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175 Cards in this Set
- Front
- Back
Steps of treatment plan, in order
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systemic, emergency, initial prep, reevaluation, surgical, restorative, finishing, reevaluation, maintenance, periodic reevaluation
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standard premed
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amoxicillin 2 gms 1 hr pre-op
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larger width of PDL would be on which side of force - tension or pressure
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tension
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injury resulting from the application of excessive occlusal forces to a tooth with normal periodontal support
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primary occlusal trauma
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injury resulting from the application of totherwise normal occlusal forces to a tooth with reduced periodontal support
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secondary occlusal trauma
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t/F occlusal trauma, w/o inflammation, does not cause loss of fibrous attchmnt to the tooth or apical migration of the epi attchmnt
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T
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Angles class - buccal groove of mand 1st perm molar articulates w/ MB cusp of max 1st perm molar
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I
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Angles class - buccal groove of mand 1st perm molar articulates post to the MB cusp of max 1st perm molar
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II
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Angles class - buccal groove of mand 1st perm molar articulates ant to the MB cusp of max 1st perm molar
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III
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injury caused in clinic
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iatrogenic
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injury caused by self
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facticial
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total biowidth, how much of each
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2 mm, 1 mm JE attchmnt, 1 mm supracrestal fibers
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4 strata of epithelium (bottom up)
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basale, spinosum, granulosum, corneum
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epi layer that secretes basement membrane
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basale
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epi layer that undergoes differentiation, prickle cell layer
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spinosum
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epi layer of flattening cells, producing keratohyalin protein
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granulosum
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epi layer of loose nucleus, impermeable, desquamated cells
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corneum
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# of days of epi layer from mitosis to exfoliation
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30
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layer of epi that contains stratum corneum
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keratinized
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no submucosa, lamina propria continuous w/ periosteum
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masticatory mucosa
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2 examples of masticatory mucosa
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gingiva, hard palate
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k or n.k.? - gingiva
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keratinized
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k or n.k.? - hard palate
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keratinized
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k or n.k.? - lining mucosa
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non-keratinized
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k or n.k.? - gingival sulcus
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non-keratinized
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k or n.k.? - junctional epi
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non-keratinized
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k or n.k.? - taste buds
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non-keratinized
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epi vascularity?
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none
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CT layer directly beneath epi
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lamina propria
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nutrient supply to epi?
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diffusion across basement membrane from CT
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epi interdigitation into CT
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rete ridges
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CT interdigitation into epi
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dermal papilla
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allow greater surface area for diffusion to epi
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rete ridges
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main fiber element of CT
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collagen 60%
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gel-like material that coats cells & collagen fibers
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intercellular ground substance
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fiber type in CT that maint tissue tone w/ memory-like rubber bands
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elastin 5%
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3 components of intercellular ground substance
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hyaluronic acid, chondroitin sulphate, mucopolysaccharides
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junction between CT & stratum basale
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basement membrane
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loose CT layer between lamina propria & bone or muscle containing BV, glands, hair follicles, etc.
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submucosa
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helix structure of collagen
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left hand
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keratinized gingiva becomes ____ after tooth eruption
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sulcular epi
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continuous w/ gingival & junctional epi
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sulcular epi
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attaches to tooth via hemidesmosomes
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junctional epi
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functions as adhesion for JE to tooth
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intercellular ground substance
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2 enzymes that can break biochemical attchmnt of JE
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hyaluronidase, chondroitin sulphatase
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interproximal dip of thin epi between contacting teeth
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col
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function of collagen fibers of PDL
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prevent breakdown of Sharpey's fibers via apical migration
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orients tooth in position w/in bone socket, absorbs occlusal forces, proprioception sensory
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PDL
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6 cell types contained in PDL
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fibroblast/clast, osteoblast/clast, cementoblast/clast
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BVs in ___ supply bone, cementum & gingiva
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PDL
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collagen embedded in cementum & bone
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Sharpey's fibers
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5 principal fiber groups of PDL
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alveolar crest, horizontal, oblique, apical, interradicular
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aka oblique fibers
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axial loading
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ging fiber group that attaches cementum to cementum
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transseptal
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ging fiber group that attaches tooth to periosteum
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dentoperiosteal
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cells in the ____ can remodel bone and ligament to accommodate forces
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PDL
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produce alkaline phosphatase
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osteoblasts
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produce acid phosphatase
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osteoclasts
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outer shell of dense, strong bone
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compact or cortical bone
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bone in contact w/ Sharpey's fibers
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alveolar bone proper or cribiform plate
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bone of main jaw, remains after extraction
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basal bone
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bone on top of basal bone to support teeth & sockets
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alveolar process
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bone forming inner wall socket, perforations allow for vascular comm w/ PDL
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alveolar bone proper, cribiform plate
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radiopacified line surrounding tooth socket
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lamina dura
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coronal aspect of bone parallel to adjacent CEJs
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alveolar crest
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thin plate of bone in interproximals of adjacent teeth
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septal bone
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V shaped defect of alveolare bone, usually buccal surface of prominent teeth
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dehiscence
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window through alveolar bone, usually on buccal surface
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fenestration
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min 2 mm of soft tissue attachmnt
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biological width
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vascularized layer of cells covering bone
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periosteum
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cementum receives nutrition via ____
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diffusion
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calcified tissue covering surface of root
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cementum
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cementum is continually deposited in ___ area
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apical
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cementum deposited during root formation & eruption
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acellular
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cementum formed after tooth eruption in apical third of root
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cellular
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% of cementum-enamel overlap
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60
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2 complications of CEJ
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enamel projection, enamel pearl
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loose CT tissue w/ odontoblast layer, BV & nerve supply
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pulp
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main blood supply of gingiva
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supra periosteal vessels
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3 blood supply to gingiva
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supra periosteal vessels, vessels of PDL, septal vessels (nutrient canals)
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primary etiology of periodontitis
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bacteria
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4 examples of bacterial morphology
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cocci, bacilli, filaments, spriochetes
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anaerobic cell that does not allow oxygen
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obligative
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anaerobic cell that can function w/ or w/o oxygen
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facultative
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most pathogenic gram staining
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negative
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functions to identify species & anitbiotic sensitivites
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culture
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9 problems w/ micro analysis
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site specific, diminished reliability, false negatives, inability to identify pathogens by species w/ microscope, uncertainty of which organisms are pathogens, no antibiotic sensitivity w/o culture, difficult to maintain viable anaerobic cultures, time consuming, expensive
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initial % of bacteria & type prior to experiment
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90% gram +
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# of days to increase in # of bact & shift to gram - rods & cocci
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2
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# of days to gram - filaments & fusobacteria
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3-4
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# of days to spriochetes & flagellated forms
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5-9
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lipopolysaccharide
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gram -
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lipotechnoicacids
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gram +
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3 factors influencing severity of infection
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host resistence, local factors, virulence of flora
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3 factors influencing host resistence
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systemic disease, immune deficiency, stress
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4 examples of local factors
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plaque control, restorations, occlusion & habits
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spell Aa
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actinobacillus actinomycetemcomitans
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complex of bacterioides forsythus, porpyromonas gingivalis, treponema denticola
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red
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complex that adheres to epi lining of pocket wall
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red
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complex associated w/ most cases of chronic perio
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red
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complex associated w/ aggressive types of perio
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orange
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may be present w/ or w/o red complex, asso w/ tissue invasion & aggressive perio
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green cluster
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complex of Aa, eikemella corrodens, capnocytophaga
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green cluster
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mass of microbes who, as a team, function to overcome host immune defenses
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biofilm
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functions as glycoprotein rain tarp
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biofilm
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foreign cell mediates immune response
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antigen
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lymphocyte released into blood if during 1st pass goes to Thymus then it become a ____, if to Peyer's patches then a ____
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T-cell, B-cell
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reside adjacent to capillary wall, increase blood flow to site
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mast cells
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function of mast cells
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detect irritants & release Histamine = vasodilation & capillary wall permeability
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1st WBC to arrive at site, capable of chemotaxis & phagocytosis
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PMNs
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PMN standsfor
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polymorphonuclear leukocytes or neutrophils
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# of days to PMN & macrophage/monocyte arrival
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2-4
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release hydrolytic enzymes to destroy bacteria & host tissue
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PMN
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circulating monocyte migrates through vessel wall to become a ____
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macrophage
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active chemotaxis & phagocytosis characterized by destruction of bacteria via lysosomal enzymes
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macrophage
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cells can coalesce to form foreign body giant cels
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macrophage
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leukocytes that arrive later in process
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lymphocytes
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early arriving lymphocytes become _____ to _____
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sensitized, antigen
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sensitized lymphocytes differentiate into ____ or ____ cells
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B, T
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# of days of inital differentiation of lymphocytes
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14
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mature, sensitized B cells
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plasma cells
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produce antibody specific for bacterial antigen
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plasma cells
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immunity characterized by B-cells
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humeral
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immunity characterized by T-cells
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cell mediated
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3 types of differentiated T-cells
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helper, killer, suppressor
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p/u antigen protein & present to macrophage
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helper T-cells
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carry antigen back to nodes to sensitize more B cells, augmenting reponse of humeral immune system
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helper T-cells
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recognize antigen & seek out foreign cells, attack specific invading cells
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killer T-cells
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doesn't destroy host tissue during battle w/ bacteria
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killer T-cells
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monitor activity of immune response & influence other classes of cells to reduce imm. activity when invader is defeated
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suppressor T-cells
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help bring host back to stable function after battle
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suppressor T-cells
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some reside in nodes after inital attack to enhance future response
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B-cells
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soluable proteins secreted by cells as messaenger molecules influencing other cells
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cytokines
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example of cytokine produced by both B & T-cells
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interleukin
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proinflammatory cytokine that induces osteoclast activation
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interleukin-1
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primary class of immunoglobin in perio
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IgG
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antibodies are produced by ____
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plasma cells
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The F-ab end binds ____, the F-c end binds ____
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antigen, complement/macrophage
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system of 9 proteins in blood w/ profound immunological effects
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complement
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group together on F-c end of IgG antibody forming macroprotein to rupture cell wall
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complement
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complement that induces PMN degranulation resulting in increased inflammation
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C3, C5
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profound mediators of inflammation
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prostaglandins
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phospholipids produced by PMNs & macrophages
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prostaglandins
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most potent bone resorbing agent
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PGE2 (prostaglandin E2)
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most potent chemotactic agent, attracts PMNs
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LtB4 (leukotrine B4)
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only essential fatty acid
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arachnidonic acid
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example of matrix metalloproteinases (MMPs)
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collagenase
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released from pts own PMNs & macrophages, destroys tissue
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collagenase
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approx 60% of pts w/ aggressive forms of perio exhibit ____
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leukocyte dysfunction
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results in decreased migration & hyper-reactiveness to bacterial antigens, inherited
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leukocyte dysfunction
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test for increased bone loss due to release of too much interleukin-1 in response to bacterial anitgens
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PST (perio susceptibility)
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constricts blood vessels & has negative impact on immune system
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epinephrine
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lack of ability to ____ w/ stress can be determining factor of perio
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cope
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2 theories of stress in perio
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behavioral, psychoneuroimmunological
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3 indicators of behavioral stess
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denial, failure to seek Tx, increased smoking
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stress theory of hormonal influence aggravating inflammation
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psychoneuroimmunological
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2 steroids released that are stress induced
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glucocorticoids, epinephrine
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lesion w/ mast cell degradation, exudation of crevicular fluid, increased capillary permeability, migration of PMNs & macrophages
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initial
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days to initial lesion
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2-4
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lesion w/ alteration of cornoal cells into JE, perivascular collagen reduced to 60-70%
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initial
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lesion of increased exudate, pmns & macrophage 90% occupation of CT volume
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early
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days to early lesion
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7-14
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lesion of pathological changes in fibroblasts, further loss of collagen & beginning proliferation of JE
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early
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lesion of plamsa cells & lymph, chronic inflammation, immunoglobin in tissue
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established
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days to established lesion
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>14
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lesion of apical migration of JE & early pocket formation w/o much bone loss
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established
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lesion of persistent chronic inflammation, extension of lesion into alveolar bone & PDL
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advanced
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days to advanced lesion
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months - years
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lesion of attchmnt loss & further pocket formation, conversion of bone to fibrous CT, periods of quiescence & exacerbation
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advanced
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4 stages of perio lesion
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initial, early, established, advanced
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8 components of bacterial toxonomy
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morphology, metabolism, gram staining, motility, dark field microscopy, immunofluorescent staining, DNA analysis, culture techniques
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12 steps of prognosis of tooth
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amt&distribution of remaining bone, attchm't loss, furcations, crown-root ratio,tooth&root anatomy,relation to otherteeth&structures,mobility,future use,soundness of surrounding teeth,caries severity,occlusion,etiological factors
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4 classifications of prognosis
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good, fair, poor, hopeless
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12 steps of prognosis of dentition
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desire of pt,#&loc of remaining teeth,amt of gen bone loss,relationship of bone loss-age,response to previous tx,chronology&actv of disease,systemic health,occlusion,habits,avail of tx & maint care, summarized px of individual teeth
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Prognosis 1st based on what 2 factors
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neg PST, non-smoker
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