IntroToPerio - Midterm04

  1. Different perio probes
    • Michigan O probe – 1,2,3,5,7,8,9,10, preclinic
    • North Carolina probe – 1-15 without skipping numbers, used in clinic
  2. In normal healthy situation, the pocket should be from ___ to the __ – normally, JE is at ___. Pocket should be ___ max in normal.
    • CEJ
    • FGM
    • CEJ
    • 3 mm
  3. When the pocket depth has exceeded the MGJ, it is considered __________.
    mucogingival defect
  4. HISTOLOGY & FIBER SYSTEMS
    • Gingival collagen fiber system
    • 1. Gingivodental Group, Circular & Transseptal
    • Epithelium
    • 1. Masticatory Mucosa – keratnized
    • 2. Alveolar mucosa – non-kerratinized
    • Connective Tissue
    • 1. Masticatory Mucosa – Collagen fibers
    • 2. Alveloar Mucosa - Elastic fibers
    • Periosteum – Inner most layer of the connective tissue - Bound Down (2 layers)
  5. BIOLOGIC WIDTH CONCEPT
    • a. Junctional Epithelium
    • b. Collagen fibers from the attached gingiva, which attach to cementum on the facial and lingual; or Transseptal fibers that attach the cememtum of one tooth to the adjacent tooth’s cementum.
  6. Attachment of a tooth
    • Begins with the biologic width
    • Also includes the housing of the root by the bony socket - periodontal ligament & cementum of the root
  7. TYPES OF ATTACHMENT
    • Long Junctional Epithelium
    • Connective Tissue (fibers + cementum)
    • True Attachment (bone , ligament + cementum)
  8. ATTACHMENT APPARATUS POSSIBLE RELATIONSHIPS OF THE ROOT
    • Normal relationship – Cementum + Periodontal Ligament + Bone. The reason a tooth can be extracted.
    • Ankylosis – Cementum + Bone. There is no ligament and the cementum and bone are fused. Has to cut the tooth out. Same mechanism for implant.
    • Resorption – Normal relationship, but the cementum is resorbed and the tooth structure is destroyed. Etiology is unknown.
  9. Gingival bio-type
    • thin = triangular teeth, bone is more scalloped -> very easy to get a black triangle -> esthetic challenge
    • flat and thick = rectangular or square teeth
  10. Periodontal disease
    • Etiology – retained plaque
    • Results – inflammation, bleeding, pocketing, attachment (bone) loss
  11. Sulcular epithelium is thin, non-keratinized, and has no rete pegs
  12. Gingival Pseudo-pockets
    • No migration of the junctional epithelium
    • Usually due to gingival hyperplasia
    • No loss of attachment
  13. STRUCTURAL PROBLEMS - MUCO-GINGIVAL DEFECTS
    • Lack of attached keratinized tissue
    • a. Probe passes MGJ – keratnized tissue unattached
    • b. no keratinized tissue present
    • Aberrant frenum is present & is pulling on the gingival margin
    • Shallow vestibule
  14. MAJOR OBJECTIVES
    • Don’t only treat symptoms
    • Always try to establish a diagnosis by a careful diagnostic review, clinical exam, radiographic exam, occlusal exam and interview, in order to determine the etiology of the specific problem/s
  15. Dental plaque-induced GINGIVAL DISEASES
    • Gingivitis associated with plaque w/ or w/o local contributing factors
    • modified by systemic factors
    • modified by medications
    • modified by malnutrition
  16. Non-plaque-induced GINGIVAL DISEASES
    • of specific bacterial origin
    • of viral origin
    • of fungal origin
    • of genetic origin
    • Gingival manifestations of systemic conditions
    • Traumatic lesions
    • Foreign body reactions
    • Not otherwise specified
  17. Signs of Gingivitis
    • a. Bleeding
    • b. Change in tissue color
    • c. Change in tissue consistency
    • d. Retractable tissue
  18. GINGIVAL RESPONSE
    • a. Fibrotic
    • b. Edematous
    • c. Both – Fibrotic & Edematous
  19. LOCAL CONTRIBUTING FACTORS which can make plaque control more difficult:
    • a. Tooth anatomic factors (root grooves & furcation grooves)
    • b. Dental restorations - iatrogenic
    • c. Root fractures
    • d. Cervical root resorption
    • e. Calculus deposits
  20. Grooves on the roots of teeth
    • a. Palatal of maxillary lateral and sometimes the central incisors
    • b. Proximal surfaces of the max 1st bicuspids and the mesial roots of the lower 1st molar – furcation grooves
  21. CERVICAL ROOT RESORPTION
    After gingival recession, the root cementum becomes exposed and becomes a plaque trap and potential area of decay.
  22. SYSTEMIC FACTORS
    • Endocrine System
    • a. Puberty
    • b. Pregnancy
    • c. Diabetes mellitus
    • Blood Dyscrasias
    • a. Leukemia
    • b. Agranulocytosis
    • c. Thrombocytopenia
  23. Drugs causing gingival enlargement
    • a. Anticonvulsants – Dilantin
    • b. Calcium Channel Blockers – Procardia
    • c. Immunosuppressants - Cyclosporin
  24. Drugs influencing gingivitis
    Oral contraceptives
  25. MALNUTRITION
    Ascorbic Acid Deficiency - Scurvy
  26. VIRAL ORIGIN - Herpes virus Infections
    • a. Primary Herpetic Gingivostomatitis - always on attached tissue
    • b. Recurrent Oral Herpes - injection on the palate may induce it
    • c. Varicella-Zoster Infections - shingles limit to one side; follows course of sensory nerve
  27. Fungal origin
    Candida Infections
  28. CANDIDIASIS
    • Also called Moniliasis or Thrush
    • Caused by Candida Albicans - fungus
    • Can also be a secondary infection - induced by VDO decrease
    • 4 oral forms – pseudomembranous, hyperplastic, atrophic, & angular cheilosis
  29. HEREDITARY GINGIVAL FIBROMATOSIS
    • Slow progressive enlargement
    • Esthetic & functional problems
  30. MANIFESTATIONS OF SYSTEMIC CONDITIONS
    • Mucocutaneous disorders
    • 1. Erosive Lichen Planus
    • 2. Pemphigoid
    • 3. Pemphigus Vulgaris
    • Allergic reactions
    • 1. Dental restorative materials
    • 2. Toothpastes - Mouthrinses
  31. TRAUMATIC LESIONS
    • 1. Chemical injury
    • 2. Physical injury
    • 3. Thermal injury
  32. FOREIGN BODY REACTIONS
    • Trapped toothpick
    • Seed from a food product
    • Shell from a peanut or seafood
  33. PERIODONTAL DISEASES
    • 1. Chronic Periodontitis
    • 2. Aggressive Periodontitis
    • 3. Manifestation of a systemic disorder
    • 4. Necrotizing Periodontal Disease
    • 5. Abscesses of the Periodontium
    • 6. Associated with Endodontic lesions
    • 7. Developmental or Acquired Deformaties and Conditions
  34. PERIODONTITIS
    • Chronic or Aggressive
    • Inflammatory type disease
  35. In 1976 Page & Schroeder described periodontal disease based on histopathology of the diseased tissues.
    • a. Initial lesion
    • b. Early lesion
    • c. Established lesion
    • d. Advanced lesion
  36. CHRONIC PERIODONTITIS
    • Localized - < 30% of sites involved
    • Generalized - > 30% of sites involved
    • Slight – 1 to 2 mm of CAL
    • Moderate – 3 to 4 mm of CAL
    • Severe - > or = to 5 mm of CAL
    • Slow to moderate rate of progression
    • Amount of destruction consistent with local factors
  37. AGGRESSIVE PERIODONTITIS
    • Rapid attachment loss & bone loss – pocket formation
    • Amount of plaque inconsistent with disease severity
    • Genetic trait
    • Healthy individual
    • Occurs at puberty or ages 10 to 30 yrs
    • Localized – 1st molars & incisors
    • Generalized – >=3 teeth; 1st molars & incisors
  38. PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES
    • Hematologic Disorders
    • a. Acquired neutropenia
    • b. Leukemias
    • Immune Compromised
    • Genetic Disorders
    • N.B. - Diagnosis depends upon the amount of local factors – Can be Chronic Periodontitis modified by the systemic condition or as stated above
  39. NECROTIZING PERIODONTAL DISEASES
    • Necrotizing Ulcerative Gingivitis – NUG
    • Necrotizing Ulcerative Periodontitis – NUP
  40. ACUTE NECROTIZING ULCERATIVE GINGIVITIS
    • ANUG or Trench Mouth
    • Marginal gingiva is affected
    • Punched out gingival margins
    • Painful – odor
    • Pseudomembrane
    • Fusospirochetes predominant
  41. ABSCESSES OF THE PERIODONTIUM
    • Gingival abscess
    • Periodontal abscess
    • Pericoronal abscess or Pericoronitis
  42. GINGIVAL ABSCESS
    • no loss of attachment
    • starts in the gingival unit
    • usually a result of trapping a foreign body in the gingival sulcus
  43. PERIODONTAL ABSCESS
    • usually caused by a closed periodontal pocket
    • resulting from loss of attachment
    • a swelling or a fistula
  44. differentiate between a periapical abscess and a periodontal abscess.
    • periapical abscess starts at the apex or apicies of the tooth and is caused by injury to the pulp – needs RCT
    • A periodontal abscess occurs on the side of the tooth and is usually a closed pocket.
  45. PERIODONTITIS ASSOCIATED WITH ENDO
    • Combined lesions
    • a. Endo – Perio: good prognosis
    • b. Perio – Endo (Retrograde Pulpitis): hopeless
  46. DEVELOPMENTAL OR ACQUIRED DEFORMITIES
    • Localized tooth-related factors
    • Mucogingival deformities and conditions around teeth
    • Mucogingival deformities and conditions on edentulous ridges.
    • Occlusal Trauma
  47. TOOTH-RELATED FACTORS
    • Tooth anatomic factors
    • Dental restorations
    • Root fractures
    • Cervical root resorption
  48. LOCALIZED TOOTH RELATED FACTORS - Root Proximity problem
    • a. makes plaque control difficult
    • b. restoring the tooth becomes a problem
  49. MG DEFECTS & SOFT TISSUE DEFORMITIES - TEETH
    • Gingival recession
    • Lack of keratinized tissue
    • Decreased vestibular depth
    • Aberrant frenum
    • Gingival overgrowth
    • Abnormal color
  50. MG DEFECTS & SOFT TISSUE - DEFORMITIESEDENTULOUS RIDGES
    • Vertical-horizontal ridge deficency
    • Lack of keratinized gingiva
    • Aberrant muscle pull
    • Decreased vestibular depth
    • Abnormal color
  51. OCCLUSAL TRAUMA - TFO
    • Primary Occlusal Trauma
    • Secondary Occlusal Trauma
  52. SIGNS - TFO
    • Clinical Signs – Mobility and/or Fremitus
    • A. Primary Trauma from Occlusion
    • a. Prematurity
    • b. Parafunctional habit
    • c. Poor prosthetic design
    • B. Secondary Trauma from Occlusion
    • C. Functional
    • Radiographic Sign – Thickened PD ligament
  53. TFO CLASSIFICATION
    • Primary
    • 1. Clinical sign – Mobility and/or Fremitus
    • 2. Cause - Overload of force
    • 3. Treatment – Correct the force overload
    • Secondary (to periodontal disease)
    • 1. Clinical Sign – Mobility
    • 2. Cause - Significant loss of attachment
    • 3. Treatment - Do nothing or splint
  54. UPDATE BY AAP ON CLASSIFICATION
    • Patients on maintenance w/ previous attachment loss
    • If return with probing depths of <=3mm and no inflammation – healthy but reduced periodontium.
    • If return with inflammation, and/or recession, and probing depths <= 3mm – reduced periodontium with inflammation.
    • If return with inflammation, BOP, and/or recession, and probing depths > 3mm – periodontitis with severity guided by the following:
    • Slight – 3-5 mm pocket, x-ray bone loss = 15% of root length & 1-2 mm of CAL
    • Moderate – 5-7mm pocket, x-ray bone loss = 16-30% of root length & 3-4 mm of CAL
    • Severe – >=7mm pocket, x-ray bone loss > 30% of root length & >=5mm of CAL
Author
akhan
ID
320052
Card Set
IntroToPerio - Midterm04
Description
IntroToPerio - Midterm04
Updated