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94 Cards in this Set

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State the 4 components of the periodontium
Alveolar Bone
Attachment Apparatus + 1 more component
What are the 2 components of the gingiva
Marginal Gingiva
Attached Gingiva
Give this description a name:

The unattached gingiva that is the terminal edge or border of the gingiva surrounding the teeth in a collarlike fashion
Marginal Gingiva
The margingal gingiva can be separated by the adjacent gingiva by a SHALLOW linear depression called the ___ ____ ____.

How wide is it?
Free (Marginal) Gingival Groove
1mm wide
The ___ ___ is theshallow crevice or space around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other. It is V shaped.

Depth of the ____ ____is an important diagnostic marker
Gingival Sulcus
Give this description a name:

Continuous with the marginal gingiva. It is firm, resilient and tightly bound to the underlying periosteum of alveolar bone. The facial aspect extends to the relatively loose and movable alveolar mucosa, from which it is separated by the mucogingival junction.
Attached Gingiva
How do you determine the width of the attached gingiva?

Width on the facial is greatest in the ____ region, less in the ____ region and least in the ____ region.

Width increases with ___ and ____ teeth (due to modifications in the coronal portion of the attached gingiva).
It is from the MCJ to the bottom of the gingival sulcus or periodontal (pd) pocket

IT IS NOT the Width of KERATINIZED GINGIVA (this includes the marginal gingiva)

Greatest Width= Incisor (I) Area
Less Width= Molar (M) Area
Least= Premolar (PM) area

Width of attached gingiva increases with AGE and Supereupted Teeth.
On the lingual aspect of the mandibular teeth where does the attached gingival terminate.
The attached gingiva ends where the lingual alveolar mucosa and the mucous membrane lining the mouth meet.
Give this description a name:

Occupies the gingival embrasure which is the interproximal space beneath the area of tooth contact. Can be pyramidal (where the tip of the papilla is just below the contact point) or have a “col” shape (there is a valley like depressionthat connects a facial and lingual papilla and conforms to the shape of the interproximal contact).
Interdental Space
The shape of the interdental area depends on the ____ and the ____.
Contact Point
Amount of Recession
The lateral borders and tips of the interdental papillae are formed by the ____ gingiva of the adjoining teeth. The intervening portion consists of ____ gingiva
Lateral borders and tips= marginal gingiva

Intervening portion= attached gingiva
If a diastema is present will there be interdental papilla?
No;If a diastema is present, the gingiva is firmly bound over the interdental bone and forms a smooth, rounded surface without interdental papillae (Figure 4-8).
List the component parts of the attachment apparatus
Periodontal Ligament (PDL)
Alveolar Bone
Define Plaque
Soft deposits that form the biofilm on the tooth/hard surfaces

*Plaque can stick to removable or fixed restorations
How is plaque classified
Based on where it is located on the tooth's surface:
Since different regions of plaque are significant to different processes associated with diseases of the teeth and periodontium:

Marginal Plaque is associated with ____.

Supragingival Plaques and TOOTH ASSOCIATED Subgingival plaque are critical in _____ formation and _____.

TISSUE ASSOC. Subgingival Plaque is important in the soft tissue destruction that characterizes different forms of _____.
Marginal Plaque= Gingivitis

Supragingivaland Tooth Assoc. Subgingival Plaque= Calculus formation and Root caries

Tissue Assoc. Subgingival Plaque= Soft tissue destruction---> Periodontitis
What is plaques composition?
Organic and Inorganic organisms or substances that are derived from saliva the gingival crevicular fluid and bacterial products
Give an estimate on the # of microoraganisms in dental plaque.

Are there non bacterial organisms in dental plaque? Can you name some?
More than 500
-some have yet to be identified

YES: Mycoplasma, Yeast, Protozoa and Viruses
Where do the microorganisms in dental plaque exist?

Does anything else exist in here?
In the Intracellular Matrix
YES: Host cells (epithelial cells, macrophages, and leukocytes)
How much of the plaque mass does the intracellular matrix account for?
We have learned that the intracellular matrix consists of organic and inorganic materials derived from Saliva, Gingival Crevicular Fluid, and Bacterial Products.

Can you name the 4 organic components of the matrix and where they are from?
-produced by bacteria
*Dextran is the main form

-Albumin is from the gingival crevicular fluid

-from saliva
-initial coats the teeth for protection---> component of pellicle

Lipid Material
-Debris from membranes of disrupted bacterial and host cells
The inorganic component of plaque is predominately ___ and ____.

Trace amounts of ___, ___, and ____ also exist.
Ca and Phosphorus

Trace amts: Sodium, Potassium, Fluoride
The source of the inorganic component of SUPRAgingival plaque (Ca//Phosphorus) is primarily ____.

As the mineral content increases the plaque becomes ___.

The inorganic component of subgingival plaque derived from the ____ which is a serum transudate. Calcification of subgingival plaque will lead to ___ formation.

What is a trasudate vs and exudate?

Increase in mineral content of plaque= calculus

Subgingival Plaque= Crevicular Fluid
-calcification= calculus
Transudates are caused by disturbances of hydrostatic or colloid osmotic pressure, not by inflammation.
-Differs from an exudate b/c an exudate is any fluid that filters from the circulatory system into lesions or areas of inflammation. Its composition varies but generally includes water and the dissolved solutes of the blood, some or all plasma proteins, white blood cells, platelets and (in the case of local vascular damage) red blood cells.
Calculus is frequently found in areas of the dentition adjacent to _____.

Most commonly in the lingual surface of the mandibular ____ and the buccal surface of the maxillary ___ molars), reflecting the high concentration of minerals available from saliva in those regions.
Salivary ducts
-Lingual surface of mandibular anteriors

-Buccal surface of maxillary 1st molars
What color is subgingival calculus and why?
Drk Green to Drk brown
-due to the presence of subgingival matrix (blood products from subgingival hemorrhage)
Where does the fluoride come from in the inorganic portion of dental plaque?
External sources
T or F: Plaque is a heterogeneous structure that has open fluid filled channels running through the plaque mass. These channels may provide for circulation within plaque to facilitate movement of soluble molecules such as nutrients or waste products. The bacteria exist and proliferate within the intercellular matrix through which the channels course.
Supragingival components from saliva
Subgingival INorganic components from GCF (Ca and Phosphorus with trace amounts of sodium, potassium, and fluoride)

SUPRAgingival= Saliva

Organic Component= Polysacchs, Proteins, Lipid Material
Hard Mineralized form of plaque is aka ____.
-Supragingivally it is __to___% INorganic. Of that % most is ____ (76%) and 3% is Calcium Carbonate and traces of Mg Phosphate. Crystals of Hydroxyapatite, Magnesium whitlockite, Octacalcium, and Brushite).

Organic component is prtn-polysach. complexes., leukocytes, and various microorganisms.
-70-90% inorganic
(most is Calcium Phosphate)
Name the type of gingivitis:

Sudden Onset
Short Duration
Can be painful
Acute Gingivitis
Name the type of gingivitis

Slow onset
Long duration
Painless unless complicated by acute or subacute exacerbations
Most Commonly encountered
Chronic Gingivitis
Name the type of gingivitis:

Around a single tooth or group teeth
Localized Gingivitis
Name the type of gingivitis:

Involves the gingival margin
May include some of the attached gingiva
Marginal Gingivitis
Name the type of gingivitis:

Interdental papilla are involved

Can extend into the adjacent gingival margin
Papillary Gingivitis
Name the type of gingivitis:

Gingivitis that affects the gingival margin, attached gingiva, and interdental papillae
Diffuse Gingivitis
Name the type of gingivitis:

Confined to one or more areas of the marginal gingiva
Localized Margingal Gingivitis
Name the type of gingivitis:

Extends from the margin to the mucobuccal fold
But limited in area
Localized Diffuse Gingivitis
Name the type gingivitis:

Confined to one or more interdental spaces in a limited area
Localized Papillary Gingivitis
Name the type of gingivitis:

Involves the gingival margin in relation all the teeth
-Interdental papillae ar usually affected also
Generalized Marginal Gingivitis
Name the type of gingivitis:

Involves the entire gingiva
Alveolar mucosa and attached gingiva are also affected
Can not see the MCJ
Systemic conditions should be evaluated as a suspected etiologic cofactor if you see this
Generalized Diffuse Gingivitis
Name the classifying group of periodontitis:

Slow Progressing
Adult Periodontitis
Name the classifying group of periodontitis:

Localized to the incisors and/or 1st molars
Rapidly Progressing
Juvenile Periodontitis
Name the classifying group of periodontitis:

Rapidly progressing
Rapidly progrssive Periodontitis
Name the classifying group of periodontitis:

Rapidly Progressing
Young pt
Pre pubertal periodontitis
Name the classifying group of periodontitis:

Usually localized
Acute Necrotizing Ulcerative Periodontitis
What are the 3 CLINICAL symptoms of periodontitis?
Gingival inflammation
Periodontal Pocket (attachment loss)
Bone Resorption (attachment loss)
What is the most important HISTOLOGIC differences (4) between gingivitis and periodontitis?
All these occur in Peridontitis:

Bone Resorption
Apical proliferation
Ulceration of JE
Progressive loss of CT attachent
In the acute/active phases of periodontitis there may be bacterial invasion of the tissue which can result in micro/macro ___ formation
Abcess formation
The plaque in periodontitis is made of adherent gram ___ and non adherent gram ___ bacteria
Adherent= gram +

Nonadherent= gram -
Name the types of non inflammatory periodontal diseases(2) causes?
Primary Occlusal Trauma
-from clenching

Ill fitting Denture
What is occlusal traumatism?
When occlusal forces exceed the adaptive ability of the tissues, tissue injury results

(When biting forces are more than the tissues can bare)
What results from occlusal trauma?
Excessive occlusal forces may also disrupt the function of the masticatory musculature and cause painful spasms, injure the temporomandibular joints, or produce excessive tooth wear
T or F:

The term trauma from occlusion is generally used in connection with injury in the periodontium. May be chronic or acute.
State the size of the edentulous/partially edentulous population in the US in 1994?
Partially edentulous= 10 million

Edentulous= 20 million
State the percentage of lost teeth due to periodontal disease in the under thirty five year old population and over thirty five year old population
Before 35= 70% of tooth loss is due to tooth decay and After 35= 70% of tooth loss is due to perio disease
State the percentage of dental services which are periodontal in nature?
Of treatment in the dental office only 5% of treatment is perio treatment
State the epidemiological relationship between age and the frequency and degree of gingivitis in the US?

Age 6?
Age 15?
Age 20?
Age 45?
Age 6= 1% had severe gingivitis

Age 15= 5% had severe gingivitis//80% will have slight to moderate.
Age 20=10% will have severe
Age 45= 95% will have some form of gingivitis
Identify any correlations which exist between educational status and the frequency and severity of gingivitis and periodontitis
The higher the income and education, the less perio disease there is (less income and severity)
Identify any correlations which exist between sex of the patient and the severity and extent of gingivitis and periodontitis
Positive correlation between gender and perio disease.
- Males usually don’t take care of mouths as well as females do--->Males therefore have more perio diseases.
-Males tend to have higher plaque levels, seek dental care less frequently and have more dental disease
Identify any correlations which exist between extent of caries and the severity and extent of periodontal disease
There is no relationship between caries and perio diseases

These are caused by different kinds of bacteria
Caries is more closely associated with ____.
Is there a correlation between periodontal disease and diet
Is there a relationship between malocclusion and the severity and extent of perio disease.
NO;There is no relationship between tooth position problems and perio disease.
T or F:
Dentist cannot tell patient with malpositioned teeth that they will lose teeth due to perio diseases.
T or F:
Dentist and patient can minimize perio disease and tooth loss without ortho
Malpositioned teeth can lead to primary occlusal trauma but there will be no loss in ___ ___. Loss of this results from inflammatory disease
Bone Height
Identify any correlations which exist between race and the frequency and severity of periodontal disease

T or F:This is not genetic, its socioeconomic.
Caucasians have less perio disease than non caucasians

Identify any correlations which exist between various intraoral sites and the frequency and severity of gingivitis and periodontitis.
-Mid ridular groove

-Enamel projections and spurs which project onto cementum
*(esp problems at furcations)

-Distopalatal grooves (may occur on the roots/often on max lateral incisors)
*bone wont attach and predisposes one to perio disease

-tori which are bony projections usually found on lingual mandibular premolars and mid palatal area

5) frenum which is fold of alveolar mucosa usually between max and mand central incisors.

*They interfere with the ability to maintain area or with free gingival margin.
T or F:
If enamel overlaps cementum, bone won’t attach to it, and pockets form
Identify any correlations which exist between various intraoral sites and the frequency and severity of gingivitis and periodontitis.
(Part II)

Locations may be localized or generalized (also take into account keratinization)
1) Papillary gingivitis associated with papillary interdental area usually from not flossing
2) Marginal gingivitis which is midfacial or lingual and free gingiva is involved *usually see 1) and 2) together).
3) Diffuse gingivitis involves free gingiva and attached gingiva.
Can’t define MG junction and can’t differentiate gingiva from alveolar mucosa.
Identify any relationships which exist between various systemic diseases and the frequency and severity of periodontal diseases.
There is no relationship with systemic diseases and perio disease with a few exceptions.
-->lymphocytic infiltrations of bone,
--> hodgkin’s disease
--> leukemia
-->immunocompromised patients
-->hormonal variations
Define the term “primary etiologic factor” and list the primary etiologic factors of periodontal disease
"Primary etiologic factor:" is something that is considered to be the main cause to a certain problem.

The primary factors in the etiology of periodontal disease are
-->mechanical injury
-->thermal injury
-->chemical injury
-->allergic reactions
-->systemic diseases.
Define the term “predisposing etiologic factors” and list the predisposing factors of periodontal disease
A predisposing etiologic factor is something that tends to cause something, in this case, periodontal disease. These are anatomic factors and iatrogenic factors
Gender is considered a ____ risk factor for periodontitis, although it is unkown as to how males and females are affected
-it is primarily the female _____ that are assoc. w/ the progression of plaque-elicited gingivitis.
Secondary; female sex hormone
Can you name some sources of an elevations in the sex hormones that cause pdd
Pregnancy gingivitis
Oral contraceptive or “pill” gingivitis
Gingivitis menstrualis
Ginigivits climacterica (very rare)
Puberty gingivitis
*P. intermedia subs progesterone and estradiol for vitamin K as growth factors
T or F: Access and visibility play important roles in cleansing, so it is more common to find perio disease in the posterior regions of the mouth.

Also, interproximal areas are more likely to be periodontally compromised than buccal or lingual surfaces.

The maxilla is more commonly affected than the mandible, either because of access issues or maybe due to differences in bone density.
Define the term “modifying etiologic factor” and list the modifying etiologic factors of periodontal disease

Can you give an examples?
Agents that causes pdd but that agent varies from person to person and situation to situation

Define the term “perpetuating factor” and list the perpetuating factors of periodontal disease

Can you give examples?
These are agents that if you leave will perpetuate the disease process. Continued presence guarantees maintainence of disease.

Ex: Pd pocket with calculus and plaque
Discuss the therapeutic uses of sodium dipheylhydantolin and discuss the frequency of its use in the US
Dilantin is an ___ usually for epilepsy.
In US, __% have some form of epilepsy and more than __ million people in the US are on dilantin.
2% have some form of epilepsy
2 mil on dilantin
Pts on dilantin have increased gingival reactivity to ___.

Gingival hyperplasia is seen in __% of patients on dilantin.

T or F: Younger patients are more susceptible to hyperplasia than adults.

Hyperplasia increases and peaks at about __-__ months.

T or F: If patient goes off med, you will see regression (ie reversible).

Tissues will decrease in size about __-__ months after patient is off medication.

T or F: Hyperplasia is related to dose of medication or duration of therapy.

Hyperplasia is idiopathic, some get it and some don’t. Young 60-70%
Older 20%.

The more plaque and calculus the worse the situation.
Increased Reactivity to Plaque

Gingival Hyperplasia= 50%

T: younger pts are more susceptible than adults

Hyperplasia increase and peaks at about 12 to 18 months on medication

T: If meds are removed hyperplasia will regress

Tissue decreases in size 1-2 months after pt is off of meds

False: dosage and duration are not related to the hyperplasia
The relationship between dilantin is based on the following observations. (Complete the sentences)

1) increased plaque = increased ____.

2) If there is hyperplasia and teeth are extracted there is resolution (doesn’t happen in sulcusless population or edentulous population).

3) Monkeys given dilantin will develop hyperplasias and ____significantly reduces hyperplasias.

4) Hall study showing that kids with multiple scalings and great oral hygiene on dilantin didn’t develop hyperplasia over 1 year.

5)Individuals with unilateral parasthesia who couldn’t brush developed hyperplasia on numb side.
1)Increase plaque= Increased hyperplasia

3) Chorohexidine decreases hyperolasis significantly
How does dilantin work?

Dilantin is a ___ channel blocker which decreases collagenase activity.

--> This results in a decrease turnover rate of gingival complex

Although, Microscopically there is a tremendous increase in collagen concentration in gingival connective tissue. This is ___. It is not associated with the ____. It is associated with ___ ___.
Ca Blocker
Hyperplasia; NOT associated with the epithelium; assoc. with CT
Is the gingival hyperplasia associated with dilantin use painful?

Clinically describe a pts oral cavity on dilatin.
NO; Painless-->

Free gingiva increases in size usually papillary and maybe marginal.

Tissues are pale, pink, stippled and may or may not have bleeding upon probing.

Attached gingiva is NOT affected to a great degree

More plaque and calculus increases hyperplasia.

Can be localized or generalized.

In mouth you see variability.

Areas of mouth are NOT equally affected.
-This may be related to flora of the areas but no one really knows.
T or F: Kids with mixed dentition have NO problem with hyperplasia on dilantin
F: There are MAJOR problems in kids with mixed dentitions because they have tremendous fibrotic overgrowths which cause delayed eruption of the permanent teeth.
T or F:

Hyperplasia doesn’t = hypertrophy or inflammation
Describe the effect of Dilantin therapy on the edentuluous ridge areas and non oral connective tissue regions
You need a sulcus to have plaque accumulation to have disease, therfore there is NO hyperplasia in these patients
State the proper sequential tx of the patient with gingival hyperplasia due to dilantin therapy
Multiple prophies with recall at 3 months
*If physician refers patient before the hyperplasia presents, hyperplasia can then be avoided. Usually patients come in with hyperplasia already presenting.

Therapy is then subgingival plaque and calculus removal and OH instruction.

Patient compliance is the final determinant of whether hyperplasia resolves.

If low patient compliance there is no use in surgery since hyperplasia will return
What are the surgical procedures done on a pt that has hyperplasia due to dilantin therapy?
Surgical procedures are:
-Gingivoplasty with hyperplastic recurrence when dilantin therapy high.
State the rationale for the use of the kessling appliance in the management of dilantin gingival hyperplasia
Describe the mechanism of action of the immuno-suppressive drugs
-cyclosporine and the
-various calcium channel blockers
Ca channel blockers are used as anticonvulsives and for people with hrt problems

Ca channel blockers block ca uptake at neuromuscular junctions (used to decrease contractility) and also uptake of Ca by fibroblast

Due to the lack of Ca uptake by fibroblast they are also unable to take up folic acid
-thus fibroblast are depleted in Ca and folic acid

Fibroblast are responsible in synthesis and breakdown of collagen---> thus collagen turn over rate is

Collagen is synthesized in the pro form but CANT be converted into its active form without FOLIC ACID

Thus fibroblast are loaded with pro-collagen BUT unable to convert it
State the effect of immunosuppresive and or calcium channel blocking drug therapy.

Procardia therapy?
30% of patients on procardia get gingival hyperplasia.

Controlling an immunosuppressed patient is not easy.
-Medications can cause perio disease, allergic reactions or can modify gingival reactivity.
T or F:
Drugs can increase or decrease gingival reactivity, ie there could be lots of plaque and calculus with no inflammation. Therefore, don’t let clinical manifestations fool you. Patient gets infected with destruction of tissue and bone, many times in the absence of clinical signs.
Discuss the dental tx modifications which should be considered when treating a patient on immunosuppressive and/or calcium channel blocking drug therapy