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what is defined as the tissues that invest and support the teeth
periodontum
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what are two types of tissues that invest and support the teeth?
gingiva and alveolar bone
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what are the three parts of alveolar bone?
- lamina dura
- alveolar crest
- periodontal ligament space
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what does the lamina dura appear as when healthy?
dense radiopaque line
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when healthy where is the alveolar crest located?
approx 1.5 to 2.0 mm apical to the cementoenamel junction CEJ
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what does the alveolar crest look like in the anterior area?
pointed and sharp
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what does the alveolar crest appear like for the posterior area?
flat smooth and parallel to a line between adjacent CEJs. Slightly less radiopaque compared to anteriors
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how does the periodontal ligament space appear?
thin radiolucent line between root of tooth and lamina dura
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when the periodontal ligament space is healthy how does it appear?
continuous around the root structure and is uniform in thickness
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what means around a tooth?
periodontal
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what refers to a group of diseases that affect the tissues around the teeth?
periodontal disease
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what does the tissue look like with periodontal disease?
- inflammation of gingiva
- loses stippling, pink and firm appearance
- swollen, red, bleeding with pocketing
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periodontal disease involves destruction of the ______ ______ and ______ ______
- supporting bone
- periodontal ligament
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with periodontal disease the alveolar crest is no longer located where?
1.5 to 2.0 mm apical to CEJ
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with periodontal disease the alveolar bone no longer appears _____
radiopaque
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how does the alveolar bone appear with periodontal disease?
indistinct and bone loss is seen
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how is periodontal disease detected?
clinically and radiographically both necessary
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_____ examination provides info about soft tissue
clinical
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_____ examination provides info about the bone?
radiographic
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what type of info does a clinical examination provide?
about soft tissue
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what type of info does radiographic examination provide?
about the bone
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who can perform the clinical examination?
DDS or RDH
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what are you evaluating the soft tissues for in a clinical examination?
inflammation-redness, bleeding, swelling, pus
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what must be included in you clinical examination?
periodontal probing
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what do the periodontal probing measurements help you do?
classify the perio
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what are you looking for in a radiographic examination for periodontal disease?
amount of bone present
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what do radiographs provide for periodontal disease?
documentation
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what type of film is used to look at periodontal disease?
PA's
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what technic is used for periodontal disease radiographs?
paralleling
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what types of radiographs are not used for periodontal disease examinations?
- horizontal BWX
- Pano
- Bisecting
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what type of periodontal disease is easier to treat, vertical or horizontal?
horizontal
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what is limited to see on a radiograph?
furcation area
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how is bone loss estimated?
difference between the physiologic level and the height of the remaining bone
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how is bone loss described?
in terms of pattern, distribution and severity of loss
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what type of bone loss occurs in a plane parallel to the CEJ's of adjacent teeth?
horizontal bone loss
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what type of bone loss does not occur in a plane parallel to the CEJ's of adjacent teeth?
vertical bone loss (angular)
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what type of distribution occurs in isolated areas with less than 30% of the sites involved?
localized bone loss
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what type of bone loss accounts for less than 30% of sites involved?
localized
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what type of distribution occurs evenly throughout the dental arches with more than 30% of the sites involved?
generalized bone loss
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what type of bone loss accounts for more than 30% of sites involved
generalized bone loss
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how is bone loss severity classified?
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how is bone loss measured?
by the clinical attachment loss (CAL) from the CEJ to bas of sulcus or pocket (probe)
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slight bone loss is how many mm?
1-2mm
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moderate bone loss is how many mm
3-4mm
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severe bone loss is how many mm?
5mm or greater
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what are the four ADA classifications of periodontal disease?
- 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
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Describe ADA case type I
- Gingivitis
- no bone loss
- no radiographic changes seen
- only gingival tissues are affected by the inflammatory process
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describe ADA case type II
- mild or slight periodontitis
- mild crestal changes
- lamina dura becomes unclear and fuzzy also no longer appears to be a continuous radiopaque line
- horizontal bone loss
- alveolar bone level appox 3-4 mm
- bleeding may occur on probing pocketing and recession may be present clinically
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which ADA case has alveolar bone level approx 3-4 mm apical to CEJ
type II
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what ADA case does the lamina dura become unclear and fuzzy, also no longer appears to be a continuous radiopaque line
type II
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what case type has horizontal or vertical bone loss that is localized or generalized
type III
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what ADA case type is moderate periodontitis?
type III
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what ADA case type has alveolar bone level at approx 4-6 mm apical to CEJ
type III
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which ADA case type may have furcation involvement?
type III
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clinically what ADA case type has pocketing, attachment loss up to 6 mm, recession, furcation areas, and slight mobility possible?
type III
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what is the alveolar bone level for ADA case type IV?
6 mm or greater from the CEJ
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which ADA case type has furcation involvement and is readily viewed on posterior radiographs?
type IV
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what does ADA case type IV look like clinically?
pocket depths and attachment loss is greater than 6mm, furcation involvement and mobility are more severe
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what are some predisposing risk factors of periodontal disease?
medications, tobacco use, diabetes
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_______, _______ and ______ of local irritants are important
- identifications
- detection
- elimination
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what are some local irritants that must be eliminated?
- calculus
- defective restorations
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what is a stone like concretion that forms on crowns and roots of teeth due to calcifications of bacterial plaque?
calculus
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what are three characteristics of calculus?
- radiopaque
- pointed or irregular projections
- extends from proximal root surfaces
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what are three forms calculus can take?
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calculus is a _____ or _____ projection
sharp or pointed
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defective restorations act as potential _____ _____ and contribute to _______ _______
- food traps
- periodontal disease
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what do radiographs help to identify with restorations?
open or loose contacts, uneven marginal ridges, overhangs and inadequate margins
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