Case Study Questions
A 32 patient presents with a history of smoking <10 ciggs a day, has no history of diabetes, but has experienced >1.0 bone loss since you last seen him. Name the periodontal grade of said patient.
What is Grade C?
[Because BL is >1.0]
Remember, you take the WORST risk factor.
What is gram (-) bacteria?
This type of healing occurs after nonsurgical periodontal instrumentation.
What is healing by repair?
These are important parts of the nonsurgical periodontal treatment plan.
[You must name atleast 3 things.]
What is updating pt HHX, evaluating effectiveness of tx, clinical assessment (probing, BOP, exudate), OHI education, periodontal instrumentation, use of chemical agents, eliminate local factors, minimize systemic risk factors?
What is Prostaglandins (E series)?
Upon initial examination of this pt you note interdental CAL of >5mm. They have lost <4 teeth due to periodontist and vertical bone loss is present. Name the periodontal stage.
What is stage 3?
This bacteria has a single layer composed of peptidogylcan and easily retains the purple dye.
What is gram (+) bacteria?
Explain maintenance of implants.
1st year: cleanings every 3 mos.
>1 year: cleanings every 6 mos
Xrays annually
Polish with nonabrasive agent OR air polish
The periodontitist needs to stimulate regeneration of lost periodontal structures [cementum, PDL, alveolar bone] to save tooth #4. This surgery can be offered to the patient to help treat it.
What is guided tissue regeneration (GTR)?
This biochemical mediator breaks down connective tissue.
What is matrix metalloproteinases (MMP's)?
Name the periodontal stage and grade.
What is stage II [because the bone loss and probing depth] and grade A [because she's nonsmoker and no diabetes]?
This layer protects against antimicrobials.
What is extracellular slime layer?
You get a 6 mm reading from measuring the base of the sulcus -> CEJ. What are you measuring?
What is the CAL?
This is an acceptable treatment option for a stage 1, grade A periodontal patient.
What is nonsurgical periodontal debridement?
This biochemical mediator is a powerful regulatory protein that signals additional phagocytes to area of infection.
What are cytokines?
Nicholas Cage presents to your clinic with upper and lower partials due to missing a significant amount of teeth. Vertical bone loss is present and you are getting CAL readings of >6mm. He has smoked for 20 years and has uncontrolled diabetes.
Name the periodontal stage and grade.
What is stage IV [because he is missing >5 teeth], grade C [because he smokes like a chimney]?
The PDL has 5 functions. Name at least 3.
[Tricked ya, not a bacteria question :) ]
1) Supportive- suspends / maintains tooth in socket
2) Sensory function- nerve endings
3) Nutritive function- provides oxygen / nutrients to tissues
4) Formative function- contains many specialized cells
5) Remodeling function- can remodel bone in response to pressure
Name procedures that would be included in periodontal surgery.
What is gingivectomy, osteotomy, implant placement, bone graft materials?
Name the different bone grafts.
What are ...
Autografts- bone taken from self
Allograft- bone taken from another human donor
Xenograft- bone taken from another species (cow / pig)
Alloplast- manmade / artificially / synthetic made bone
Tooth #17 is erupting. You take a PA and notice an infection around the eruption site. Name the eruption infection.
What is pericoronal abscess or pericoronitis?
Ms. Suzzie Snicker Pitts has returned to your chair with interdental CAL of 2mm. She has mostly horiziontal bone loss and you are getting 5mm probe readings. She tells you her last HbA1c was 6%.
Name her periodontal stage and grade.
5 Total!
What is Treponema denticola, Fusobacterium nucleatum, Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacer actinomycetemcoitans?
Name the stages of biofilm formation.
What are.....
Stage 1: Initial attachment- happens within seconds -> minutes. Contains free floating planktonic microbes that attach to pellicle.
Stage 2: Permanent attachment- Cell adhesion / coaggregation (bacteria attach to one another)
Stage 3: Maturation phase 1- Self extracellular matrix forms
Stage 4: Maturation phase 2- mushroom shaped microcolonies grow, fluid channels are formed and quorum sensing begins
Stage 5: Dispersion- bacteria escape matric to invade other areas.
These medications can cause gingival enlargement.
(3 groups, 300 extra points if you can name the medications too!)
These are the first cells to arrive at an inflammatory site.
What are polymorphonuclear (PMN's) / neutrophils?