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Patient Care III > Anatomy of the Periodontium > Flashcards

Anatomy of the Periodontium Flashcards

1
Q

What is periodontium?

A

Specialized connective tissue that provides support needed to maintain teeth in function

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2
Q

What are the four main components of the periodontium?

A

 gingiva
 Cementum
 Periodontal ligament
 Alveolar bone

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3
Q

What are the three zones of the oral mucosa?

A
  1. The gingiva & covering of the hard palate (masticatory mucosa)
  2. Dorsum of the tongue (specialized mucosa)
  3. Oral mucous membrane lining remainder of oral cavity
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4
Q

What type of mucosa is on the dorsum of the tongue?

A

specialized mucosa

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5
Q

What type of mucosa is the gingiva and covering the hard palate?

A

masticatory mucosa

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6
Q

What is gingiva?

A

Masticatory mucosa that covers alveolar bone and tooth root coronal to the cementoenamel junction (CEJ)

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7
Q

What are the three sections of the gingivia?

A

Marginal gingiva
Attached gingiva
Interdental areas

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8
Q

__________ mucosa covers alveolar bone and tooth root coronal to the cementoenamel junction (CEJ)

A

Masticatory

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9
Q

What is another name for marginal gingiva?

A

unattached gingiva

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10
Q

What is the marginal gingiva?

A

Free, collar-like tissue surrounding the teeth on facial, lingual, and interproximal surfaces

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11
Q

What type of epithielium is the marginal gingiva?

A

nonkeratinized epiethelium

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12
Q

What is the most coronal portion of the gingiva called?

A

gingival margin
- scalloped outline of teeth

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13
Q

What are the characteristics of the gingival margin?

A
  • about 1 mm wide
  • forms the soft-tissue wall of the gingival sulcus
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14
Q

What is the gingival sulcus?

A
  • the shallow, natural space aroudn a tooth bounded by the surface of the tooth on one side and epithelium lining the free margin of the gingiva on the other side
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15
Q

How should the gingival sulcus allow enterance for the periodontal probe?

A
  • barely permits enterance
  • sulcular measurements of 1-3 mm
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16
Q

What is the clinical significance of the gingival sulcus?

A

helps to identify the health status of the sulcus; an important factor when accessing restorability of a tooth

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17
Q

Boundaries of the gingival sulcus are the…

A
  • sulcular epithelium
  • tooth
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18
Q

Sulcular epithelium is the ___________ continuation of keratinized epithelium covering the marginal gingiva

A

nonkeratinized

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19
Q

What is the interdental gingiva (papilla) part of the gingiva?

A
  • occupies the gingival embrasure space between 2 adjacent teeth (interproximal spaces)
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20
Q

What part of the gingiva includes the interdental gingiva?

A

free gingiva

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21
Q

What attaches the interdental gingiva to the tooth?

A
  • JE (junctional epithelium)
  • connective tissue fibers
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22
Q

If a _____ space exists between 2 teeth-papilla will be flat or saddle-shaped

A

wide

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23
Q

What is the gingival col?

A

valley-like depression of the interproximal contact areas

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24
Q

Is the gingival col keratinized or non keratinized?

A

non-keratinized

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25
Q

If interdental space is ______ the papilla will be pointed or pyramidal

A

narrow

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26
Q

What does the gingival col connect?

A

lingual and buccal interdental papilla

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27
Q

The gingival col is ______ when teeth are not in contact

A

absent

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28
Q

____________ epithelium is susceptible to inflamation and disease progression

A

nonkeratinized
- mostly the gingival col

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29
Q

What does the free gingival groove divide?

A

free gingiva from attached gingiva

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30
Q

The free gingival groove is found in _____% of patients

A

50%

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31
Q

What type of epithelium is covering the free gingival groove?

A

keratinized epithelium

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32
Q

What type of epithelium is attached gingiva?

A

keratinized epithelium

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33
Q

What is attached gingiva?

A
  • firm, resilient, tightly bound to underlying periosteum of aleolar bone
  • continious with marginal gingiva
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34
Q

The _____ aspect of the attached gingiva extends to the relatively loose and movable alveolar mucosa

A

facial

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35
Q

The attached gingiva and alveolar gingiva transition is demarcated by the…

A

mucogingival junction (MGJ)

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36
Q

The width of the attached gingiva varies from…

A

1-9 mm

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37
Q

Where is the attached gingiva the widest in the facial aspect?

A

maxillary central incisors

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38
Q

Where is the attached gingiva the narrowest in the facial aspect?

A

mandibular premolar facial areas

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39
Q

Attached gingiva is not typically measured on what oral surface?

A

palate

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40
Q

Any changes in the width of attached gingiva results from changes at the ______ end

A

coronal
(recession)

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41
Q

What is the equation for measuring the width of attached gingiva?

A

total width of gingiva (from MGJ to GM) - PD = width of attached gingiva

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42
Q

When attached gingiva is diminished it results in…

A

gingival recession

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43
Q

What is the mucogingival junction (MGJ)?

A

visible line where the pink keratinized gingiva meets the more vascular alveolar mucosa

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44
Q

Where is mucogingival junction (MGJ) found?

A
  • maxillary facial
  • mandibular facial and lingual
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45
Q

What is the alveolar mucosa?

A

movable tissue, loosely attached to underlying alveolar bone

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46
Q

What type of epithelium is the alveolar mucosa?

A
  • thin, soft, nonkeratinized epithelium
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47
Q

What is separated from the attached gingiva at the MGJ?

A

alveolar mucosa

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48
Q

Why is the alveolar mucosa a darker shade of red than gingiva?

A

rich blood supply (vascularization)

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49
Q

The gingiva is made of what?

A
  • stratified squamous epithelium (mostly cellular in nature)
  • connective tissue (less cellular and mostly composed of collagen fibers and ground substance)
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50
Q

What are the functions of the gingival epithelium?

A
  • physical barrier to infection
  • protection of deep structures
  • allows a selective interchange with oral environment
  • participate actively in responding to infection in signaling host response
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51
Q

How can you differentiate epithelium covering the free gingiva?

A
  1. The oral (outer) epithelium
  2. The sulcular epithelium
  3. The junctional epithelium
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52
Q

What is the oral (outer) epithelium of the gingiva?

A

Covers the crest and outer surface of the marginal gingiva and the surface of attached gingiva

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53
Q

How thick is the oral (outer) epithelium?

A

0.2-0.3 mm

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54
Q

What are the four layers of the oral (outer) epithelium?

A

 Basal layer
 Prickle cell layer
 Granular layer
 Cornified layer

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55
Q

What type of epithelium is the oral (outer) epithelium?

A

Keratinized or parakeratinized, or combination of the two

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56
Q

What is the sulcular epithelium?

A
  • Lines the gingival sulcus
  • Extends from the coronal limit of the junctional epithelium to the crest of the gingiva margin
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57
Q

What type of epithelium is the sulcular epithelium?

A

Thin, nonkeratinized epithelium without rete pegs

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58
Q

Where does the sulcular epithelium extend?

A

Extends from the coronal limit of the junctional epithelium to the crest of the gingival margin
short

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59
Q

Why is sulcular epithelium important?

A

may act as a semipermeable membrane through which injurious bacterial products pass into the gingiva and seeps into the sulcus

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60
Q

Which is more permeable, sulcular epithelium or junctional epithelium?

A

junctional epithelium is more permeable

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61
Q

What is junctional epithelium?

A

Nonkeratinized epithelium surrounding and attaching to the tooth on one side, and the gingival connective tissue on the other side

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62
Q

What is the length of the junctional epithelium?

A

0.25-1.35 mm

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63
Q

What is another name for the base of the sulcus/pocket?

A

junctional epithelium

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64
Q

What is the function of the junctional epithelium?

A

Serves as route of passage of fluid and cells from the connective tissue into the sulcus for bacteria/bacterial products from sulcus to connective tissue

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65
Q

Can the junctional epithelium be penetrated by the periodontal probe?

A

yes, easily- especially when gingiva is inflamed

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66
Q

What epithelium is completely restored after pocket instrumentation or surgery, and it forms around implants?

A

junctional epithelium

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67
Q

What forms the junctional epithelium?

A

Formed by the confluence of the oral epithelium and the reduced enamel epithelium during tooth eruption

68
Q

What are gingival fibers?

A

Connective tissue of the marginal gingiva is densely collagenous and contains a prominent system of collagen fiber bundles

69
Q

What type of collagen are gingival fibers made of?

A

type I collagen

70
Q

What are the functions of gingival fibers?

A
  1. to brace the marginal gingiva firmly against the tooth
  2. to provide the rigidity necessary to withstand the forces of mastication without being deflected away from the tooth surface
  3. to unite the free marginal gingiva with the cementum of the root and the adjacent attached gingiva
71
Q

What are the dentogingival fibers?

A

embedded in the cementum between the CEJ and crest of alveolar bone; fan outward into the attached and free gingiva; attach gingiva to the tooth apical to the epithelial attachment

72
Q

What are the alveologingival fibers?

A

inserted in crest of alveolar process and splay out through lamina propria into the free gingiva

73
Q

What are the circumferential fibers?

A

encircle each tooth in a cufflike fashion within the free gingiva

74
Q

What are the dentoperiosteal fibers?

A

embedded in the same portion of the cementum as the dentogingival fibers, but extend apically over the alveolar crest after passing through the lamina propria and the periosteum

75
Q

What are the transseptal fibers?

A

Embedded in the same portion of the cementum as the dentogingival and dentoperiosteal fibers; run a horizontal path from adjacent teeth

76
Q

Because of the___________________, the connective tissue of the gingiva has remarkably good healing and regenerative capacity

A

high turnover rate

77
Q

What should you look for clinically to understand the microscopic features?

A

color
size
contour
shape
consistency
surface texture
position

78
Q

What is the color of the marginal and attached gingiva?

A
  • when healthy should be coral pink
  • presence of pigment-containing cells
79
Q

Gingiva is _____ in individuals with fair complexions and hair and ______ in individuals with dark complexions and hair

A

lighter; darker

80
Q

What is the color of the alveolar mucosa?

A
  • Red
  • Smooth
  • Shiny
81
Q

_________ is responsible for normal pigmentation of the skin, gingiva and remainder of the oral mucous membrane

A

Melanin

82
Q

Melanin is present in all people, but it can be absent or severely diminished in…

A

albinos

83
Q

Melanin pigmentation is ______ in individuals with dark skin tones

A

prominent

84
Q

Melanin pigmentation in the oral cavity can appear as…

A

a diffuse, deep-purplish discoloration or as irregularly shaped brown and light-brown patches

85
Q

_____ of gingiva corresponds with the number of cellular/intercellular elements and vascular supply

A

Size

86
Q

Change in the size of gingiva indicates…

A

gingival disease (inflammation present)

87
Q

_____ of gingiva varies depending on the shape of the teeth and alignment

A

contour

88
Q

Marginal gingiva follows what outline?

A

scalloped

89
Q

What is biotype?

A

thickness of gingiva
*varies

90
Q

_____ of interdental gingiva guided by contour of proximal tooth surfaces, location, and shape of embrasures

A

Shape

91
Q

Interdental papilla can appear as…

A

peaked/pointed in form or flattened depending on location and tooth contact points

92
Q

What is the consistency of gingiva?

A

firm and resilient (except the free
margin)

93
Q

What determine firmness of attached gingiva?

A

collagen fibers

94
Q

What determines firmness of gingival margin?

A

gingival fibers

95
Q

What is the surface texture of gingiva?

A
  • stippled (best viewed by drying the tissue)
96
Q

What type of gingiva should be stippled?

A

attached gingiva

  • marginal gingiva is not stippled
97
Q

Stippling is less prominent on which surface of the gingiva?

A

lingual

98
Q

What are the four characteristics of gingiva for clinical assessment?

A
  • color
  • contour
  • consistency
  • surface texture
99
Q

How Does Smoking Affect the Periodontium?

A
  • causes vasoconstriction (affects immune system)
  • impaires chemotaxis and phagocytosis
  • decreases bone density
  • leaves gingival tissues firm and fibrotic
100
Q

What is the periodontal ligament (PDL) composed of?

A

Composed of a complex vascular and highly cellular connective tissue that surrounds the tooth root and connects it to the inner wall of the alveolar bone
*continuous with the connective tissue of the gingiva

101
Q

What is the function of the periodontal ligament?

A

it communicates with the marrow spaces through vascular channels in the bone
- shock absorbers

102
Q

When is the periodontal space diminished around teeth?

A

teeth that are not in function
and in unerupted teeth

103
Q

When is the periodontal space increased in teeth?

A

teeth that have been subjected to hyperfunction

104
Q

What is the most important element of the PDL?

A

principal fibers

105
Q

Where are the principal fibers of the PDL located?

A

Located in periodontal space between cementum and bone

106
Q

What are the principal fibers of the PDL made of?

A

Composed of connective tissue cells and intracellular substance

107
Q

The principal fibers are inserted into the…

A

inserted into the cementum on one side and bone on the other are called: Sharpey’s fibers

108
Q

What are the different general functions of the PDL?

A
  • physical
  • formative and remodeling
  • nutritional and sensory
109
Q

What are the physical functions of the PDL?

A
  • Provision of a soft-tissue ‘casing’ to protect the vessels and nerves from
    injury by mechanical forces
  • Transmission of occlusal forces to the bone
  • Attachment of the teeth to the bone
  • Maintenance of the gingival tissues in their proper relationship to teeth
  • Resistance to the impact of occlusal forces
110
Q

What are the formative and remodeling functions of the PDL?

A
  • The PDL and alveolar bone are exposed to physical forces in response to mastication, parafunction, speech and orthodontic tooth movement
  • Cells of the PDL participate in the formation and resorption of cementum and bone which occur during physiologic tooth movement
  • The PDL is constantly undergoing remodeling
  • The rate of formation and differentiation of osteoblasts, cementoblasts, and fibroblasts affect the rate of formation of collagen, cementum, and bone
111
Q

What are the nutritional and sensory functions of the PDL?

A
  • PDL supplies nutrients to cementum, bone and gingiva by way of blood vessels; also provides lymphatic drainage
  • PDL is highly vascularized tissue; the high blood vessel content may provide hydrodynamic damping to applied forces as well as high perfusion rates to the PDL
  • PDL is abundantly supplied with sensory nerve fibers that are capable of transmitting tactile, pressure, and pain sensations via the trigeminal pathways
112
Q

The rate of formation and differentiation of osteoblasts, cementoblasts, and fibroblasts affect the rate of formation of…

A

collagen, cementum, and bone

113
Q

PDL supplies nutrients to cementum, bone and gingiva by way of…

A

blood vessels; also provides lymphatic drainage

114
Q

PDL is highly vascularized tissue; the high blood vessel content may provide…

A

hydrodynamic damping to applied forces as well as high perfusion rates to the PDL

115
Q

What does the PDL width depend on?

A

age, stage of eruption, function of tooth, and angle of film

116
Q

What are the different principal fiber groups of the PDL?

A
  • transseptal fibers
  • apical fibers
  • oblique fibers
  • horizonal fibers
  • alveolar crest fibers
  • interradicular fibers
117
Q

What are transseptal fibers?

A

extend interproximally over the alveolar bone crest and are embedded in the cementum of adjacent teeth

118
Q

What are apical fibers?

A

from the root apex to adjacent surrounding bone to resist vertical forces

119
Q

What are oblique fibers?

A

from the root above the apical fibers obliquely toward the occlusal to resist vertical and unexpected strong forces

120
Q

What are horizontal fibers?

A

from the cementum in the middle of each root to adjacent alveolar bone to resist tipping of the tooth

121
Q

What are alveolar crest fibers?

A

from the alveolar crest to the cementum just below the CEJ to resist intrusive forces

122
Q

What are the interradicular fibers?

A

from cementum between the roots of multirooted teeth to the adjacent bone to resist vertical and lateral forces

123
Q

What type of fibers are not on single rooted teeth?

A

interradiucular fibers

124
Q
A
125
Q
A
126
Q
A
127
Q
A
128
Q
A
129
Q
A
130
Q
A
131
Q
A
132
Q
A
133
Q
A
134
Q
A
135
Q

Does cementum have blood, lymph and innervation?

A

nah

136
Q

What is the function of cementum?

A

to attach fibers of the PDL to the tooth (like cement); to seal the tubules of the root dentin

137
Q

What are the two types of cementum?

A

2 types: acellular (primary) and cellular (secondary)

138
Q

What is the least mineralized tissue of the tooth?

A

cementum

139
Q

What is cementum?

A

Calcified, avascular mesenchymal tissue covering the roots of the teeth

140
Q

What type of cementum is the first type formed?

A

acellular cementum

141
Q

What cementum covers approximately the cervical third or half of the root?

A

acellular cementum

142
Q

Which type of cementum is less calcified?

A

cellular cementum

143
Q

Which cementum does not have cells?

A

Acellular cementum

144
Q

When is the acellular cementum formed?

A

Formed before the tooth reaches the occlusal plane

145
Q

When is cellular cementum deposited?

A
  • Deposited throughout life of tooth
  • Deposited at intervals, producing arrest lines
146
Q

When is cellular cementum formed?

A

Formed after tooth reaches occlusal plane

147
Q

What is the function of cellular cementum?

A

contains cells (cementocytes) in individual spaces (lacunae) that communicate with each other through a system of anastomosing canaliculi

148
Q

What is hypercementosis?

A
  • Local abnormal thickening of parts of the cementum
149
Q

Where is hypercementosis usually seen?

A

apical region of the root

150
Q

Hypercementosis may be found as a result of…

A

 Chronic inflammation of the tooth
 No opposing tooth
 Additional eruption
 Tooth becoming fused to surrounding alveolar bone proper

151
Q

What are the three CEJ relationships that exist?

A

Space: 10%
End-to-end: 30%
Overlap: 60%

152
Q

Understanding the relationship between the cementum and enamel junction is of clinical importance in…

A

scaling and root planing procedures

153
Q

What is the alveolar process?

A

Bone that forms and supports the alveoli (tooth sockets)

154
Q

When does the alveolar process form?

A

Forms when the tooth erupts to provide the osseous attachment to the forming PDL

155
Q

When would the alveolar process be lost?

A

disappears gradually after the tooth is lost

156
Q

What are the parts of the alveolar process?

A

Consists of alveolar bone proper and supporting bone

157
Q

The contour of the alveolar bone follows the contour of what?

A

CEJ and arrangement of the dentition

158
Q

Where is the alveolar process?

A
  • approximately 1.5-2mm apical to the CEJ
  • Shape of the alveolar crest is generally parallel to the CEJ of adjacent teeth
159
Q

Cortical plates are usually thicker in the mandible or the maxilla?

A

mandible

160
Q

Alveolar bone consists of…

A

two-thirds inorganic matter and one-third organic matrix

161
Q

Does the form of the alveolar bone change during remodeling?

A

the alveolar bone is constantly changing its internal organization, it retains approximately the same form from childhood through adult life

162
Q

Cancellous trabeculae between the two compact layers act as…

A

supporting alveolar bone

163
Q

An external plate of cortical bone formed by…

A

haversian bone and compacted bone lamellae

164
Q

The inner socket wall of thin, compact bone is called the…

A

alveolar bone proper

165
Q

The alveolar bone proper has a series of openings through which what occurs?

A

through which neurovascular bundles link the PDL with the central component of the alveolar bone: the cancellous bone

Patient Care III (30 decks)

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