Periodontology Comprehensive Final Study Guide

What are the components of a comprehensive periodontal assessment?

Level of mucogingival involvement, mobility, and GMs/CAL

________ inflammation is a prolonged, out-of-control inflammatory response that continues for more than a few weeks and results in varying degrees of tissue injury.

Chronic

________ inflammation is a short-term, normal process that protects and heals the body following physical injury or infection.

Acute

_________________ is an in-depth information gathering process used to gather detailed data needed to document the complete periodontal health status of a patient.

Comprehensive periodontal charting (assessment)

True or False: Comprehensive periodontal charting includes probe depths, BOP, presence of exudate, level of free GMs and mucogingival junction, tooth mobility, furcation involvement, presence of calculus/plaque, inflammation, radiographic bone loss, AND local contributing factors.

FYI: Remember these

True

_______________ is an efficient, easy to use screening system for the detection of periodontal disease that helps separate patients into health, gingivitis, and periodontitis.

Periodontal screening and recording

True or False: If periodontal health or gingivitis is determined, there is no further clinical periodontal assessment that is needed.

True

A ________________ is used to observe the position of the reference mark in relation to the gingival margin and other clinical features.

WHO probe (ball tip probe)

How is the mouth divided into units for PSR?

By sextant

What are the limitations of PSR?

Not precise, can underestimate the severity of periodontal distruction

What features CAN be viewed radiographically pertaining to bone loss and periodontal disease?

Widening of PDL, bone changes, bone loss around prosthetics, alveolar crest irregularities, and abscesses

What CAN NOT be viewed on a radiograph pertaining to bone loss and periodontal disease?

Level of epithelial attachment, mobility, gingival description, and bleeding

What is the ideal crown to root ratio?

1:2

Why is knowing the crown to root ratio important?

To evaluate whether a tooth is suitable to act as an abutment for a fixed or removable denture

What CAN be determined about periodontal disease on radiographs?

Bone loss, furcation involvement, calculus deposits, peri-implant bone loss, crown-to-root ratio, and implant planning (CBCT)

What CANNOT be determined about periodontal disease on a radiograph?

Early stages of bone loss, mobility, Class I furcations or maxillary furcations, presence of absence of periodontal pockets, gingival description

What is the first goal of nonsurgical periodontal therapy?

Mechanically remove the bacterial challenge to the patient

What is the second goal of nonsurgical periodontal therapy?

Eliminate or control the local environmental risk factors for periodontal disease

What is the third goal of nonsurgical periodontal therapy?

Minimize the impact of systemic risk factors for periodontal disease

What is the fourth goal of nonsurgical periodontal therapy?

Stabilize the attachment level by eliminating inflammation

What pattern of healing is described as:

-Formation of tissues that do not fully restore to their original state or function

-A wound made by periodontal instrumentation results in a close adaption of epithelium to tooth root

-LONG JUNCTIONAL EPITHELIUM WITHOUT RECONSTRUCTION OF NEW TISSUE

Healing by repair

What pattern of healing is described:

-Two tissues that have been separated by surgical incision or injury but NOT by disease

-In periodontal surgery, it is necessary to gently separate the healthy tissue away from the underlying tooth root

Healing by reattachment

Which pattern of healing is described:

-When epithelium and connective tissues are newly reattached to a tooth root where periodontitis has destroyed the attachment

Healing by new attachment

Which pattern of healing is described:

-Architecture and function of lost tissue is completely restored

-Reestablishment of original tissues that were present before the disease or damage occured

-Reformation of new cementum, PDL fibers, and alveolar bone

-Possible with modern technology

Healing by regeneration

_______________ is a noncommunicable, destructive, inflammatory disease that is limited to the interdental and marginal gingiva.

Necrotizing gingivitis

What are the signs/symptoms of necrotizing gingivitis?

Necrosis/ulcers in the interdental papilla

Gingival bleeding

Pain

Pseudomembrane formation

Halitosis

Lymphadenopathy

Fever

An ____________ is a circumscribed, collection of pus localized within the gingival wall of the periodontal pocket.

Abscess

True or False: An acute abscess has no pain.

False

A ______________ abscess involves tissues of the crown of an unerupted tooth.

Pericoronal

A ______________ abscess is primarily limited to the GM or interdental papilla without involvement of the rest of the periodontium.

Gingival

____________________ are infections of both the dental pulp and periodontium in the same tooth and can cause resorption of the bone, deep pockets to the apex, spontaneous pain, mobility, and suppuration.

Endodontic periodontal lesions

How do periodontally derived endodontic periodontal lesions develop?

Infection in the periodontium that enters the pulp through the accessory canal or apex

How do pulp-derived endodontic periodontal lesions develop?

From infection in the pulp that escapes out of the root into the periodontium

________________ results from an initial infection with herpes simplex virus, occurs in children and infants and is very contagious.

Primary herpetic gingivostomatitis

What are the signs of primary herpetic gingivostomatitis?

Pain, edematous gingival tissue, bleeding, blisters/ulcers, high body temperature, malaise, and swollen lymph nodes

True or False: Root caries are a frequent issue for patients with periodontitis due to higher CAL.

True

True or False: Drinking fluoridated water reduces development of root caries.

True

Using toothpaste with ____________ results in decrease of root caries by 67%.

1100ppm NaF dentrifice

What is the ideal percentage of NaF in a mouth rinse to reduce the incident of root caries?

0.05%

True or False: Application of 1.23% APF gel every three months reduces formation of new root caries.

True

_____ promotes remineralization, reduces carie progression in enamel/dentin/cementum, and reduces risk of caries on adjacent tooth surfaces.

SDF

__________ is specialized epithelium that forms at the base of the sulcus and joins the gingiva to the tooth surface.

Junctional epithelium

___________ is epithelial lining of the gingival sulcus that is continuous with oral epithelium and extends from the crest of the GM to the coronal border of the JE.

Sulcular epithelium

What are the groups of supragingival fibers?

Circular, alveogingival, dentogingival, and periosteogingival

Which supragingival fibers are on the mandible?

Circular, intergingical, intercircular, interpapillary, dentinogingival, transgingival, and transeptal

What are the PDL fibers?

Alveolar crest, horizontal, interradicular, oblique, apical

Are the following characteristics of periodontitis or gingivitis:

-Inflammation

-Calculus deposits and biofilm

-Erythema

-Edema

-Gingival bleeding

-Suppuration

-Periodontal pockets

-RBL

-Mobility

-Attachment loss

Periodontitis

Are the following characteristics of periodontitis or gingivitis:

-BOP

-Red/bluish

-Rolled, bulbous, blunted, cratered papilla

-Soft/spongy

-Shiny stretched

-Inflammation

Gingivitis

What disease is described from the following:

-Inflammatory response of the gingiva resulting from plaque inflammation

-Most common form of periodontal disease

-Can happen at any age

Plaque-induced gingivitis

What disease is described from the following:

-Levels of estrogen and progesterone are higher during pregnancy which cause an exaggerated tissue response to plaque biofilm

-Hormones trigger gingival crevicular fluid, which precipitates gingival inflammation

Pregnancy gingivitis

Which oral lesion is associated with pregnancy-induced gingivitis?

Pyogenic granuloma

Inflammation is described as ________ if it extends to the GM, the papilla, and the attached gingiva.

Diffuse

Inflammation is __________ if it only affects the GM and papilla.

Marginal

___________ refers to the return of periodontal disease in a patient that has been previously successfully treated with periodontitis.

Recurrent periodontitis

_______________ is a form of periodontitis seen in a patient that has been previously treated and monitored over time but still exhibits attachment loss despite treatment and homecare.

Refractory

______________ is a state of balance in the internal environment of the body.

Biologic equilibrium

True or False: Diabetes, smoking, genetics, HIV, defective restorations, and crowding may all be risk factors for periodontal disease.

True

___________ is a well-organized community of bacteria that adheres to a surface and is embedded on an extracellular slime layer.

Biofilm

In what stage of periodontal disease are polymorphonuclear leukocytes (PMNs) most abundant?

Inflammatory stage

___________________ are phagocytic cells that actively engulf and destroy microorganisms. They play a vital role in combating the pathogenic bacteria responsible for periodontal disease.

Polymorphonuclear leukocytes (PMNs)

Which cells play a major role in cell-mediated immunity?

T-lymphocytes

Which cell is described by the following:

-Most important lymphocyte

-Regulates the differentiation and maturation of B-cells into plasma cells so antibodies can be produced

-They activate T-cytotoxic cells

-Induce macrophages to phagocytose the target agent

T-helper (CD4 receptor)

Which cell is described by the following:

-Neutralize infected cells and tumors

-Releases perforin (proteins) which bind to the target and creates pores in the membrane to kill it

T-cytotoxic CD8 receptor

Which cell is described by the following:

-Remembers pathogens from previous exposures

T-memory

Which cell is described by the following:

-Immediately commence with cytokine secretion

-Endowed to kill their targets and unleash a massive quantity of inflammatory mediators

NKT-lymphocytes (natural killer T-cells)

Which cell is described by the following:

-Phagocytic leukocytes located in the blood stream

-Large phagocytes with irregular, kidney-shaped nucleus

-Lack cytoplasmic granules

Monocytes

Which cell is described by the following:

-Large phagocytic leukocyte that have one kidney shaped nucleus and some granules

-Antigen-presenting cell (after eating a cell, it takes the fragments to warn T-cells that there is bacteria in the body)

Macrophages

______________ is the sequence of events that occur during the development of a disease or abnormal condition.

Pathogenesis

___________ is a highly regulated process that occurs following the removal of a microbial challenge and leads to the resolution of inflammation and a return to homeostasis.

Catabasis

______________ is a protein catalyst expressed on the membrane of an osteoblast. It is an osteoclastic differentiation factor.

Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL pathway)

________________ occurs when RANKL binds to RANK expressed on the cell surfaces of osteoclastic precursor cells.

Bone resorption

At what BMI is a person considered obese?

30 or more

______________ occurs when there is a continuous release of pro-inflammatory cytokines into the systemic circulation from adipose tissue.

Inflammatory cytokines

True or False: The relentless release of cytokines explains how obesity intensifies infections (periodontal disease).

True

The ___________ is the tooth/prosthesis connected to the abutment of the implant body.

Crown

The _____________ is the part of the implant that is surgically placed in the alveolar bone and acts as the root of the tooth.

Implant body

The ____________ connects the implant prosthesis to the implant body.

Abutment

Which Cario Classification is characterized by gingival recession with no loss of interproximal attachment?

RT1

Which Cario Classification is characterized by gingival recession with loss of interproximal attachment less than or equal to the buccal attachment loss?

RT2

Which Cario Classification is characterized by the amount of interproximal loss is greater than the buccal attachment loss?

RT3

___________ is mineralized tissue that covers the roots of the teeth and serves to attach the tooth to the alveolar bone via collagen fibers of the periodontal ligament.

Cementum

True or False: Cementum is part of the tooth but not part of the periodontium.

False

________________ is lattice-like bone that fills the interior portion of the alveolar process between the cortical bone and the alveolar bone proper.

Cancellous bone (spongy bone)

True or False: Cancellous bone is oriented around the tooth to form support for the alveolar bone proper.

True

The _______________ is a thin layer of bone that lines the socket and surrounds the root of the tooth (AKA the alveolar bone proper).

Cribriform plate

True or False: The PDL fibers are embedded in the alveolar bone proper.

True

The ____________ is the space between the free gingiva and the tooth surface.

Gingival sulcus

The ____________ is a thin sheet of fibrous connective tissue that surrounds the roots of the teeth and joins the root cementum to the socket wall.

Periodontal ligament

What is the broad function of gingival fibers?

Connects the root of the tooth to the alveolar bone

______________ are the ends of the periodontal ligament fibers that are embedded in the cementum and the alveolar bone.

Sharpey’s fibers

_____________ are finger-like epithelial projections extending into the underlying connective tissue of the attached gingiva.

Rete pegs

What is the function of the periodontal ligament?

Connects the tooth to the alveolar process and supports the tooth in the socket; absorbs mechanical loads places on the tooth; protects the tooth in the socket

Where are horizontal fibers located?

Apical to the alveolar crest

A _______________ is horizontal bone loss; the JE forms at the BASE of the pocket; located CORONAL to the crest of the alveolar bone.

Suprabony

__________ is vertical bone loss; the JE forms the base of the pocket, located APICAL to the alveolar bone; the base of the pocket is within a CRATERED-OUT area of bone

Infrabony

Which class of furcation has the probe feel the curvature of the furcation concavity with no entry?

Class I

Which class of furcation has the probe enter the furcation but not more than 1mm, it does not pass through to the other side?

Class II

Which class of furcation has the probe pass completely through the furcation?

Class III

Which class of furcation is the furcation clearly visible?

Class IV

What is the clinical evidence of peri-implant mucositis?

Plaque biofilm-induced inflammation of the soft tissues with no loss of supporting bone localized around an implant. Red inflammation, BOP, suppuration, increased probe depths