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What are the 4 stages of development of periodontal disease?
- initial lesion
- early lesion
- established lesion
- advanced lesion
With an accumulation of dental biofilm on the cervical tooth surface adjacent to the gingival margin, an_____ _____is set up, and the_______ ________ _______ respond
- inflammatory reaction
- natural defense mechanisms
What is the initial response to periodontal disease defined as?
inflammatory response to dental biofilm
Which stage of periodontal disease occurs within 2-4 days of irritation from bacterial accumulation?
initial response, or inflammatory response
What is the bodies natural response to the initial lesion and inflammatory response? (4)
- white blood cells move into junctional epithelium and gingival sulcus
- increase flow of sulcus fluid
- collagen break down
- spaces in connective tissue fill with fluid
What is the clinical appearance if the initial lesion, or inflammatory response in periodontal disease? (2)
- No clinical evidence/changes
- marginal inflammation
How is the early lesion of periodontal disease defined?
as increased inflammatory response
When does the early lesion, or increased inflammatory response occur in periodontal disease?
7-14 days of irritation from bacteria
In the early lesion, or increased inflammatory response, infiltration of fluid goes where?
into the connective tissue
What does fluid in the connective tissue in the early lesion, or increased inflammatory response, do to the gingival margin and epithelium?
- breaks down collagen fibers to support the gingival margin
- proliferates epithelium, and forms rete ridges
true or false. The junctional epithelium may start to migrate in the early lesion, or increased inflammatory response in periodontal disease
Describe the clinical appearance the early lesion, or increased inflammatory response of periodontal disease.
early signs of gingivitis - slight gingival enlargement
true or false. Early gingivitis (early lesion) is reversible when biofilm is controlled and inflammation is reduced.
true or false. The susceptibility of individuals varies, and the time before the lesion becomes established varies
both statements are true
What can the established lesion of periodontal disease be defined as?
progression from the early lesion
In which stage of periodontal disease development does fluid and leukocytes migration increase, and pocket epithelium is formed?
the established lesion, or progression from early lesion
plasma cells in periodontal disease are related to areas of what?
In the extablished lesion, or progression from early lesion of periodontal disease, proliferation of the junctional and sulcular epithelium continue in an attempt to what?
wall out the inflammation
Why do areas of ulceration of the lining epithelium develop in the established lesion, or progression form early lesioin of periodontal disease?
because the pocket epithelium is more permeable
true or false. collagen destruction continues, and connective tissue fiber support is lost in the established lesion, or progression from early lesion stage of periodontal disease.
Can progression to early periodontal lesions occur in the established lesion, or progression from early lesion stage of periodontal disease?
Describe the clinical appearance of the established lesion, or progression from the early lesion stage of periodontal disease. (4)
- marginal redness
- spongy marginal gingiva
- bleeding on probing
What can the advanced lesion stage of periodontal disease be defined as?
extension of inflammation
In the advanced lesion, or extension of inflammation stage of periodontal disease, what provides the source for subgingival biofilm?
bacteria from supragingival biofilm enters the sulcus
What produces irritants in the advanced lesion, or extension of inflammation stage of periodontal disease?
In what stage of periodontal disease does alveolar bone destruction occur?
advanced lesion, or extension of inflammation
Where does inflammation spread in the advanced lesion, or extension of inflammation in periodontal disease?
through the bone marrow and into the periodontal ligament
In what stage does extreme progressive destruction of the connective tissue occur?
advanced lesion, or extension of inflammation
When are fibers destroyed below the junctional epithelium?
during progressive destruction of connective tissue in the advanced lesion stage
Where does the epithelium migrate in the advanced lesion stage?
along the root surface
What 2 structures become detached in the destruction of connective tissue in the advanced lesion stage?
- junctional epithelium
- sharpey's fibers
In the advanced lesion stage of periodontal disease, there are endotoxins in the________
What are the signs of periodontitis seen in the advanced lesion stage?
- pocket formation
- bone loss
What are 3 characteristics of periodontitis seen in the advanced lesion stage?
- chronic inflammatory process
- continued migration of junctional epithelium
Periodontal case type I
healthy, or early gingivitis
Early gingivitis, tissue changes, possible bleeding, and 1-3 mm pockets are characteristics of which perio class type?
Periodontal case type II
early periodontitis, slight bone loss, slight attachment loss, and 1-5 mm pockets are characteristics of which perio class?
Periodontal case type III
moderate periodontitis, destruction of perio structures, beginning of tooth mobility, possible furcations, and 4-6 mm pockets are characteristics of what perio case type?
in perio case type III noticeable bone loss is present, and seen where?
on radiographs especially
perio case type IV
advanced periodontitis, severe bone loss, increased tooth mobility, furcation involvment, and pockets deeper than 7 mm, are characteristics of which perio case type?
How deep are the pockets in perio case type:
- I = 1-3 mm
- II = 1-5 mm
- III = 4-6 mm
- IV = deeper than 7 mm