibodies in the GCF
  42. What is calculus & how is it attached?
    • Calcified Dental Plaque
    • Covered With A Layer Of Uncalcified Plaque

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Author:
akhan
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320963
Filename:
IntroToPerio - Final Review
Updated:
2016-06-14 00:51:27
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IntroToPerio - Final Review
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