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175 Cards in this Set

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  • Back
Steps of treatment plan, in order
systemic, emergency, initial prep, reevaluation, surgical, restorative, finishing, reevaluation, maintenance, periodic reevaluation
standard premed
amoxicillin 2 gms 1 hr pre-op
larger width of PDL would be on which side of force - tension or pressure
tension
injury resulting from the application of excessive occlusal forces to a tooth with normal periodontal support
primary occlusal trauma
injury resulting from the application of totherwise normal occlusal forces to a tooth with reduced periodontal support
secondary occlusal trauma
t/F occlusal trauma, w/o inflammation, does not cause loss of fibrous attchmnt to the tooth or apical migration of the epi attchmnt
T
Angles class - buccal groove of mand 1st perm molar articulates w/ MB cusp of max 1st perm molar
I
Angles class - buccal groove of mand 1st perm molar articulates post to the MB cusp of max 1st perm molar
II
Angles class - buccal groove of mand 1st perm molar articulates ant to the MB cusp of max 1st perm molar
III
injury caused in clinic
iatrogenic
injury caused by self
facticial
total biowidth, how much of each
2 mm, 1 mm JE attchmnt, 1 mm supracrestal fibers
4 strata of epithelium (bottom up)
basale, spinosum, granulosum, corneum
epi layer that secretes basement membrane
basale
epi layer that undergoes differentiation, prickle cell layer
spinosum
epi layer of flattening cells, producing keratohyalin protein
granulosum
epi layer of loose nucleus, impermeable, desquamated cells
corneum
# of days of epi layer from mitosis to exfoliation
30
layer of epi that contains stratum corneum
keratinized
no submucosa, lamina propria continuous w/ periosteum
masticatory mucosa
2 examples of masticatory mucosa
gingiva, hard palate
k or n.k.? - gingiva
keratinized
k or n.k.? - hard palate
keratinized
k or n.k.? - lining mucosa
non-keratinized
k or n.k.? - gingival sulcus
non-keratinized
k or n.k.? - junctional epi
non-keratinized
k or n.k.? - taste buds
non-keratinized
epi vascularity?
none
CT layer directly beneath epi
lamina propria
nutrient supply to epi?
diffusion across basement membrane from CT
epi interdigitation into CT
rete ridges
CT interdigitation into epi
dermal papilla
allow greater surface area for diffusion to epi
rete ridges
main fiber element of CT
collagen 60%
gel-like material that coats cells & collagen fibers
intercellular ground substance
fiber type in CT that maint tissue tone w/ memory-like rubber bands
elastin 5%
3 components of intercellular ground substance
hyaluronic acid, chondroitin sulphate, mucopolysaccharides
junction between CT & stratum basale
basement membrane
loose CT layer between lamina propria & bone or muscle containing BV, glands, hair follicles, etc.
submucosa
helix structure of collagen
left hand
keratinized gingiva becomes ____ after tooth eruption
sulcular epi
continuous w/ gingival & junctional epi
sulcular epi
attaches to tooth via hemidesmosomes
junctional epi
functions as adhesion for JE to tooth
intercellular ground substance
2 enzymes that can break biochemical attchmnt of JE
hyaluronidase, chondroitin sulphatase
interproximal dip of thin epi between contacting teeth
col
function of collagen fibers of PDL
prevent breakdown of Sharpey's fibers via apical migration
orients tooth in position w/in bone socket, absorbs occlusal forces, proprioception sensory
PDL
6 cell types contained in PDL
fibroblast/clast, osteoblast/clast, cementoblast/clast
BVs in ___ supply bone, cementum & gingiva
PDL
collagen embedded in cementum & bone
Sharpey's fibers
5 principal fiber groups of PDL
alveolar crest, horizontal, oblique, apical, interradicular
aka oblique fibers
axial loading
ging fiber group that attaches cementum to cementum
transseptal
ging fiber group that attaches tooth to periosteum
dentoperiosteal
cells in the ____ can remodel bone and ligament to accommodate forces
PDL
produce alkaline phosphatase
osteoblasts
produce acid phosphatase
osteoclasts
outer shell of dense, strong bone
compact or cortical bone
bone in contact w/ Sharpey's fibers
alveolar bone proper or cribiform plate
bone of main jaw, remains after extraction
basal bone
bone on top of basal bone to support teeth & sockets
alveolar process
bone forming inner wall socket, perforations allow for vascular comm w/ PDL
alveolar bone proper, cribiform plate
radiopacified line surrounding tooth socket
lamina dura
coronal aspect of bone parallel to adjacent CEJs
alveolar crest
thin plate of bone in interproximals of adjacent teeth
septal bone
V shaped defect of alveolare bone, usually buccal surface of prominent teeth
dehiscence
window through alveolar bone, usually on buccal surface
fenestration
min 2 mm of soft tissue attachmnt
biological width
vascularized layer of cells covering bone
periosteum
cementum receives nutrition via ____
diffusion
calcified tissue covering surface of root
cementum
cementum is continually deposited in ___ area
apical
cementum deposited during root formation & eruption
acellular
cementum formed after tooth eruption in apical third of root
cellular
% of cementum-enamel overlap
60
2 complications of CEJ
enamel projection, enamel pearl
loose CT tissue w/ odontoblast layer, BV & nerve supply
pulp
main blood supply of gingiva
supra periosteal vessels
3 blood supply to gingiva
supra periosteal vessels, vessels of PDL, septal vessels (nutrient canals)
primary etiology of periodontitis
bacteria
4 examples of bacterial morphology
cocci, bacilli, filaments, spriochetes
anaerobic cell that does not allow oxygen
obligative
anaerobic cell that can function w/ or w/o oxygen
facultative
most pathogenic gram staining
negative
functions to identify species & anitbiotic sensitivites
culture
9 problems w/ micro analysis
site specific, diminished reliability, false negatives, inability to identify pathogens by species w/ microscope, uncertainty of which organisms are pathogens, no antibiotic sensitivity w/o culture, difficult to maintain viable anaerobic cultures, time consuming, expensive
initial % of bacteria & type prior to experiment
90% gram +
# of days to increase in # of bact & shift to gram - rods & cocci
2
# of days to gram - filaments & fusobacteria
3-4
# of days to spriochetes & flagellated forms
5-9
lipopolysaccharide
gram -
lipotechnoicacids
gram +
3 factors influencing severity of infection
host resistence, local factors, virulence of flora
3 factors influencing host resistence
systemic disease, immune deficiency, stress
4 examples of local factors
plaque control, restorations, occlusion & habits
spell Aa
actinobacillus actinomycetemcomitans
complex of bacterioides forsythus, porpyromonas gingivalis, treponema denticola
red
complex that adheres to epi lining of pocket wall
red
complex associated w/ most cases of chronic perio
red
complex associated w/ aggressive types of perio
orange
may be present w/ or w/o red complex, asso w/ tissue invasion & aggressive perio
green cluster
complex of Aa, eikemella corrodens, capnocytophaga
green cluster
mass of microbes who, as a team, function to overcome host immune defenses
biofilm
functions as glycoprotein rain tarp
biofilm
foreign cell mediates immune response
antigen
lymphocyte released into blood if during 1st pass goes to Thymus then it become a ____, if to Peyer's patches then a ____
T-cell, B-cell
reside adjacent to capillary wall, increase blood flow to site
mast cells
function of mast cells
detect irritants & release Histamine = vasodilation & capillary wall permeability
1st WBC to arrive at site, capable of chemotaxis & phagocytosis
PMNs
PMN standsfor
polymorphonuclear leukocytes or neutrophils
# of days to PMN & macrophage/monocyte arrival
2-4
release hydrolytic enzymes to destroy bacteria & host tissue
PMN
circulating monocyte migrates through vessel wall to become a ____
macrophage
active chemotaxis & phagocytosis characterized by destruction of bacteria via lysosomal enzymes
macrophage
cells can coalesce to form foreign body giant cels
macrophage
leukocytes that arrive later in process
lymphocytes
early arriving lymphocytes become _____ to _____
sensitized, antigen
sensitized lymphocytes differentiate into ____ or ____ cells
B, T
# of days of inital differentiation of lymphocytes
14
mature, sensitized B cells
plasma cells
produce antibody specific for bacterial antigen
plasma cells
immunity characterized by B-cells
humeral
immunity characterized by T-cells
cell mediated
3 types of differentiated T-cells
helper, killer, suppressor
p/u antigen protein & present to macrophage
helper T-cells
carry antigen back to nodes to sensitize more B cells, augmenting reponse of humeral immune system
helper T-cells
recognize antigen & seek out foreign cells, attack specific invading cells
killer T-cells
doesn't destroy host tissue during battle w/ bacteria
killer T-cells
monitor activity of immune response & influence other classes of cells to reduce imm. activity when invader is defeated
suppressor T-cells
help bring host back to stable function after battle
suppressor T-cells
some reside in nodes after inital attack to enhance future response
B-cells
soluable proteins secreted by cells as messaenger molecules influencing other cells
cytokines
example of cytokine produced by both B & T-cells
interleukin
proinflammatory cytokine that induces osteoclast activation
interleukin-1
primary class of immunoglobin in perio
IgG
antibodies are produced by ____
plasma cells
The F-ab end binds ____, the F-c end binds ____
antigen, complement/macrophage
system of 9 proteins in blood w/ profound immunological effects
complement
group together on F-c end of IgG antibody forming macroprotein to rupture cell wall
complement
complement that induces PMN degranulation resulting in increased inflammation
C3, C5
profound mediators of inflammation
prostaglandins
phospholipids produced by PMNs & macrophages
prostaglandins
most potent bone resorbing agent
PGE2 (prostaglandin E2)
most potent chemotactic agent, attracts PMNs
LtB4 (leukotrine B4)
only essential fatty acid
arachnidonic acid
example of matrix metalloproteinases (MMPs)
collagenase
released from pts own PMNs & macrophages, destroys tissue
collagenase
approx 60% of pts w/ aggressive forms of perio exhibit ____
leukocyte dysfunction
results in decreased migration & hyper-reactiveness to bacterial antigens, inherited
leukocyte dysfunction
test for increased bone loss due to release of too much interleukin-1 in response to bacterial anitgens
PST (perio susceptibility)
constricts blood vessels & has negative impact on immune system
epinephrine
lack of ability to ____ w/ stress can be determining factor of perio
cope
2 theories of stress in perio
behavioral, psychoneuroimmunological
3 indicators of behavioral stess
denial, failure to seek Tx, increased smoking
stress theory of hormonal influence aggravating inflammation
psychoneuroimmunological
2 steroids released that are stress induced
glucocorticoids, epinephrine
lesion w/ mast cell degradation, exudation of crevicular fluid, increased capillary permeability, migration of PMNs & macrophages
initial
days to initial lesion
2-4
lesion w/ alteration of cornoal cells into JE, perivascular collagen reduced to 60-70%
initial
lesion of increased exudate, pmns & macrophage 90% occupation of CT volume
early
days to early lesion
7-14
lesion of pathological changes in fibroblasts, further loss of collagen & beginning proliferation of JE
early
lesion of plamsa cells & lymph, chronic inflammation, immunoglobin in tissue
established
days to established lesion
>14
lesion of apical migration of JE & early pocket formation w/o much bone loss
established
lesion of persistent chronic inflammation, extension of lesion into alveolar bone & PDL
advanced
days to advanced lesion
months - years
lesion of attchmnt loss & further pocket formation, conversion of bone to fibrous CT, periods of quiescence & exacerbation
advanced
4 stages of perio lesion
initial, early, established, advanced
8 components of bacterial toxonomy
morphology, metabolism, gram staining, motility, dark field microscopy, immunofluorescent staining, DNA analysis, culture techniques
12 steps of prognosis of tooth
amt&distribution of remaining bone, attchm't loss, furcations, crown-root ratio,tooth&root anatomy,relation to otherteeth&structures,mobility,future use,soundness of surrounding teeth,caries severity,occlusion,etiological factors
4 classifications of prognosis
good, fair, poor, hopeless
12 steps of prognosis of dentition
desire of pt,#&loc of remaining teeth,amt of gen bone loss,relationship of bone loss-age,response to previous tx,chronology&actv of disease,systemic health,occlusion,habits,avail of tx & maint care, summarized px of individual teeth
Prognosis 1st based on what 2 factors
neg PST, non-smoker