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periodontal abscess tx1. numb 2. establish drainage pathway 3. debride 4. pain releif (otc or rx) 5. adjustment of occlusion 6. antibiotics 7. salt water rinseattached gingiva widestincisor and molarattached gingiva narrowestpremolarsno attached gingvaadditional destruction to surrounding perio tissues and treatment options for restorations are limited -organisms are in connective tissues. -w/o surgical intervention the tooth will be lostmucogingival involvementbase of pocket is beyong mucogingival junction and into the alveolar mucosemucogingival defectall attached gingiva in area is destroyed -festoon -soft tissue graft to correct defectmucogingival involvement causeperio disease self inflicted harm frenum pullrecessionCEJ to gingival marginCALossrecession+probing depthattached tissue calculationgingival margin to mucoginigval junction measurement-probing depthcase type 0healthy (new=pristine perio health)case type 1gingivitis (new= clinical perio health-gngivitis) 1-4mmcase type IIslight chronic perio (stage 1 grade b perio) -4-5mm, grade 1 mobility, stage 1 furcationscase type IIImoderate chronic perio (stage 2 grade b perio) -5-6mm, 1 and 2 mobility, stage 1&2 furcationscase type IVsevere chronic perio (stage 3/4 grade b perio) -6+ mm, 1-3 mobility, stage 1-4 furcationcase type Vaggressive perio (grade c) -6+ mm, 1-3 mobility, stage 1-4 furcation -rapid attachment lossPerio as a manifestation of systemic diseaseyounger age. from other diseaseNecrotizing Periodontal Diseasenecrosis of gingival tissues -HIV, malnutiriton, immunosupressedSystemic Risk Factors for Periodontitistobacco use diabetes obesity aids osteporisis hormone alteration stress genetics systemic medications marijuana useAssessment and preliminary therapy phaseassessment data collection, emergency dental care, extract hopeless teeth, case presentation, medical care for systemic conditionsnonsurgical therapy phase 1-ohed and nutritional counseling -tobacco cessation -perio debridement -antimicrobial therapy -correct local risk factors -fluoride -occlusal therapy -minor ortho -reevaliation of perio statussurgical therapy phase 2perio surgery and referrals endo therapy and referrals dental implants and referralsrestorative therapy phase 3dental resorations fixed and moveable appliance reeval overall responseperio maintenance phase 4ongoing care at specified interval prevent recurrencenonsurgical therapyalways indicatedsurgucal therapymoderate and severe perioclindamycin systemic300 mg 3x/day for 8daysmetronidazole systemic500mg 3x/day for 8days (NUG)nitrus oxideanxiety, high doses=pain controltopical benzocaineminimal soft tissue releiftopical lidocaine and prilocaine (oraqix)slight-moderate perio, needle freeinfiltrationonly numb in area penetratedblocklarge area numb lasts longerinfective endocarditisinfection of endocardium, valves, or prostesis from microbal invasion. -can caise cardiac failurepremed indications-history of infective endocarditis -at risk for infective endocarditis -cardiac transplant with valve issue -congenital heart conditions -total joint replacementpremed amoxicillin2g 30-60 mins before (oral)premed clindamycin-allergic to amoxicillin -600 mg 30-60 mins before (oral)if pt taking premed for another conditionuse antibiotic from different classpremed time limitschedule appts no less than 10 days apart to reduce antibiotic resistancewhitening contraindications-anterior aestethic restorations -cracked/hypoplastic enamel -caries -cervical abrasion -sensitvity -light activated contraindicated in chemo, radiation, photosensitive meds and melanomafood impaction sourcesopen contacts overhanging restorations blunted papilla fractured teeth caries calculushypothyroidism causeautoimmune (hashimoto) iodine deficient pituitary disease developmental disturbance medical txhypothyroidism features-puffy facial tissues from water retention -enlarged lips and tongue -goiter -pharyngeal edema -delayed exofoliation and erruption of teeth -weight gain, decreased HR and respirations -bruise easily, brittle hair -slowed thinkingaphthous ulcerscanker sores are also known as whatrecurrent herpescold sores, fever blisters are also know as whatcanker soresHIV infection, nutritional deficiencies (iron, folic acid, vitamin B), smoking cessation, reaction to sodium laurel sulfate-familial and cyclic neutropenia -down syndrome -papillon-lafevre syndrome -chediak-higashi syndromeperiodontitis associated with generic disorderschediak-higashi syndromeinherited disease of the immune and nervous system. impairment of neutrophilspapillon-lafevre syndromesevere periodontal destruction, premature tooth loss, hyperkeratosis of the palms of hands and soles of feetcariesDown syndrome does not increase risk for whatneutropeniadeficiency of neutrophilsTreponema denticola, prevotella intermedia, prophyromonas gingivialis, and fusobacteriawhat are the spirochetes associated with necrotizing diseasetetracycline because it concentrated in gingival crevicular fluidwhat drug do u use for necrotizing periodontal diseasepunches out papillae, pseudomembrane, fetid BAD odor, pain and severe inflammationclinical findings of necrotizing periodontal diseaseperiodical abscessresults form infection of the tooth pulp. usually secondary to deep dental cariesstage 1-4histopathology of periodontal lesionsstage 1initial lesions (2-4) daysstage 2early lesions (4-7 days) clinical signsstage 3established lesions (2-3 weeks)stage 4advanced lesions (3 weeks + to years) irreversiblestage one initial lesionno clinical changes, vasodilation of small capillaries. increased number of white blood cells (PMN/neutrophils) increased flow of gingival fluidstage 2 early lesion or gingivitisclinical signs of gingivitis appear, white blood cells infiltration into connective tissue. rate pegs develop in sulcular lining, collagen destruction, fleeing occurs due to ulcerated sulcular lining, PMNS found in sulcus.stage 3 established lesionscapillary proliferation (overgrowth) causes ether (redness), gingival enlargement may increase probing depths, plasma cells become prominentstage 4 advanced lesionstransition from ginvigits to periodontitsitl. irreversible. junctional epithelium detected from root surface and migrated apically. osteoclasts and bone loss.marginationthe movement of the WBCs to the periphery of vessel wallspavementingWBCs line the wall of the vesseldiapedesisprocess by which neutrophils squeeze between endothelial cells in the vessel wallemigrationcells move into the tissues from the blood vesselschemotaxisthe movement of cells to the site of inflammationPagocytosisneutrophils main functionarachidonic acidmetabolized to produce inflammatory mediators. it is produced where there is tissue injuryprostaglandins and leukotrienesarachidonic acid produce what inflammatory mediatorsprostaglandins (Prostaglandins = Pain)cause swelling, pain and inflammationNSAIDSprostaglandins are inhibited by whatleukotrienes (leukotrienes = lungs)cause bronchoconstriciton, cellular infiltration, cytokine release and inflammationcollagen and wound healingvitamin c is necessary for whatprotein deficiencykwashiorkor is whatkwashiorkorprotein malnutritionmedications, puberty, menstruation, and menopausewhat can affect periodontal tissuesPrevotella intermedia, camphylocater rectuswhat bacteria cause pregnancy gingivitisdeveloping cariessmokers are NOT at increased risk for whatelongated filiformsmokers may develop black hair tongue which is whatXerostomia Mucositis-inflammation Dysguesia-loss/altered taste Fungual and viral infectioncancer patients may present with whatlinear gingival erythema, necrotizing ulcerative periodontitis, aphthous ulcers, kasposis' sarcomapatients with HIV+ may present with whatthreewhat is better, 1 wall or threeginivectomymost common surgical producer to reduce pocket depths. removes soft tissue onlyperiodontal ligament, gingiva, cementum, alveolar bonewhat are the tissues of the periodontiumtooth anchorage, transmits, occlusal forces to the bone and resists impact of these forces, supplies nutrients to periodontal structures, sensory function include touch, pressures and pain, acts as a shock absorber for the teeth, nerves and blood vesselsfunctions of the PDLcementumall PDL fibers attach to the tooth's whatsharpey's fibersfiber bundles that are attached and embedded in cementum and bonetranseptal fibersinterdental ligament. entend inter proximally over the alveolar crest. hold teeth in inter proximal contact with each other.alveolar crest fiberslocated apical to the junctional epithelium. resists tilting and horizontal forces.oblique fibers**most numerous type of fiber - resists "intrusive" or "vertical" masticatory forces - prevents the tooth from being "jammed" into the bony socketHorizontal fibersresist horizontal and tilting forcesapical fibersextend fro apical area of the tooth to base of the tooth socket. resists "extrusive" forces. prevents the tooth from being lifted out of the bony socket (sticky foods)Interradicular fibersfound only in multi-root teeth. located in tooth furcations. stabilizes tooth rootgingival fibers.what fibers are not part of the PDLgingival fiberscircular fibers found within the marginal gingiva. these fibers encircle the tooth, helping to maintain gingival integrity like pulling on the strings of a purse.fibroblastsmost common cell of the PDL, important in collagen synthesis and fiber production. "primary cell of the PDL"osteoblastsproduction of boneosteoclastrespiration (break down) of bonecementoblastsproduction of cementumcementoclastsresorption (break down) of cementumneutrophilswhat cell is the most prevalent in gingivitisdevelops slowly, may appear normal, not usually painfuldiscribe chronic gingivitiscyanosisbluish, high vascular, often found around crownspallorlighter than normal, associated with anemia, leukemia, fibrotic tissuevasodilationedema is the result of whatstillmans cleftvertical loss of tissue, caused by improper flossingPhenytoin (Dilantin), nifedipine (pericardia), cyclosporinwhat are the drugs that increase the risk of gingival enlargementmouth breathing, periodontal inflammation, genetic/hereditary factors, systemic conditions (leukemia and hormonal imbalance)what are some other causes of gingival enlargementhyperplasiagingival enlargement due to and increase in cell numbershypertrophygingival enlargement due to an increase in cell sizedehiscencea loss of alveolar bone, usually on the facial aspect of the tooth root, oval-shaped root exposure apical to the CEJ, includes gingival recession, alveolar bone loss and root exposuredehiscence toothfenestrationa window-like opening in the bone covering the root of the tooth. border by alveolar bone on the coronal aspect of the toothfenestration toothdental plaquenot readily removed by rinsingglycoproteinswhat is from saliva that is absorbed to the tooth surface, formation the acquired pellicleglycoproteins form the pellicle, bacteria adhere to the pellicle, bacteria multiple to create a biofilm, as plaque grows the bacteria detach from the biofilm and become "planktonic" bacteria (free), later calculus forms from the mineralized plaque biofilmdescribe the plaque formationfree bacteriawhat is platonic bacteriacocciround shaped bacteria found in early plaque formation.bacillirod shaped bacteria, most common typer founding periodontal diseasespirochetesspiral-shaped bacteria, often associated with NUG/NUPcoccibacteria found in early plaque formationbacillimost common bacteria found in periodontal diseasespirochetesbacteria most often associated with NUG/NUPaerobicrequire oxygen to growaerobic bacterianot found in periodontal pocketsanerobicgrow in the absence of oxygenanaerobic bacteriafound in the periodontal pockets and gingival sulcusfacultative anaerobescan grow in the presence or absence of oxygenmotile bacterianon-motile bacteria turns into what when the disease progressesgram -gram + bacteria turns into what when the disease progressesanaerobic bacteriaaerobic bacteria turn into what when the disease progressesbacillicocci bacteria turns into what when the disease progressesbacillicoccistreptococcus: s. mitts, s. oralis, s. sanguis, and s. mutans. Actinomyces: a. viscouswhat are the gram + bacteria in early health plaque, able to attach to the acquired pellicle.extracellular matrixmakes up the bulk of the plaque biofilm and functions to hold the bacteria together, and allow for the exchange of nutrients between bacteria, and for the removal of waste productsadherent plaquecontains non-motile bacteria. may mineralize and become CALCULUSnon-adherent plaquealso known as planktonic plaque. the removal of loose or non-adherent plaque is an oral irrigator. increases acute infection. mostly motile rods and spiroches.pellicle formation is deprived form salivary glycoproteins. this pellicle is a sticky matrix that allows for bacterial attachment to the tooth. attachment beings mostly with gram positive cocci. as plaque matures, more facultative anaerobic bacteria are presentdiscribe supraginigval plaqueaccumulates after supraginigval plaque. contains more motile, gram - anaerobic than supra gingival plaque. there are also free floating or loosely adherent plaque in the pocket/sulcus.describe subginigval plaqueendotoxins, collagenase, protease, hyaluronidase, exotoxinswhat are the bacteria productsendotoxinsassociated with gram - bacterial. stimulate osteoclasts. inhibit fibroblasts and may harm neutrophils (PMNS)collagenasedirectly breaks down connective tisseusproteasedirectly breaks down tissueshyaluronidasebreaks down the extracellular matrix, allowing bacteria to detach "spreading factor"exotoxinsbacterial waste products that cause direct tissue injury. examples include hydrogen sulfite, uric acid and fatty acidsmeasure the pocket depth, measure amount of recession, add two numbers togetherhow to measure CALanterior teethattached gingival is widest wherepremolarattached gingiva is the narrowest wheresupra bony pocketsoccur above (coronal to) the alveolar crest of boneInfrabony pocketbase of the pocket is below (apical to) the alveolar crest. infrabony pockets are treated with regenerative proceduresocclusal traumawhat does not cause periodontal diseaseprimary occlusal traumaexcessive force on a tooth with normal bone supportsecondary occlusal traumainjury as the result of forces applied to a tooth that has previously experienced bone or attachment loss. rapid bone loss/pocket formation may results from excessive occlusal forces on a tooth that has bone/attachment los previouslysensitivity, wear facets, tooth migration, increased tooth mobility, widening of the PDL spacesigns and symptoms of occlusal traumaattritionwhat does wear facets meanAggregatibacter actinomycetemcomitansaggressive periodontal disease is associated with what bacteriaAggregatibacter actinomycetemcomitansrod shaped bacteriaCampylobacter rectusgram negative anaerobe associated with inflammation during pregnancyprevotella intermediaassociated with periodontal disease. a gram negative anaerobe MOST associated with inflammation during pregnancyfursobacterium nucleatumplays a critical role in biofilm formation. an anaerobic gram negative rod-shaped bacteriaTannerella forsythiaanother important pathogen in adult periodontitistreponema denticolaa spirochetefood importation, often caused by open contacts between teethanother way gingivitis can be caused