Questions Perio

7/25/2019 Questions Perio

1/9

KNOW your bacterial byproducts (like

liposaccarides from G- and

Lipotechoic acids from G-) and

immune products (like prostglands, TNF, MMP)!

Which of the following is signs of gingivitis? (Bleeding. Not loss of attachment or

deep pockets)

Gingivitis Periodontitis

Colour change- red

Contour

Consistency of gingiva

Bleeding

inflammation

Inflammation spread beyond gingiva

Marginal alveolar bone resorption

Continued degradation of collagen

fibres (apically)

Deepened periodontal pocket

ANSWER: NOT ATTACHMENT LOSS

What inflammatory mediator causes osteoclast activity

ANSWER: PGE2,IL -1, TFNa

What directly leads to bone resportion?

ANSWER: Inflammatory mediators triggering osteoclast action

What did Salvy et al study find regarding smoking over 3 weeks

ANSWER: Smokers and non smokers have the same initial stages

Which of these diseases is not linked to periodontitis

Pregnancy

COPD

Diabetes

low pre-term birth weight

ANSWER: SQUAMOUS CELL CARCINOMA)

What is the primary goal of periodontal therapy ANSWER: Make the oral environment compatible with health

o remove calculus or reduce inflammation

Which of these is not secreted by bacteria

Protease- release by colonies instead of inflammatory response

Lipopolysaccharideve

Leukotoxins- target WBC

Lipteichnoic acid- +ve

ANSWER: liposacchyries, Tumour Necrosis Factor, etc)


2/9

Which of the following is not an inflammatory mediator

ANSWER: lipotechoic acid

What is characterised in the initial phaseby Page & Schoder?

ANSWER: blood vessel vascularity)

What is biofilm: PLAQUE is a biofilmSOFT ADHERENT STRUCTURED DEPOSITS On THE TEETH AND OTHERSTRUCTURES IN THE MOUTH, CONSISTING OF A CONTINUALLY GROWINGMICROBIAL COLONY IN AN INTER-MICROBIAL MATRIX.

What is not part of the periodontium?

a. Investing & supportive structures

b. Cementum-support fibres of the periolegament

c.

PeriodontialLigament- attachment apparatusd. Alveolar bonee. Gingiva, protection of underlying tissues

Cementum? What does it do?

f. Supports fibres of the PDL

g. Harder than dentin

h. Has acellular & cellular componentsi.

None

j. All of the above

2.

Which one is not a periodontial classification?a. Refractory periodontitis

What are things that can modify chronic periodontitis

Modifying factors or associated with systemic diseases(e.g. diabetes, HIV).

Other modifying factors: cigarette smoking and emotional stress

Chronic periodontitis:

1. Localised

2. Aggressive

Infectious disease = inflammation of supporting structure (tissue, teeth, progressive attachment loss)

Characterised:o

Pocket formation

o Gingival recession

Clinical features & charcteristics:o Prevalence adults/ ?occurs children

o Amount destruction = consistet with local factors

o Subgingival calculus = present (frequent finding)

o Slow to moderate rate of progression Periods: rapid progression

Further classified:

a. LOCALISED: 30% sites are affected

c. Mild slight 1-2mm clinical attachment loss (CAL)

d.

Moderate: 3-4mm (CAL)e. Severe: >4mm (CAL)


3/9

PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE:

haematological disorders:

o Acquired neutropenia

o Leukemia

Associated with genetic disorders:

o

Cyclic neutropeniao Downs syndrome

o Leukocyte adhesion deficiency syndrome

o Papillion-Lefevre syndrome

o Histiocytosis

o Cohen syndrome

o Hypophosphatasia

o Glycogen storage disease

o Infantile genetic agranulocytosis

o Ehlers-Danlos syndrome (types IV and VIII)

What is characterised in the established phase by Page & Schoder?

plasma cells dominate

Which bacteria are/arent part of the RED PYRAMIDa. T. forsyth

b. T. denticola

c. P.gingivalis

When is plaque mature enough to cause inflammation?Takes around 21 days for plaque to be mature enough to incite and inflammatoryresponse from the host

Antigenic bacteria products are:a. Protease- release by colonies instead of inflammatory response

b. Lipopolysaccharideve

c. Leukotoxins- target WBC

d. Lipteichnoic acid- +ve

Features of aggressive periodontitis

b. rapid bone distruction

which is not associated with periodontitis in a systemic disease?c.

Squamous cell carcinoma

Chronic vs aggressive periodontitis which is not true?d. Aggressive periodontitis is not consistent with local factors

What are the main inflammatory mediators:a. Cytokinesb. Prostaglandinsc. Interleukinsd. Tumour necrosis factor

e. Liptotic acid: antigenic bacteria- product not mediator

Which disease is not associated:

Ans: Squamous cell carcinoma


4/9

What is a biofilm?a.

Food mass

b. Supragingival accumulations

c. Microbial colony deposits on the teeth

What are bacteria in disease?

e. Gramve

f. Anaerobic bacteria

g. P. gingivalis

h. T. denticola

i. A.actinomycetemcomitans

Which bacteria are found in health

ANSWER: aerobes and gram postitive)

What angle do you hold a scaler

ANSWER: 60-80degree

What is the difference between Gracey and Universal scalers

ANSWER: universal have two working sides on each end

gracey have one)

Which is a *fancy word for definite confirming indicator* of periodontitis

ANSWER: irreversible attachment/bone loss, NOT bacteria, inflammation etc)

Classifications of periodontal diseasethey asked which one wasnt an existing

classification

ANSWER: Refractory ..

Differences of the features of Gingivitis and Periodontitis e.g. bone loss, loss of

attachment, bacteria assoc., with perio; and gingivitis has bleeding gums, know the

bacteria assoc. as well.

When does gingivitis occur?

ANSWER: 2-3 days without mechanical removal of plaque

How do you treat chronic perio?

ANSWER: with mechanical removal of plaque, not sure if it was right though

Main pathogonomic finding of periodontitis

ANSWER:bone loss


5/9

Primary goal of perio therapy

ANSWER: stop the inflammation and bleeding

What is the next phase of treatment for PSR of 2? PSR 2 has calculus, so I think

the answer was something along the lines of OHI, mechanical debridement and oneother thing that I forgot

KNOW the different types of bacteria in the biofilm:

a. In health

b. And in periodontal disease

KNOW which bacteria are in Socranskys (?) red complex of the pyramid in the

pyramid picture these are at the tip of the apex

What do cytokines do?

What causes the production of antibodies? plasma cells

Which of the following is an osteoclast stimulator?just to be safe, the ones he

talks about are PGE2, IL-1 and TFNa

Causes of tooth mobility bruxism is NOT a factor

What is the definition of a modifying factor?

Which of the following are predisposing factors? overhangs

What are the effects of uncontrolled diabetes

KNOW about aggressive perio


6/9

1.

Perio can cause:a. Can cause cardiovascular disease through a variety of pathological

mechanisms

b. Can cause cardio through spread of bacteria from subgingival plaque

c. Can cause artheroma on vessel

WHICH SYSTEMIC DISEASES HAVE BEEN ASSOCIATED WITH

PERIODONTAL DISEASE?1.

Cardiovascular disease

2. Pulmonary disease COPD and Bacterial pneumonia

3.

Low birth weight and preterm pregnancy4. diabetes

2. What is the most appropriate Tx for a Max molar grade III furcation?

a. Resection (root amputation), tunnel exo

b. GTR

c. Crown lengthening

d. ?

WHAT ARE THE MAIN TREATMENTS FOR FURCATION

INVOLVEMENTSeverity Tx options

Class I Non-surgical therapy (ARP)

Furcation plasty

Class II SRP

Furcation plasty

Regeneration (Mandibular molars)

Resectve surgeries (root resection/hemi-

section)

Tunnel preparation

Extraction

Class III SRP

Resective surgeries

Tunnel preparation

extraction

3. What is the most appropriate Tx for a Mand molar Grade III furcation?

a.

Occlusal splinting

b.

Crown lengthening

c.

Fill furcation

d.

tunnel prep


7/9

4.

What is GTR?

a. The repopulation of defected cells derived from PDL and bone at the

expense of gingval epithelium and CT

WHAT ARE THE BIOLOGICAL PRINCIPLES BEHIND:

GUIDED TISSUE REGENERATION

GTR by excluding the epithelium and preventing it from attaching to the root

surface therefore allowing development of PDL, cementum and bone.

EMDOGAIN

EMD uses the porcine foetal amelogenin which promotes PDL fobroblast

proliferation and inhibits epithelial proliferation

NOTE* Both seek to mimic the natural embryonicdevelopment of theperiodontium.

5. Which of the following is correct regarding chemical plaque control?

a. Long term substitute to tooth-brushing

b. Short term sub to toothbrushing i.e. after perio surgery

c. Essential in everyday use

d. Reduces perio disease

6.

When do you use Perio surgery?a.

No improvement after hygienic phase

b.

Poor oral hygiene

c.

Improvement after hygienic phase

d.

Pocket depths greater the 5mm

WHAT ARE THE INDICATIONS FOR PERIODONTAL SURGERY

1. Areas with irregular bony contours, deep contours and other defects.

2. Pockets on teeth which prevent complete removal of plaque, commonly

molars (deep pocket depths)

3.

Grade II or III furcation involvement4.

Infrabony pockets on distal side of last molars

5. Persistant inflammation that is unresponsive to non-surgical treatment


8/9

WHEN DO WE USE PERIODONTAL SURGERY FOR THE TREATMENT

OF PERIODONTITIS?1.

When conservative non-surgical treatment has failed, after phase 1 therapy

(scaling and root planning)

2.

Assessed at the review session 1-3 months after treatment.

7. What is regeneration of tissue?

a. Reconstruction of periodontial tissue, PDL, cementum and bone over a

disease root surface

WHAT S THE DEFINITION OF PERIODONTAL REGENERATION & HOW

DOEA IT DIFFER FROM OTHE TYPES OF PERIODONTAL HEALING?

1.

REGENERATIONis defined as a reproduction or reconstitution of a lost orinjured part in such a way that architecture and function are completely

restored. Histologically characterised by restoration of all of the tooths

supporting tissues including alveolar bone, PDL and cementum over a

diseased root surface.

2. HEALING is restoration of new tissue that does not replicate the structure

and function of the lost tissue. Eg the formation of an elongated epithelial

junction but there is no PDL, cementum or bone replacement.

3. NEW ATTACHMENT- is the reunion of connective tissues with a

pathologically exposed root surface that is deprived of its periodontal ligamentand may or may not include new cementum

8. What is different about the bone around an implant?

a. no PDL

b. Incr elasticity

c. Harder bone

d. More blood supply

9. What is different about the soft tissues around an implant?

a. No CT

b. No blood vessel

c. NO inserting fibres

10.What is the treatment for a perio-endo lesion?

a.

b. Endo Tx then Perio is the lesion reduces in size

c. Endo then Perio is necessary

d. Perio then Endo


9/9

11.What are the common side effects of periodontal surgery?

a. Root sensitivity and recession

b. Gingival hyperplasia and pain

c. Pain and infection

d.

?

12.What is involved in the maintenance of implants?

a. Radiograph and OH frequently

b. Refer to specialist

c. Clinical exam

d. Clinical and radiographic exams frequently

13.

Grade II furcation is:a. Horizontal bone loss 3mm through furcation

b.

Horizontal bone loss 3mm through furcation and bleeding on probing

c. Horizontal bone loss 3mm through furcation and does not

penetrate all the way through

d.

Probe penetrates all the way through

14.The prognosis of 44

a. Good, secure

b.

Doubtful

c.

Bad, irrational to Tx

15.

37

16.21

17.28

18.What type of Perio does this pt have?

a. Chronic generalised gingivistis

b. Chronic localised ging

c. Chronic generalised perio

d.

Chronic localised perioe. Aggressive perio

19.What is the Tx for the pt

a. Disease info, OHI, S/C, review

b. Disease info, OHI, CHX for 4 week, S/C, review

c. OHI, S/C, review

d. Disease info, OHI, antibiotics, S/C, review

e. Disease info, OHI, occlusal splinting and stabilisation, S/C, review

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Questions Perio