What are the key components of health according to the WHO?
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Complete physical, mental, and social well-being.
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What are the key components of health according to the WHO?
Complete physical, mental, and social well-being.
What type of epithelium regenerates during healing from oral epithelium?
Oral epithelium
What are the clinical characteristics of pristine gingiva?
Sulcus < 3mm, pink, firm, scalloped outline, no bleeding, stippled, knife-edge margin.
What is SRD and when should it ideally be performed?
SRD stands for Scaling and Root Debridement, and it should ideally be performed at the first appointment, depending on the patient's pain level.
What are some corrective treatments to restore normal gingival topography?
Corrective treatments include gingivectomy, gingivoplasty, and regenerative/respective surgery.
Are microbes consistent between endodontic infections and deep periodontal pockets?
Yes, microbes are consistent between endodontic infections and deep periodontal pockets.
Name three types of cells found in connective tissue (CT).
Fibroblasts, cementoblasts, osteoblasts/clasts
What are the principal fibres of the periodontal ligament?
Alveolar crest fibres, horizontal fibres, oblique fibres, (peri)apical fibres
What are the different pontic designs mentioned?
Sanitary, (Modified) Ridge lap, Ovate, and Conical.
What additional treatment is recommended for Class II/III periodontal disease?
Debridement with surgery.
What type of cells predominate in the advanced lesion stage of periodontitis?
Plasma cells predominate (>50%).
What factors should be considered regarding the strategic value of a tooth?
Whether the tooth is needed for removable partial dentures (RPDs) or other functional and aesthetic demands.
What major change was made in the 2018 classification of periodontitis?
The chronic and aggressive classifications from Armitage 1999 were merged into a single classification called 'periodontitis'.
What are the two components of the basement membrane between epithelium and underlying connective tissue?
Lamina densa and Lamina lucida
What are the two methods of orthodontic extrusion mentioned?
Slow if bone surgery is involved, and rapid if orthodontic extrusion is combined with fibrectomy.
What vascular changes occur in clinically healthy gingiva?
Increased hydrostatic pressure and vascular permeability leading to exudate into CT and increased GCF flow.
Which rare disease associated with periodontitis involves a deficiency in leucocyte adhesion?
Leucocyte adhesion deficiency
Which rare disease associated with periodontitis involves a deficiency in alkaline phosphatase?
Hypophosphatasia
What is the recommended management for gingivitis?
3-monthly recall for prophylaxis and oral hygiene instruction (OHI) for 3 years, followed by a life-long commitment. Only scale if there’s calculus to avoid unnecessary gum irritation.
How is plaque-induced gingivitis defined?
An inflammatory lesion resulting from interactions between the dental plaque biofilm and the host’s immune-inflammatory response, which remains contained within the gingiva and does not extend to the periodontal attachment beyond the mucogingival junction.
Do endodontic lesions often involve the marginal periodontium?
No, endodontic lesions rarely involve the marginal periodontium unless abscessed.
What are some examples of benign neoplastic lesions in the oral cavity?
Fibromas, papillomas, peripheral and central granulomas, leukoplakia, gingival cyst.
What are some restorative considerations for root-resected teeth?
Remove overhang, avoid convexities, reduce occlusal table, and use a metal finishing line.
What is the management approach for Grade 2 horizontal bone loss?
Tunnel preparation, open flap debridement, root resection, guided tissue regeneration (especially for mandibular molars).
What are the management steps for a periodontal abscess?
Management steps include draining the abscess through the pocket by compression or incision, or extraction if the tooth is hopeless, debriding the pocket, and irrigating with water or 0.2% solution.
What type of epithelium is the sulcular epithelium?
Multilayer and parakeratinised with rete pegs.
What structures attach the junctional epithelium to the tooth and other epithelial cells?
Hemidesmosomes attach to the tooth, and desmosomes attach to other epithelial cells.
What is the status of the periodontium in health?
The periodontium is intact and exhibits complete physical, mental, and social well-being.
What is the prognosis if there is communication between endodontic and periodontal lesions?
The prognosis is poor to hopeless.
List three types of immune cells found in the periodontium.
Neutrophils, lymphocytes, macrophages
How do the blood vessels of the gingiva anastomose?
They anastomose with alveolar bone and PDL vessels.
What tissue changes are observed in early gingivitis?
Loss of collagen, fibroblast degeneration, rete peg proliferation in coronal JE, clinical signs like BOP and marginal erythema.
What is the role of diabetes and smoking in periodontitis?
They are modifying factors, not diagnoses.
What vascular changes are seen in early gingivitis?
Vessels in dento-gingival plexus remain dilated, increased vascular proliferation with looping and activation of previously inactive capillary beds.
Why is maintenance crucial in periodontal disease management?
To ensure ongoing oral health and prevent disease progression.
How many layers does the junctional epithelium have?
Two layers: basal and suprabasal.
What is the primary aim of periodontal treatment?
To establish and maintain oral health.
What characterizes intrinsic fiber cementum and where is it predominantly located?
Intrinsic fiber cementum contains primarily intrinsic fibers produced by cementoblasts, oriented parallel to the cementum surface. It is predominantly located at sites undergoing repair following surface resorption and plays no role in tooth anchorage.
What is mixed fiber cementum?
Mixed fiber cementum contains a mixture of extrinsic and intrinsic fiber cementum.
What substance does S. sanguis produce that inhibits the pathogenesis of periodontal disease?
H2O2 (Hydrogen Peroxide)
Where are accessory and furcation canals commonly found?
In furcal areas.
What is the default grade for periodontitis?
Grade B is the default.
What is the recommended review period after managing the acute phase of a periodontal condition?
48 hours (Rincon says 24-48, eTG says 48-72)
What are Sharpey's fibres?
The part of the fibres embedded in cementum and bone
What are the clinical signs of established gingivitis?
Bleeding on probing (BOP), increased oedema, and changes in color and contour indicating moderate to severe inflammation.
What are the characteristics of the advanced lesion stage in periodontitis?
Apical down-growth of biofilm, increasingly anaerobic environment, irreversible damage, pocket deepening (≥ 5mm), JE migrates apically from the CEJ, extensive damage to collagen fibers, and loss of connective tissue attachment.
What shape is the junctional epithelium and where is it wider?
Triangular shape, wider coronally.
Does susceptibility to recession compromise bone dimension?
No, if the bone is thick; Yes, if the bone is thin.
What developmental condition is associated with more coronal gingival margins and sometimes bone, leading to pseudopockets and aesthetic concerns?
This condition can be corrected with periodontal surgery.
What is the most important step in tooth preparation according to periodontal principles?
Placement of margins, considering the base of the sulcus as the top of the attachment.
What term replaced 'biological width' in the 2018 classification system?
Supracrestal attached tissues.
What were the findings of Zandbergen et al. (2013) regarding systemic antimicrobial therapy as an adjunct to SRP?
They found that systemic antimicrobial therapy using a combination of amoxicillin and metronidazole can enhance the clinical benefits of non-surgical periodontal therapy, with a full-mouth weighted mean change for PD improvement of 1.41 mm and CAL gain of 0.94 mm.
What is the epithelial attachment?
The epithelial attachment is the attachment apparatus, including the internal basal lamina and hemidesmosomes, that connects the junctional epithelium to the tooth surface.
What are the management steps for the acute phase of necrotising periodontal diseases?
Gentle removal of plaque and necrotic debris, ultrasonic debridement, local irrigation with 0.2% chlorhexidine mouthwash or 3% H2O2, elimination of causative factors (e.g., smoking cessation, stress), antibiotic therapy (e.g., Metronidazole: 400 mg orally, 12-hourly for 5 days), analgesics (e.g., 400-600 mg ibuprofen orally, 4-hourly; alternate with 1000 mg paracetamol orally, 4-hourly), oral hygiene instructions (OHI)
What pocket depth is considered healthy?
1-3 mm.
How do clinical skills affect periodontal treatment outcomes?
Experienced clinicians achieve better outcomes compared to those with minimal experience.
How is bone loss categorized in periodontal disease severity?
Bone loss is categorized as <30% (mild), 30-65% (moderate), >65% (severe).
How is furcation involvement classified in periodontal disease?
Furcation involvement is classified as: I (incipient), II (moderate), III (severe).
What is the main distinction between Stage III and Stage IV periodontitis?
The distinction is mainly based on the complexity of management, such as a high level of mobility indicating Stage IV.
Why is exposure of subgingival caries contraindicated in the aesthetic zone?
Because it can lead to recession of papillae and margins.
Name a rare disease that can directly manifest as periodontitis.
Papillion-Lefèvre Syndrome
What cellular activity is predominant in early gingivitis?
PMNs predominate, infiltrate 15% of CT, lymphocytes and plasma cells appear.
What are the average measurements for papilla height?
4.5-5 mm on average.
What are the types of bone loss detectable in radiographs?
Horizontal, vertical, and angular bone loss.
How does the presence of calculus affect periodontal disease?
The presence of calculus is associated with periodontal disease, except in cases of aggressive periodontitis.
What percentage of bone loss and furcation grade is associated with a 'Hopeless' prognosis according to McGuire (1991;1996)?
70% bone loss with Grade III furcation
What is the minimum residual bone required to avoid root proximity issues?
0.8 mm of residual bone.
How does the acquired pellicle affect bacterial adhesion to the tooth surface?
It alters the charge and free energy of the tooth surface, increasing bacterial adhesion.
Which types of bacteria are considered early colonizers in oral biofilm development?
Gram-positive cocci, such as Oral streptococci (e.g., S. sanguis, S. gordonii, S. oralis).
What is considered a low risk number of remaining teeth for functionality of dentition?
Less than 4 teeth.
What are the characteristics of a 'Questionable' prognosis?
Advanced bone loss, doubtful cooperation, tooth mobility, Grade II/III furcation, inaccessible areas, and systemic/environmental factors
What happens during the biofilm multiplication and maturation stage?
Further bacterial proliferation occurs, late colonizers arrive, and an intermicrobial matrix develops, composed of bacterial lysates, GCF, and salivary components.
Describe RT2 in the Cairo classification for gingival recession.
Interproximal CAL is less than or equal to buccal CAL
What is the difference between IV and oral bisphosphonates in periodontal treatment?
IV bisphosphonates have a higher risk of complications compared to oral bisphosphonates.
What are the characteristics of a good prognosis according to McGuire and Nunn (1996)?
Adequate bone support, patient cooperation, control of aetiological factors, and manageable systemic or environmental factors.
What PSR score indicates bleeding on probing?
What PSR score indicates a pocket depth of less than 5.5 mm?
What does the 2018 Classification address in terms of periodontal health?
Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium.
What factors are considered in grading periodontitis?
Rate of disease progression, risk of further progression, potential responsiveness to standard therapy, and effect on general health.
What arteries supply blood to the teeth and periodontal tissues?
Superior/inferior dental artery, dental artery, intraseptal artery, rami perforantes.
What does the clinical attachment level indicate?
It tells you where the bone is by measuring the level of the bottom of the pocket (depth in relation to soft tissue) relative to the cementoenamel junction (CEJ).
What tool is used to grade furcations in periodontal examination?
Naber’s probe.
What is the recommended treatment for Class I periodontal disease?
Non-surgical debridement with ultrasonic tools.
What changes occur in the gingival crevicular fluid (GCF) during established gingivitis?
There is an increase in GCF flow.
Why is angular bone loss considered to have a better prognosis than horizontal bone loss?
Because it provides more surfaces for possible bone formation.
What percentage of bone loss and furcation grade is associated with a 'Questionable' prognosis according to McGuire (1991;1996)?
50-70% bone loss with Grade II furcation
What is necessary to see in periodontal retreatment?
Improvement in soft tissues and oral hygiene.
What is the prognosis for a successful root canal treatment (RCT)?
Long-term survival if successful; retreatment required if failed.
What determines if a faulty restoration is restorable?
The extent of the caries and the condition of the restoration.
What are the characteristics of a 'Poor' prognosis?
Moderate to advanced bone loss, doubtful cooperation, tooth mobility, Grade I/II furcation, difficult to maintain, and systemic/environmental factors
What are some key actions in Phase I therapy?
Extracting hopeless teeth, caries control, endodontic treatment, and oral hygiene instruction (OHI).
What role does F. nucleatum play in the coaggregation and microbial succession stage of biofilm development?
F. nucleatum acts as a bridge between initial colonizers and later colonizers, forming corn-cob-like structures as filamentous bacteria adhere to the oral streptococci.
What factors influence the decision between extraction and conservation of a tooth?
Factors include initial assessment of patient expectations, treatment expectations (short-term and long-term), aesthetics, financial status, and patient compliance.
What are the options to correct biological width violations?
Crown-lengthening, which includes protocols like gingivectomy and apically repositioned flap with ostectomy/osteoplasty.
What are the layers of oral epithelium?
The layers of oral epithelium are the basal layer, prickle cell layer (stratum spinosum), granular cell layer (stratum granulosum), and keratinized cell layer.
What factors influence the effectiveness of periodontal treatment?
Clinician’s skill level, initial pocket depth, predisposing factors, tooth morphology, tooth type, time, and patient’s compliance.
What does bleeding on probing imply?
Junctional epithelium ulceration.
What PSR score indicates health?
What is the purpose of Phase II - Surgical/Corrective phase therapy in periodontal treatment?
To address issues that non-surgical methods cannot reach, such as pockets deeper than 5.5 mm, through procedures like gingivectomy, open flap debridement, grafting, regenerative surgery, implant placement, endodontic surgery, and extraction of non-responding teeth.
What is the incidence of lesions developing in the marginal periodontium from accessory and furcation canals?
It seems to be low.
What does the periodontal ligament (PDL) connect?
Bone to cementum
What cellular activity is observed in clinically healthy gingiva?
Some PMNs in JE and sulcus, lymphocytic infiltrate 5% of CT, pro-inflammatory cytokines leading to vasodilation.
What is the management approach for Grade 1 horizontal bone loss?
Scaling and root debridement (ultrasonic), odontoplasty (reshaping crown).
What does the O’Leary plaque score represent?
The percentage of plaque present in the mouth.
What is extrinsic fiber cementum and what role does it play?
Extrinsic fiber cementum contains primarily extrinsic fibers, such as Sharpey's fibers, which are continuous with the principal fibers of the periodontal ligament. These fibers are oriented perpendicularly to the cementum surface and play a major role in tooth anchorage.
What are some cons of using radiography in periodontal disease management?
Not diagnostic of active periodontal disease, no indication of cellular activity, shows less bone loss than actual, crestal lamina dura not related to clinical inflammation, angulation can influence detection, shallow palate can distort CEJ and alveolar crest, may not show interdental defects, thick bone can hide defects.
What was the accuracy of McGuire's prognostication at 8 years?
35% overall
What are the standard management steps for periodontitis?
OHI (smoking cessation, tooth brushing, and interdental cleaning), SRD (± LA, e.g., ultrasonic cleaning and/or hand scaling), and periodontal surgery if advanced (OFD ± bone recontouring).
What did Sgolastra et al. (2012) find in their meta-analysis regarding SRP + AMX/MET?
They found significant CAL gain (WMD = 0.21; 95% CI = 0.02 to 0.4; P <0.05) and PD reduction (WMD = 0.43; 95% CI = 0.24 to 0.63; P <0.05) in favor of SRP + AMX/MET.
What is Phase I therapy in periodontal treatment also known as?
Initial phase therapy, local therapy, hygiene phase, non-surgical phase, or host-related phase.
What is cellular intrinsic fiber cementum and where is it located?
Cellular intrinsic fiber cementum is found in resorption lacunae at the apex of the tooth, at sites of cemental repair. It contains cementocytes, which are cementoblasts in the matrix that have lost their secretory ability, and it plays no role in tooth anchorage.
What is the significance of having 20 teeth (5-5) in terms of dental arch?
It indicates a shortened dental arch.
How do systemic conditions like diabetes and HIV affect periodontal disease?
Uncontrolled systemic conditions worsen the prognosis, while controlled conditions improve it.
What is the prognosis for a tooth with recurrent periodontal abscess?
A tooth with recurrent periodontal abscess generally has a hopeless prognosis.
What is the recommended time frame for reviewing a patient after initial debridement?
4-6 weeks after initial debridement.
What is the classification based on the thickness of gingiva in periodontal phenotype?
Thin phenotype: probe visible (< 1 mm); Thick phenotype: probe invisible (> 1 mm)
What does Grade 0 indicate in the classification of gingival enlargement?
No sign of enlargement
What PSR score indicates the presence of calculus or subgingival margins?
What are the two main criteria for staging periodontitis?
Severity of disease and anticipated complexity of management.
What is the histological state of pristine gingiva?
Histological perfection is a theoretical concept with no infiltrate and continuous sparse neutrophil migration into the coronal JE and crevice.
Which arteries contribute to the blood supply of the gingiva?
Sublingual, Mental, Buccal, Facial, Greater palatine, Intraorbital, Posterior superior dental artery.
What is a neoplasm that can manifest as periodontitis?
Squamous Cell Carcinoma (SCC)
What is a periodontal abscess?
A periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus due to an inflammatory process that attracts PMNs.
Does diabetic periodontitis have unique phenotypic features?
No, there are no unique phenotypic features unique to diabetic periodontitis.
Name a neoplasm other than SCC that can manifest as periodontitis.
Langerhan’s cell histiocytosis
What are the clinical signs of clinical gingival health?
Less than 10% bleeding on probing (BOP) and probing depth of ≤ 3 mm. It also assumes biological and inflammatory markers compatible with homeostasis, with health being predominantly neutrophilic infiltrate for immune surveillance.
What are the types of oral mucosa?
The types of oral mucosa are masticatory, lining, and specialized mucosa.
What systemic complications should be controlled in periodontal treatment?
Uncontrolled diabetes (HbA1c <6.5%), immunosuppression, acute infections, and medication-related issues.
What medications are considered in systemic therapy for periodontal treatment?
Bisphosphonates, cyclosporine, and amlodipine.
What are the components of emergency therapy in periodontal treatment?
Managing acute conditions such as pain (e.g., abscesses), rapid bone loss, and ANUG.
What mechanisms do early colonizers use to attach to the acquired pellicle?
They form reversible attachments via van der Waals and hydrogen bonding interactions, and then irreversible attachments via specialized surface adhesins and receptors.
Why is patient education and motivation important in periodontal treatment?
Patients are responsible for compliant oral maintenance and elimination of undesirable habits such as smoking.
How does smoking affect periodontal prognosis?
Smokers have a worse prognosis compared to non-smokers.
What were the findings of Santos et al. (2015) regarding adjunctive systemic antibiotic use in diabetic patients?
They found a small additional benefit in terms of reductions in mean PD and mean percentage of BoP, with significant effects favoring SRP plus antibiotic for reductions in mean PD (-0.22 mm) and mean percentage of BoP (4%). There was no significant effect for CAL gain and plaque index reduction.
What are root anomalies and how do they affect periodontal prognosis?
Root anomalies include enamel projections, pearls, grooves, etc., and they can complicate periodontal treatment and affect prognosis.
What is the cut-off percentage for periodontal stability in terms of bleeding on probing?
25%.
What does Grade 1 indicate in the classification of gingival enlargement?
Enlargement confined to interdental papilla
What does Stage IV Grade C periodontitis indicate?
It indicates aggressive periodontitis with a molar-incisor pattern.
What factors influence the prognosis of a tooth with endodontic and periodontal communication?
Factors include the cause, level of attachment loss (LOA), healing response, oral hygiene, supportive periodontal therapy (SPT) compliance, restoration longevity, and skill of the clinician.
What are some examples of malignant neoplastic lesions in the oral cavity?
Carcinoma (e.g., squamous cell carcinoma), melanoma.
What happens to the junctional epithelium (JE) during the established gingivitis lesion stage?
The JE detaches from the tooth, forming pocket epithelium that is ulcerated and more permeable, allowing further apical migration of biofilm.
What are some techniques for alveolar ridge reconstruction?
Rolled flap, Pouch graft, (Combined) Onlay graft, and GBR.
What factors are essential for aesthetic tissue management in interproximal embrasures?
Interproximal embrasures, tooth contact, and papilla.
What type of cells increase in number during the established gingivitis stage?
Plasma cells (10-30% infiltrate) and B cells increase.
What are some methods for reconstructing papilla?
Pedicle graft, Semilunar coronally positioned flap, and Envelope.
What should be checked to ensure that radiolucency is not due to accessory canal infection?
The endodontic condition of the tooth, including a pulp test.
What are some pros of using radiography in periodontal disease management?
Aids diagnosis, helps determine prognosis and treatment, adjunct to clinical assessment, reveals altered calcification, shows past effects on bone, detects systemic skeletal conditions.
According to Splieth (2002), what was the common attachment level for teeth extracted due to periodontal reasons?
Most had 50-70% attachment
When should teeth be extracted based on periodontal prognosis?
Only non-restorable teeth, those with concurrent endo-perio lesions with grade III mobility, and 8s with poor accessibility or furcation involvement
What are the components of the supracrestal attached tissues and their respective dimensions?
Supra-crestal connective tissue attachment (1.07 mm) and junctional epithelium (0.97 mm).
Where is specialized mucosa found?
Specialized mucosa is found on the dorsum of the tongue.
When should the prognosis be re-evaluated in periodontal treatment?
The prognosis should be re-evaluated after Initial Periodontal Therapy (IPT) based on the response to treatment and control of local, systemic, and environmental factors.
What is the recommended chlorhexidine mouthwash regimen for patients with necrotising periodontal diseases?
0.12% chlorhexidine, 15 mL, rinse for 1 minute, 8 to 12-hourly, for a maximum of 2-3 weeks
What does RT3 signify in the Cairo classification for gingival recession?
Interproximal CAL is greater than buccal CAL
What pocket depth indicates a high probability of periodontal disease?
Greater than 4 mm.
Why is occlusal therapy sometimes necessary in periodontal treatment?
Because periodontal disease may be related to occlusal overload.
What are the expected soft tissue changes after successful initial periodontal therapy?
Reduced pocket depths, reattachment/repair via formation of long junctional epithelium, resolution of inflammation, reduced bleeding on probing, elimination of exudates, and gingival recession.
What hard tissue changes can be expected after periodontal therapy?
Vertical bone filling, very little horizontal bone gain, and possible sensitivity due to debridement.
What percentage of connective tissue (CT) is infiltrated during the established gingivitis stage?
30% of the connective tissue is infiltrated.
What are some causes of a periodontal abscess?
Causes include foreign body impaction, bacterial invasion, and underlying systemic diseases such as diabetes.
What factors influence the management of Grade 3 vertical bone loss?
Tooth-related factors such as mobility, probing depth (PD), sound tooth remaining, occlusal antagonisms/tooth position, and endodontic condition.
What begins to occur in the alveolar bone during the advanced lesion stage of periodontitis?
Alveolar bone loss begins.
What are the main components of the periodontium?
The periodontium includes the gingiva, periodontal ligament, cementum, and alveolar bone.
What happens to the reduced enamel epithelium during the approach of an erupting tooth?
The reduced enamel epithelium and the basal layer of oral epithelium increase mitotic activity and migrate into the underlying connective tissue, forming an epithelial mass that prevents bleeding.
What covers the portions just apical to the incisal area of enamel when a tooth penetrates?
The junctional epithelium (JE) covers these portions.
What happens to the reduced enamel epithelium in the later phases of eruption?
It is replaced by the junctional epithelium, which becomes continuous with the oral epithelium and provides the attachment between the tooth and gingiva.
What is the mucogingival line?
The mucogingival line is the boundary between the attached gingiva and the alveolar mucosa, present only on the buccal mucosa.
What is prognosis in the context of periodontal disease?
Prognosis is the prediction of a disease’s probable course duration and outcome, established after diagnosis and before treatment.
What does RT0 indicate in the Cairo classification for gingival recession?
No recession
What is the purpose of debridement in periodontal treatment?
To remove plaque, bacterial by-products, and calculus while preserving cementum to aid in healing.
What does tooth mobility indicate in periodontal disease assessment?
Tooth mobility indicates the severity of periodontal disease: 0/1 (normal or slight), 2 (moderate), 3 (severe).
What factors influence the presence of a black triangle according to Singh et al. (2013)?
Underlying osseous support, bioform (scalloping), and tooth morphology
What does a pocket depth greater than 6 mm indicate?
Incomplete treatment and requires further therapy.
What is the significance of bone defect morphology in periodontal prognosis?
Deep, narrow bone defects generally have a better prognosis compared to superficial, wide (horizontal) bone defects, which are associated with poorer outcomes.
How long may healing take for deeper periodontal pockets?
Healing may take 9-12 months for deeper sites.
What does Grade 3 indicate in the classification of gingival enlargement?
Enlargement covers three-quarters of the crown
What is the normal distance of the alveolar crest from the CEJ?
1.5 – 2 mm
What is the reduced enamel epithelium and when does it form?
It forms after amelogenesis when ameloblasts become reduced in height, produce a basal lamina that contacts enamel, and epithelial cells communicate via hemidesmosomes.
What are some systemic modifying factors that influence the immune-inflammatory response in gingivitis?
Smoking, metabolic factors (e.g., hyperglycemia), nutritional factors (e.g., scurvy), pharmacological agents (e.g., phenytoin, cyclosporine, nifedipine), hormonal changes, and hematological conditions (e.g., leukemia, myelodysplasia, thrombocytopenia, clotting-factor deficiencies).
What are non-plaque-induced gingival diseases caused by?
Developmental/genetic factors, infections, immune conditions, reactions, neoplasms, endocrine diseases, trauma, etc.
What is the risk status of stable periodontitis patients with a history of periodontitis?
They have an increased risk of recurrent periodontitis even if there is no current disease and can go through periods of exacerbation. They are still considered periodontitis cases if inflammation is present.
What additional clinical feature is present if necrotising periodontitis occurs?
Bone loss
What are the two gingival responses to the infringement of supracrestal connective tissue attachment by subgingival restorations?
What did Angaji et al. (2010) find regarding adjunctive antibiotic therapy in smokers with chronic periodontitis?
They found that the evidence for an additional benefit of adjunctive antibiotic therapy in smokers with chronic periodontitis is insufficient and inconclusive.
What type of epithelium is oral epithelium?
Oral epithelium is keratinized stratified squamous epithelium.
What environmental gradients develop within a mature biofilm?
Gradients for oxygen, pH, and nutrients develop, with the biofilm becoming increasingly anaerobic in deeper areas.
How does pocket depth reflect periodontal disease severity?
Pocket depth reflects disease severity as follows: <5 mm (mild), 5-7 mm (moderate), >7 mm (severe).
What are the indications for crown-lengthening procedures?
No adequate zone of attached gingiva, supracrestal attachment < 3 mm, improve bone architecture, and recontouring periodontal defects.
What did Grellman et al. (2016) find about the efficacy of adjunctive therapy in diabetic subjects?
They found that adjunctive therapy may improve the efficacy of SRP in reducing PD in diabetic subjects, with a WMD in PD reduction of -0.15 mm favoring antibiotic use. However, WMDs in CAL gain, PI, and BOP reductions did not favor adjunctive antibiotic use.
Why is ultrasonic instrumentation favored in periodontal debridement?
It is effective in removing plaque and calculus, flushes out bacteria and by-products, is anti-bacterial via cavitation, and causes less fatigue for the clinician.
What does the presence of residual pockets greater than 4 mm following treatment indicate?
Success and periodontal stability.
What is the goal of regenerative surgery in periodontal treatment?
To guide the growth of new periodontium using barrier membranes, preventing gingiva from interfering with bone and periodontal ligament (PDL) regeneration.
What factors influence the shape and width of the alveolar crest?
Proximal convexity at CEJ level
What are some local predisposing factors for plaque-induced gingivitis?
Plaque-retentive factors and oral dryness.
Where is masticatory mucosa found?
Masticatory mucosa is found on the hard palate and gingiva.
What is the gingival margin?
The gingival margin, also known as free gingiva, has a dull surface, a rounded and scalloped outline, and is firm.
What is the difference between attached gingiva and free gingiva?
Attached gingiva extends from the sulcus to the mucogingival line and is stippled, while free gingiva is the gingival margin with a dull surface and rounded outline.
What are the characteristics of a 'Fair' prognosis?
Less than adequate bone support, patient cooperation, some tooth mobility, Grade I furcation, and SPT possible
Where is cellular mixed stratified cementum found and what is its composition?
Cellular mixed stratified cementum is found in the apical 1/3 of the tooth and furcation areas. It is composed of mineralized extrinsic collagen (Sharpey's fibers) that are more irregular than in acellular cementum, and it includes a combination of intrinsic and extrinsic fibers with trapped cementoblasts.
What additional clinical feature is present if necrotising stomatitis occurs?
Extension beyond the gingiva and bone denudation through alveolar mucosa, osteitis, and bone sequestra (generally only in severely immunocompromised patients)
What is the characteristic of RT1 in the Cairo classification for gingival recession?
Gingival recession with no interproximal clinical attachment loss (CAL)
What are the characteristics of an excellent prognosis according to McGuire and Nunn (1996)?
No bone loss, good cooperation, excellent gingival condition, and no systemic/environmental factors.
What tooth morphology is more likely to have pronounced scalloping and predisposition for black triangles?
Triangular teeth
What does the absence of bleeding on probing indicate?
High probability of periodontal health.
What should be done if there is persistency of BOP, inflammation, pockets, or further bone loss during periodontal treatment?
Identify the cause, which may require further instrumentation or periodontal surgery, and possibly refer to a specialist.
What are some procedures included in Phase II - Surgical/Corrective phase therapy?
Gingivectomy, open flap debridement, grafting, regenerative surgery, implant placement, endodontic surgery, and extraction of non-responding teeth.
What is addressed during Phase III - Restorative phase therapy?
Corrective orthodontics, final restorations, fixed and removable prosthetics, and evaluation of restorative and periodontal conditions.
How does the angulation of the alveolar crest relate to the CEJ?
It is parallel to the CEJ projection.
What are the components of a periodontal examination?
Chief complaint, medical history, extraoral exam, intraoral exam, occlusion, and mobility assessment.
What components are involved in the formation of the acquired pellicle on the tooth surface?
Salivary proteins (e.g., mucins, antibodies, slatherin, enzymes) and lipids.
What are the histopathological inflammatory zones in necrotising periodontal diseases?
Superficial bacterial zone, Neutrophil-rich zone, Necrotic zone, Spirochaetal/bacterial infiltration zone
What are the clinical features of necrotising periodontal diseases?
Papilla necrosis, ulcers, bleeding on probing (BOP), pain, halitosis, pseudomembrane formation, lymphadenopathy, fever
What increases the chance of failure in post and core restorations?
The presence of extensive caries.
Is there evidence that margins being in the sulcus cause problems if the patient is compliant with self-performed oral hygiene and maintenance?
No, there is no evidence suggesting problems if the patient maintains adequate oral hygiene.
What is the most effective way to examine for periodontal or peri-implant disease?
Probing.
What is strongly associated with necrotising periodontal diseases?
Host immune impairment
What are the characteristics of chronic gingival overgrowth?
Painless, slow-growing discrete, sessile or pedunculated masses ballooning of papilla and margin
What are the causes of gingival overgrowth?
Mouth-breathing, systemic conditions, idiopathic (rare, congenital fibromatosis)
What PSR score indicates a pocket depth of greater than 5.5 mm?
What might diminished radiodensity in the furcation area indicate?
Marked bone loss.
What does a discrete radiolucency indicate?
An abscess.
What happens if the periodontal disease extends all the way to the tooth apex?
Unless periodontal disease extends all the way to the tooth apex, the dental pulp is capable of surviving significant insults, and the effect of periodontal disease and treatment on the dental pulp is negligible.
What are the components of an osteon in alveolar bone?
An osteon is comprised of lamellae, which are concentric layers of compact bone surrounding the central Haversian canal. The blood supply is facilitated by Volkmann’s canals that communicate with Haversian canals to connect osteons and supply nutrients to the bone.
What is acellular extrinsic fiber cementum and where is it located?
Acellular extrinsic fiber cementum is located in the cervical 2/3 of the tooth, including the coronal and midroot areas. It is characterized by well-defined collagen type I fibrils, specifically Sharpey's fibers.
How does the crown-to-root ratio affect support?
A favourable ratio is less than 1:1; an unfavourable ratio is greater than 1:1.
What did Smiley et al. (2015) conclude about the effectiveness of SRP with adjunctive therapies?
They found a 0.5-millimeter average improvement in CAL with SRP, and combinations of SRP with assorted adjuncts resulted in CAL improvements between 0.2 and 0.6 mm over SRP alone. Four adjunctive therapies were judged beneficial with moderate certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser.
What is the implication of having more than 8 teeth lost?
Impaired oral function.
What are the characteristics of a 'Hopeless' prognosis?
Advanced bone loss, non-maintainable areas, extraction indicated, and uncontrolled systemic and environmental factors
How does good supragingival plaque control benefit periodontal health?
It can slow the rate of bacterial recolonization and prevent more pathogenic bacteria from emerging and causing disease progression.
What are the main cell types found in oral epithelium?
The main cell types in oral epithelium are keratinocytes, melanocytes, Langerhans cells, Merkel's cells, and inflammatory cells.
Why does the pathogenicity of a biofilm increase in deeper areas?
The biofilm becomes more anaerobic, attracting Gram-negative strict anaerobes such as spirochetes and Aggregatibacter actinomycetemcomitans (Aa).
What is the lamina propria?
The lamina propria is the underlying connective tissue of the oral epithelium.
How does the distance from the alveolar bone to the contact point affect the presence of the papilla?
If the distance is 5 mm, the papilla is present in 98% of cases; if 7 mm, it is present in only 27% of cases.
What changes in microflora are expected if a patient is doing well with oral hygiene and initial periodontal therapy?
Reduced quantity of plaque and a shift in composition towards gingival health, with less Gram-negative anaerobic bacteria and more Gram-positive aerobic bacteria.
What should be done if a patient has high caries risk and poor plaque control?
Organize frequent reviews to ensure they are ready to progress or manage palliatively.
What is a notable difference in CEJ height between permanent and primary molars?
Primary molars have a more coronal CEJ height.
What are the average pocket depth reductions after initial periodontal therapy for different initial depths?
1-3 mm pockets: 0 mm reduction, 4-6 mm pockets: 1.3 mm reduction, >7 mm pockets: 2.2 mm reduction.
What does Grade 2 indicate in the classification of gingival enlargement?
Enlargement involves papilla and margin
What is the focus of Phase IV - Maintenance phase therapy (supportive periodontal therapy - SPT)?
Periodic recall to assess plaque/oral hygiene, bleeding on probing (BOP), clinical attachment level (CAL), pockets, restorations, new caries, occlusion, mobility, and other pathological conditions.
What should be assessed during an intraoral exam in a periodontal examination?
Cancer screening, saliva, halitosis, and gingiva.
What are interdental craters and how do they appear radiographically?
They are irregular reduced radiopacity areas.
What is the role of accessory canals in periodontal disease?
Accessory canals connect the root canal system's neurovasculature with that of the periodontal ligament, and they are more common in molars than in premolars or anteriors.
What does the presence of vessel alveolar canals indicate?
They are normal despite looking suspicious.
What are the two types of bone loss that can be observed in periodontal disease?
Horizontal and vertical bone loss.
What does red gingiva indicate?
Red gingiva indicates inflammatory vascular changes.
What are the signs of oedema in the gingiva?
Oedema in the gingiva appears as puffy or spongy tissue.
What are the effects of Phenytoin on the gingiva?
Phenytoin stimulates fibroblasts and epithelial cell proliferation, leading to gingival overgrowth in approximately 50% of patients.
What might wedge-shaped radiolucencies with the apex pointing to the root indicate?
Furcation arrows.
What does a positive pulp test indicate?
A positive pulp test indicates that the lesion is not endodontic in origin, unless there is necrobiosis in multi-rooted teeth.
What antibiotics are recommended for a patient with systemic symptoms or who is immunocompromised?
500 mg phenoxymethyl penicillin qid for 5 days OR 300 mg clindamycin 8-hourly for 5 days.
What can radiographs detect in terms of periodontal disease?
Localized or generalized periodontal disease.
What is the lamina dura and how does it appear radiographically?
It is a continuous white line, though its appearance can vary depending on beam angulation.
How does Cyclosporin affect the gingiva?
Cyclosporin suppresses T cell function and can cause more vascularized gingival enlargement.
What do finger-like radiolucent projections indicate?
They are indicative of periodontal disease.
Why can't host defense mechanisms combat infection in necrotic pulps?
Host defense mechanisms can’t reach far into the canals of necrotic pulps to combat infection, leading to a chronic inflammatory zone unless treated.
Which medical conditions are important to note in a periodontal examination?
Diabetes, arthritis, cardiovascular disease, pregnancy, genetic conditions, blood disorders, blood-borne infections, and autoimmune conditions.
What are the characteristics of normal gingiva color?
Normal gingiva color is coral pink.
Can pulpal disease cause periodontal changes?
Yes, pulpal disease can cause periodontal changes.
What can advanced periodontitis allow bacteria to do?
Advanced periodontitis can allow bacteria to gain access to the pulp via accessory canals or the apex of the root and lead to infection of the pulp.
What is observed in the majority of teeth with advanced periodontal disease?
Normal pulps are observed in the majority of teeth with advanced periodontal disease.
What does a radiopaque horizontal line indicate?
A labial or lingual defect.
Is the absence of the lamina dura predictive of health or disease?
No, the absence of the lamina dura is not predictive of health or disease.
What changes might be seen in the interdental septa in periodontal disease?
Reduced height and possible angular defects.
What does grey discoloration of the gingiva suggest?
Grey discoloration suggests necrotizing gingivitis, metal deposition, or amalgam tattoos.
Is the effect of periodontal disease on the pulp clear-cut?
No, the effect of periodontal disease on the pulp is not clear-cut.
What is the significance of gingival consistency being firm and resilient?
Firm and resilient gingiva with a stippled texture indicates healthy connective tissue projections.
How can traumatic occlusion be detected radiographically?
Via a widened periodontal ligament (PDL).
What does a break in the continuity of the lamina dura indicate?
It is not always diagnostic, but its presence indicates health.
How can radiopaque material be used in periodontal examination?
To corroborate probing depths.
What are the innate immune responses in adjacent pulp?
The innate immune responses include increased vascular permeability, PMN migration, and nerve fiber sprouting in adjacent pulp.