Histology and Anatomy
Gingiva, Cementum, PDL, Alveolar bone
What are fluid channels?
Pathways for flow of saliva to bring in nutrients and carry out waste in a biofilm
The very first step before you stage and grade is to do this:
Diagnose periodontitis.
What is an example of a local risk factor for periodontal disease?
Examples: biofilm retention, calculus, direct damage, caries, anatomical conditions, ortho, iatrogenic damage from restorations, smoking, chew tobacco
Comprehensive periodontal examination
This type of cementum compensates for wear over the life of a tooth.
Cellular cementum
This is a protective matrix that prevents large molecules and inflammatory cells from penetrating deeply into biofilm.
The extracellular matix
Biofilm-induced gingivitis falls under what AAP classification umbrella?
Periodontal Health, Gingival Diseases, and Conditions
What is an example of a systemic risk factor for periodontal disease?
Examples: Smoking, diabetes mellitus, stress, hormones, obesity, neutropenia, HIV, Down's Syndrome, medications, vitamin deficiency
Class 2 Mobility
The attachment mechanism between epithelial cells and the basement membrane.
Hemidesmosomes
When layers of bacteria go dormant, metabolically inactive.
Quiescence (hibernation)
What factors must be present in the mouth for periodontal tissue destruction to occur?
Biofilm + Host (+ Risk) + TIME
What is one effect of smoking on the periodontium?
Reduced clinical signs (no bleeding); biofilm increase in P. gingivalis; low O2; nicotine suppresses osteoblasts and insulin production; Impaired cellular and humoral; impaired neutrophils; decreased antibodies; nicotine increases TNF, MMPs, & IL-6; Reduced attachment gains from periodontal therapy, high risk of implant failure; increased risk and rate of periodontitis progression
What is at least one limitation of radiographs during periodontal evaluation?
2D image, Angulation and technique dependent, no info on soft tissue attachment
Which of the gingival epitheliums is non-keratinized with a smooth CT border in health?
Junctional epithelium
What are two leukocytes seen in periodontal tissues during chronic inflammation?
Neutrophils, macrophages, B cells, T cells
Irregular pattern of loss, site specificity, horizontal, vertical; soft tissue migration precedes bone loss
What is one effect of uncontrolled diabetes on the periodontium?
Xerostomia; erythema and bleeding; abscesses; cheilosis; burning sensation; Prolonged osteoclastic activity; osteoblast apoptosis; glycation damages collagen & elastin; Hyper-inflammatory response; impaired neutrophils, overactive macrophages; increase in cytokines, TNF, IL-1; Reduced healing response, poorer long-term prognosis; increased risk of acute infections; Increased risk and rate of periodontitis progression
The contour of the alveolar crest when one of the adjacent teeth is tilted or erupted at a different height.
Angular contour (aka vertical contour)
What is the function of the supragingival fiber bundles?
–Reinforce attachment of JE to tooth
–Provide rigidity to free gingiva so it can withstand chewing forces
–Connect free gingiva with root cementum and alveolar bone
–Connect adjacent teeth to one another
This theory of pathogenesis states that a key pathogen in the biofilm triggers dysbiosis, and subsequently triggers an uncontrolled host response and periodontal destruction.
Keystone Pathogen Hypothesis
Presence of severe ridge defects or drifting/shifting is case complexity related to what Stage of periodontitis?
Stage IV
The width of the attached gingiva cannot be measured in this area of the mouth.
Palate (cannot determine where gingiva ends and palatal tissue begins)