Normal Periodontum pt.1 Flashcards
the terminal edge or border of the gingiva that surrounds the teeth in collar-like fashion
Marginal/ Unattached Gingiva
A shallow linear depression that demarcates
Free gingival groove
How wid is the marginal gingiva and what does it form?
1mm wide, forms the soft tissue wall of the gingival sulcus
Can be seperated by the tooth surface with a periodontal probe
Marginal Gingiva
**most apical point of the marginal gingival scallop **
Its apicocoronal and mesiodistal dimensions vary between 0.06 and 0.96 mm
Gingival Zenith
The so-called probing depth of a clinically normal gingival sulcus in humans is what?
1-3mm
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
Where is the width of the attached gingiva greatest?
Anterior teeth.
Crevice that surrounds the tooth and is not directly attached to the tooth surface.
Gingival Sulcus
an important landmark when measuring the depth of the gingival sulcus or periodontal pocket.
Gingival Margin
GIngival tissue that occupies the gingival embasure space.
Interdental GIngiva (papilla)
the tip of one papilla is located immediately beneath the contact point
Pyramidal Interdental Gingiva
valley-like depression that connects a facial and lingual papilla and that conforms to the shape of the interproximal contact
Col-shaped interdental papilla
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
If a ____ is present then there is an absence of interdental papillae
Diastema
Microscopically
gingiva is composed of
overlying= stratified squamous epithelium
underlying = central core of connective tissue
The connective tissue of the gingiva is composed primarily of what two things?
- Collage fibers
- Ground substanced
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.
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
What are the other clear cells found in the epithelium?
clear cells or non-keratinocytes
Langerhans cells, the Merkel cells, and the melanocytes.
How are keratinocytes innterconnected>
Demososmes
are dendritic cells located in the basal and spinous layers of the gingival epithelium. They synthesize melanin.
Melanocytes
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
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
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?
- Through the basment membrane
- Through wide spaces of JE
- Into the sulcules
What are the 4 main things GCF does?
- Cleanse sulcus
- Cont. plasma protiens that helps to imporve adhesion of epethelium to tooth
- Antimicrobial properties
- 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?
- Proteoglycans
- 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?
- Collagen
- Reticular
- 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 prominent system of collagen fiber bundles called
Gingival Fibers
3 main functions of gingival fibers
- brace marginal gingiva firmly agaisn tooth
- Provide ridgitiy to withstand forces of mastication w/out being defelected from tooth surface
- 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
- **Syntheisize **collagen an elastic fibers
- Regulate collagendegredation 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 resilient 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?
- 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 andouter 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 thegingival 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.
