Carranza Flashcards
1
Q
What is the reported gingival sulcus depth?
Ch 3
A
1.8mm, range 0-6mm
2
Q
What is the “col”?
A
Interdental gingiva that has a depression - identical to junctional epithelium (non-keratinized stratified squamous epithel)
3
Q
Which of the following epithelial layers is composed of flat squamous cells (orthokeratinized):
a. stratum basale
b. stratum spinosum
c. stratum granulosum
d. stratum corneum
Ch 3
A
stratum corneum - flat squamous eosinophilic cells without nuclei (orthokeratinization)
all distinct keratinized epithelial strata in process of keratinization
4
Q
What types of epithelium are reported to have Langerhans cells important for the local immune response?
Ch 3
A
Gingival epithelium and sulcular epithelium
not found in junctional epithelium
5
Q
What layer connects the epithelium to underlying connective tissue, and what collegen type predominates?
Ch 3
A
basal lamina, type IV collagen
6
Q
What type of epithelial cells make up sulcular epithelium?
Ch 3
A
Non keratinized
7
Q
How many layers thick can junctional epithelium be?
Ch 3
A
20 layers stratified squamous nonkeratinizing epithelium
8
Q
How is junctional epithelium formed?
Ch 3
A
formed by the confluence of the oral epithelium and the reduced enamel epithelium during tooth eruption
REE not essential for its formation; in fact, the junctional epithelium is completely restored after pocket instrumentation or surgery, and it forms around an implant
9
Q
What are the turnover rates for palate/tongue/cheek oral epithelium and gingival epithelium?
Ch 3
A
5-6 days; 10-12 days respectively
The turnover of the junctional epithelium is 1 -6 days
10
Q
What cells produce sulcular (crevicular) fluid?
Ch 3
A
The main route of the gingival fluid diffusion is through the basement membrane, through the relatively wide intercellular spaces of the junctional epithelium, and then into the sulcus
11
Q
What are the 4 functions of crevicular/gingival fluid?
Ch 3
A
(1) cleanse material from the sulcus; (2) contain plasma proteins that may improve adhesion of the epithelium to the tooth; (3) possess antimicrobial properties; and (4) exert antibody activity to defend the gingiva.
12
Q
What are the 6 types of PDL fibers?
Ch 3
A
transseptal, alveolar crest, horizontal, oblique, apical, and interradicular fibers
13
Q
What amount of dentin thickness is thought to decrease chances of pulpitis?
Ch 46 Endo-perio lesions
A
2mm
14
Q
Define a class 1 perio-endo lesion?
Ch 46 Endo-perio lesions
A
Primary endodontic comprmise causing secondary periodontal disease
15
Q
Define class 2 perio-endo lesion?
Ch 46 Endo-perio lesions
A
Primary periodontisis with HBL that causes secondary pulpitis from apex
16
Q
Define class 3 perio-endo lesion?
Ch 46 Endo-perio lesions
A
Too advanced to tell if primary endo or perio, or the two happen simultaneously
17
Q
What are the two theories for shock absorption of the PDL?
Ch 3
A
Tensional theory - that ligament fibers tranfer the shock from tooth to bone
Viscoelastic theroy - extracellular fluid transfers the shock to the lacunae of bone, with ligaments playing secondary role
18
Q
Where is the axis of rotation for single rooted teeth and multi-rooted teeth respectively?
Ch 3
A
Single: between apical third and middle third of the root
Multi: the bone between roots
19
Q
What nerve endings are present in the PDL to sense pressure, tactile and pain sensations?
Ch 3
A
(1) free endings, which have a treelike configuration and carry pain sensation
(2) Ruffini-like mechanoreceptors, which are located primarily in the apical area
(3) coiled Meissner corpuscles and mechanoreceptors, which are found mainly in the midroot region
(4) spindle-like pressure and vibration endings, primarily apical
20
Q
What are the two main sources of collagen fibers in cementum?
Ch 3
A
(1) Sharpey fibers (extrinsic, from fibroblasts) – Type III collagen appears to coat the type I collagen of the Sharpey fibers
(2) Intrinsic fibers of cementum
21
Q
What is the inorganic content % of cementum?
Ch 3
A
45-50%
22
Q
What is the alveolar process?
CH 3
A
the portion of the maxilla and mandible that forms and supports the tooth sockets (alveoli)
23
Q
What are the histologic layers of the alveolar process?
CH 3
A
- An external plate of cortical bone is formed by haversian bone and compacted bone lamellae.
- The inner socket wall of thin, compact bone called the alveolar bone proper is seen as the lamina dura in radiographs.
- Cancellous trabeculae between these two compact layers act as supporting alveolar bone
24
Q
What are the 4 events in bone resorption?
Ch 3
A
- Attachment of osteoclasts to the mineralized surface of bone
- Creation of a sealed acidic environment through the action of the proton pump, which demineralizes bone and exposes the organic matrix
- Degradation of the exposed organic matrix to its constituent amino acids via the action of released enzymes (e.g., acid phosphatase, cathepsin)
- Sequestering of mineral ions and amino acids within the osteoclast
25
What is bundle bone?
## Footnote
Ch 3
Bundle bone is the term given to bone adjacent to the periodontal ligament that contains a great number of Sharpey fibers. Localized within the alveolar bone proper
26
How does plaque biolfilm adhere to teeth?
## Footnote
Ch 8
Binding of the bacterial species to receptors of the pellicle, then creating a nascent surface and acting as a bridge for additional species
## Footnote
There are primary and secondary colonizing species -- Biofilm maturation is a highly specific event that involves a nonrandom aggregation of different bacteria.
27
Above what surface roughness will plaque begin to adhere?
## Footnote
Ch 8
Ra ≈ 0.2 µm
## Footnote
However, smoothness below this threshold does not decrease plaque adherence more - tapers off once this smooth
28
How much more resistant to ABX are biolfilm bacteria?
## Footnote
Ch 8
Almost without exception, organisms in a biofilm are 1000 to 1500 times more resistant as compared with antibiotics in their planktonic state
29
Saliva contains many components of the oral cavity's innate immune response. What do the follow components do?
Mucin
Histatins
Lactoferrin
## Footnote
Ch 7
Mucin - inhibits agglutination and therefore adherence of bacteria to form biofilm
Histatins - inhibit virulence factors, neutrolizes LPS
Lactoferrin - inhibit bacterial cell growth
## Footnote
Saliva also contains specific immunoglobulin A antibodies to periodontal pathogens
30
What antibody is largely present in saliva?
## Footnote
Ch 7
IgA
31
What produces gingival crevicular fluid? And what does it contribute to the immune system in the mouth?
## Footnote
Ch 7
postcapillary venules of the gingival plexus
brings in PMNs, Abs, and compelement (innate)
flow increases with inflammation
32
What are the 3 groups of gingival fibers?
## Footnote
Ch 3
Gingivodental
Circular
Transseptal
33
What are the 3 sources of blood for the gingiva?
## Footnote
Ch 3
Supraperiosteal arterioles
Vessels of the periodontal ligament
Arterioles
34
How does RANK/RANKL/OPG regulate bone resorption?
## Footnote
Ch 7
RANKL binds to RANK and stimulates osteoclast differentiation and activation. OPG antagonizes this action by binding to RANKL and preventing it from binding to RANK.
## Footnote
The ratio of RANKL to OPG is important, with studies reporting higher levels of RANKL and lower levels of OPG in patients with advanced periodontitis compared with healthy controls
35
What bacteria make up the red complex of the microbiome?
## Footnote
Ch 8
P. gingivalis, T. forsythia, and T. denticola
## Footnote
These are secondary colonizers
36
What are the components of calculus?
## Footnote
Ch 13
Inorganic:
76% calcium phosphate
3% calcium carbonate
4% magnesium phosphate
2% carbon dioxide
Organic content: protein– polysaccharide complexes, desquamated epithelial cells, leukocytes, and various types of microorganisms
## Footnote
Calculus consists of mineralized bacterial plaque that forms on the surfaces of natural teeth and dental prostheses
37
What are the differences between suprabony and infrabony pockets?
## Footnote
Ch 23
Suprabony: base of pocket above alveolar bone, pattern of bone loss horizontal, transeptal fibers are horizontal
Infrabony: base of pocket is below alveolar bone, pattern of bone loss is vertical, transeptal fibers are obliqued
38
What % of volume of the junctional epithelium do PMNs (neutrophils) reach to cause detachment?
## Footnote
CH 23
60%
## Footnote
The degree of leukocyte infiltration of the junctional epithelium is independent of the volume of inflamed connective tissue; thus this process may occur in gingiva with only slight signs of clinical inflammation.
39
What antibody is largely present in saliva?
## Footnote
Ch 7
IgA
40
What produces gingival crevicular fluid (GCF)?
## Footnote
Ch 7
Postcapillary venules of the gingival plexus
41
What does GCF contribute to the immune system in the mouth?
## Footnote
Ch 7
Flushing ability of bacteria in sulcus
Neutrophils
Antibodies
42
What is the predominant T cell in stable periodontitis?
## Footnote
Ch 7
CD4+ Helper T cells
43
What is the main antibody to periodontal pathogens?
## Footnote
Ch 7
IgG
44
What role does RANK and RANKL play in periodontal disease?
## Footnote
Ch 7
Binding of RANKL to RANK results in osteoclast differentiation and activation and thus bone resorption
45
Which of the following is not a definitive microbial virulence factor?
a) Fimbriae
b) Lipopolysaccharides (LPS)
c) Adhesins
d) eDNA
## Footnote
ch 7
d) eDNA
46
In the context of periodontal health, which immune response is central to the host response to periodontal pathogens?
## Footnote
Ch 7
Innate immune response
47
Which layer of the acquired pellicle is difficult to remove as observed under transmission electron microscopy?
A) Thin basal layer
B) Thick globular layer
C) Salivary layer
D) Hard tissue layer
## Footnote
Ch 8
A) Thin basal layer
48
Which phase of colonization of teeth by bacteria involves specific interactions between microbial cell surface adhesin molecules and receptors in the salivary pellicle?
A) Phase 1: Transport to the surface
B) Phase 2: Initial reversible adhesion
C) Phase 3: Strong attachment
D) Phase 4: Biofilm formation
## Footnote
Ch 8
B) Phase 2: Initial reversible adhesion
49
Which of the following complexes is associated with bleeding on probing?
Green complex
Orange complex
Yellow complex
Red complex
## Footnote
Ch 8
Red complex
50
What is the definition of Materia alba?
## Footnote
Ch 8
Soft accumulation of salivary proteins, some bacteria, many desquamated epithelial cells
51
How many times more is Biofilm bacteria more resistant to antimicrobial agents than their planktonic counterparts
## Footnote
Ch 8
1000 times more resistant
52
What bacterial species are considered to be the primary colonizers of a tooth surface?
A. Lactobacillus species
B. Steptococcus, Staphylococcus and Fusobacterium species
C. Steptococcus species, obligate aerobes and facultative anaerobes
D. Anaerobes including Actinomyces and Veiollenla
## Footnote
Ch8
C. Steptococcus species, obligate aerobes and facultative anaerobes
53
Which of the following statements accurately describes the inorganic composition in calculus?
A) Dental calculus primarily consists of hydroxyapatite, constituting approximately 58% of its content.
B) The major crystalline structure found in dental calculus is octacalcium phosphate.
C) Subgingival calculus exhibits a higher calcium-to-phosphate ratio compared to supragingival calculus.
D) Dental calculus comprises a significant amount of carbon dioxide.
## Footnote
Ch 13
A) Dental calculus primarily consists of hydroxyapatite, constituting approximately 58% of its content.
54
What is the major inorganic component of calculus?
a. sulfate
b. calcium phosphate
c. magnesium phosphate
d. calcium carbonate
## Footnote
Ch 13
b. calcium phosphate
55
Which of the following correctly differentiates supragingival and subgingival calculus?
A) Subgingival calculus contains less octacalcium phosphate than supragingival calculus.
B) The ratio of calcium to phosphate is lower in subgingival calculus.
C) The inorganic composition of subgingival calculus is similar to dental enamel.
D) Subgingival calculus is primarily composed of salivary constituents.
## Footnote
Ch 13
A) Subgingival calculus contains less octacalcium phosphate than supragingival calculus.
56
What % of calculus is inorganic?
## Footnote
CH 13
70-90%
57
What are the two most common locations for dental calculus to accumulate?
## Footnote
Ch13
Buccal aspect of caudal maxillary teeth and lingual aspect of rostral mandibular teeth
58
Which of the following drugs has been shown to have higher concentrations in GCF than serum?
A. Tetracyclines
B. Aminoglycosides
C. Cephalosporins
D. NSAIDs
## Footnote
Ch 16
A. Tetracyclines
59
Which of the following matches the salivary component with its function correctly?
A. Lysozyme → tooth integrity maintenance
B. Minerals → lubrication
C. IgA → cleansing
D. Bicarbonate and phosphate → buffering
## Footnote
Ch 16
D. Bicarbonate and phosphate → buffering
60
What is the probing depth of clinically normal gingival sulcus in humans
## Footnote
Chp 3
2-3mm
61
Nonkeratinized epithelium lacks what two key cellular structures?
## Footnote
Chp 3
No granulosum or corneum strata
62
How thick is the basal lamina?
## Footnote
Chp 3
300 to 400 A
63
What are the most to least keratinized oral mucosal structures?
## Footnote
Chp 3
Palate > gingiva > ventral aspect of tongue > cheek
64
How thick is oral epithelium?
## Footnote
Chp 3
02. - 0.3mm
65
This histo image depicts what type of gingival epithelium?
## Footnote
Chp 3
Keratinized
66
This histo image depicts what type of gingival epithelium?
Nonkeratinized
67
This histo image depicts what type of gingival epithelium?
## Footnote
Chp 3
Parakeratinized
68
What is sulcular epithelium composed of?
## Footnote
Cho 3
thin, nonkeratinized stratified sqaumous epithelium without rete pegs
69
What is the dentogingival unit?
## Footnote
Chp 3
The junctional epithelium and gingival fibers that attach the gingiva to the tooth
70
What is the definition of the gingival sulcus?
## Footnote
Chp 3
A shallow space that is coronal to the attachment of the junctional epithelium and bounded by the tooth on one side and the sulcular epithelium on the other. The coronal extent of the gingival sulcus is the gingival margin
71
What are the functions of gingival fibers and what are they composed of?
Type 1 Collagen
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
72
What does gingival innervation derive from?
## Footnote
Chp 3
Fibers that arise from nerves in the PDL and the labial, buccal and palatal nerves
73
Principal fibers of the periodontal ligament are composed of what type of collagen?
## Footnote
Chp 3
Type 1 Collagen
74
What group of PDL fibers is most predominant?
## Footnote
Chp 3
Oblique fibers
75
What is the role of oxytalan fibers in the PDL?
## Footnote
Chp 3
They run parallel to the root surface in a vertical direction and bend to attach to cementum in the cervical third of the root.
Thought to regulate vascular flow in the PDL
76
The epithelial rests of Malassez are considered remanents of what developmental structure?
## Footnote
Chp 3
Hertwig root sheath
77
Proliferation of the epithelial rests of Malassez are associated with formation of what types of cysts?
## Footnote
Chp 3
Periapical and lateral root cysts
78
What are the two main sources of collagen fibers in cementum?
## Footnote
Chp 3
Sharpey fibers (extrinsic) --> embedded portion of the principal fibers of the PDL formed by fibroblasts
Fibers that belong to cementum matrix (intrinsic) produced by cementoblasts
79
Sharpey fibers are composed of what type of collagen?
## Footnote
Chp 3
Type I (90%)
Type III (~ 5%)
## Footnote
Type III thought to coat Type I fibers
80
When does acellular cementum form and what part of the tooth does it cover?
## Footnote
Chp 3
first cementum formed before tooth reaches the occlusal plane
Covers ~ the cervical third or half of the root
## Footnote
Sharpey fibers make up most of the structure of acellular cementum
81
What is cellular cementum?
## Footnote
Chp 3
formed after tooth reaches occlusal plane, more irregular and contains cells (cementocytes) in lacunae that communicate with canaliculi
Less calcified and occupied by smaller portion of cellular cementum arranged parallel to root surface or at random
82
What is the inorganic content (hydroxyapatite) of cementum, bone, enamel and dentin respectively?
## Footnote
Chp 3
Cementum 45-50%
Bone 65%
Dentin 70%
Enamel 97%
83
What is the most common morphology type of the cementoenamel junction in people?
## Footnote
Chp 3
Cementum overlapping enamel 60-65% of cases
84
What type of cementum is primarily responsible for the anchorage of the tooth in the alveolus?
## Footnote
Chp 3
Acellular extrinsic cementum
## Footnote
Lots of tightly packing Sharpey fibers
85
What cell surface receptors recognize LPS?
## Footnote
Ch 7
CD14, TLR-4, MD-2
## Footnote
Porphyromonas gingivalis has an atypical form of LPS that is recognized by both TLR-2 and TLR-4
86
What plaque bacteria metabolic waste products contribute directly to tissue damage?
## Footnote
Ch 7
ammonia, hydrogen sulfide, short chain carboxylic acids (butyric acid and proprionic acid), proteases
87
COX-2 is upregulated by what factors?
## Footnote
Ch 7
IL-1beta, TNF-alpha, bacterial LPS
## Footnote
Leads to increased production of PGE2
88
What prostaglandin has a major role in contributing to the tissue destruction of periodontitis?
## Footnote
Ch 7
PGE2
## Footnote
induces MMPs and osteoclastic bone resorption
89
What class of antibiotics possesses the ability to downregulate matrix metalloproteinases?
Tetracyclines
## Footnote
subantimicrobial doxycycline inhibits collagenase activity
90
What key proinflammatory cytokine up-regulates inflammatory respones and is produced by multiple cell types in the periodontium?
## Footnote
Ch 7
IL-1Beta
91
What are the key MMPs in periodontitis produced by neutrophils?
MMP-8 and MMP-9
92
What does IL-1Beta stimulate?
## Footnote
Ch 7
synthesis of PGE2, platelet-activating factor and nitrous oxide, ICAM-1 and IL-8
## Footnote
Tissue levels of IL-1Beta correlate with periodontal disease severity
93
What is the role of IL-1alpha in periodontal disease
Expressed intracellularlly normally --> becomes an alarmin when released from necrotic cells --> signaling cytokine for tissue damage
94
What is the role of Tumor Necrosis Factor Alpha (TNF-alpha) in periodontal disease?
## Footnote
Ch 7
Key inflammatory mediator --> increases neutrophil activity, mediates cell and tissue turnover by inducing MMP secretion. Stimulates development of osteoclasts and limits tissue repair by activated macrophages in response to LPS, activation of macrophage IL-1Beta production and induction of PGE2
## Footnote
Less potent effect on osteoclasts than IL-1Beta, present at lower levels in inflamed gingival tissue than IL-1Beta
95
What is the role of IL-6 in periodontal pathogenesis?
## Footnote
Ch 7
Secretion stimulated by IL-1Beta and TNF-alpha, stimulates bone resorption and development of osteoclasts
## Footnote
plays an important role but less than IL-1Beta or TNF-alpha
96
Bone resorbs to maintain a width of how much noninfiltrated connective tissue over the bone?
## Footnote
Ch 7
0.5 to 1.0mm
97
Bone resorption ceases when how many mm of distance is present between bacteria in the pocket and the bone?
## Footnote
Ch 7
2.5mm distance
98
What mediators stimulate osteoclastic bone resorption?
## Footnote
Ch 7
IL-1Beta, TNF-alpha, IL-6, PGE2
99
What does IL-8 stimulate?
## Footnote
Ch 7
neutrophil chemotaxis
100
How much bacteria does 1 gram of plaque contain?
## Footnote
Ch 8
10^11 bacteria
101
How much bacteria live in a healthy gingival crevice vs a deep periodontal pocket?
## Footnote
Ch 8
Healthy: 10^3 bacteria
Deep pocket: 10^8
102
What are the phases of plaque accumulation?
## Footnote
Ch 8
1.) The formation of the pellicle on the tooth surface
2.) The initial adhesion/attachment of bacteria
3.) Colonization/plaque maturation
103
Do bacteria adhere to enamel or the acquired enamel pellicle?
## Footnote
Ch 8
Acquired enamel pellicle
104
What species are considered the primary colonizers of the tooth surface?
## Footnote
Ch 8
Streptococcus (> 20% bacteria)
Haemophilus spp, Neisseria (obligate aerobes)
Actinomyces spp, Veillonella spp (facultative anaerobes)
## Footnote
facultative anaerobes can grow in the prsence or abscence of oxygen
105
What are the secondary colonizers of dental plaque?
## Footnote
Ch 8
Campylobacter spp, Fusobacterium nucleatum, Prevotella spp, Tannerella forsythia, Porphyromonas gingivalis
(Orange and red complexes)
106
How quickly does clinically visible plaque appear after stopping dental home care?
## Footnote
Ch 8
3 days
107
What role does quorum sensing play in plaque biofilm formation?
## Footnote
Ch 8
Modulates expression of genes for antibiotic resistance
encourages growth of beneficial spp in the biofilm
Discourages growth of competitors
108
What class of antibiotics is unaffected by the ion-exchange resin properties of the biofilm?
## Footnote
Ch 8
Macrolides
109
What mechanisms of antibiotic resistance have been demonstrated in plaque biofilms?
## Footnote
Ch 8
Conjugation (exchange of genes through direct interbacteria connection formed by sex pilus)
Transformation (movement of small pieces of DNA from environment into bacterial chromosome)
Plasmid transfer
Transposon transfer
110
What are the most common fungal spp isoloated from the human oral cavity?
## Footnote
Ch 8
Candida spp (C. albicans)
111
What is the nonspecific plaque hypothesis?
## Footnote
Ch 8
QUANTITATIVE
Periodontal disease results from elaboration of noxious products by the entire plaque flora.
Less plaque, less periodontal disease
## Footnote
Discarded in favor of other hypotheses. Treatment of perio still based on these principles
112
What is the Specific Plaque Hypothesis?
## Footnote
Ch 8
QUALITATIVE
The pathogenicity of dental plaque depends on the presence of or an incrase in specific microorganisms
Concept of red complex bacteria supported this hypothesis
113
What is the Ecologic Plaque Hypothesis?
## Footnote
Ch 8
COMBINATION
Both the total amount of dental plaque and the specific microbial composition of plaque may contribute to the transition from health to disease.
114
What is the Keystone Pathogen Hypothesis?
## Footnote
Ch 8
Certain low-abundance microbial pathogens can orchestrate inflammatory disease by remodeling a normally benign microbiota into a dysbiotic one.
## Footnote
P. gingivalis labeled keystone pathogen
115
What microbial shifts occur from health to periodontitis?
## Footnote
Ch 8
From gram-positive to gram-negative
From cocci to rods (at later stages to spirochetes)
Nonmotile to motile organisms
Facultative anaerobes to obligate anaerobes
Fermenting to proteolytic spp
116
What bacteria is considered the primary etiologic agent in most cases of localized aggressive periodontitis?
## Footnote
Ch 8
Aggregatibacter actinomycetemcomitans
117
Plaque becomes 50% mineralized in how many days?
2 days
## Footnote
Calcification can occur within as little as 4 to 8 hours
118
Drug induced gingival overgrowth can occur how soon after starting the associated medications (anticonvulsants, calcium channel blockers, immunosuppressants)?
## Footnote
Ch 19
3 months
119
What is the suggested etiopathogenesis of drug-induced gingival overgrowth?
## Footnote
Ch 19
DIGO medications affect the extracellular matrix metabolism by decreasing collagenase activity and increasing production of matrix proteins
120
Infiltration of what percent of the junctional epithelium by PMNs leads to apical migration of the junctional epithelium?
## Footnote
Ch 23
60% PMNs
