L2 - Tour Continued Flashcards
vascular supply of periodontium in the maxilla
anterior and posterior superior alveolar arteries + the infraorbital artery and greater palatine artery
vascular supply of periodontium in the mandible
inferior alveolar artery and branches including the mental and sublingual branches
+ buccal
+facial arteries
remember the long buccal
gingival plexus importance?
the vessels supply major capillary plexuses that are located in the connective tissue adjacent to the otal epithelium and the junctional epithelium
- important that these receive the anesthetics that get put into the vascular system
so getting supply from the blood vessels within the alveolar process also contributing
anastamoses in the oral mucosa?
arteries that supply the oral mucosa with the branches of the superior and inferior dental artieries
gingiva dual blood supple?
YES
INTERNAL –> bone and PDL
EXTERNAL –> through periosteum
but ALSO within the alveolar process we have vessels contributing to regional blood supply
lymph drainage of gingival tissue mainly through?
submandibular lymph nodes
submental lymph drains?
mandibular anteriors
upper deep cervical lymph drains?
the third molars
deep cervical nodes drain?
palatal gingiva
what do the nerves of periodontium register?
pressure, touch, temperature, and pain
which branches provide sensory and propooceptive functions?
TRIGEMINAL
innervation of the max and mandibular GINGIVA
- maxillary –> anterior middle and posterior superior alveolar
- infraorbital
- greater palatine
- nasopalatine - mandibular –> long buccal, mental (vestibular) and lingual for lingual gingival tissue
what do autonomic nerves control within the periodontium?
smooth muscles associated with the periodontal vasculature – which originate from the superior cervical ganglion
three zones of the intraoral tissue and general description of each
- MASTICATORY MUCOSA – gingiva and the tissue covering the hard palate
- SPECIALIZED MUCOSA – the dorsum of the tongue
- ORAL MUCOUS MEMBRANE - lines the remainder of the oral cavity
4 main functions of the oral mucosa
- protection (primarily from keratinized)
- sensation (taste)
- secretion (minor salivary glands)
- thermal regulation
gingiva - general description and only one of periodontal tissues that is what?
only one that is VISIBLE IN HEALTH *
gingiva is part of the oral mucosa that covers the alveolar process of the jaws and the necks of the teeth
how is gingva attached to alveolus and tooth complex- general of each
TWO COMPONENTS
- fibrous connective tissue
- COLLAGEN FIBER BUNDLES that connect cementum and alveolar bone - epithelial attachment
- HEMIDESMOSOME -mediated attachments to an inner basement membrane lining the hard tissues surface of the tooth
clinical appearance of gingiva and its overall size
distinguished from the alveolar mucosa (more red) by its lighter more salmon color and is KERATINIZED surrounding the tooth anywhere from 1-9mm (depending on tooth and location in mouth)
- stippling
color of gingiva dependent on?
level of
- keratiization
- vascular supply
- thickness
- pigmentation
melanin pigment synthesized where and by?
MELANOCYTES IN BASAL LAYER OF EPITHELIUM
3 clinical boundaries of gingiva - general
- marginal
- attached
- interdental
is the gingival margin attached to tooth? location
NO - it is the most coronal boundary of the gingiva
marginal gingiva describe and what is the free gingival groove?
portion of gingiva near the gingival margin and is UNNATTACHED surrounding the tooth in a collar fashion
- usually about 1 mm wide and forms the soft tissue wall of the sulcus which we can probe
the free gingival groove is present in about 50% of people and demarcates the marginal gingiva from the attached gingiva
- DOES NOT signify health in presence or absence
mucogingival junction - location and what it separates
MOST APICAL part and separates the gingiva from the alveolar mucosa
describe palatal gingiva
THERE IS NO MUCO-GINGIVAL JUNCTION
- the gingiva blend in with the masticatory mucosa that protects the hard palate
“free” gingiva
the part of gingiva that surrounds the tooth and is not directly attached to the TOOTH SURFACE
- anatomically ‘incorrect’
“attached” gingiva
what is APICAL to the “free” gingiva
- firmly bound to underlying tooth and alveolar processes via collagenous inerstions into the periosteum
- firm
- dense
- excellent barrier to mechanical stress
shape of the interdental gingiva
PARABOLIC FORM with the interproximal tissue MORE CORONAL to the direct facial or lingual sufaces
“SCALLOPED” appearance
- can be pyramidal or have a “col” shape
interproximal papilla shape?
knife edged when teeth in contact and should FILL ENTIRE GINGIVAL EMBRASURE COMPLETELY
col shaped or pyramidal shape of interdental gingiva?
pyramidal - more anterior teeth
col - more posterior shape and has a ‘valley’ like depression that connects the facial and lingual papilla which conforms to the shape of the interproximal contact - where it is more broad in the posterior
shape of ‘col’ depends on
gingiva in any interdental space is related to the CONTACT point b/w two interproximal surfaces
where is col most broad?
in a bucco-lingual direction in posterior teeth
is the col keratinized?
susceptible?
no not keratinized - so is more susceptible to noxious agents or trauma – so common site for initiation of periodontal pathologic breakdwon
what forms the col
fusion of interproximal junctional epithelia of two teeth
col if no contacts exists?
then the col does not exist and neither does the interdential papilla —> and the attached keritinized gingiva courses uninterrupted facio-lingually
describe alveolar mucosa
- moveable, delicate and poorly bound down to bone
- continous with vestibular mucosa and mucosa of floor of mouth and cheeks
- more reddish
If gingiva is lost beyonf the mucogingival junction?
goes right to alveolar mucosa which is a BAD REPLACEMENT for the gingiva
compare attached gingiva to alveolar mucosa 'keratinization? stippled? rete pegs? lamina propria? elastic fibers? submucosa? attachement?
THIS IS IMPORTANT
‘keratinization? ONLY attached
stippled? – only attached as alveolar is smooth unstippled
rete pegs? – wider/short/few in alveolar
lamina propria? – thick in attached
elastic fibers? - many in moveable vs few in attached
submucosa? - indistinct in attached and alveolar has distinct
attachement? non-moveable = attached vs moveable in alveolar
TWO cell layers in alveolar mucosa
- basal cell layer
2. stratum spinosum – ABOVE BASAL CELL layer
collagen in alveolar mucosa?
yes - but random arrangements
+ elastin and some muscle
cornoapical dimension of gingiva as ages?
tends to INCREASE with age
average thickness of attached gingiva?
relation to health?
1.41 mm (if went buccally into the tissue)
NO minimum thickness for health –> as long as oral hygiene habits are good
sulcus aka
DENTO-GINGIVAL SPACE
surfaces of sulcus and shape
tooth on one side anf the epithelial lining of the free gingival margin on the other
“V-shaped”
probing depth of clinically normal heathly sulcus?
crevice?
sulcus = 2-3 mm
(have seen 1.8mm to 6mm)
crevice = 0mm–> but only experiemntally
histological sulcus means
this is the term used for the gingival sulcus in the state of absolute clinical health
NEVER PROBE THE DEPTH OF THE HISTOLOGIC SULCUS
lateral boundary of the gingival sulcus
oral sulcular epithelium and enamel of tooth
coronal border of sulcular epithelium?
free gingival margin
apical /BASE aspect of sulcular epithelium?
coronal apect of the junctional epithelium
probe the histological sulcus?
NO - base is the coronal aspect of the JUNCTIONAL EPITHELIUM - and can be easily penetrated
- impossible to clinically identify the depth