Intro to Perio Flashcards
What are the macroscopic clinical features of gingiva?
Marginal gingiva
Gingival sulcus
Attached gingiva
Interdental gingiva
These features describe the visible parts of the gingiva in the mouth.
What are the microscopic clinical features of gingiva?
- Oral epithelium
- Sulcular epithelium
- Junctional epithelium
What is the depth of the gingival sulcus considered normal?
About 1mm in depth
2-3 mm is still considered normal
What is another name for marginal gingiva?
Free gingiva
Unattached gingiva
In ~50% of cases the marginal gingiva is demarcated from the attached gingiva by a…
free gingival groove
The ________ gingiva is bound to the underlying periosteum of alveolar bone
attached
The attached gingiva is firm and resilient, bordered apically by the mucogingival junction.
What are the characteristics of attached gingiva?
Firm, resilient
The attached gingiva is border apically by the…
mucogingival
junction
What happens to the gingival sulcus if attachment loss occurs?
periodontal pocket
This change indicates a pathological condition.
What is the relationship between keratinized tissue and attached gingiva?
Keratinized tissue is not necessarily attached gingiva
Is attached gingiva keratinized or nonkeratinized?
keratinized
What is the equation for determining attached gingiva?
KG-PD=Attached gingiva
keratinized tissue - probing depth = attached gingiva
Fill in the blank: The ______ occupies the embrasure between teeth.
Col
The Col is a pyramidal or col-shaped area of interdental gingiva.
What type of epithelium is the col?
non-keratinized stratified squamous
What type of epithelium is the oral epithelium composed of?
Keratinized stratified squamous epithelium
This type of epithelium has a turnover rate of about 30 days.
What type of epithelium is the junctional epithelium composed of?
- non-keratinized stratified squamous
- attaches to the tooth surface via hemidesmosomes
High turnover rate of 7-10 days
What type of epithelium is the sulcular epithelium composed of?
Non-keratinized stratified squamous epithelium
Unattached to enamel
What are the layers of the oral epithelium?
- Stratum corneum
- Stratum granulosum
- Stratum spinosum
- Stratum basale
What are the main cells of the oral epithelium?
*Keratinocytes (majority of cells)
*Non-Keratinocytes
– Melanocytes (melanin)
– Langerhans cells (deals with antigens)
– Merkel cells (touch)
What layers does the sulcular epithelium have?
- Stratum spinosum
- Stratum basale
Langerhans cells present
What is the important function of sulcular epithelium?
Semi-permeable membrane against bacterial products passing into underlying tissue
What is the main function of junctional epithelium?
Attachment to the tooth surface via hemidesmosomes and non-collagenous proteins (proteoglycans & glysosaminoglycans)
What is the difference between histological sulcus and clinical sulcus?
What are the parts of the supracrestal attachement?
also called biological width
- sulcular epithelium
- junctional epithelium
- connective tissue attachment
How many mm is the supracrestal attachment/biological width?
2.0mm
What are three groups of gingival fibers?
- gingivodental group (cementum -> gingiva)
- circular group (around the tooth in the gingiva)
- transeptal group (cementum -> cementum of adjacent tooth)
What are gingival fibers?
Fibers that are in close proximity to the alveolar crest contribute to the connective tissue attachment component of the “supracrestal attachment”.
What are the clinical features of gingiva?
- Color: coral pink (Melanin is variable)
- Contour: scalloped outline
- Consistency: firm and resilient
- Texture: stippling
What is stippling?
a form of adaptive specialization or reinforcement for function
40% of population
What are the primary functions of the periodontal ligament (PDL)?
- Suspensory mechanism attaching tooth to alveolar bone
- absorbs occlusal forces
- transmists occlusal forces to bone
- contains blood vessels
- contains collegen I, III, and IV
- contains proprioceptive nerve endings (via trigeminal nerve)
What types of cells are found in the periodontal ligament?
- Undifferentiated mesenchymal cells
- Fibroblasts
- Cementoblasts/Cementoclasts
- Osteoblasts/Osteoclasts
- Inflammatory cells
- Epithelial rests of Malassez
What are the five types of PDL fibers?
- alveolar crest
- horizontal
- oblique
- apical
- interradicular
What type of PDL fibers…
*Cementum → crest of alveolar bone
*Prevents extrusion and lateral movements
Alveolar crest
What type of PDL fibers…
*Cementum → alveolar bone at 90º
*Opposes lateral forces
Horizontal
What type of PDL fibers…
*Cementum → alveolar bone coronal direction
* Largest group
* Resists vertical masticatory forces
Oblique
What type of PDL fibers…
*Cementum → apical alveolar bone
* Resists tipping
Apical
What type of PDL fibers…
*Cementum → furcation bone
* Resist luxation and tipping
Interradicular
What are the characteristics of cementum?
- Calcified mesenchymal tissue
- Contains 45-50% hydroxyapatite (HA)
- Non-vascularized
- No nerves
- No lymphatics
- Grows by apposition
- Attached to the fibers of the PDL (Sharpey’s Fibers)
What is the texture of exposed cementum?
- Rough surface texture facilitates plaque adherence
- Porosities
—facilitate attachment of calculus
—facilitate absorption of bacterial enzymes - Smear layer inhibits attachment of connective tissue
What structure supports the tooth and contains blood vessels and lymphatics?
Alveolar process
The alveolar process is vascularized and contains nerves in the periosteum.
What are the components of the alveolar process?
- External plate
- Inner socket wall-alveolar bone proper
- Cancellous trabeculae
What is the bundle bone?
attachment of PDL fibers into the bone (alveolar process)
What is the distance between the alveolar process and CEJ in health?
1-1.5 mm
1.5-2 mm in adults
What is a dehiscence?
lack of bone on the facial or lingual of the tooth but with interproximal bone
What is fenestration?
lack of bone on the facial or lingual of the tooth resembling a “window”
What is the shape of the anterior versus the posterior alveolar process?
Scalloped - anterior
Flattened - posterior
The alveolar process has thin facial and lingual __________ plates overlying root surfaces
cortical
Increased fibrosis of and increased lipid cell content in marrow spaces (and therefore a decrease in progenitor cell populations) in adults over the age of ________
40 years
What percentage of adult tooth loss is attributed to periodontal disease, caries, prosthetic, and other?
perio - 70%
caries - 20%
prosthetic - 9%
other - 1%
At least ___% of dentate U.S. adults aged 30 to 90 have periodontitis
48%
-30.5% have a mild form
-17.7% have a moderate or severe form
What are the five ‘F’s of periodontics?
- Failure to diagnose
- Failure to treat
- Failure to refer for treatment
- Failure to establish and follow an appropriate maintenance schedule
- Failure to accept treatment (patient)
What are the court dictated roles for general dentists regarding perio?
- Must diagnose periodontal disease
- Must inform the patient of clinical findings
- Must refer patient to a Periodontist, or treat
themselves - Must treat to the current standard of care
What is the classification of periodontal diseases according to the AAP?
What characterizes Stage I (initial) Periodontitis?
- 1-2 mm clinical attachment loss
- less than 15% bone loss
- no tooth loss due to perio
- probing depth of 4 mm or less
- mostly horizontal BL
What defines Stage II (moderate) Periodontitis?
- 3-4 mm clinical attachment loss
- 15%-33% bone loss
- no tooth loss due to perio
- probing depth of 5 mm or less
- mostly horizontal BL
What are the characteristics of Stage III (severe) Periodontitis?
- 5 mm or more clinical attachment loss
- radiographic bone loss beyond 33%
- tooth loss of four teeth or less
- complexity factors like probing depth of 6 mm or more
- vertical BL of 3mm or more
- Class II-III furcations
What conditions are included in Stage IV (severe with potential for loss of dentition) Periodontitis?
Encompasses all of Stage III with additional features requiring complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collapse, pathologic migration of teeth, less than 20 remaining teeth, etc.
What does the grading system for periodontal disease assess?
Risk of progression
The grading system includes grades A (low risk), B (moderate risk), and C (high risk) based on specific criteria.
What is direct versus indirect evidence for periodontal disease?
- Direct Evidence
* historical radiographic bone loss or
* clinical attachment loss - Indirect Evidence
* % bone loss/patient age
* Case Phenotype
* Heavy plaque accumulation but minimal destruction vs. minimal plaque but major destruction
What is Grade A in the grading system?
Low risk of progression
This grade is assigned when there is no loss over 5 years.
What does Grade B indicate in the grading system?
Moderate risk of progression
This is indicated by less than 2 mm loss over 5 years.
Define Grade C in the grading system.
High risk of progression
This grade is assigned when there is more than 2 mm loss over 5 years.
What is the primary criteria for grading periodontal disease?
Direct evidence of historical radiographic bone loss or clinical attachment loss
The grading system relies on both direct and indirect evidence to assess risk.
What is the grading-indirect evidence calculation?
Percentage of bone loss divided by patient age
A 60 year-old with 10% bone loss =0.16 (A)
A 50 year-old with 25% bone loss =0.5 (B)
A 40 year-old with 40% bone loss =1.0 (C)
What is the goal of the new system for staging and grading periodontal diseases?
- Easy to use
- Should promote better communication (?) with
—Patient
—Referring dentists, hygienists
—Other health care professionals - Identify response to treatment
What is the significance of the 2017 New Classification of Periodontal Diseases?
It aims to identify response to treatment and improve communication
This classification system is intended to enhance the management of periodontal disease.
What stage is this?
Stage 1
What stage is this?
stage 4
What stage is this?
stage 3
What stage is this?
stage 2
What stage is this?
stage 3
What stage is this?
stage 1
What stage is this?
stage 2
What stage is this?
stage 4
