Pathogenesis of Periodontal Tissues – Flashcards
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| Pathogenesis |
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| what occurs in the development of disease or abnormal condition |
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| What are the three basic states? |
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| 1.health 2.gingivitis 3.periodontitis |
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| What is periodontal disease? |
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| bacterial infection of the periodontium |
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| What are the three stages of microscopic changes? |
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| 1.subclinical 2.gingivitis 3.periodontitis |
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| Is periodontal disease and periodontitis the same thing? |
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| no, periodontitis and gingivitis are forms of perio disease |
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| What is gingivitis? |
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| bacterial infection confined to the gingiva |
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| Is tissue damage from gingivitis reversible? |
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| yes! |
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| What is subclinical gingivitis? |
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| a stage of periodontal disease that can only be detected microscopically |
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| Is subclinical gingivitis seen before or after inflammatory response? |
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| prior to |
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| What is periodontitis? |
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| a bacterial infection of all parts of the periodontium |
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| What are the aspects of the periodomtium? |
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| 1.gingiva 2.PDL 3.Bone 4.Cementum |
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| Is tissue damage from periodontitis reversible? |
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| NO, it is irreversible |
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| What is the number one sign of inflammation? |
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| bleeding |
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| What is the color of healthy gingiva? |
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| pink pigmentation, exact pigmentation related to genetics |
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| Gingival margin in healthy gingiva? |
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| knife edge |
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| Interdental papilla in healthy gingiva? |
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| fills embrasures |
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| Texture of healthy gingiva |
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| attached- stippled free-smooth |
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| Sulcus depth of healthy gingiva? |
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| 1-3 mm |
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| What is a healthy JE like? |
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| -firmly atached by hemidesmosomes to enamel -coronal to CEJ |
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| Is the JE a smooth or random boundary? |
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| smooth |
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| What should the gingival fiber bundles be like? |
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| in tact and supporting the JE |
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| Where should a healthy alveolar bone crest be? |
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| 2 mm apical to base of JE |
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| How soon after plaque accumulation in the sulcus do you see gingivitis? |
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| 4-14 days so if you don't floss foe 4 days you could begin to develop gingivitis! |
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| What is the duration like in acute gingivitis? |
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| short |
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| What is acute gingivitis characterized by? |
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| fluid in gingival connective tissues |
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| What does the gingiva look like in acute gingivitis? |
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| apprears swollen(edema), vascular, red in appearance |
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| What is the duration of chronic gingivitis? |
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| months or years |
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| How does the body attempt to repair tissue damage in chronic gingivitis? |
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| by forming new collagen fibers |
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| What does the tissue appear like in chronic gingivitis? |
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| enlarged and fibrotic |
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| Is the gingiva red in chronic gingivitis? |
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| no, excess collagen fibers mask redness, it is lacking bright red appearance |
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| What determines if a patient's gingivitis will move to perio disease? |
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| the patient's host response |
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| What are two things that may cause gingival enlargement? |
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| swelling or fibrosis |
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| Where is the gingival margin in gingival enlargement? |
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| it covers more of the crown, this results in greater probe depths |
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| What can gingival enlargement cause? |
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| "pseudo" pocketing |
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| How big will the gingival pocket be in gingival enlargement? |
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| over 3 mm |
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| What happens in pseudo pocketing? |
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| the gingiva is swollen but the JE remains coronal to the CEJ |
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| What is the progression of gingivitis to periodontitis like? |
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| gingivitis may persist for years without progressing to periodontitis |
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| What is the color of the gingiva in clinical gingivitis? |
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| red, blue |
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| What is the gingival margin like in clinical gingivitis? |
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| rounded, covers more of the crown |
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| What is the consistency like in clinical gingivitis? |
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| smooth, spongy |
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| Is there bleeding found in clinical gingivitis? |
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| yes, bleeding upon gentle probing |
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| What is the sulcus like in clinical gingivitis? |
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| may be more than 3 mm, but the JE has not apically migrated |
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| Where is damage found in clinical gingivitis? |
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| in supragingival fiber bundles, reversible with bacterial infection control |
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| Has the bacterial infection progressed to the alveolar bone in gingivitis? |
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| no |
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| Is the tissue destruction in periodontitis reversible? |
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| no, it is permanent |
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| What is periodontitis characterized by? |
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| -apical migration of the JE -loss of connective tissue attachment -loss of alveolar bone |
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| What does bluntness of the interdental papilla tell you? |
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| that there is interdental attachemnt loss |
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| Is tissue destruction in periodontitis a continuous process? |
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| no, it occurs intermittently |
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| What is tissue destruction in periodontitis like? |
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| extended periods of inactivity followed by short periods of destruction |
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| Does tissue destruction occur at the same rate throughout the whole mouth? |
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| no, it occurs at different rates throughout the mouth |
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| What color is the gingiva in clinical periodontitis? |
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| blue, purple, pallor |
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| What is the gingival margin like in clinical periodontitis? |
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| swillon, fibrotic, may be apical to the CEJ |
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| What is the interdental papailla like in periodontitis? |
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| bulbus, blunted, flat, cratered away, not not fill embrasures |
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| Is there bleeding with periodontitis patients? |
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| yes, and may have suppuration |
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| What are the pocket depths in periodontitis? |
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| 4mm or greated, apical migration of the JE |
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| What happens to the JE in periodontitis? |
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| apically migrates, located on cementum |
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| What determines the patient's chance of getting periodontal disease and the severity to which they will get it? |
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| the host response |
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| What is inflammation? |
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| the body's reaction to injury or invasion by disease-producing organisms |
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| What does inflammation cause in periodontitis? |
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| results in permanent tissue destruction |
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| What is included in this destruction? |
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| -gingival connective tissues -PDL -alveolar bone |
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| WHat are the two patterns of bone loss? |
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| horizontal and vertical |
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| Is horizontal or vertical boneloss more common? |
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| horizontal |
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| Is the boneloss in horizontal even? WHat kind of pocket does it produce? |
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| fairly even overall reduction, produces suprabony pocket |
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| Is vertical bone loss even? |
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| no, this is when bone resorption progresses more rapidly in the bone next to the root surface |
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| What kind of pocket does vertical boneloss cause? |
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| infrabony pocket |
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| Does vertical bone loss typically affect all teeth? |
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| no, usually just one |
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| What are infrabony defects? |
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| classified on the basis of the number of osseous(bony) walls remaining |
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| What is a 1 wall bony defect? |
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| only one wall of the bone around a tooth remains EX: facial, lingual, and distal plates of the canine are missing but the mesial wall of the premolar remains |
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| What is a 2 wall bony defect? |
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| 2 walls remain EX: L and M plate remains of the premolar but the distal and facial plates of the canine remain |
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| What is a three-wall infra bony defect? |
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| 3 walls of bone around the tooth remain EX: F, M, & L plates remain of premolar |
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| How many teeth does an interproximal osseous crater effect? What is it? |
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| affects 2 teeth, bowl shaped(dip) osseous defect interdentally |
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| example of an interproximal osseous crater |
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| bone loss at mesial of premolar and distal of canine |
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| Inflammation spreads through the path of... |
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| least resistance(gingival tissue, alveolar bone, PDL space) |
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| What is the order in which inflammation spreads in vertical bone loss? |
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| 1.gingival fibers 2.directly into the PDL space(sharpeys fibers) 3.Alveolar bone |
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| What happens in vertical bone loss when the crestal fiber bundles are weakened? |
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| once they are weakened, they are no longer an effective barrier |
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| What else can weaken crestal fibers? |
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| occlusal trauma |
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| What is the order of disease in Horizontal bone loss |
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| 1.connetive tissue sheaths 2.into bone 3. into periodontal ligament space |
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| In periodontal pockets how does tissue destruction spread? |
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| apically and laterally |
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| Does every root surface of a tooth have the same pocket reading? |
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| they can have different ones |
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| Where is the disease site? How big are they? |
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| area of tissue destruction, may involve only a single surface of a tooth |
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| What does an active disease sit show? |
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| apical migration of JE over time |
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| What is an inactive disease site? |
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| -stable -attachment level of JE remains the same over time |
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| What is bleeding a sign of? |
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| inflammation, NOT disease |
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| What is disease activity assessed with? |
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| a periodontal probe |
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| What reading indicated a healthy sulcus? |
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| 1-3 mm |
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| What is a "pocket" |
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| area of destruction left by the disease process |
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| Does a presence of a pocket always indicate active disease? |
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| No, not always |
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| Are a majority of pockets in adult patients active or inactive? |
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| inactive |
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| What are gingival pockets? |
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| deepening of the gingival sulcus solely as a result of gingival enlargement |
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| IS there destruction of PDL fibers or alveolar bone in a pseudo pocket? |
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| no |
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| Is there apical migration of the JE with gingival pockets? |
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| no, it remains coronal to the CEJ, there is just an increased probe depth caused by edema |
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| What are periodontic pockets? |
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| pathologial deepening of gingival sulcus |
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| What are periodontal pockets caused by? |
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| 1.apical migration of the JE 2.destruction of PDL fibers 3.destruction of alveolar bone |
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| Suprabony pockets occur when BLANK bone loss is present. The JE is located BLANK to the crest of the alveolar bone. |
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| -horizontal -coronal |
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| Infrabony pockets occur when BLANK bone loss is present. JE is located BLANK to the crest of the alveolar bone. |
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| -vertical -apically |
