1. Orthokeratinize 2. Parakeratinize

Perio doc micks Flashcards by yan mae de

Parts of Periodontium

Gingiva
PDL
Cementum
Alveolar bone

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REMEMBER‼️📌📌

PDL, Cementum, & Alveolar Bone

Attachment Apparatus

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Gingival fibers & Epithelial attachment

Gingival Apparatus

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composed of epithelium & conn. tissue

Gingiva

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Characteristics of Normal gingiva
Color
Shape
Tone
Texture

Coral pink 
Knife edge free gingival margin
Scalloped gingival margin-follow CEJ contour
Tone: resilient & fibrous
Texture: Stippling

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found in attached gingiva
irregularities of epithelial ridges & rete pegs
least determinant for gingivitis

Stippling

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‼️📌REMEMBER

Absence of Stippling

Normal variation
Inflammation
Edema

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Most important criteria for Gingivitis

Bleeding on Probing

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Why bleed?

Microulceration in the gingiva

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Stippling

Orange peel/ Peau’d orange

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Gingival Epithelium Histologic divisions

Oral Epithelium
Sulcular Epithelium
Junctional Epithelium

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parakeratinized but both present

keratinized stratified, squamous epithelium

Oral Epithelium

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non-keratinized but can keratinized

but some has parakeratinized

Sulcular Epithelium

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part of biologic width
Non-kerarinized
Collar-like band of stratified squamous epithelium
thicker near the sulcus
thinner at the apex

Junctional Epithelium

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Ideal at the CEJ

Junctional Epithelium

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type of transudate that is produced in the gingival sulcus
contains cells (neutrophils) enzymes & IgA

Gingival Crevicular Fluid (GCF) / Sulcular Fluid

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gingival sulcus

transudate

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exudate

pus

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specific gravity

Exudate

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protein content

Transudate

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Keratinization

Orthokeratinize

2. Parakeratinize

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complete keratinization

w/out nucleus

Orthokeratinize

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incomplete

w/ nucleus

Parakeratinize

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Prevent relapse after tx

Supracrestal fiberotomy
Retainer
Overcorrection

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Aka. Supracrestal connective tissue fibers

Gingival Fiber Group

Attaches the gingiva to the tooth & alveolar bone | Made up of Type I collagen

Gingival Fiber Group

1. Dentogingival Fibers 2. Dentoperiosteal Fibers 3. Circular Fibers 4. Alveologingival fibers 5. Transseptal Fibers

attached to the cementum to the gingiva

Dentogingival fibers

from cementum to the periosteum

Dentoperiosteal fibers

from cementum to the periosteum

Dentoperiosteal fibers

encircles the tooth , resist rotational forces

Circular Fiber

attaches gingiva to the alveolar crest

Alveologingival fibers

attaches cementum to cementum of adjacent teet ; doesn't attach to bone Most cause of relapse

Transseptal fibers

Principal Periodontal Ligament Fiber Group

Made up Type I collagen

from cervical cementum of tooth to alveolar crest | Mainly resists lateral movements

Alveolar Crest Fiber Group

run perpendicularly from the root of the tooth to alveolar bone resists lateral movements & vertical movements

Horizontal Fiber Group

runs obliquely from cementum & extends occlusally towards bone found in the middle 3rd of root 📌Most numerous 📌Mosr resistant to forces along lomg axis of thd tooth / masticatory forces

Oblique Fiber Group

radiate apically from cementum to bone primary fibers that resist tooth towards occlusal direction Compressed during intrusion & masticatiom

Apical Fiber Group

from cementum in the fircarion towards bone in the furcation area Found only in multirooted teeth

Interradicular Fiber Group

‼️📌REMEMBER📌‼️ | Periodontal fibers embedded in cementum & bone are called

Sharpey's Fibers (mineralized)

Other name of Alveolar Bone Proper

Bundle bone / Cribriform plate

Most numerous cells found in PDL

Fibroblast

Anatomic Parts of the Gingiva

1. Free Gingiva / Marginal Gingiva 2. Gingival Margin 3. Free gingival groove 4. Attached ginigva 5. Gingival sulcus

tissue not attached to the tooth or bone | measured from free gingival crest (gingival margin) to the free gingival groove

Free Gingiv or Marginal Gingiva

most coronal portion of gingiva

Gingival Margin

line between marginal gingiva & attached gingiva | coincides with apical border of junctional epithelium

Free Gingival groove

Measured from the free gingival groove to the mucogingival junction Stipplings are found here Tightly bound to underlying periosteum & cementum

Attached Gingiva

between marginal gingiva & attached gingiva | coincides with apical border of junctional epithelium

Free Gingival Groove

measured from free gingival groove to the mucogingival junction stippling are found here tightly bound to underlying periosteum & cementum

Attached Gingiva

between marginal gingiva & tooth surface; GCF is found here bounded by Sulcular epithelium- laterally JE- apically

Gingival sulcus

‼️📌BE Thinnest Attached gingiva Thickest

Posterior portion of the mandible | Anterior (maxilla) - labial surface of lateral incisors

valley like structure between the lingual papilla & facial papilla

Interdental Col / Inter papillary Saddle

Occupies the gingival embrasure of the interdental space above the alveolar crest Pyramidal shape

Interdental or Interproximal gingiva (papilla)

A line betweem attached gingiva & alveolar mucosa

Mucogingival Junction

loosely attached mucosa covering the base of the alveolar process continuing towards the vestibule & floor of the mouth

Alveolar mucosa

Probing force

10gm- 25gm 0. 010 kg - 0.025 kg 0. 022 lbs - 0.055 lbs

normally in CEJ or above CEJ (in enamel)

Level of Free Gingival Margin in Relation to CEJ

Probing must be gentle- Walking Technique

BOP

measured from Gingival margin to base of sulcus

Pocket Depth or Probing Depth

Position , angulation & orientation of probe

Ideally: Parallel to the tooth surface Maximum: Angle 0-10* xray angle bitewing radiograph

readily combines with mercury to form gamma 2 phase weakest ohase & contributes to failure of amalgam restoration

Tin

scazenger

zinc

‼️📌 Calcular deposits are composed of

Calcium & Phosphate

Sticky deposits in oral cavity where microorganisms accumulate are called?

Plaque

Immediately after cleansing a tooth a thin film of saliva covers the tooth .,It is called

Pellicle

measured from CEJ towards Base of Sulcus

CAL

measured from CEJ to Gingival margin | Gingival recessiom = CAL- Pocket depth

Gingival recession

📌‼️‼️REMEMBER | can be tx by Free Gingival graft

Recessions

obtained from Edentulous region or palatal area

Graft

Most common failure of autographs

Loss of Blood supply | infection

source of Blood supply of Autografts

Bed of recipient tissue

important to evaluate prognosis of tooth

Mobility

due to coronal migration of gingival margin gingival hyperplasia gingival hypertrophy

Pseudopocket

apical migration of the junctional epithelium (loss of attachment) related to bone loss

Tru Pocket

Miller Classification of Tooth Mobility

Grade I Grade II Grade III

horizontal mobililtyn<1mm, normal

Grade I

Horizontal mobility > 1mm - 2mm

Grade II

Horizontal Mobility >2mm or vertical mobility; Poorest prognosis

Grade III

Joint between a tooth & alveolaf bone

Gomphosis

use Naber's Probe

Furcation Evaluation

Furcation Classification by Glickman

Grade I Grade II Grade III Grade IV

Incipient furcation involvement Pocket primarily affects soft tissue & coronal to alveolar bone Depression due to furcation opening can be felt using probe

Grade I

Furcation bone loss Not through & through Probe enters under the roof of furcation

Grade II

Total furcation bone loss | Through & through Not seen clinically

Grade III

Total furcation bone loss , through & through seen clinically

Grade IV

📌‼️REMEMBER What is the most Critical factor in determining if a tooth is candidate for Extraction or can be saved with surgical periodontal therapy

CAL

evaluated by Digital pressure on buccal & lingual of each tooth

Exudates

Radiographic Evidence of Bone Loss

Periodontitis

Periodontitis Diagnosis

Multiple Periapical Bitewing Panoramic

Change in tissue tome Gingivitis Periodontal Disease

Erythema | Cyanosis

📌‼️REMEMBER | Most effective way to determine presence of plaque?

Disclosing Solution

What is the best indicator to evaluate success of scaling & root planing

Reduction of Bleeding Index & Plaque Index

Scaling & Root Planing removes

Cementum Dentin Plaque

removal of calcular deposits in root surface

Scaling

smoothing of root to remove infected tooth substances

Planing

scraping gingival wall

Curettage

Gold standard of all curettes

Gracey Curettes

* Most common complication after root planing

Sensitivity

Anterior Teeth

1,2, 3, , 4

5, 6

ant.teeth & PM

7,8,9,10

Posterior buccal & Lingual

11, 12, 15, 16

Post. teeth mesial

13, 14,,17, 18

Post. teeth distal

Masticatory Mucosa

KSSE Dorsum tongue hard palate attached gingiva

NKSSE | found almost everywhere in the oral cavity

Lining

Lining Mucosa inside lining of cheeks inside lining of the lips lining between buccal & labial mucosa

Buccal mucosa Labial mucosa Alveolar mucosa

found in taste buds responsible for sensory perception of the tongue

Specialized Mucosa

most common involves Canines & Premolars (Abrasion) | Due to hard bristle brush

Toothbrush trauma

chemical action

Erosion

Mechanical wear

Abrasion

physiologic action

Attrition

loading resulting to tooth flexure & microfractures

Abfraction

Toothbrushing Techniques

1. Bass Method 2. Stillman 3. Charters 4. Circular Force 5. Horizontal

bristles at 45* in relation to tooth towards sulcus, cleans gingival sulcus Best toothbrush technique

Bass Method

bristles at degrees in relation to tooth towards sulcus, half of bristles in gingiva, half in sulcus

Stillman

45* in relation to tooth but towards occlusal

Charters

least effective toothbrushing techniques

Circular Force

Most common used by the px.

Horizontal

Classification types of Toothbrushing techniques according to movement

``` Roll Vibratory Circular Vertical Horizontal ```

roll method or modified stillman technique

Roll

stillman, charters & bass techniques

Vibratory

Fones techniquee

Circular

Leonard technique

Vertical

scrub technique

Horizontal

Induced by Nifedipine. phenytoin, & cyclosporine, genes | Prevented by good oral hygiene

Gingival Overgrowth

Tx. Gingival overgrowth

Gingivectomy

After gingivectomy | dressing

1. Reduce pain/ bleeding 2. Mechanical protection 3. ⬆️ Healing 4. Debris- free environment (plaque- free)

Gingival margin moving CORONALLY due to GINGIVAL OVERGROWTH

Pseudopockets

Degree of Gingival Enlargement

Grade 0 Grade I Grade II Grade III

no signs of gingival enlargement

Grade 0

enlargement confined to interdental papillae

Grade I

enlargement involves papilla & marginal gingiva

Grade II

enlargement covers 3 quarter or more of the crown

Grade III

GINGIVAL ENLARGEMENT BASED ON LOCATION | limited to the gingiva adjacent to a single tooth or group of teeth

Localized

involving the gingiva throughout the mouth

Generalized

confined to the marginal gingival

Marginal Gingiva

Confined to the Interdental Papilla

Papillary

involving the marginal & attached gingvae & papillae

Diffuse

isolated sessile or pedunculated, tumor- like enlargement

Discrete

Most common Periodontal disease | Most common cause is Poor Oral Hygiene

Gingivitis

Characteristics of Gingivitis

``` Inflammation of Gingiva Bleeding on probing Absence of pockets Absence of radiographic finding Absence of stippling ```

Scurvy

Scrobutic Gingivitis

Pregnancy Gingivitis

⬆️⬆️Progesterone more | ⬆️ estrogen

Red glazed, atrophic, or eroded gingiva Desquamting gingiva/ sloughing gingiva atrophic stratified squamous epithelium short or absent rete pegs

Desquamative Gingivitis

Desquamative Gingivitis | Associated with

Pemphigus Vulgaris Pemphigoid Lichen planus Chronic ulcerative stomatitis

desmosomes

Pemphigus Vulgaris

Hemidemosomes

Pemphigoid

anbsence of rete pegs or saw toothing- White patches (wickham's striae)

Lichen Planus

punched out grayish pseudomembrane of interdental papilla pain & bleeding fetid odor, fever & malaise absence of pocket

NUG/ Trench Mouth / Vincents Ds. | Old: ANUG

``` NUG/ Trench mouth/ Vincents Causative Agent (FuPS) ```

Fusobacterium Prevotella Intermedia Spirochetes (Treponema Pallidum)

📌‼️Elevated Prevotella Intermedia

Down Syndrome

Tx. of NUG

Debridement- removal of damage tissue Irrigation w/ chlorhexidine gluconate Antibiotic (penicillins)

Same as NUG with CAL & Bone Loss Presence of Pockets

NUP

Causative agent of NUG

FuPS

rapid progression of attachment loss Absence of plaque- usually <30 yrs

Aggressive Periodontitis / Juvenile Periodontitis

Ex. Of Aggressive / Juvenile Periodontitis

LAP/LJP

‼️📌Teeth involved in LAP/LJP

Incisors & 1st molars

Causative agent of LAP/LJP

Actinobacillus (old term) Aggregatibacter Actinomycetemcomitans Capnocytophagea Ochracea

Most common cause of Localized Aggressive Periodontitis

Aa | Aggregatibacter Actinomycetemcomitans📌📌

Causative Agent of Generalized Aggressive Periodontitis (Generalized Juvenile Periodontitis) Causative Agent

Prevotella Intermedia | Eikenella Corrodens

slow to moderate progressiom, with periods of rapid progressiom of attachment loss "burst of destruction" Presencec of subgingival calculus- frequent finding

Chronic Periodontitis

causative agents- multiple microorganisms

Chronic Periodontitis

Other Syndromes Associated with Severe Periodontitis

1. Chediak- Higashi Syndrome 2. Papillon Lefevre Syndrome 3. Down Syndrome 4. Lazy Leukocyte Syndrome 5. Leukocyte Adhesion Deficiency

severe periodontitis | cafe- au-lait spots (brownish spot in skin)

Chediak- Higashi Syndrome

AKA Palmoplantar Keratoderma Periodontitis Severe Periodontitis Palmoplantar keratoderma- hyperkeratosis of palms & soles

Papillon -Lefevre Syndrome

severe periodontitis due to increase P. intermedia | Less prone to caries

Down Syndrome

poor response of leukocytes to infections Prone to infection kulang ang px ⬇️ signaling hormone in the body

Lazy Leukocyte Syndrome

inability of leukocyte to adhere in sites of infection | ⬇️ adhesion proteins

Leukocyte Adhesion Deficiency

sensitive heat & cold

Reversible

relieved by cold

Irreversible Pulpitis

Pulp Necrosis

Irreversible Pulpitis

‼️📌REMEMBER | Does true periodontitis always begins with gingivitis ?

YES

Radiographic findings of Periodontitis

Loss of Lamina dura Widening of Periodontal space Horizontal / Vertical bone loss

What cell produce by Lymphokines?

T- Lympocytes

📌‼️‼️ Mediators of Tissue Destruction

1. MMP 2. Cytokines 3. Prostaglandins

primart proteinase that destroy periodontal tissue

MMP - Matrix Metalloproteinase (MMP)

signaling molecules like interleukins & tumor necrosis fx

Cytokines

Microprganisms appear

10-12hrs after birth

1st microogranism to appear after birth , most numerous

S. Salivarius

only appear after a tooth has erupted

Strep.mutans & sanguis

1st colonizee

Sanguis

way of communicatim of microorganisks

Quorum Sensing

Probing Age

13-14 y/ o

oral microflora is same to adults

By the age 4-5

Healthy Oral Cavity

Gm (+) facultative (cocci) anerobes Streptococcus & Actinomyces Fermenting microorganism - sugar as source of energy Non-motile

Unhealthy Oral Cavity

Gm (-) obligate anaerobes (rods) Proteolytic Microorganisms Motile

Most common primary colonizer of plaque | yellow complex microorganisms

Rods & Cocci

Purple Complex

Actinomyces

``` Late / Secondary Colonizers Green Complex (GrEAC) ```

Eikenella Corrodens Actinobacillus Actinotherapeutics Capnocytophaga

Orange Complex (FPC)

Fusobacterium Prevotella Campylobacter

Red complex - causes bleeding | PTT

Porphyromonas Treponema Denticola Tannerella Forsythia

One wall

Hemiseptum

two wall

Osseous crater

Lowest success after grafting procedure

One wall- hemiseptum

Most common type of Osseous Defect or Vertical Bone Loss

Two wall- Osseous crater

highest success rate after grafting procedure

3 wall- intrabony defect

📌‼️‼️ Most commom pattern of bone loss | reduction in height

Horizontal

reduction in width

Vertical Bone Loss

Horizontal Bone Loss

Probing- True Pocket- Suprabony Pocket

Vertical Bone Loss

Pocket- Infrabony Pocket (Intrabony Pocket)

provide ACCESS & VISIBILITY to root surfaces of debridement | although it may result to REDUCTION OF POCKET DEPTH

Primary Goal of All Flaps

include epithelium , C.TT & periosteum most common type of flap alveolar bone is exposed

Full thickness flap/ Mucoperiosteal Flap

includes epithelium & conn. tissue only periosteum remains attached to alveolar bone alveolar bone is not exposed

Partial Thickness Flap/ Split Thickness Flap

takes 1month

Complete Healing of Tissue After a flap surgery