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AU 15 - Periodontology > Periodontal Anatomy > Flashcards

Periodontal Anatomy Flashcards

1
Q

What does “periodontal” mean?

A 
Perio = around
odontos = tooth
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2
Q

What structures make up the periodontal structures?

A

Gingiva
Periodontal ligament
Root Cementum
Alveolar bone

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3
Q

Periodontal ligament

A

Attaches to the root cementum and the alveolar bone

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4
Q

Sharpey’s Fibers

A

Projections that attach the PDL to cementum

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5
Q

What makes up the alveolar bone?

A

Outer cortical plate, inner cortical plate, and cancellous bone in between them

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6
Q

Outer cortical plate

A

The portion of the alveolar bone that the gingiva attaches to

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7
Q

Inner cortical plate

A

Portion of the alveolar bone that the PDL attaches to

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8
Q

What is the functions of periodontal structures

A

Attach the tooth to the bony tissue of the jaw

Maintain the integrity of the masticatory mucosa

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9
Q

What happens if you don’t have a good PDL?

A

Teeth would move whenever you chew or did almost any mouth movement

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10
Q

What type of cells do the periodontal structures originate from?

A

Neural crest cells beneath the stomodeal epithelium

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11
Q

What structure in development gives rise to the periodontal ligaments

A

Dental follicle

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12
Q

Why doesn’t a tooth bleed when it erupts?

A

It erupts through an epithelial passage - and there is no blood supply in epithelium

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13
Q

What is the first tooth structure to erupt?

A

Crown

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14
Q

What cells form dentin?

A

Odontoblasts

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15
Q

What type of cells secrete enamel-related proteins?

A

Amelogenins

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16
Q

What happens when the root sheath fenestrates?

A

Ectomesenchymal cells of the dental follicle contact the root surface, and amelogenin induces differentiation into cementoblasts

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17
Q

What does the PDL form from?

A

Fibroblasts that are differentiated from the dental follicle lateral to the cementum

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18
Q

Gingia definition

A

Part of the masticatory mucosa which covers the alveolar processes and surrounds the cervical portions of the teeth

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19
Q

What are the 3 macroscopic anatomical parts of the gingiva?

A

Free gingiva
Attached gingiva
Interdentinal papilla

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20
Q

Free gingiva

A

Extends from the free gingival margin to the free gingival groove
Made of keratinized epithelium

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21
Q

Free gingival margin

A

Coronal end of the gingiva

Located 1.5-2.0 mm coronal to the CEJ

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22
Q

Free gingival groove

A

Junction between the free and attached gingiva
Corresponds to the CEJ
only seen in 30-40% of adults

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23
Q

What microscopic anatomical structures can be seen on the gingiva

A

Oral epithelium
Oral sulcular epithelium
Junctional epithelium

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24
Q

Oral epithelium

A

Microscopic structure of the gingiva that faces the oral cavity

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25
Q

Oral sulcular epithelium

A

Microscopic structure of the gingiva that faces the tooth surfaces without actually conacting

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26
Q

Junctional epithelium

A

Microscopic structure of the gingiva that provides contact between the gingiva and the tooth

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27
Q

What are the macroscopic limits of the free gingiva?

A

Extends from the free gingival margin to the free gingival groove

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28
Q

What are the microscopic limits of the free gingiva?

A

Extends from the free gingival margin to the junctional epithelium

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29
Q

Why do we care about the limits of the free gingiva?

A

Because how these landmarks change from health to disease will determine the accuracy of probe readings

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30
Q

Attached gingiva description

A

Firm texture
Coral pink
Immobile
Width varies

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31
Q

How and why does the width of attached gingiva change?

A

It increases with age due to passive eruption

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32
Q

What teeth have the widest and narrowest attached gingiva?

A 
-Buccal Side-
narrowest = premolar
widest = incisors
-Lingual Side-
narrowest = incisors
widest = molars
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33
Q

Stippling of attached gingiva

A

Present in 40% of adults
An indicator of health, but absence is not necessarily an indicator of them being unhealthy - if a patient had stippling previously, but lost it, then it’s a sign of poor gingival health

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34
Q

Why isn’t there a muco-gingival junction on the palate?

A

All of the palate is keratinized gingiva

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35
Q

What is the importance of attached gingiva?

A

Supports marginal/free gingiva
It’s a base for movable elements (cheeks, lips, tongue)
Can withstand frictional and functional stress
Barrier for inflammation

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36
Q

What helps the attached gingiva withstand frictional and functional stress?

A

It has a thick connective tissue layer

and is firmly bound to the periosteum and bone

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37
Q

Why should we care about the attached gingiva?

A

If the patient has great oral hygiene, the thickness of attached gingiva doesn’t matter
But thickness is important in patients with poor gingival health

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38
Q

What are some gingival landmarks?

A

Keratinized gingiva
Free gingival groove
Mucogingival junction

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39
Q

Keratinized gingiva

A

The combination of the attached gingiva and the free gingiva

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40
Q

Mucogingival junciton

A

Border between the attached gingiva and alveolar mucosa

41
Q

What is the keratinized gingiva minus the sulcus?

A

Attached gingiva

42
Q

What is the marginal gingiva?

A

Sulcus

43
Q

When we say the “width” of the gingiva, what are we talking about?

A

The height occluso-cervically

44
Q

When we say the “thickness” of the gingiva, what are we talking about?

A

Thickness bucco-lingually

45
Q

What is the interdentinal papilla?

A

The part of the gingiva that comes together in a concave shape between the teeth

46
Q

What does the shape of the interdentinal papilla depend on?

A

The contact relationships between adjacent teeth (concave because teeth are contacting…if teeth are missing, they will be flat)
Width of approximal tooth surfaces
Course of CEJ

47
Q

What is the Col?

A

The concavity seen in contact areas of premolar and molar regions

48
Q

Is interdentinal papilla keratinized or non-keratinized? Why?

A

Non-keratinized because it has no stimulus to become keratinized. It could be if it were stimulated

49
Q

The bottom of the gingival sulcus in a healthy mouth is positioned apical to the CEJ. When is this most likely to occur?
A. Prenatally
B. 10-20 years of age
C. Before the roots of the primary teeth are resorbed
D. 40-60 years of age
E. Just after a permanent tooth has erupted

A

D. 40-60 years of age

50
Q

Describe oral epithelium

A

Keratinized, stratified squamous epithelium in layers

51
Q

What are the layers of the oral epithelium?

A

Basal layer
Prickle cell layer
Granular cell layer
Keratinized cell layer

52
Q

Orthokeratinized

A

No nucleus

53
Q

Parakeratinized

A

Has some nuclear remnants

54
Q

Clinically, how do orthokeratinized and parakeratinized cells differ?

A

They don’t

55
Q

What changes occur from the basal layer to the granular layer of oral epithelium?

A

Cytoplasmic tonofilaments and the number of desmosomes increase
The number of organelles decreases
Function decreases, but attachment increases

56
Q

What is the major cell type in the oral epithelium?

A

Keratinocytes (90%)

57
Q

What are some “other” cells in the oral epithelium?

A

Melanocytes (synthesize melanin pigment)
Langerhans cells (defense cells)
Merkel’s cells (sensory)

58
Q

Basement membrane

A

Present between the basal layer of the oral epithelium and the CT
1-2 um wide
Rich in glycoproteins
Contains protein-polysaccharide complexes

59
Q

What are the 2 layers of the basement membrane?

A

Lamina lucida - adjacent to basal cells

Lamina densa - adjacent to CT

60
Q

Hemidesmosomes

A

Dense plaques that attach epithelium to the basement membrane
Two of them make up a desmosome

61
Q

What microscopic features describe the macroscopic stippling?

A

CT projects into epithelium by CT papillae
Inbetween the papilla are rete pegs
When rete pegs are fused, it seen as stippling
When rete pegs are missing at the junctional epithelium site, papilla depressions are seen clinically

62
Q

Biologic width definition

A

Where attached gingiva is not attached to the alveolar bone, but enamel and cementum

63
Q

Where do the cells of the junctional epithelium originate before tooth eruption?

A

Reduced enamel epithelium

64
Q

Where do the cells of the junctional epithelium originate after tooth eruption?

A

Cells of the OE possess the ability to differentiate into cells of JE

65
Q

At what portion is the JE thickest and what portion is the thinnest?

A 
Widest coronally (15-20 cells)
Thinnest towards CEJ (3-4 cells)
66
Q

T/F - JE is continually renewed

A

True - and the turnover rate is faster than the oral epithelium

67
Q

Does the JE or OE have larger cells? Why?

A

JE - it has many functions to carry out, so it has many contents to do so

68
Q

Does the JE or OE have larger interstitial space? Why?

A

JE - allows for neutrophils and other defense cells to get out to the sulcus and kill pathogens

69
Q

Does JE or OE have more desmosomes?

A

OE

70
Q

At what tooth level will the JE be at in healthy adult sulcuses?

A

At or just apical to the CEJ

71
Q

What will occur to the JE in diseased adult teeth?

A

There will be attachment loss of the JE

72
Q

Necrotizing Ulcerative Periodontitis

A

Necrosis of junctional epithelium, leading to pocketing

Marginal epithelium falls away and the bone is exposed

73
Q

What cells are found in the gingival connective tissue?

A 
Fibroblasts (synthesize matrix and fibers)
Mast calles (vasoactive substances)
Macrophages (phagocytosis and synthesis)
Neutrophilic granulocytes
Lymphocytes
Plasma cells
74
Q

What fibers are found in the gingival connective tissue?

A

Collagen
Reticulin
Oxytalan
Elastic

75
Q

What is the role of collage in gingival connective tissue?

A

Characteristic cross-banding
Produced by fibrobasts, cementoblasts, and osteoblasts
The most abundant fiber

76
Q

What is the importance of reticulin in gingival connective tissue?

A

Numerous adjacent to basement membrane

Around blood vessels

77
Q

What is the importance of Oxytalan in gingival connective tissue?

A

They are mostly in the pdl

Run parallel to the long axis of the tooth

78
Q

What is the importance of elastic fibers in the gingival connective tissue?

A

They are around the blood vessels like a cuff

79
Q

What is the function of Gingival fibers?

A

Reinforce the gingiva
Provide resilience and tone
Maintain architectural form and integrity

80
Q

What are the types of Gingival fibers?

A

Circular fibers
Dentogingival fibers
Dentoperiosteal fibers
Transseptal fibers

81
Q

Circular fibers

A

Gingival fibers that encircle the tooth like a cuff

82
Q

Dentogingival fibers

A

Gingival fibers that fan out from the supracrestal cementum to the free gingiva

83
Q

Dentoperiosteal fibers

A

Gingival fibers that run from supracrestal cementum to the attached gingiva

84
Q

Transseptal fibers

A

Gingival fibers that run from tooth to tooth and embed in the cementum of each
Maintains the M-D demensions

85
Q

What is the richly vascular and cellular CT that surrounds the roots and joins the cementum and alveolar bone?

A

PDL

86
Q

What is the function of the PDL?

A

Permits forces to be distributed

Essential for the tooth’s mobility - otherwise teeth would chip much more than they do

87
Q

What are the fibers of the PDL?

A

Alveolar crest fibers
Horizontal fibers
Oblique fibers
Apical fibers

88
Q

Cementum

A

Mineralized tissue covering the root surface, and occasionally small portions of the crowns of the teeth

89
Q

What is the difference between bone and cementum?

A

Their makeup is similar

Cementum lacks blood vessels, lymph, innervation, and physiologic remodeling/resorption

90
Q

Intrinsic cemental fibers

A

Produced by cementoblasts

Composed of fibers oriented parallel to root

91
Q

Extrinsic cemental fibers

A

Sharpey’s fibers

Produced by PDL fibroblasts

92
Q

What are the different forms of cementum?

A

Acellular, extrinsic fiber cementum
Cellular, mixed stratified fiber cementum
Cellular, intrinsic fiber cementum

93
Q

Acellular, extrinsic fiber cementum location

A

At the coronal or middle portion of the root

94
Q

Cellular, mixed stratified cementum location

A

At the apical third of the root and in the furcations

95
Q

Cellular, intrinsic fiber cementum location

A

In the resorption lacunae

96
Q

T/F - Cementum thickness increases by gradual aposition through out life

A

True

97
Q

What is the thickness of cementum in the cervical portion of the root?

A

20-50 um

98
Q

What is the thickness of cementum in the apical portion of the root?

A

150-250 um

AU 15 - Periodontology (8 decks)

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