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Endemic Oral disease > PAP 1 - The periodontium anatomy and function > Flashcards

PAP 1 - The periodontium anatomy and function Flashcards

1
Q

What does the periodontium mean?

A

“Around the tooth”

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2
Q

what 4 (3) major structures is the periodontium comprised of?

A
  • Gingiva
  • Periodontal ligament
  • alveolar bone
  • Cementum (sometimes not included)
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3
Q

What is the function of the periodontium?

A
  • Attachment of teeth to the jaws.

* Effective support during masticatory function ( transport forces through teeth to dissipate it)

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4
Q

What are the 2 parts of the gingiva?

A
  • free gingiva

- attached gingiva

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5
Q

where is the free gingiva found?

A

coronal to the epithelial attachment

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6
Q

where is the attached gingiva found?

A

tightly bound to the underlying bone = muco-periosteum

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7
Q

what is the function of the gingiva?

A
  • Provides attachment between the oral mucosa membrane and the teeth
  • Prevents bacterial invasion of the underlying periodontal tissues
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8
Q

Where is the gingiva attached in health?

A

Attached to the teeth at or just coronal (above) to the Amelo-Cemental Junction (ACJ)

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9
Q

What does the gingiva comprise of?

A
  • fibrous connective tissue covered by epithelium

- extends from mucogingival junction to the tooth surface

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10
Q

Describe gingival health.

A
  • Firm.
  • Pale pink.
  • Stippling of the attached gingiva: orange peel appearance
  • Interdental papillae fill space under tooth contacts.
  • No bleeding on probing (BOP).
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11
Q

In pristine gingival health, what do you see?

A

Gingival groove: junction between the free and attached gingiva

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12
Q

What is the part of the gingiva between the teeth?

A

interdental papilla

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13
Q

In health, what does the interdental papilla look like?

A

triangular/pyramidal in shape -

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14
Q

Describe the contact point.

A

The contact point between immediately adjacent

incisors is narrow. Between molars it is broader

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15
Q

what is the Col?

A

Where the buccal & lingual papillae meet interdentally

(premolars/molars) and this is below the contact point

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16
Q

What problems arise at the Col?

A

• Covered in non-keratinised epithelium.
• Difficult to clean – interdental cleaning.
• Fragile blood supply – at the junction between the
buccal & lingual microvessels.
• Therefore the col is an area is very prone to periodontal
inflammation & disease progression

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17
Q

what is the basic structure of the oral epithelium?

A

Stratified squamous epithelium

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18
Q

What 2 groups of cells compose the oral epithelium ?

A
  • Keratinocytes (90%)

- Non-keratinocytes

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19
Q

Name 4 types of non-keratinocytes -clear cells.

A
  • Langerhans cells (involved in defence - antigen presenting cells)
  • Melanocytes (produce the pigment melanin)
  • Lymphocytes (immune).
  • Merkel cells (slowly adapting sensory touch receptors)
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20
Q

In keratinised sites , what are the 4 layers histologically?

A
  • Basal cell layer (stratum basale/ germinativum)
  • Prickle cell Layer (stratum spinosum)
  • Granular cell layer (stratum granulosum)
  • Keratinized layer (stratum corneum)
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21
Q

Where does cell division of epithelium occur?

A
  • Cell division basal cell layer.

* Cells tend to move through the epithelium towards the surface - shed.

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22
Q

During the cell division, what happens to the cells?

A

Cells increase in size + become more flattened + keratin is produced

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23
Q

what does the process of the cells changing their shape do?

A
  • This process packs cells together in the keratinized layer.
  • Creates a mechanically tough outer surface
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24
Q

What is this maturation of the cells called?

A

Differentiation

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25
Q

Give an example of non-keratinizng epithelium?

A

Alveolar mucosa

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26
Q

what is less marked in non-keratnized epithelium?

A

changes in the keratinocytes

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27
Q

what layers are absent in non-keratinised epithelium?

A

Granular & keratinized layers are absent

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28
Q

What is the granular layer replaced with in non-keratnisied epithelium?

A

Intermediate layer

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29
Q

What is the keratinised layer replaced with in non-keratnisied epithelium?

A

surface layer

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30
Q

Why is alveolar mucosa more red?

A

so the blood shines throguh as blod vessels are close to surface

31
Q

what is synthesised during epithelial differentiation and in what layers?

A

Membrane Coating Granules (MCG) are synthesized in the prickle & granular cell layers

32
Q

What do membrane coating granules contain?

A

lipids which are discharged into intercellular spaces in both keratinized & non-keratinized epithelium

33
Q

What do these discharged lipids do?

A
  • Forms a barrier to free permeability of water & water- soluble substances.
  • Barrier incomplete & varies from site to site
34
Q

What 3 regions is the gingival epithelium divided into?

A
  • Oral gingival epithelium
  • Oral sulcular epithelium
  • Junctional epithelium
35
Q

Where is the oral gingival epithelium found?

A

-Faces towards the oral cavity : attached gingiva + free gingiva

36
Q

Where is the oral sulcular epithelium found?

A

Faces towards the tooth but not attached to it

37
Q

Where is the junctional epithelium found?

A

In contact with the tooth

38
Q

What is oral gingival epithelium?

A

Orthokeratinised - cells in the keratinised layer of thew epithelium are flattened and do not contain nuclei

39
Q

Describe the appearance of the junction between the oral gingival epithelium and the underlying gingival connective tissue.

A

-“wavy” course as the tissues project into each other :
>connective tissue papillae
>rete pegs (epithelial ridges)

40
Q

Describe the oral sulcular epithelium?

A
  • Lines the gingival sulcus/crevice.
  • Faces the tooth surface
  • Non-keratinized
  • Rapid turnover of epithelial cells to help shed attached bacteria in the gingival sulcus.
  • Shallow rete-peg pattern.
41
Q

Describe junctional epithelium .

A
  • Forms epithelial attachment to the tooth.
  • Non-keratinised.
  • Hemi-desmosomes anchor basal keratinocytes to the basement membrane
42
Q

what is found at the base of the sulcus?

A

Amelo-cemental junction

43
Q

How is the junctional epithelium formed?

A
  • Formed by fusion of the Reduced enamel epithelium with the Oral epithelium on tooth eruption.
  • As the tooth reaches occlusion the attachment moves apically down the crown.
  • Stabilizes near the Amelocemental junction (ACJ)
44
Q

where does the junctional epithelium terminate?

A

coronally in the base of the gingival crevice

45
Q

How are junctional epithelium cells orientated?

A

parallel to the tooth surface

46
Q

What is the turnover of junctional epithelium?

A

JE rapidly turns over - every 4-11 days (mean = 5 days)

47
Q

Where do cell divisions occur in the junctional epithelium and where do they shed?

A
  • Cell divisions occurs throughout the JE.

* Cells shed into the gingival sulcus

48
Q

what do a small number of neutrophils do in the junctional epithelium?

A

Small numbers of neutrophils pass through the JE to enter the gingival crevice (defence)

49
Q

How is the differentiation of the junction epithelium and what does it not synthesise?

A

JE cells are poorly differentiated & do not synthetize membrane coating granules

50
Q

What makes the junctional epithelium readily permeable?

A

large intercellular spaces making it readily permeable

51
Q

what is found in the gingival connective tissue immediately adjacent to the junctional epithelium?

A

dense dentogingival plexus of blood vessels

52
Q

What is produced from the post-capillary venues of the dentogingival plexus?

A

Gingival crevicular fluid (GCF)

53
Q

Where does gingival crevicular fluid flow?

A

gingival crevice and into the mouth

-mixes into the salvia

54
Q

How much gingival crevicular fluid is there when the mouth is healthy?

A

Very little GFC - as it is used to wash away bacteria and toxins

55
Q

What does GCF contains?

A

Various components of blood and cells:

  • various plasma proteins
  • Defence cells/proteins
  • Neutrophils (PMNs)
  • Antibodies
  • complement
56
Q

when does volume/flow of GCF increase?

A

gingival / periodontal disease

57
Q

what is the main components of the gingiva?

A

gingival connective tissue -highly vascular connective tissue

58
Q

What are the 2 main components of gingival connective tissue?

A
  • Collagen fibres (60% volume)

- extracellular matrix

59
Q

what produces gingival connective tissue?

A

fibroblast

60
Q

What cells types are found in gingival connective tissue?

A 
•Fibroblasts (predominant). 
-spinde shaped or stellate cells
-oval shaped nucleus
•Macrophages
-inflammtory defence cells
•Polymorphs / Neutrophils
-inflammatory defence cells
•Lymphocytes & Plasma cells
-defence cells
61
Q

In gingival connective tissue, how are the collagen fibres arranged?

A
  • Circular fibres (ring around tooth)
  • Trans-septal fibres (embedded in the cementum of adjacent teeth)
  • Dento-ginigval fibres
  • Dento-periosteal fibres
  • Crestal fibres
62
Q

What do the college bundles do?

A

Attaches gingival tissues tooth and bone

63
Q

where do crestal fibres go from?

A

Fan out from the crest of the alveolar bone into the attached gingiva

64
Q

what is collagen in gingival connective tissue synthesised and degraded by?

A

gingival connective tissue fibroblasts:

  • type I collagen most common in gingiva
  • others found in gingiva are type III, IV and V
65
Q

What is the extracellular matrix?

A

A complex network of polysaccharides (such as glycosaminoglycans or cellulose) and proteins (such as collagen) secreted by cells. Serves as a structural element in the tissues and also influences their development and physiology

66
Q

what synthesises extracellular matrix?

A

fibroblasts

67
Q

what role does extracellular matrix play?

A

important role in the regulation of cell behaviour

68
Q

what does the extracellular include?

A

glycosaminoglycans (GAG) / proteoglycans / glycoproteins

69
Q

what is the most common GAG?

A

hyaluronic acid

70
Q

What are GAGs?

A

GAGs are negatively charged long unbranched polysaccharides:

  • bind a lot of H20
  • thus acts to resist compressive forces -hydrostatic cushion
71
Q

what is a periodontal ligament?

A

-Specialised vascular connective tissue :
>continuous with the gingiva and pulp
>derived from the dental follicle

72
Q

where is the periodontal ligament found?

A
  • Fibrous attachment of the tooth (collagen).

* Inserts into root cementum one side & onto alveolar bone on the other

73
Q

what are the functions of the periodontal ligament?

A 
-Physical :
>attachement of teeth to the jaws
>absorption/ transmission of forces 
>roles in tooth movement 
-Tissue formation/ maintenance
-Nutrition:
>bone/cementum 
-Sensory :
>mechanoreception/ touch/ reflexes  
>nociception / pain
74
Q

Describe the variable width of the periodontal ligament?

A
  • Ranges from 0.15mm to 0.38mm
  • thinnest in the middle third of the tooth
  • Progressively decrease in width with age

Endemic Oral disease (13 decks)

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