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In the recognition of normal gingiva, gingival infections, and deeper periodontal involvement, it is necessary to know the_____________of the disease
extent
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___________infections are confined to the gingiva, whereas______________infections include all parts of the periodontium, namely the gingiva, periodontal ligament, bone, and cementum
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What are 8 markers that show signs and effects of inflammation during a clinical examination of the gingiva and periodontium?
- gingival tissue changes
- bleeding and exudate
- mucogingival involvement
- probing depths; pocket formation
- furcation involvement
- dental biofilm and calculus present
- mobility of teeth
- radiographic evidence
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Name 5 specific gingival tissue changes
- color
- size
- shape
- surface texture
- position
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Why is it that patients may or may not have specific symptoms to report because of periodontal infections?
because periodontal infections are insidious in development
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Patients with periodontal and/or gingival infections may notice bleeding in the gingiva in what 3 instances?
- bleeding while brushing
- bleeding with drooling at night
- bleeding spontaneously
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Name 7 symptoms of advanced periodontal disease
- sensitivity to hot and cold
- tenderness or discomfort while eating
- pain after eating
- food retained between teeth
- unpleasant mouth odors
- chronic bad taste
- feeling that teeth are loose
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What is radiographic evidence of advanced periodontal disease?
bone loss
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What are symptoms that are described by the patient?
subjective symptoms
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What are the color shades of clinically normal teeth?
shade of pale, or coral pink (varied by complexion and pigmentation)
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Describe clinically normal or healthy gingival margin
knife-edged gingival margin that adapts closely around the tooth
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true or false. stippling; firmness; and minimal sulcus depth with no bleeding on probing are signs of clinically normal and healthy gingival tissue
true
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What are 3 causes of tissue changes?
- disease
- biofilm products
- systemic changes; including pregnancy (nausea in 1st trimester)
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Severity of gingival and periodontal disease is expressed as_________, __________, or___________
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What are 5 terms used to describe the distribution of gingival or periodontal disease?
- localized
- generalized
- marginal
- papillary
- diffuse
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The gingiva is involved only about a single tooth or a specific group of teeth
localized
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the gingiva is involved about all or nearly all of the teeth throughout the mouth
generalized
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A condition may also be generalized throughout a __________ __________, the maxillary or the mandibular
single arch
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a change that is confined to the free or marginal gingiva, specified as either localized or generalized
marginal
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a change that involves the papilla but not the rest of the free gingiva around the tooth, it may be localized or generalized
papillary
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spread out, dispersed; affects the gingival margin, attached gingiva, and interdental papilla; may extend into alveolar mucosa, it is more frequently localized, rarely generalized
diffuse
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name 5 marked changes in infected gingiva or periodontia that are easy to detect even with little experience
- moderate to severe redness
- enlargement
- sponginess
- deep pockets
- mobility
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when tissue changes are subtle, localized about one or a few teeth, and of a lesser degree of severity, more ________ __________ of ________ is necessary
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Why is it so important to recognize tissue changes early?
- because it prevents neglect of conditions that can develop into severe disease
- treatment is less complicated
- success of treatment and recovery to healthy tissue is predictable
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describe healthy gingival tissue seen in a gingival exam.
pale pink; darker in people with darker complexions
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describe color changes in chronic diseased gingival tissue.
- dark red
- bluish red
- magenta
- deep blue
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describe color changes in acute inflammation of gingival tissue
bright red
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Describe the size of healthy free gingiva.
flat, not enlarged, fits snugly around the tooth
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describe the size of healthy attached gingiva.
width of attachments varies among patients, from 1-9mm5
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The width of the attached gingiva is wider in the_________than ____________; broadest zone related to___________, narrowest at the________and__________regions
- maxilla
- mandible
- incisors
- canine
- premolar
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describe tissue size changes in diseased free gingiva and papilla
become enlarged, and the col deepens
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describe changes in diseased attached gingiva
decreases in amount as the pocket deepens
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describe the shape (form or contour) of healthy free gingiva
- follows a curved line around each tooth
- the margin is knife-edged or slightly rounded and closely adapted to the tooth
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describe the shape (form or contour) of healthy papillae
- teeth with a contact area; pointed or slightly rounded papilla with a col area under the contact
- spaced teeth; papilla is flat or saddle shaped
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describe the shape (form or contour) of diseased free gingiva
rounded or rolled
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describe the shape (form or contour) of diseased papillae
blunted, flattened, bulbous, cratered
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an enlargement of the marginal gingiva with the formation of a life-saver like gingival prominence, frequently the total gingiva is very narrow, with associated apparent recession
festoon seen in diseased papilla
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a localized recession may be 'V' shaped, apostrophe shaped, or form a slit like indentation that may extend several millimeters towards the mucogingival junction or even to or through the junction; seen in the papillae
clefts (stillman's cleft)
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a cleft created by incorrect floss positioning appears as a vertical linear or V-shaped fissure in the marginal gingiva. It usually occurs on one side of an interdental papilla, the injury can develop when dental floss is curved repeatedly in an incomplete C around the line angles so the floss is pressed across the gingiva
floss cleft in the papillae
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