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DMD II > Perio (support tissue) > Flashcards

Perio (support tissue) Flashcards

1
Q

What is Periodontics?

A

= the study of the prevention, diagnosis, treatment and maintenance of diseases of the gingiva and supporting tissues of the teeth.

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2
Q

severity of disease “equation”

A

(frequency x duration x mass of irritant)/ (risk factors and resistance of host)

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3
Q

What is Inflammation?

A

Inflammation is the local response to a noxious stimulant, to protect the injured tissues, to localize or minimize the injurious agents and to set the stage for repair.

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4
Q

Etiology of inflammation (5)

A

Microbiological Thermal Chemical Trauma Allergy

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5
Q

Periodontal disease zones (4)

A
  1. ZONE OF INFECTION (microorganisms and PMNs replace normal cells) 2. ZONE OF CONTAMINATION (toxins of dead cells + bacteria + WBCs repace normal cells) 3. ZONE OF IRRITATION (histiocytes + osteocytes predominate with some normal cells intact) 4. ZONE OF STIMULATION (fibroblasts and osteoblasts wall of source of irritation and form new bone)
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6
Q

Normal healthy gingiva: Colour = Density = Crevice depth = Form =

A

Colour = pale pink/pigmented Density = Firm, tough, matt (not shiny), stippled Crevice depth = 1 to 3 mm Form = contour reflects bone contour NOTE: Absence of pain, edema, pus, exudate or visible tooth movement.Theoretically no crevicular fluid or no infiltrate of plasma cells or PMNs.

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7
Q

Gingival components (3)

A
  1. Marginal gingiva (free gingiva)
  2. Attached gingiva
  3. gingival papilla (interdental)
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8
Q

What is the marginal (free) gingiva)

A

Gingival is not held down by underlying bone. It contours the teeth

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9
Q

What is the attached gingiva

A

separates the free gingiva from the alveolar mucosa

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10
Q

what is the gingival papilla

A

Fills interproximal area, following CEJ. Anterior teeth have 1 central peak Post. teeth have 2 peaks joined by concavity

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11
Q

what is the Col?

A

Anatomically it is concavity found in gingiva papilla in ther interproximal. Histologically it is CT covered by thin layer of junctional epithelium (odontogenic E.) early after eruption. Eventually it’s replaced by more protective oral epithelium from the buccal and lingual peaks of posterior gingival papilla The Col is most suceptible to early periodontal disease

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12
Q

4 stages of epithelial attachment with age

A
  1. After eruption - heaped collar of gingiva with long attachments to CEJ 2. Free gingiva recedes slightly to coronal to CEJ 3. Slow apical migration of attached epithelium at CEJ until late 20s - migrating onto cementum, the gingiva recedes at the same pace to maintain sulcus depth 4. Attached epithelium is below the CEJ without pocket depth (physiologically normal)
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13
Q

Microscopic appearance of healthy gingival CT

A
  • composed of LP (no submucosa) - dense collagen fibers anchored into cementum and bone -inflammatory cells are in small numbers - vasculature is abundant - crevicular fluid may be detected
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14
Q

4 types of gingival fibres

A
  1. dentogingival fibers 2. dentoperiosteal fibers 3. circular fibers 4. transseptal fibers
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15
Q

Attached gingiva vs. alveolar mucosa

A

ATTACHED GINGIVA - keratinized - thick/densely bound to tooth and bone - collagen fibers - minimal vasculature ALVEOLAR MUCOSA -non-keratinized - thin/loose/moveable - elastic fibers - extremely vascular (hence why its redder)

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16
Q

Signs of periodontal disease (4)

A
  • BLEEDING (earliest sign) - COLOUR (red to purple) - FORM ( margins enlarge and move coronally or receded apically) - APPEARANCE (glossy, loss of stippling, clefts, exudate, mobility, bad taste/odor
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17
Q

The oral cavity is lined by three types of **stratified squamous epithelial tissue **zones, name them

A
  1. **Lining mucosa: **covers floor of mouth, cheeks, lips, and soft palate. It’s not involved in mastication
  2. **Maticatory mucosa: ** covers hard palate and alveolar ridges. It comes into primary contact with food during mastication. This includes the gingiva (covers alveolar process, surrounding the teeth)
  3. Specialized mucosa: covers tongue and is quite different in appearence from above two tissues
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18
Q

Label the diagram

A

A. Gingival sulcus

B. Marginal gingiva (free gingiva)

C. Marginal Groove

D. Attached gingiva

E. Mucogingival junction

F. Alveolar mucosa

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19
Q

define Marginal gingiva (free gingiva)

A
  • border of the gingiva surronding the teeth
  • Usually 1 mm wide, it forms the soft tissue wall of the gingival sulcus
  • 50% of the time it is demarcated from attached gingiva by the free gingival groove (shallow depression)
20
Q

Define gingival sulcus

A
  • The V-shaped space around the tooth bounded by the free margin of the gingiva and the tooth
  • Probing depth of a clinically normal gingival sulcus is 2-3 mm
21
Q

Define attached gingiva

A
  • Continuous with the marginal gingiva but is firm and tightly bound to the underlying periosteum of alveolar bone
  • The facial aspect of attached gingiva extends to the loose alveolar mucosa (demarcatd by mucogingival junction)
22
Q

How many frenum are found in the mouth

A
  • Buccal: 2 labial frenum (central) and 4 buccal frenum (lateral)
  • Lingial: 1 lingual frenum

TOTAL: 7

23
Q

define the width of the attached gingiva

A

The distance betwen the mucogingival junction and the and the bottom of the gingival sulcus (as seen from external surface)

NOTE: the width of the keratinized gingiva includes the width of the attached gingiva with the free gingiva as well . Therefore it is the TOTAL lenght of the gingiva

24
Q

define: Interdental gingiva

A

interdental gingiva occupies the gingival embrasure. It is either pyramidal or “col” shaped (facial + lungual papilla with depression)

**Col is covered by nonkeratinized stratified squamous epithelium, similarl to the alveolar mucosa and unlike rest of gingiva which is keratinized.**

25
Q

The shape of the gingiva is dictated by? (2 points)

A
  1. the interdental space and its contact point
  2. The presence of absence of some degree of recession

With recession, the Col shape is lost and the pyrimidal shape is what remains

26
Q

Gingival epithelium can be broken down into three regions:

A
  1. Oral (outer) epithelium)
  2. **Crevicular (sulcular) epithelium **(non-attached in sulcus)
  3. Junctional epithelium (attached to tooth below sulcus)

NOTE: gingival epithelium is stratified squamous epithelium

27
Q

The stratified squamous epithelium that makes up the gingiva is composed mainly of what type of cell

A

Keratinocytes

note: Langerhan cells, Merkel cells, and melanocytes may also be present

28
Q

What’s the main function of the gingival epithelium

A

the main function of the gingival epithelium is to protect deep structures, while allowing selective interchange with outer environment

This is achieved by PROLIFERATION, and DIFFERENTIATION of keratinocytes

29
Q

Gingival epithelium can be catagorized based on keratinization, name the three types

A
  1. Orthokeratinized = no nuclei in the keratinized layer
  2. **Parakeratinized **= nuclei in keratinized layer
  3. Non-keratinized
30
Q

Orthokeratinzed is found where in the gingiva? Name the layers it consists of.

A

Orthokeratinized is found in the outer oral gingival epithelium.

It’s layers are:

  1. Basal layer (basale)
  2. Prickle cell layer (spinosum)
  3. Granular layer (granulosum)
  4. Keratinized layer (corneum))
31
Q

Parakeratinzed is found where in the gingiva? Name the layers it consists of.

A

Parakeratinized make up part of the crevicular epithelium (along with non-keratinized)

Layers:

  1. Basale
  2. Spinosum
  3. Corneum (no granulosum layer)
32
Q

Non-keratinzed is found where in the gingiva? Name the layers it consists of.

A

Non-keratinized is found in the crevicular epithelium (along with parakeratinized) and junctional epithelium

layers:

  1. basale
  2. spinosum (prickle cell)
  3. Superficial layer (viable nuclei)
33
Q

Junctional epithelium contain which layers?

A
  1. Basal layer
  2. Prickle cell layer (attached to tooth structure by hemidesmosomes)

Junctional epithelium is made of non-keratinized cells only.

Early life = 3-4 layers thick

Later life = 10-20 layers

The layers taper towards apical end until it reached Cemento-enamel junction (1 mm lenght)

34
Q

What is the biological width components and their lenghts (2 parts)

A

junctional epithlium = 1mm

Connective tissue = 1mm

TOTAL 2mm

35
Q

List the 3 main features of the junctional epithelial layer that contributes to preventing colonization

A
  1. barrier: prevents bacterial penetrance subgingivally along the tooth via hemidesmosome attachment
  2. **Host defense: **allows access of gingival fluid, inflammatory cells and immunologic components into gingival margin
  3. Rapid turnover: contributes to host-parasite equilibrium and quick repair of damaged tissue (cells move coronally towards surface where they shed)
36
Q

**Gingival fluid (Sulcular fluid, crevicular fluid) **can be found in two forms:

A
  • Transudate (small normal composition)
  • Exudate (larger inflammatory composition in unhealthy state)

The fluid contains components of connectiv tissue, epithelium, inflammatory cells, serum and microbial flora

Found in the gingival margin (sulcus)

37
Q

What is the route of the gingival fluid diffusion ?

and

What is its function (4)?

A

diffuses through basement membrane, through the intracellular spaces of junctional epithelium - then into the sulcus

functions:

  1. cleanse sulcus
  2. contais plasma proteins to improve adhesion of epithelium to tooth
  3. Antimicrobial properties
  4. Antibody activity
38
Q

What are the major components of the gingival CT? (5)

A
  1. collengen fibers (60%)
  2. fibroblast cells (5%)
  3. vessels
  4. nerves
  5. matrix
39
Q

Connective tissue of gingiva (the lamina propria) consists of 2 layers:

A
  1. Papillary layer (projections below epithelium)
  2. Reticular layer (deeper layer adjacent to periosteum of the alveolar bone)

CT (the lamina propria) is made of extracellular (fibers + ground substance) and intracellular compartments

40
Q

What is the ground substance of CT

A

ground substance fills the space between fibers and cells. It is amorphous and high in water content.

Composition: glycoproteins (fibronectin and laminin) and proteoglycans (mostly hyaluronic acid)

41
Q

What does fibronectin do?

What does laminin do?

A

Fibronectin - binds fibroblast to the fibers and other intercellular matrix components, mediating cell adhesion and migration. Fibronectin makes up the bulk of glycoproteins within the ground substance.

Laminin - another glycoprotein found in basal lamina, serving to attach epithelial cells

42
Q

What are the 3 types of connective tissue fibers?

A
  1. **Collagen type I **- bulk of lamina propria, providing tensile strenght to gingiva
  2. **Collagen type IV **- branches between type I collagen bundles and it is continuois with fibers of the BM and vessels.
  3. **Elastic fibers - **oxytalan, elaunin and elastin fibers are distributed among collagen fibers
43
Q

What is gingival fiber and what is its functions (3)?

A

Gngival fibers ar a system of collagen fiber bundles consisting of type I collagen (groups: gingivodental, circular, and transseptal)

functions:

  1. holds marginal gingival to tooth
  2. rigidity from masticatory forces
  3. unites free gingival margin with cementum and the adjacent attached gingiva
44
Q

Three sources of blood supply to gingiva:

A
  1. **Supraperiosteal arterioles **
    • ​​along facial and lingial surface of bone
    • capillaries extend along sulcular epithelium
    • some branches pass through alveolar bone to the PDL or over the crest of the bone
  2. Vessels of PDL
    • ​​extend into gingiva and anastomose with capillaries in sulcus area
  3. Arterioles
    • emerge from crest of interdental septa and extend parallel to crest of the bone.
    • anastomoses with vessels of PDL, capillaries in crevicular areas and vessles over crest.
45
Q

what is PERIODONTICS?

A

Specialty of dentistry that encompasses prevention, diagnosis, and treatment of diseases of the supporting/surrounding tissues of teeth and dental implants

46
Q

What structures are covered by perio? (4)

A

Supporting tissues:

  • gingiva,
  • periodontal ligament,
  • cementum,
  • alveolar bone
47
Q
A

DMD II (4 decks)

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