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84 Cards in this Set

  • Front
  • Back
Know medication and ways it impacts Tx
?
How does perio impact treatment?
Smoking increases the risk of Periodontitis by 5-10x: clinical attachment loss Pocket depth
What is the best number for long term glucose level management?
HbA1c 7 or under
Which patients are best referred to a periodontist?
??
important to maintain good hygiene over a long period of time
downward trend w/attachment loss
What are risk factors for periodontal disease?
Smoking
Diabetes
Osteoporosis
Drug induced conditions: dilantin, Ca++ channel blockers, verapamil
Compromised immune system
Deteriorating risk profile (charting)
Cancer therapy
Joint replacement therapy
What are the best radiographs to show bone height?
Bitewings
can't see bone loss until 30-50% decalcification
What are Bone problems you can identify off radiographs?
(straight off slides)
Amount of bone loss
Distribution and pattern (vertical or horizontal)
What do you need for diagnosis of bone loss?
Relies on clinical attachment loss
How are both bone loss & clinical attachment loss classified?
Mild, Moderate, severe
When you are diagnosing bone problems, what are you using for diagnosis?
Diagnosing by probing depth and recession (clinical attachment level) Not the bone loss
T/F
Bone loss correlates with clinical attachment loss, but is not used in the diagnostic procedure
True
Why do we use clinical attachment level for bone problem diagnosis?
If there is recession on the facial, you will not see it on x-rays so you would not know that there is bone loss
What is the difference between a maintenance visit and a regular cleaning?
Maintenance is active therapy to identify what's falling by the wayside, more frequent, more in depth. To track and identify progress and re-evaluation.
What is the purpose of a re-evaluation appt after a scaling and root planing?
It's a decision making point
Determine how successful the initial periodontal therapy was.
Collect data of All the clinical parameters
Re-evaluate the Data
Decide what to do next.
More OHI?, more root planing? Perio surgery? or Truly into maintenance
T/F
For patients that are new to you, look at the past periodontal history that is on the back of our charting
T
Why is a maintenance more expensive than a prophy?
Takes more time because you are measuring everything
What's the hallmark of Aggressive periodontitis, localized & general?
Rapid attachment loss and bone destruction
What is the first step in treating localized periodontitis?
Antibiotics and scaling, the re-evaluate, make a decision that patient is probably best co-managed
What are the demographics of aggresive localized periodontitis?
Young <30 years old
Blacks
Profile of a severe periodontitis patient, how far are the bone levels from the CEJ?
Severe is 5 or more
Moderate 3-4
Mild 1-2
What does loss of attachment refer to?
Loss of gingival connective tissue
The attachment of the gingival fibers to the cementum on the roots
The gingival attachment level is the coronal fiber attachment (which is also the depth of the pocket)
When we say Clinical Attachment Level, the word Attachment refers to?
to the gingival connective tissue attachment to the cementum on the root.
This should be 1-2 mm
How do you calculate clinical attachment level?
Base of Pocket to CEJ
How is Localized CHRONIC different from Generalized?
If it's less than 30% it is Localized
Generalized if more than 1/3 of sites in mouth
Histologically, how do you measure the attached gingiva?
Base of pocket (sulcus) to the mucogingival junction
What is Trauma from Occlusion?
Injury to the PDL
Injury to the Alveolar bone
What are signs on radiograph from trauma?
Widened Periodontal Membrane
Loss of Resorption of the root surface
Vertical or angular Bony Defects (CANNOT BE REGARDED AS AN EXCLUSIVE SIGN OF TRAUMA FROM OCCLUSION)
You do not see radiographic signs of trauma from occlusion often
Chronic trauma from occlusion can be caused by?
Bruxing or clenching
Occlusion & periodontitis...Does the presence of inflammation change the rate of attachment loss? Bone loss?
Yes
Chronic inflammatory periodontal disease is classified into how many different types of lesions?
4
1. Initial - 2-4 days plaque accumulation, gingival crevicular fluid increases
2. Early - LYMPHOID cells accumulate
3. Established
4. Advanced - AKA Chronic periodontitis, histology of chronic lesion you see Plasma cells
In advanced stage of Chronic inflammatory periodontal disease, what cells are present?
Plasma cells
In Early Chronic inflammatory periodontal disease what cells accumulate?
Lymphoid cells
What kind of cells are found in Acute Periodontal Abscess?
PMNs
What is the depth of a Moderate perio pocket?
4-6 mm
Different types of bone loss?
Vertical
Horizontal
Combination (most likely)
How many walls are in an interdental crater?
2 walls
A shallow defect with one wall, (wide shallow with 1 wall, deep and narrower with 3 walls) Which has a better prognosis?
Narrower deep with 3 walls has better pognosis
How do you differentiate clinically between chronic periodontitis vs plaque induced gingivitis?
Periodontal Attachment Loss
What causes tooth mobility?
Trauma from occlusion
Clinical attachment loss (bone loss)
Abscess lesion
On a 3 walled boney defect, what is the 4th wall?
tooth
Biofilm/calculus will hurt the prognosis of that tooth
What is Reverse architecture?
Interproximals are lower than normal
It is bad
Which disease occurs only in an acute form?
Primary Herpetic Gingivostomatitis
What are the clinical features of an acute periodontitis abscess?
Swollen
Throbbing pain
Tooth mobility (with chronic due to hydraulic forces)
Sensitivity to percussion
NO sensitivity to thermal changes
When is the correct time to start definitive treatment when a patient presents with an acute periodontal abscess?
Manage symptoms (abx and pain control) when the acute form has left, then you can diagnose the chronic problem and be able to treat the real problem
How does ANUG manifest?
Smells horrible
Painful
Bleeding
Inflammation Tissue looks pink, red & white
White is Necrotizing tissue
When NUG or NUP heals what are you left with?
Punched out lesions, deformed gingival tissue
What are you left with after acute pericoronitis?
Gingiva looks exactly how it did before, no deformities or changes
What is left after Desquamative gingivitis is out of the acute phase?
It should return to normal
Biologic width is measured from the?
Bottom of the gingival sulcus to the alveolar crest
Periodontal vertical osseous defects can be classified according to Goldman and Cohen by?
Identifying the number of walls remaining
Based on the Goldman and Cohen defect classification, this represents a?
3 wall defect
Attachment level is measured from?
CEJ to base of pocket
The components of a complete periodontal diagnosis include?
Type of perio disease
Severity of perio disease
Distribution of periodisease
Re-evaluation after initial therapy is performed to evaluate?
Oral hygiene
Medical history
Attachment level
Patient's compliance
During initial examination, a patient has a red, edematous gingiva with generalized 4-5 mm pockets which bleed very easily upon probing. Apical boundaries of the pockets are located at or near the cementoenamel junction. What is the most appropriate treatment?
Scaling and root planing
Which of the following types of periodontal pockets offers the best possibility for bone regeneration?
a) suprabony pocket
b) one wall infrabony pocket
c) two wall infrabony pocket
c) three wall bony pocket
Three wall
Which of the following changes is clinically observed during the initial phase of inflammatory periodontal disease?
a) Gingival margin in red
b) Gingival margin is swollen
c) Bleeding on probing
d) A & C
e) None of the above
None of the above
In a healthy periodontium, how long does it take for the clinical features of the early lesion of inflammatory periodontal disease to appear from the time of stopping all oral hygiene measures?
4-7 days
Radiographically, alveolar bone loss is seen in which of the following stages of inflammatory periodontal disease?
a) Early lesion
b) Advanced lesion
c) Established lesion
d) B& C
e) None of the above
Advanced lesion
The established lesion of perio disease is clinically synonymous with?
a) chronic gingivitis
b) chronic periodontitis
c) aggressive periodontitis
d) none of the above
none of the above
What are the characteristics of the advanced lesions of periodontal disease?
Gingival pockets
Destruction of PDL
Increased tooth mobility
The vasculitis which is present in the initial lesion of inflammatory periodontal disease is associated with?
Increased capillary permeability
Increased diameter of the small blood vessels
The increase in the amount of gingival crevicular fluid starts to occur at which of the following stages of inflammatory perio disease?
Initial Stage
In chronic inflammatory periodontal disease, apical migration of the junctional epithelium along the root surface of the tooth occurs ____ the destruction of the dentogingival group of collagen fibers of the periodontium
After
The response to the presence of chronic inflammatory cellular infiltrate in the connective tissue of the periodontium is?
Resorption of the bone
Destruction of the collagen fibers
Proliferation of the adjacent epithelium
During the development of inflammatory periodontal disease, the following cells appear in the connective tissue of the periodontium in what order?
Plasma cells
T lymphocytes
B lymphocytes
PMNs
???
In long standing chronic inflammation, the color of the gingiva may return to the normal coral pink color due to the presence of ?
Excessive fibrous tissue formation
Radiographically, the distance between the crest of the interproximal bone and the cemento-enamel junction in patients with chronic perio is ____ than that of the healthy perio
Less than
When the alveolar bone is lost due to periodontitis around the mand 1st molar to the extent that you can probe through and through the furcation area, this condition is classified as?
Class III bifurcation involvement
The time period for the established lesion of inflammatory perio to progress to the advanced stage is?
???
In the advanced lesion of inflammatory periodontal disease bone resorption is histologically evidenced by the presence of?
Mast cells
Osteoclasts
Howship's lacunae
Acute periodontal disease is a clinical situation of recent onset and?
Associated w/pain
Related to gingivitis or periodontitis
Unrelated to gingivitis or periodontitis
Acute periodontal abscess is defined as a _____ area of inflammation
Localized
Circumscribed
Purulent
What clinical features are usually associated with an acute periodontal abscess?
Increased tooth mobility
Tooth is sensitive to percussion
Connection between the periodontal pocket and the abscess
Which of the following findings are considered to be diagnostic aids for acute periodontal abscess?
a) Sensitivity of the tooth to thermal changes
b) Presence of a radiolucent area around the root
c) No connection between the pocket and the abscess cavity
d) None of the above
e) All of the above
None of the above
Clinically acute periodontal abscess is best described as?
Localized swelling
Purulent in nature
Located at the lateral aspect of the involved root
a 14 year old male patient has a diffuse erythema of the gingiva with scattered isolated ulcers on the tongue, oropharynx and cheek mucosa. His condition os of 3 days duration is painful and he has a fever and malaise. The most probable diagnosis is?
Acute herpetic Gingivostomatitis
The most common microorganisms implicated in the etiology of necrotizing ulcerative gingivitis are?
Borrelia vencenti
Fusiform bacilli
Which of the following lesions may create gingival deformities that require gingival surgery?
a) acute pericoronitis
b) desquamative gingivitis
c) necrotizing ulcerative gingivitis
d) acute herpetic gingivostomatitis
Necrotizing ulcerative gingivitis
The actual position of the gingiva is determined by?
The level of the epithelial attachment on the tooth
a 14 year old male patient has a diffuse erythema of the gingiva with scattered isolated ulcers on the tongue, oropharynx and cheek mucosa. His condition os of 3 days duration is painful and he has a fever and malaise. The most probable diagnosis is?
Acute herpetic Gingivostomatitis
The most common microorganisms implicated in the etiology of necrotizing ulcerative gingivitis are?
Borrelia vencenti
Fusiform bacilli
Which of the following lesions may create gingival deformities that require gingival surgery?
a) acute pericoronitis
b) desquamative gingivitis
c) necrotizing ulcerative gingivitis
d) acute herpetic gingivostomatitis
Necrotizing ulcerative gingivitis
The actual position of the gingiva is determined by?
The level of the epithelial attachment on the tooth