Ella Elwood Flashcards
What type of epithelium is junctional epithelium
Stratified non keratinised
What type of epithelium is sulcular epithelium
Non keratinised stratified squamous
What type of epithelium is free gingiva
Keratinised stratified squamous
What type of epithelium is attached gingiva
Keratinised stratified squamous
What type of epithelium is lining mucosa
Non keratinised stratified squamous
How many basal laminar does junctional epithelium have
2 basal laminae, one against tooth and the other against connective tissue
What are properties of sulcular epithelium
2
Tooth facing
Distinct lamina propria
What are properties of free gingiva epithelium
3
Faces oral cavity
Has stippling
Distinct lamina propria
What are properties of attached gingiva
3
Faces oral cavity
Has stippling
Mucoperiosteum
What is the extra cellular matrix of gingival connective tissue composed of
2
Collagen fibres
Ground substance
What cells are present in gingival connective tissue
4
Fibroblasts
Macrophages
Mast cells
Neutrophils
What is stippling
Orange peel like texture due to presence of coarse collagen bundles attaching epithelium of the attached gingiva to underlying alveolar bone
What is the free gingival groove
The junction between the free and attached gingiva
What is the mucogingival junction
The junction between the attached gingiva and alveolar mucosa
What is transudate and where is it found
A filtrate of blood arising from an increased pressure in veins and capillaries that forces fluid through vessel walls against plasma osmotic pressure
Found in clinically healthy gingiva
What is exudate and where is it found
A fluid escaping from the intra vascular to extra vascular compartment containing proteins and cellular material in response to inflammation
Found in gingivitis
What is GCF
An inflammatory transudate
Which nerve goes through incisive foramen
Which artery goes through incisive foramen
Nasopalatine nerve
Sphenopalatine artery
Which nerve goes through greater palatine foramen
Which artery goes through greater palatine foramen
Greater palatine nerve
Greater palatine artery
Which nerve goes through lesser palatine foramen
What artery goes through lesser palatine foramen
Lesser palatine nerve
Lesser palatine artery
What part of the palate does the greater palatine foramen supply
What part of the palate does the lesser palatine foramen supply
Hard palate
Soft palate
What type of muscles make up the soft palate
Skeletal muscle
What muscles make up soft palate
4
Tensor veli paltini
Levator veli paltini
Palatoglossus
Palatopharyngeus
Inervation and action of tensor veli paltini
Mandibular nerve
Contracts to tense soft palate
Pathway of tensor veli paltini
Arises outside pharynx from base of skull
Passes down and hooks around hamulus
Becomes flat triangular tendon that forms framework of soft palate
Innervation and action of levator veli paltini
Innervated by pharyngeal plexus of vagus nerve
Contracts to pull palate up
What is the pathway of levator veli paltini
Arises from petrous temporal bone and cartilaginous parts of eustacian tube
Passes down towards soft palate
Innervation and action of palatoglossus
Innervated by pharyngeal plexus of vagus nerve
Contracts to pull palate down
Pathway of palatoglossus
From soft palate to lateral aspects of tongue
Innervation and action of palatopharyngeus
Innervated by pharyngeal plexus of vagus nerve
Contracts to pull palate down
Pathway of palatopharyngeus
From soft palate to lateral wall of pharynx
What type of epithelium lines hard palate
Keratinised stratified squamous epithelium
What type of epithelium lines soft palate
non Keratinised stratified squamous epithelium
What is the pharyngeal plexus
Network of nerve fibres inner sting most of palate and pharynx located on surface of middle pharyngeal constructor muscle
Which nerves does the pharyngeal plexus receive fibres from
3
Vagus nerve- motor innervation to skeletal muscle of palate and pharynx
Glossopharyngeal nerve- provides sensory and secretomotor innervation to pharyngeal mucosa and minor glands of pharynx
Sympathetic chain of cervical branch of facial nerve
What are the features of healthy gingiva
Pale pink Stippled Firm Knife edge interdental papillae No bleeding on probing Full bone support Periodontal ligament attached to tooth at CEJ
How are the teeth divided for BPE
Sextants
What features have BPE 0
Black band remains completely visible
No plaque retentive factors
No bleeding on probing
What features have BPE score 1
Black band remains completely visible
No plaque retentive factors
Bleeding on probing
What features have BPE score 2
Black band completely visible
Plaque retentive factors
What features have BPE score 3
Black band partially visible
What features have BPE score 4
Black band completely disappears
What does a * mean
Furcations
What does BPE X mean
No teeth or only one tooth in sextant
How do you calculate total attachment loss
Probing depth+gingival recession = total attachment loss
What type of epithelium lines floor of mouth
Non keratinised stratified squamous epithelium
Where does mylohyoid muscle originate and insert
Origin
Mylohyoid line
Insertion
Anterior three quarters of midline raphe and posterior quarter of superior body of hyoid bone
What anatomical structure do mylohyoid muscles form
Floor of mouth
What innervates mylohyoid muscle
The mylohyoid nerve, a motor branch of inferior alveolar nerve from mandibular division of trigeminal nerve
What artery supplies mylohyoid
Sublingual artery
Which gland is associated with the mylohyoid muscle
Submandibular gland
What innervates all extrinsic and intrinsic muscles of tongue
Hypoglossal nerve
Except palatoglossus which is innervated by vagus nerve
What innervates the anterior 2/3 of tongue
Taste innervated by chorda tympani branch of facial nerve
Sensation innervated by lingual branch of mandibular branch of trigeminal nerve
What innervates posterior 1/3 of tongue
Glosopharyngeal nerve
What innervates base of tongue
Superior laryngeal nerve branching from vagus nerve
What are the types of papillae on anterior 2/3 of dorsum of tongue and their functions
4
Circumvallate papillae -taste
Filiform papillae -mastication
Fungiform papillae -taste
Foliate papillae -taste
What type of mucosa is the ventral surface of the tongue lined with
Non keratinised oral mucosa with prominent vasculature in sub mucosa
Name the intrinsic muscles of the tongue
4
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
What do superior longitudinal intrinsic tongue muscles do
What do inferior longitudinal intrinsic tongue muscles do
Raise tip and sides and shorten tongue
Curled tip down and shortens tongue
What do transverse intrinsic tongue muscles do
What do vertical intrinsic tongue muscles do
Narrow and lengthen tongue
Flattens and broadens tongue
What are the extrinsic muscles of the tongue
4
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
What does genioglossus extrinsic tongue muscles do
What smooth hyoglossus extrinsic tongue muscles do
Raise tip and sides and shorten tongue
Curl tip down and shorten tongue
What does styloglossus extrinsic tongue muscle do
What does palatoglossus extrinsic tongue muscle do
Narrow and lengthen tongue
Flatten and broaden tongue
Where does lymph from tip of tongue drain
Where does lymph from anterior 2/3 of tongue drain
Where does lymph from posterior 1/3 of tongue drain
Sub mental nodes
Submandibular lymph nodes
Jugulo omohyoid nodes
What are the prevalancies of gingivitis, chronic periodontitis and aggressive periodontitis
90% will get gingivitis
60% get chronic periodontitis
5-15% get aggressive periodontitis
Define gingivitis
Reversible inflammation of the gingivae with no accompanying destruction of the periodontal tissues
How long does initial gingivitis take to develop
2-4 days
What are the features of initial gingivitis
5
Vascular dilation of blood vessels
Moderate amounts of infiltration of polymorphonuclear neutrophils to junction and sulcular epithelium
Predominant immune cell polymorphonuclear neutrophils
Peri vascular collagen loss
Increased GCF flow
How long does early gingivitis take to develop
5-7 days
What are the features of early gingivitis
5
Vascular proliferation of blood vessels
High amounts of infiltration of polymorphonuclear neutrophils to junctional and sulcular epithelium
Collagen loss
Predominant immune cells are lymphocytes
Bleeding on probing
How long does established gingivitis take to develop
8-21 days
What are the features of established gingivitis
5
Vascular proliferation and blood stasis
Very high infiltration of polymorphonuclear neutrophils to junctional and sulcular epithelium
Predominant immune cells are plasma cells
Collagen loss
Gingivae becomes red smooth shiny and inflamed
What are the key bacteria’s of periodontitis
4
Aggregacibacter spp
Porphyromonas spp
Treponema spp
Prevotella spp
What are the pathophysiological features of periodontal disease
5
Chronic inflammation Pocketing Epithelial migration Destruction of periodontal fibres Destruction of alveolar bone
What are the progressive stages of periodontal lesion
4
Initial lesion
Early lesion
Established lesion
Advanced lesion
What are the features of the initial periodontal lesion
5
Periodontitis localised to gingival sulcus
Vasculitis and oedima with fluid exudate in gingival sulcus
Increased migration of leukocytes to gingival crevice
Early changes in junctional epithelium
Loss of peri vascular collagen
What are the features of early periodontal lesion
3
Accentuated features of initial lesion
Signs of basal cell proliferation in junctional epithelium
Further collagen loss
What are the features of the established periodontal lesion
5
Plasma cells become dominant cell type
Extravascular immunoglobulins in connective tissue and junctional epithelium
Proliferation and apical micration of junctional epithelium
Pocket formation
More Collagen loss
What are the features of the advanced periodontal lesion
4
Bone and collagen loss
Periodontal pockets
Bone marrow converted to fibrous connective tissue
Abscess formation and furcation
What is the difference between gram positive and gram negative bacteria
Gram positive have thick peptidoglycan cell wall with no lipopolysaccharides in outer membrane
Gram negative have thin peptidoglycan cell wall with lipopolysaccharides in outer membrane
Which enzymes do obligate aerobes poses
Which enzymes do facultative anaerobes poses
Which enzymes do aerotolerant enzymes poses
Which enzymes do obligate anaerobes poses
SOD and catalase
SOD and catalase
SOD
-
What provides nutrients to supra gingival plaque
Diet and saliva
What is the main energy source of supra gingival plaque
Carbohydrates
What supplies nutrients to sub gingival plaque
Gingival crevicular fluid proteins
What are the differences between tooth associated and epithelium associated sub gingival plaque
Tooth associated plaque is densely packed and is associated with root caries, calculus and periodontal destruction
Epithelium associated plaque is loosely adherent and associated with periodontal destruction
What properties make the sub gingival environment a niche
4
More anaerobic as it gets deeper
Few mechanical forces to remove bacteria
Environment relatively static
Alkaline pH of 7.4-7.8
Compare sub gingival environment at gingival health and gingival inflammation
4
Low vs high plaque levels
No inflammation vs inflammation
Low GCF flow vs high GCF flow
High redox potential vs low redox potential
What type of bacteria are present in the healthy gingival sulcus
Mainly gram positive cocci
Name the bacteria in healthy gingival sulcus
5
Streptococcus sanguinis Streptococcus oralis Actinomycetes naesludil Actinomycetes viscosus Veilonella spp
What type of bacteria are present in gingivitis
More gram negative
Half gram positive cocci
Name bacteria’s present in gingivitis
6
Streptococcus spp Actinomycetes ssp Prevotella intermedia Capnocytophaga spp Fusobacterium nucleatum Veilonella spp
What is the key bridging species of periodontitis
Fusobacterium nucleatum
What type of bacteria are present in periodontitis
75% gram negative, mostly obligate anaerobes
Predominantly motile rods and spirochetes
What is the red complex and which three bacteria’s are part of it
Red complex: associated with progression of periodontal disease
Porphyromonas gingivalis
Tanerella forsythia
Treponema denticola
What are the clinical features of periodontal pocket
3
Over 3mm
Apical migration of junctional epithelium
Bone loss
What does the mandibular nerve supply sensory innervation to
Lower 1/3 of face
Lower jaw
Anterior 2/3 of tongue
What does the mandibular nerve supply motor innervation to
Muscles of mastication
What is found in meckels cave/trigeminal fossa?
Trigeminal ganglion containing sensory cell bodies
What nerve passes through foramen ovale and between which areas
Mandibular nerve
From middle cranial fossa to inferior cranial fossa
What nerve passes through foramen rotundum and between which two areas
Maxillary nerve
From middle cranial fossa to pterygopalatine fossa
What passes through foramen spinosum
Meningeal branch of mandibular nerve/ nervus spinosus
Which nerves pass through superior orbital fissure
4
Ophthalmic nerve
Oculomotor nerve
Abducens
Trichoclear nerve
What is the lingula
Lip of bone protecting mandibular foramen
What passes through mandibular foramen
Inferior alveolar nerve
What passes through mental foramen
Mental nerve
What is the pterygomandibular raphe
A ligamentous band attached to posterior end of mylohyoid line
Where does the trigeminal nerve leave the brain stem
PONS
What is the pterygomandibular space
A potential space between medial pterygoid muscle and medial surface of ramus of mandible
What anatomical structures are located in pterygomandibular space
3
Mandibular division of trigeminal nerve
Inferior alveolar artery and vein
Spenomandibular ligaments
Which nerves/branches form the anterior division of the mandibular nerve
4
Massateric nerve
Temporal nerves
Nerve to lateral pterygoid
Buccal nerve
Which nerves / branches form the posterior division of the mandibular nerve
5
Auriculotemporal nerve Lingual nerve Chorda tympani Inferior alveolar nerve Mylohyoid nerve
Which nerves branch from trunk of mandibular nerve
2
Meningeal branch/nervus spinosum
Nerve to medial pterygoid
What is Hilton’s law
A nerve supplying joint with sensation will be the same nerve supplying the muscles of the joint
Which foramen does the vagus nerve pass out of
Jugular foramen
Which nerves pass through the anterior division of the jugular foramen
2
Inferior petrosal sinus
Glossopharyngel nerve
Which nerves pass through middle division of the jugular foramen
2
Vagus nerve
Accessory nerve
Which structure passes through posterior division of jugular foramen
Sigmoid sinus
What are the functions of the vagus nerve
5
Innervates mexhanoreceptors in gag reflex
Taste
Innervates constrictors of pharynx
Innervates muscles of larynx
Innervates all muscles of soft palate except tensor paltini
What fibres form pharyngeal plexus
Some motor fibres of vagus nerve
Fibres from cranial component of accessory nerve
What does the pharyngeal plexus do
Provides sensory innervation to oropharynx and laryngopharynx and motor innervation to levator paltini, palatoglossus and palatopharangeus
What are the branches of the vagus nerve
5
Auricular branch Pharyngeal branch Superior laryngeal branch Recurrent laryngeal nerve Sinus nerve
What is the role of superior laryngeal nerve
Sensation to larynx above vocal folds and motor innervation to cricothyroid
What is the pathway of recurrent laryngeal nerve
Branches in thorax
Re enters neck
Passes upwards to enter larynx
What does recurrent laryngeal nerve innervate
Supplies sensation to mucous membrane below vocal folds and motor innervation to intrinsic muscles of larynx
What type of tissues bone
Connective tissue
What are the components of bone
3
Extra cellular matrix of primarily type 1 collagen in highly organised fibres
Ground substance of non collagenous proteins- glycoproteins, proteoglycans
Hydroxyapatite crystals
What is osteoid
Which components of bone make up osteod
The unmineralised organic matrix secreted by bone building cells (osteoblasts)
Extra cellular matrix of type 1 collagen
Ground substance with glycoproteins and proteoglycans
Functions of bone
5
Protection Support Movement Reservoir Blood cell formation
What minerals in bone give it strength
2
Calcium
Phosphorus
What are the types of bone
3
Cortical
Trabecular bone
Woven bone
What percentage of skeletal mass is cortical bone
80%
What is the primary structural unit of cortical bone
Osteon
What is the structure of cortical bone
Solid bone with only few small canals
Surrounds trabecular bone
What are properties of cortical Bone
3
Bundles of collagen fibres organised into sheets or lamellae
Remodelled from woven bone by vascular channels
Forms internal and external parts of flat bones and external surfaces of long bones
What percentage of skeletal mass is trabecular bone
20%
What are properties of trabecular bone
Present on inside of bones
Less dense and more elastic than cortical bone
Higher turnover rate than cortical bone
Makes up most bone tissue of axial skeleton
What is the structure of trabecular bone
Scaffold like honey comb structure with spaces filled with bone marrow cells
Properties of woven bone
Immature
Found during embryonic development, fracture healing and some pathological states
Normally replaced with cortical bone
Remains in tooth sockets and where tendons insert into bones
Structure of woven bone
Randomly arranged collagen bundles and irregular shaped vascular spaces lined with osteoblasts
What does the periosteum membrane cover
Covers and protects outer surface of bones not covered in cartilage
How is periosteum anchored to bone
Sharpeys collagen fibres
How many layers is periosteum made up of
What are the purposes of these
Double layered
Inner layer is an osteogenic layer containing osteoblasts and osteoclasts
Outer layer is a fibrous layer of dense irregular connective tissue proper for protection
What does endosteum membrane line
Bodies inner cavities that contain marrow or blood vessels
What is endosteum made up of
Mainly osteocytes and osteoclasts
What is intermembranous ossification
Mineralisation of tissue with differentiation of mesenchymal cells to osteoblasts
Where does intermembranous ossification occur
Within membranous plate of mesenchymal cells
What are the steps of intermembranous ossification
3
At ossification centre mesenchymal cells differentiate into osteoblasts
Osteoblasts deposit osteoid
Thin sheet of woven bone called the periosteal collar is deposited around shaft of cartilage model
What is endochondral ossification
Formation of bone from cartilage into bone
Steps of endochondral ossification
3
Periosteal bud invades cartilage model and allows mesenchymal cells to enter cartilage
Invading mesenchymal cells mature into osteoblasts
Osteoblasts deposit bone using framework of calcified cartilage
What do osteoblasts do
Form collagen, glycoproteins and proteoglycans of matrix and controls deposition of crystals on collagen fibrils
What do osteocytes do
Control extra cellular concentration of calcium and phosphorus
What do osteoclasts do
Large multi nucleated bone reabsorbing cells
What are the mineral contents of: Alveolar bone Cementum Dentine Enamel Pulp
70% 70% 70% 96% 0%
How is periodontal disease treated
5
Preventative techniques Bone grafts Tissue grafts Guided tissue regeneration Dentures
What makes collagen
Fibroblasts and some epithelial cells
What are the properties of collagen
5
Contributes to stability of tissues and organs
Maintains structural integrity of tissues and organs
High tensile strength
Involved in cell differentiation, polarity and movement
Role in tissue and organ development
What is the primary structure of collagen
4
Gly X Y: every third amino acid glycine which has no side chains and helps create tight turns
Has carboxyl terminal ends involved in assembly of procollagen
Hydroxyproline involved in H bonding
Hydroxylysine involves in covalent bonding
What type of bond is involved in secondary structure of collagen
Hydrogen bonding
What is the tertiary structure of collagen
Triple helical rod molecule of procolagen
Terminal ends
C telopeotides
N telopeptides
What is the quaternary structure of collagen
Collagen molecules align to form microfibrils, microfibrils align to form collagen fibres
What creates longitudinal alignment of microfibrils
C terminal aligns with N terminal with N always towards growing tip of fibril
What creates lateral alignment of microfibrils
C terminal ends with shaft of neighbouring molecule to create cross links
