Periodontal Diseases
Question 1. What are the constituent parts of periodontium?
Answer. The periodontium consists of several tissues namely the gingiva, periodontal ligaments, cementum and alveolar bone.
Question 2. Define periodontal diseases.
Answer. The periodontal diseases are a group of heterogenous, chronic destructive inflmmatory conditions affecting the periodontium.
Read And Learn More: Oral Pathology Short Notes Question And Answers
Question 2a. What is the oxygen consumption of healthy gingiva?
Answer. 1.6 + 0.37.
Question 2b. What is the glucose level of gingival crevicular flid?
Answer. It is 3 to 4 times higher than the blood glucose level.
Question 2c. What is the average depth of gingival crevice?
Answer. 2 to 3 mm.
Question 3. What is gingivitis?
Answer. The term gingivitis is used to designate inflmmatory lesions that are confied to the marginal gingiva.
Question 4. What is periodontitis?
Answer. Once the inflmmatory process from gingiva extends into the deeper tissues and causes destruction of the periodontal ligaments along with loss of alveolar bone; the disease is designated as asperiodontitis.
Question 5. How many types of etiological factors are found in periodontal diseases?
Answer. There are two types of factors:
- Local factors
- Systemic factors.
Question 6. What are the local factors in the etiology of periodontal diseases?
Answer.
- Microorganisms
- Calculus
- Food impaction
- Faulty restorations
- Tooth malposition
- Mouth breathing habit
- Use of different drugs or chemicals.
Question 7. Name the systemic factors in the etiology of periodontal diseases.
Answer.
- Nutritional deficiency
- Pregnancy
- Diabetes
- Allergy
- Heredity
- Immunological disorders
- Psychogenic factors.
Question 8. Name the two important oral diseases which are caused by the same type of microorganisms.
Answer. Dental caries and periodontal diseases.
Question 9. How the role of bacteria can be established in the initiation of periodontal disease?
Answer.
- Accumulation of plaque bacteria in mouth initiates periodontal disease while plaque control re-establishes periodontal health
- Administration of antimicrobial agents can prevent gingivitis and periodontitis
- Bacteria isolated from human dental plaque are capable of inducing periodontal disease when introduced into the mouths of gnotobiotic animals
- Several species of pathogenic bacteria have been isolated from periodontal pockets.
Question 10. What is dental plaque?
Answer. Plaque is a thin, transparent fim produced on the tooth surface and it consists predominantly of microorganisms suspended in salivary mucins.
Question 11. Mention the composition of dental plaque.
Answer.
- Microorganisms
- Food debris
- Salivary mucin
- Extracellular bacterial polysaccharides (glucans)
- Desquamated epithelial cells
- Leukocytes.
Question 12. What is acquired pellicle?
Answer. Acquired pellicle is initial component of the dental plaque, which is made by the salivary glycoprotein and is formed just prior to the bacterial colonization.
Question 13. Describe the composition of acquired pellicle.
Answer.
- Salivary glycoprotein
- Albumin
- Immunoglobulin G
- Immunoglobulin A.
Question 13a. Describe the stages of formation of dental plaque.
Answer. Formation of plaque in the healthy mouth occurs in the following manner:
Question 13b. Name the factors which often favor the development of plaque in the mouth.
Answer. Presence of the following factors can enhance the plaque deposition in mouth:
- Calculus
- Food impaction
- Overhanging restoration
- Malocclusion
- Deep pockets
- Mouth breathing.
Question 14. What are the pioneering organisms in dental plaque?
Answer. One hour after the formation of acquired pellicle, for the fist time some organisms such as S. sanguinis, A. viscosus, A. naeslundii and Peptostreptococcus, etc. become attached to it. These organisms are called pioneering organisms.
Question 15. Name the bacteria which are generally present in healthy periodontal tissues.
Answer. Healthy periodontal tissues of humans are associated with a scanty flra located almost entirely supragingivally on the tooth surface. The microbial accumulations are 1–20 cells in thickness and comprise mainly Gram-positive bacteria Streptococcus and Actinomyces species predominate, for example Streptococcus sanguinis, A. naeslundii, A. viscosus, etc.
Question 16. Name the bacteria which might be present in gingivitis.
Answer. Members of the genus Actinomyces predominate, but there is a substantial increase in strict anaerobes and Gram-negative organisms.
Question 17. Which bacteria predominate in subgingival tissue in periodontotis?
Answer. Microbial population in subgingival plaque in periodontitis comprises of Gramnegative rods, motile forms and spirochetes. Black-pigmented bacteroid group are the predominant cultivable organisms in most subjects and they have been reclassifid as
Porphyromonas or prevotella species, for example Porphyromonas gingivalis, Prevotella melaninogenica and Prevotella intermedia, etc.
Question 18. Name the common bacteria causing periodontal disease.
Answer.
- Actinomycetemcomitans
- Actinomyces viscosus
- Capnocytophaga group
- Eikenella corrodens
- Fusobacterium nucleatum
- Porphyromonous gingivalis
- Prevotella intermedia
- Treponema
- Wolinella.
Question 19. What is calculus?
Answer. Mineralized plaque present on the tooth surfaces as hard deposit is called calculus.
Question 20. How calculus forms on the tooth surface?
Answer. Calculus forms as the soft dental plaque gets mineralized due to the deposition of calcium and other minerals.
Question 21. During development of calculus where do the minerals come from?
Answer. Minerals are coming either from the saliva or the blood serum.
Question 22. How calculus helps in the development of periodontal diseases?
Answer. The calculus contributes to the development of periodontal diseases either by harboring the plaque bacteria or by causing irritation to the gingival tissues.
Question 23. What is the role of systemic factors in the initiation of periodontal diseases?
Answer. These factors can alter the host’s response to local irritants in the mouth and therefore can inflence the development and progression of periodontal lesions.
Question 24. Name the systemic factors which mightinflencethe development and progression of periodontal diseases.
Answer.
- Diabetes mellitus
- Hormonal changes in puberty or pregnancy
- Nutritional deficiency
- Hematological disorders
- Drugs
- Immunodeficiency
- Smoking.
Question 25. How diabetes mellitus can contribute to the periodontal diseases?
Answer. Vascular changes (tiny vessels supplying the periodontium get obliterated due to atherosclerosis causing diminished blood supply) and defects in cellular defense mechanisms both have been suggested as possible mechanisms in which diabetes could increase the susceptibility of periodontal tissue to irritants from dental plaque.
Question 26. How hormonal changes affect the gingival tissue health?
Answer. Hormonal changes (during puberty and pregnancy) simply modify the tissue response to dental plaque; they increase the susceptibility of the gingival tissue to become inflamed by local irritants.
Question 27. How nutritional deficiency can contribute to the development of periodontal diseases?
Answer. Nutritional deficiency particularly deficiency of protein and vitamin C in the diet can cause hemorrhagic gingivitis and generalized edematous enlargement of the gingiva.
Question 27a. What is the most important function of vitamin C?
Answer. Synthesis of collagen fiers.
Question 27b. What is the function of collagen fiers in our body?
Answer. The collagen fiers produce the ground substance of all the connective tissues in the body i.e. connective tissue proper, bone, cartilage, tendons, ligaments and blood vessels, etc.
Question 27c. Describe the role of vitamin C in the synthesis of collagen.
Answer. At the beginning of collagen synthesis, vitamin C helps hydroxylation of proline and glycine (these are amino acids); which leads to formation of hydroxyproline and hydroxyglycine. The latter two molecules react together to produce a chemical substance called procollagen which then converts into tropocollagen and then fially into collagen through a series of chemical processes.
Question 28. Name the blood disorder which has the most profound effect on the gingival tissue.
Answer. Acute leukemia.
Question 29. How the periodontal tissues get damaged in leukemia?
Answer. In leukemia the malignant WBC cells (leukemic cells) often infitrate into the gingiva and the deeper structures of periodontium; often causing severe alveolar bone loss and periodontal destruction.
Question 30. Name the drugs which can affect the periodontal tissue health.
Answer.
- Phenytoin sodium
- Cyclosporine
- Nifedipine
- Azathioprine
- Naproxen sodium
- Verapamil
- Estrogen and progesterone.
Question 31. How these drugs cause changes in the periodontium?
Answer. These drugs often modify the response of the host (periodontal tissue) to local irritants and product from microbial plaque.
Question 32. What is the role of immunodeficiency in the development of periodontal diseases?
Answer. Diminished cell-mediated as well as humoral immunity can predispose to many periodontal diseases; it is particularly more often seen in HIV-infected individuals.
Question 32a. Name the important periodontal diseases, which occur in HIV infected patients.
Answer.
- HIV-gingivitis: A linear gingival erythema which is a firy red band along the gingival margin and attached gingiva with profuse bleeding tendency
- Necrotizing ulcerative gingivitis: With typical destruction of interdenral papilla
- Rapidly progressing HIV periodontitis: Advanced necrotic destruction of the periodontium, rapid bone loss, loss of periodontal ligament and sequestration, etc.
Question 33. What is the role of tobacco habits in periodontal diseases?
Answer. There is ample evidence that tobacco smoking is an important risk factor for the development and progression of periodontal diseases. Smoking probably impairs the phagocytic function of polymorphoneutrophils (PMN).
Question 34. Name the factors which counter or resist the occurrence of periodontal diseases.
Answer.
- Salivary factors
- Gingival crevicular flud
- Epithelial barrier
- Transmigration of neutrophils
- Immune response.
Question 35. Name the different stages of periodontal diseases.
Answer. Periodontal diseases are broadly divided into two groups; gingivitis and periodontitis.
- Gingivitis designates three stages:
- Initial lesion
- Early lesion
- Established lesion
- Periodontitis designates only the advanced lesion.
Question 36. How early the initial lesion of gingivitis develops after accumulation of plaque?
Answer. The initial lesion of gingivitis develops within 2–4 days following the onset of plaque accumulation.
Question 37. Can the gingival changes in the initial lesion be clinically detected?
Answer. The changes in the initial lesion are histological and cannot be detected clinically.
Question 38. Describe the histological appearances of initial lesion of gingivitis.
Answer. It shows acute inflammatory response in the gingiva which is characterized by vasodilatation accompanied by formation of both flid and cellular exudates and infitration of polymorphonuclear neutrophilic leukocytes (PMN) in the subgingival connective tissue and intercellular spaces of the junctional epithelium.
Question 39. When does the early lesion of gingivitis develops?
Answer. The early lesion develops within 4–7 days following the onset of plaque accumulation.
Question 40. Describe the clinical features of early gingivitis.
Answer.
- Gingival swelling with excessive bleeding tendency either spontaneously or by slight provocation (e.g. tooth brushing)
- The gingiva appears red or bluish red in color with a bogy or spongy consistency.
Question 41. Does the level of gingival attachment alter in early gingivitis?
Answer. The gingival attachment level on the tooth surface remains unchanged in early gingivitis.
Question 42. Are there any radiographic changes seen in the alveolar bone in early gingivitis?
Answer. Radiographic changes in the bone are absent in early gingivitis as it is a superficial lesion.
Question 43. When and how the established lesion of gingivitis develops?
Answer. The established lesion of gingivitis develops as an extension of early lesion, usually within 2–3 weeks of the onset of plaque accumulation.
Question 44. How the established lesion of gingivitis can be distinguishes from the early lesion
histologically?
Answer. The characteristic feature of the established lesion, which distinguishes it from the early lesion, is the shift in the inflmmatory cell population within the gingival connective tissue from predominantly lymphocytic (T cell) to predominantly plasma cell (B cell) type.
Question 45. How destruction of collagen (extracellular matrix) occurs in periodontal disease?
Answer. It occurs as a consequence of decreased rate of synthesis, increased rate of degradation, or a combination of both:
- Since collagen is synthesized by firoblast cells, damage to these cells in the inflmed area would result in decreased synthesis
- Increased degradation of collagen often results from enhanced enzyme activity.
Question 46. Name the various collagenolytic enzymes.
Answer.
- Collagenase
- Stromalysin
- Metalloproteinase.
Question 47. What are the common consequences of gingivitis?
Answer. Gingivitis may have various consequences in different patients:
- It may remain stable for years in few patients
- It can progress slowly to periodontitis in some patients
- Occasionally it can have rapid progression with advanced bone loss at an early age.
Question 47a. What is the difference between gingivitis and periodontitis?
Answer. Loss of epithelial attachment occurs in periodontitis but not in gingivitis.
Question 48. In periodontal disease, what is an advanced lesion?
Answer. The advanced lesion corresponds to chronic periodontitis, a disease characterized by destruction of the connective tissue attachment of the root of the tooth with loss of alveolar bone and pocket formation.
Question 49. Describe the process of pocket formation in periodontitis.
Answer. Early true pocket formation occurs in the following steps:
- Extension of gingival inflmmation beneath the base of the junctional epithelium into the supra-alveolar connective tissue
- Increase in the area and density of inflammatory infitrate causes destruction of collagen in the supra-alveolar connective tissue
- Loss of attachment of the collagen fiers from cementum on the root of the tooth
- Loss of collagen attachment causes apical migration of the junctional epithelium on the root surface leading to early true pocket formation.
Question 50. Name the inflmmatory cells which predominate in advanced lesions of periodontitis.
Answer. Plasma cells dominate the infitrate at all stages of the advance lesions, although lymphocytes and macrophages are also present.
Question 51. Name the different types of periodontitis.
Answer.
- Pre-pubertal periodontitis
- Juvenile periodontitis
- Rapidly progressive periodontitis
- Adult-type periodontitis.
Question 52. What is pre-pubertal periodontitis?
Answer. It is a rare form of periodontitis affecting the deciduous dentition that may be localized or generalized.
Question 53. What is most important underlying cause of pre-pubertal periodontitis?
Answer. It is mostly genetic and there may be a variety of medical conditions associated with it.
Question 54. What is juvenile periodontitis?
Answer. Juvenile periodontitis is an uncommon form of periodontitis, which has onset in puberty or in adolescence; and which exhibits relativity well-defied clinical features.
Question 55. What is rapidly progressive periodontitis?
Answer. It is an uncommon form of periodontitis with onset in late adolescence and early adulthood; and is characterized by episodes of localized or generalized periodontal tissue destruction.
Question 56. What is most important underlying cause of rapidly progressive periodontitis?
Answer. Defective leukocyte function.
Question 57. What is adult-type periodontitis?
Answer. It is the most common form of periodontitis, which is typically seen in adults over the age of 30 years.
Question 58. Which people are commonly affected in Juvenile periodontitis?
Answer. Juvenile periodontitis mostly occurs in young people and is more common in females.
Question 58a. Is accumulation of plaque and calculus necessary for development of juvenile periodontitis?
Answer. No.
Question 58b. What is the fist indication of development of juvenile periodontitis in a person?
Answer. Unexplained drifting of otherwise healthy teeth in a relatively healthy mouth.
Question 59. Which teeth are commonly affected in juvenile periodontitis?
Answer. Teeth affected in juvenile periodontitis are those which erupt at the time of puberty i.e. permanent fist molar and/or maxillary incisor teeth.
Question 60. Describe the characteristics of juvenile periodontitis.
Answer. The disease is characterized by rapid destruction of alveolar bone with vertical bone loss resulting in deep infra-bony pockets. All these happen at an early age (when conventional periodontitis should not occur) and even in people with a relatively good oral hygiene and little plaque in the teeth.
Question 60a. What is the drug of choice in the treatment of juvenile periodontitis?
Answer. Tetracycline.
Question 61. Name the bacterias commonly found in the subgingival plaque in juvenile periodontitis.
Answer. The subgingival plaque in juvenile periodontitis is dominated by some distinct types of Gram-negative anaerobic rods:
- Actinobacillus actinomycetemcomitans
- Capnocytophaga species
- Eikenella corrodens.
Question 62. What is the common age of occurrence of rapidly progressive periodontitis?
Answer. Rapidly progressive periodontitis usually occurs between puberty and 30 years of age.
Question 63. Describe the common features of rapidly progressive periodontitis.
Answer. There will be very fast developing (occurring within a few weeks or months) severe inflammation of the periodontium; affecting nearly the entire dentition with evidence of rapid bone destruction.
Question 64. Describe the common characteristics of adult-type periodontitis.
Answer.
- It is the most common form of chronic periodontal disease
- Although the entire dentition can be involved but most severe tissue destruction is often seen in lower incisors and molar regions
- Predominantly shows horizontal bone loss
- Usually does not progress to tooth loss until after 50 years of age.
Question 65. What is the most common radiographic fiding in chronic periodontitis?
Answer. Destruction of alveolar bone with widening of the periodontal ligament space around the roots of teeth.
Question 66. Name some other diseases where typical widening of the periodontal ligament space occurs.
Answer.
- Periapical abscess
- Current orthodontic therapy
- Trauma from occlusion
- Scleroderma
- Osteosarcoma of the jaw.
Question 67. Name the factors which determine the prognosis in periodontal diseases.
Answer.
- Oral hygiene status of the patient
- Age of the patient
- Tooth factor
- Host resistance
- Patient motivation toward consistent oral hygiene maintenance.
Question 67a. What type of brushing technique is recommended for patients with periodontal disease?
Answer. Sulcular technique.
Question 68. What is tissue hyperplasia and tissue hypertrophy?
Answer. An increase in the number of cells causing tissue growth is called hyperplasia while an increase in the size of cells causing tissue growth is called hypertrophy.
Question 69. What is gingival hyperplasia?
Answer. Gingival hyperplasia refers to the excessive, exuberant proliferation of gingival tissue causing swelling or overgrowth of the gingiva.
Question 70. What are the two main types of gingival hyperplasias?
Answer. Gingival hyperplasias may be of two types:
- Inflammatory gingival hyperplasia
- Fibrous gingival hyperplasia.
Question 71. Name the different causes of inflmmatory gingival hyperplasia.
Answer.
- Vitamin C deficiency (scurvy)
- Leukemias
- Chronic hyperplastic gingivitis
- Endocrine imbalance (puberty/pregnancy)
- Sarcoidosis
- Crohn’s disease.
Question 72. What are the different causes of firous gingival hyperplasia.
Answer.
- Heredity (genetic)
- Drug intake
- Orofacial angiomatosis
- Wegner’s granulomatosis
- Idiopathic.
Question 72a. What is the commonest cause of firous type gingival hyperplasia?
Answer. Medication.
Question 73. Describe the clinical features of inflammatory gingival hyperplasia due to vitamin C deficiency.
Answer.
- Swelling, ulceration, pain and hemorrhage in the gingival
- The gingiva is often appears red and spongy and it is often necrosed
- Gingival sulcus is often filed with blood clot and foul smell is often present in the mouth.
Question 74. Why gingival hyperplasia occurs in case of leukemia?
Answer. It occurs predominantly due to the infitration of malignant leukemic cells within the gingival tissue.
Question 75. Which types of leukemias more often cause gingival hyperplasia?
Answer.
- Acute monocytic leukemia
- Acute lymphocytic leukemia
- Acute myelocytic leukemia.
Question 76. Describe the features of gingival hyperplasia in leukemia.
Answer.
- The gingiva becomes ulcerated, edematous and swollen
- It is usually painful, has a purplish color with extreme bleeding tendency
- Pallor in the surrounding mucosa with petechiae or ecchymoses is often observed.
Question 77. Why gingival hyperplasia occurs due to hormonal imbalance?
Answer. Because hormonal imbalance often increases the proliferative potential of gingival tissue in response to local irritations caused by plaque bacteria and other irritants.
Question 78. Describe the features of hormone-induced gingival hyperplasia.
Answer. The gingiva is often red, painless, swollen and it may or may not bleed upon provocation.
Question 79. What are pregnancy tumors?
Answer. Sometimes, a localized tumor-like growth may develop in the gingiva during pregnancy and it is often known as pregnancy tumor.
Question 80. Why pregnancy tumor occurs?
Answer. A lot of hormonal changes take place in the body during pregnancy which sometime result in excessive exuberant proliferation of the gingival tissue leading to the development of pregnancy tumor. It is therefore understood that pregnancy tumor is a type of gingival hyperplasia due to hormonal imbalance.
Question 81. Is any treatment required for pregnancy tumor?
Answer. The condition regresses spontaneously after the pregnancy period is over; therefore, no treatment is required except oral prophylaxis and maintenance of oral hygiene.
Question 82. What is Crohn’s disease?
Answer. Crohn’s disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus. It is often characterized by granulomatous superficial ulceration of the intestinal epithelium with frequent development of multiple fitulas.
Question 83. Name the oral manifestations of Crohn’s disease.
Answer.
- Granular, erythematous swelling of the gingiva with ulceration and occasional bleeding tendency
- Cobble-stone appearance of the buccal mucosa with many linear hyperplastic folds
- Diffuse indurated swelling on the lips and multiple ulcerations on the palate.
Question 84. Name the common drugs which can cause gingival hyperplasia.
Answer. The drugs, which can cause gingival hyperplasia are divided into the following groups:
- Anticonvulsants
- Calcium channel blockers
- Cyclosporine
- Erythromycin
- Oral contraceptives.
Question 85. Name the common anticonvulsants which can cause gingival hyperplasia.
Answer.
- Phenytoin
- Carbamazepine
- Ethotoin
- Felbamate
- Mephenytoin
- Phenobarbital
- Sodium valproate.
Question 86. Name the calcium channel blockers which can cause gingival hyperplasia.
Answer.
- Amlodipine
- Bepridil
- Diltiazem
- Nifedipine
- Verapamil.
Question 87. Describe the features of gingival hyperplasia due to ilantin sodium therapy.
Answer. The condition presents as a painless, rough, lobulated swelling of the interdental papilla with a typical pebbly surface. The gingival tissue feels fim, non-tender with no tendency to bleed.
Question 88. What is hereditary or familial gingival hyperplasia?
Answer. Hereditary or familial gingival hyperplasia occurs among several members of the same family and in such case the gingival tissue is usually fim and resilient and of normal color.
Question 89. What is the special signifiance of hereditary or familial gingival hyperplasia?
Answer.
- Gingiva is of normal color
- Pain and hemorrhage, etc. are usually absent
- Sometimes the gingival growth is so severe that it may cover up the entire crowns of the teeth
- This type of gingival hyperplasia may even prevent the eruption of teeth in younger individuals.
Question 90. How gingival tissue changes in orofacial angiomatosis?
Answer. Angiomatous proliferation of the gingival blood vessels may sometimes cause gingival hyperplasia and in such cases, the gingiva clinically appears swollen and red. The enlargements may cause false gingival pocket formation on few occasions.
Question 91. What happens to the gingiva in Wegener’s granulomatosis?
Answer. Focal or diffuse gingival swelling can occurs in this disease.
Question 92. What is desquamative gingivitis?
Answer. Desquamative gingivitis refers to the condition in which the gingival epithelium sloughs spontaneously or can be scrapped with gentle rubbing.
Question 93. Is desquamative gingivitis a single disease entity?
Answer. Desquamative gingivitis is not a single disease entity but is a clinical term applied to the gingival manifestations of several different diseases.
Question 94. Desquamative gingivitis commonly affects which category of people?
Answer. The condition is more common in females (80 percent) than males and most cases occur after 30 years of age.
Question 95. Name the diseases which might precipitate desquamative gingivitis.
Answer.
- Benign mucous membrane pemphigoid
- Lichen planus
- Pemphigus
- Erythema multiforme
- Local hypersensitivity reactions to toothpastes, cosmetics chewing-gums and cinnamon, etc
- Hormonal disturbances in menopausal females.
Question 96. What is plasma cell gingivitis?
Answer. The gingival reaction associated with chewing gum hypersensitivity is also referred to as plasma cell gingivitis; as there is often widespread distribution of large numbers of plasma cells throughout the gingiva.
Question 97. What is acute necrotizing ulcerative gingivitis?
Answer. Acute necrotizing ulcerative gingivitis (ANUG) is a relatively rare condition and is characterized clinically by necrosis of the free gingival margin, the crest of the gingiva and the interdental papillae, etc.
Question 98. Which microorganism causes acute necrotizing ulcerative gingivitis?
Answer. Acute necrotizing ulcerative gingivitis is a fuso-spirochetal disease and is caused predominantly by the fusiform bacilli and a spirochete called Borrelia vincentii.
Question 99. Name the precipitating factors in ANUG.
Answer.
- Immunosuppression (AIDS, infectious mononucleosis)
- Sudden change in lifestyle, e.g. lack of rest and sleep or emotional and professional stress
- Poor nutritional status and poor oral hygiene
- Local tissue damage local trauma
- Recent debilitating diseases, (e.g. bacterial infections, diabetes, blood dyscrasias, etc)
- Down’s syndrome
- Smoking.
Question 100. Acute necrotizing ulcerative gingivitis often affects which people?
Answer. It usually occurs among young and middle-aged adults, between the ages of 15 and 35 years and males suffer more often than females. Stressed professionals like army recruits tend to suffer more (7 percent) from the disease than the normal population (1 percent).
Question 100a. Which part of the gingiva is predominantly affected in ANUG?
Answer. Interdental papilla.
Question 101. What are the clinical features of acute necrotizing ulcerative gingivitis?
Answer.
- Initially the gingiva becomes red, edematous, hemorrhagic and painful
- This is followed by development of a sharply demarcated punched–out craterlike erosion of the interdental papillae
- The gingiva is often covered by a gray pseudomembrane with exquisite pain and an extremely unpleasant fetid odor in the mouth.
Question 102. What is necrotizing ulcerative stomatitis?
Answer. When the gingival lesion of ANUG extends further to the mucosal surfaces of the soft plate and tonsils it is called necrotizing ulcerative stomatitis.
Question 103. What is acute necrotizing ulcerative periodontitis?
Answer. Acute necrotizing ulcerative periodontitis is the advanced lesion of ANUG and it occurs when the necrotizing process from the gingiva spreads into the deeper tissues of periodontium and causes loss of epithelial attachment, subsequently leading to periodontitis.
Question 104. What is noma or cancrum oris?
Answer. When the necrotizing process of ANUG extends further and deeper by destroying the oral mucosa and the underlying oral tissues and reaches the extra oral skin surface, the condition is called noma or cancrum oris.
Question 105. Describe the histopathological features of ANUG.
Answer. Inflammation, ulceration and extensive necrosis of the gingiva which is often covered with a pseudomembrane. The pseudomembrane often consists of microorganisms, polymorphonuclear neutrophils (PMN) and necrotic tissue debris. The underlying connective tissue shows intense hyperemia and inflmmatory cell infitration by PMN.
Question 106. Name the lesions which often clinically simulate ANUG.
Answer.
- Primary acute herpetic gingivostomatitis
- Erosive lichen planus
- Cicatricial pemphigoid
- Drug allergy.
Question 107. What is the drug of choice in the treatment of ANUG?
Answer. Metronidazole.
Question 108. What is lateral periodontal abscess?
Answer. The lateral periodontal abscess is a localized area of suppurative inflmmation arising within the periodontal tissue alongside a tooth root.
Question 109. How lateral periodontal abscess develops?
Answer. It develops under the following conditions:
- Occlusion in the opening of infra-bony periodontal pockets
- Impaction of foreign material, such as food debris into a preexisting pocket
- Following traumatic injury to a tooth
- Lateral perforation of the root during endodontic therapy.
Question 110. What are the clinical features of lateral periodontal abscess?
Answer.
- The affected tooth is extremely sensitive to palpation, tender to percussion
- Throbbing pain, redness, swelling, and tenderness of the overlying mucosa
- Foul taste in the mouth with discharge of pus.
Question 111. What is the vitality status of the affected tooth in case of lateral periodontal abscess?
Answer. The tooth is mostly vital.
Question 112. What is the radiographic appearance of a fully developed lateral periodontal abscess?
Answer. There is often presence of a discrete radiolucent area along the lateral aspect of the root.
Question 113. What is pericoronitis?
Answer. Pericoronitis is inflmmation of the soft tissue overlying the crown of an impacted or partially erupted tooth; and is seen commonly in association with mandibular third molars.
Question 114. How pericoronitis develops?
Answer. Pericoronitis mostly develops due to accumulation of bacterial plaque and food debris in the space between the crown of an impacted or partially impacted tooth and the overlying gum flp.
Question 115. Describe the clinical features of pericoronitis.
Answer.
- Edema, swelling, and pain in the gum flp around the tooth
- The pain is usually very severe and often radiates to the ear and flor of the mouth
- Difficulty in closing the jaws due to swelling in the pericoronal tissue
- Difficulty in opening the mouth due to trismus and dysphagia.
Question 116. Name the factors which leads to extrinsic staining of teeth.
Answer.
- Tobacco
- Coffee, tea and cold drinks, etc.
- Chromogenic microorganisms
- Mouth washes e.g. chlorhexidine gluconate.
Question 117. What types of stains are often produced on the tooth surface by the chromogenic bacteria?
Answer. Mostly the brown, black, green or orange stains are produced.
Question 118. What type of staining occurs on the teeth by chlorhexidine gluconate mouth washes?
Answer. Chlorhexidine often produces yellow-brown discoloration, especially on the proximal surfaces of teeth near the cervical region.
Question 119. What type of staining occurs on the teeth by silver amalgam?
Answer. Black-gray stains.
Question 120. Which agents cause brown discoloration of teeth?
Answer. Tobacco, tea, and coffee, etc. often cause brown discoloration of teeth.
Question 121. In case of smokers which teeth are often discolored?
Answer. Smokers often have brownish discoloration of lingual surfaces of mandibular incisors.
Question 122. How green stains can develop on tooth surfaces?
Answer. Green stains are generally produced by metals, e.g. copper and nickel, etc and these stains are usually seen on the labial surface of upper anterior teeth as a band and are probably caused by the blood pigments secondary to gingival hemorrhage.
Question 123. What type of staining occurs in teeth in case of florosis?
Answer. White-yellow or yellow-brown.
Question 124. What type of staining occurs in teeth in case of tetracycline toxicity?
Answer. Yellow-brown.
Question 125. How the tooth appears in case of internal resorption?
Answer. The teeth with internal resorption generally appears pink.
Question 126. What type of staining occurs in teeth in case of amelogenesis imperfecta?
Answer. Yellow-brown.
Question 127. What type of staining occurs in teeth in case of dentinogenesis imperfecta?
Answer. Blue-gray.
Question 128. In which disease yellow or brown-red discoloration of teeth occurs?
Answer. Congenital porphyria.
Question 129. In case of erythroblastosis fetalis and jaundice, the teeth often exhibit which staining?
Answer. Yellow-green staining in both cases.
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