Intro to Perio Flashcards
______ is that specialty of dentistry which encompasses the
prevention, diagnosis and treatment of diseases of the supporting and
surrounding tissues of the teeth or their substitutes and the maintenance of
the health, function and esthetics of these structures and tissues.
Periodontics
A ______ is a dentist who specializes in the prevention, diagnosis, and
treatment of periodontal disease, in the placement of dental implants. Periodontists are
also experts in the treatment of oral inflammation. Periodontists receive extensive
training in these areas, including three additional years of education beyond dental
school.
Periodontist
What is the most common reason for adult tooth loss?
Periodontal disease
What percentage of americans have periodontitis?
42%
- Bacterial dysbiosis in a susceptible host
causing loss of periodontal attachment
PERIODONTAL DISEASE
____ is an imbalance in the microbial community that is associated with disease. this imbalance could be due to the gain of harmful bacteria or loss of beneficial bacteria
Dysbiosis
The fibrous investing tissue, covered by keratinized epithelium, that immediately surrounds a tooth and is contiguous with its periodontal ligament and with the other mucosal tissues of the mouth.
Gingiva
The portion of the gingiva bound to the tooth and to the alveolar bone,
extending from the free gingival groove to the mucogingival junction.
Attached gingiva
Terminal edge of the gingiva surrounding the tooth in
collar-like fashion, directly not attached to the tooth. Usually
about 1 mm wide, it forms the wall of the gingival crevice
in health.
Marginal/free gingiva
•Not attached to enamel or cementum
•Bounded apically by the free gingival groove on the
oral epithelium (if present)
•If attachment loss occurs then referred to as a
periodontal pocket
Gingival sulcus
• Bound to underlying periosteum of alveolar bone • Firm, resilient • Bordered apically by the mucogingival junction • Varies in width in: – Maxillary – Mandibular
Attached Gingiva
• It occupies the embrasure
• Pyramidal or col shaped
• The interproximal space beneath the area of tooth
contact. (Col)
Interdental Gingiva
(Microscopic component of gingiva)
– Keratinized stratified squamous epithelium
– Turnover of 30 days
Oral Epithelium
(Microscopic component of gingiva)
– Unattached to enamel
– Non-keratinized stratified squamous epithelium
Sulcular epithelium (~1 mm)
(Microscopic component of gingiva)
– Attached by hemidesmosomes
– Non-keratinized stratified squamous epithelium
– High rate of turnover (7-10 days)
Junctional Epithelium (~ 1mm)
• Keratinized stratified squamous epithelium
– Stratum corneum
– Stratum granulosum
– Stratum spinosum
– Stratum basale
• Turnover in 30 days
• Cells
– Keratinocytes (majority of cells)- production of keratin
– Non-Keratinocytes
• Melanocytes-production of melanin
• Langerhans cells-the capture, uptake and processing of antigens
• Merkel cells-the sense of touch and found in stratum
basale
Oral Epithelium
• Non-keratinized
• Stratified squamous epithelium
• Lacks stratum corneum and granulosum; Langerhans
cells
• Importance: it is a semi-permeable membrane against
bacterial products passing into underlying tissue
- Sulcular Epithelium
What attaches the JE to the tooth surface?
Hemidesmosomes
• Non-keratinized
• Stratified squamous epithelium
• Rapid turnover : 10.4 days
• Few layers: from 3 to 20
• Attachment to the tooth surface via hemidesmosomes and
non-collagenous proteins (proteoglycans & glysosaminoglycans)
- Junctional Epithelium
What is the 2mm created by JE and connective tissue attachment?
Supracrestal tissue attachment
Biologic width
What are the types of collagen present in gingival fibers
Type 1 and 3
Fibers that are in close proximity to the
alveolar crest contribute to the
connective tissue attachment component
of the “supracrestal tissue attachment”.
Type I and III collagens are must
abundant.
Gingival fibers
• Is a form of adaptive specialization or reinforcement for function. The pitted,
orange-peel appearance frequently seen in attached gingiva.
• If it is present it means health; if it is not present it does not mean no health
• ~40% of population
Stippling
What types of collagen are prevalent in the PDL?
1,3, and 4
• Suspensory mechanism attaching tooth to alveolar bone • Absorbs occlusal forces • Transmits occlusal forces to bone • Contains blood vessels • Contains Collagen I, III and IV • Contains proprioceptive nerve endings: transmits pressure and pain via trigeminal nerve • Cells – Undifferentiated Mesenchymal cells – Fibroblasts – Cementoblasts/Cementoclasts – Osteoblasts/Osteoclasts – Inflammatory cells (in disease) – Epithelial rests of Malassez: remnants of Hertwig’s root sheath
PDL
PDL fibers
– Cementum → crest alveolar bone
– Prevents extrusion and lateral movements
• Alveolar crest
PDL fibers
– Cementum → alveolar bone at 90º
– Opposes lateral forces
• Horizontal
PDL fibers
– Cementum → alveolar bone coronal direction
– Largest group
– Resists vertical masticatory forces
• Oblique
PDL fibers
– Cementum → apical alveolar bone
– Resists tipping
• Apical
PDL fibers
– Cementum → furcation bone
– Resist luxation and tipping
• Interradicular
- Calcified mesenchymal tissue
- Contains 45-50% HA
- Non-vascularized
- No nerves
- No lymphatics
- Grows by apposition
- Attached to the fibers of the PDL (Sharpey’s Fibers)
Cementum
• Supports the teeth
• Vascularized
• Nerves (?)-are not in bone but in the periosteum
• Lymphatics
• Attachment of PDL fibers (Sharpey’s fibers)
• Components
– External plate
– Inner socket wall: alveolar bone proper
• Bundle bone: attachment of PDL fibers into the
bone
– Cancellous trabeculae
Alveolar Process
attachment of PDL fibers into the
bone
Bundle bone:
is lack of bone on the facial or lingual
of the tooth but with interproximal bone
Dehiscence
is a lack of bone on the facial or
lingual of the tooth resembling a “window”
Fenestration
is the inflammation of
the gingival tissues without loss of
connective tissue attachment”.
Gingivitis
is inflammation of the gingival
tissues with apical migration of the junctional
epithelium with concomitant loss of connective
tissue attachment and bone”.
Periodontitis
is the distance from the soft
tissue margin to the tip of the periodontal
probe ”.
Probing depth
is the
distance from the cementoenamel
junction (CEJ) to the tip of the periodontal
probe during normal probing. ”
Clinical attachment level (CAL)
_____ pocket: 1-3mm
Shallow (Sulcus - Health):
_____ pocket: 4-6 mm
Moderate:
_____ pockets: ≥ 7 mm
Severe:
Based upon: • Severity • Complexity of case mgmt Consider: • CAL • Amount and % of bone loss • PD • Presence/extent of ridge defects and Furcation Involvement • Tooth Mobility • Tooth loss (due to periodontitis)
Staging of Periodontitis
Considers biologic features: • RATE of disease progression • RISK of further advancement • potential threats to GENERAL HEALTH (e.g. smoking, diabetes) A to C: • A - Low risk of progression • B - Moderate risk • C - High risk
Grading of periodontits
Stage ____ of periodontal disease:
• 1–2 mm clinical attachment loss (CAL), less than 15%
bone loss (BL) around root, no tooth loss due to
periodontal disease, probing depth (PD) 4 mm or less,
mostly horizontal BL
Stage 1
Stage ____ of periodontal disease:
• 3–4 mm CAL, 15%–33% BL, tooth loss, PD 5 mm
or less, mostly horizontal BL
Stage 2
Stage ___ of periodontal disease:
• 5 mm or more CAL, BL beyond 33%, tooth loss of four teeth or
less, with complex issues such as PD 6 mm or more, vertical BL 3
mm or more, Class II–III furcations, and/or moderate ridge defects
Stage 3
Stage ___ of periodontal disease
• Encompasses all of Stage III with additional features that will require the
need for complex rehabilitation due to masticatory dysfunction,
secondary occlusal trauma, severe ridge defects, bite collapse, pathologic
migration of teeth, less than 20 remaining teeth (10 opposing pairs)
Stage 4
