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Perio - Exam 1 > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

What are clinical findings?

A

What we see, feel, smell, etc

*Inflammation, erythema, etc.

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2
Q

What are histological findings?

A

What we see in the microscope and the underlying immune response to pathology

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3
Q

Will healthy periodontium have resident immune cells?

A

Yes. At some point, all of us have had periodontitis in some form, so those cells (interleukins, PMN infiltration, etc.) are there on standby

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4
Q

Be able to label the parts of the oral cavity.

A

In photos. Look at it, especially the retromolar trigone

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5
Q

Know the borders of the combined oral cavity.

A

Sup - Hard/soft palate

Ant - Lip

Lat - Cheeks

Post - Oropharyngeal isthmus

Inf - Membrane covering mylohyoid m (occupied by tongue)

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6
Q

Masticatory mucosa is what type of epithelium?

A

Keratinized stratified squamous epithelium

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7
Q

Where is masticatory mucosa found?

A

Dorsum of tongue

Hard palate

Attached gingiva

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8
Q

The lining mucosa is what type of epithelium?

A

Non-keratinized stratified squamous epithelium

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9
Q

Where is lining mucosa found?

A

Buccal mucosa

Labial mucosa

Ventral tongue

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10
Q

Where is specialized mucosa found?

A

Dorsum of tongue

Taste buds on lingual papillae

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11
Q

Oral mucosa and oral mucoperiosteum are made from what germ layer?

A

Ectoderm

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12
Q

What is atypical about the mucoperiosteum?

A

NO SUBMUCOSA

*Hard palate and attached gingiva

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13
Q

What does ortho keratinized mean?

A

No nuclei visible in keratin layer

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14
Q

What does parakeratinized mean?

A

Pyknotic nuclei retained in keratin layer

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15
Q

T/F - The difference b/t ortho and parakeratinized is rarely totally clear cut and they can transition back and forth.

A

TRUE

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16
Q

Why is healing w/in oral cavity good and rapid?

A

Cells from bsmt membrane move up to top layer quickly

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17
Q

What do rete pegs do?

A

Resist shearing forces

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18
Q

How does the lining mucosa differ from the masticatory mucosa, in terms of rete pegs?

A

Lining - Flatter, rounded rete pegs

Masticatory - Sharper, more pronounced rete pegs

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19
Q

Both the _______ and _______ _________ contribute to the bsmt membrane.

A

Epithelium

Connective tissue (Lamina propria)

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20
Q

Desmosomes do what adhesion?

Hemidesmosomes do what adhesion?

A

Des - Cell-cell

Hemi - Cell-bsmt mem

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21
Q

What is the bsmt membrane?

A

ECM sheet attaching epithelium to CT

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22
Q

How are cells anchored to bsmt membrane?

A

HEMIDESMOSOMES

And other attachment proteins

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23
Q

Lamina densa is made up of primarily what type of collagen?

A

Type IV

Attaching proteins

Type VII as well

Fibrillin

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24
Q

The lamina lucida is made up of what types of proteins?

A

Laminins

Integrins

Entactins

Dystroglycans

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25
Q

Lamina reticularis is made of what type of collagen?

A

III - As reticular fibers

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26
Q

Hemidesmosomes attach to basal lamina by intergrin-laminin and collagen ________.

A

Type XVII

BP180 = Collagen XVII

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27
Q

What things are in the junctional complex?

A

Tight junctions

Zonula adherens

Desmosomes

Gap junctions

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28
Q

What is the terminal bar?

A

Group of junctional complexes that attach cells on their lateral surfaces. Keep cells attached

Looks like a band

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29
Q

70-80% of patients with pemphigoid have antibodies to one or more bsmt membrane zone __________.

A

Antigens

BP 180 or 230

-Components of hemidesmosomes and junctional adhesion complexes

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30
Q

What is direct immunofluorescence?

A

Antibodies deposited in a thin linear pattern

*Present in the lamina lucida

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31
Q

Blister contents in mucus membrane pemphigoid: 2 things. Name them.

A

Fibrin

Inflammatory cells

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32
Q

Blisters in mucous membrane pemphigoid. Describe it.

A

Unilocular, subepidermal

Roof attenuated

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33
Q

T/F - Pemphigus vulgaris is also another disease associated with faulty cell-cell proteins.

A

True

*Blistering is seen here

**Keratinocytes stick together b/c desmogleins act as glue to hold them together

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34
Q

What are the 5 functions of the periodontium?

A

Attach

Resist

Maintain - tooth support

Adjust - shock absorber

Defend

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35
Q

The periodontium does NOT include what 4 things associated with teeth?

A

Enamel

Dentin

Pulp

Surrounding bone of alveolar process

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36
Q

The periodontium does include what 5 things?

A

Gingiva

Sulcus

Cementum

PDL

Alveolar bone (process)

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37
Q

Different types of gingiva?

A

Unattached (Marginal, free)

Gingival sulcus

Attached

Interdental

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38
Q

Be able to label the anatomical areas of the gingiva.

A

In your photos.

*Starting at the crown and moving superiorly:

  • Free gingiva
  • Attached gingiva
  • Mucogingival junction
  • Alveolar mucosa
  • Interdental gingiva
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39
Q

Be able to label the picture of the gingival sulcus.

A

In photos

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40
Q

What is the coronal gingival boundary?

A

Free gingival margin

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41
Q

What is the apical boundary of the gingiva?

A

Mucogingival junction

42
Q

The free gingiva is what type of epithelium?

A

Keratinized stratified squamous epi

43
Q

Two types of gingival biotypes. Name and describe them.

A

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
44
Q

A clinically normal sulcus is how deep?

A

1-3 mm

45
Q

The base of the gingival sulcus is formed by what?

A

Junctional epithelium

*This is the part of the gingiva that is adhered to the enamel leading down to the CEJ

46
Q

T/F - The epithelium from the free gingival margin (FACING THE TOOTH) down to the CEJ is NONKERATINIZED.

A

TRUE

47
Q

In a clinically normal sulcus, does the probe tip touch the CEJ?

A

NO. It touches the junctional epithelium

48
Q

When probing and attachment loss is occurring, what is the sulcus now called?

A

Gingival pocket

49
Q

What is the difference between periodontitis and gingivitis?

A

Bone loss in periodontitis

50
Q

Is the sulcular epithelium keratinized or non-keratinized?

A

NON-KERATINIZED

51
Q

If attachment loss is present, where does the probe tip touch, how deep is the depth, and what happens after probing?

A

Below the CEJ

> 3mm

Bleeding - Bleeding on probing “BOP”

52
Q

What 4 things does the gingival crevicular fluid (GCF) do?

A

Cleanses the gingival sulcus

Aids in adhesion of epithelium to the tooth

Possesses antimicrobial properties

Exerts antibody activity in defense of the gingiva

53
Q

What happens with the GCF in a healthy gingival crevice?

A

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

54
Q

Healthy GCF is considered _________. Stimulated/diseased GCF is considered ____________.

A

Transudate

Exudate

55
Q

4 ways to collect GCF.

A

Intracrevicular washings

Micropipettes

Absorbing paper strips

Twisted threads

56
Q

Specific activity is defined as?

SA = ?/?

A

Units of enzyme activity per mg protein

SA = units/mL enzyme//mg Protein/mL enzyme

57
Q

Name 3 important cellular elements found in the GCF.

A

Bacteria and other microbial plaque

Desquamated epithelial cells

Leukocytes (PMNs, lymphocytes, and monocytes)[They migrate thru the sulcular epithelium]

58
Q

What 5 electrolytes are found in the GCF?

A

K, Na, Ca, Mg, F

*W/ inflammation, positive correlation of Ca and Na concentrations and the Na/K ratio

59
Q

What organic compounds are found in the GCF?

A

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

60
Q

Cytokines (Interleukins) are local mediators of inflammation that are produced by a variety of cells. Name the potential diagnostic markers for periodontal disease.

A

Interleukin - 1alpha (IL1alpha), 1beta (IL1beta)

Interleukin - 6 (IL-6)

Interleukin - 8 (IL-8)

TNF-alpha (Tumor necrosis factor alpha)

61
Q

IL-1alpha and IL-1beta have __________ effects and depending on a variety of factors can stimulate either bone __________ or ___________.

A

Pro-inflammatory

Resorption

Formation

62
Q

What is PGE2?

A

Prostaglandin E2

63
Q

What is PGE2?

A

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

64
Q

Junctional epithelium is derived from what?

A

Reduced enamel epithelium (REE)

65
Q

What happens to REE?

A

It is replaced when the tooth erupts - replaced by squamous epithelial cells

Transformed REE and oral epithelium form dentogingival junction and junctional epithelium

66
Q

Final conversion of REE to JE may not occur until __-__ yrs post eruption.

A

3-4

67
Q

T/F - When the tooth first erupts, most of enamel is covered by JE.

A

TRUE

68
Q

When tooth reaches occlusal plane, how much of the enamel surface is covered by JE?

A

1/4

69
Q

Finally, JE lies close to what?

A

CEJ

70
Q

Elderly patients with root exposure, what happens to JE?

A

Proliferates apically - firm attachment with cementum

71
Q

What is the junctional epithelium?

A

Stratified squamous, NONKERATINIZED epi

72
Q

What is unique to the JE compared to the other tissues in the body?

A

2 basal laminae

Internal basal lamina - attaches to the ENAMEL

External basal lamina - attaches to CT (Lamina propria = CT)

73
Q

How does the JE attach to enamel and CT?

A

Hemidesmosomes

74
Q

T/F - JE is nonkeratinized, but the free gingiva is keratinized.

A

ABSOLUTELY TRUE

75
Q

What is the JE reinforced by?

A

Collagenous fibers in the marginal gingiva - known as dentino-gingival units

*These have a rapid turnover of about 1 day

76
Q

What nourishes the JE?

A

Lamina propria

*JE turns over rapidly

77
Q

What 2 roles does the JE play?

A

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

78
Q

GCF contains _______ globulins and ________, giving it immunological/phagocytes properties to combat disease/

A

IgG

PMNs

79
Q

T/F - Masticatory epithelium is keratinized and has rete pegs.

A

TRUE

80
Q

What is the color of healthy gingiva?

A

Pale/coral pink

*May be pigmented
-More frequent in dark-skinned individuals
—Light brown to black

81
Q

What are two functions of attached gingiva?

A

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

82
Q

T/F - Stippling of gingiva is determined by genetics.

A

TRUE

83
Q

_______ of stippling does not imply disease, _________ of stippling does not imply health.

A

Lack

Presence

84
Q

What attaches the gingival tissue to cementum and bone?

A

Dense CT fibers

85
Q

Average width of facial maxillary attached gingiva?

A

Incisors - 3.5-4.4 mm

Premolar- 1.9 mm

86
Q

Average width of mandibular attached facial gingiva?

A

Incisors - 3.3 - 3.9 mm

Premolar - 1.8 mm

87
Q

T/F - Palate is keratinized.

A

TRUE

88
Q

T/F - The entire hard palate is attached tissue.

A

TRUE

*Except for free gingival margin

89
Q

T/F - Papilla is also called interdental gingiva.

A

TRUE

90
Q

Shape of papilla largely due to what 3 things?

A

Relationship to teeth (Crowns)

Genetics

State of health

91
Q

The shape of the papilla varies according to the dimension of the _________.

A

Embrasure

92
Q

The papilla is present 100% of time when distance b/t crest of bone and contact point is less than or equal to _______ mm.

A

5

93
Q

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.

A

6

94
Q

T/F - In health, the papilla is nonkeratinized.

A

TRUE

95
Q

If there is no tooth contact, what happens to the papilla?

A

It becomes keratinized

96
Q

What is a diastema?

A

Space or gap b/t 2 teeth

97
Q

What is the COL?

A

Depression b/t facial and lingual interdental gingiva

-Connects facial and lingual papillae

98
Q

T/F - Center of the COL is nonkeratinized.

A

TRUE

99
Q

T/F - The COL is susceptible to disease?

A

TRUE

100
Q

The JE is widest at the ___________ epithelium ( ____ to ____) cells, and narrows to a few cells (___ to ___) at the ________ end.

A

Sulcular

15, 30

1,3

Apical

101
Q

T/F - Sulcus and col are non-keratinized.

A

TRUE

Perio - Exam 1 (3 decks)

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