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134 Cards in this Set

  • Front
  • Back
What is epidemiology?
Studying the distribution of disease in human populations and the factors that influnce the distribution
What is (probably) the most successful public health intervention?
Fluoridation of water to prevent caries
Why do epidemiological studies matter so much to periodontists?
Because it is an evidence-based practice
Define prevalence. How is it calculated?
The percentage of people in a population who have disease at a given point in time. # of people with the disease / # of people in the population
Define incidence. How is it calculated?
The average percentage of unaffected people who will develop disease during a specific period of time, or the measure of how much new disease there is. # of new cases / # of persons at risk when the study began
Prevalence or incidence: Tells the risk/probability that a person will become a new case.
Name the two overall types of studies done for prevalence or incidence.
1 - Observational 2 - Experimental
Name the three types of observational studies.
1 - Cross-sectional 2- Cohort 3- Case-control
Most epidemiological studies are (observational/experimental).
Name the most common type of experimental study.
Drug trials
What are two synonyms for Cross-sectional studies?
1 Disease freqency studies 2 Prevalence studies
If a cross-sectional study is repeated at regular intervals, what are two advantages?
1 Gives information on trends in disease over time 2 Shows effectiveness of prevention/treatment programs
Name two reasons why cross-sectional studies are better than cohort or case-control studies.
1. Cheaper 2. Quicker to conduct
What does a cohort study reveal about a population?
Whether an exposure or characteristic is associated with development of disease
What kind of study starts off with all subjects free of disease?
Cohort study
Name 2 disadvantages to cohort studies.
1 Requires long observation periods 2 Expensive
What kind of study starts off with 2 groups; patients with or patients without disease?
Case-control study
Name 2 disadvantages to case-control studies.
1 Can't determine prevalence 2 Can't determine incidence
If you want to calculate prevalence, what type of study should you do?
Cross-sectional study
If you want to calculate incidence, what type of study should you do?
Cohort study
If you want to study association between exposure and disease, what type of study should you do?
Case-control study
Sensitivity or Specificity: The percentage of people who have the disease who test positive.
Sensitivity or Specificity: The percentage of people who don't have the disease who test negative.
Define risk. Define risk factor.
Risk = The likelihood that a patient will get a disease in a specific time period. Risk factor = Characteristics that place a patient at risk for getting a disease
What are three ways for exposure to occur?
1 Single point in time 2 Episodic 3 Continuous
If you eliminate a risk factor, does it prevent new disease? Does it get rid of existing disease?
Prevents - yes. Eliminates - no.
Name 2 true risk factors for periodontal disease.
1 Smoking 2 Diabetes
Once a patient has periodontal disease, what are two things we must do?
1 Reduce risk at healthy sites 2 Increase risk for positive prognosis in diseased sites
What are 2 different definitions of gingivitis?
1 Inflammation on teeth with no attachment loss 2 Inflammation on tooth with healthy, stable, non-progressing attachment loss
What is gingival index used for?
It's used to quantify amount and severity of disease in individuals/populations, over time
What does a gingival index compare: Prevalence or incidence?
Name 4 features of an "ideal index".
1 Quick to use 2 Accurate 3 Reproducible 4 Quantitative
Gingival index is (subjective/objective). Gingival bleeding index is (subjective/objective) for diagnosing inflammation.
Gingival index: Subjective… Gingival bleeding index: objective.
What happens first in gingiva: bleeding or color change?
Bleeding always occurs first!
Describe how you differentiate gingivitis from periodontitis using bleeding index.
Gingivitis: Drag a perio probe (2 mm) through each sulcus, wait a few seconds, then note bleeding…. Periodontitis: Base of pocket, then note bleeding
What is the direct cause of gingivitis (that all studies have shown)?
Bacterial plaque
When and who performed the "classic" experimental gingivitis study?
1965 - Loe
Why have there been no experimental studies on chronic periodontitis?
Because it is an irreversible destruction of the connective tissue
Maxillary _________ and mandibular __________ have the most attachment loss of any tooth.
MOST: Maxillary molars, mandibular incisors
Maxillary _________ have the least attachment loss of any tooth.
LEAST: Maxillary incisors
T/F: Increased pocket depth correlates with age.
False! It does not!
Periodontitis becomes clinically significant after age ____.
According to the 'new paradigm' for the etiology of periodontitis, what determines the clinical extent and severity of the disease?
Host inflammatory response
Smokers are ____ times as likely to develop severe periodontitis than non-smokers.
What is the most important host factor for developing periodontitis?
Cigarette smoking
What ist he most important predictor for periodontitis?
Oral hygiene
Periodontitis is (more severe with/not affected by) the following risk factors: Low socioeconomic/educational status; osteoporosis; HIV/AIDS; infrequent dental visits.
Low socioeconomic/educational status - more severe; osteoporosis - not affected; HIV/AIDS - not affected; infrequent dental visits - not affected by.
Periodontitis is (more severe with/not affected by) the following risk factors: bacteria; bleeding on probing; previous periodontal disease; genetic factors; stress.
bacteria - more severe; bleeding on probing - more severe; previous periodontal disease - more severe; genetic factors - more severe; stress - more severe.
What is Scaling? What is Root planing?
Scaling = Removing calculus, food, plaque on enamel AND cementum. Root planing = Removing calculus and contaminated cementum ONLY on root
With scaling and root planing, the oral flora shifts from Gram (-/+) to Gram (-/+) aerobes.
From gram - to Gram +
Name the three classes of bacteria that are bad for oral health.
1 Motile rods 2 spirochetes 3 Any black pigmented bacteria
What researchers' study had 3 periodontists scale/cavitron, and found that deep pockets were affected much more than shallow pockets (even had destroyed periodontal fibers)?
What were the results of Sherman's study?
Deeper pockets gained attachment with 3 SRP & Cavitrons, but shallow pockets had no change, or even lost attachment
What researchers' study compared open (surgical) to closed (non-surgical) treatment and found that in deeper pockets, less calculus was left but there was no difference for shallow pockets?
What were the results of Buchanan's study?
Surgical calculus removal has no affect on pockets less than 6 mm, but there is significant change for deeper pockets when surgical SRP is done
What very important study compared different SRP techniques on furcations?
What were the results of Matia's study?
Ultrasonics must be used on furcations because the tip is smaller! Also, surgical is more effective
How many days does it take, after SRP, to get bacteria to levels of health?
If maintenance of plaque control is absent, it takes __ to ___ weeks to repopulate the pocket with bad bacteria.
4-8 weeks
What researchers' study found that SRP was equally effective as surgical therapy?
Lindhe and Nyman
What researchers' study found that at pocket depths greater than 7 mm, there was no difference between surgical and non-surgical treatment?
What researchers' study found that RP, and surgical procedures produced similar gains in pockets greater than 7 mm?
What is substantivity?
The ability of an agent to bind to tissue surfaces and be released over time
What item in dentistry has high substantivity?
Why are gracey curettes the best for subgingival SRP?
They provide the best adaptation to root anatomy
What kind of fulcrum is best for using the Gracey 11-12?
Extraoral or opposite arch
Ultrasonics vibrate between __,000 and __,000 cycles/second.
The ideal angle between the face of the blade and the lateral surface of any curette is __ to ___ degrees.
What is the name of the author who changed her position from 1985 (ultrasonics no good for light treatment) to 1992 (ultrasonics are first choice in treatment of most patients)?
Irene Woodall
What is periodontal debridement?
The mechanical removal of tooth/root surface irritatnts to return to non-inflamed state
Name 4 basic ways that ultrasonic debridement is accomplished.
1 Mechanical 2 Cavitation 3 Irrigation/Submarginal lavage 4 Acoustic turbulence
What mechanical measurement represents the number of times per second that a tip vibrates back and forth?
What unit of measurement is used for frequency?
What mechanical measurement represents how great the tip is vibrating side-to-side or round-to-round?
Tip amplitude
Frequency or tip amplitude: Can be changed by the power setting on the ultrasonic unit.
Tip amplitude
Define cavitation.
Bursting air bubbles (produced by vibration) cause shock waves in the water, which causes rupture of the cell wall membrane
What basic component of ultrasonic debridement results in disruption of the bacterial matrix?
Acoustic turbulence
How many cps does a sonic instrument use?
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Titan Scaler
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Micro ICS Scaler
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Cavitron SPS
Magnetostrictive Ultrasonic
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Turbo 25K/30K
Magnetostrictive Ultrasonic
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Odontosan
Magnetostrictive Ultrasonic
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Piezon Master 400/Mini
Piezoelectric Ultrasonic
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: P-5 Booster
Piezoelectric Ultrasonic
Sonic, Magnetostrictive Ultrasonic, or Piezoelectric Ultrasonic: Pro-Select 3 Scaler/Irrigator
Piezoelectric Ultrasonic
How many cps does a magnetostrictive ultrasonic instrument use?
25,000-42,000 cps
How many cps does a piezoelectric ultrasonic instrument use?
40,000-50,000 cps
How does an ultrasonic instrument work?
Converts electrical energy into mechanical vibrations
Name the two types of Ultrasonic instruments.
1 Magnetostrictive 2 Piezoelectric
What surfaces of a magnetostrictive ultrasonic are active?
Which functions with an elliptical/orbital motion: Magnetostrictive or piezoelectric?
Magnetostrictive Ultrasonic
Which functions with a linear motion: Magnetostrictive or piezoelectric?
Piezoelectric Ultrasonic
Which surfaces of a Piezoelectric ultrasonic are active?
Lateral sides only
T/F: There is more tactile sense with an ultrasonic scaler.
False - LESS
Name 5 medical contraindications to using an ultrasonic scaler.
1 Infectious disease 2 Respiratory disease 3 Predisposition to infection 4 Pacemakers 5 Swallowing defects
Name 3 dental contraindications to using an ultrasonic scaler.
1 Sensitivity 2 Areas of demineralization 3 Margins of restorations
What setting should the water knob on the ultrasonic scaler be set at (%)?
Name three types of strokes that can be used with an ultrasonic scaler.
1 Vertical 2 Oblique 3 Circumferential
Loe's 1965 demonstrated that in the absence of plaque there (was/was no) disease.
was NO disease
T/F: Dental plaque bacteria are strongly influenced by environmental factors that may be host mediated.
What determines periodontal health?
Balance between bacteria and the host
Can dental plaque be removed by water squishing into the pockets?
No, they are adherent to the tooth surface
Name the two types of bacteria that accumulate at the tooth surface. Name the two types that are found in the outer surface of the mature plaque mass.
Tooth surface: Gram + Cocci and short rods. Outer surface: Gram - rods and filaments
Define Long Junctional Epithelium. What is its function?
It is the migration of the epithelium following SRP. It replaces the lost CT attachment, but is not as good (debatable)
What did the 1998 Socransky study show about different-colored oral bacteria complexes?
Red and orange complexes were associated together, and the red complex showed the strongest relationship to periodontal diagnosis.
Name the three bacteria that made up the "red complex" in the 1998 Socransky study.
1 B. Forsythus 2 P.Gingivalis 3 T. Denticola
In the Brochut study, at six weeks after therapy, the mean total bacterial loads had (no/significant) impact on the bleeding tendency of the subject, six months later.
What did the Brochut study show about the effects of scaling and root planing, which explains why we're required to do 3 OHCs before we can start SRP?
Perfect oral hygiene is VERY important before non-surgical therapy
What did the Colombo study show about SRP?
SRP decreased certain periodontal pathogens, and increased beneficial species for up to 9 months following treatment.
What did the Haffajee study show about OHC?
Meticulous removal of suprgingival plaque affects nature of bacteria below and above the gingival margin! (in a good way)
What did the Fujise study show about P.gingivalis, B.Forsythus, and A.A?
They are all usefull in assessing treatment outcome!
What did the Petersilka study demonstrate about intensive subgingival SRP in PPD less than 3 mm?
This should be avoided, as it will result in AL and traumatize the periodontium.
What did the Darby study demonstrate about humoral immune response?
There were no significant post-therapy effects, except reduced antibody avidity to P gingivalis/intermeia (host response may fail to make the antibodies to fight oral flora)
What did the Cugini studyc conclude about perio maintenance?
It is essential in maintaining clinical/microbial improvements made by initial treatment.
What did the Loesche study show about non-invasive treatment?
It reduced the need for surgery/ext, for at least five years after initial SRP
Is metronidazole dental gel indicated for an adjunctive treatment for adult periodontitis?
What did the Shiloah study show about microbial pathogens in the oral cavity?
Their presence negatively affects the outcome of both surgical and non treatment!
Name the 3 changes in cementum that occur with periodontitis
1 Destruction of collagen fibers in cementum 2 Degeneration of Sharpey's fibers 3 NECROSIS of cementum
What is the one indirect affect of bacteria?
Their endotoxins prevent attachment of gingival fibroblasts, in vitro
Name the major etiologic factor of periodontal disease.
Plaque, especially bacteria that are embedded in the biofilm
Name the most common endotoxin released by bacteria to disrupt fibroblasts.
Name 2 proposed mechanisms for hypersensitivity following SRP.
1 Hydrodynamic (tubules are exposed) 2 Bacterial sensitization of the pulp
What is the main goal of removing plaque/calculus?
Reducing inflammation
What is the primary goal of SRP treatment itself?
Reduction of the pocket depth
In the Experimental Gingivitis study by Loe and Theilade, gingivitis appears after ___ days without plaque control,and returns to gingival health within ___ days after reestablishing oral hygiene.
3, 7.
Name the 4 stages of periodontal disease progression, according to Page and Schroeder.
1 Initial lesion 2 Early lesion 3 Established lesion 4 Advanced lesion
What stage of disease progression is: subclinical, widening of capillaries, and PMN?
Initial lesion
What stage of disease progression is: erythematous, and has intensified inflammatory cell response?
Early lesio n
What stage of disease progression is: Deeper, bluish colored, has lots of plasma cells, widened intercellular space, destroyed basal lamina/collagen fibers (periodontal tissue destruction)?
Established lesion
What stage of disease progression has: extension into alveolar bone?
Advanced lesion
__-___ mm of PPD reduction occurs after SRP.
2-3 (.5 mm new attachment, 1-.15 junctional epithelium, other from recession of gingiva and decreased inflammation)
Name the three things that occur with healing after SRP.
1 Recession 2 Junctional epithelium attachment 3 New attachment
Which gingival structure is (basically) impossible to restore if you destroy it during SRP?
Interdental papilla