perio Flashcards
tissues of the periodontium
gingiva
cementum
PDL
alveolar bone
the gingiva is located ___ to CEJ of each tooth
coronal
Function of the gingiva
protects underlying tooth- supporting structures from oral environment
demacrations of gingiva include
free gingival groove
mucogingival junction
4 anatomical areas of gingiva
free gingiva
attached gingiva
interdental gingiva
gingival sulcus
free gingiva is also refered to as
unattached gingiva or marginal gingiva
surround tooth like a turtleneck- located coronal to CEJ
free gingiva
the free gingiva meets the tooth in a thin rounded edge called
gingival margin
attached gingiva is located ____ free gingiva and alveolar mucosa
between
attached gingiva is widest where?
incisor and molar regions
narrowest attached gingiva in what region
premolar
in health what may have a stippled appearance (like an orange peel) and may be pigmented dependant upon individials skin color
attached gingiva
purpose of attached gingiva
to withstand forces during chewing, speaking and toothbrushing
the interdental gingiva prevents
food from becoming packed between teeth during chewing
gingival col is a valley like depression that is
apical to the contact area of 2 adjacent teeth that connects facial and lingual papillae
will the col be present if there is a large space between 2 teeth or if there is notable ging recession
no
healthy sulcus measurment
1-3mm
base of gingival sulcus is formed by what
junctional epithelium
gingival crevicular fluid (GCF) seeps from underlying ___ into ___
connective tissue, into sulcular space
how much GCF is in a healthy sulcus?
little to none
5 functions of the periodontal ligament
Supportive
Sensory
Nutritive (provides nutrients to cementum and bone)
Formative (provides cementoblasts and osteoblasts)
Remodeling
root cementum primary function
periodontal ligament attachment
what are sharpeys fiber in relation or cementum and PDL
sharpeys fibers are terminal endings of PDL attached to cementum
what is alveolar bone
mineralized connective tissue that forms bones of upper and lower jaw
what does alveolar bone form that provides support to roots of the teeth
bony sockets
the existence of alveolar bone is dependant upon
the presence of teeth
alveolar bone proper is aka
cribriform plate
cortical bone is aka
compact bone
cancellous bone is aka ?
and it fills the interior protion of?
spongy bone
alveolar process (mostly in interproximal areas)
what is the periosteum of alveolar bone
layer of connective tissue that covers outer surface of bone
gel like substance (mesh-like) containing interwoven protein fibers surrounding most cells
extracellular matrix
epithelial cells secrete a thin mat of extracellular matrix called
basal lamina
is keratinized tissue very flexible?
no
the heaviest keratinized epithelium of the body is found on the
palms of hands and soles of feet
examples of non-keratinized tissue in the oral cavity
lining of cheeks
connective tissue is composed of
fibroblasts
macrophages
neutrophils
lymphocytes
enamel is derived from
epithelial tissue
which type of cell junction allows the cell to attach to the basal lamina
hemidesmosome
how would you describe the basal layers of the squamous stratified epithelium
cube shaped cells
the epithelial lining of the gingival sulcus is
thin and non keratinized
in health the junctional epithelium attaches to the tooth?
slightly coronal/above CEJ
known collectively as dentogingival unit
Junctional epithelium and gingival fibers
what supragingival fibers encircle the tooth in a collar like fashion?
circular
which fibers of the periodontal ligament are located around the tip of the root
apical fibers
Root cementum description
Thin layer of CT that covers the surface of the root
Attached to dentin
More resistant to resorption so can do ortho
Root cementum functions
PDL attachment
Seals open tubules
Compensates for attrition to maintain length
Keratinized epithelial cells are
Waterproof
Wavy boundary (epi/ct) describe deep extensions of
Epithelial ridges of epithelium that reach down into CT
(Rete ridges/rete pegs)
Wavy boundary (epi/ct) enhances adhesion of
Epi to ct by increasing surface area
The oral epithelium joins CT
Wavy interface with epithelial ridges
Oral epithelium consists of what 4 stratified squamous epithelial layers
Basal
Prickle
Granular
Keratinized
Dulcimer epithelium joins CT with
Smooth interface (no ridges)
Sulcular epithelium 3 layers
Basal
Prickle
Superficial
2 epithelium layers of Junctional epithelium
Basal
Prickle
Microscopic anatomy of the JE is smooth or wavy interface
Smooth
4 Supragingival fiber bundles function
Strengthens attachment of JE to tooth by bracing gingival margin against tooth
Provides rigidity to withstand chewing
Connects adjacent teeth together
Connects free ging with cementum and alveolar bone
Supragingival fibers bundles: alevogingival
Attach gingiva to bone
Supragingival fiber bundles: periosteogingival
Attach gingiva to bone
5 periodontal ligament fibers
Alveolar crest
Horizontal
Apical
Oblique
Interradicular
Periodontal ligament fibers main function
To provide support and sensing of pain and tactile pressure
Biologic component of mature cementum:
Growth factor molecules are produced during formation then stored in matrix to assist with PDL regeneration
3 types of cementum
Intermediate (located at CEJ)
Acellular (mainly sharpey fibers)
Cellular (apical and interradicular portions of root )
Three arrangements of cementum to enamel (OMG)
Cementum overlaps enamel for a short distance
Cementum meets enamel
Cementum leaves a gap between itself and enamel
Constantly undergoes periods of bone remodeling when teeth are subject to mechanical forces
Alveolar bone
Osteoblasts
Bone forming
Osteoclasts
Bone resorbing
Alveolar bone consists of
Alveolar bone proper
Travecular (spongy) bone
Cortical (compact) bone
Pathogenesis refers to
Sequence of events that occur during the development of a disease
2 types of periodontal disease
Gingivitis
Periodontitis
Bacterial infection confined to the gingiva and can be reversible
Gingivitis
A bacterial infection including all parts of periodontium (bone, cementum, gingiva and PDL) IRREVERSIBLE
periodontitis
What is the difference between perio disease and periodontitis
Perio disease- bacterial infection of periodontium
Periodontitis is a type of perio disease
Periodontium in health appears
Pink
Firm
No bleeding
Sulcus in health the Junctional epithelium will be ___ to CEJ
Coronal
Gingivitis is a type of perio disease characterized by changes in
Colour, contour and consistency of gingival tissues
Gingivitis is observed clinically how many days after plaque biofilm accumulates
4-14 days
In gingivitis is the Junctional epithelium still coronal to CEJ
Yes
Acute gingivitis lasts for
Tissues appear
A short period of time
Swollen
Chronic gingivitis lasts for
New collagen fibers are formed resulting in a more
Months/years
Fibrotic tissue
Gingivitis may persist for years without
Progressing to periodontitis
Periodontitis is characterized by the apical
Migration of the JE
With periodontitis widespread destruction of Supragingival fiber bundles occur but what continues to regenerate
Transseptal fiber bundles
In health the crest of the bone is located approximately how many mm apical to CEJ
2mm
Bone loss must be recorded in client record according to
Pattern
Distribution
Severity
Horizontal bone loss is described as
Bone loss occurring in a plane parallel to CEJ of adjacent teeth
Localized bone loss occurs in
Isolated areas
Generalized bone loss occurs evenly throughout
Dental arches
Mild bone loss %
20-30%
Moderate bone loss
30-50%
Severe bone loss
Greater than 50%
What is the most common pattern of bone loss
Horizontal
What pattern of bone loss results in more rapid progression of bone loss to next root surface
Vertical (trench like)
Pathway in horizontal bone loss
Into gingival tissue
Into alveolar bone
Into PDL
Pathway in vertical bone loss
Into gingival CT
Directly into PDL space
Into alveolar bone
Infrabony defect result when
Bone loss occurs in an uneven oblique direction
There is NO apical migration of JE describes what kind of pocket
Gingival pocket
Gingival pockets are also called
Pseudopockets
Periodontal pocket is characterized by apical
Migration of the JE
2 types of perio pockets
Suprabony
Infrabony
Suprabony pocket occurs when there is what kind of bone loss
Horizontal
Infrabony pockets occur when there is vertical bone loss and the JE is located?
Apical to crest of alveolar bone
Attachment loss describes destruction of
Fibers and alveolar bone that supports the teeth
A disease site is an area of
Tissue destruction
An active disease site is
A disease sure that shows continued apical migration of JE over time
Periodontal disease is characterized by periods of
Disease activity and inactivity
Disease prevalence describes the number of both old and new cases of a disease that are identified in a
Specific population at a given point in time
Prevalence vs incidence
Prevalence all cases at given time
Incidence number of new disease cases over a period of time
Variables associated with prevalence of disease
Gender
Age
Education level
Socioeconomic status
Access to dental care
Tobacco has been identified as a
Behavioural risk factor
Staging classifies
Severity and extent of disease
to assess specific factors
Grading of perio disease aims to indicate
Rate of perio progression
Responsiveness to standard therapy
Potential impact on systemic health
3 steps of staging and grading pt
Initial case overview
Establish stage
Establish grade
Healthy tissue does not
Bleed
In health gingival margin is evenly
Scalloped and smooth
In health margin is slightly
Coronal to CEJ
Papilla changes in gingivitis can manifest as
Bulbous
Blunted
Cratered
Tissue becomes what 3 things in gingivitis
Soft spongy and nonelastic
If distribution of inflammation is diffuse this means
It is throughout gingival margin papilla and attached gingiva
Reduced periodontium means
Pre existing loss of periodontal tissue but no current activity
Plaque induced gingivitis on a reduced periodontium in a non periodontitis patient may result from
Orthodontically induced movement of teeth
Intact periodontium refers to no loss of
Periodontal tissue past or present
What type of periodontal disease is most common
Plaque induced gingivitis
Erythema aka
Redness
A patient exhibits a bacterial infection of all parts of the periodontium what is the state of pts periodontium
Periodontitis
Potential modifying factors of plaque induced gingivitis
Systemic (pregnancy, period, hyperglycaemia, smoking)
Oral factors (hyposalivation)
Drug induced
Pyogenic granuloma aka
Pregnancy tumour (non cancerous)
Oral changes are often first clinical signs of leukemia resulting in
Enlarged tissue and increased bleeding
Tissues tear easily
Usually begins in papilla
What vitamin helps to maintain healthy sulcular epithelium
Vitamin a
Vitamin c deficient pt tissue characteristics
Bright red
Swollen
Ulcerated
Bleed easily
Medications commonly associated with gingival enlargement
Anticonvulsants (seizure; Dilantin)
Calcium channel blockers (amlodipine)
Immunosuppressant (cyclosporine)
Onset of gingival enlargement by medications usually occurs
3 months of taking meds
Non plaque induced gingival diseases are not resolved after
Plaque removal
Non plaque induced gingival diseases may include
Hereditary/ genetic development
Infection
Immune conditions
Neoplasms
Traumatic lesions
Is there loss of periodontal attachment in necrotizing gingivitis
No
Primary herpetic gingivostomatitis- initial oral infection with
Herpes simplex 1 virus
Primary herpetic gingivostomatitis is characterized by
Fiery red tiny fluid filled blisters that easily rupture to form painful ulcers
Erythema multiforme is a hypersensitivity reaction or allergic reaction which includes
Swollen lips and excessive crust formation
Lichen planus is an
Autoimmune disease
Granulomatous inflammatory conditions include
Crohns disease
Allergic reaction to toothpaste characterized by
Tissue sloughing
Oral lichen planus is characterized by?
Can last how long
May be what kind of reaction?
Lacy white patches
Can last for many years
May be allergic or immune reaction
Number 1 cause of tooth loss in adults
Periodontitis
What is not a reliable indicator of the presence or severity of chronic periodontitis
Clinical appearance
Signs/ symptoms of periodontitis
Abundance of mature plaque/calc
Reddish or purplish tissue (tissues may be pale pink)
Gingival bleeding
Loss of attachment mobility
Swelling
Suppuration(pus)
Clinical attachment loss or CAL means
Loss of alveolar bone support from around tooth
What is not usually a symptom with periodontitis
Pain
Once a perio client
Always a perio client
Determine pathogenesis and rate of progression of the disease
Contributing factors
Necrotizing gingivitis examples
HIV
AIDS
Stress
Smoking
Necrotizing periodontitis affects ?
Examples?
Personal attachment and bone
HIV aids stress smoking
Necrotizing stomatitis affects
Oral mucosa
Two categories which are starting points of a periodontitis case
Full perio assessment to determine CAL
radiographs to determine RBL
Stage 1 periodontitis pertains to what third of the tooth
Cervical third (less than 15%)
Apical third of the tooth is involved in what stage of periodontitis
Stage 3/4
Grade A refers to
Slow rate periodontitis
No loss over 5 years in regards to RBL/CAL refers to what grade of perio
Grade A
Grade B: moderate rate periodontitis
RBL or CAL less than 2mm over 5 years
Destruction equivalent with biofilm deposits
Grade C: rapid rate periodontitis
RBL OR CAL Greater or = 2mm over 5 years
destruction exceeds expectations given biofilm deposits
When it comes to staging early and moderate periodontitis will be stage
1 and 2
When grading, the consensus is to assume it is grade?
B
Our #1 indicator of gingival inflammation
Bleeding
Someone can have inflammation up to __% of the oral cavity and still be considered?
10%
Healthy
If there is a __mm interdental pocket with bleeding (open pocket) we still?
4mm
Still grade and stage
Necrotizing periodontal disease rapidly escalates and can produce loss of periodontal attachment within
Days
