Intro to Periodontics I Flashcards
what are the macroscopic clinical features of the gingiva
- marginal gingiva
- gingiva sulcus
- attached gingiva
- interdental gingiva
what are the microscopic clinical features of the gingiva
- oral epithelium
- sulcular epithelium
- junctional epithelium
describe the marginal/free gingiva
- unattached (free)
- about 1mm deep
in 50% of cases what is the marginal gingiva demarcated from the attached gingiva by
a free gingival groove
where is the sulcus epithelium
adjacent to tooth
what depth in considered normal in marginal gingiva
2-3mm
describe the attached gingiva
- bound to underlying periosteum of alveolar bone
- firm, resilient
- bordered apically by the MGJ
- varies in width in maxillary and mandibular
describe the gingival sulcus
- not attached to enamel or cementum
- bounded apically by the free gingival groove on the oral epithelium
what is the gingival sulcus called if attachment loss occurs
a periodontal pocket
describe the interdental gingiva
- occupies the embrasure
- pyramidal or col shaped
- the interproximal space beneath the area of tooth contact- col
describe the oral epithelium
keratinized stratified squamous epithelium
- turnover of 30 days
describe the sulcular epithelium
- 1mm
- unattached to enamel
- non-keratinized stratified squamous epithelium
describe the junctional epithelium
- attached by hemidesmosomes
- non-keratinized stratified squamous epithelium
- high rate of turnover ( 7-10 days) with average of 10.4 days
what are the layers of the oral epithelium
- stratum corneum
- stratum granulosum
- stratum spinosum
- stratum basale
what are the cells of the oral epithelium
- keratinocytes
- non- keratinocytes
what do the keratinocytes in the oral epithelium do
produce keratin
what are the majority of cells in the oral epithelium
keratinocytes
what are the non-keratinocytes in the oral epithelium and what do they do
- melanocytes- produce melanin
- langerhans cells- capture, uptake and process antigens
- merkel cells- sense of touch and found in stratum basale
what layers does the sulcular epithelium lack
stratum corneum and granulosum
what is the importance of sulcular epithlium
it is a semi- permeable membrane against bacterial products into underlying tissue
how many layers are in the junctional epithelium
3-20
how is the junctional epithelium attached to the tooth surface
via hemidesmosomes and non-collagenous proteins- proteoglycans and glycosaminoglycans
what does clinical probing depth/sulcus depend on
where the probe stops depending on tissue inflammation, probe diameter, probing pressure
what are the gingival fibers and where are they located
- gingivodental (dentogingival) group: cementum to gingiva
- circular group: around the tooth in the gingiva
- transseptal group: cementum to cementum of adjacent tooth
what are the 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 healthy gingiva? color, contour, consistency, and texture
- color: coral pink
- contour: depending on location, scalloped
- consistency: firm and resilient
- texture: stippling
what is stippling
a form of adaptive specialization or reinforcement for function
what percentage of the population has stippling
40%
what does the PDL Do
- attaches the tooth to alveolar bone
- absorbs occlusal forces
- transmits occlusal forces to bone
what does the PDL contain
- blood vessels
- collagen I, III, and IV
- proprioceptive nerve endings: transmits pressure and pain via trigeminal nerve
what are the cells in the PDL
- undifferentiated mesenchymal cells
- fibroblasts
- cementoblasts/cementoclasts
- osteoblasts/osteoclasts
-inflammatory cells - epithelial rests of malassez: remnants of hertwig’s root sheath
what are the PDL fibers
- alveolar crest
- horizontal
- oblique
- apical
- interradicular
where are alveolar crest fibers located and what do they do
- cementum-> crest alveolar bone
- prevents. extrusion and lateral movements
where are horizontal fibers located and what do they do
- cementum-> alveolar bone at 90 degrees
- opposes lateral forces
where are the oblique fibers located and what do they do
- cementum -> alveolar bone coronal
- largest group
- resists vertical masticatory forces
where are the apical fibers located and what do they do
- cementum -> apical alveolar bone
- resists tipping
where are the interradicular fibers located and what do they do
-cementum -> furcation bone
- resist luxation and tipping
describe cementum
- calcified mesenchymal tissue
- contains 45-50% HA
- non- vascularized
- no nerves
- no lymphatics
- grows by apposition
- attached to the fibers of the PDL (sharpeys fibers
what are the features of exposed cementum
- rough surface
- porosities
- smear layer
what does the rough surface of cementum allow for
plaque adherence
what do porosities in cementum do
- facilitate attachment of calculus
- facilitate absorption of bacterial enzymes
what does the smear layer of cementum do
inhibits attachment of CT
describe the alveolar process
- supports the tooth
- vascularized
- nerves in the periosteum NOT bone
- lymphatics
- attachment of PDL fibers
what are the components of the alveolar process
- external plate
- inner socket wall: alveolar bone proper
- cancellous trabeculae
what is the bundle bone and where is it found in the alveolar process
- attachment of PDL fibers into the bone
- in inner socket wall
what is the shape of the alveolar process in the anterior and posterior
- anterior: scalloped
- posterior: flattened
what does the shape of the alveolar process depend on
interdental distance, tooth contours, root contours
what is the distance of the alveolar process from the CEJ in health
- 1-1.5mm
-1.5-2mm in adult
what is dehiscence
lack of bone on the facial or lingual of the tooth but with the interproximal bone
what is fenestration
lack of bone on the facial or lingual of the tooth resembling a window
the alveolar process is a _____ facial and lingual ______ overlying root surfaces
thin; cortical plates
what happens to alveolar process in adults over the age of 40 years
- increased fibrosis of and increased lipid cell content in marrow spaces and decrease in progenitor cel populations
at least ____% of dentate US adults aged 30-90 have perio
48%
what are the 5 F’s of peroi
- failure to diagnose
- failure to treat
- failure to refer for tx
- failure to establish and follow an appropriate maintenance schedule
- failure to accept treatment
what must general dentists do for patients with perio
- diagnose perio disease
- inform the patient of clinical findings
- refer patient to periodontist or treat
- treat to current standard of care
describe stage 1 of perio disease
- initial stage
- 1-2mm of clinical attachment loss
- less than 15% bone loss
- no tooth loos due to perio disease
- probing depth 4mm or less
- mostly horizontal bone loss
describe stage 2 perio disease
- moderate stage
- 3-4mm CAL
- 15-33% bone loss
- no tooth loss due to perio disease
- PD 5mm or less
- mostly horizontal bone loss
describe stage 3 perio disease
- severe with potential for additional tooth loss
- 5mm or more CAL
- radiographic bone loss beyond 33%
- tooth loss of four teeth or less
- PD 6mm or more
- vertical bone loss of 3mm or more
- class II-III furcations
- moderate ridge defects
what is stage 4 perio disease
- severe with potential for loss of dentition
- all stage 3 features
- need for rehabilitation due to masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collapse, pathologic migration of teeth
- less than 20 remaining teeth or 10 opposing pairs
what is the grading of risk of progression for perio disease
A: low risk of progression
B: moderate risk of progression
C: high risk of progression
what should you initially assume the grade of perio disease is
grade B then find more evidence to shift to A or C
what are the primary criteria for grading
- direct evidence
- indirect evidence
what is the direct evidence for grading
- historical radiographic bone loss or CAL
what is the indirect evidence for grading
- % bone loss/patient age
- case phenotype
- heavy plaque accumulation but minimal destruction vs. minimal plaque but major destruction
what is the direct evidence for each grade
- grade A: no loss over 5 years
- grade B: less than 2mm loss over 5 years
- grade C: greater than 2 mm over 5 years
what is the indirect evidence for each grade and how is it calculated
- calculate bone loss percentage / age
- grade A: less than 0.25
- grade B: 0.25-1.0
- grade C: greater than or equal to 1
what is the goal of the new system for staging and grading
- easy to use
- should promote better communication with patient, referring dentists and hygienists, and other healthcare professionals
- identify response to tx
what are the components of supracrestal attachment
junctional epithelium and connective tissue
what is the length of supracrestal attachment
2mm made of 1mm JE and 1 mm of CT
