Oral Mucosa part II Flashcards
Name some host derived enzymes found in the GCF.
Acid phosphates Alkaline phosphatase Alpha 1 antitrypsin Arulsulphatse Aspartate aminotransfarase B-glucuronidase Cathespin D, G Matrix metalloprotiens MMPS Elastase Plaminogen activators
Where does elastase come from? What does high levels of elastase indicate?
PMNs. Disease
If there are high levels of anitbodies in the GCF what does that indicate?
That the sulcus has turned into a pocket.
Name some bacterial derived enzymes in the GCF.
Acid phosphates Alkaline phosphatase Collagenase Hyaluronidase phosphlipase A phospholipase c Bacterial proteinases ENDO and EXOpeptidases
Name the cellular elements of the GCF (3)
Bacteria desquamated epithelial cells leukocytes PMNs, lymphocytes, monocytes
Where do leukocytes migrate through into the sulcus in healthy tissue?
Sulcular epithelium
List the electrolytes found in the GCF (5)
Potassium K Sodium Na Calcium Ca Magnesium Mg Fluoride F
During inflammation, _____ and ____ concentrations have a positive correlation with _____ ratio in the GCF.
Ca and Na Na/K
List (2) organic compounds found in the GCF.
GLUCOSE hexosamine Hexuronic acid
Glucose concentration in the gingival fluid is _____ times greater than that in _____.
3-4 serum
The excess glucose in diabetic patients can be used by what and cause what?
Bacteria lactic acid that leads to caries
List the metabolic end products of bacteria (6)
Lactic Acid Endotoxins Urea Hydroxyproline Cytotoxic substances Hydrogen sulfide - smelly!!
What are cytokines?
Potent local mediators of inflammation. Produced by a variety of cells Communication between white blood cells
What can cytokine be diagnostic markers for in the oral mucosa?
Periodontal disease
List (5) types of cytokines.
Interleukin 1alpha Interleukin 1beta interleukin 6 interleukin 8 tumor necrosis factor
What interleukins have pro-inflamatory affects?
IL 1 alpha IL 1 beta * can stimulate bone reposition or formation
What is prostaglandin E2?
inflammatory mediator A product of the cyclooxyrgenase path
Where the levels of PGE2 elevated or depressed in patients with periodontitis?
ELEVATED!
What color is the attached gingiva?
Light pink, coral pink * may be pigmented depending on skin color. Darker skin - darker attached gingiva
What are the functions of the attached gingiva?
Withstand mechanical forces Prevents free gingival from being pulled away from the tooth when tension is applied to mucosa (lip being pulled out)
What are stipplings?
The attachement points of fibers to the gingival tissue, cement, and bone. Rete pegs and epithelial projections.
Healthy texture is ______
stippled
Does the absence of stippling mean anything?
NO! Presence of stippling does not mean disease.
Maxillary ATTACHED GINGIVA width: * incisors:_______ * premolar:__________
3.5 - 4.4 mm 1.9 mm * more recession can occur in the incisors before it is huge concern.
Mandibular ATTACHED GINGIVA width: * Incisors: _______ * Premolars: ________
3.3 - 3.9 mm 1.8 mm
The entire palate is attached tissue? T or F
True
Should lacerations of the palatal rugae be noted in the patients chart? Why?
Yes! It is a clinical finding. Can occur due to sharp foods.
Interdental paplla
should extend up between the teeth until tooth contact. Fill the entire inter proximal space.
What largely determines the shape of the gingiva? (3)
- Relationship to teeth (crowns) 2. Genetics 3. State of health Varies according to the dimension
If you change the relationship of the contact points and bone what can you change?
The height of the contact point - and eventually the height of papilla
What is the length of the papilla?
5mm or less (100% of time) 6 mm or more (present 56% of the time)
If there is no contact what affect does this have on the papilla?
No contact – NO PAPILLA
What is the Col?
Depression between facial and lingual interdental gingiva. Interproximal area
Is the Col nonkeratinized or keratinized tissue?
Nonkeratinized * more susceptible to disease!
List the fiber bundles near the Col. (4)
Dentogingival group Circular group Periosteal group Alveologingival group
With recession what happens to the interdental gingiva?
It becomes nonkeratinized tissue (keratinized –> Nonkeratinized) *good result health wise, bad cosmetically
What shape does the cole have before recession and after?
Concave Convex
When perio-probing where is the probe ending at?
Junctional epithelium (not CEJ)
During a healthy situation there is a space at the sulcus. T or F
False - healthy tissue should be approximated to the enamel via the GCF.
What attaches the sulcus to the enamel of the tooth?
Hemidesmosomes
Name 3 aspects of the junctional epithelium.
- Continuous with sulcular epithelium 2. Encircles the tooth 3. On enamel and extends apically onto CEJ
As you get recession what happens to the junctional epithelium>
Depresses down the root surface. That is why it seems there is a pocket because you are still robin till the junctional epithelium - it is just further down that usual.
What is junctional epithelium derived from?
Reduced enamel epithelium
How long after eruption does it take for the REE to turn into the junctional epithelium?
3-4 years post eruption
What is the histology of junctional epithelium?
Stratified squamos, non keratinized Surrounded by TWO basal laminas Reinforced by collagenous fibers in the marginal gingiva.
What is the typical cell length of the JE
.25 to 1.35mm
How many basal laminas surround the JE
TWO! only area in the body that has two * internal – attaches to enamel * external – attaches to CT
What connects the JE to the basal laminas?
Hemidesmosomes
What is the Dentino-gingival unit
Junctional epithelium reinforced by collagenous fibers in the marginal gingiva.
Where is the JE widest? Narrowest?
Widest - suclular epithelium (15 - 30 cells) Narrow - apical end (1-3 cells)
With more inflammation where will the probe reach?
Apical end of the JE
JE length varies according to stage of eruption. T or F
True!
When a tooth first erupts the JE covers what?
Most of the enamel
Where does the fluid for the GCF in a healthy sulcus pass through?
Junctional Epithelium
If diseased (pocket) where does the GCF enter the pocket?
Junctional epithelium and Sulcular wall
Rate of JE turnover is VERY RAPID! Epithelial cells move coronally and she into the oral cavity via gingival crevice.
TRUE!
What does the turnover rate of the JE depend on?
Demands placed on tissue. Directly related to degree of inflammation.
Label this image:
Circular Group
Dentinogingival Group
Dentoperiosteal Group
Alvelogingival Group
Alveolar Bone
What are the two layers of ther Lamina Propria?
What extends into the papillary layer?
Rete Pegs
List the gingival Fiber Groups:
1
2
3
4
5
Gingivodental
Circular
Dentoperiosteal
Alveologingival
Transeptal
List some cells of the gingival connective tissue:
Osteoblasts, osteoclasts, fibroblasts…..
What is the composition of connective tissue?
65% Fibers
5% cells
Remaining % proteoglycans
What is the periodontal ligament?
Suspends and maintins the tooth in the socket
Direct conection between cementum and bone
Anastomosis of Fibers
What is the attachment apparatus?
PDL, cementum, alveolar bone
What is characteristic of the fibers in the PDL?
Fiber bundles are thicker and less abundant on the bone surface
What are the collagen fibers found in the PDL? (4)
Principle fiber
Intermediate plexus
Sharpey’s fibers
indifferent fiber plexus
What are the elastic fibers found in the PDL?
oxytalan fibers
What is the thickness of the PDL?
.1 - .25 mm
Widest during heavy occlusion
Thinner in nonfunctioning teeth
Diameter doubles from eruption to fully functional
What are the groups of ther periodontal ligament fibers?
Alveolar Crest
Horizontal
Oblique
Apical
Interradicular
Transseptal?
Label the fiber groups of the periodontal ligaments.
Alveloar Crest
Horizontal
Oblique
Apical
Interradicular
