Oral Soft Tissues I Flashcards
What 5 types of fibers make up Gingival Tissue?
Circular
Dentogingival
Dentoperiosteal
Alveologingival
Transseptal
Where are the 5 types of fibers making up gingival tissue not seen?
Implants
What area the 3 fibers that make up the Gingivodental Group of Gingival Fibers?
Dentogingival
Dentoperiosteal
Alveologingival
What type of fibers make up the PDL?
Collagen
What is the width of the PDL?
0.2 mm
What are the 5 principal Fiber Groups that make up the PDL?
Alveolar Crest
Horizontal
Oblique
Apical
Interradicular
In the PDL, the Principal fibers insert into the ______ and _____
Cementum
Alveolar bone
Within the PDL, what are the fibers that exist at the terminal ends and insert into cementum and alveolar bone?
Sharpey’s fibers
*again, not on implants
What are 4 categories of Plaque-Induced Gingival Disease?
Ental plaque
Modified by Systemic Factors (puberty, pregnancy, Leukemia)
Modified by medications
Modified by malnutrition
What are 3 drugs that can cause Gingivitis - (enalrgements)?
class and name
Anti-seizure medications - Dilantin
Calcium channel blockers - Nifedipine
Immunosuppressents - Cyclosporin
*Also Oral Contraceptives
T/F
Oral contraceptives can cause Gingivitis
True
________ periodontitis is most prevalent in adults
Chronic
What 3 attributes do bacteria have that produce a perio immune-inflammatory response?
Antigens, LPS, and Virulence factors
Name 4 perio Immune-Inflammatory responses:
Antibodies
PMN’s
Cytokines
Prostanoids
What cytokine breaks down connective tissue?
MMP (1 and 8)
T/F
Genetic risk factors and environmental acquired risk factors affect the host immune-inflammatory response including connective tissue and bone metabolism
True
Name 4 Risk categories of Periodontal disease:
Microbial
Systemic factors (diabetes, genetics, etc)
Behavioral
Local (restorations, malocclusion, etc)
What 2 processes cause Periodontal Disease?
Bacterial growth
Inflammatory response
T/F
In periodontal disease, the amount of destruction is generally equivalent to the amount of bacteria
True
Name 4 species of bacteria associated with chronic periodontitis
(red complex + 1)
***additional species most periodontitis is associated with
Porphyromonas gingivalis
Tannerella forsythia
Prevotella intermedia
*that’s red complex
Aggregatibacter actinomycetemcomitans
***Prevotella intermedia
What is the average periodontal disease attachment loss per year?
0.1 - 0.2 mm/yr
What are 4 clinical signs of Periodontal Disease?
Redness, altered contours
Bleeding upon probing
CAL (clinical attachment loss)
Increased probing depth
T/F
Increased probing depth and CAL are associated with Periodontal disease progression
True
T/F
The 4 stages of Perio treatment are: Initial soft tissue Therapy, Re-evaluation after 4-6 weeks, If Periodontically Stable - maintenance, If Periodontically unstable - Surgery
True
What is the most common form of Periodontal disease?
General Mild Periodontal Disease
chronic?
At what age does Gingivitis peak?
Puberty
*endocrine/hormonally mediated
**bacteria thrive on hormones/steroids
Proper diagnosis is very important in periodontal treatment - what 5 factors is this diagnosis based on?
Color
Contour
Consistency (density, tone)
Probing depths
Level of attachment (CAL)
What are the 4 tissues of the Periodontium?
Gingiva/Alveolar mucosa
Periodontal ligament
Cementum
Alveolar bone
What are the 3 tissues of the Attachment Apparatus?
PDL
Cementum
Alveolar bone
T/F
The mucogingival junction changes throughout a lifetime
False
What is the clinical importance of the MGJ?
mucogingival junction
Measuring width of attached gingiva
What does the MucoGingival Junction (MGJ) form the boundary between?
Attached Gingiva and Alveolar Mucosa
*exists at the line of the alveolar bone
3 types of Gingiva, starting at the top
Keratinized (Free Gingiva + Attached Gingiva)
Attached (from bottom of sulcular crevice to MGJ)
Alveolar (MGJ down)
Rank the teeth with the most amount of Gingival Width:
Incisors > Molars > premolars
T/F
Keratinized gingiva is a tough barrier, is less plaque sensitive, more resilient, and less likely to recede
True
What is the minimum clinically acceptable amount of Keratinized Gingiva on the Premolar?
2 mm
What are the 3 kinds of Oral Epithelium?
Outer
Sulcular
Junctional
T/F
The oral outer epithelium can be mostly keratinized (palate) or parakeratinized - have very little keratin (cheek)
True
How thick is the Oral Outer Epithelium?
How often does it turn over?
0.2 - 0.3 mm
10-12 days
Where is the Sulcular Epithelium?
Sulcus to coronal limit of the free gingiva
T/F
Sulcular Epithelium is Keratinized and resistant to fluid flow in a healthy mouth
False
*non-keratinized and thin
Describe Junctional epithelium:
Non-keratinized
1-6 day turnover
Sulcus to Cemento-enamel junction
How is the Junctional Epithelium attached?
Hemidesmosomes
Internal Basal Lamina > Junctional Epithelium
External Basal Lamina > connective tissue
2 Keratinized surfaces of the mouth:
Palate
Cheek
3 nonkeratinized surfaces of the mouth:
Alveolar mucosa
Sulcular Epithelium
Junctional Epithelium
What is the textured surface of gingiva?
Where is it found?
Stippling
Attached Gingiva bound to Alveolar bone
*fusion of epithelial ridges (rete pegs)
T/F
The Oral outer epithelium turns over every 10-12 days.
T/F
The Junctional epithelium turns over every 1-6 days.
True
True
T/F
The PDL functions to transmit physical forces, maintain attachment, remodel, and sense touch.
True
The ______ fibers support and form the contour of free gingiva
Circular
The ______ fibers support the gingiva
Dentogingival
The ______ fibers anchors tooth to bone
Dentoperiosteal
The _______ fibers attach gingiva to alveolar bone
Alvoelogingival
The ______ fibers keep teeth in alignment, protects bone, and continuously reforms as bone/fibers are destroyed and made.
Transseptal
Which 3 fibers aren’t seen on implants?
Transseptal, Dentioperiosteal, Dentogingival
*also PDL
The natural seal that develops around the teeth protecting the alveolar bone from infection and disease is known as _______
Biological Width
What is found Coronoal to the crest of the Alveolar Bone?
Biological Width
Biological Width is measured between what 2 points?
Deepest point gingival sulcus
Alveolar Bone Crest
What is Biologic Width measurement?
2.04 mm
T/F
Biologic width is composed of epithelial attachment and the gingival connective tissue attachment
True
T/F
If Biologic width is violated, Inflammation, Increased probing depth, and Inconsistent resorption of Alveolar Bone results
True
The 2.04 mm of Bioligic Width is made up of what 2 components?
What are their measurements?
Junctional Epithelium: 0.97 mm
Connective Tissue: 1.07 mm
What need to be subtracted when calculating CAL?
If Gingival Margin is above the Cemento-enamael junction
If CEJ = GM, CAL =
Distance to PDL
CAL = CEJ to GM (either +or-) + distance to PDL
True
What are the 2 types of Gingivitis?
Plaque-Induced
Non Plaque-Induced
What are the 3 types of Plaque-Induced gingivitis?
Systemic
Meds
Malnutrition
T/F
Non-plaque induced Gingivitis can be Specific Bacteria, Viral, Fungal, Genetic, Systemic, Traumatic, or Foreign body induced.
True
T/F
Ambisol, used to treat canker sores, can cause a Traumatically induced gingivitis
True
Give 4 examples of Systemic Plaque-Induced Gingivitis:
Endocrine Puberty
Endocrine Pregnancy
Endocrine Diabetes
Leukemia (blood dyscrasias)
Red Complex:
P. gingivalis
T. forsythia
T. denticola
T/F
Biofilm makes plaque resistant to normal host defense strategies (like PMN’s)
True
T/F
The growth and pathogenicity of Subgingival plaque is influenced by Supragingival plaque
True
*this is why mechanical removal is important
T/F
Non-motile bacteria dominate the Subgingival population
False
Subgingival tooth-associated bacteria are generally ____, while Subgingival tissue-associated bacteria are generally _____.
G+
G-
Dental plaque can form what?
Calculus
What is calculus dependent on to form?
Calcium and Phosphate in our own saliva
T/F
Calculus is what causes periodontal disease
False
T/F
Calculus is a secondary contributing factor to periodontal disease
True
Inflammation defines ________, and loss of connective tissue defines _______
Gingivitis
Periodontitis
________ serves as a trap for increased plaque formation and retention
Calculus
What are the 4 modes of Calculus attachment?
Pellicle
Penetration to Cementum
Mechanical locking with surface irregularities (CEJ)
Undersurface depression/concavities in roots
Function of the following throughout inflammation:
PMN’s
Mast Cell
Macrophage
T-lymphocytes
B-lymphocytes
1st responder
Increase vascular permeability and releases amines
Present antigen to T-cells (also release cytokines)
Delay hypersensitivity/Lymphokines
Plasma cell transformation/antibody formation
3 major cytokines involved in Perio disease and their function:
IL-beta (interleukin) = bone resorption
MMP (matrix metalloproteinase) = conn. tissue breakdown
TNF alpha = bone resorption with PGE
Name 3 cytokines involved in bone resorption:
Interleukins (IL beta)
TNF alpha
PGE2
What 2 factors are responsible for the degradation of the ECM and breakdown of collagen?
MMP (matris metalloproteinase)
Elastase
Early lesion =
Established lesion =
Advanced lesion =
T-cell
B-cell
B-cell
What type of cell-lesion is responsible for clinical signs of gingivitis, redness, bleeding, and edema?
Timeframe?
T-cell lesion
4-7 days
What type of cell-lesion has plasma cells and chronic gingivitis?
Timeframe?
B-cell Established lesion
2-3 weeks
What type of cell-lesion defines periodontitis (and is therefore irreversible)
B-cell Advanced lesion
timeframe unknown
T/F
Smoking has fewer signs of inflammation
True
T/F
Smokers still have gingival cervicular fluid that’s being released as a result of vascular permeability
True
The junction between Alveolar Mucosa and Keratinized Attached Tissue
Muco Gingival Junction
MGJ
T/F
The Alveolar Mucosa is unattached and therefore moveable, which is why the MGJ doesn’t move/change throughout life
True
Current smokers have ____ more periodontal disease and former smokers have _____ more periodontal disease
4x
1.6x
T/F
Smokers have increased pathogenic Macrophage in pockets, decreased PMN chemotaxis/phagocytosis, and increased cytokine activity
True
What type of therapy is designed to adjust the severity of the immune response and decrease the effects of periodontitis?
Host Modulatory Therapy
What is prescribed in Host Modulatory Therapy?
What are 2 other meds that can have similar effects?
…cyclines like doxycycline (Periostat)
*decreased cytokines, MMP’s, proteinase, etc
NSAIDS, bisphosphonates (systemic)
What is the single most important factor to consider when diagnosing Periodontal Disease?
CAL - clinical attachment loss
T/F
Increasing probing depths, increasing CAL, and decreased cementum would all indicate increased disease severity
False
- only CAL/increased probing depths
- *Cementum loss doesn’t matter - it’s attachment to the cementum
What does the “orange peel” texture to healthy gingiva indicate?
Stippling
T/F
Healthy gingiva is pink/salmon and unhealthy is red (edematious)
True
*also has no “tone”
Where is the width of the Cementum the largest?
Thinnest?
Apically
Coronal
Genetic polymorphism that can increase the severity of periodontal disease increase what cytokine in the inflammatory response?
IL-1
The untreated Periodontal Disease Attachment loss/yr
0.1 - 0.2 mm/yr
T/F
Diabetes can be either level 1 or 2 and is often comanaged, Smoking is level 2, and level 3 is severe
True
T/F
Alveolar Mucosa is keratinized, Gingiva is not
False
*opposite
In healthy gingiva, ____mm is unattached and ___ mm is attached
3
6
T/F
Interdental gingiva occupies the Col/embrasures, is pyramidal, and susceptible contact point
True
T/F
The Nonkeratinocytes are Melanocytes, Langerhan’s cells, and Merkel cells
True
Describe Sulcular Epithelium
3 things
Nonkeratinized
Thin
no Rete pegs
What types of collagen are in Gingival Connective Tissue
I and III
T/F
The post-capillary venous plexus feeds the junctional epithelium
True
Width of the Periodontal Ligament:
0.2 mm
T/F
Rests of Malassez are isolated clusters of epithelium
True
Normal cementum can present as an Overlap, Butt, or Exposed Dentin. What are the %’s of each?
Overlap: 60-65%
Butt: 30%
Exposed Dentin: 5-10%
Bone layers from inside out:
Alveolar bone (cribiform plate/Lamina Dura)
Cancellous trabeculae
External plate
T/F
Age is not considered a true risk factor in Periodontal Disease
True
3 non-plaque producing species:
Streptococcal
Neisseria
Treponema
Aggressive periodontitis can be localized to the _____ and _____ or generalized to all the teeth.
Molars
Incisors
HIghly testable list: 8 disorders of the immune system associated with Periodontitis (with genetic component)
Familial/cyclic neutropienia
Down syndrome
Leukocyte adhesion deficiency syndrome
Pipillion-Lefevre syndrome
Chekiak-Higashi syndrome
Histocytosis syndromes
Cohen syndrome
Hypophosphatasia
The extent of Chronic Periodontitis is Localized when what % of sites are involved
Less than 30%
T/F
The severity of Chronic Perio is Slight (1 or 2 mm CAL), Moderate (3 or 4 mm CAL) and Severe (5 and above)
True
T/F
Tooth associated subgingivals are G+, cocci, and less virulent than other subgingivals (which are G-, spirochetes, and more virulent/motile)
True
Pregnancy associated gingivitis sees an increase in what species?
Prevotella intermedia
*uses steroids as growth factor
G- produce ____ that activates macrophage
A.a. produces ______
P.g. produces ______
LPS
leukotoxin
protease
T/F Arachidonic acid metabolite is a class of Prostaglandin
True
T/F
Bacteria are essential but insufficient to cause Periodontitis
True
T/F
Aggressive Periodontitis is associated with the following Genetic/Inherited disorders:
LAD - laukocyte adhesion deficiency
Chekiak-Higashi Syndrome
Ehler-Danos Syndrome
Hypophosphatasia
Trisomy 21
True
T/F
Aggressive Periodontitis is associated with the follwoing Systemic Neutrophil Abnormalities:
Neutropenia
Chediak-Higashi
Papillon-Lefevre
LAD
True
T/F
MMP’s break down collagen
True
T/F
Smokeless tobacco has no effect on periodontitis
True
