Perio ch 8

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Perio ch 8
2011-03-06 18:11:30

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  1. defined as clinical attachment loss with subsequent bone loss
  2. What is the diagnosis of periodontitis based on?
    clinical and radiographic findings
  3. periodontitis is catoragized as
    chronic and aggressive
  4. Primary risk factor for periodontitis
    dental biofilms
  5. last structures to be lost in PD
    periodontal ligament fibers
  6. plasma cell/antibody mediated
  7. occurs with clinical connective tissue attachment loss to the root surface and the apical migration of the apical aspect of the JE along the root surface taht was previously occupied by connective tissue
    Periodontal pocket
  8. What are developed in PD pockets between the root surface and the gingiva
    rete pegs and microulcerations
  9. __and__migration of the junctional epithelium continues and as this epithelium separates from the root surface
    apical and lateral
  10. Two types of periodontal pockets
    • suprabony
    • infrabony
  11. What distinguishes the two types of pockets
    relationship of the base of the pocket or the coronal extent of the JE to the alveolar crest and type of bone destruction
  12. If the base is coronal to the crest of bone
  13. base is apical to the crest of bone
  14. Where is the JE in gingivitis and healthy gingiva
  15. how is teh texture of cementum without PDL fibers
  16. Is it necessary to remove the roughness of cementum in order to remove the endotoxins, bacteria, and other byproducts?
    No, rootplanning is not needed bc the endotoxins are found to be very superficia and not embedded deeply into the cementum.
  17. Bone loss involves inflammatory cells including
    PMNs and macrophages
  18. Substances involved in bone resorption (4)
    • prostaglandins
    • endotoxins
    • cytokines
    • b-cells
  19. what release prostoglandins?
    • PMNs
    • Macrophages
  20. What do prostaglandins do
    • activate osteoclasts
    • increase # of osteoclasts
    • increase # of macrophages
    • inhibit bone collagen formation
  21. most important in periodontal distruction
  22. what do endotoxin do
    activate inflammatory cells such as macrophages
  23. What do macrophages release
    • cytokines
    • IL-1
  24. What can IL-1 stimulate the production of
  25. cytokines and prostaglandis stimulate collagenase which does what?
    breaks down collagen
  26. Does pocket formation and bone loss occur in all areas of the dentition at the same time?
    no: site specific
  27. Is the degree of bone loss aloways correlated with the depth of periodontal pockets
    no; a person could have changed and now has healthy gingiva but lots of bone resorption
  28. They types of pockets that form and the pattern of bone loss depend on what?
    the rout the inflammation takes from the gingiva to the underlying supporting sturcutures
  29. Where is bone most vascular?
    interdentally (so it has the most resorption)
  30. two patterns of bone loss
    • verticle
    • horizontal
  31. Bone loss that occurs from its outer aspect buccal and lingual walls. lost equally on the surfaces of two adjacent teeth. Deepest portion of the pocket is located coronal to the alveolar crest
    Horizontal bone loss
  32. Bone loss that occurs when teh inflammation travels directly formt eh gingiva into the peridontal ligament and then the bone. occurs at different rates aroun the tooth...more rapid ont eh side of the tooth than the other. the deepest poriton of the bony defect is apical to the alveolar bone crest
    Vertical /angular bone loss
  33. A three wall defect that wraps around the tooth and involves two or more adjacent root surfaces is referred to as
    circumferential defect
  34. classified according to the number of osseous walls surrounding the pocket
    infrabony defects
  35. three bony walls remaining interproximally or facially or lingually and the tooth forming the fourth wall
    three wall bony defect
  36. Infrabony defects are usually composed of what bone

    what about intrabony

  37. how do you determine if it is intra or infra
  38. a three wall defect that wraps around the tooth and involves two or more adjacent root surfaces is referred to as
  39. has two bony walls remaining
    two wall bony defect
  40. the most common angular bony defect
    an interdental crater (two wall bony defect with buccal and lingual remaining)
  41. has one wall remaining
    one wall bony defect
  42. usually occurs interdentally
    one wall defect
  43. if teh remaining wall is the proximal wall the defect is referred to as a
  44. outside a __mm circle, bone loss occurs
  45. Bone destruction occuring where thiere is a wide interdental septume and more thatn 2 mm of with is lost will be verticl or horizontal?
  46. bone destruction occuring where the interdental septum is narrow, less than 2 mm, results in vertical or horizontal
  47. Teeth in anterior are usually
  48. molars are usually
  49. most common form of PD
    chronic PD
  50. has a slow rate of progression
    chronic PD
  51. in order to develope chronic pd what must be present first
  52. is chronic pd consisered a specific bacterial infection?
    no, its a nonspecific bacterial infection
  53. Presence of what bacteria indicates a high probability that pd is presence
  54. Local risk factors for pd
    • calculus
    • overhang restorations
    • retentive conditions
    • smoking
    • systemic conditions
    • hormonal facots
    • stress
  55. chronic Pd is classified according to
    extent and severity of disease
  56. defined as the number of sites affected
  57. extent is divided into
    • localized less than 30%
    • generalized..more than 30%
  58. how much disease has occured
  59. severity is calculated from the
  60. mild
    • 1-2mm
    • 3-4
    • more than 5
  61. features of chronic periodiontisi include
    • pocket formation
    • alveolar and supporitng bone destruciton
  62. is mobiity always evident in CHronic PD
  63. established risk factors for PD
    • bacteria in dental plaque
    • smoking
    • diabetes mellitus
  64. nicotine in tobacco causes
    constriction of blood vessels
  65. smokers appear to have decreased..
    PMNs or macrophages..not both
  66. decreasedPMN migration into the oral cavity leads to
    depressed phagocytic fxn and impaired healing response
  67. rapidly progressive form of periodontitis
    Aggressive periodontitis (AgP)
  68. common features of localized and generalized aggressive periodontisi
    • except for the presence of pd, patient are otherwise clincally healthy
    • rapid attachment loss and bone destruction
    • familial disposition
  69. secondary features that may be present include the following
    • amts of microbial depositis are inconsistent with teh seerity of the periodontal tissue destruction
    • elevated levels of Aa and in some populations, Pg
    • progressiong of attachment loss and bone loss may be self-arresting
    • pahgocyte abnormlities
  70. features of localized aggressive pd
    • circumpubertal onset
    • serum antibody response to the bacteria
    • localized first molar/incisor presentaion with interproximal atachemnt loss on at least two permanent teeth, one of which is a first molar and involving no moreht than two teeth other than first molars adn incisors
  71. features of gineralized aggressive periodontitis
    • usuaally affecting individuals under 30 years of age but can be older
    • pronounced episodic nature of the destruction of attachment oand bone
    • poor antibody response to the bacteria
    • generalized interproximal attachment looss and bone destructionaffecting at least three permanent teeth other than the first molars and inisiors
  72. a distinguishing feature found in AfP that is not seen in chronic PD is the presence of
    PMN an macrophage defects
  73. Periodontisis can be linked to
    • heart attacks
    • diabetes melitus
    • lowbirth weight babies
  74. children with GAgP are more pron to
    • ear
    • skin
    • upper respiratory tract infections
  75. Plaque accumulation is minimal
    bone los is not super rapid
    usually no accompanying infection
    slight gingival inflammation
  76. there is a defect in PMN chemotaxis and impaired phagocytosis in what percent of patients
  77. Predominant bacteria in LAP
    • Aa
    • Prevotella intermedia
    • Kikenella corrodens
    • Campylobacter rectus
    • Capnocytophaga
  78. high numbers of what are in the subgingvial pocke associate with LAP which invade the soft tissue
  79. what personce of LAP have hgih counts of Aa
    90% must be on antiobiotics bc it's reaching the soft tissue
  80. patient previously treated conventionally and do not respond favorable to therapy and are concidered to be resistant to tx
    refractory Periodontitis
  81. patient with poor compliance are termed
    recurrent periodontitis
  82. high numbers of which bacterias are found in refractory pd
    • prevotella intermedia
    • tannerella forsythensis
    • fusobacterium nucleatum
    • Porphyromonas gingivalis
  83. Lesions of the PDL and adjacent alveolar bone may originate from interactions of the periodontium or tissues of the dental pulp. This is periodontitis associate with what?
    Endodontic lesions
  84. Which systemic diseases contribute to periodontitis
    • familial or cyclic neutropenia
    • down syndrome
    • leukocyte adhesion deficiency syndromes
    • papillon-Lefevre syndrome
    • chediak-higashi syndrom
    • histiocytosis syndromes
    • glycogen storage disease
    • infantile genetic agranulocytosis
    • cohen syndrome
    • ehlers-danlos syndrome
    • hypophosphatasia
  85. collective term for soft-tissue inflammation surrounding an inplant
    peri-implant disease
  86. term used to describe reversible inflammation in the gingiva around a functioning implant
    peri-implant mucosititis
  87. Tx of all types of periodontal diseases begins with
    • oral hygiene care
    • nonsurgical therapy
    • smoking cessation
  88. may be required for pocket elimination or reduction
    periodontal sugery
  89. Do patients with chronic periodontitis require systemic antibiotics?
  90. In selected cases if the patient is having a difficult time with homecare, what may be implicated
    mouthrinses (chlorhexadine)
  91. do patients with aggressive periodontits require systemic antibiotic during scaling and root planing and periodontal surgery
  92. why do patients with aggressive periodontitis require systemic antibiotic require med
    bc 90% LAP paitients have so much Aa
  93. What do to with diabetic patients who have PD
    placed in a monitored oral health program that will take care of bothe the paitent's dental and general health.