DD - Till Page 100. - Perio
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Questions and Answers

What is the ultimate goal of periodontal treatment?

  • Removal of tooth-supporting bone
  • Regeneration of lost periodontal tissues (correct)
  • Reshaping of bone
  • Pocket reduction

    • What type of defects has the best prognosis for osseous regeneration?

  • One-wall defects
  • Wide, shallow two-walled defects
  • Interdental craters
  • Defects with three bony walls and are deep in nature (correct)

    • What is the purpose of osteoplasty in osseous resective surgery?

  • Removal of tooth-supporting bone
  • Reshaping bone without removing tooth-supporting bone (correct)
  • Flattening of the interproximal bone
  • Gradualizing marginal bone

    • What is the role of the remaining available bone in osseous regeneration?

    <p>It acts as a matrix for the development of new osseous tissue</p> Signup and view all the answers

    What is the purpose of guided tissue regeneration (GTR) in periodontal treatment?

    <p>To allow for the repopulation of a periodontal defect by cells capable of forming new connective tissue attachment and alveolar bone</p> Signup and view all the answers

    What is the interface between the newly regenerated bone and the previously diseased root surface composed of?

    <p>New periodontal ligament fibers engaging new cementum</p> Signup and view all the answers

    What is the purpose of a lateral pedicle graft in the treatment of gingival recession?

    <p>To cover the exposed root</p> Signup and view all the answers

    What is the difference between osteoplasty and ostectomy?

    <p>Osteoplasty involves reshaping bone without removing tooth-supporting bone, while ostectomy involves removal of a small amount of tooth-supporting bone</p> Signup and view all the answers

    What is an advantage of the lateral pedicle graft over other surgical procedures?

    <p>Tissue color and morphology blend with the healed surgical site</p> Signup and view all the answers

    What is a common indication for the lateral pedicle graft?

    <p>Isolated, deep, narrow defects</p> Signup and view all the answers

    What can accumulate in pseudopockets in the maxillary tuberosity region?

    <p>Plaque</p> Signup and view all the answers

    What are the three main causes of gingival enlargement?

    <p>Inflammation, medications, and systemic diseases or conditions</p> Signup and view all the answers

    What is the goal of osseous resective surgery?

    <p>To reshape the bone to resemble that of the alveolar process undamaged by periodontal disease</p> Signup and view all the answers

    What is a classification of flaps based on?

    <p>Bone exposure after flap reflection, placement of the flap after surgery, and management of the papilla</p> Signup and view all the answers

    What type of incision involves the least amount of tissue loss?

    <p>Sulcular incision</p> Signup and view all the answers

    What is a characteristic of a papilla preservation flap?

    <p>It incorporates the entire papilla in one of the flaps</p> Signup and view all the answers

    What is a type of horizontal incision?

    <p>Internal bevel incision</p> Signup and view all the answers

    What is the main reason why regenerative surgery may be considered the best treatment choice in deep, one-wall intrabony defects?

    <p>Osseous resective surgery may require a large amount of bone removal compromising the prognosis of the most uninvolved root</p> Signup and view all the answers

    Which of the following bacteria are associated with periodontitis?

    <p>Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans</p> Signup and view all the answers

    What is the main difference between the Nonspecific Plaque Hypothesis and the Specific Plaque Hypothesis?

    <p>The presence of specific pathogenic microorganisms</p> Signup and view all the answers

    What is the term for the thin layer of bacteria that harbors pathogenic types of bacteria when left undisturbed?

    <p>Biofilm</p> Signup and view all the answers

    What is the role of collagenase in periodontal disease?

    <p>It degrades collagen</p> Signup and view all the answers

    What is the primary function of antibodies or immunoglobulins in response to oral bacteria?

    <p>To enhance phagocytosis and neutralize bacterial toxins</p> Signup and view all the answers

    What is the characteristic of the microbial flora in a clinically healthy periodontium?

    <p>Predominantly gram-positive facultative cocci and rods</p> Signup and view all the answers

    What is the component of the gram-negative bacterial cell wall with significant pathogenic potential?

    <p>Lipopolysaccharide (LPS)</p> Signup and view all the answers

    What is the most likely source of bacteria found in diseased periodontal tissue?

    <p>Subgingival plaque</p> Signup and view all the answers

    What is the term for the group of bacteria that includes Treponema denticola, Tannerella forsythia, and Porphyromonas gingivalis?

    <p>Red complex</p> Signup and view all the answers

    What is the effect of plaque accumulation on the severity of gingivitis?

    <p>It increases the severity of gingivitis</p> Signup and view all the answers

    What is the primary factor in determining the location of incisions in periodontal flap surgery?

    <p>All of the above</p> Signup and view all the answers

    What is the main purpose of distal wedge procedures in periodontal flap surgery?

    <p>To reduce pocket depth</p> Signup and view all the answers

    In which area is the distal wedge procedure contraindicated?

    <p>Retromolar area with insufficient space</p> Signup and view all the answers

    Smoking has been shown to increase the risk of developing periodontal disease by how much?

    <p>2.6 to 6 times</p> Signup and view all the answers

    What is the effect of smoking on the host defense mechanisms?

    <p>It exerts a significant negative effect</p> Signup and view all the answers

    What is the association between osteoporosis and periodontal disease?

    <p>Osteoporosis increases the risk of periodontal disease</p> Signup and view all the answers

    What is the effect of bisphosphonates on periodontal disease?

    <p>They reduce bone loss</p> Signup and view all the answers

    What is the association between autoimmune conditions and periodontal disease?

    <p>Autoimmune conditions increase the risk of periodontal disease</p> Signup and view all the answers

    What is the effect of radiation therapy on periodontal disease?

    <p>It only affects the radiated side</p> Signup and view all the answers

    What is the role of matrix metalloproteinases (MMPs) in periodontal disease?

    <p>They are involved in periodontal tissue destruction</p> Signup and view all the answers

    Which cytokine is responsible for stimulating bone resorption and inducing tissue-degrading proteinases?

    <p>Interleukin-1</p> Signup and view all the answers

    Which of the following is NOT a diagnostic aid for gingival or periodontal disease?

    <p>Stippling</p> Signup and view all the answers

    Which periodontal pathogens are responsible for producing Matrix Metalloproteinases (MMPs)?

    <p>P.gingivalis and A.actinomycetemcomitans</p> Signup and view all the answers

    What is the primary function of cyclooxygenase-2 (COX-2)?

    <p>To synthesize prostaglandins from arachidonic acid</p> Signup and view all the answers

    Which vitamin is essential for the absorption of calcium from the Gl tract and for the calcium-phosphorus balance?

    <p>Vitamin D</p> Signup and view all the answers

    What is the primary function of macrophages in the immune response?

    <p>To regulate the immune response through the release of cytokines</p> Signup and view all the answers

    Which of the following is a characteristic of healthy gingival tissue?

    <p>Resilient and fibrotic texture</p> Signup and view all the answers

    What is the primary role of IL-8 in periodontal disease?

    <p>To attract inflammatory cells</p> Signup and view all the answers

    What is the impact of vitamin A deficiency on the periodontium?

    <p>It can impact the barrier function of epithelial cells</p> Signup and view all the answers

    What is the primary function of prostaglandin E2 (PGE2)?

    <p>To induce MMPs and osteoclastic bone resorption</p> Signup and view all the answers

    What is the origin of the lateral periodontal cyst?

    <p>Developmental in origin</p> Signup and view all the answers

    What is the most significant factor in periodontal disease?

    <p>Attachment loss</p> Signup and view all the answers

    What is the typical age of occurrence of the lateral periodontal cyst?

    <p>50 years and above</p> Signup and view all the answers

    What is the primary composition of the microbiota in chronic gingivitis?

    <p>Approximately equal proportions of gram-positive and gram-negative species</p> Signup and view all the answers

    What is the characteristic of the associated tooth in a lateral periodontal cyst?

    <p>Vital</p> Signup and view all the answers

    What is the primary function of the acquired pellicle on tooth surfaces?

    <p>To facilitate the attachment of bacteria</p> Signup and view all the answers

    What is the radiographic feature of the lateral periodontal cyst?

    <p>Small radiolucency (seldom over 1 cm in diameter)</p> Signup and view all the answers

    What is the most common cause of bad breath?

    <p>Tongue coating</p> Signup and view all the answers

    What is the primary difference between a good prognosis and a fair prognosis in periodontal disease?

    <p>The extent of attachment loss</p> Signup and view all the answers

    What is the effect of diabetes on the periodontal tissues?

    <p>It alters the response of the periodontal tissues to bacterial plaque</p> Signup and view all the answers

    What is the characteristic of the gingiva in poorly controlled diabetes?

    <p>Enlarged</p> Signup and view all the answers

    What is the characteristic of the microbiota in health compared to gingivitis and periodontitis?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of chronic hyperglycemia on collagen and extracellular matrix?

    <p>It adversely affects the synthesis, maturation, and maintenance</p> Signup and view all the answers

    What is the primary factor influencing the prognosis of a periodontally-involved tooth?

    <p>Attachment loss</p> Signup and view all the answers

    What is the primary component of the acquired pellicle on tooth surfaces?

    <p>All of the above</p> Signup and view all the answers

    What is the typical location of the lateral periodontal cyst?

    <p>Mandibular canine-premolar area</p> Signup and view all the answers

    What is the primary cause of the shift from gram-positive to gram-negative bacteria in dental plaque development?

    <p>Decrease in oxygen levels</p> Signup and view all the answers

    What is the primary reason for the shift from facultative to obligate anaerobes in the microbiota?

    <p>Decreased oxygen levels</p> Signup and view all the answers

    What is the main difference between the lateral periodontal cyst and a lateral periodontal abscess?

    <p>Pain and swelling</p> Signup and view all the answers

    What is the characteristic of the bone loss in advanced periodontitis?

    <p>Extensive horizontal bone loss or extensive bony defects</p> Signup and view all the answers

    What is the primary characteristic of the microbiota in periodontitis?

    <p>A shift from facultative to obligate anaerobes</p> Signup and view all the answers

    What is the minimum percentage of bone mass loss required for a change in bone height to be appreciated on radiographs?

    <p>30%</p> Signup and view all the answers

    What is the clinical feature that distinguishes periodontitis from gingivitis?

    <p>Presence of clinically detectable attachment loss</p> Signup and view all the answers

    What is the term used to describe the wear of tooth structure due to functional contacts with opposing teeth?

    <p>Attrition</p> Signup and view all the answers

    What is the term used to describe the loss of tooth structure due to mechanical wear?

    <p>Abrasion</p> Signup and view all the answers

    What is the term used to describe the hypersensitivity of roots due to exposure of dentinal tubules?

    <p>Hypersensitivity</p> Signup and view all the answers

    What is the scoring system used to evaluate the degree of gingival enlargement?

    <p>Grade 0-III</p> Signup and view all the answers

    What is the term used to describe the isolated, sessile or pedunculated, tumor-like enlargement of gingiva?

    <p>Discrete</p> Signup and view all the answers

    What is the type of radiograph used to assess alveolar bone loss?

    <p>Bitewing radiograph</p> Signup and view all the answers

    What is the term used to describe the distance from the gingival margin to the base of the pocket?

    <p>Periodontal pocket depth</p> Signup and view all the answers

    What is the primary etiologic factor in plaque-induced gingivitis and/or periodontitis?

    <p>Bacterial plaque</p> Signup and view all the answers

    What type of pocket is formed by gingival enlargement without apical migration of the junctional epithelium?

    <p>Pseudopocket</p> Signup and view all the answers

    What is the role of calculus in periodontal disease?

    <p>Secondary etiologic factor</p> Signup and view all the answers

    What is the average biologic width?

    <p>2 mm</p> Signup and view all the answers

    What is the effect of hormonal changes during pregnancy on the gingiva?

    <p>Increased inflammation</p> Signup and view all the answers

    What is the role of the nonmineralized layer of plaque on the calculus surface?

    <p>It is the principal irritant</p> Signup and view all the answers

    What is the result of a prolonged exposure to dental plaque?

    <p>Chronic inflammatory gingival enlargement</p> Signup and view all the answers

    What is the relationship between plaque and calculus in periodontal disease?

    <p>Plaque accumulation is a primary factor, and calculus is a secondary factor</p> Signup and view all the answers

    What is the result of an increase in crevicular fluid associated with gingival inflammation?

    <p>An increase in mineralization of plaque</p> Signup and view all the answers

    What is the effect of orthodontic therapy on plaque retention?

    <p>It increases plaque retention</p> Signup and view all the answers

    What is the characteristic of the enlarged gingiva during pregnancy?

    <p>Bright red or magenta, soft, and friable with a smooth, shiny surface</p> Signup and view all the answers

    What is the term for the lesion that appears in the gingival margin or interproximal space during pregnancy?

    <p>Pregnancy tumor</p> Signup and view all the answers

    Which of the following systemic conditions can impact the immune response and affect gingival disease?

    <p>All of the above</p> Signup and view all the answers

    What is the main goal of oral hygiene during pregnancy?

    <p>To remove plaque and calculus</p> Signup and view all the answers

    Which of the following medications can cause gingival enlargement?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a type of gingival disease of specific bacterial origin?

    <p>Neisseria gonorrhoeae</p> Signup and view all the answers

    What is the term for the relationship between periodontal infection and certain diseases or systemic conditions?

    <p>Inflammation</p> Signup and view all the answers

    Which of the following is a complication of diabetes?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of well-controlled diabetes on the risk and severity of periodontal disease?

    <p>Has no effect on the risk and severity</p> Signup and view all the answers

    Which of the following is a risk factor for developing periodontitis?

    <p>All of the above</p> Signup and view all the answers

    What is the primary objective of the maintenance phase of periodontal therapy?

    <p>To prevent disease recurrence</p> Signup and view all the answers

    What indicates that the crevicular epithelium is ulcerated due to active gingival or periodontal disease?

    <p>Bleeding on probing</p> Signup and view all the answers

    When should the first recall visit be scheduled after periodontal treatment?

    <p>Three months</p> Signup and view all the answers

    What is a common observation during puberty?

    <p>Exaggerated response of the gingiva to plaque</p> Signup and view all the answers

    What is the effect of hormonal contraceptives on the gingival response?

    <p>They aggravate the gingival response to local factors</p> Signup and view all the answers

    What is a common observation in patients with blood dyscrasias?

    <p>Disturbances to the gingiva and periodontium</p> Signup and view all the answers

    What determines if the patient is maintaining adequate plaque control?

    <p>The appearance and condition of the gingival tissues</p> Signup and view all the answers

    How often should the interval between recall visits be lengthened with excellent plaque control and maintenance of periodontal health?

    <p>Every 4 to 6 months</p> Signup and view all the answers

    Which of the following is NOT a characteristic of Necrotizing Gingivitis (NG)?

    <p>Loss of periodontal attachment and bone</p> Signup and view all the answers

    Which bacteria are most abundant in a healthy sulcus?

    <p>Gram-positive cocci</p> Signup and view all the answers

    At what age does the oral flora resemble that of an adult?

    <p>4-5 years</p> Signup and view all the answers

    What is the primary characteristic of Desquamative Gingivitis (DG)?

    <p>Fiery red, glazed, atrophic or eroded-looking gingiva</p> Signup and view all the answers

    Which of the following is NOT a type of necrotizing periodontal disease?

    <p>Necrotizing Ulcerative Gingivitis (NUG)</p> Signup and view all the answers

    Which of the following bacteria are normal inhabitants of the oral cavity?

    <p>Streptococcus and Actinomyces</p> Signup and view all the answers

    What is the significance of a biopsy in Desquamative Gingivitis (DG)?

    <p>To diagnose the underlying systemic disease</p> Signup and view all the answers

    Which of the following diseases can be mistaken for Desquamative Gingivitis (DG)?

    <p>Plaque-induced gingivitis</p> Signup and view all the answers

    What is the primary role of bacterial endotoxins in gingival inflammation?

    <p>To play a major role in inflammation</p> Signup and view all the answers

    What is the significance of the removal of plaque in reducing inflammation?

    <p>It reduces the level of bacterial endotoxins</p> Signup and view all the answers

    Study Notes

    Osseous Resective Surgery

    • Indications: one-wall defects, interdental craters, and wide, shallow two-walled defects
    • Steps involved:
      • Vertical grooving
      • Radicular blending (osteoplasty)
      • Flattening of the interproximal bone
      • Gradualizing marginal bone (ostectomy)

    Osseous Regeneration

    • Best prognosis in defects with three bony walls and are deep in nature
    • The remaining available bone acts as a matrix for the development of new osseous tissue
    • Development of a new attachment apparatus can be facilitated by placement of a membrane for guidance or guided tissue regeneration (GTR)

    Gingival Recession

    • Treatment options:
      • Pedicle soft tissue grafts
      • Free soft tissue grafts
      • Regenerative techniques
    • Lateral pedicle graft:
      • A root coverage technique
      • Indicated in isolated, deep, narrow defects
      • Contraindicated if sufficient adjacent keratinized tissue and bone does not exist at the donor site

    Periodontal Flap

    • Classification:
      • Bone exposure after flap reflection
        • Full thickness (mucoperiosteal)
        • Partial thickness (mucosal)
      • Placement of the flap after surgery
        • Nondisplaced flaps
        • Displaced flaps
      • Management of the papilla
        • Conventional flaps
        • Papilla preservation flaps

    Periodontal Surgery

    • Incisions:
      • Horizontal (running mesial to distal)
      • Vertical incisions
      • Internal bevel incision (a type of horizontal incision)
      • Sulcular incision (involves the least amount of tissue loss)
    • Treatment of periodontal pockets on the distal surface of the terminal molars:
      • Distal wedge procedures
      • Designs include:
        • Triangular
        • Square, parallel, or H-shaped
        • Linear or pedicle

    Smoking and Periodontal Disease

    • Smoking is a significant risk factor for periodontal disease
    • Effects of smoking:
      • Less reduction in probing depth and smaller gains in attachment levels
      • Demonstrate more orange and red microbial complexes
      • Increase in Tannerella forsythia levels
      • Depressed immune system
      • Negative effect on the protective elements of the immune system

    Systemic Diseases and Periodontal Disease

    • Osteoporosis:
      • Associated with periodontal disease in post-menopausal women
      • Treatments for osteoporosis, such as bisphosphonates, may reduce bone loss
    • Autoimmune conditions:
      • Associated with a higher incidence of periodontal disease
    • Radiation therapy:
      • Periodontal attachment loss and tooth loss are greater on the radiated side
    • Matrix metalloproteinases (MMPs):
      • Primary proteinases involved in periodontal tissue destruction
      • Produced by periodontal pathogens, such as P. gingivalis and A. actinomycetemcomitans

    Cytokines and Periodontal Disease

    • Interleukin-1 (IL-1), IL-8, and tumor necrosis factor alpha (TNFα):
      • Central role in periodontal tissue destruction
      • Stimulation of bone resorption and induction of tissue-degrading proteinases
    • Monocytes/macrophages:
      • Important in regulating the immune response through the release of cytokines
      • Activated to produce prostaglandins (e.g., prostaglandin E2)

    Diagnostic Aids for Gingival and Periodontal Disease

    • Inflammation, bleeding on probing, and increased pocket depth
    • Gingival color, contour, tone, and texture
    • Plaque, calculus, and stippling
    • Importance of disclosing solution in evaluating plaque

    Nutrition and Periodontal Disease

    • No nutritional deficiencies that can cause gingivitis or periodontitis
    • Nutritional deficiencies can affect the condition of the periodontium
    • Vitamin deficiencies:
      • Vitamin A: important for protecting against microbial invasion
      • Vitamin D: essential for calcium absorption and bone health
      • Vitamin B-complex: contributes to gingivitis
      • Vitamin C: severe deficiency results in scurvy

    Microbiology of Periodontal Disease

    • Gingival crevice harbors bacteria in both health and disease
    • Development of gingivitis occurs in parallel with a tremendous increase in bacteria
    • Shift in bacterial composition of the plaque
    • Important bacteria associated with periodontitis:
      • Porphyromonas gingivalis
      • Fusobacterium nucleatum
      • Aggregatibacter actinomycetemcomitans
      • Tannerella forsythia
      • Prevotella intermedia
      • Peptostreptococcus micros
      • Campylobacter rectus
      • Treponema denticola
      • Eikenella corrodens

    Plaque Hypothesis

    • Nonspecific Plaque Hypothesis: periodontal disease results from the elaboration of noxious products by the entire plaque flora
    • Specific Plaque Hypothesis: only certain plaque is pathogenic, and its pathogenicity depends on the presence of or increase in specific microorganisms
    • Biofilm: a thin layer of bacteria that harbors pathogenic types of bacteria
    • Red complex of bacteria: a group of bacteria associated with severe periodontitis
    • Actinobacillus actinomycetemcomitans: associated with aggressive periodontitis### Desquamative Gingivitis (DG)

    • DG is a clinical presentation characterized by fiery red, glazed, atrophic, or eroded-looking gingiva. • It is more common in middle-aged to elderly females, is painful, and predominantly affects the buccal/labial gingiva. • The clinical appearance of DG is not significantly altered by traditional oral hygiene measures or conventional periodontal therapy alone. • The role of plaque is vague in DG. • DG can be mistaken for plaque-induced gingivitis, leading to delayed diagnosis and inappropriate treatment of potentially serious dermatological diseases.

    Lateral Periodontal Cyst

    • A lateral periodontal cyst is a slow-growing, asymptomatic, non-expansile odontogenic cyst that may present as a localized, tender swelling. • It occurs in adults, with a mean age of 50 years, and is more common in males than females. • The associated tooth is usually vital. • Radiographic features of a lateral periodontal cyst include a small radiolucency (seldom over 1 cm in diameter) on the lateral surface of the root of a tooth.

    Periodontitis

    • Early periodontitis: areas of localized erosion of the alveolar bone crest, attachment loss of 1-2 mm. • Moderate periodontitis: destruction of alveolar bone extends beyond early changes, attachment loss of 3-4 mm. • Advanced periodontitis: extensive bone loss, attachment loss of 5 mm or more, teeth show excessive mobility, and are in jeopardy of being lost.

    Diabetes Mellitus and Periodontal Disease

    • Diabetes is a risk factor for periodontal disease. • Individuals with diabetes have a higher prevalence and severity of periodontal disease than those without diabetes. • Diabetes does not cause periodontal disease, but it alters the response of the periodontal tissues to bacterial plaque. • Poorly controlled diabetics often have enlarged gingiva, sessile or pedunculated gingival polyps, polypoid gingival proliferations, abscess formation, and loosened teeth.

    Prognosis for Periodontally-Involved Teeth

    • Factors considered in establishing a prognosis for periodontally-involved teeth include tooth type, furcation involvement, bone loss, pocket depth, tooth mobility, occlusal force, patient's home care, presence of systemic disease, and cigarette smoking. • The two most critical factors are attachment loss and mobility. • McGuire and Nun classification system of prognosis: + Good prognosis: control of etiologic factors and adequate periodontal support. + Fair prognosis: approximately 25% attachment loss or grade I furcation invasion. + Poor prognosis: 50% attachment loss or grade I furcation invasion. + Questionable prognosis: greater than 50% attachment loss or poor crown-to-root ratio. + Hopeless prognosis: inadequate attachment to maintain health, comfort, and function.

    Microbiota of Gingivitis and Periodontitis

    • The initial microbiota of acute gingivitis consists of gram-positive rods, gram-positive cocci, and gram-negative cocci. • The transition to gingivitis is evident by inflammatory changes and is accompanied by the appearance of gram-negative rods and filaments, then by spirochetal and motile organisms. • The microbiota of chronic gingivitis consists of approximately equal proportions of gram-positive and gram-negative species, as well as facultative and anaerobic microorganisms.

    Periodontal Examination

    • Clinical features to evaluate during a periodontal exam: + Level of the free gingival margin in relation to the CEJ. + Periodontal pocket depth. + Loss of attachment. + Bleeding. + Exudate. + Mucogingival complications. + Erosion. + Abrasion. + Attrition. + Abfraction. + Hypersensitivity of roots. + Gingival enlargement.

    Gingival Enlargement

    • Gingival enlargement can be scored as follows: + Grade 0: no signs of gingival enlargement. + Grade I: enlargement confined to interdental papillae. + Grade II: enlargement involves papilla and marginal gingiva. + Grade III: enlargement covers three-quarters or more of the crown. • Gingival enlargement may result from chronic or acute inflammatory changes. • Chronic inflammatory gingival enlargement originates as a slight ballooning of the interdental papilla and marginal gingiva.

    Pseudopocket

    • A pseudopocket is a pocket formed by gingival enlargement without apical migration of the junctional epithelium. • It does not involve bone or attachment loss. • Pseudopockets are also referred to as gingival, false, or relative pockets.

    Calculus and Plaque

    • Calculus plays an important role in maintaining and accentuating periodontal disease by keeping plaque in close contact with the gingival tissue. • Bacterial plaque is always the primary etiologic factor in "plaque-induced gingivitis and/or periodontitis". • Calculus is a secondary etiologic factor after plaque.

    Other Contributing Factors

    • Food impaction or retention. • Open and loose contacts. • Overhanging margins of restorations and improperly designed prostheses. • Soft or sticky consistency of diet. • Violation of the "biologic width". • Orthodontic therapy.

    Pregnancy Gingival Enlargement

    • Pregnancy gingival enlargement may be marginal and generalized or may occur as single or multiple tumor-like masses. • The enlargement is usually generalized and tends to be more prominent interproximally than on the facial and lingual surfaces. • The so-called pregnancy tumor is not a true neoplasm; it is an inflammatory response to bacterial plaque and is modified by the patient's condition.

    Gingival Diseases Modified by Systemic Factors

    • Endocrine changes during pregnancy, puberty, and diabetes. • Blood dyscrasias (e.g., leukemia). • Medications (e.g., anticonvulsants, antihypertensive calcium channel blockers, and immunosuppressant drugs). • Genetic origin (e.g., hereditary gingival fibromatosis).

    Non-Plaque-Induced Gingival Lesions

    • Gingival diseases of specific bacterial origin (e.g., Neisseria gonorrhoeae, Treponema pallidum, Streptococcus species). • Gingival diseases of viral origin (e.g., Herpes virus infections, Varicella zoster). • Gingival diseases of fungal origin (e.g., Candidiasis caused by Candida albicans). • Gingival diseases of genetic origin (e.g., Hereditary gingival fibromatosis). • Gingival manifestations of systemic conditions (e.g., desquamative lesions, ulcerations of the gingiva, or both).

    Periodontal Infection and Systemic Conditions

    • Periodontal infection may enhance the risk for certain diseases or alter the natural course of systemic conditions via inflammation. • Organ systems and conditions possibly influenced by periodontal infection: + Cardiovascular system (e.g., atherosclerosis, coronary heart disease, angina, myocardial infarction, cerebrovascular accident). + Endocrine system (e.g., diabetes mellitus). + Reproductive system (e.g., preterm low-birth-weight infants). + Respiratory system (e.g., chronic obstructive pulmonary disease, acute bacterial pneumonia).### Diabetes and Periodontal Disease

    • Diabetes increases the risk and severity of periodontal disease.
    • Poor metabolic control in diabetes patients typically leads to increased prevalence and severity of periodontitis.
    • Periodontal disease is considered the "sixth complication of diabetes", along with retinopathy, nephropathy, neuropathy, macrovascular disease, and altered wound healing.
    • Well-controlled diabetes does not increase the risk and severity of periodontal disease.

    Risk Factors for Periodontitis

    • Genetic, environmental, and acquired risk factors can increase susceptibility to periodontitis.
    • Risk factors can affect onset, rate of progression, and severity of periodontal disease, as well as response to therapy.

    Periodontal Therapy and Maintenance

    • The main goal of periodontal therapy is to establish a periodontal environment that can be maintained by the patient through good oral hygiene.
    • Prevention of disease recurrence is the main objective of the maintenance phase of periodontal therapy.
    • The first year after treatment is critical, as the patient has demonstrated susceptibility to periodontal disease.
    • The appearance and condition of the gingival tissues will determine if the patient is maintaining adequate plaque control.

    Gingival Tissues and Bleeding

    • Bleeding on probing indicates ulcerated crevicular epithelium due to active gingival or periodontal disease.

    Periodontal Maintenance Schedules

    • After periodontal treatment, the first recall visit should be scheduled at three months.
    • With excellent plaque control and maintenance of periodontal health, the interval may be lengthened to 4 to 6 months.

    Hormonal Influences on Periodontal Health

    • Puberty can lead to an exaggerated response of the gingiva to plaque due to gonadotropic hormones.
    • The menstrual cycle is not accompanied by notable gingival changes, but increased gingival bleeding may be seen.
    • Hormonal contraceptives can aggravate the gingival response to local factors similar to pregnancy.
    • Oral disturbances are not a common feature of menopause, but some females may develop gingivostomatitis.

    Systemic Conditions and Periodontal Health

    • Patients with blood dyscrasias (e.g. leukemia, anemia, neutropenia, agranulocytosis, thrombocytopenia purpura) often demonstrate disturbances to the gingiva and periodontium.

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    Understanding osseous resective surgery, a predictable pocket reduction technique in surgical periodontal therapy, including its indications and steps.

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