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PERIO 5002: Exam 1
Terms in this set (84)
recall for re-evaluation after initial perio therapy
initial therapy -> cause-related
indications for root planing
• Loss of periodontal attachment (CAL
loss > 1 mm
• Probing depths 4 mm or greater with bleeding on probing
• Detectable subgingival calculus and/or rough root surfaces
two types of ultrasonic scalers
-magnetostrictive - elliptical motion
-piezo-electric - linear motion
desired endpoint for perio therapy
- plaque (< or = 20%)
- inflammation (BOP < or = 20%)
- pocket depths (< or = 4 mm)
-stabilization or gain of clinical attachment
t/f 3 wall defects have better resolution than 2 wall defects
clinical manifestations of down syndrome
-congenital heart disease (30-45%)
-risk for lymphocytic leukemia
immunologic abnormalities in down syndrome
-defective neutrophil function (defective chemotaxis) with release of degrading enzymes extracellularly
-peripheral blood with high T-lymphocytes w/ low activity
-abnormal B lymphocytes w/ high IgG and low IgM
oral manifestations of down syndrome
-susceptibility to gingival and periodontal disease, despite low caries index.
-reduced salivary flow
-accelerated bone loss bc of increased osteoclasts and MMP's
Chédiak-Hiagashi syndrome genetics
-abnormal intracellular protein transport
-susceptibility to infection
-lack of tyrosinase
-defects in monocytes and lymphocytes
-PMN's w/ giant granules
clinical/oral manifestations of Chédiak-Hiagashi syndrome
-hypopigmentation of skin, eyes, and hair
Papillon Lefevre syndrome (1924) genetics
-loss of function of Cathepsin C gene; chrom. #11
-chemotaxis defect due to leukocyte adhesion defect
-actinomecetem is accumulated
oral and dermatologic manifestations of Papillon Lefevre syndrome (1924)
-altered immune response, skin lesions, loss of integrity of sulcular epi.
-juvenile periodontitis (AA)
-pre-pub: tooth loss bc of perio
-post-pub: bone loss
-Palmar plantar keratosis (white yellow keratotic)
-radiographically: floating teeth
juvenile periodontitis + plantar & palmer keratosis =?
Papillon Lefevre syndrome (1924)
syndromes associated with leukocyte malfunction in chemotaxis
-Leukocyte adhesion syndrome
-Juvenile Periodontitis (Accelerated Perio)/ Papillon-Lefevre syndrome
syndromes associated with leukocyte malfunction in phagocytosis
syndromes of leukocyte degranulation malfunction
-Specific granule deficiency
syndrome of leukocyte malfunction in oxidative burst
Chronic granulomatous disease of childhood
syndrome of leukocyte malfunction in hypochlorus acid production malunction
Myeloperoxidase (MPO) deficiency
Leukocyte Adhesion Deficiency (Type-1)
-cannot recruit leukocytes
-marked by leukocytosis and localized bacterial infections and impaired pus production (minimal inflammation like other forms of neutropenia)
-gingivitis and periodontitis
-periodic reduction in neutrophils
-diagnosis: sequential CBC 3 times/ week for 8-10 weeks
ligneous gingivitis is associated with __ deficiency
-destructive membranous disease
-affects eyes, respiratory tract, genital tract, kidneys and mouth
congenital cases of ligneous gingivitis is related to mutation in what gene?
acquired cases of ligneous gingivitis are secondary to build up of what drugs?
anti-fibrinolytic drugs -> build up of fibrin
two types of plasminogen deficiency
Type 1 - quantitiative - 8-14 mg/dL
Type 2 - qualitative - 65 = 176 mg/dL (coagulation test)
A generic term for hematopoietic malignancies characterized by malignant white blood cell proliferation on the expense of marrow
-myeloid (granulocytic) vs lymphocytic
oral clinical manifestations of leukemia
- Anemia; mucosal pallor
- Susceptibility to infections (bacterial/viral/fungal)
- Hemorrhagic tendency
- Leukemic infiltrates (mainly gingiva)
most commonly "monocytic leukemia"; also seen in skin
-diffuse gingival enlargement
what drugs induce gingival hyperplasia?
Ca2+ channel blockers
(antihypertensives and anti-epileptic drugs)
Granulomatous Gingival Inflammation is seen with what diseases?
kaposi sarcoma's etiology is what herpesvirus?
Kaposi sarcoma epidemiologic groups
-italian, jew, or slavic origin (classic western indolent)
-immune suppressed patients
cardinal signs of inflammation
loss of fxn
most objective sign of gingival inflammation?
when is comprehensive periodontal examination (D0180) indicated?
done on pt's with history of perio problems
when to premedicate?
-Hx of bacterial endocarditis
4 components of periodontium
mobile tooth, think ->
avg PDL thickness =?
first perio changes occur where
upper buccal gingiva
clinical perio indicators
-width of attached gingiva
probing depths of > or = to __ constitutes a periodontal pocket
-apical shift = +
-occlusal shift higher than CEJ = -
probing depth + gingival recession =?
-3.5mm to first black band
-5.5 mm to top of first black band
PSR Code 0
Colored area of probe remains completely visible in the deepest crevice in the sextant. No calculus or defective margins are detected. Gingival tissues are healthy with no bleeding after gentle probing.
PSR Code 1
Colored area of probe remains completely visible in the deepest probing depth in the sextant. No calculus or margins are detected. There is bleeding after gentle probing.
PSR Code 2
Colored area of probe remains completely visible in the deepest probing depth in the sextant. Supra- or subgingival calculus and/or defective are detected
PSR Code 3
Colored area of probe remains partly visible in the deepest probing depth in the sextant.
PSR Code 4
Colored area of probe completely disappears, indicating probing depth of greater than 5.5 mm.
PSR Code *
Denotes clinical abnormalities including but not limited to furcation invasion, mobility, mucogingival problems, or recession extending to the colored area of the probe (3.5 mm or greater).
PSR Code X
Denotes edentulous sextant.
CAL = ?
pocket depth + recession
-distance from base of pocket to fixed reference point on crown usually CEJ
what is clinical determinant of treatment needs?
what is clinical estimation of tissue destruction; essential for diagnosis
width of attached gingiva is measure from where to where?
base of pocket to MGJ
(GM to MGJ) - (pocket depth)
hamp's index for nabor's probe
classification of mobility
1: <1mm in buccal direction
2: >1mm in buccolingual direction
3: tooth moves up and down
radiograph: distance of bone crest to CEJ
1-2 mm normal
>2mm - periodontitis
cleaning appointment for patient with no hx of perio disease
D1110 Prophylaxis/Scale and Polish
t/f GI and probing depth needs to be checked before disclosing
appointment for perio patient with active periodontitis
periodontal maintenance D4910
severity of Perio disease
slight: 1-2mm CALoss
Moderate: 3-4 mm CALoss
severe: 5+ CALoss
extent of perio disease
localized if 30% or less of sites are involved
localized if 30% or less of sites are involved + any anterior tooth
generalized: not common
mobility means more than anything in predicting prognosis
common order for perio tooth loss
canine is last
most common form of perio is __
prognosis for class 3 mobile tooth
hopeless but sometimes poor
perio treatment planning phases
-cause-related - address etiology
-corrective - fix damage caused by disease
components of periodontal problem list
1. Systemic conditions which require special patient management procedures
2. Risk factors which predispose the patient to periodontitis
3. Clinical findings which can be corrected or improved by periodontal treatment
4. Secondary etiological factors
smoking makes patient 4x more susceptible to perio disease and 4x more likely treatment will fail
sequencing periodontal treatment plan
1 - cause-related tx
1 - re-evaluation
2 -surgical therapy (any pockets > 5mm)
2 - complete direct restorative therapy
2 - post surgery re-evaluation
3 - Fixed/Removable pros therapy
3 - periodontal maintenance
most important disease when it comes to perio health
-collagen down, MMP's up
-PMN's malfunctioning while more inflammatory cytokines are produced
average periodontal wound is how big?
20 square cm
what did Loe call the "sixth complication of diabetes"?
smart questions about diabetes
• When was the last time you went to see your phisician?
• Do you check your blood sugar level regularly?
• How was it today?
• How was it yesterday?
• How often is it above 120/140/160?
for HbA1C level: 1% = what concentration of Avg. Blood Sugar (mg/dL)
1% A1C = 30 mg/dL Avg. Blood Sugar
(eg: 8% A1C = 180 mg/dL Avg Blood Sugar)
Studies show that our tx (control inflammation and perio maintenance) could decrease hba1c up to...
BP quick ref
two hormonal changes associated with periodontal disease
-pregnancy/oral contraceptives (progesterone)
main complications of diabetes that contribute to inflammation and periodontal disease?
peripheral vascular changes
two types of diabetes
-Type- I insulin dependent DM (IDDM)
-Type-II non-insulin dependent DM (NIDDM) - decreased insulin secretion or tissue resistance to insulin even though there is normal
-seen in diabetes
-due to advanced glycation end products.
-Processed sugar that is deposited in blood vessels impairing blood flow.
Can't fight bacteria due to impaired neutrophilic fxn.
three oral pathologies complicated by diabetes
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