Normal Periodontum pt.1 Flashcards by Maria Zepeda

the terminal edge or border of the gingiva that surrounds the teeth in collar-like fashion

Marginal/ Unattached Gingiva

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A shallow linear depression that demarcates

Free gingival groove

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How wid is the marginal gingiva and what does it form?

1mm wide, forms the soft tissue wall of the gingival sulcus

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Can be seperated by the tooth surface with a periodontal probe

Marginal Gingiva

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**most apical point of the marginal gingival scallop **
Its apicocoronal and mesiodistal dimensions vary between 0.06 and 0.96 mm

Gingival Zenith

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The so-called probing depth of a clinically normal gingival sulcus in humans is what?

1-3mm

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the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or the periodontal pocket

Attached GIngiva

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Where is the width of the attached gingiva greatest?

Anterior teeth.

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Crevice that surrounds the tooth and is not directly attached to the tooth surface.

Gingival Sulcus

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an important landmark when measuring the depth of the gingival sulcus or periodontal pocket.

Gingival Margin

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GIngival tissue that occupies the gingival embasure space.

Interdental GIngiva (papilla)

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the tip of one papilla is located immediately beneath the contact point

Pyramidal Interdental Gingiva

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valley-like depression that connects a facial and lingual papilla and that conforms to the shape of the interproximal contact

Col-shaped interdental papilla

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What does the shape of interdental papilla depends on?

Presense of abcence of a contact point btwen adjacent teeth
Distance btwn cotact points
Tooth shape
Presnce or abscense of recession

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If a ____ is present then there is an absence of interdental papillae

Diastema

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Microscopically

gingiva is composed of

overlying= stratified squamous epithelium
underlying = central core of connective tissue

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The connective tissue of the gingiva is composed primarily of what two things?

Collage fibers
Ground substanced

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Epithelia cells play a role in what?

Innate hote defense, reponds to bacteria and infection.

increased proliferation, the alteration of cell-signaling events, changes in differentiation and cell death, and, ultimately, the alteration of tissue homeostasis.

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The principal cell type of the gingival epithelium as well as of other stratified squamous epithelia are the?

forms a fibrous, structural, protective protein

Kertatinocyte

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What are the other clear cells found in the epithelium?

clear cells or non-keratinocytes

Langerhans cells, the Merkel cells, and the melanocytes.

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How are keratinocytes innterconnected>

Demososmes

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are dendritic cells located in the basal and spinous layers of the gingival epithelium. They synthesize melanin.

Melanocytes

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Dendritic cells located among keratinocytes at all suprabasal levels, contain elongated granules, and they are considered macrophages with possible antigenic properties

Langerhan Cells

Immune reaction

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are in the deeper layers of the epithelium; they harbor nerve endings, and they are connected to adjacent cells by desmosomes. They have been identified as Tactile perceptors.

Merkel Cells

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What are the 4 layers of the oral epithelum?

Outter most to inner most 1. Stratum corneum (cornified layer) 2. Stratum granulosum (granular layer 3. Stratum spinosum (prickle cell layer) 4. Stratum basale (basal layer)

What is the turnover time of the oral epithelium on the, **5-6 days.** What tissues?

* Palette * Tounge * Cheek

What is the turnover time of the oral epithelium on the, **10-12 days** What tissues?

Gingiva

What is the turnover time of the oral epithelium on the, **1-6 days** What tissues?

Junctional epithelium

What epithelium has the **potential to keratinize** if it is reflected and exposed to the oral cavity or if the bacterial flora of the sulcus is eliminated.

Sulcular Epithelium

What epithelium loses its keratinization when it is placed in contact with the tooth

Outer epithelium

What findings suggest that local irritation of the sulcus prevents sulcular keratinization.

The sulcular epithelieum can keratinize if it is exposed to the oral cavity and if bactria is removed | Needs to be HEALTHY

What is present in very high amounts in the Juctional Epithelium if there is accumulationof dental plaque and gingival inflamation?

migrating polymorphonuclear neutrophil leukocytes

The junctional epithelium is attached to the tooth surface (epithelial attachment) by means of an _____

Internal Basal Lamina

The junctional epithelium is attached to the gingival connective tissue by an ____ ____ ____ that has the same structure as other epithelial–connective tissue attachments elsewhere in the body.

external basal lamina

What are the two layers of the internal basal lamina?

Lamina Densa= adj to enamel Lamina lucida= hemidesmsomes attached

# Internal Basal Layer Lamina Densa adjacent to what?

Tooth Enamel

# Internal basal lamina Lamina Lucida what attached to it?

Hemidesmosomes

a decisive role in the firm attachment of the cells to the internal basal lamina on the tooth surface.

Hemidesmosomes (attached to lamina lucida)

After enamel formation is complete, the enamel is covered with what?

reduced enamel epithelium (REE)

reduced enamel epithelium (REE) is attached to the tooth by what?

basal lamina and hemidesmosomes

When the tooth penetrates the oral mucosa, the REE unites with the oral epithelium and transforms into the

Junctional Epithelium

a continually self-renewing structure, with mitotic activity occurring in all cell layers.

Junctional Epithelium

**regenerating epithelial cells** move toward ____ and along it in a coronal direction to the gingival sulcus, where they are **shed**.

the tooth surface

is the **shallow, V-shaped space or groove** between the tooth and the gingiva that encircles the newly erupted tip of the crown.

Gingival Sulcus

The value of the ____ ____ is that it can be represented as either a** transudate or an exudate. **

GINGIVAL FLUID

Gingival fluid is a good ____ or____ of the the biologic state of the **periodontium in health** and it also contains components of connective tissue, epithelium, inflammatory cells, serum, and microbial flora that inhabit the gingival margin or the sulcus /pocket.

Diagnositc or prognostic biomarker

In a healthy sulcus how much gingival fluid is there?

Not much.

During inflamation what happens to levels of GCF?

gingival fluid flow** increases**, and its composition starts to resemble that of an inflammatory **exudate**

What is the main round of gingiva fluid diffusion into the sulcus?

1. Through the basment membrane 2. Through wide spaces of JE 3. Into the sulcules

What are the 4 main things GCF does?

1. Cleanse sulcus 2. Cont. plasma protiens that helps to imporve adhesion of epethelium to tooth 3. Antimicrobial properties 4. Antibody activty to defend gingiva

What makes up the extracllular compartment of connecitve tissues?

Collagen fibers & ground substances

# WHat part of connective tissues? fills the space between fibers and cells; it is amorphous, and it has a high water content

Ground Substances

WHat 2 things make up ground substance of connecitve tissue?

1. Proteoglycans 2. Glycoprotiens

# What componet of ground substances mainly hyaluronic acid and chondroitin sulfate

Proteoglycans

# What componet of ground substances Mainly fibronectin and laminin.

Glycoprotiens

# What componet of ground substances binds fibroblasts to the fibers and many other components of the intercellular matrix, thereby helping to mediate cell adhesion and migration

FIbronectin

# What componet of ground substances another glycoprotein found in the basal lamina, serves to attach it to epithelial cells

Laminin

What are the 3 types of connective tissues?

1. Collagen 2. Reticular 3. Elastic

forms the bulk of the lamina propria and provides the tensile strength to the gingival tissue.

Collagen I

branches between the collagen type I bundles, and it is continuous with fibers of the basement membrane and the blood vessel walls.

Type IV collagen

The connective tissue of the marginal gingiva is densely collagenous, and it contains a p**rominent system of collagen fiber** bundles called

Gingival Fibers

3 main functions of gingival fibers

1. **brace** marginal gingiva firmly agaisn tooth 2. Provide **ridgitiy** to withstand forces of mastication w/out being defelected from tooth surface 3. **unite** the free marginal gingiva with the cementum of the adj. attached gingiva

The yellow are what fibers? these fibers are unique because they exist entirely within the gingiva, however, they do not contact the tooth

Circular gingival fibers

The orange are? fibers that extend towards the crest of the gingiva. fibers that extend laterally to the outer surface of the gingiva and. fibers that extend outward, past the alveolar bone

Gingivodental fibers

#5 is what gingival fiber? spanning the interproximal tissue between adjacent teeth, where they are embedded

Transeptal gingival fiber

The predominat cellular element in gingival connective tissue is the ?

Fibroblast

are of **mesenchymal origin **and play a major role in the development, maintenance, and repair of gingival connective tissue.

Fibroblast

2 main functions of fibroblasts

1. **Syntheisize **collagen an elastic fibers 2. **Regulate collagen**degredation through phagocytosis & secretion of collagenases

What inflamatorry cells are present in gingival connecive tissues?

* Mast cells * Fixed macrophages * Histocytes Inflmaatory cells! Present in small amounts in clinically normal gingiva

WHat tissue is really good at healign and regenration with little scarring? | Not as good as PDL or epithelial tissue

Gingival connective tissue

# What blood supply? **along the facial and lingual surfaces of the alveolar bone** from which capillaries extend along the sulcular epithelium and between the rete pegs of the external gingival surface

Supraperiosteal arterioles

# What blood supply? which extend into the gingiva and anastomose with capillaries in the sulcus area.

Vessels of the PDL

# What blood supply? **Emerge from the crest of interdental septa.** Extend parallel to the crest of the bone to **anastomose** with vessels of the periodontal ligament, with capillaries in the gingival crevicular areas and vessels that **run over the alveolar crest.**

Aterioles

* derived from fibers that arise from **nerves in the periodontal ligament** and from the labial, buccal, and palatal nerves

Gingival innervation

WHat influences the color of the marginal gingiva? | Coral Pink

* Vasuclar supply * Degree of keratinization * Presence of pigmant containing cells (melanin)

a non–hemoglobin-derived brown pigment, responsible for normal pigmentation of tissues, present in all individuals at diffrent levels.

Melanin

What directly down-regulates melanin pigmentation in gingival tissues

Ascorbic Acid

What does the contoure/shape of the depend on?

* Shape of teeth * Allignment of the arch * Location/size of contact * Dimesions of embasures

What is the consistancy of gingiva?

is **firm and resilien**t and, except for the movable free margin, **tightly bound **to the underlying bone.

collagenous nature of the lamina propria and its contiguity with the mucoperiosteum of the alveolar bone determin what? + gingival fibers contribute as well

firmess of gingiva

orange peel texture on attached gingiva varys with age.

Stippling

Is the marginal gingiva stippled?

No! Smooth. Only attached is stippled.

Explain stippling trend with age

* Abscent in infancy * In some 5y/o * increases until adulthood * Begings to dissapear during old age

The surface texture of the gingiva is also related to the presence and degree of ____

epithelial keratinization

Hard palate and gingiva of alveolar processes

Masticatory Mucosa

Dorsum of tongue

Specialized Mucosa

lines the remainder of the oral cavity (vestibule and reflects to form the inner lining of lips and cheeks

Lining Mucosa

Gingiva (free gingiva, attached gingiva, and interdental gingiva)

Protecitve Periodontum

Cementum * Periodontal Ligament * Bone

Supporting Periodontium (Attachment apparatus)

What is #3?

Gingival Groove

What is #4

Attached gingiva

What is #5?

5. Mucogingival Alveolar Junction

What is #6?

Alveolar Mucosa

WHat is #7?

Interdental Gingiva

On the lingual aspect of the mandible, the attached gingiva terminates at the?

mucous membrane lining the floor of the mouth

On the palatal surface, the attached gingiva blends in with the ?

Paletal Mucosa

The junction of the attached gingiva and the mucosa

Mucogingival Junction

Mucosa covering the basal part of the alveolar process and continuing into the vestibular area on the buccal aspect of the teeth and the floor of the mouth on the lingual aspect of the teeth. Very movable, loosley attached to periosteum

Alveolar mucosa

Running a perio probe horizontally from alveolar mucosa to attached gingiva

Roll test

epithelial extensions that project into the underlying connective tissue

Rete Pegs | Point left

no nucleus remaining

Keratinized

Nucleated

Non-keratinized

* Covers the crest and**outer surface of the marginal gingiva** and the surface of the attached gingiva * 0.2 - 0.3mm thick * Most commonly **Parakeratinized** ***Presence of Rete pegs**

Gingiva/oral epithelium

* Lines the**gingival sulcus** * Extends from the crest of the gingival margin to the coronal limit of the junctional epithelium * Thin, **nonkeratinized** stratified squamous epithelium **without rete pegs**

Sulcular Epithelium

The sulcular epitheloum has a ____ degree of enzymatic acivity compared to outer, less keratinization

Lower degree of enzymatic acitivty.