The tissues that invest and support the teeth such as the gingiva and alveolar bone
periodontium
What are 2 tissues that make up the periodontium?
gingiva
alveolar bone
What are the 3 anatomic landmarks of the alveolar bone?
lamina dura
alveolar crest
periodontal ligament space
In health, this structure around the roots of the teeth, appears as a dense radiopaque line
lamina dura
In health, this structure is located approximately 1.5 to 2.0 mm apical to the cementoenamel junctions of adjacent teeth
alveolar crest
Where is a healthy alveolar crest located in relation to the CEJ of adjacent teeth?
1.5-2.0 mm apical to them
How does the Alveolar area appear in the anterior area?
pointed, sharp, and very radiopaque
How does the alveolar crest appear in the posterior area?
flat, smooth, and parallel to a line between adjacent teeth, also it is slightly less radiopaque then in anterior areas
Normally appears as a thin radiolucent line between the root of the tooth and the lamina dura, in health it is continuous around the root structure and is of uniform thickness
periodontal ligament space
around a tooth
periodontal
refers to a group of diseases that affects the tissues around the teeth
periodontal disease
Gingival tissue affected by periodontal disease exhibits varying degrees of inflammation. Describe their appearance.
swollen, red, and bleeding, and soft tissue pocket formation is seen
True or False. The gingival tissues affected by periodontal disease appear stippled, pink, and firm.
false
true or false. periodontal disease includes destruction of the supporting bone and periodontal ligament.
true
In periodontal disease, the alveolar crest is no longer located at 1.5 - 2.0 mm apical to the CEJ's, and the alveolar crest no longer appears radiopaque.
both statements are true
true or false. In periodontal disease, the alveolar crests appear indistinct, bone loss is seen, and it may result in sever destruction of bone and loss of teeth.
true
true or false. Both clinical and radiographic examination is necessary in the detection of periodontal disease.
true
clinical examination provides information about________________, and radiographic examination provides information about__________________in detection of periodontal disease
soft tissue
the bone
A clinical examination for interpretation of periodontal disease must be performed by who?
The dentist and/or the dental hygienist
In a clinical examination of interpretation for periodontal disease, what is the evaluation of the soft tissues (gingiva) for?
inflammation - redness, bleeding, swelling, pus
true or false. clinical examination for interpretation of periodontal disease must include periodontal probing, and whenever there is evidence of periodontal disease, radiographs must be taken
both statements are true
What are 4 things that can be examined radiographically with interpretation of periodontal disease?
amount of bone present
pattern of bone loss
distribution of bone loss
severity of bone loss
True or false. Dental radiographs allow the dental professional to document periodontal disease
true
What films and with what technique are the best choice for interpretation of periodontal disease?
PA's
paralleling technique
What type of films are the best for follow-up visits of a patient with periodontal disease?
vertical bitewings
Why is it not a good idea to use the bisecting technique, or panoramic x-rays for the interpretation of periodontal disease?
bisecting technique may result in films that show more or less bone loss than is actually present because of dimensional distortion
panoramic x-ray has little diagnostic value in the identification of periodontal disease
What are the limitations in viewing furcation areas on a radiograph?
bone loss may not be detected because of the superimposition of buccal and lingual bone
a radiograph allows the dental professional to view the amount of bone________________rather than the amount of bone_______________
remaining
lost
in documenting bone levels, is the amount of bone lost, or amount of bone remaining recorded?
amount of bone lost
The amount of bone loss can be estimated as the difference between the______________and the___________________
physiologic bone level
height of bone remaining
what are 3 terms used to describe bone loss?
pattern
distribution
severity of loss
What are 2 different patterns of bone loss?
horizontal
vertical
What is another name for vertical bone loss?
angular bone loss
bone loss occurs in a plane parallel to the CEJ's of adjacent teeth
horizontal bone loss
bone loss that does not occur in a plane parallel to the CEJ's of adjacent teeth, with less than 30% of the sites involved
vertical (angular) bone loss
Bone loss that occurs in isolated areas
localized
bone loss that occurs everywhere throughout the dental arches with more than 30% of the sites involved
generalized
What are the 3 classification terms for bone loss severity?
slight
moderate
severe
How is the bone loss measured?
by the clinical attachment loss (CAL)
from the base of the sulcus or pocket with a probe
1-2 mm pocket
slight bone loss
3-4 mm pocket
moderate bone loss
5 mm or greater pocket
severe bone loss
ADA case type I
gingivitis
ADA case type II
mild or slight periodontitis
ADA case type III
moderate periodontitis
ADA case type IV
advanced or severe periodontitis
How many ADA case types of periodontal diseases are there? name them from least to most advanced
4
gingivitis
mild or slight periodontitis
moderate periodontitis
advanced or severe periodontitis
In this case type no bone loss or radiographic changes are seen, only the gingival tissues are affected by the inflammatory process
ADA case type I
gingivitis
In this case type, there are mild crestal changes, the lamina dura becomes unlcear and fuzzy and no longer appears as a radiopaque line, horizontal bone loss is seen more often, the alveolar bone level is about 3-4 mm apical to the CEJ, and bleeding may occur on probing, pocketing, and recession may be present clinically
ADA case type II
mild or slight periodontitis
In what case type does the lamina dura become fuzzy and unclear, and no longer appears to be a continuous radiopaque line?
Case type II
mild or slight periodontitis
In this case, horizontal or vertical bone loss is present, it can be localized or generalized, alveolar bone level is about 4-6 mm apical to the DEJ, furcation involvement may be present, clinically- pocketing, attachment loss up to 6 mm, recession, furcation areas, and slight mobility possible
ADA case type III
moderate periodontitis
In what case type might slight mobility start being a possibility?
ADA case type III
moderate periodontitis
In this case type there is horizontal or vertical bone loss, alveolar bone level is 6 mm or more from the CEJ, furcation involvement is readily viewed on posterior radiographs, clinically - pocket depths and attachment loss is greater than 6 mm, furcation involvement and mobility are more than severe
ADA case type IV
advanced or sever periodontitis
alveolar bone level at 6 mm or more from the CEJ
case type IV
advanced or sever periodontitis
Alveolar bone level is 4-6 mm from the CEJ
case type III
moderate periodontitis
Alveolar bone 3-4 mm apical to CEJ
case type II
mild or slight periodontitis
Name 3 predisposing risk factors of periodontal disease
effects of certain medications
tobacco use
diabetes
________________play a major roll in the detection of local irritants
dental radiographs
name 2 local irritants that are important to detect and eliminate
calculus
defective restorations
a stone-like concretion forms on crowns and roots of teeth due to calcification of bacterial plaque
calculus
Does calculus appear radiolucent or radiopaque?
radiopaque
calculus has a_______________or_________________projection
pointed
irregular
calculus extends from the_______________
proximal root surfaces
name 3 different ways that calculus may appear on the teeth
ring-like radiopacity encircling cervical portion
nodular radiopaque projection
smooth radiopacity on root surfaces
This predisposing factor for periodontal disease may act as potential food traps, accumulate food debris and bacterial deposits, and contribute to periodontal disease
defective restorations
true or false. defective restorations can be detected both radiographically and clinically.
true
What 4 things do radiographs help identify with defective restorations?
