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when does an inflammatory response to dental biofilm occur?
withinin 2 to 4 days of irritation
what is the natural body response to infectious agent with an initial lesion?
migration and infiltration of white blood cells into the junctional epithelium and gingival sulcus
t/f no clinical signs of an initial lesion can be seen.
true-maybe some marginal inflammation
how many days until it is considered an early lesion?
during the early lesion what happens to the epithelium?
it proliferates: epithelial extensions and rete ridges are formed
what is the clinical appearance of an early lesion?
4 mm pockets
what happens to the junctional epithelium of an established lesion
migrates and tries to wall out the inflammation
t/f the pocket epithelium is less permeable with and established lesion.
false-more permeable-areas of ulceration of the lining epithelium develop
with the lesion progress _____ fibers are brokendown.
what is the clinical appearance of an established lesion? (4)
spongy marginal gingiva
bleeds on probing
with an advanced lesion the bacteria from the ______ biofilm enter the sulcus and provide a source for _____ biofilm
with an advanced lesion you start to see destruction of what?
once the lesion is into the _____ _____ it spreads faster
how does the inflammation enter the bone?
small vessel channels in the alveolar crest
how does inflammation spread with an advanced lesion
through the bone marrow and out into the PDL
what produces irritants with an advanced lesion
with the progression of an advanced lesion what happens to the CT fibers below the JE?
they are destroyed and the epithelium migrates along the root surface
with the progression of an advanced lesion the cementum is exposed where what fibers used to be attached, why?
altered by inflammatory products of bacteria and sulcus fluid
the cementum contains a thin layer of what during the progression of an advanced lesion? and why?
endotoxins from the bacterial breakdown
with the progession of an advanced lesion without treatment what will happen?
the pocket will deepen
what are five signs of periodontitis?
with an advanced lesion the bacteria can be _____ and then ____
healthy gums don't ____
what are 4 characteristics of type 1 perio
bleeding on probing
1-3 mm pockets
what perio type has 1-3 mm pockets
with type 1 the pockets are ____-____ mm
what is a factor other than pocket depth that helps to determine the perio class?
t/f type I perio class is early periodontitis
type II perio class is early ______
what are the type II pocket measurements
type II has slight _____ loss and slight ______ loss
type III is classified as ______ periodontitis
type III has noticeable ______ ______
type III can have possible ______ involvement?
furcation (class I or II)
what are the pocket measurements for type III
what perio class has 1-5 mm pockets
what perio class has pockets 4-6 mm
what perio class has pockets >7mm
what are the pocket measurements for type IV
type III has beginning tooth ____
type IV is classified as _____ periodontitis
type IV has severe ____ ____, increased tooth _____ and _____ involvement.
t/f type two can have a lot or a little calculus
what is defined as a pocket formed by gingival enlargement without apical migration of the junctional epithelium
t/f a gingival pocket must have apical migration of the junctional epithelium
false! it is formed by gingival enlargement WITHOUT apical migration of the junctional epithelium. dur dur
does a gingival pocket involve attachement loss?
no-deeper perio structures not involved
where is the base of the sulcus with a gingival pocket
3mmm above alveolar bone
a gingival pocket is considered ______ (outside the bone)
what is defined as a pocket formed as a result of disease that causes the junctional epithelium to migrate apically along the cementum
unlike a gingival pocket with a perio pocket the _____ ____ is involved
what is the attachment with a perio pocket?
a perio pocket can be _____ or _____
suprabony or intrabony
what is it called when a pocket base is below alveolar bone
when calculus deposits are present what does the pocket wall do?
follows contour of calculus
in health what does the pocket wall follow
contour of the tooth
the deeper the pocket the ____ it can be cleaned by toothbrusing
what does a deeper pocket mean for biofilm
more opportunity for biofilm to collect and too deep for toothbrush to reach
what are five substances found in a pocket?
what are some microorganisms and their products found in the pocket
enzymes, endotoxins and metabolic products
what are the numbers of leukocytes during inflammation of the tissue
what is purulent exudate made up of?
living and broken down leukocytes, living and dead microorganisms and serum
_____ help with the formation of a pocket
PDL fibers _____ with a pocket and the JE _____ _____
when a pocket deepens the ____ becomes exposed to the open pocket and oral fluids
what surface changes can occur as a result of the exchange of minerals with oral fluids and exposure to biofilm bacteria? (4)
dental bioflim and debris collection
periodontal disease is formed by ____ and ____ not calculus
plaque and biofilm
how are supragingival tooth surface irregularities detected?
drying the surface and observing (explorer used as needed)
how are subgingival tooth irregularities detected?
tactile and auditory sensitivity transmitted by a probe and explorer
what are causes of surface roughness on the enamel surface (supragingivally) (5)
cracks and grooves
erosion and abrasion
what % does the cementum overlap the enamel?
what % does the cementum and enamel meet?
what % does the cementum and enamel have a gap exposing dentin?
what are some causes of surface roughness with the CEJ?
cementum and enamel overlap
cementum and enamel meet
cementum and enamel gap
what are 6 causes of surface roughness on the root?
grooves from previous instrumentation
periodontal disease development