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Gingival Inflammation Important Notes

1. Stages of gingivitis

2. Stage 3 gingivitis

Clinical features:

• Engorgement of blood vessels
• Bluish red appearance of the gingiva
• Changes in size and texture

Histological features:

• Infiltration of connective tissue and junctional epithelium with neutrophils, and lymphocytes with the predominance of plasma cells

3. Gingival pigmentation caused by heavy metals

Gingival Inflammation Short Essays

Question 1. Stages of Gingivitis.
Answer:

Stage 1 Initial Lesion:

• Classic vasculitis of vessels
• Exudation of fluid from gingival sulcus
• Changes in the coronal portion of JE
• Migration of leukocytes
• Presence of serum proteins
• Loss of collagen

Stage 2-Early Lesion:

• Erythematous Gingiva
• Bleeding on probing
• Development of recipes in JE
• Presence of lymphocytes
• Cytotoxic changes of fibroblasts
• Loss of collagen

Stage 3-Established Lesion:

• Bluish hue on reddened gingiva
• Moderate to severely inflamed gingiva
• Presence of plasma cells deep into connective tissue

Read And Learn More: Periodontics Question and Answers

• Apical migration of junctional epithelium
• Collagen destruction
• Continuous loss of ground substance
• Pocket formation
• Elevated levels of acid and alkaline phosphate, B- glucuronidase, aminopeptidase

Stage 4-Advanced Lesion:

• Persistence of infection
• Bone loss
• Loss of collagen
• Presence of all inflammatory cells Formation of pockets
• Leads to periodontics

Question 2. Gingival pigmentation.
Answer:

• The color of gingiva is determined by several factors in which pigments within the epithelium are one of the factors

Types:

1. Endogenous pigmentation
2. Exogenous pigmentation

Causes:

1. Localized:

• Amalgam tattoo
• Graphite
• Nevus
• Melanotic macules
• Malignant melanoma
• Kaposi’s sarcoma

2. Generalized pigmentation:

• Genetics- Peutz-Jegher’s syndrome
• Habits- Smoking, betel chewing
• Drugs
  • Antimalarial
  • Antimicrobial
  • Minocycline
  • Ketoconazole
  • Contraceptive pills
  • Heavy metal exposure
• Endocrine
  • Addison’s disease
  • Albright’s syndrome
  • Pregnancy
• Post-inflammatory
  • Periodontal disease
  • Post-surgical gingival pigmentation
• Others
  • Haemochromatosis
  • Generalised neurofibromatosis
  • HIV disease
  • Thalassaemia

Question 3. Stage 2-Early lesion.
Answer:

Stage 2-Early Lesion:

• Erythematous Gingiva
• Bleeding on probing
• Development of rete pegs in JE
• Presence of lymphocytes
• Cytotoxic changes of fibroblasts
• Loss of collagen

Gingival Inflammation Short Answers

Question 1. Stage III of gingivitis.
Answer:

• Stage 3 gingivitis is an established lesion

Features:

• Bluish hue on reddened gingiva
• Moderate to severely inflamed gingiva
• Presence of plasma cells deep into connective tissue
• Apical migration of junctional epithelium
• Collagen destruction
• Continuous loss of ground substance
• Pocket formation
• Elevated levels of acid and alkaline phosphate, beta-glucuronidase, aminopeptidase

Q. 2. Plasma cell gingivitis.
Answer:

• Plasma cell gingivitis is also referred to as atypical and plasma cell gingivostomatitis
• It consists of a mild marginal gingival enlargement that extends to the attached gingiva
• Gingiva appears red, friable, and bleeds easily
• Microscopically, connective tissue contains a dense infiltrate of plasma cells that also extends to oral epithelium

Auses:

• Allergy
• Related to components of chewing gums or denitrifies

Gingival Inflammation Viva Voce

1. The predominant cell in acute gingivitis is the T lymphocyte
2. Gingivitis is the most common form of gingival disease
3. Bacteria found in gingivitis are localized in the gingival sulcus
4. Extension of inflammation into the supporting structures occurs in stage 4
5. Stage I gingivitis is subclinical
6. Erythema and bleeding on probing occurs in stage 2
7. The established lesion of gingivitis is characterized by the predominance of plasma cells and B lymphocytes
8. The B cells found in established lesions are predominantly IgG and IgG, subclasses

 

 

Epidemiology Of Gingival And Periodontal Diseases Definitions

1. Epidemiology

• It is defined as the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems

2. Index

• Numerical values describing the relative status of the population on a graduated scale with definite upper and lower limits designated to permit and facilitate comparisons with other populations that are classified by the same criteria and methods are referred to as index

3. Incidence

• It is defined as the number of new cases of a specific disease occurring in a defined population during a specified time

4. Prevalence

• The total number of all individuals who have an attribute or disease at a particular time divided by the population at risk of having the attribute or disease at this point in time or midway through the period

Epidemiology Of Gingival And Periodontal Diseases Long Essays

Question 1. Define epidemiology. Write in detail about indices used in assessing gingival inflammation.
Answer:

Epidemiology

It is defined as the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems

Indices Used To Assess Gingival Inflammation:

1. Papillary marginal attachment index by Schour and Massler:

• The gingival unit is divided into three parts
  • Papillary gingiva
  • Marginal gingiva
  • Attached gingiva
• The presence or absence of inflammation in each unit is recorded and scored
  • -0- Absence of inflammation
  • -1- Presence of inflammaion
• The severity of gingivitis is assessed by the following scoring
  • Papillary gingiva-0-5
  • Marginal gingiva-0-3
  • Attached gingiva- 0-3

2. Gingivitis component of the periodontal disease:

• Teeth selected- 3, 9, 12,19, 25, 28
• Sulcus depth is examined in these teeth and scored

3. Gingival index by Loe and Silliness:

• All teeth are examined
• The surfaces examined are:
  • Distal facial papillaae
  • Facial margin
  • Mesial facial papillae
  • Lingual margin
• Scoring is done

Interpretation:

4. Indices of gingival bleeding:

• Sulcular bleeding index by Muhlemann and Son
  • All teeth are examined
  • Four gingival units are scored
    • Labial and lingual marginal gingiva
    • Mesial and distal papillary gingiva
  • The probe is helped parallel with the long axis of the tooth and scoring is done after 30 seconds

Scoring:

• Papillary bleeding index by Muhlemann
  • A blunt periodontal probe is inserted into the gingival sulcus, bleeding is examined and scored

Scoring:

• Bleeding point index by Lennox and Kopczy
  • It determines the presence or absence of gingival bleeding interproximal and on facial and lingual surfaces of each tooth
• Interdental bleeding index by Caton and person
  • A triangular-shaped interproximal cleaner is inserted to depress the interproximal papillae up to 2 mm
  • The presence or absence of bleeding within 15 sec is noted

Read And Learn More: Periodontics Question and Answers

• Gingival bleeding index by Ainamo and Bay
  • The presence or absence of gingival bleeding is determined by gentle probing of gingival cer-vice

Epidemiology Of Gingival And Periodontal Diseases Short Essays

Question 1. Plaque Index.
Answer:

• Selected tooth – entire dentition

1. Selected teeth

• Surfaces: Distofacial, facial, mesiofacial and lingual
• Site: Cervical third of the tooth

Plaque Index Scoring:

Plaque Index Calculation:

• Per tooth-Score/4
• Per person – Score per tooth/No. of teeth

Question 2. OHI-S by Greene and Vermillion.
Answer:

• The oral hygiene index-simplified was described by John C. Greene and Jack R. Vermillion in 1964

Tooth Examined:

• 16/17, 11, 26/27
• 46/47,31 36/37

Surfaces: Facial of 16/17, 11, 26/27, 36/37 Lingual of 31

Sites:

• D1-S – Incisal third to gingival third
• C1-S Distal gingival crevice subgingivally from dis- tal to medial contact

Scoring: For D1-S:

• 0-No debris
• 1-Debris covering 1/3rd of tooth surface
• 2-Debris covering more than 1/3rd and less than 2/3rd of tooth surface
• 3-Debris covering more than 2/3rd of tooth surface

For CI-S:

• O-No calculus
• 1-Supragingival calculus covering 1/3rd of tooth surface
• 2-Supragingival calculus covering more than 1/3rd but less than 2/3rd of tooth surface
• 3-Supragingival calculus covering more than 2/3rd of the tooth surface, heavy bands of subgingival
  calculus also present

Calculation:

• OH1 – S = D1-S+C1-S

Interpretation:

• Good – 0.0 to 1.2
• Fair – 1.3 to 3.0
• Poor – 3.1 to 6.0

Question 3. Russel’s Periodontal Index.
Answer:

By Russell Al.

Teeth examined:

All

Surfaces:

Interpretation:

• 0-0.2 – Normal
• 0.3-0.9 – Simple Gingivitis
• 0.7-1.9 – Beginning of destructive disease
• 1.6-5.0 – Established destructive disease
• 3.8-8.0 – Terminal disease

Question 4. Gingival Index – by Loe and Stillness.
Answer:

• Teeth Examined: All or selected

Surfaces:

• Distal facial papillae
• Facial margin
• Mesial facial papillae
• Lingual margin

Scoring:

• 0-No inflammation
• 1-Mild inflammation, no bleeding on probing
• 2-Moderate inflammation, and bleeding on probing
• 3-Severe inflammation

Calculation:

• Per tooth-Score/4
• Per person\( -\frac{\text { TotalScore }}{\text { Total teeth examined }}\)

Interpretation:

• 0.1-1.0 – Mild gingivitis
• 1.1-2.0 – Moderate gingivitis
• 2.1-3.0 – Sever gingivitis

Question 5. CPITN.
Answer:

Objectives:

• Mild gingivitis Moderate gingivitis Severe gingivitis
• To survey and evaluate periodontal treatment needs Identify actual and potential problems posed by periodontal diseases both in the community and in the individual

Teeth examined: Ten specified index teeth are

• 17-16  11  26-27
• 47-46  31  36-37

Scoring:

• Code X – When only one tooth or no teeth are present in the sextant
• Code 0 – Healthy periodontium
• Code 1 – Bleeding on probing
• Code 2 – Calculus present
• Code 3 – Pocket of 4-5 mm
• Code 4 – Pocket of more than 6 mm

Treatment Needs:

• TN-0 -No treatment
• TN-1 -Improvement of personal oral hygiene
• TN-2 -Professional scaling
• TN-3 Complex treatment involving deep scaling, root planning, and complex procedures

Question 6. Incidence and prevalence.
Answer:

Incidence:

• It is defined as the number of new cases of a specific disease occurring in a defined population during a specified period

Uses:

• Provide a clue for the etiology and pathogenesis of the disease
• Study the distribution of the study
• Control the disease

Types:

1. Episode incidence
   • It is the rate of occurrence of new episodes of a dis- case arising in the population
2. Cumulative incidence
   • Similar to incidence but the time interval is ex-presses as a fixed period

Prevalence:

• The total number of all individuals who have an attribute or disease at a particular time divided by the population at risk of having the attribute or disease at this point or midway through the period

Uses:

• Estimate the magnitude of disease or health problems in the community
• Identify the potential high-risk population
• Useful in administrative and planning purposes like assessing manpower needs in health services

Types:

1. Point prevalence:

• It is the number of all current cases of a specific disease at one point in time about a defined population

2. Period prevalence:

• It is defined as the total number of existing cases of a specific disease during a defined period of time ex- pressed concerning a defined population

Question 7. Describe the possible causes as to why the incidence, and prevalence of periodontal diseases are very high in India.
Answer:

• The prevalence of periodontal disease in India is high due to:
• Low socioeconomic group
• Poor oral hygiene practice
• Greater prevalence in mentally retarded children due to
  • Lack of awareness of oral hygiene
  • Nutritional deficiency
  • Malocclusion
  • Oral health habits like bruxism, tongue thrusting, mouth breathing
  • Low power of concentration
  • Low neuromuscular coordination
• Vegetarian diet
• Hereditary
• Presence of habits like smoking and betel nut chewing
• Evaluate the efficacy of preventive and therapeutic
• Malnutrition
• measures
• Presence of systemic disease

Question 8. Define index, uses and ideal requirements of an index.
Answer:

Index Definition:

• Numerical values describing the relative status of the population on a graduated scale with definite upper and lower limits designated to permit and facilitate comparisons with other populations that are classified by the same criteria and methods are referred to as index

Index Uses:

1. In the case of individual patients
   • Provides individual assessment
   • Reveals the degree of effectiveness
   • Motivates the patient
   • Evaluates the progress of treatment
2. In the case of research studies
   • Determines the baseline data before the introduction of experimental factors
   • Measures effectiveness of specific agents for pre-version control and treatment of oral conditions
   • Measures effectiveness of devices for personal care
3. In community health
   • Provides baseline data
   • Assesses the needs of a community
   • Evaluates the results

Index Ideal Requirements:

• Clarity simplicity
• The examiner should remember the rules of the index clearly
• The index should be simple & easy to apply
• The criteria should be objective
• Validity
• The index should measure what it is intended to measure
• It should correspond to the clinical stages of the disease under study
• Reliability
• The index should be measured consistently at different times & under a variety of conditions
• Quantifiability
• The index should be amenable to statistical analysis so that the status can be expressed by a number
• Sensitivity
• The index should be able to detect small shifts in either direction
• Acceptability
• The use of an index should not be painful or demeaning to the subject

Epidemiology Of Gingival And Periodontal Diseases Short Answers

Question 1. Index.
Answer:

Numerical values describing the relative status of the population on a graduated scale with definite upper and lower limits designated to permit and facilitate comparisons with other populations that are classified by the same criteria and methods

Index Ideal Requisites:

• Clarity, simplicity, and objectivity
• Validity Reliability
• Quantifiability
• Sensitivity
• Acceptability

Question 2. Epidemiology.
Answer:

The study of the distribution and determinants of health-related states or events in specific populations and the application of this study to control health problems.

Epidemiology Principles:

• Exact observation
• Correct interpretation
• Rationale explanation
• Scientific construction

Epidemiology Types:

• Descriptive epidemiology
• Analytical epidemiology

Question 3. Incidence and prevalence.
Answer:

Incidence:

• It is defined as the number of new cases of a specific disease occurring in a defined population during a specified period of time

Incidence Types:

• Point prevalence
• Period prevalence

Question 4. Indices used to measure calculus.
Answer:

• The following are the various indices used to measure calculus
• Calculus surface index
• Calculus surface severity index
• Marginal line calculus index by Muhlemann and Villa
• Volpe-Manhold index
• PDI
• Calculus component of OHI-S
• Calclus component of PDI by Ramfjord
• Probe method of calculus assessment by Volpe and as- sociates
• Calculus surface index by Ennever and co-workers

Oral Malodor

Definitions

1. Halitosis Definition: Unpleasant odor exhaled in breathing

Oral Malodor Important Notes

1. Bana test

• It is a chairside test
• It exploits unusual trypsin enzymes found in Treponema denticola, P.gingivalis, and Bacteroides
  Forsyth

Bana Test Procedure:

• Subgingival plaque is obtained with a curette
• The samples are placed on the BANA strip, which is then inserted into a slot on a small toaster-sized incubator
• The incubator automatically heats the sample to 55 degrees for 5 minutes
• If P.gingivalis, T.denticola, and B.forsythus is present the test strip turns blue
• The bluer it turns, the higher the concentration and greater the number of organisms

2. A trained judge sniffs the expired air and tests whether it is unpleasant or not using an intensity rating normally from 0 to 5

Oral Malodor Short Essays

Question 1. Diagnosis of halitosis.
Answer:

Halitosis Diagnosis:

1. Medical history:

• Evaluates the cause
• The patient is asked about
  • Relevant pathologies
  • Frequency
  • Time of appearance
  • A time when the problem first appeared
  • Presence of contributing factors like dry mouth, allergies
  • Medications taken

2. Clinical examination:

• Self-examination is done by
  • Smelling metallic/plastic spoon after scraping the back of the tongue
  • Smelling toothpick after introducing it in the inter-dental area
  • Spitting in a small cup

3. Measurement approach:

• Subjective organoleptic approach:
  • The subject is instructed not to eat, chew, rinse, or smoke before 2 hours
  • Trained clinician sniffs the expired air and rates it from 0-5
  • 0- No odor present
  • 1- Barely noticeable odor
  • 2-Slight but clearly noticeable odor
  • 3-Moderate odor
  • 4- Strong offensive odor
  • 5- Extremely foul odor
• Gas chromatography:
  • Consists of a monitor which measures levels of Hydrogen Sulphide, methyl mercaptan, and dimethyl sulfide and displays in the form of a graph
• Halimeter:
  • Measures sulfide levels in healthy persons
• BANA test:
  • BANA – Benzoyl-d, L-arginine-naphthylamide
  • Bacteria like P-gingivalis, T denticola, and B- forsythias degrade the BANA compound
  • This changes its color
  • Thus, used to measure bad breath
• Chemiluminescence:
  • Step Mixing of the sulfur compound and mercury compound
  • Resultant product results in fluorescence

Question 2. Halitosis.
Answer:

Halitosis Definition:

• Unpleasant odor exhaled in breathing

Read And Learn More: Periodontics Question and Answers

Halitosis Classification:

• Physiologic
• Pathologic
• Oral
• Extraoral

Halitosis Causes:

1. Physiologic:

• Mouth breathing
• Medication
• Fasting
• Aging
• Tobacco
• Food

2. Pathologic:

• Periodontal infection
• Tongue coating
• Stomatitis, Xerostomia
• Faulty restoration
• Unclean denture
• Ulcers, Abscess
• Systemic diseases

Halitosis Pathogenesis:

Microbial putrefaction
↓
Proteolysis of protein
↓
Rises to volatile sulfur compounds

Halitosis Diagnosis:

• Clinical examination
• Subjective organoleptic
• Halimeters
• BANA test
• Chemiluminescence
• Gas chromatography

Halitosis Treatment:

• Scaling
• Irrigation
• Tongue brushing
• Use of mouth rinse

Recent: use of Halita

Oral Malodor Short Answers

Question 1. Halimeter.
Answer:

• It is an electronic device that analyzes the concentration of hydrogen sulfide and methyl mercaptan
• Mouth air is aspirated by inserting a drinking straw fixed on the flexible tube of the instrumental
• Straw is kept about 2 cm behind the lips while the per- son keeps the mouth slightly open and breathes through the nose
• It uses a voltammetric sensor that generates a signal when exposed to sulfur-containing gases

Halimeter Result:

• 150 ppb or lower-indicates absence of oral malodor
• 300-400 ppb- Indicates elevated concentration of volatile sulfur compounds

Halimeter Advantages:

• Easy to use
• Inexpensive
• Less embarrassing for patients

Halimeter Disadvantages:

• Lack specificity
• Detects only sulfur compounds
• Used only for intraoral causes

Question 2. BANA test.
Answer:

• BANA – Benzoyl-d, L-arginine-naphthylamide
• Bacteria like P-gingivalis, T denticola, and B-forsythias degrade the BANA compound
• This changes its color
• Thus, used to measure bad breath

Question 3. Halita.
Answer:

• Used for treatment of Halitosis

Halita Composition:

• 0.05% Chlorhexidine
• 0.05% Cetyl Pyridium chloride
• 0.14% zinc lactate

Halita Mechanism:

• Bonding of zinc ion with twice negatively charged sulfur radicals
• Results in a reduction in the expression of volatile sulfur compounds
• Halita also has antimicrobial action

Question 4. Causes of halitosis
Answer:

Physiologic

• Mouth breathing
• Medication
• Fasting
• Aging
• Tobacco
• Food

Pathologic

• Periodontal infection
• Tongue coating
• Stomatitis, Xerostomia
• Faulty restoration
• Unclean denture
• Ulcers, Abscess
• Systemic diseases

Oral Malodor Viva Voce

1. Organoleptic assessment by a trained judge is the gold standard in the examination of breath malodor
2. 0.05% chlorhexidine is used in halitosis
3. Mouth spray reduces oral malodor by means of masking the oral malodor
4. Skatole has the highest volatility

Host Response – Basic Concepts Important Notes

1. Leucocytes

• They constitute a major protective mechanism against the extension of plaque into the sulcus
• They are attracted by plaque bacteria

2. Leukotoxin

• It is an exotoxin produced by A.a. contains which has a toxic effect on PMNs
• This enables these microorganisms to evade the host defense of phagocytosis

3. Interleukin-1-includes

• Osteoclast activating factor – causes bone resorption
• Lymphocyte activating factor – has the ability to stimulate the proliferation of T cells
• Interleukin-1 and TNF are key cytokines in the pathogenesis of periodontitis

4. Prostaglandin Ez

• The cells that produce it in periodontium are macrophages and fibroblasts
• It induces the secretion of metal matrix proteins and osteoclastic bone resorption
• Contributes to the loss of alveolar bone as seen in periodontitis

Host Response – Basic Concepts Short Essays

Question 1. Role of saliva in oral defense mechanism.
Answer:

• Swallows bacteria
• Inhibits bacterial attachment
• Bacteriocidal action

Peroxidase System:

Peroxidase (Synthesize by ductal cells)
↓
Bound to bacteria (or) Hydrogen peroxide (secreted by bacteria, neutrophils & host cells)
↓
This combines with thiocyanate secreted by ductal cells
↓Oxidation

This leads to hypothiocyanous acid
↓
Causes the death of bacteria

Lactoferrin:

Secreted by serous salivary gland
↓
Binds to iron
↓
Cut off nutrition to bacteria
↓
Results in bacteriostatic action

Lysozyme:

Secreted by mucous salivary gland
↓
Degrades cell wall
↓
Lysis of cell

Question 2. Phagocytosis.
Answer:

Phagocytes reach the site of inflammation
↓
Opsonization recognizes micro-organisms coated by Cзb
↓
Attach to them
↓
Extends pseudopodia and engulfs microorganisms
↓
Fusion of lysozymes and phagosomes occurs
↓
Resulting in phagolysosome
↓
Kill the infectious agent by following the mechanism

1. Oxidative:

• Stimulation of Phagocytes
• This leads to increased O2 consumption
• Formation of O2 metabolite
• Conversion of the phagocyte to superoxide anion
• Conversation to H2O2 [microbicidal]

Read And Learn More: Periodontics Question and Answers

2. Non-Oxidative:

• Granules involved
  • Primary granules
  • Secondary granules
  • Tertiary granules

Question 3. Lymphocytes.
Answer:

Lymphocytes Types:

1. T-cells:

• Derived from thymus
• Secrete prostaglandins

Helper T-cell (TH):

• CD4
• Releases IL2 and Interferon
• In adult periodontitis, TH increased

Suppressor T-cell (TS):

• CDa
• Releases IL4 and IL5

2. B-Cells:

• Derived from the liver, spleen, and bone marrow
• Help in humoral immunity

3. Natural Killer Cells:

1. Plaque antigens diffuse through the junctional epithelium
2. Langerhans cells within the epithelium capture and process the antigens
3. Antigen-presenting cells (macrophages & Langerhans cells) leave the gingiva in the lymphatics
4. Antigen-presenting cells reach the lymph node and begin to stimulate lymphocytes to produce a specific immune response
5. Periodontal microbe-specific antibodies are produced by plasma cells within the lymph nodes and travel back to the gingiva via blood vessels
6. Antibodies leave the circulation and are carried to the crevice in the transudate from the inflamed and dilated blood vessels
7. Antibody action on microbes in the crevice can result in killing, aggregation, precipitation, detoxification, opsonization, and phagocytosis of bacteria

Lymphocytes Functions:

Recognizes antigen:

Divides and provides a large no. of cells called “clonal expansion”
↓
Differentiate into
↓
Humoral responses
Different lymphocytes into plasma cells Secret es antibody

Question 4. Inflammatory cells.
Answer:

1. Neutrophils:

• The first cell of defense
• Exit circulation and reaches the site

Inflammatory cells Functions:

• Emigration:
  • Neutrophils adhere to endothelial cells
  • These, then migrate across the endothelium
• Chemotaxis:
  • Attracted by chemical signals from multiple sources
• Phagocytosis:
  • Attaches to micro-organisms and engulfs it

2. Macrophages:

• Develop from blood monocytes
• Migrate to the site of inflammation
• Triggered by cytokines, inflammatory mediators, and bacterial products

Inflammatory cells Functions:

• Phagocytose kill bacteria
• Remove damaged host tissue
• Present antigens to lymphocytes
• Secretes inflammatory mediators
• Secretes tissue-damaging enzymes
• Secretes complement components

Host Response – Basic Concepts Short Answers

Question 1. Complement.
Answer:

Components – C1-C9:

Effect: Cytolytic and cytotoxic damage to cell

Functions:

Question 2. Neutrophils.
Answer:

• The first cell of defense
• Exit circulation and reaches the site

Functions:

1. Emigration:

• Neutrophils adhere to endothelial cells
• These, then migrate across the endothelium

2. Chemotaxis:

• Attracted by chemical signals from multiple

3. Phagocytosis:

• Attaches to micro-organisms and engulfs it

Question 3. Antibacterial factors in saliva.
Answer:

• The antibacterial action of saliva is through

1. Perioxidase System:

Peroxidase (Synthesize by ductal cells)
↓
Bound to bacteria (or) Hydrogen peroxide (secreted by bacteria, neutrophils & host cells)
↓
This combines with thiocyanate created by ductal cell
↓
Oxidation
This leads to hypothiocyanous acid
↓
This leads to hypo thiocyanic acid
↓
Causes the death of bacteria

2. Lactoferrin:

Secreted by serous salivary gland
↓
Binds to iron
↓
Cut off nutrition to bacteria
↓
Results in bacteriostatic action

3. Lysozyme:

Secreted by mucous salivary gland
↓
Degrades cell wall
↓
Lysis of cell

Question 4. Any 5 Neutrophil disorders causing periodontitis.
Answer:

• Papillon Lefevre syndrome
• Down’s syndrome
• Chediak-Higashi syndrome
• Agranulocytosis
• Cyclic Neutropenia

Question 5. Functions of leukocytes
Answer:

1. Phagocytosis:

• Leukocytes engulf bacteria and foreign material

2. Chemotaxis:

• Enables leukocytes to locate their target

3. Antiallergic effect:

• Eosinophil inhibits histamine release during allergic conditions

4. Antibody formation:

• Lymphocytes are responsible for antibody formation

5. Heparin production:

• Basophils produce heparin which prevents in-intravascular clotting

6. Trephone formation:

• Leukocytes help in the formation of the telephone from plasma proteins

Question 6. Functions of IgG.
Answer:

Functions of IgG:

• Complement fixation Delayed antibody response
• Opsonization
• Cross placental barrier
• Increased concentration in GCF

Question 7. Name functional defects of leukocytes.
Answer:

Host Response – Basic Concepts Viva Voce

1. Predominant immunoglobulin in saliva is IgA
2. Orogranulocytes are PMNs that reach the oral cavity

 

 

 

 

 

Dental Calculus And Other Etiological Factors

Definitions

1. Calculus: Calculus is an adherent, calcified, or calcifying mass that forms on the surfaces of teeth and dental appliances

2. Food impaction: Forceful wedging of the food into the periodontium by occlusal forces

Dental Calculus And Other Etiological Factors Important Notes

1. Composition of calculus

2. Theories of calculus formation

• Booster mechanism
• Colloidal proteins in saliva
• Liberation of phosphate
• Epideictic concept
• Inhibition theory

3. Differences between supra gingival and subgingival calculus

4. Modes of attachment of calculus

• By means of an organic pellicle
• By mechanical interlocking into lacunae and caries
• Penetration into cementum
• Close adaptation to cementum surface

5. Sequele of food impaction

• Gingivitis
• Periodontal pocket
• Bone loss
• Tooth mobility

Read And Learn More: Periodontics Question and Answers

6. Factors causing vertical food impaction

• Uneven occlusal wear
• Opening of the contact point
• improper restoration

7. Stains and their causes

8. Features of different terms

Dental Calculus And Other Etiological Factors Long Essays

Question 1. Define and classify calculus. Describe its structure, composition, and etiology.
Answer:

Calculus Definition:

• Calculus is an adherent, calcified, or calcifying mass that forms on the surfaces of teeth and dental
  appliances

Calculus Types:

1. Supra gingival:

• Location – Above gingival margin
• Formation – From salivary secretion

2. Subgingival:

• Location – Below free gingiva
• Formation – Gingival exudates

Calculus Structure

1. Supra gingival: Whitish yellow in color
2. Subgingival: Dark brown or greenish black

Calculus Forms:

• Ring like
• Ledge like
• Crusty
• Spiny
• Nodular
• Finger-like
• Fern-like

Calculus Composition:

Calculus Inorganic constituents:

• Calcium
• Phosphorous
• Carbonate
• Sodium
• Magnesium
• Fluoride
• Hydroxyapatite
• Whitlock lite
• octacalcium phosphate
• Brush ite

Calculus Organic constituents:

• Carbohydrate
• Proteins
• Lipids
• Leukocytes
• Micro-organisms
• Desquamated cells

Calculus  Etiology:

• Bacterial deposits
• Poor oral hygiene
• Iatrogenic factors
  • Faulty restoration
  • Overhanging
• Plunger cusps
• Orthodontic appliances
• Unreplaced missing teeth
• Malocclusion
• Habits

Question 2. Discuss the role of iatrogenic factors in the etiology of periodontal diseases.
Answer:

Dental Calculus And Other Etiological Factors Short Essays

Question 1. Theories regarding mineralization of Dental calculus. (or) Theories of Calculus Formation.
Answer:

• Precipitation of minerals due to a local rise in Calcium and Phosphate

1. Booster mechanism:

2. Colloidal proteins in saliva:

3. Liberation of phosphatize:

• By precipitation of calcium phosphate

4. Epideictic concept:

1. Seeding agents (intercellular matrix of plaque, carbohydrate, protein complexes, and plaque bacteria)
2. Induce small foci of calcification
3. These enlarge and form calcification

5. Inhibition theory:

• States that calcification occurs at specific sites because of inhibiting mechanism at non-calcifying sites
• At the calcifying site, the inhibiting mechanism is removed

Example: Pyrophosphate

Question 2. Supra and Subgingival Calculus/Difference between supra gingival and subgingival Calculus. Answer:

Question 3. Modes of attachment of calculus.
Answer:

• By means of an organic pellicle
• By mechanical interlocking into lacunae and caries
• Penetration into cementum
• Close adaptation to cementum surface

Dental Calculus And Other Etiological Factors Short Answers

Question 1. Pathologic migration of tooth/ Causes of Patho- Faulty restoration logic migration.
Answer:

Refers to tooth displacement that results when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease. Teeth affected: Common in the anterior region

Pathologic Migration of Tooth Symptoms:

• Mobility of teeth
• Rotation of teeth
• Extrusion

Pathologic Migration of Tooth Causes:

• Weakened periodontal support
• Changes in forces exerted on teeth
• Unreplaced missing teeth
• Failure to replace the first molar

Pathologic Migration of Tooth Other Causes:

• Pressure from tongue
• Pressure from granulation tissue

Question 2. Epideictic concept of calculus formation.
Answer:

1. Seeding agents (intercellular matrix of plaque, carbohydrate, protein complexes, and plaque bacteria)‎
2. Induce small foci of calcification
3. These enlarge and form calcification

Question 3. Modes of Attachment of Calculus.
Answer:

• By means of an organic pellicle
• By mechanical interlocking into lacunae and caries
• Penetration into cementum
• Close adaptation to cementum surface

Question 4. Etiological Significance of Calculus.
Answer:

• Initially, calculus causes damage to the gingival margin
• Provides retention of more microorganisms
• Brings microorganisms close to supporting structures
• Interferes with a self-cleansing mechanism
• Initiates periodontal destruction
• Results in periodontal diseases

Question 5. Bruxism.
Answer:

It is unconscious grinding of teeth, usually at nighttime.

Bruxism Types:

• Nocturnal
• Diurnal

Bruxism Features:

• Presence of Occlusive factors
• No association with periodontal disease
• Lead to tooth fracture
• Tooth wear
• Muscle hypertrophy

Bruxism Etiology:

• Occlusive disharmony
• Psychological

Bruxism Treatment:

• Maxillary stabilization

Question 6. The sequence of food impaction.
Answer:

• Gingivitis
• Periodontal pocket
• Bone loss
• Tooth mobility

Question 7. Etiological significance of calculus in periodontitis (or) What is the role of calculus in periodontitis?
Answer:

Role Of Calculus In Periodontitis:

• Calculus provides a fixed nidus for continuous plaque accumulation
• It brings plaque bacteria close to the supporting tissues • Interferes with a local self-cleansing defense mechanism
• Acts as a reservoir for irritating substances such as en- endotoxins, antigenic material, and bone-resorbing factors
• Makes plaque removal more difficult for the patient

Question 8. Define Food Impaction.
Answer:

Forceful wedging of the food into the periodontics by occlusive forces

Food Impaction Causes:

• Uneven occlusal wear
• Loss of proximal contact
• Congenital abnormalities
• Faulty restoration

Dental Calculus And Other Etiological Factors Viva Voce

1. Anti-tartar agents are triclosan, pyrophosphate, and zinc salts
2. Anti-tartar agents inhibit mineralization
3. Calculus embedded deeply into the cementum is called calculocementum
4. Calculus provides a fixed nidus for the continued accumulation of plaque
5. The irritating effect of material alba on the gingival is caused by bacteria and their products
6. Distolingual cusp of upper second molar is common- est plunger cusp
7. Subgingival calculus is the dark green or dark brown because of the presence of blood products
8. A. viscous possess fimbriae that help bond to the dental pellicle
9. The location and extent of the subgingival calculus may be evaluated clinically by the explorer
10. Calculus attaches to the tooth surface through chemical bonding to the hydroxyapatite
11. In the pathogenesis of periodontal disease, calculus acts as a contributing factor.