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D1 Spring > Perio 1 Final (1st half) > Flashcards

Perio 1 Final (1st half) Flashcards

1
Q

A functional system of different tissues that invest & support teeth

A

Periodontium

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2
Q

What is included in the periodontium?

A

Cementum
PDL
Alveolar bone
Gingiva

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3
Q

Soft tissue that covers the alveolar process & cervical portions of teeth; firmly attached to teeth & surrounding bone

A

Gingiva

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4
Q

Gingival unit consists of

A
  1. gingival margin
  2. marginal/free gingiva
  3. gingival sulcus
  4. attached gingiva
  5. interdental gingiva
  6. col
  7. free gingival groove
  8. mucogingival jx
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5
Q

What describes the following clinical presentation?

Free gingival margin (scalloped, coral pink, keratinized), attached gingiva (keratinized & stippled), alveolar mucosa (loose, darker red, NONkeratinized), bleeding <10% total probing sites; pocket depth 1-3 mm, can occur on intact or reduced periodontium

A

Healthy gingiva

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6
Q

Pigmentation results from synthesis of melanin by melanocytes, located in

A

The basal layer of the epithelium

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7
Q

Unattached/free gingiva, border that surrounds the teeth, can be separated from tooth by a perio probe

A

Marginal gingiva

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8
Q

Shallow crevice between the marginal gingiva & enamel/cementum, can be also be called a pocket

A

Gingival sulcus

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9
Q

Transudate or exudate; contains a wide array of biochemical factors and is used as a marker for health & disease

A

Gingival (crevicular) fluid

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10
Q

In a healthy sulcus, the amount of gingival fluid is _______ ________. During inflammation, the gingival fluid flow ________.

A

very small; increases

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11
Q

Gingival fluid functions (4)

A
  1. Cleanse materials from sulcus.
  2. Contains plasma proteins to improve adhesion of epithelium to tooth
  3. Antimicrobial properties
  4. Antibody activity to defend gingiva
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12
Q

Firm, dense, stippled, tightly bound to periosteum/tooth/bone; coral pink color; immobile; keratinized

A

Attached gingiva

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13
Q

Attachment of gingiva on anterior vs. posterior teeth

A

Great on anterior teeth (maxilla more than mandible); narrowest on posterior teeth

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14
Q

Contour of gingiva

A

More scalloped anteriorly, becomes a straighter line posteriorly

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15
Q

A shallow, V-shaped groove that’s closely associated with the apical free gingiva; runs parallel to margin of gingiva; seldom present

A

Free gingival groove

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16
Q

Shape determined by interproximal relationship of teeth; pyramidal in anterior regions, flattened in BL direction in molar regions

A

Interdental gingiva (papilla)

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17
Q

Relationship of interdental gingiva to labial and lingual gingiva; conforms to shape of interproximal contact

A

Col

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18
Q

In areas of diastemas, is there a col?

A

No, because there is no interproximal contact

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19
Q

Junction of gingiva & alveolar mucosa

A

Mucogingival junction

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20
Q

Covers basal part of alveolar process, continues into vestibular area on buccal aspect of teeth & floor of the mouth on the lingual aspect; loosely attached to periosteum (movable)

A

Alveolar mucosa

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21
Q

Gingival epithelium consists of _________ __________ epithelium. What are the 3 types?

A

Stratified squameous

  1. Outer/oral epithelium
  2. Sulcular epithelium
  3. Junctional epithelium
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22
Q

Continuous lining of stratifed squameous epithelium; covers marginal gingiva & attached gingiva; keratinized/parakeratinized; 4 layers (stratum basale, spinosum, granulosum, & corneum)

A

Oral epithelium

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23
Q

Lines gingival sulcus; thin, NONkeratinized, stratified squamous epithelium (without rete pegs); from coronal limit of JE to crest of gingival margin; semipermiable membrane (bacteria can pass thru); lacks stratum granulosum & corneum; no merkel cells

has the potentail to keratinize if exposed to the oral cavity

A

Sulcular epithelium

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24
Q

Stratified squamous, NONkeratinized epithelium; attached to tooth surface by internal basal lamina (no type IV collagen)

A

Junctional Epithelium

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25
Q

Gingival fiber group that attaches gingiva to tooth

A

Gingivodental fibers

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26
Q

Gingival fiber group that attaches the tooth to the periosteum

A

Dentoperiosteal fibers

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27
Q

Gingival fibers consist of

A

Type 1 collagen

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28
Q

Gingival fiber functions (3)

A
  1. Brace marginal gingiva
  2. Withstand forces of mastication
  3. Unite marginal gingiva to cementum and attached gingiva
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29
Q

3 groups of gingival fibers

A
  1. gingivodental (tooth to gingiva)
  2. circular (around tooth)
  3. transseptal (between 2 teeth)
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30
Q

Gingival fibers extend from:

A
  1. the tooth to the crest of the gingiva (pulls sulcus towards tooth)
  2. the tooth to the outer surface of attached gingiva
  3. the tooth to the external periosteum
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31
Q

Cellular elements of gingiva (6)

A
  1. fibroblasts
  2. mast cells
  3. macrophages
  4. histocytes
  5. adipose
  6. eosinophils
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32
Q

Gingival blood supply is primarily from?

A

PDL
Alveolar process
Supraperiosteum

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33
Q

Gingival blood supply is secondarily from?

A

Vascular plexus adjacent to JE & oral epithelium

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34
Q

Palatal mucosa does NOT have

A

Mucogingival junction

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35
Q

Hard CT that covers root; main function is to attach PDL fibers to tooth; non-vascularized; more resistant to resorption; light yellow color (lighter than dentin); not as hard as dentin

A

Cementum

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36
Q

Cementum chemical composition

A

45-50% inoraganic substances (Ca & P hydroxyapatite, trace elements)

50-55% organic material & H2O

Type I collagen & proteoglycans

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37
Q

Types of cementum

A

Cellular
Acellular

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38
Q

Forms 1st (before teeth are in occlusion); covers cervical 1/3 or 1/2; no cells; calcified Sharpey’s fibers (Type I collagen); collagen fibers are parallel to roots

A

Acellular cementum

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39
Q

Formed after teeth are in occlusion; irregular; contains cementocytes; less calcified; resembles bone

A

Cellular cementum

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40
Q

Cementum thickness

A

Continuous deposition, especially at apex (due to occlusal wear)

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41
Q

What is hypercementosis due to?

A

Physiological or pathologic conditions (ex= bruxing)

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42
Q

Cementum functions (3)

A
  1. Attachment of collagen fibers from tooth to alveolar bone
  2. Protects dentin
  3. Passive eruption
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43
Q

Form the bone that supports the teeth within the sockets; only develops during the eruption of teeth

A

Alveolar process

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44
Q

Chemical composition of alveolar bone

A

1/3 organic = 90% type I collagen

2/3 inorganic = hydroxyapatite, Na, Mg, & Fl

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45
Q

Alveolar process components (3)

A

Cortical plate
Alverolar bone proper
Trabaculae

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46
Q

Where is the alveolar crest located?

A

1.5-2 mm below CEJ

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47
Q

Fenestration vs. dehiscence

A

Fenestration = hole
Dehiscence = complete opening

*Cause is not clear and may complicate periodontal surgery

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48
Q

CT that surrounds the root & connects it to the bone; continuously adapting to support teeth; highly cellular & vascular

A

PDL

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49
Q

PDL fiber composition

A

Principle fibers = Sharpey’s fibers
Type 1 collagen

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50
Q

Anastamosing network between tooth & bone

A

PDL fibers

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51
Q

Principle fibers of the PDL (6)

A
  1. Transseptal group
  2. Alveolar crest group
  3. Horizontal group
  4. Oblique group
  5. Apical group
  6. Interradicular group
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52
Q

Extend over the alveolar crest between teeth; imbedded in cementum at both ends; always present

A

Transseptal fibers

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53
Q

Extend obliquely from alveolar crest to cementum below JE; prevents extrusion; resists lateral movements

A

Alveolar crest fibers

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54
Q

Extend at right angles to tooth; anchored in cementum at one end and in alveolar bone at the other

A

Horizontal fibers

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55
Q

Largest group of PDL fibers; extend from bone to cementum in an apically oblique direction; withstand vertical forces

A

Oblique fibers

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56
Q

Fibers extend from apex to base of socket; not present on incomplete roots

A

Apical fibers

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57
Q

Fibers extend from cementum to bone in furcations

A

Interradicular fibers

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58
Q

PDL functions (5)

A
  1. soft-tissue casing to protect vessels/nerves from injury by mechanical forces
  2. transmission of occlusal forces to bone
  3. attachment of teeth to bone
  4. maintains gingival tissues in proper relationship to teeth
  5. resists impact of occlusal forces
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59
Q

PDL blood supply sources

A

Branches from the alveolar A
Branches from the interradicular AA
Gingival vessels

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60
Q

PDL blood supply is very well ______________

A

vascularized

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61
Q

PDL nerve supply

A

Sensory = penetrates ligament thru apical foramina, foramina in alveolar wall, terminates as free endings

Autonomics = from superior cerivcal ganglion

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62
Q

4 types of nerve endings in PDL

A
  1. free nerve endings (pain)
  2. Ruffini-like mechanoreceptors
  3. Meissner corpuscles (mechanoreceptors)
  4. pressure & vibration endings
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63
Q

Fusion of the cementum & alveolar bone, obliteration of PDL; results in root resorption, PDL replaced by bone

A

Ankylosis

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64
Q

Principal fibers are comprised of collagen ______, reticular fibers of collagen ______, and basal lamina collagen ______.

A

Type I; Type III; Type IV

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65
Q

The expression of collagen type XII occurs during…

A

Tooth development & timed with alignment and organization of periodontal fibers

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66
Q

The expression of collagen type XII is limited to…

A

Tooth development to cells within PDL

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67
Q

Type VI collagen immunolocalized to

A

PDL and gingiva

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68
Q

Gingival epithelium cell types

A

Primary= Keratinocytes

Secondary= Langerhans cells, Merkel cells, & Melanocytes

69
Q

Proliferates in basal & suprabasal layers; progressively flattens; increases tonofilaments & desmosomes; produces keratohyaline granules; nucleus disappears

A

Keratinocytes

70
Q

basal layer; cuboidal cells; forms BM; site of cell replication; full complement of organelles

A

Stratum basale

71
Q

prickle cell layer; prominent peripheral cytoplasmic processes (appear spiny); rich in tonofilaments that end in attachment plaques of desmosomes

A

Stratum spinosum

72
Q

Keratohyalin granules; flattened cells with diminished oragnelles; pyknotic nuclei; degenerative mitochondria; desmosomal changes in upper regions

A

Stratum granulosum

73
Q

flattened, pyknotic cells; tightly packed tonofilaments; no organelles; continued degredation of desmosomal attachment

A

Keratinized layer

74
Q

2 dense attachment plaques; tonofibrils insert into plaques & extend into cytoplasm

A

Desmosomes

75
Q

1/2 desmosomes; attachment of epithelial cells to BM and tooth surface; cell junctions

A

Hemidesmosomes

76
Q

Cell communication channels; lost in areas of inflammation

A

Gap junctions

77
Q

Zona occludens & macula occludens; fusion of cell membranes that function in ion exchange, compartmentalization & adhesion

A

Tight junctions

78
Q

Length of the JE ranges from ______ in health.

The JE attaches to afibrillar cementum, which lacks what type of collagen?

A

0.25-1.35 mm

Type IV

79
Q

Name the disease:

Associated with dental biofilm; color change to blue/red; no attachment loss; inflammation causes shiny appearance, loss of stippling, soft tissue, loss of knife edge; confined to the gingiva; dental plaque can exacerbate; reversible; bleeding on probing > 10% of sites

A

Gingivitis

80
Q

Name the disease:

Not associated with dental biofilm; attachment loss; usually only seen in patients 40+

A

Gingival disease

81
Q

What is a normal gingival sulcus? A periodontal pocket?

A

Normal= 1-3 mm

Perio= 4+mm

82
Q

What types of organisms predominate in healthy gingiva & gingivitis?

A

Facultative organisms

83
Q

What types of organisms predominate in periodontitis?

A

Anaerobic organisms

84
Q

Can the inflammatory process of gingivitis be reversed?

A

Yes! Can reverse within 1 week with oral hygiene practice.

85
Q

Localized vs Generalized gingivits

A

Localized= < 30% sites BOP (canines and back)

Generalized= > 30% sites BOP (canine forward)

86
Q

Effects of smoking on BOP?

A

Significantly reduces BOP due to vasoconstriction

87
Q

Are there stages to CLINICAL gingivitis?

A

NO

88
Q

Are there stages to HISTOPATHOLOGICAL gingivitis?

A

Yes!

Inital (no plasma cells)
Early (few plasma cells)
Established (10-30% plasma cells)
Advanced (>50% plasma cells)

89
Q

Increased migration of leukocytes (mainly neutrophils) into the JE and gingival sulcus; alteration to most coronal aspect of JE; loss of perivascular collagen (5-10%)

A

Initial lesion (histopatholgical gingivitis)

90
Q

Accumulation of lymphoid cells (T lymphocytes) subjacent to JE; further loss of collagen fibers (60-70%) that support marginal gingiva

A

Early lesion (histopatholgical gingivitis)

91
Q

Predominance of plasma cells w/out appreciable bone loss; presence of immunoglobulins in CT and JE; proliferation, apical migration & lateral extension of the JE

A

Established lesion (histopatholgical gingivitis)

92
Q

Cytopathically altered plasma cells; formation of periodontal pockets

A

Advanced Lesion (histopatholgical gingivitis)

93
Q

Types of soft deposits that can produce disease

A
  1. Acquired pellicle
  2. Bacterial plaque
  3. Materia alba
  4. Food debris
94
Q

How does the oral cavity support microbial growth?

A

Warmth
Moisture
Available nutrients
pH
O2
Metabolic inhibitors

95
Q

How are nutrients provided for Supragingival bacteria?

A

-dietary patterns & types of food (prefer carbs)

-stickiness of foods & frequency

-dietary effects on Strep. Mutans & dental carries are well documented

-interbacterial feeding mechanism

96
Q

V. alkalescens metabolizes lactic acid produced by streptococci (cannot metabolize glucose)

This raises the pH of the environment, which facilitates the carbohydrate metabolism by streptococci

A

Interbacterial feeding mechanism

97
Q

How are nutrients provided for subgingival bacteria?

A

-do NOT use dietary nutrients

-metabolize peptides & amino acids (from the breakdown of tissue, crevicular fluid and interbacterial feeding)

inflammation increases crevicular fluid flow & tissue breakdown

98
Q

Environment for disease (primary factors)

A

Microbial plaque
Plaque by-products
Host response.

99
Q

What determines predominance of anaerobic or facultative bacteria?

A

pH & O2

100
Q

Early colonizers

A

Streptococci & actinomyces (aerobic)

*utilize O2, which then favors the growth of anaerobic species

101
Q

Environment of the gingival crevice has limited nutrition. What are the 3 sources?

A
  1. Diet
  2. Host
  3. Gingival crevicular fluid (not rich in nutrients)
102
Q

What are the components of biofilm?

A

-pellicle
-bacterial plaque
-materia Alba
-food debris

103
Q

Associates w/tooth surface; microbes bind together in a polysaccharide matrix; protects bacteria from antimicrobial agents; must be mechanically removed

A

Biofilm

104
Q

Thin, unstructured glycoprotein film that covers the tooth surface (including restorations & calculus) within minutes of dental cleaning

A

Pellicle

105
Q

Pros and cons of the pellicle

A

Pros = protects against acid; lubricates
Cons = participates in plaque formation

106
Q

What are the initial colonizers of the pellicle?

A

Actinomyces Viscosus
Streptococcus Sanguis

107
Q

What is one of the most important 2nd colonizers of the pellicle?

A

Porphyromonas gingivalis

108
Q

Bacterial plaque is visible after _____ if oral hygiene isn’t effective.

Why does plaque accumulate easily on the gingival 1/3?

A

1-2 days

-mastication & movement cause mechanical removal of the coronal 2/3rds only

109
Q

Soft accumulation of bacteria; lacks organized structure of plaque; easily displaced with H2O spray

A

Materia alba

110
Q

Hard deposit; mineralized plaque; covered by unmineralized plaque layer

A

Calculus

111
Q

Soft, nonmineralized microbial accumulation that forms biofilm; firmly adheres to tooth/restorations/prosthetics; organized (filamentous forms dominate); organic matrix; CANNOT be removed by rinsing/water spray

A

Bacterial plaque

112
Q

What are the 3 types of interbacterial relationships?

A
  1. coaggregation (interbacterial adherence)
  2. adhesins
  3. inhibitors
113
Q

What is coaggregation (interbacterial adherence) responsible for?

A

Secondary colonization (interaction between Gram + and Gram - species)

114
Q

Allow microorganisms to attach to 1+ surfaces

A

Adhesins

115
Q

Antibodies (Secretory IgA)

A

Inhibitors

116
Q

What are the stages of plaque formation?

A
  1. Formation of pellicle
  2. Intial colonization of bacteria
  3. Secondary colonization, which leads to plaque maturation
117
Q

How long does primary colonization take during plaque maturation?

A

1-2 days

118
Q

How do gram negative organisms attach to plaque?

A

They attach to surface receptors on gram + cocci/rods

*Otherwise, they would have a poor ability to attach.

119
Q

During plaque maturation, when do we see an increase in gram negative species?

A

Days 4-7

120
Q

As a result of the ______ surface of calculus, it can become a ________ _______ for pathogenic bacteria. (becomes a microbial niche)

A

rough; retentive site

121
Q

What are the 3 steps of calculus formation?

A
  1. Pellicle formation
  2. Plaque formation
  3. Mineralization (occurs within 24-72 hours)
122
Q

What are the primary sites of calculus formation?

A

Facial aspect of max. molars
Lingual aspect of man. incisors

(develops in areas that are difficult to access)

123
Q

What are the effects of calculus on plaque?

A

Amplifies the plaques effect by keeping it in close contact with the tissue surface

124
Q

Supragingival calculus is ____ and is made of _____ crystalline form(s). It is influenced by ___________ secretions

A

heterogenous; 4; salivary

125
Q

Subgingival calculus is ____ and is made of _____ crystalline form(s). As tissue receeds, subgingival calculus can appear _______________

A

homogenous; 1; supragingivally

126
Q

Supragingival calculus is composed of ______ inorganic salts, mainly ________ _________.

A

70-90%; calcium phosphate

127
Q

Supragingival calculus also contains varying amounts of ________ ___________ and __________ __________

A

calcium carbonate; magnesium phosphate

128
Q

What are the 4 crystals of calcium phosphate that are in calculus?

A
  1. Brushite (B)
  2. Octacalcium phophate (OCP)
  3. Hydroxyapatite (HP)
  4. Whitlockite (W)
129
Q

What is the first inorganic crystal of supragingival calculus to appear? The 2nd? What is the major form?

A

1st= Brushite
2nd= Octacalcium phosphate
Major= Hydroxyapatite

130
Q

What is the average mineral content of supragingival calculus?

A

37%

131
Q

What is the predominant crystal in subgingival calculus?

A

Whitlokite

132
Q

What are the modes of attachment for calculus?

A
  1. Pellicle
  2. Penetration of calculus bacteria into cementum
  3. Mechanical locking into surface irregularities
  4. Close adaptation of calculus to unaltered cementum
133
Q

T/F It is possible to remove all calculus on the root without sacrificing some hard tissues of the root

A

FALSE

134
Q

Non-specific plaque hypothesis

A

Overgrowth of plaque causes perio disease
More plaque= greater extent of disease
Tx= get rid of all plaque

135
Q

Specific plaque hypothesis

A

Only certain plaques are pathogenic
Pathogenicity dependent on presence/increase in specific microorganism

136
Q

What are the 3 types of gingival pockets?

What are they associated with?

A
  1. Relative
  2. False
  3. Pseudopocket

Associated with gingivitis - caused by gingival enlargement WITHOUT destruction to underlying perio tissues

137
Q

What are the 2 types of periodontal pockets?

A
  1. Absolute
  2. True

Associated with destruction of perio tissues and attachment loss

138
Q

2 types of true pockets

A
  1. Suprabony (pocket above alveolar bone)
  2. Infrabony (pocket at/below alveolar bone)
139
Q

How are bacteria associated with periodontitis able to evade the host defense mechanisms?

A
  1. Breakdown of the periodontal tissues
  2. Production of leukotoxins (kill neutrophils)
  3. Production of proteolytic enzymes that kill antiboides
  4. Production of factors that suppress the immune response
140
Q

What are the direct effects of bacteria to periodontia?

A
  1. Gingipains (produced by P. gingivalis)
  2. Leukotoxins (produced by Aa)
  3. Lipopolysacharides (capable of inducing bone resorption)
  4. Metabolic byproducts (H2S, NH3, fatty acids) that are toxic to surrounding cells
141
Q

Measured pocket (probe depth) + visible recession below CEJ

A

CAL

142
Q

If the CEJ of adjoining teeth are not at the same level and the alveolar crest appears horizontal, is this indicative of alveolar bone loss?

A

No

143
Q

3 types of bone loss

A
  1. Horizontal
  2. Vertical
  3. Complex lesion (moat/troughlike appearance)
144
Q

Develops between teeth; bone of outer B or L plate resorbed, but the outer plates of bone remain intact; can be difficult to see radiographically unless heights of B and L plates are different

A

Crater

145
Q

Interpretation of bone loss complicated by anatomic structures; found on max & man molars; found on proximal surfaces of max premolars

A

Furcation

146
Q

T/F The absence of calculus on a root on a radiograph indicates that there is no calculus present on the root

A

False, can be undetectable on a radiograph

147
Q

Crown to root ratio for:

  1. Normal Periodontium
  2. Slight horizontal resorption
  3. Moderate periodontitis
  4. Advanced horizontal resorption
A
  1. 1:2 (very favorable)
  2. 1:1.5 (favorable)
  3. 1.2: 1 (unfavorable)
  4. 2:1 (very unfavorable)
148
Q

Glickman Grade I (furcation classifications)

A
  1. Incipient
  2. Pocket formation into flute, intact interradicular bone.
  3. Minimal bone loss.
  4. Suprabony pocket.
149
Q

Glickman Grade II (furcation classifications)

A
  1. “Cul-de-sac”
  2. Loss of interradicular bone & pocket formation, not extended to opposite side.
  3. Bone destroyed on 1+ aspect of furcation, but a portion of the alveolar bone & PDL remain.
150
Q

Glickman Grade III (furcation classifications)

A
  1. Through-and-through
  2. Tunnel like bone loss that’s occluded by gingival tissue (clinically not visible)
151
Q

Glickman Grade IV (furcation classifications)

A
  1. Grade III furcation with severe gingival recession, which exposes the furcation entrance
152
Q

The study of distribution & determinants of health-related states/events; application of this study to control of disease

A

Epidemiology

153
Q

ALL cases of a disease present within a designated population at a specific time (new & pre-existing)

A

Prevalence

154
Q

NEW cases of a disease CONTRACTED in a population w/in a specified time

A

Incidence

155
Q

Number of diseased patients who are correctly IDd as having disease

A

Sensitivity

156
Q

Number of healthy persons correctly determined NOT to have the disease

A

Specificity

157
Q

What is the marker of gingivitis/periodontal disease?

A

bleeding upon probing (high specificity, low sensitivity)

158
Q

What are the determinants of disease?

A
  1. Risk factor
  2. Risk indicator
  3. Odds Ratio
159
Q

A characteristic that places an individual at an increased risk of contracting a disease

A

Risk factor

160
Q

A probable risk factor that is IDd in cross-section correlation studies, but not in longitudinal studies

A

Risk indicator

161
Q

Probability that exposure to certain risk factors will result in disease

<1 = more protected

> 1= more risk

A

Odds ratio

162
Q

How do you decrease a type I error (false positive)?

A

decrease p-value (significance criterion); ideally p < 0.5

163
Q

How do you decrease a type II error (false negative)?

A

increase power (ideally > 0.8)

164
Q

What is the prevalance of gingivitis in schoolchildren in the US?

A

40-60%

165
Q

Is BOP more likely to be found in males or females?

A

Males

166
Q

What % of adults were found to have gingivitis on at least 3-4 teeth?

A

50%

167
Q

Effects of smoking of periodontal health

A

Increases alveolar bone loss, even with the same amount of oral hygiene.

Can restrict vasculature and make BOP less likely, even in the presence of disease.

168
Q

What is the primary etiology of periodontitis?

A

Bacterial plaque

169
Q

Periodontitis is possibly modified by or associated with _____ and ______.

A

diabetes; smoking

D1 Spring (47 decks)

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