Exam 1 Flashcards
Can bacteria alone cause PD
No, bacteria are ESSENTIAL but insufficient to cause disease
What host factors play a role in periodontitis?
- Heredity
- Environmental factors (smoking)
- Equally important as bacteria in determining disease occurrence and severity of disease outcome
Bacteria and host factors (heredity, env. factors) are equally important in determining what two things?
- Disease occurrence
2. Severity of disease outcome
3 microbial risk factors to periodontitis
- Specific microorganism
- Total microbial burden
- Biofilm pathogenicity
System risk factors to periodontitis
- Diabetes
- Genetic factors
- Sex/race
- HIV
What is the most common form of PD?
Slight (mild) PD
What is important in diagnosing PD?
Clinical Attachment Loss
What are the tissues of the periodontium
- Gingiva and alveolar mucosa
- Periodontal attachment apparatus (PDL, Cementum, Alveolar Bone)
T or F, The MGJ can recede along with periodontitis but cannot be restored
False, the MGJ does not change, that line is permanent
Where is the MGJ located?
At base of gingival mucosa and the top of the alveolar mucosa
Describe the MGJ as far as keratinized or non-keratinized epithelium
The point at which keratinized and non-keratinized epithelium meet
T or F, keratinized tissue extends from the gingival margin to the MGJ
True
How is attached gingiva measured?
From the gingival sulcus (GM) to the MGJ minus PD
Keratinized gingiva and mucosal epithelium is separated by what?
The MGJ
Where in the mouth is the tissue most keratinized and least keratinized?
Most: Hard palate
Least: Cheek
Describe the progression of teeth with most keratinized tissue to those that have the least amount.
Incisors > Molars > Premolars
Where would you find the most attached tissue and least attached tissue in the mouth?
Most attached gingiva –> Junctional epithelium
Least attached tissue –> Crevicular epithelium
What are the 2 mathematical equations to determine the attached gingiva
- AG=KG - Probing depth
2. AG=(GM to MGJ) - Probing depth
What are the 3 different types of epithelium
Crevicular (Sulcular) epithelium
Oral or outer epithelium
Junctional Epithelium
Junctional epithelium
- Keratinized?
- Thickness
- Length
- Turnover
- Non-keratinized
- 2-30 cells thick
- 0.25-1.35 mm length
- Turnover 1-6 days
How do hemidesmosomes play a role in junctional epithelium?
The attach:
- Cell to tooth/implant
- Cell to connective tissue
Describe the attachment for junctional epithelium
- Internal basal lamina
- To tooth or implant
- Lamina densa
- Lamina lucida
- External basal lamina
- To connective tissue
Oral or outer epithelium
- Keratinized?
- Turnover
Keratinized or parakeratinized
Turnover 10-12 days
Crevicular Epithelium
- Keratinized?
non-keratinized (has potential to keratinize), thin and without rete pegs
What is Stippling?
Depressions/raised areas in surface of attached gingiva
- Occurs at sites of rete pegs
Junctional epithelium
- keratinized?
- Turnover?
Non-keratinized
Turnover 1-6 days
What is the PDL?
a group of principal fibers that insert into cementum and the alveolar bone
What are the terminal fibers of the PDL called?
Sharpey’s fibers
PDL is composed of what type of cells?
Connective tissue cells
- (Fibroblasts, cementoblasts, & osteoblasts)
Host defense cells
Rests of malassez (isolated clusters of epithelium)
PDL function
To transmit forces & maintain attachment
PDL width
0.1-0.2 mm
Is PDL found in implants?
No, implants form hemidesmosomes with the alveolar bone
What is the gingival fiber group made up of and their functions?
Circular: support & contour to free gingiva
Gingivodental group
- Dentogingival: support of gingiva
- Dentoperiosteal: anchors tooth to bone
- Alveologingival: attaches gingiva to alveolar bone
Transseptal fibers: keep teeth in alignment and protects bone; continuously reform as bone and fibers are destroyed
Which of the gingival fiber groups are not on implants?
Dentogingival
Dentoperiosteal
Transseptal
What is the periodontal fibers group made up of and their functions?
Alveolar crest: resists lateral movement
Horizontal: opposes lateral forces
Oblique: absorbs occlusal forces (largest group)
Apical: resists tipping of tooth
Interradicular: resists forces of luxation (pulling out) and tipping
What is biological width?
Physiologic zone of gingival tissue coronal to the alveolar bone crest
- Also called gingival attachment, physiologic dentogingival junction
What is biological width composed of?
epithelial attachment and the gingival connective tissue attachment
Biological width
- Junctional epithelium distance
- Connective tissue distance
- Total biological width
- JE - 0.97 mm
- CT - 1.07 mm
- BW - 2.04 mm
3 violations of the biologic width
- Inflammation
- Increasing probing depth
- Inconsistent resorption of alveolar bone
Be able to calculate clinical attachment loss via numbers or words
Probing depth measurement + Gingival margin level (+ if apical to CEJ or - if Coronal to CEJ) = CAL
Two different types of gingivits
Plaque induced
Non-plaque induced
What are the systemic factors for plaque induced gingivitis
Endocrine (puberty, pregnancy, diabetes) Blood dyscrasias (leukemia)
What drugs contribute to plaque induced gingivitis
Treatment via cauterizing the tissue/vessels (dec. bleeding) will come back as long as pt is on the medication
- Anti-seizure meds (Dilantin)
- Ca channel blockers (Nifedipine)
- Immunosuppressants (cyclosporin)
- Oral contraceptives
How does malnutrition contribute to plaque induced gingivitis
Rare in US
- Vit deficiency
- Scorbutic gingivitis (scurvy)
What microorganisms contribute to non-plaque induced gingivitis
Bacteria: E. coli, Strep, Neisseria, Treponema
Viruses: Herpes
Fungal infections: Candidiasis, Histoplasmosis
What systemic diseases contribute to Non-plaque induced gingivitis
Systemic diseases: Benign mucous membrane Pemphigoid, anywhere there is a mucous membrane
Other than microorganisms and systemic diseases, what three other things can contribute to Non-plaque induced gingivitis
Trauma: toothbrush abrasion
Foreign body reactions: popcorn kernel, dental materials, ortho brackets
Genetic: Hereditary gingival fibromatosis
