Lecture 1 Flashcards
What are clinical findings?
What we see, feel, smell, etc
*Inflammation, erythema, etc.
What are histological findings?
What we see in the microscope and the underlying immune response to pathology
Will healthy periodontium have resident immune cells?
Yes. At some point, all of us have had periodontitis in some form, so those cells (interleukins, PMN infiltration, etc.) are there on standby
Be able to label the parts of the oral cavity.
In photos. Look at it, especially the retromolar trigone
Know the borders of the combined oral cavity.
Sup - Hard/soft palate
Ant - Lip
Lat - Cheeks
Post - Oropharyngeal isthmus
Inf - Membrane covering mylohyoid m (occupied by tongue)
Masticatory mucosa is what type of epithelium?
Keratinized stratified squamous epithelium
Where is masticatory mucosa found?
Dorsum of tongue
Hard palate
Attached gingiva
The lining mucosa is what type of epithelium?
Non-keratinized stratified squamous epithelium
Where is lining mucosa found?
Buccal mucosa
Labial mucosa
Ventral tongue
Where is specialized mucosa found?
Dorsum of tongue
Taste buds on lingual papillae
Oral mucosa and oral mucoperiosteum are made from what germ layer?
Ectoderm
What is atypical about the mucoperiosteum?
NO SUBMUCOSA
*Hard palate and attached gingiva
What does ortho keratinized mean?
No nuclei visible in keratin layer
What does parakeratinized mean?
Pyknotic nuclei retained in keratin layer
T/F - The difference b/t ortho and parakeratinized is rarely totally clear cut and they can transition back and forth.
TRUE
Why is healing w/in oral cavity good and rapid?
Cells from bsmt membrane move up to top layer quickly
What do rete pegs do?
Resist shearing forces
How does the lining mucosa differ from the masticatory mucosa, in terms of rete pegs?
Lining - Flatter, rounded rete pegs
Masticatory - Sharper, more pronounced rete pegs
Both the _______ and _______ _________ contribute to the bsmt membrane.
Epithelium
Connective tissue (Lamina propria)
Desmosomes do what adhesion?
Hemidesmosomes do what adhesion?
Des - Cell-cell
Hemi - Cell-bsmt mem
What is the bsmt membrane?
ECM sheet attaching epithelium to CT
How are cells anchored to bsmt membrane?
HEMIDESMOSOMES
And other attachment proteins
Lamina densa is made up of primarily what type of collagen?
Type IV
Attaching proteins
Type VII as well
Fibrillin
The lamina lucida is made up of what types of proteins?
Laminins
Integrins
Entactins
Dystroglycans
Lamina reticularis is made of what type of collagen?
III - As reticular fibers
Hemidesmosomes attach to basal lamina by intergrin-laminin and collagen ________.
Type XVII
BP180 = Collagen XVII
What things are in the junctional complex?
Tight junctions
Zonula adherens
Desmosomes
Gap junctions
What is the terminal bar?
Group of junctional complexes that attach cells on their lateral surfaces. Keep cells attached
Looks like a band
70-80% of patients with pemphigoid have antibodies to one or more bsmt membrane zone __________.
Antigens
BP 180 or 230
-Components of hemidesmosomes and junctional adhesion complexes
What is direct immunofluorescence?
Antibodies deposited in a thin linear pattern
*Present in the lamina lucida
Blister contents in mucus membrane pemphigoid: 2 things. Name them.
Fibrin
Inflammatory cells
Blisters in mucous membrane pemphigoid. Describe it.
Unilocular, subepidermal
Roof attenuated
T/F - Pemphigus vulgaris is also another disease associated with faulty cell-cell proteins.
True
*Blistering is seen here
**Keratinocytes stick together b/c desmogleins act as glue to hold them together
What are the 5 functions of the periodontium?
Attach
Resist
Maintain - tooth support
Adjust - shock absorber
Defend
The periodontium does NOT include what 4 things associated with teeth?
Enamel
Dentin
Pulp
Surrounding bone of alveolar process
The periodontium does include what 5 things?
Gingiva
Sulcus
Cementum
PDL
Alveolar bone (process)
Different types of gingiva?
Unattached (Marginal, free)
Gingival sulcus
Attached
Interdental
Be able to label the anatomical areas of the gingiva.
In your photos.
*Starting at the crown and moving superiorly:
- Free gingiva
- Attached gingiva
- Mucogingival junction
- Alveolar mucosa
- Interdental gingiva
Be able to label the picture of the gingival sulcus.
In photos
What is the coronal gingival boundary?
Free gingival margin
What is the apical boundary of the gingiva?
Mucogingival junction
The free gingiva is what type of epithelium?
Keratinized stratified squamous epi
Two types of gingival biotypes. Name and describe them.
Thin:
- 1/3 sample
- Females
- Slender teeth
- Narrow zone of keratinized gingiva
- Quick disease
Thick:
- 2/3 sample
- Males
- Quadratic teeth
- Wide zone of keratinized gingiva
- Slow disease
A clinically normal sulcus is how deep?
1-3 mm
The base of the gingival sulcus is formed by what?
Junctional epithelium
*This is the part of the gingiva that is adhered to the enamel leading down to the CEJ
T/F - The epithelium from the free gingival margin (FACING THE TOOTH) down to the CEJ is NONKERATINIZED.
TRUE
In a clinically normal sulcus, does the probe tip touch the CEJ?
NO. It touches the junctional epithelium
When probing and attachment loss is occurring, what is the sulcus now called?
Gingival pocket
What is the difference between periodontitis and gingivitis?
Bone loss in periodontitis
Is the sulcular epithelium keratinized or non-keratinized?
NON-KERATINIZED
If attachment loss is present, where does the probe tip touch, how deep is the depth, and what happens after probing?
Below the CEJ
> 3mm
Bleeding - Bleeding on probing “BOP”
What 4 things does the gingival crevicular fluid (GCF) do?
Cleanses the gingival sulcus
Aids in adhesion of epithelium to the tooth
Possesses antimicrobial properties
Exerts antibody activity in defense of the gingiva
What happens with the GCF in a healthy gingival crevice?
Resident bacterial plaque results in accumulation of high molecular weight molecules
Those molecules permeate the intercellular region of the epithelium, but are limited by the bsmt membrane
This creates an osmotic pressure that draw the fluid from the CT into the sulcus
Healthy GCF is considered _________. Stimulated/diseased GCF is considered ____________.
Transudate
Exudate
4 ways to collect GCF.
Intracrevicular washings
Micropipettes
Absorbing paper strips
Twisted threads
Specific activity is defined as?
SA = ?/?
Units of enzyme activity per mg protein
SA = units/mL enzyme//mg Protein/mL enzyme
Name 3 important cellular elements found in the GCF.
Bacteria and other microbial plaque
Desquamated epithelial cells
Leukocytes (PMNs, lymphocytes, and monocytes)[They migrate thru the sulcular epithelium]
What 5 electrolytes are found in the GCF?
K, Na, Ca, Mg, F
*W/ inflammation, positive correlation of Ca and Na concentrations and the Na/K ratio
What organic compounds are found in the GCF?
Glucose hexosamine
Hexuronic acid
**Glucose conc in gingival fluid is 3-4 times greater than that in serum due to metabolic activity of adjacent tissues and the local microbial flora
Cytokines (Interleukins) are local mediators of inflammation that are produced by a variety of cells. Name the potential diagnostic markers for periodontal disease.
Interleukin - 1alpha (IL1alpha), 1beta (IL1beta)
Interleukin - 6 (IL-6)
Interleukin - 8 (IL-8)
TNF-alpha (Tumor necrosis factor alpha)
IL-1alpha and IL-1beta have __________ effects and depending on a variety of factors can stimulate either bone __________ or ___________.
Pro-inflammatory
Resorption
Formation
What is PGE2?
Prostaglandin E2
What is PGE2?
Product of the cyclooxygenase pathway
*Elevated levels of PGE2 in GCF found in patients with periodontitis compared to gingivitis
**PGE2 levels are 3 times higher in patients with LAP compared to adult periodontitis
Junctional epithelium is derived from what?
Reduced enamel epithelium (REE)
What happens to REE?
It is replaced when the tooth erupts - replaced by squamous epithelial cells
Transformed REE and oral epithelium form dentogingival junction and junctional epithelium
Final conversion of REE to JE may not occur until __-__ yrs post eruption.
3-4
T/F - When the tooth first erupts, most of enamel is covered by JE.
TRUE
When tooth reaches occlusal plane, how much of the enamel surface is covered by JE?
1/4
Finally, JE lies close to what?
CEJ
Elderly patients with root exposure, what happens to JE?
Proliferates apically - firm attachment with cementum
What is the junctional epithelium?
Stratified squamous, NONKERATINIZED epi
What is unique to the JE compared to the other tissues in the body?
2 basal laminae
Internal basal lamina - attaches to the ENAMEL
External basal lamina - attaches to CT (Lamina propria = CT)
How does the JE attach to enamel and CT?
Hemidesmosomes
T/F - JE is nonkeratinized, but the free gingiva is keratinized.
ABSOLUTELY TRUE
What is the JE reinforced by?
Collagenous fibers in the marginal gingiva - known as dentino-gingival units
*These have a rapid turnover of about 1 day
What nourishes the JE?
Lamina propria
*JE turns over rapidly
What 2 roles does the JE play?
Attachment
Protective
-The permeability allows GCF and defense cells to pass across to underlying tissues (Periodontal disease)
*Large #’s of sentinel cells present, waiting to assist in future gingivitis bouts. If you’ve had gingivitis, those cells are there
GCF contains _______ globulins and ________, giving it immunological/phagocytes properties to combat disease/
IgG
PMNs
T/F - Masticatory epithelium is keratinized and has rete pegs.
TRUE
What is the color of healthy gingiva?
Pale/coral pink
*May be pigmented
-More frequent in dark-skinned individuals
—Light brown to black
What are two functions of attached gingiva?
Allow gingiva to withstand mechanical forces created during chewing, speaking, and tooth brushing
Prevents free gingiva from being pulled away from tooth when tension is applied to alveolar muscosa
T/F - Stippling of gingiva is determined by genetics.
TRUE
_______ of stippling does not imply disease, _________ of stippling does not imply health.
Lack
Presence
What attaches the gingival tissue to cementum and bone?
Dense CT fibers
Average width of facial maxillary attached gingiva?
Incisors - 3.5-4.4 mm
Premolar- 1.9 mm
Average width of mandibular attached facial gingiva?
Incisors - 3.3 - 3.9 mm
Premolar - 1.8 mm
T/F - Palate is keratinized.
TRUE
T/F - The entire hard palate is attached tissue.
TRUE
*Except for free gingival margin
T/F - Papilla is also called interdental gingiva.
TRUE
Shape of papilla largely due to what 3 things?
Relationship to teeth (Crowns)
Genetics
State of health
The shape of the papilla varies according to the dimension of the _________.
Embrasure
The papilla is present 100% of time when distance b/t crest of bone and contact point is less than or equal to _______ mm.
5
The papilla is present 56% of the time when the distance b/t the crest of bone and contact point is greater than or equal to ________ mm.
6
T/F - In health, the papilla is nonkeratinized.
TRUE
If there is no tooth contact, what happens to the papilla?
It becomes keratinized
What is a diastema?
Space or gap b/t 2 teeth
What is the COL?
Depression b/t facial and lingual interdental gingiva
-Connects facial and lingual papillae
T/F - Center of the COL is nonkeratinized.
TRUE
T/F - The COL is susceptible to disease?
TRUE
The JE is widest at the ___________ epithelium ( ____ to ____) cells, and narrows to a few cells (___ to ___) at the ________ end.
Sulcular
15, 30
1,3
Apical
T/F - Sulcus and col are non-keratinized.
TRUE
