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Tim's Cards > Oral Soft Tissues I > Flashcards

Oral Soft Tissues I Flashcards

1
Q

What 5 types of fibers make up Gingival Tissue?

A

Circular

Dentogingival

Dentoperiosteal

Alveologingival

Transseptal

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2
Q

Where are the 5 types of fibers making up gingival tissue not seen?

A

Implants

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3
Q

What area the 3 fibers that make up the Gingivodental Group of Gingival Fibers?

A

Dentogingival

Dentoperiosteal

Alveologingival

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4
Q

What type of fibers make up the PDL?

A

Collagen

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5
Q

What is the width of the PDL?

A

0.2 mm

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6
Q

What are the 5 principal Fiber Groups that make up the PDL?

A

Alveolar Crest

Horizontal

Oblique

Apical

Interradicular

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7
Q

In the PDL, the Principal fibers insert into the ______ and _____

A

Cementum

Alveolar bone

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8
Q

Within the PDL, what are the fibers that exist at the terminal ends and insert into cementum and alveolar bone?

A

Sharpey’s fibers

*again, not on implants

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9
Q

What are 4 categories of Plaque-Induced Gingival Disease?

A

Ental plaque

Modified by Systemic Factors (puberty, pregnancy, Leukemia)

Modified by medications

Modified by malnutrition

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10
Q

What are 3 drugs that can cause Gingivitis - (enalrgements)?

class and name

A

Anti-seizure medications - Dilantin

Calcium channel blockers - Nifedipine

Immunosuppressents - Cyclosporin

*Also Oral Contraceptives

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11
Q

T/F

Oral contraceptives can cause Gingivitis

A

True

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12
Q

________ periodontitis is most prevalent in adults

A

Chronic

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13
Q

What 3 attributes do bacteria have that produce a perio immune-inflammatory response?

A

Antigens, LPS, and Virulence factors

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14
Q

Name 4 perio Immune-Inflammatory responses:

A

Antibodies

PMN’s

Cytokines

Prostanoids

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15
Q

What cytokine breaks down connective tissue?

A

MMP (1 and 8)

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16
Q

T/F
Genetic risk factors and environmental acquired risk factors affect the host immune-inflammatory response including connective tissue and bone metabolism

A

True

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17
Q

Name 4 Risk categories of Periodontal disease:

A

Microbial

Systemic factors (diabetes, genetics, etc)

Behavioral

Local (restorations, malocclusion, etc)

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18
Q

What 2 processes cause Periodontal Disease?

A

Bacterial growth

Inflammatory response

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19
Q

T/F

In periodontal disease, the amount of destruction is generally equivalent to the amount of bacteria

A

True

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20
Q

Name 4 species of bacteria associated with chronic periodontitis
(red complex + 1)

***additional species most periodontitis is associated with

A

Porphyromonas gingivalis

Tannerella forsythia

Prevotella intermedia

*that’s red complex

Aggregatibacter actinomycetemcomitans

***Prevotella intermedia

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21
Q

What is the average periodontal disease attachment loss per year?

A

0.1 - 0.2 mm/yr

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22
Q

What are 4 clinical signs of Periodontal Disease?

A

Redness, altered contours

Bleeding upon probing

CAL (clinical attachment loss)

Increased probing depth

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23
Q

T/F

Increased probing depth and CAL are associated with Periodontal disease progression

A

True

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24
Q

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

A

True

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25
Q

What is the most common form of Periodontal disease?

A

General Mild Periodontal Disease

chronic?

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26
Q

At what age does Gingivitis peak?

A

Puberty

*endocrine/hormonally mediated

**bacteria thrive on hormones/steroids

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27
Q

Proper diagnosis is very important in periodontal treatment - what 5 factors is this diagnosis based on?

A

Color

Contour

Consistency (density, tone)

Probing depths

Level of attachment (CAL)

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28
Q

What are the 4 tissues of the Periodontium?

A

Gingiva/Alveolar mucosa

Periodontal ligament

Cementum

Alveolar bone

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29
Q

What are the 3 tissues of the Attachment Apparatus?

A

PDL

Cementum

Alveolar bone

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30
Q

T/F

The mucogingival junction changes throughout a lifetime

A

False

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31
Q

What is the clinical importance of the MGJ?

mucogingival junction

A

Measuring width of attached gingiva

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32
Q

What does the MucoGingival Junction (MGJ) form the boundary between?

A

Attached Gingiva and Alveolar Mucosa

*exists at the line of the alveolar bone

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33
Q

3 types of Gingiva, starting at the top

A

Keratinized (Free Gingiva + Attached Gingiva)

Attached (from bottom of sulcular crevice to MGJ)

Alveolar (MGJ down)

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34
Q

Rank the teeth with the most amount of Gingival Width:

A

Incisors > Molars > premolars

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35
Q

T/F

Keratinized gingiva is a tough barrier, is less plaque sensitive, more resilient, and less likely to recede

A

True

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36
Q

What is the minimum clinically acceptable amount of Keratinized Gingiva on the Premolar?

A

2 mm

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37
Q

What are the 3 kinds of Oral Epithelium?

A

Outer

Sulcular

Junctional

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38
Q

T/F

The oral outer epithelium can be mostly keratinized (palate) or parakeratinized - have very little keratin (cheek)

A

True

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39
Q

How thick is the Oral Outer Epithelium?

How often does it turn over?

A

0.2 - 0.3 mm

10-12 days

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40
Q

Where is the Sulcular Epithelium?

A

Sulcus to coronal limit of the free gingiva

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41
Q

T/F

Sulcular Epithelium is Keratinized and resistant to fluid flow in a healthy mouth

A

False

*non-keratinized and thin

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42
Q

Describe Junctional epithelium:

A

Non-keratinized

1-6 day turnover

Sulcus to Cemento-enamel junction

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43
Q

How is the Junctional Epithelium attached?

A

Hemidesmosomes

Internal Basal Lamina > Junctional Epithelium

External Basal Lamina > connective tissue

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44
Q

2 Keratinized surfaces of the mouth:

A

Palate

Cheek

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45
Q

3 nonkeratinized surfaces of the mouth:

A

Alveolar mucosa

Sulcular Epithelium

Junctional Epithelium

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46
Q

What is the textured surface of gingiva?

Where is it found?

A

Stippling

Attached Gingiva bound to Alveolar bone

*fusion of epithelial ridges (rete pegs)

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47
Q

T/F
The Oral outer epithelium turns over every 10-12 days.

T/F
The Junctional epithelium turns over every 1-6 days.

A

True

True

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48
Q

T/F

The PDL functions to transmit physical forces, maintain attachment, remodel, and sense touch.

A

True

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49
Q

The ______ fibers support and form the contour of free gingiva

A

Circular

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50
Q

The ______ fibers support the gingiva

A

Dentogingival

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51
Q

The ______ fibers anchors tooth to bone

A

Dentoperiosteal

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52
Q

The _______ fibers attach gingiva to alveolar bone

A

Alvoelogingival

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53
Q

The ______ fibers keep teeth in alignment, protects bone, and continuously reforms as bone/fibers are destroyed and made.

A

Transseptal

54
Q

Which 3 fibers aren’t seen on implants?

A

Transseptal, Dentioperiosteal, Dentogingival

*also PDL

55
Q

The natural seal that develops around the teeth protecting the alveolar bone from infection and disease is known as _______

A

Biological Width

56
Q

What is found Coronoal to the crest of the Alveolar Bone?

A

Biological Width

57
Q

Biological Width is measured between what 2 points?

A

Deepest point gingival sulcus

Alveolar Bone Crest

58
Q

What is Biologic Width measurement?

A

2.04 mm

59
Q

T/F

Biologic width is composed of epithelial attachment and the gingival connective tissue attachment

A

True

60
Q

T/F
If Biologic width is violated, Inflammation, Increased probing depth, and Inconsistent resorption of Alveolar Bone results

A

True

61
Q

The 2.04 mm of Bioligic Width is made up of what 2 components?

What are their measurements?

A

Junctional Epithelium: 0.97 mm

Connective Tissue: 1.07 mm

62
Q

What need to be subtracted when calculating CAL?

A

If Gingival Margin is above the Cemento-enamael junction

63
Q

If CEJ = GM, CAL =

A

Distance to PDL

64
Q

CAL = CEJ to GM (either +or-) + distance to PDL

A

True

65
Q

What are the 2 types of Gingivitis?

A

Plaque-Induced

Non Plaque-Induced

66
Q

What are the 3 types of Plaque-Induced gingivitis?

A

Systemic

Meds

Malnutrition

67
Q

T/F
Non-plaque induced Gingivitis can be Specific Bacteria, Viral, Fungal, Genetic, Systemic, Traumatic, or Foreign body induced.

A

True

68
Q

T/F

Ambisol, used to treat canker sores, can cause a Traumatically induced gingivitis

A

True

69
Q

Give 4 examples of Systemic Plaque-Induced Gingivitis:

A

Endocrine Puberty

Endocrine Pregnancy

Endocrine Diabetes

Leukemia (blood dyscrasias)

70
Q

Red Complex:

A

P. gingivalis

T. forsythia

T. denticola

71
Q

T/F

Biofilm makes plaque resistant to normal host defense strategies (like PMN’s)

A

True

72
Q

T/F

The growth and pathogenicity of Subgingival plaque is influenced by Supragingival plaque

A

True

*this is why mechanical removal is important

73
Q

T/F

Non-motile bacteria dominate the Subgingival population

A

False

74
Q

Subgingival tooth-associated bacteria are generally ____, while Subgingival tissue-associated bacteria are generally _____.

A

G+

G-

75
Q

Dental plaque can form what?

A

Calculus

76
Q

What is calculus dependent on to form?

A

Calcium and Phosphate in our own saliva

77
Q

T/F

Calculus is what causes periodontal disease

A

False

78
Q

T/F

Calculus is a secondary contributing factor to periodontal disease

A

True

79
Q

Inflammation defines ________, and loss of connective tissue defines _______

A

Gingivitis

Periodontitis

80
Q

________ serves as a trap for increased plaque formation and retention

A

Calculus

81
Q

What are the 4 modes of Calculus attachment?

A

Pellicle

Penetration to Cementum

Mechanical locking with surface irregularities (CEJ)

Undersurface depression/concavities in roots

82
Q

Function of the following throughout inflammation:
PMN’s

Mast Cell

Macrophage

T-lymphocytes

B-lymphocytes

A

1st responder

Increase vascular permeability and releases amines

Present antigen to T-cells (also release cytokines)

Delay hypersensitivity/Lymphokines

Plasma cell transformation/antibody formation

83
Q

3 major cytokines involved in Perio disease and their function:

A

IL-beta (interleukin) = bone resorption

MMP (matrix metalloproteinase) = conn. tissue breakdown

TNF alpha = bone resorption with PGE

84
Q

Name 3 cytokines involved in bone resorption:

A

Interleukins (IL beta)

TNF alpha

PGE2

85
Q

What 2 factors are responsible for the degradation of the ECM and breakdown of collagen?

A

MMP (matris metalloproteinase)

Elastase

86
Q

Early lesion =

Established lesion =

Advanced lesion =

A

T-cell

B-cell

B-cell

87
Q

What type of cell-lesion is responsible for clinical signs of gingivitis, redness, bleeding, and edema?

Timeframe?

A

T-cell lesion

4-7 days

88
Q

What type of cell-lesion has plasma cells and chronic gingivitis?

Timeframe?

A

B-cell Established lesion

2-3 weeks

89
Q

What type of cell-lesion defines periodontitis (and is therefore irreversible)

A

B-cell Advanced lesion

timeframe unknown

90
Q

T/F

Smoking has fewer signs of inflammation

A

True

91
Q

T/F

Smokers still have gingival cervicular fluid that’s being released as a result of vascular permeability

A

True

92
Q

The junction between Alveolar Mucosa and Keratinized Attached Tissue

A

Muco Gingival Junction

MGJ

93
Q

T/F

The Alveolar Mucosa is unattached and therefore moveable, which is why the MGJ doesn’t move/change throughout life

A

True

94
Q

Current smokers have ____ more periodontal disease and former smokers have _____ more periodontal disease

A

4x

1.6x

95
Q

T/F
Smokers have increased pathogenic Macrophage in pockets, decreased PMN chemotaxis/phagocytosis, and increased cytokine activity

A

True

96
Q

What type of therapy is designed to adjust the severity of the immune response and decrease the effects of periodontitis?

A

Host Modulatory Therapy

97
Q

What is prescribed in Host Modulatory Therapy?

What are 2 other meds that can have similar effects?

A

…cyclines like doxycycline (Periostat)

*decreased cytokines, MMP’s, proteinase, etc

NSAIDS, bisphosphonates (systemic)

98
Q

What is the single most important factor to consider when diagnosing Periodontal Disease?

A

CAL - clinical attachment loss

99
Q

T/F

Increasing probing depths, increasing CAL, and decreased cementum would all indicate increased disease severity

A

False

  • only CAL/increased probing depths
  • *Cementum loss doesn’t matter - it’s attachment to the cementum
100
Q

What does the “orange peel” texture to healthy gingiva indicate?

A

Stippling

101
Q

T/F

Healthy gingiva is pink/salmon and unhealthy is red (edematious)

A

True

*also has no “tone”

102
Q

Where is the width of the Cementum the largest?

Thinnest?

A

Apically

Coronal

103
Q

Genetic polymorphism that can increase the severity of periodontal disease increase what cytokine in the inflammatory response?

A

IL-1

104
Q

The untreated Periodontal Disease Attachment loss/yr

A

0.1 - 0.2 mm/yr

105
Q

T/F

Diabetes can be either level 1 or 2 and is often comanaged, Smoking is level 2, and level 3 is severe

A

True

106
Q

T/F

Alveolar Mucosa is keratinized, Gingiva is not

A

False

*opposite

107
Q

In healthy gingiva, ____mm is unattached and ___ mm is attached

A

3

6

108
Q

T/F

Interdental gingiva occupies the Col/embrasures, is pyramidal, and susceptible contact point

A

True

109
Q

T/F

The Nonkeratinocytes are Melanocytes, Langerhan’s cells, and Merkel cells

A

True

110
Q

Describe Sulcular Epithelium

3 things

A

Nonkeratinized

Thin

no Rete pegs

111
Q

What types of collagen are in Gingival Connective Tissue

A

I and III

112
Q

T/F

The post-capillary venous plexus feeds the junctional epithelium

A

True

113
Q

Width of the Periodontal Ligament:

A

0.2 mm

114
Q

T/F

Rests of Malassez are isolated clusters of epithelium

A

True

115
Q

Normal cementum can present as an Overlap, Butt, or Exposed Dentin. What are the %’s of each?

A

Overlap: 60-65%

Butt: 30%

Exposed Dentin: 5-10%

116
Q

Bone layers from inside out:

A

Alveolar bone (cribiform plate/Lamina Dura)

Cancellous trabeculae

External plate

117
Q

T/F

Age is not considered a true risk factor in Periodontal Disease

A

True

118
Q

3 non-plaque producing species:

A

Streptococcal

Neisseria

Treponema

119
Q

Aggressive periodontitis can be localized to the _____ and _____ or generalized to all the teeth.

A

Molars

Incisors

120
Q

HIghly testable list: 8 disorders of the immune system associated with Periodontitis (with genetic component)

A

Familial/cyclic neutropienia

Down syndrome

Leukocyte adhesion deficiency syndrome

Pipillion-Lefevre syndrome

Chekiak-Higashi syndrome

Histocytosis syndromes

Cohen syndrome

Hypophosphatasia

121
Q

The extent of Chronic Periodontitis is Localized when what % of sites are involved

A

Less than 30%

122
Q

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)

A

True

123
Q

T/F
Tooth associated subgingivals are G+, cocci, and less virulent than other subgingivals (which are G-, spirochetes, and more virulent/motile)

A

True

124
Q

Pregnancy associated gingivitis sees an increase in what species?

A

Prevotella intermedia

*uses steroids as growth factor

125
Q

G- produce ____ that activates macrophage

A.a. produces ______

P.g. produces ______

A

LPS

leukotoxin

protease

126
Q 
T/F
Arachidonic acid metabolite is a class of Prostaglandin
A

True

127
Q

T/F

Bacteria are essential but insufficient to cause Periodontitis

A

True

128
Q

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

A

True

129
Q

T/F
Aggressive Periodontitis is associated with the follwoing Systemic Neutrophil Abnormalities:

Neutropenia

Chediak-Higashi

Papillon-Lefevre

LAD

A

True

130
Q

T/F

MMP’s break down collagen

A

True

131
Q

T/F

Smokeless tobacco has no effect on periodontitis

A

True

Tim's Cards (140 decks)

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