Perio
Terms
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- Steps of treatment plan, in order
- systemic, emergency, initial prep, reevaluation, surgical, restorative, finishing, reevaluation, maintenance, periodic reevaluation
- standard premed
- amoxicillin 2 gms 1 hr pre-op
- larger width of PDL would be on which side of force - tension or pressure
- tension
- injury resulting from the application of excessive occlusal forces to a tooth with normal periodontal support
- primary occlusal trauma
- injury resulting from the application of totherwise normal occlusal forces to a tooth with reduced periodontal support
- secondary occlusal trauma
- t/F occlusal trauma, w/o inflammation, does not cause loss of fibrous attchmnt to the tooth or apical migration of the epi attchmnt
- T
- Angles class - buccal groove of mand 1st perm molar articulates w/ MB cusp of max 1st perm molar
- I
- Angles class - buccal groove of mand 1st perm molar articulates post to the MB cusp of max 1st perm molar
- II
- Angles class - buccal groove of mand 1st perm molar articulates ant to the MB cusp of max 1st perm molar
- III
- injury caused in clinic
- iatrogenic
- injury caused by self
- facticial
- total biowidth, how much of each
- 2 mm, 1 mm JE attchmnt, 1 mm supracrestal fibers
- 4 strata of epithelium (bottom up)
- basale, spinosum, granulosum, corneum
- epi layer that secretes basement membrane
- basale
- epi layer that undergoes differentiation, prickle cell layer
- spinosum
- epi layer of flattening cells, producing keratohyalin protein
- granulosum
- epi layer of loose nucleus, impermeable, desquamated cells
- corneum
- # of days of epi layer from mitosis to exfoliation
- 30
- layer of epi that contains stratum corneum
- keratinized
- no submucosa, lamina propria continuous w/ periosteum
- masticatory mucosa
- 2 examples of masticatory mucosa
- gingiva, hard palate
- k or n.k.? - gingiva
- keratinized
- k or n.k.? - hard palate
- keratinized
- k or n.k.? - lining mucosa
- non-keratinized
- k or n.k.? - gingival sulcus
- non-keratinized
- k or n.k.? - junctional epi
- non-keratinized
- k or n.k.? - taste buds
- non-keratinized
- epi vascularity?
- none
- CT layer directly beneath epi
- lamina propria
- nutrient supply to epi?
- diffusion across basement membrane from CT
- epi interdigitation into CT
- rete ridges
- CT interdigitation into epi
- dermal papilla
- allow greater surface area for diffusion to epi
- rete ridges
- main fiber element of CT
- collagen 60%
- gel-like material that coats cells & collagen fibers
- intercellular ground substance
- fiber type in CT that maint tissue tone w/ memory-like rubber bands
- elastin 5%
- 3 components of intercellular ground substance
- hyaluronic acid, chondroitin sulphate, mucopolysaccharides
- junction between CT & stratum basale
- basement membrane
- loose CT layer between lamina propria & bone or muscle containing BV, glands, hair follicles, etc.
- submucosa
- helix structure of collagen
- left hand
- keratinized gingiva becomes ____ after tooth eruption
- sulcular epi
- continuous w/ gingival & junctional epi
- sulcular epi
- attaches to tooth via hemidesmosomes
- junctional epi
- functions as adhesion for JE to tooth
- intercellular ground substance
- 2 enzymes that can break biochemical attchmnt of JE
- hyaluronidase, chondroitin sulphatase
- interproximal dip of thin epi between contacting teeth
- col
- function of collagen fibers of PDL
- prevent breakdown of Sharpey's fibers via apical migration
- orients tooth in position w/in bone socket, absorbs occlusal forces, proprioception sensory
- PDL
- 6 cell types contained in PDL
- fibroblast/clast, osteoblast/clast, cementoblast/clast
- BVs in ___ supply bone, cementum & gingiva
- PDL
- collagen embedded in cementum & bone
- Sharpey's fibers
- 5 principal fiber groups of PDL
- alveolar crest, horizontal, oblique, apical, interradicular
- aka oblique fibers
- axial loading
- ging fiber group that attaches cementum to cementum
- transseptal
- ging fiber group that attaches tooth to periosteum
- dentoperiosteal
- cells in the ____ can remodel bone and ligament to accommodate forces
- PDL
- produce alkaline phosphatase
- osteoblasts
- produce acid phosphatase
- osteoclasts
- outer shell of dense, strong bone
- compact or cortical bone
- bone in contact w/ Sharpey's fibers
- alveolar bone proper or cribiform plate
- bone of main jaw, remains after extraction
- basal bone
- bone on top of basal bone to support teeth & sockets
- alveolar process
- bone forming inner wall socket, perforations allow for vascular comm w/ PDL
- alveolar bone proper, cribiform plate
- radiopacified line surrounding tooth socket
- lamina dura
- coronal aspect of bone parallel to adjacent CEJs
- alveolar crest
- thin plate of bone in interproximals of adjacent teeth
- septal bone
- V shaped defect of alveolare bone, usually buccal surface of prominent teeth
- dehiscence
- window through alveolar bone, usually on buccal surface
- fenestration
- min 2 mm of soft tissue attachmnt
- biological width
- vascularized layer of cells covering bone
- periosteum
- cementum receives nutrition via ____
- diffusion
- calcified tissue covering surface of root
- cementum
- cementum is continually deposited in ___ area
- apical
- cementum deposited during root formation & eruption
- acellular
- cementum formed after tooth eruption in apical third of root
- cellular
- % of cementum-enamel overlap
- 60
- 2 complications of CEJ
- enamel projection, enamel pearl
- loose CT tissue w/ odontoblast layer, BV & nerve supply
- pulp
- main blood supply of gingiva
- supra periosteal vessels
- 3 blood supply to gingiva
- supra periosteal vessels, vessels of PDL, septal vessels (nutrient canals)
- primary etiology of periodontitis
- bacteria
- 4 examples of bacterial morphology
- cocci, bacilli, filaments, spriochetes
- anaerobic cell that does not allow oxygen
- obligative
- anaerobic cell that can function w/ or w/o oxygen
- facultative
- most pathogenic gram staining
- negative
- functions to identify species & anitbiotic sensitivites
- culture
- 9 problems w/ micro analysis
- site specific, diminished reliability, false negatives, inability to identify pathogens by species w/ microscope, uncertainty of which organisms are pathogens, no antibiotic sensitivity w/o culture, difficult to maintain viable anaerobic cultures, time consuming, expensive
- initial % of bacteria & type prior to experiment
- 90% gram +
- # of days to increase in # of bact & shift to gram - rods & cocci
- 2
- # of days to gram - filaments & fusobacteria
- 3-4
- # of days to spriochetes & flagellated forms
- 5-9
- lipopolysaccharide
- gram -
- lipotechnoicacids
- gram +
- 3 factors influencing severity of infection
- host resistence, local factors, virulence of flora
- 3 factors influencing host resistence
- systemic disease, immune deficiency, stress
- 4 examples of local factors
- plaque control, restorations, occlusion & habits
- spell Aa
- actinobacillus actinomycetemcomitans
- complex of bacterioides forsythus, porpyromonas gingivalis, treponema denticola
- red
- complex that adheres to epi lining of pocket wall
- red
- complex associated w/ most cases of chronic perio
- red
- complex associated w/ aggressive types of perio
- orange
- may be present w/ or w/o red complex, asso w/ tissue invasion & aggressive perio
- green cluster
- complex of Aa, eikemella corrodens, capnocytophaga
- green cluster
- mass of microbes who, as a team, function to overcome host immune defenses
- biofilm
- functions as glycoprotein rain tarp
- biofilm
- foreign cell mediates immune response
- antigen
- lymphocyte released into blood if during 1st pass goes to Thymus then it become a ____, if to Peyer's patches then a ____
- T-cell, B-cell
- reside adjacent to capillary wall, increase blood flow to site
- mast cells
- function of mast cells
- detect irritants & release Histamine = vasodilation & capillary wall permeability
- 1st WBC to arrive at site, capable of chemotaxis & phagocytosis
- PMNs
- PMN standsfor
- polymorphonuclear leukocytes or neutrophils
- # of days to PMN & macrophage/monocyte arrival
- 2-4
- release hydrolytic enzymes to destroy bacteria & host tissue
- PMN
- circulating monocyte migrates through vessel wall to become a ____
- macrophage
- active chemotaxis & phagocytosis characterized by destruction of bacteria via lysosomal enzymes
- macrophage
- cells can coalesce to form foreign body giant cels
- macrophage
- leukocytes that arrive later in process
- lymphocytes
- early arriving lymphocytes become _____ to _____
- sensitized, antigen
- sensitized lymphocytes differentiate into ____ or ____ cells
- B, T
- # of days of inital differentiation of lymphocytes
- 14
- mature, sensitized B cells
- plasma cells
- produce antibody specific for bacterial antigen
- plasma cells
- immunity characterized by B-cells
- humeral
- immunity characterized by T-cells
- cell mediated
- 3 types of differentiated T-cells
- helper, killer, suppressor
- p/u antigen protein & present to macrophage
- helper T-cells
- carry antigen back to nodes to sensitize more B cells, augmenting reponse of humeral immune system
- helper T-cells
- recognize antigen & seek out foreign cells, attack specific invading cells
- killer T-cells
- doesn't destroy host tissue during battle w/ bacteria
- killer T-cells
- monitor activity of immune response & influence other classes of cells to reduce imm. activity when invader is defeated
- suppressor T-cells
- help bring host back to stable function after battle
- suppressor T-cells
- some reside in nodes after inital attack to enhance future response
- B-cells
- soluable proteins secreted by cells as messaenger molecules influencing other cells
- cytokines
- example of cytokine produced by both B & T-cells
- interleukin
- proinflammatory cytokine that induces osteoclast activation
- interleukin-1
- primary class of immunoglobin in perio
- IgG
- antibodies are produced by ____
- plasma cells
- The F-ab end binds ____, the F-c end binds ____
- antigen, complement/macrophage
- system of 9 proteins in blood w/ profound immunological effects
- complement
- group together on F-c end of IgG antibody forming macroprotein to rupture cell wall
- complement
- complement that induces PMN degranulation resulting in increased inflammation
- C3, C5
- profound mediators of inflammation
- prostaglandins
- phospholipids produced by PMNs & macrophages
- prostaglandins
- most potent bone resorbing agent
- PGE2 (prostaglandin E2)
- most potent chemotactic agent, attracts PMNs
- LtB4 (leukotrine B4)
- only essential fatty acid
- arachnidonic acid
- example of matrix metalloproteinases (MMPs)
- collagenase
- released from pts own PMNs & macrophages, destroys tissue
- collagenase
- approx 60% of pts w/ aggressive forms of perio exhibit ____
- leukocyte dysfunction
- results in decreased migration & hyper-reactiveness to bacterial antigens, inherited
- leukocyte dysfunction
- test for increased bone loss due to release of too much interleukin-1 in response to bacterial anitgens
- PST (perio susceptibility)
- constricts blood vessels & has negative impact on immune system
- epinephrine
- lack of ability to ____ w/ stress can be determining factor of perio
- cope
- 2 theories of stress in perio
- behavioral, psychoneuroimmunological
- 3 indicators of behavioral stess
- denial, failure to seek Tx, increased smoking
- stress theory of hormonal influence aggravating inflammation
- psychoneuroimmunological
- 2 steroids released that are stress induced
- glucocorticoids, epinephrine
- lesion w/ mast cell degradation, exudation of crevicular fluid, increased capillary permeability, migration of PMNs & macrophages
- initial
- days to initial lesion
- 2-4
- lesion w/ alteration of cornoal cells into JE, perivascular collagen reduced to 60-70%
- initial
- lesion of increased exudate, pmns & macrophage 90% occupation of CT volume
- early
- days to early lesion
- 7-14
- lesion of pathological changes in fibroblasts, further loss of collagen & beginning proliferation of JE
- early
- lesion of plamsa cells & lymph, chronic inflammation, immunoglobin in tissue
- established
- days to established lesion
- >14
- lesion of apical migration of JE & early pocket formation w/o much bone loss
- established
- lesion of persistent chronic inflammation, extension of lesion into alveolar bone & PDL
- advanced
- days to advanced lesion
- months - years
- lesion of attchmnt loss & further pocket formation, conversion of bone to fibrous CT, periods of quiescence & exacerbation
- advanced
- 4 stages of perio lesion
- initial, early, established, advanced
- 8 components of bacterial toxonomy
- morphology, metabolism, gram staining, motility, dark field microscopy, immunofluorescent staining, DNA analysis, culture techniques
- 12 steps of prognosis of tooth
- amt&distribution of remaining bone, attchm't loss, furcations, crown-root ratio,tooth&root anatomy,relation to otherteeth&structures,mobility,future use,soundness of surrounding teeth,caries severity,occlusion,etiological factors
- 4 classifications of prognosis
- good, fair, poor, hopeless
- 12 steps of prognosis of dentition
- desire of pt,#&loc of remaining teeth,amt of gen bone loss,relationship of bone loss-age,response to previous tx,chronology&actv of disease,systemic health,occlusion,habits,avail of tx & maint care, summarized px of individual teeth
- Prognosis 1st based on what 2 factors
- neg PST, non-smoker