Periodontics and Gum Disease Flashcards

A 55-year-old male patient presents for a routine exam. His medical history is significant for hypertension, for which he takes amlodipine. Clinical examination reveals generalized, firm, fibrotic gingival enlargement, particularly prominent in the anterior regions, with pseudopocketing. Which of the following is the most likely diagnosis for his gingival condition?

Answer: Drug-influenced gingival enlargement

Amlodipine is a calcium channel blocker, a class of drugs well-known to be associated with gingival enlargement. [3] The clinical presentation of firm, fibrotic overgrowth, often more pronounced in the anterior sextants, is characteristic of drug-influenced gingival enlargement. While other conditions can cause enlargement, the patient's specific medication history is the most significant etiological factor here.

According to the 2017 AAP/EFP classification, which of the following is the primary criterion used to determine the 'Grade' of a periodontitis case?

Answer: The rate of disease progression over time

The 'Grade' in the 2017 classification system provides supplemental information about the biological features of the disease, including its rate of progression, risk for future progression, and potential impact on systemic health. [12] Grade is determined by assessing direct or indirect evidence of progression over time, such as historical radiographic bone loss or CAL changes. Grade A is slow progression, Grade B is moderate, and Grade C is rapid progression. [10]

A healthy 42-year-old female presents with a chief complaint of a "long tooth" on her maxillary right canine. The clinical exam reveals a 4mm recession defect. The recession extends beyond the mucogingival junction, but there is no loss of interdental bone or soft tissue. According to Miller's classification, what is the most likely classification and prognosis for root coverage?

Answer: Class II, with 100% anticipated root coverage

Miller's Class II is defined as marginal tissue recession that extends to or beyond the mucogingival junction, with no periodontal loss (bone or soft tissue) in the interdental area. [22] This classification predicts that 100% root coverage can be anticipated with surgical treatment. Class I does not extend to the MGJ, while Classes III and IV involve interdental bone or soft tissue loss. [15]

The primary principle of Guided Tissue Regeneration (GTR) in treating periodontal intrabony defects is to:

Answer: Use a barrier membrane to prevent the apical migration of the junctional epithelium and allow periodontal ligament cells to repopulate the defect.

The fundamental concept of GTR is the use of a physical barrier to exclude gingival epithelial and connective tissue cells from the root surface during healing. [29] This selective exclusion allows cells from the periodontal ligament and alveolar bone, which have the potential for true regeneration (new cementum, PDL, and bone), to repopulate the wound area. [24, 28]

A patient with a history of generalized chronic periodontitis, now stable after treatment, has a dental implant replacing tooth #30. Which of the following clinical findings is most characteristic of peri-implantitis when compared to periodontitis?

Answer: Inflammation and bone loss often progress more rapidly and in a non-linear, accelerating pattern.

Peri-implantitis lesions are characterized by a more pronounced inflammatory response and a faster, non-linear pattern of bone destruction compared to periodontitis lesions. [26] This is attributed to differences in the tissue structure and vascular supply around implants versus natural teeth, making the peri-implant tissues more vulnerable to bacterial challenge. [25, 11]

Which of the following systemic conditions has the most well-established bidirectional relationship with periodontal disease, where the presence of one adversely affects the other?

Answer: Diabetes Mellitus

A strong, bidirectional relationship has been established between diabetes mellitus and periodontal disease. [2] Poorly controlled diabetes is a major risk factor for the development and progression of periodontitis. Conversely, severe periodontitis can complicate glycemic control in diabetic patients. [1] Treatment of periodontal disease has been shown to improve glycemic control in individuals with type 2 diabetes.