Periodontal Effects of Ageing Flashcards
REVIEW
What are the 4 structures of the periodontium and their main function?
- Gingiva = protects underlying supporting structures of teeth
- Cementum = provides attachment to PDL, protects underlying dentine and formative capacity
- Periodontal ligament = supporting, sensory, nutritive, formative, and resorptive functions
- Bone = forms bony sockets to support and protect roots of teeth
Describe the clinical appearance of the gingiva
Part of the mucosa that surrounds the cervical portion of the teeth and the alveolar processes of the jaws
Composed of thin outer layer of epithelium and underlying connective tissue
Ends coronal of the CEJ of each tooth and attaches with special epithelial tissue known as the junctional epithelium
What are the 4 anatomical areas of the gingiva?
- Free ginigva
- Attached gingiva
- Interdental gingiva
- Ginigval sulcus
What is free gingiva?
Unattached portion of the gingiva surrounding the tooth in a cuff-like manner near CEJ
What are the characteristics of the free gingiva?
- Fits closely to tooth but not directly attached to the tooth
- Contours the teeth forming a scalloped outline around them
- Forms the soft tissue wall of the gingival sulcus
What is the attached gingiva and its purpose?
Part of the gingiva conencted tightly to the cementum cervical third of the root or the periosteum of the alveolar bone
Allows tissue to withstand mechanical forces (mastication, speaking, tooth brushing)
Prevents free gingiva from being pulled away from tooth when tension is applied to alveolar mucosa
What are the characteristics of the attached ginigva?
- Located between the free gingiva and the alveolar mucosa
- Colour may be pale pink or pigmented
- Widest at incisor and molar regions (from 3.3 - 4.5mm) narrowest at premolars (1.8mm)
- May exhibit dimpled appearance (stippling)
What is the interdental gingiva?
The portion of the gingiva that fills the interdental embrasure betwee ntwo adjacent teet hapical to contact area
Prevents food form becoming packed between teeth during mastication
The interdental gingiva conssits of two interdental papillae (facial and lingual/palatal). What are their characteristics?
Lateral borders and tips of interdental papilla is free gingiva, centre is attached
Valley like area lies directly between the contact area of 2 adjacent teeth = the col
No col exists when adjacent teeth are not in contact or recession is present
What is the ginigival sulcus?
The space between the free ginigva and tooth surface
What are the characteristics of the gingival suclus?
Depth of normal sulcus = 1 - 3mm
Base of sulcus formed by junctional epithelium
Gingival crevicular fluid (GCF) or gingival sulcular fluid seeps into sulcular space from underlying connective tissue
- Little to no fluid = healthy
- GCF flow increases with tooth brushing, mastication, or other stimulus
- Flwo increases in presence of biofilm and inflammation
What are the boundaries of the gingiva?
Coronal boundary = gingival margin
Apical boundary = alveolar mucosa
What are the demarcations of the gingiva?
Free gingival groove = shallow linear depression seperating free for attached gingiva
Mucoginigival junction = clinically visible boundary where atatched ginigiva meets alveolar mucosa
What is the periodontal ligament?
A layer of soft conenctive tissue that covers the root and attaches it to the bone of tooth socket
What are the characteristics of the periodontal ligament?
Composed of mostly dense fibrous connective tissue
Also supports tooth in socket and absorbs mechanical loads placed on tooth
What are the functions of the periodontal ligament?
- Attaches tooth to its bony socket
- Suspends tooth in socket
- Sensory (tactile pressure and pain sensation)
- Nutritive to cementum and bone
- Formative as contains cementoblasts
- Resorptive as severe pressure initiates osteoclasts
What is cementum?
A mineralised layer of connective tissue that covers the root of the tooth
Components of mature cementum = collagen fibres, mineralised portions (hydroxyapatite crytsals - calcium and phosphate), vessels, adn innervation (contains NO blood vessels or nerves)
What are the two types of cementum?
- Acellular
Attaches tooth to the alveolar bone, contains no living cells within mineralised form, thickness ranges from 30 - 60 microns - Cellular
Contains cementoblasts and fibroblasts within mineralised tissue, deposited trhoughout life, thickness ranegs from 150 - 200 microns
What is the alveolar bone?
Part of the maxilla and mandible that form and support the sockets of the teeth
What is the function of the alveolar bone?
Supports and protects the roots of teeth
Remodels in response to mechanical forces and inflammation (alternating between bone formation and resorption)
What is the composition of the alveolar bone?
Major cell types
- Osteoblacts = bone-forming cells which produce bone matrix made up of collagen and other protein fibres
- Osteoclasts = bone eating cells that remove mineral materials and matrix of alveolar bone
Extracellular matrix
- Collagen fibres and gel-like subtance
- Calcium and phosphate (hydroxyapatite) are deposited to mineralise bone matrix and make bone rigid
What are the histological characetristics of healthy periodontium?
- Juncitonal epithelium is firmly attached by hemidesmosomes to the enamel slightly coronal to the CEJ
- Periodontal ligament fibres are intact bundles that extend between bony walls of tooth socket to cementum of the root
- Alveolar bone and gingival fibres are intact
How can you describe healthy gingiva?
Three Cs = Colour, Contour, Consistency
Colour = Pink, pigmented, eerthematous, cyanotic
Contour (ginigival margin) = knife-edge, bulbous, receded, rolled, scalloped
Contour (interdental) = pyramidal, bulbous, blunted, cratered
Consistency = firm, spongy, retractable, shiny, fibrotic
What are 5 common misconceptions about ageing?
- Tooth less is an inevitable part of the normal ageing process
- Most teeth are lost as people become “long in the tooth” because of advancing periodontal disease
- All adults are susceptible to severe periodontal disease
- Dental caries is not a common oral disease in older patients and occurs mainly in the young
- Salivary flow is decreased in all older adults
