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Flashcards in this deck (96)

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  • Why is a classification system used for periodontal and peri-implant diseases?

    It provides a framework to study these diseases in an organized manner.

    periodontology classification

  • Why must classification systems for diseases be updated regularly?

    As scientific knowledge and understanding of disease cause and pathogenesis increase, classification systems must be aligned and updated.

    periodontology pathogenesis

  • Which of the following is categorized under 'Peri-Implant Diseases and Conditions' in the 2017 classification?

    Periodontitis

    Mucogingival Deformities

    Peri-Implantitis

    Necrotizing Periodontal Diseases

    periodontology classification

  • Which category of conditions includes 'Systemic diseases or conditions affecting the periodontal supporting tissues'?

    Peri-Implant Diseases

    Periodontitis

    Other Conditions Affecting the Periodontium

    Periodontal Health

    periodontology classification

  • What are the two major divisions under 'Periodontal Diseases and Conditions'?

    Peri-Implant Health; Peri-Implantitis

    Periodontitis; Other Conditions Affecting the Periodontium

    Gingivitis; Necrotizing Periodontal Diseases

    Periodontal Health, Gingival Diseases and Conditions; Periodontitis

    periodontology classification

  • What is the primary aetiological factor of gingivitis?

    The presence of microbial biofilm.

    gingivitis etiology

  • Which of the following is considered a systemic modifying risk factor for dental plaque-induced gingivitis?

    Prominent restoration margins

    Hyperglycemia

    Dental plaque biofilm retention

    Oral dryness

    gingivitis risk-factors

  • List the three patient categories for dental biofilm induced gingivitis.

    • Patients with an intact periodontium (no attachment loss)
    • Patients with reduced periodontium (attachment loss not due to periodontitis)
    • Patients with reduced periodontium in successfully treated periodontitis
    gingivitis classification

  • Define biofilm-induced gingivitis in terms of physiological response.

    It is an inflammatory response of the gingival tissues resulting from bacterial biofilm accumulation near and below the gingival margin.

    gingivitis pathology

  • Which of the following is categorized as a predisposing local risk factor for dental plaque-induced gingivitis?

    Puberty

    Smoking

    Hyperglycemia

    Oral dryness

    gingivitis risk-factors

  • What broad body reaction occurs in response to trauma or bacterial infection?

    An inflammatory response.

    physiology inflammation

  • What are the primary clinical characteristics of gingivitis?

    • Gingival redness
    • Oedema
    • Absence of periodontal attachment loss
    gingivitis pathology

  • Why is the control of gingivitis essential for the prevention of tooth loss?

    Gingival inflammation is a key risk factor for the onset of periodontitis, a condition that causes attachment loss and eventually leads to tooth loss.

    gingivitis periodontitis prevention

  • How is gingivitis typically diagnosed?

    It is a purely clinical diagnosis based on professional assessment, as there are no standard microbiological or molecular tests performed during routine clinical examinations.

    gingivitis diagnosis

  • What is the distinction between a symptom and a sign in the context of gingivitis?

    A symptom is a subjective experience reported by the patient, while a sign is objective evidence observable by others.

    gingivitis terminology

  • List common symptoms reported by patients with gingivitis.

    • Bleeding on brushing or flossing
    • Red and swollen gums
    • Bad taste or breath
    • Soreness
    • Difficulty eating
    • Altered taste sensation
    gingivitis symptoms

  • What are the clinical signs of gingivitis that a clinician would observe?

    • Increased BOP (Bleeding on Probing)
    • Erythema
    gingivitis signs

  • Is gingivitis typically a painful condition?

    No, it is usually painless despite being an inflammatory disease.

    gingivitis pathology

  • Why are radiographs not used to diagnose gingivitis?

    Gingivitis is limited to the gingival soft tissues and does not cause attachment loss or alveolar bone loss.

    diagnosis periodontology

  • What are the clinical signs and symptoms of gingivitis?

    • Oedema and loss of contour/consistency
    • Presence of biofilm and calculus
    • Smell of halitosis
    • Discomfort on probing
    symptoms gingivitis

  • What is the clinical case definition of a patient with an intact periodontium?

    • No probing attachment loss
    • No pocket depth greater than \(3\) mm
    • No recession
    • No radiographic bone loss
    diagnosis periodontology

  • What is the Bleeding on Probing (BOP) score threshold for localized gingivitis in an intact periodontium?

    \(≤ 10\)%

    \(≥ 50\)%

    \(> 30\)%

    \(≥ 10\)%, \(≤ 30\)%

    diagnosis periodontology

  • What is the Bleeding on Probing (BOP) score threshold for generalized gingivitis in an intact periodontium?

    \(≥ 10\)%, \(≤ 30\)%

    \(> 30\)%

    \(≤ 10\)%

    \(> 50\)%

    diagnosis periodontology

  • Can a patient with a reduced periodontium exhibit gingival recession without having periodontitis?

    Yes, for example, due to the effects of orthodontic treatment.

    periodontology recession

  • What Bleeding on Probing (BOP) percentage defines localized gingivitis in a reduced periodontium?

    \(10\% \le \text{BOP} \le 30\%\)

    periodontics gingivitis

  • What Bleeding on Probing (BOP) percentage defines generalized gingivitis in a reduced periodontium?

    \(\text{BOP} > 30\%\)

    periodontics gingivitis

  • What is the only objective measure available to assess the extent of gingival inflammation?

    Bleeding on Probing (BOP)

    dentistry diagnosis

  • What components should be included when writing a diagnostic statement for gingivitis?

    • Whether it is localized or generalized BOP
    • The disease name (gingivitis)
    • Additional details (e.g., biofilm association or specific mediation like pregnancy or leukemia)
    dentistry diagnosis

  • Why is the severity of gingivitis no longer formally defined in clinical practice?

    It relies on highly variable clinical signs like colour and swelling, and lacks objective clinical criteria.

    dentistry gingivitis

  • What is the probing depth criterion for a diagnosis of gingivitis in a reduced periodontium?

    Probing depth of \(\le 3 \text{ mm}\)

    periodontics gingivitis

  • What are the clinical signs of moderate gingivitis?

    • Pronounced bleeding on probing (BOP)
    • Swelling
    • Obvious loss of stippling
    gingivitis pathology

  • What are the clinical signs of severe gingivitis?

    • Copious bleeding on probing (BOP)
    • Potential spontaneous bleeding
    • Loss of stippling
    • Redness of gingiva
    gingivitis pathology

  • How does the bacterial composition of biofilm change as it matures and gingivitis develops?

    It shifts from relatively simple communities dominated by gram-positive cocci and rods to increasingly complex communities, trending from aerobic to anaerobic and gram-negative bacteria.

    pathogenesis biofilm

  • What is the result of removing bacterial biofilm in the context of gingival inflammation?

    Removal of bacterial biofilm leads to the resolution of gingival inflammation.

    pathogenesis gingivitis

  • How do oral hygiene practices influence the plaque index?

    Stopping oral hygiene practices causes the plaque index to increase, while continuing or restarting practices causes the plaque index to decrease.

    pathogenesis hygiene

  • What characterizes early bacterial biofilm in a healthy state?

    It consists of relatively simple bacterial communities dominated by gram-positive cocci and rods.

    biofilm health

  • Which Gram-negative bacterial genera are positively correlated with the development of gingivitis?

    • Campylobacter
    • Fusobacterium
    • Lautropia
    • Leptotrichia
    • Porphyromonas
    • Selenomonas
    • Tannerella
    microbiology gingivitis

  • What structure acts as a biological seal at the site of the gingival epithelium?

    The junctional epithelium.

    anatomy periodontology

  • What is the typical timeframe for changes in microvascular structures within gingival tissue after exposure to biofilm?

    Within 24-48 hours.

    pathology gingivitis

  • Which of the following is a factor that can give dental biofilm a competitive advantage over host defenses?

    Increased saliva production

    Open proximal contact

    Healthy junctional epithelium

    Frequent tooth brushing

    pathology biofilm

  • Which immune cells are present even in clinically healthy gingiva?

    PMNs and lymphocytes.

    immunology gingiva

  • Upon entering the sulcus opening, what specific immune components do microorganisms first encounter?

    • Gingival crevicular fluid (GCF)
    • Plasma factors (complement system and antibodies)
    immunology periodontology

  • What is the consequence of allowing supragingival biofilm to accumulate without disruption?

    It irritates the sulcular epithelial cells.

    dentistry periodontology

  • List the metabolites produced by the bacteria of supragingival biofilm.

    • Fatty acids
    • Peptides (FMLP)
    • LPS
    dentistry microbiology

  • How does the immune system respond to LPS present in the sulcus region?

    It recognizes LPS as an antigen and initiates an inflammatory response.

    immunology dentistry

  • Which inflammatory mediators are released by sulcular and junctional epithelial cells in response to biofilm products?

    • Interleukin 8 (IL-8)
    • Interleukin 1 alpha (IL-1\(\alpha\))
    • Prostaglandin E (PGE)
    • TNF alpha (TNF\(\alpha\))
    immunology dentistry

  • In reaction to cytokines, what substances do gingival tissues produce?

    Neuropeptides and histamine.

    dentistry histology

  • What is the function of histamine in the local vascular reaction?

    It causes local capillaries to open up.

    physiology dentistry

  • How does histamine release by mast cells assist in the immune response?

    It widens capillaries and slows blood flow, which allows PMNs to get closer to the vessel wall.

    immunology dentistry

  • What are the two pathways by which bacterial metabolites trigger PMN recruitment?

    • Direct pathway: Bacterial LPS or outer membrane proteins directly react with endothelial cells.
    • Indirect pathway: Macrophages release proinflammatory cytokines (such as IL-1 and TNF-alpha) upon contact with bacterial products, which then affect endothelial cells.
    immunology pmn recruitment

  • What is the function of the adhesion molecule ELAM-1 expressed on the surface of endothelial cells?

    It causes PMNs (polymorphonuclear leukocytes) to roll along the endothelium.

    immunology adhesion elam-1

  • Which specific receptor interaction facilitates stable contact between PMNs and the endothelium?

    The interaction between the leukocyte adhesion receptor integrin beta 2 and the endothelial integrin ICAM-1.

    immunology pmn receptors

  • Through what process do PMNs leave blood vessels after contacting the endothelium?

    Amoeboid diapedesis.

    immunology diapedesis pmn

  • Which chemical factors form the gradient that guides PMN migration towards the sulcus?

    Chemotactic factors including FMLP and IL-8.

    immunology chemotaxis pmn

  • Which cells release chemotactic factors such as FMLP and IL-8 in response to biofilm?

    Junctional epithelial cells.

    immunology biofilm epithelial

  • What components support PMNs in the sulcus to assist in the phagocytosis of bacteria and their products?

    Complement and antibodies.

    immunology phagocytosis sulcus

  • What is the primary immune response to increased biofilm accumulation in clinically healthy-looking gingiva?

    A constant PMN (polymorphonuclear leukocyte) reaction.

    dentistry gingivitis immunology

  • What condition occurs when dental biofilm continues to grow beyond the initial accumulation phase?

    The first histological signs of gingivitis.

    dentistry gingivitis

  • What triggers the increased recruitment and migration of PMNs through the junctional epithelium?

    The accumulation of bacterial metabolites.

    dentistry immunology biofilm

  • How do PMNs interact with dental biofilm to protect gingival tissues?

    PMNs form a dense palisade layer over the biofilm, engulfing bacteria to separate them from the gingival sulcus.

    dentistry immunology biofilm

  • What happens when the PMN barrier is overwhelmed by continuous biofilm growth?

    The inflammatory response intensifies, leading to the increased release of inflammatory substances by tissues and PMNs.

    dentistry inflammation immunology

  • What physiological processes are regulated by pro-inflammatory cytokines?

    They regulate cell proliferation, cell growth, cell activation, inflammation, immunity, and repair.

    inflammation cytokines immunology

  • What is the typical volume percentage of the free gingiva occupied by an infiltrate in early gingivitis?

    It occupies about 10-15% of the volume of the free gingiva.

    gingivitis pathology

  • What is the cellular composition of the infiltrate in an early gingivitis lesion?

    It consists of 75% T-cells, activated macrophages, and a few plasma cells.

    gingivitis immunology

  • What vascular changes cause the redness observed in the gingival margin during early gingivitis?

    The redness is caused by an increase in both the size and the number of vascular units due to the opening of previously inactive capillary beds.

    gingivitis vascular

  • What causes the influx of plasma proteins, such as acute phase reactants and complement, into the connective tissue?

    The influx is caused by an increase in vascular permeability.

    gingivitis vascular

  • What is the effect of PMN-related micro abscesses on the gingival sulcus?

    They cause the sulcus to begin to deepen.

    gingivitis periodontology

  • Why do the basal cells of the junctional epithelium proliferate in early gingivitis?

    They proliferate as an attempt by the body to enhance the mechanical barrier against biofilm bacteria and their products.

    gingivitis epithelium

  • What enzyme is responsible for breaking down collagen fibers within a lesion?

    MMP (Matrix Metalloproteinase)

    periodontology lesion

  • How long of undisturbed biofilm accumulation is required for an established lesion to develop in adults?

    2-4 weeks

    periodontology biofilm

  • What occurs to the bacterial population as a biofilm grows and matures in the periodontal tissues?

    There is a shift from gram-positive to more gram-negative bacteria.

    periodontology bacteria

  • What function does the PMN wall perform in an established lesion?

    It acts to separate the biofilm from the periodontal tissues.

    periodontology pmn

  • Which cells coordinate the inflammatory response in the infiltrate by releasing cytokines?

    Activated T cells

    immunology periodontology

  • What is the result of B cell differentiation in the inflammatory infiltrate?

    They turn into plasma cells and produce immunoglobulin gamma antibodies and cytokines.

    immunology b-cells

  • What characterizes tissue homeostasis in healthy periodontal tissue?

    A balance between the synthesis and resorption of the extracellular matrix and collagen.

    physiology homeostasis

  • Which mediators help fine-tune the balance of tissue homeostasis?

    Cytokines, growth factors, prostaglandin E2, MMP, and TIMP

    Only PMNs and lymphocytes

    Only biofilm and gram-negative bacteria

    Only growth factors and vitamins

    homeostasis mediators

  • What substance do macrophages release during gingivitis that leads to the destruction of collagen and the extracellular matrix?

    MMP (Matrix metalloproteinases)

    gingivitis macrophages pathology

  • How do macrophages alter fibroblast activity during gingivitis?

    They stimulate fibroblasts to secrete destructive mediators like MMP instead of producing collagen.

    gingivitis fibroblasts pathology

  • Why does a pseudopocket form during gingivitis?

    The sulcus deepens because the junctional epithelium (JE) cells attempt to move away from the bacteria.

    gingivitis periodontology anatomy

  • Why is the gingival pocket formation during early gingivitis called a 'pseudopocket'?

    Because the base of the junctional epithelium (JE) still covers the cemento-enamel junction (CEJ).

    gingivitis periodontology

  • What type of bacteria thrive in the subgingival region after the formation of a pseudopocket?

    Anaerobic bacteria

    microbiology gingivitis

  • What defines the transition from longstanding gingivitis to destructive periodontitis?

    Changes in the pathogenic potential of the biofilm, shifts in the host immune response, and the presence of risk factors.

    periodontitis pathology gingivitis

  • What is the full term for the abbreviation \(LPS\) as used in immune signaling?

    Lipopolysaccharide

    immunology abbreviations

  • What does the abbreviation \(TIMP\) represent in the context of biological mediators?

    Tissue inhibitors of MMP

    biology abbreviations

  • What clinical signs are associated with the proliferation of blood vessels and vasodilation during gingival inflammation?

    • Color change
    • BOP (Bleeding on Probing)
    • Exudate and GCF
    • Swelling and contour loss
    • Retractability and loss of stippling
    periodontics gingivitis pathology

  • What is a 'pseudopocket' in the context of periodontal assessment?

    A pocket measurement of up to 4mm caused by gingival swelling rather than true attachment loss.

    A pocket resulting from the complete destruction of collagen fibers inserted into the cementum.

    A clinical sign indicating the loss of all stippling and retractability in healthy periodontium.

    A deep pocket formed exclusively by bacterial biofilm accumulation under the CEJ.

    periodontics diagnostics

  • What physiological change occurs in the JE (junctional epithelium) within the first 4 days after removal of bacterial biofilm?

    Repair of the junctional epithelium (JE) and a reduction in the number of polymorphonuclear leukocytes (PMNs) in the sulcus tissue.

    periodontics healing

  • What clinical improvements are typically reported by a patient 4 days after biofilm removal?

    The mouth feels fresher, often with a reduction in bad taste or breath.

    periodontics patient-care

  • Approximately how long after biofilm removal does a reduction in vascular permeability and chronic inflammatory infiltrate typically occur?

    21-28 days

    1-2 days

    4 days

    7-14 days

    periodontics healing

  • What happens to gingival tissues during the healing process as fibroblast numbers and collagen increase?

    Tissues become firmer and more resistant to probing.

    dentistry healing

  • What is the typical clinical sign of healing after 7-14 days?

    • Decreased redness
    • Reduced BOP (bleeding on probing)
    • Decreased oedema
    • Decreased tissue retractability
    • Decreased pocket depth
    dentistry clinical

  • What histopathological changes occur at 4+ days of healing?

    • Repair of junctional epithelium
    • Reduced number of polymorphs in tissue and sulcus
    dentistry histopathology

  • Are tissue alterations in gingivitis reversible?

    Yes, all tissue alterations that occur during gingivitis are completely reversible once the dental biofilm is removed.

    dentistry gingivitis

  • What characterizes periodontitis regarding attachment loss?

    Once attachment loss occurs, it is irreversible.

    dentistry periodontitis

  • What is considered the key risk factor for the onset of periodontitis?

    Any inflammation in response to biofilm accumulation.

    dentistry prevention

  • Why is the control of gingival inflammation essential?

    It is absolutely essential for the primary prevention of periodontitis.

    dentistry prevention