1
Q
what is reattachment?
A
the reunion of root and connective tissue serperated by incision/injury
2
Q
is reattachment used in periodontal healing?
A
no. reattachment is not a term used in periodontal healing
3
Q
what is new attachment?
A
union of connective tissue with previously pathogenically altered root surface
4
Q
what is regeneration?
A
attachment of PDL cells and fibres to new cementum formation and coronal rewgrowth of alveolar bone
5
Q
what happens following debridement within the following week?
A
- acute inflammation begins to subside 24-48 hrs after
- decrease vasodilation
- decrease GCF
- decrease PMN’s
- decrease ulceration of pocket
6
Q
pocket epithelium begins to attach to root surface via what?
A
- via formation of basement membrane and hemidesmosome attachment
- these hold keratinocytes to the cementum(forming long junctional epithelium)
7
Q
what does long epithelium result in?
A
long epithelium results in the gradual closure of a pocket and may continue for moths after treatments
8
Q
junctional epithelium acts like what?
A
junctional epithelium acts as a zip
9
Q
what is regeneration?
A
regeneration means attachment of PDL cells and fibres to new cementum formation and coronal regrowth of alveolar bone
10
Q
if epithelium is allowed to grow into the wound space. What will happen?
A
- it will proliferate quickly
- it will prevent fibroblasts becoming attached to cementum and forming new attachment
11
Q
what is guided tissue regeneration?
A
- most successful method of new attachment formation
- it promotes repopulation of cells derived from PDL and bone
12
Q
What are some clinical features of NUG?
A
- sudden onset and very painful
- necrotic ulcers
- initially red swollen
- ulceration starts on tips of ID papillae and spreads laterally along gingival margin
- halitosis
- spontaneous bleeding
- metllic taste
- localised or generalised
13
Q
how long do symptoms of NUG usually last?
A
acute symptoms last around 2-3 weeks leaving chronic periodontitis to occur
14
Q
what can NUG develop into?
A
- cancrum oris
- orofacial necrosis
15
Q
what bacteria are involved with NUG?
A
- anaerobic fuso-spirochaetal complex
- treponema vincentii&denticoli
- fusobacterium nucleatum
- prevotella intermedia
- porphyromonas gingivalis
16
Q
what are some predisposing factors of NUG?
A
- smoking
- poor OH
- stress
- Immunodeficiency
17
Q
what is the tx of NUG?
A
- OHI and explanation
- gentle USS
- antimicrobis (metronidazole 200mg for 3 days)
- review in 48 hrs
18
Q
what are non-plaue induced gingival lesions?
BIVFGTSTF
A
- bacterial origin
- viral origin
- fungal
- genetic
- systemic
- traumatic
- foreign body
19
Q
what are some examples of gingival diseases of viral origin?
A
- herpes virus infections
- primary herpatic gigivostomatitis
- varicella zoster infections
20
Q
give some examples of gingival diseases of fungal origin?
A
- candida species infections
- linear gingival erythema
- hystoplasmosis
21
Q
give an example of a gingival disease of genetic origin?
A
-hereditary gingival fibromatosis
22
Q
what is recession?
A
-a seemingly inflammation free clinical condition characterised by the apical retreat of th periodontium
23
Q
what is a fenestration?
A
window in bone
24
Q
what is a dehiscence?
A
a lack of bone
25
what are some examples of recession?
- ortho tx
- frenum pulls
- excessive perio scaling
26
what is stillmans cleft?
'v' shape in gums
27
what is mcCalls festoon?
gum has rolled margin
28
what is a furcation plasty?
-surgical procedure used to remove tooth substance to widen entrance to furcation
29
what is guided tissue regeneration?
-procedure which enables bone and tissue to regenerate in defects around periodontally compromised teeth
30
what are 3 dentine hypersensitivity theories?
1. dentinal receptor mechanism
2. hydrodynamic mechanism(branhstroms theory)
3. modulation of nerve impulses by poly peptides
31
what is it in toothpaste that helps sensitivity?
-pottasium ions
32
what do anti-epileptic drugs cause oraly?
-gingival hyperplasia
33
what anti-epileptic drug most commonly causes hyperplasia and where does it begin?
- phenytoin
| - hyperplasia is worse anteriorly and begins interdentally and then grows
34
what type of drug is cyclosporin?
-immunosupressant
35
what does cyclosporin do oraly?
- gingival hyperplasia
| - higher incidence in women and children
36
what are some commonly used corticosteriods?
-prednisalone, betlamethason, hydrocortisone
37
what do immunosupressants cause oraly?
- reduced inflammatory response/reaction to plaque
- decreased swelling/bleeding
- impaired wound healing
- increased susceptibility to infection
38
how do NSAIDs work?
-inhibit synthesis and release of prostaglandins
39
what oraly do NSAIDs cause?
- decreased bleeding
- decreased swelling
- decreased bone loss
40
how can oestrogen affect the periodontal tissues?
-oestrogen promotes keratinization and alters the composition of blood
41
how can progesterone affect the periodontal tissues?
-progesterone increases the permeability of gingival blood vessels
42
what is a pregnancy epulis?
soft, pedunculated granuloma arising from an inflammed gingival papilla
43
does the OCP affect periodontium if there is no pre-existing condition?
- No
| - OCP only affect the periodontium if there is a pre existing condition
44
is the percentage of female smokers increasing or decreasing?
% of female smokers is increasing
45
smoking increases the prevelance of what?
- lung cancer
- cardiovascular disease
- GI disease
- low birth weight
46
is smoking an important risk factor in the development and progression of periodontal disease?
Yes. Smoking is now seen to be one of the most significant risk factors in the development and progression of periodontal disease
47
what are the constituents of a cigarette that cause the disease?
- nicotine
- napthalene
- phenols
- carboxylic acids
- aromatic amines
- tar
- many more...
48
what are some constituents of the gaseous phase?
- ammonia
- hydrogen sulphide
- hydrocarbons
- carboxylic acids
49
where can low doses of nicotine be stored and released?
-low doses of nicotine cane be stored and released by the periodontal fibroblasts
50
does nicotine act as a vasodilator or vasoconstrictor?
vasoconstrictor
51
list things that smokers are more likely to have :
| big list
- spend less time brusing their teeth
- have more calc. deposits
- have more plaq. deposits
- deeper pockets
- greater alveolar bone loss
- lose more teeth than smokers
- gingivae have more keratinised cells
- perio. tx often fails
52
what are some things the perio tissued do in response to smoking?
- promotes vasoconstriction
- initial increase in GCF
- PMNs are impaired by smoking
53
is there any relationship between NUG and smoking?
yes. there is a clear relationship between NUG and smoking
54
tobacco may play a significant role in the development of a ........... response to perio tx?
refractory response
55
there are clear links between smokeless tobacco products (snuff, betel nut) and what?
leukoplakia, and carcinoma
56
the periodontal pockets of smokers are more ........ than non smokers
the periodontal pockets of somkers are more ANAEROBIC than non-smokers
57
is smoking thought to alter the composition of plaque?
NO. smoking is not thought to alter the composition of plaque
58
with regards to 'the effects on the response to periodontal treatment' what do smokers have:
(another list)
- decreased salivary IgA antibodies to fusobacterium and P.intermedia
- decreased serum IgG antibodies to fusobacterium and P.intermedia
- decreased no. of T helper lymphocytes
- decreased neutrophil function
- tobacco smoke can impair the motility and chemotaxis of oral and peripheral PMNs
59
what can downs syndrome cause orally?
- class 3 occlusion
- anterior open bite
- large tongue
- lack of lip seal
- prone to infections
- prone to destructive periodontitis
- increased susceptiblity to NUG
- impaired chemotaxis and phagocytosis of PMNs
60
what can hypophosphatasia cause orally?
- premature exfoliation of premature teeth
- absence of gingival inflammation
- loss of alveolar bone
- prenament dentition does not appear infected
61
what can papillon lefevre syndrome cause?
- primary dentition prematurely lost and are shed in order of eruption
- pernament dentition erupts early
- aggressive periodontitis associated with permanent dentition
- perio tx is usually unsucessful
- accompanied with sever gingival inflammation
62
what can ehlers danlos syndrom cause orally?
- oral mucosa becomes fragile and susceptible to bruising
- gingival tissues bleed easily
- teeth become fragile and fracture easily
- perio. tx should be as atraumatic as possible
63
what are some features of hereditary gingival fibromatosis?
- condition does not manifest till after eruption of the teeth
- associated with pernament dentition
- gingival tissues are enlarged
- hyperplasia due to excessive production of collagen
- may delay eruption of the teeth
64
what is mucopolysacharidosis?
- group of inherited disorders
| - teeth are small and widely spaced
65
what can a vitamin C deficiency cause?
scurvey
66
chemical antimicrobials may cause?
- sensitivity to the indvidual
- resistance
- super infections (mrsa, candidosis)
67
what do quaternary ammonium compounds do?
-have moderate plaque inhibitory activity but is not retained in mouth for long
68
give an example of a phenolic antiseptic?
listerine mouthwash
69
what are some possible uses of antiseptic mouthwashes?
- to replace mechanical toothbrushing when this is not possible
- after oral surgery
- during acute gingival conditions
- for mentally/physically handicapped people
70
can mouthwashes reach the subgingival area?
-no
71
what are agents used systemically for subgingival plaque control?
antibiotics
72
what are agents used topically/locally for subgingival plaque control?
antibiotics or antiseptics
73
what is the 'perio chip'?
- contains 2.5mg chlorhexidine
- prolonged chlorhexidine release from single chip
- placed into pocket following RSD and arrest of haemorrhage
- chips swells on contact with moisture this retains it in the pocket
74
should antibiotics be the primary agent in the treatment of periodontal disease?
-No. Antibiotics should only be used as an adjunct in the tx of perio. disease
75
the development of ....... can be caused by frequent misuse of antibiotics.
-hypersensitivity reaction
76
what are the 5 phases of tx planning?
1. initial examination and pain relief
2. cause related therapy
3. re-examination outcomes
4. definitive tx
5. maintenance
77
what is the goal of cause related therapy?
to render the roots biologically compatible with soft tisue by eliminating calculus and altered cementum and reducing periodontal pathogenic micro-organisms.
78
what is palliative care?
- not the same as maintenance
- palliative care recognises that the disease is not stable and it is not possible to achieve stability
- sc&p every 2-3 months
