Ch. 26, 28, 29, and 30: Nonsurgical Periodontal Therapy, Chemotherapeutics, Host Modulation, and Periodontal Surgery

Comprehensive vocabulary flashcards covering self-care aids, chemotherapeutic agents, host modulation therapy, and periodontal surgical procedures from Chapters 26, 28, 29, and 30.

Sonic Action Toothbrush

A power toothbrush utilizing sound waves that vibrate the brush head side to side at $25{,}000\text{--}100{,}000$ movements per minute.

Ultrasonic Action Toothbrush

A power toothbrush featuring an embedded piezoelectric device that converts electrical energy into mechanical energy, producing high-frequency vibrations of $200\text{ million}$ movements per minute.

Ionic Toothbrush

A toothbrush operating on the physics principle of electrical attraction to repel positively charged plaque biofilm and food debris away from the tooth surface and toward the bristles.

Gingival Embrasure Space

The small triangular opening space situated between the curved proximal surfaces of two adjoining teeth, classified into Type I, Type II, and Type III.

Root Concavity

A trench-like depression found on root surfaces, commonly occurring on proximal surfaces of anterior and posterior teeth, facial and lingual surfaces of molars, and especially teeth numbers $5$ and $12$.

Air Flosser

A power-driven device that emits a rapid burst of air interspersed with microdroplets of water to physically disrupt and loosen interdental plaque biofilm.

Interdental Brush

A tiny cylindrical or pine-tree-shaped nylon bristle brush recommended for biofilm removal in Type II and Type III embrasure spaces and root concavities; used without toothpaste.

End-Tuft Brush

A brush featuring a small, single tuft of bristles designed to clean difficult-to-reach sites, Type III embrasure spaces, exposed furcation areas, and root concavities.

Tufted Dental Floss

A specialized floss composed of regular floss connected to a thicker, fluffy, yarn-like segment; indicated for Type II embrasures, cleaning under fixed bridge pontics, and widely spaced proximal surfaces.

Wooden Wedge

A short, triangular stick of soft wood inserted interdentally with its flat side next to the gingiva; long-term use in Type I embrasures can cause permanent loss of the interdental papilla.

Volatile Sulfur Compounds (VSCs)

A family of gases responsible for halitosis, including foul-smelling hydrogen sulfide and methyl mercaptan produced by periodontal pathogens in tongue coatings.

Chemotherapeutics

Chemical agents used as adjunctive therapy concurrently with conventional mechanical periodontal therapy to control disease via systemic or local delivery routes.

Microbial Reservoirs

Niches where periodontal pathogens can persist and escape therapy, including furcation areas, residual calculus deposits, epithelial layers, connective tissue, and dentinal tubules.

Controlled-Release Chemotherapeutic Agents

Locally delivered formulations in which an antibacterial mediator is embedded in a carrier material, placed into a periodontal pocket to dissolve slowly and deliver therapeutic levels over a sustained period.

Minocycline Hydrochloride Microspheres (Arestin)

A controlled-release, broad-spectrum, semisynthetic tetracycline derivative delivered into the pocket via cannula as powdered biodegradable microspheres that dissolve over $5\text{ to }7\text{ days}$.

Doxycycline Hyclate Gel (Atridox)

A controlled-release, biodegradable gel expressed into a periodontal pocket via cannula using steady pressure, where it solidifies into a wax-like substance to treat chronic periodontitis.

Chlorhexidine Gluconate Chip (PerioChip)

A tiny biodegradable gelatin chip impregnated with chlorhexidine that is inserted into periodontal pockets measuring $5\text{ mm}$ or deeper.

Povidone-Iodine (PVP-I)

A water-soluble, non-controlled-release iodophor complex of povidone, hydrogen iodide, and elemental iodine that acts as a broad-spectrum bactericidal agent by oxidizing and introducing oxygen to the pocket.

Sodium Hypochlorite

A non-controlled-release chemotherapeutic compound of sodium, oxygen, and chlorine that generates highly reactive hypochlorous acid ($\text{HOCl}$) when mixed with water to kill bacteria and fungi.

Substantivity

The property of an active therapeutic agent to remain bound in the oral cavity after rinsing and be slowly released over an extended time while retaining its potency.

Chlorhexidine Gluconate Rinse

A prescription mouth rinse ($0.12\%$ in the U.S.) that disrupts bacterial cell membranes; known for high substantivity, but may cause extrinsic staining, calculus formation, and taste alterations.

Delmopinol

A mouth rinse agent that forms a chemical barrier preventing biofilm from adhering to teeth and gingiva, while interfering with bacterial enzymes responsible for biofilm formation.

Host Modulation Therapy

Therapy aimed at manipulating or altering the host's inflammatory response to bacterial challenge to limit tissue destruction, rather than directly targeting periodontal pathogens.

Subantimicrobial Dose Doxycycline (SDD)

A low-dose form of doxycycline ($20\text{-mg}$ administration) that inhibits the destructive enzyme collagenase without exerting antibacterial effects on oral bacteria; the only FDA-approved host-modulating agent.

Chemically Modified Tetracyclines (CMTs)

Derivatives of tetracyclines that lack antimicrobial activity but retain potent host-modulating effects, such as inhibiting matrix metalloproteinases (MMPs) and proinflammatory cytokines.

Denosumab (Prolia)

A neutralizing monoclonal antibody that suppresses osteoclast-mediated bone resorption by binding to RANKL and preventing it from activating its receptor, RANK.

Specialized Proresolution Mediators (SPMs)

Derivatives of omega-3 fatty acids, such as resolvins and protectins, that promote the resolution phase of inflammation by limiting further neutrophilic infiltration to the target site.

Emdogain

An enamel matrix protein formulation and the only FDA-approved agent for adjunctive topical use during periodontal surgery to promote wound healing or tissue regeneration.

Relative Contraindication

A clinical condition—such as hypertension or smoking—where caution must be exercised before performing periodontal surgery, weighing risks against benefits.

Absolute Contraindication

A severe clinical scenario—such as full-blown AIDS—where periodontal surgical procedures must be avoided entirely.

Healing by Repair

Wound healing resulting in the formation of tissue (such as a long junctional epithelium) that stabilizes the site but does not fully restore the original tissue architecture or function.

Healing by Reattachment

The reunion of connective tissue and tooth root surfaces that were separated by surgical incision or mechanical injury, but not by periodontal disease.

Healing by New Attachment

The union of pathologically exposed root surfaces with newly formed connective tissue or epithelium following periodontal disease.

Healing by Regeneration

A biologic process in which the architecture and function of destroyed periodontal tissues (cementum, periodontal ligament, and alveolar bone) are completely restored.

Healing by Primary Intention

Wound closure and subsequent healing that occurs when surgical wound margins are closely adapted to each other with minimal gap.

Healing by Secondary Intention

Healing that occurs when wound edges are not closely adapted, requiring the gap to slowly fill with granulation tissue (e.g., following a gingivectomy).

Healing by Tertiary Intention

Healing in a wound that is cleaned and intentionally left open to drain before being closed surgically at a later date.

Full-Thickness Flap

A flap procedure that elevates the epithelium, connective tissue, and periosteum using blunt dissection to provide complete access to the underlying alveolar bone.

Partial-Thickness Flap

A surgical flap created with sharp dissection that elevates only the surface epithelium and a thin layer of connective tissue, leaving periosteum intact on the bone.

Flap for Access

Also called modified Widman flap surgery; a procedure using internal bevel and crevicular incisions to elevate tissues just enough to allow meticulous root instrumentation, typically healing by repair.

Ostectomy

The surgical removal of tooth-supporting alveolar bone to reestablish physiologic osseous contours.

Osteoplasty

The surgical reshaping and recontouring of surface alveolar bone contours without removing any tooth-supporting bone.

Osteogenesis

The formation of new bone by viable, living cells contained directly within a bone replacement graft material.

Osteoinduction

A biological process where chemical molecules within a graft material recruit and induce host osteoblasts to migrate to the site and form bone.

Osteoconduction

A physical process in which a graft material functions as a passive scaffold to support the ingrowth of host bone-forming cells.

Autograft

Bone replacement graft material harvested from the patient's own body, offering the highest osteogenic potential.

Allograft

Bone replacement graft material obtained from another genetically non-identical human donor, most commonly cadaveric tissue.

Xenograft

Bone replacement graft material derived from a non-human species, such as bovine-derived bone.

Alloplast

A synthetic or inert bone-like material manufactured in a laboratory, such as plaster of Paris, bioactive glass, or calcium phosphate.

Free Soft Tissue Autograft (FTSA)

A mucogingival graft consisting of surface epithelium and underlying connective tissue harvested from a donor site (leaving an open wound healing by secondary intention); often results in a 'tire-patch' esthetic appearance.

Subepithelial Connective Tissue Graft

A mucogingival procedure transplanting harvested donor connective tissue without epithelium; widely used for root coverage and ridge augmentation, resulting in optimal esthetic color matching.

Acellular Dermal Matrix Allograft

A soft-tissue substitute derived from donated human skin processed to remove cellular components and screened for HIV-1 and hepatitis C, eliminating the need for a palatal harvest site.

Gingivectomy

A surgical resection to excise enlarged gingival tissue without modifying bone; leaves a wide open wound that heals by secondary intention as gingival epithelium migrates at a rate of $0.5\text{ mm}$ daily.

Gingivoplasty

A surgical procedure that simply reshapes and recontours the external surface of the gingiva without excising large amounts of diseased tissue.