Periodontal Health- Gingival Disease/Conditions Flashcards
In looking at the gingiva, its either:
in health or disease
Periodontal Health- What is the importance?
to find the common reference point for assessing disease and determining the meaningful treatment outcomes
The portion of the gingival surrounding the neck of the tooth:
marginal/free gingiva
Describe the attachment of marginal/free gingiva:
not directly attached to the tooth
Marginal/free gingiva forms the:
soft tissue wall of the gingival sulcus
Marginal/free gingiva extends from the:
gingival margin to the gingival (marginal) groove
The space bounded by the tooth and the free gingiva:
Gingival sulcus
The gingival sulcus has ___ at its base
junctional epithelium
The gingival sulcus is comprised of _____ epithelium
non-keratinized
No _____ are present within the gingival sulcus
rete pegs
The gingival sulcus is considered a ____ membrane
semi-permeable
Portion of the gingival that extends apically from the area of the free gingival groove to the mucogingival junction:
attached gingiva
The attached gingiva is normally covered by:
keratinized epithelium with rete ridges
There is no ____ present within the attached gingiva
submucosa
The attached gingiva is bound to the:
underlying tooth and bone
Portion of the gingiva that extends between the teeth:
interdental gingiva
Includes the Col area which is composed of a non-keratinized stratified squamous epithelium in the interproximal space
Interdental gingiva
Describe the gingival col
area composed of non-stratified squamous epithelium in the interproximal space
What is the cellular makeup of the gingival col?
non-stratified squamous epithelium
The gingival col is found in what area of gingiva?
interdental gingiva
Microscopic features of the anatomy of the periodontal includes: (3)
- oral epithelium
- sucular epithelium
- junctional epithelium
The oral epithelium is comprised of:
keratinized stratified squamous epithelium
Describe the turnover rate of the oral epithelium:
turnover rate of 30 days
The sulcular epithelium is comprised of:
non-keratinized stratified squamous epithelium
Rete pegs are present in the sulcular epithelium. The sulcular epithelium is considered a semi-permeable membrane.
first statement false; second statement true
The junctional epithelium is comprised of:
non-keratinized stratified squamous epithelium
The junctional epithelium is attached to the tooth with:
hemidesmosomes
The junctional epithelium can be infiltrated by:
PMNs
Describe the rate of turnover for the junctional epithelium:
high rate of turnover (7-10 days)
- keratinized epithelium
- rete pegs present
- resistance to forces from mastication
Oral epithelium
- non-keratinized epithelium
- no rete pegs present
- semi-permeable membrane
sulcular epithelium
- non-keratinized epithelium
- hemi-desmosomal and non-collagenous proteins attachment
- attachment on the tooth is normally at or near the CEJ
- can be infiltrated by PMNs
Junctional epithelium
- diffuse amorphous ground substance
- collagen fibers
- blood vessels in the papillary projections of the connective tissue
gingival connective tissue
_____ form the connective tissue attachment of the junctional epithelium
densely packed collagen fibers
The stability of this attachment is a key factor in the limitation of the migration of the junctional epithelium:
Connective tissue attachment
The stability of the connective tissue attachment is a key factor in the limitation of:
migration of the junctional epithelium
The term “biologic width” has been replaced with:
supracrestal tissue attachment
Supracrestal tissue attachment (biologic width) is made up of:
Junctional epithelium (0.97mm) + connective tissue attachment (1.07mm) = 2.04 mm
When plaque is present, the epithelium lining the sulcus is prone to:
invasion by bacteria and their byproducts due to the nature of the type of epithelium
If plaque is present, the epithelium lining the sulcus is prone to invasion by bacteria and their byproducts due to the nature of the type of epithelium. Therefore:
inflammation can initiate and cause the clinical signs of gingivitis, which can progress to periodontitis if left untreated
Features of gingiva (to be noted): (7)
- color
- contour
- consistency
- shape
- size
- surface texture
- position
The color of the attached and marginal gingiva displays a range from:
brown to orange to pink
The color of the attached and marginal gingiva is dependent upon:
- vascular supply
- thickness
- degree of keratinization of epithelium
- pigment-containing cells
The color of the attached and marginal gingiva varies among different ___ and correlated with ____.
persons; cutaneous (skin) pigmentation
In the following images, the marginal and attached gingiva are _____ and the alveolar mucosa is ______.
coral pink; red/smooth/shiny
The contour of the gingiva should be:
scalloped and collar-like
In regards to the contour of the gingiva, the gingival level is higher:
interproximally
What is indicated by the arrows in the following image? What type of gingiva comprises this area?
interdental papilla (formed by attached gingiva)
The shape of the interdental gingiva is governed by the:
contour of the proximal tooth surfaces and location and shape of the gingival embrasures
The size of the gingiva should correspond with the sum total of the:
bulk of cellular and intercellular elements & vascular supply
Healthy gingival consistency should be described as:
firm and resilient
What contributes to the firmness of the gingival margin?
gingival fibers
In regard to surface texture, the attached gingiva is ____; the marginal gingiva is ____
stippled; not
Stippling varies with ___.
age
- absent during infancy, it appears in some children at the age of 5, and increases in adulthood, and frequently begins to disappear during old age
Stippling is less prominent on the ____ than the ____ surfaces and may be absent in some persons.
lingual; facial
Microscopically, stippling is produced by:
alternate rounded protuberances and depressions in the gingival surface
Describes the level to which the gingival margin is attached to the tooth:
position
The absence of clinically detectable inflammation within the gingiva:
gingival health
Microbial determinants of gingival health: (2)
- supragingival plaque
- subgingival plaque
Host determinants of gingival health: (2)
- Local predisposing factors
- Systemic modifying factors
List some LOCAL predisposing factors that contribute to gingival health: (4)
- periodontal pockets
- restorations
- root anatomy
- tooth position & crowding
List some SYSTEMIC modifying factors that contribute to gingival health: (3)
- host immune function
- systemic health
- genetics
Environmental Determinants of gingival health: (4)
- smoking
- medication
- stress
- nutrition
What might be some ways to determine gingival health?
- bleeding upon probing
- periodontal probing
- radiographic features
- tooth mobility
T/F: Periodontal probing is inadequate for diagnosis when used alone
True
T/F: Ideally, the lamina dura is 4mm from the most coronal part of the alveolar crest to CEJ
False- 2 mm
T/F: Tooth mobility is recommended as a singular means of diagnosis
false
T/F: Gingival health can be attained following treatment of gingivitis
True
The treated and stable periodontitis patient with current gingival health still remains at an increased risk for:
recurrent periodontitis
Classify the category of periodontal health:
- total absence of clinical inflammation and physiological immune surveillance with no attachment or bone loss
Pristine Periodontal Health
Classify the category of periodontal health:
- Absence or minimal levels of clinical inflammation with no attachment or bone loss
Clinical Periodontal Health
Classify the category of periodontal health:
- Absence or minimal levels of clinical inflammation in a reduced periodontium
Periodontal Disease Stability
Classify the category of periodontal health:
- Absence or minimal levels of clinical inflammation in a reduced periodontium with previous inflammation and disease
Periodontal Disease Remission/ Control
What are the 2 main categories of gingivitis:
- dental plaque-induced gingival diseases
- non-dental plaque-induced gingival diseases
_____ is the MOST common form of periodontal disease
Gingivitis
Signs and symptoms a patient with gingivitis may experience include: (4)
- bleeding when brushing
- blood in saliva
- gingival swelling and redness
- halitosis
For a patient with gingivitis, what are some of the clinical findings at the dental exam? (2)
- bleeding upon gentle probing
- change in gingival clinical features such as color, contour, shape, size, consistency, surface texture, and/or position
One of the early clinical signs of a patient with gingivitis, prior to color change or other visual signs of inflammation:
Bleeding on probing
_______ is an excellent negative predictor of future attachment loss
Absence of BOP
____ masks BOP by suppressing the inflammatory response
smoking
Smoking masks BOP by suppressing:
the inflammatory response
Color is an important clinical sign of gingival disease and can present in the following locations/ ways: (4)
- marginal
- patch-like
- generalized
- localized
What colors are associated with gingivitis? (4)
- pale
- red
- bluish-red
- whitish gray
The changes in consistency of the gingiva with gingivitis are resulting from:
predominance of destructive and reparative processes
List some of the CHRONIC forms of consistency associated with gingivitis: (3)
- soggy puffiness
- softness & friability
- firm & leathery
List some of the ACUTE forms of consistency associated with gingivitis: (3)
- sloughing with grayish, desquamative debris
- vesicle formation
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