Integrated Theory Semester 2 Part 2

Frage	Antworten
Is the following an example of primary or secondary occlusal trauma? Prosthetic replacements creating excessive force on abutment teeth	Primary occlusal trauma (since the periodontium is healthy)
True or False Although secondary occlusal trauma involves a diseased periodontium, both primary AND secondary occlusal trauma have clinically similar features (i.e. attachment loss/pocket formation)	False Evidence does not support an association of primary occlusal trauma with attachment loss, pocket formation, non-carious cervical lesions, or gingival recession
Is the following a cause of acute or chronic occlusal trauma? New restorations or prosthetic appliances that interfere with or change direction of occlusal forces on teeth	Acute Acute trauma is produced by any sudden and abrupt changes in occlusal forces. Chronic trauma usually develops from gradual changes.
Statement 1: Tooth mobility is a symptom of acute occlusal trauma Statement 2: Chronic occlusal trauma is more common than accute occlusal trauma	Both statements are true Other symptoms of acute occlusal trauma include tooth pain and sensitivity to percussion, however these should subside if force is dissipated
Recall the definition of Secondary Occlusal Trauma	Occurs when the adaptive capacity of tissues to withstand occlusal forces is impaired by bone loss that results from marginal inflammation
Explain why patients suffering secondary occlusal trauma may experience non-pathological tooth mobility	Excessive force may destroy PDL fibres, causing mobility and eventuating in a widened PDL space over time. Therefore, tooth mobility in these patients is the result of an adaptive process rather than a pathological one
Define fremitus	Adaptive tooth mobility
A patient presents to the clinic needing a bitewing radiograph. You notice on their patient file that the patient suffers from chronic secondary occlusal trauma. What would you expect to find on their bitewing?	- Increased PDL space width - Thickening of lamina dura - Vertical destruction of interdental crests, creating a "funnelled" PDL appearance - Radiolucencies and condensation of alveolar bone - Root resorption
True or False While there is great variability, any non-class-1occlusion will cause some degree of damage to the periodontium. As such, most patients exhibit at least minor signs of occlusal trauma	False Not all malocclusions are harmful to the periodontium and malocclusion is not necessary to produce trauma Similarly, dentition may be anatomically and aesthetically acceptable by functionally injurious
True or False Increases in occlusal forces are not traumatic if the periodontium can "handle" it	True However the adaptive capacity of the periodontium varies between people and even within the same person at different times
Complete the following Traumatic occlusal forces lead to ________ mobility in teeth with normal support, whereas they lead to ________ mobility in teeth with reduced support	Traumatic occlusal forces lead to ADAPTIVE mobility in teeth with normal support, whereas they lead to PROGRESSIVE mobility in teeth with reduced support
A thickened PDL, increased PDL fibres, and increased alveolar bone density are all associated with what kind of changes in occlusal force? a) Changes in magnitude b) Changes in direction c) Changes in duration d) Changes in frequency	a) Changes in magnitude
Which occlusal force directions pose the greatest risk to periodontal fibre integrity? a) Posterior and superior b) Lateral and posterior c) Mesial and torque d) Lateral and torque	d) Lateral and torque Principal fibres best accommodate forces along the long axis of the tooth
True or False In occlusal trauma, excessive forces which are constant are more injurious to the periodontium than intermittent forces	True
Which of the following IS a condition caused by traumatic occlusal forces? (Based on current evidence) a) Attachment loss b) PDL inflammation c) Abfraction d) Acceleration of existing periodontitis e) Gingival recession	d) Acceleration of existing periodontitis
Assuming plaque control and oral hygiene are poor, how might orthodontic forces adversely affect the periodontium?	- Root resorption - Pulpal disorders - Gingival recession - Alveolar bone loss
What occurs during the Injury (Stage 1) stage of the tissue response to incfreased occlusal forces?	1. The tooth rotates around the axis of rotation (fulcrum) under forces of occlusion 2. This creates pressure and tension on opposite sides of the fulcrum 3. Slightly excessive pressure stimulates resorption of alveolar bone and widening of PDL psace 4. In severe cases this may cause haemorrhage and PDL tearing
After damaged tissue is removed, what new structures/tissues are formed during the Repair (Stage 2) stage of the tissue response to increased occlusal forces?	- Connective tissue cells and fibres - Bone - Cementum
What changes occur in the periodontium when excessive forces exceed the repair rate and adaptive remodelling takes place?	- Thickened PDL or triangulation (funnel shaped at crest) - Angular defects in the bone with no pocket formation (no JE migration) - Involved teeth become mobile - Increased vascularity
While assisting a dentist, you notice them ask the patient to close their mouth then clench. The dentist then places a finger on the buccal surface of the tooth to detect movement. What is the dentist testing for?	Fremitus
Once oral hygeine instructions and debridement have been completed, how should an OHT manage a patient with occlusal trauma?	- Identify all clinical signs of occlusal trauma and record them as a baseline - Refer to D.O/Prosthodontist
Name the bacteria of significant aetiological importance to periodontitis in children	Actinobacillus Actinomycetemcomitans
Name 3 Oral Manifestations of Contraceptives	1. Gingivitis similar to that described in pregnancy 2. Exaggerated response to dental biofilm and other local irritants 3. More exudate in inflamed tissues than with pregnancy
Name 4 oral/immune changes a patient may experience as a result of the menstrual cycle	1. Exaggerated response to local irritants or unusal gingival bleeding 2. Gingival inflammation (triggered by imbalance in progesterone and estrogen which modify immune response) 3. Vigorous immune response 4. Increased permeability of microvasculature 5. Production of PGE2 6. PMN chemotaxis enhanced
After how many weeks does the foetus gain the ability to move and swallow	12 (end of first trimester)
Identify 3 factors which may cause teratogenic effects during pregnancy	1. Poor nutrition 2. Infections 3. Drug intake
In what weeks of pregnancy do the foetal tooth buds develop?	5th - 6th week
What material other than titanium may be used for implant bodies?	Ceramic
In what months of pregnancy does initial mineralisation of the foetal tooth buds occur?	4th - 5th month (Second Trimester)
In what weeks of pregnancy do the lips and palate develop?	Lips: 4th - 5th week Palate: 8th - 12th week
When does cleft lip and cleft palate become apparent during pregnancy?	Cleft lip: 8th week Cleft palate: 12th week
What weeks of pregnancy encompass the 2nd trimester?	13th - 28th week
True or False A baby born at 36 weeks rather than 40 is considered premature	True Any birth before 37 weeks gestation is considered premature A very preterm birth is a live birth after less than 32 weeks
How light is a low birth weight baby?	<2500 gms or 5 pounds 8 ounces
True or False Periodontal pathogens can cause inflammation of both the foteal tissue AND the amniotic fluid	True
Name 3 pregnancy complications related to the presence of infection	1. Preterm birth 2. Growth restriction 3. Preeclampsia 4. Foetal loss 5. Still births
True or False Periodontal diseases occur in 3 out of every 4 pregnancies	True This is attributable to changes in the tissue structure, host response, biofilm alteration, GCF amplification by progesterone, increased levels of red/orange complexes
What changes occur to the GCF during pregnancy	Progesterone increases the volume of GCF leading to altered conditions and elevated levels of porphyromonas species
Name 2 symptoms of preeclampsia	1. Hypertension 2. Proteinuria
What is the role of prostaglandins (PGs) in pregnancy?	Regulate the onset of labour (uterine contractions and delivery, fluid levels increase)
What considerations should be given for pregnant patients on medications?	- Ideally no medications should be used as nearly all of them can pass across the placenta and enter foetal circulation - Tetracycline use may cause intrinsic tooth staining
How common is "pregnancy gingivitis?"	Occurs in 30-100% of women
What changes occur to the biofilm microflora during pregnancy?	- Anaerobic : aerobic ratio increases in 2nd trimester - Increase in P.intermedia
Which oral condition is known to arise during pregnancy as a result of "morning sickness?"	Perimylolysis
Where in the mouth are pyogenic granulomas more commonly found?	Maxilla and gingival papillae
A pregnant patinet presents to the clinic needing an x-ray How should you proceed?	An x-ray CAN be taken with a pregnant patient, exposure should be minimised A lead drape is recommended, filtration and collimation should be optimised, the fastest film used, and extended target film distance
Although it can occur at any time in the pregnancy, in what trimester is scaling, debridement, and polishing ideally performed?	2nd Trimester
What seating accommodations should be made for a pregnant patient?	- Avoid prolonged chair time and ensure patient is comfortable - Place a soft wedge (e.g., rolled towel) under RIGHT side of patient
Name the syndrome wherein compression to the inferior vena cava reduces blood flow to the foetus and identify the trimester(s) it can occur in	Supine Hypotensive Syndrome 3rd Trimester
At what age does menopause generally occur and how is it diagnosed?	Age 47-55 Confirmed when a woman has no period for 12 consecutive months with no biologic or physiologic cause
What mucosal changes are associated with menopause?	- Shiny red appearance - Varied colour - Burning mouth syndrome may occur - Epithelium may become thin and atrophic - Taste perception may be altered
Identify the cause of osteoporosis	Hormal disturbances (endocrine), depletion of estrogen or calcium deficiency or absorption
Identify the treatment (injectable) which may reduce adverse effects on bone metabolism produced by osteoporosis in postmenopausal women	Hormone Replacement Therapy (HRT)
Identify 3 medications which inhibit bone resorption in osteoporosis patients	1. Bisphosphonates 2. Selective Estrogen Receptor Modulators 3. Calcitonin
Which hormone stimulates bone formation?	Parathyroid hormone
Complete the following Osteoporosis patients, along with their existing osteoporosis medications, should take _______ and Vitamin _ simultaneosuly	Complete the following Osteoporosis patients, along with their existing osteoporosis medications, should take CALCIUM and Vitamin D simultaneosuly
Describe the appearance and symptoms of BRONJ lesions	- Asymptomatic or painful - Pus-filled discharge - Oedematous - Associated with tooth mobility
A patient presents to the clinic with a large pus-filled lesion exhibited on their mandible. Beneath the pus you notice exposed bone. The patient informs you that the lesion has been there for 8 weeks and assures you they have not received any radiation therapy. When you ask what medication they're taking, you are told bisphosphonates. What is the most likely diagnosis?	Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) Lesions are considered BRONJ when exposed bone is present in the absence of head and neck irradiation and fail to show signs of heqling within 8 weeks. BRONJ also occurs more frequently in the mandible (2:1) and in the posterior region
Describe the radiographic appearance of BRONJ	Usually undetectable in early lesions In advanced lesions it may appear as a poorly defined moth-eaten radiolucency with radiopaque sequestra
True or False Evidence for hyperbaric oxygen treatment for BRONJ management is inconclusive	True There is no effective treatment for BRONJ, however debridement, antibiotics, and chlorhexidine may be used to limit it
Where must an oral ulcerative lesion spread before it can be classified as necrotising stomatitis (NS)?	>1cm from the gingival margin, including tissue beyond the mucogingival junction
Beginning at the tips of the interdental papillae, what colour are necrotising gingivitis lesions and its associated pseudomembrane?	Grey-white
Explain the mechanism behind stress-induced Necrotising Gingivitis	High release of epinephrine may cause localised ischaemia Corticosteroids may also alter lymphocyte ratios and cause decreased neutrophil chemotaxis and phagocytic response
What bacteria are related to necrotising gingigvitis?	Spirochetes, Fusobacterium, Prevotella intermedia, Treponema, and Selenomonas species
Identify 4 known risk factors for Necrotising Gingivits	1. Stress 2. Caucasian background 3. Local Trauma 4. Inadequate Sleep 5. Recent Illness 6. Poor Oral Hygiene 7. Immunocompromised status (e.g. HIV/AIDS) 8. Alcohol use 9. Low protein intake in young adults 10. Cigarette smoking
In the treatment of necrotising gingivits, which of the following is NOT used in the first appointment? a) Chlorhexidine 0.12% b) Warm saltwater c) Diluted hydrogen peroxide 3% d) Antibiotics e.g. metronidazole e) Essential oil rinses e.g. Listerine	e) Essential oil rinses e.g. Listerine
True or False Because removal of bacteria is a top priority in the treatment of necrotising gingivitis, both supragingival and subgingival scaling should be completed in the first appointment if possible	False The first appointment should consist of supragingival scaling and OHI only. Subgingival debirdement with LA should occur in the second appointment 1-2 days later, then again 5 days after the second appointment.
What unique characteristics separate necrotising periodontitis from regular periodontitis?	1. Prominent bacterial invasion and ulceration of epithelium 2. Rapid and full thickness destruction of the marginal soft tissue resulting in soft and hard tissue defects 3. Prominent symptoms and rapid resolution in response to antimicrobial treatment 4. Presence of ulceration of the gingival margin and/or fibrin deposits at sites with characteristically decapitated gingival papillae, and, in some cases, exposure of the marginal alveolar bone
The microorganism vincent vicella is uniquely associated with a) Necrotising gingivitis b) Necrotising periodontitis c) Necrotising stomatitis	b) Necrotising periodontitis
Statement 1: Antibiotics can be used in the treatment of necrotising gingivitis Statement 2: Antibiotics can be used in the treatment of necrotising periodontitis	Both statements are true
What rinse might HIV+ patients consider using in the treatment of necrotising periodontitis?	Nystatin rinse 5ml
Which of the following is NOT treated with NSAIDs a) Rhematoid Arthritis b) Systemic Lupus Erythematous c) Necrotising periodontitis d) Graves' Disease	d) Graves' Disease

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Integrated Theory Semester 2 Part 2

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