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BDS2 BAMS > Periodontium > Flashcards

Periodontium Flashcards

1
Q

what is periodontium?

A

tissues surrounding and supporting the teeth

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2
Q

functions of periodontium? (3)

A
  • retain tooth in socket
  • resist masticatory loads (resist and relieve, transfer pressure onto periodontium bone)
  • defensive barrier, protecting tissues against threats from oral environment
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3
Q

how much micro bacteria in each drop of saliva?

A

10^6

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4
Q

what do we aim to treat in periodontal disease?

A

junctional epithelium

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5
Q

what is unique about junctional epithelium?

A

it is a physical barrier that is the only breach in the body’s surface
(where teeth pass through the oral epithelium)
- separates the body tissues from oral environment

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6
Q

2 divisions of periodontal disease

A
  • diseases of the gingiva alone

- diseases of all periodontal tissues

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7
Q

gingival periodontal disease identified by….

A

no pocket present

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8
Q

periodontal tissue disease identified by….

A

pockets (more than 3.5mm)

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9
Q

what is a sulcus?

A

a pocket

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10
Q

where is cementum?

A

covers root dentine

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11
Q

what is cementum structure like? (2)

A

very similar in structure to bone
- lamellar arrangement compared to radial arrangement of bone
collagen matrix

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12
Q

difference between cementum and bone structure

A

cementum is lamellar arrangement whereas bone is radial arrangement in general

  • cementum is always linear
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13
Q

function of cementum

A

provides attachment for some periodontal fibres

- anchor for periodontal fibres

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14
Q

2 types of cementum

A

cellular cementum

acellular cementum

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15
Q

what lays down cementum?

A

cementocytes

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16
Q

acellular cementum characteristics

A

no cells within
usually adjacent to dentine
first formed (primary cementum)

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17
Q

cellular cementum

A

contains cementocytes
later formed (secondary cementum)
present in apical part of root and in furcation regions

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18
Q

why do we need to know where the different types of cementum are?

A

When doing root scaling different response in different regions due to different cementum types

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19
Q

alternative classification for acellular cementum

A

acellular extrinsic fibre cementum

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20
Q

alternative classification for cellular cementum

A

cellular intrinsic fibre cementum

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21
Q

acellular extrinsic fibre cementum characteristics (3)

A
  • collagen fibres from PDL (Sharpey’s fibres)
  • equivalent to primary acellular cementum
  • present on cervical 2/3 of roots
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22
Q

cellular intrinsic fibre cementum characteristics (5)

A
  • no Sharpey’s fibres
  • intrinsic collagen fibres parallel to surface (run alongside)
  • equivalent to secondary cellular cementum
  • no role in tooth attachment
  • may represent a transitional form
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23
Q

why do furcation regions and apex of roots need newly formed cellular cementum?

A

Furcation and apex of roots needs newly formed cementum needed to overcome tooth wear - counteracted by slight tooth eruption so cementum created at apex

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24
Q

why does acellular cementum provide?

A

anchorage of teeth

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25
Q

why is periodontal treatment less successful in furcation and apical areas?

A

as less Sharpey’s fibres are present

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26
Q

what forms the inner lining of tooth socket?

A

‘cortical plate’

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27
Q

what are functions of alveolar bone?

A

suports the teeth

provides attachment for periodontal ligament fibres (‘Sharpey’s fibres’)
- transfer of forces from teeth to bone, needs cushion to prevent bone damage as bone softer than teeth

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28
Q

why is there a need for periodontium?

A

to transfer of forces from teeth to bone, needs cushion to prevent bone damage as bone softer than teeth

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29
Q

what penetrates alveolar bone?

A

nutrient canals

- Volkmann’s canals

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30
Q

what is the inner bone of alveolar bone like?

A

inner ‘cancellous’ bone, containing marrow

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31
Q

what happens to the alveolar bone when teeth are lost?

A

alveolar process is resorbed, leaving a ‘residual ridge’

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32
Q

what 5 things are in periodontal ligament?

A
  • cells
  • extracellular matrix
  • fibres (collagen, Sharpey’s fibres)
  • nerves
  • blood vessels
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33
Q

What are the 3 things in the periodontal ligament matrix (ground substance)?

A
  • hyaluronate GAGs
  • Glycoproteins (fibronectin)
  • proteoglycans (proteodermatan sulphate, chondroitin/dermantan SO4 hybrid)
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34
Q

what glycoprotein is in PDL ground substance?

A

fibronectin

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35
Q

what proteoglycans are in the PDL ground sunstance?

A

proteodermatan sulphate

chondroitin/dermantan SO4 hybrid

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36
Q

properties of the PDL ground substance

A

viscoelastic gel

  • like glue/jelly due to proteins infrastructure
  • capacity to regain shape, bounce back
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37
Q

what can periodontal disease cause to happen to the PDL ground substance?

A

loss of viscoelastic gel property

38
Q

bacteria relationship with PDL ground substance?

A

become specialised to aggregate around chemicals in PDL ground substance - use as a way of living

39
Q

what type of bacteria harbour in PDL ground substance?

A

anaerobic or facultative (do not need O2)

- use proteins for energy (not glucose), hinder viscoelasticity

40
Q

5 types of cells in PDL

A 
fibroblasts 
cementoblasts
osteoclasts and cementoclasts
epithelial cells 
defence cells
41
Q

fibroblasts role in PDL

A

needed to create and maintain infrastructure

42
Q

cementoblasts role in PDL

A

need to create cementum

43
Q

osteoclasts and cementoclasts role in PDL

A

break down - reorganise and destroy bone

44
Q

epithelial cells role in PDL

A 
cell rests (or debris) of Malassez
- important, many functions including in pathological situations e.g. cysts
45
Q

importance of cell rests (or debris) of Malassez in PDL

A

have many functions including in pathological situations e.g. cysts

46
Q

defence cells role in PDL

A

PDL has a link to autoimmune diseases - body destroying itself

47
Q

2 classes of nerves in PDL

A

sensory - mechanoreceptors and nociceptors

autonomic (sensory)

48
Q

sensory nerve types in PDL

A

mechanoreceptors (A beta and A delta fibres)

nociceptors (A delta and C fibres)

49
Q

mechanoreceptors in PDL role

A

rapidly or slowly adapting

proprioception; chewing control (different forces and resistance applied to hard Vs soft foods)

50
Q

nociceptors in PDL role (4)

A
  • protective reflexes - recognise harm (jaw jerk reflex)
  • inhibit jaw elevator motor neurons
  • autonomic (sympathetic)
  • blood vessel control - vasoconstriction
51
Q

importance of PDL in relation to denture work

A

can have different ‘taste’ due to difference in mastication process
- no PDL in denture - lose ability to recognise food and harm as no nerves (mechano/nociceptors)

52
Q

autonomic (sympathetic) blood vessel control in PDL role

A

Blood vessel control is a way of removing LA from area
- So reduce clearance of LA from area when vasoconstrict so less LA needed for longer period of anaesthesia

Problem as reduced blood flow
- not wanted in some cases,
- here non vasoconstrictors LA used to maintain blood flow
ID block tries to block LA to core nerves

53
Q

2 PDL blood supplies

A

from inferior and superior alveolar arteries
- passing into PDL from alveolar bone

from lingual and palatine arteries
- supplying gingivae

54
Q

what is true periodontal ligament?

A

fibres connecting tooth to bone or apical to alveolar crest

55
Q

what is gingival ligament?

A

fibres mainly above the alveolar crest, including ‘free gingival’ fibres

arranged in a way to create infrastructure for gingival attached to bone or tooth or bone and tooth

56
Q

2 functions of periodontal ligament

A

attaches tooth to jaw

transmits biting forces to alveolar bone (from tooth to bone)

57
Q

2 physical characteristics of periodontal ligament

A

organised (regular) connective tissue

width of PDL is approx. 0.2mm - variable

58
Q

3 fibre types potentially in PDL

A

collagen (types I and III)
oxytalan fibres
(elastic fibres)

59
Q

role of collagen fibres in PDL

A

principal fibres - true periodontal ligament

support tooth; load bearing

diseases can affect specific types of collagen
(types I and III in PDL)

60
Q

role of oxytalan fibres in PDL

A

present in humans but no clear repsonse so function is uncertain

61
Q

role of elastic fibres in PDL

A

absent in human PDL

but used in animal research testing

62
Q

2 main principal PDL fibre groups

A

alveolo-dental ligament

interdental ligament

63
Q

5 types of alveolo-dental ligament

A
  • aleveolar crest
  • horrizontal
  • oblique
  • apical
  • interradicular
64
Q

alveolar crest ligament location and role

A

parallel upwards slant to crest
stretch when tooth goes upwards
function more bearing than energy

65
Q

horizontal ligament location and role

A

rotational activity

below alveolar crest ligament

66
Q

oblique ligament location and role

A

transfer force from tooth to bone

downwards slant from bone to tooth in mid root area

67
Q

apical ligament location and role

A

coil like receiving force

apex of tooth root

68
Q

interradicular ligament role

A

only in multi-rooted teeth

69
Q

interdental ligament type

A

transseptal fibres

70
Q

trasnseptal fibres role

A

connects tooth to tooth - important as not connected to bone

71
Q

role of gingival fibre groups

A

support free gingivae

- not connecting bone to tooth (but each separately

72
Q

where is gingival fibre groups present?

A

in lamina propria in marginal gingiva

73
Q

4 types of gingival fibre groups

A

dento-gingival
alveolo-gingival
dento-periosteal
circular

74
Q

what does dento-gingival fibres connect?

A

tooth to gingiva

75
Q

what does alveolo-gingiva fibres connect?

A

bone to gingiva

76
Q

what does dento-periosteal fibres connect?

A

tooth to periosteum

77
Q

what does circular fibres do?

A

around the tooth
creates a supportive structure for gingiva
- important in gingival disease

78
Q

3 gingiva classes

A

free gingiva
attached gingiva
alveolar mucosa

79
Q

what separates the 3 gingiva classes

A

border lines

free gingival groove
mucogingival line

80
Q

sulcular epithelium

A

epithelium that is covering the gingival surface
apically bounded by the junctional epithelium and meets the epithelium of the oral cavity at the height of the free gingival margin
- nonkeratinised

81
Q

junctional epithelium role

A

connects epithelium to enamel

82
Q

specail arrangement of junctional epithelium

A

hemidesosomes on one side
basal layers on both sides
- creates appropriate environment for enamel connection

83
Q

regeneration of junctional epithelium

A

throughout the lost space, thus reducing the loss of epithelium attachment

junctional epithelium is elongated - tissue regeneration to treat

84
Q

what is the Interdental Col?

A

area between 2 teeth that are protected by contact points

85
Q

specialisation of interdental col

A

epithelium is non keratinised

because no loading forces of mastication

86
Q

what is the PDL response to loading?

A

PDL is mostly subjected to intrusive forces
- mastication
- swallowing
- speech
- parafunction (e.g. clenching, grinding)
teeth are rarely subjected to extrusive and horizontal forces
- sticky foods, orthodontic forces

87
Q

what forces are mainly put on teeth?

A

intrusive

  • mastication
  • swallowing
  • speech
  • parafunction (e.g. clenching, grinding)
88
Q

what forces are rarely put on teeth?

A

teeth are rarely subjected to extrusive and horizontal forces
- sticky foods, orthodontic forces

89
Q

what do loads applied to tooth do?

A

push the tooth into the socket

90
Q

steps in tooth and PDL loading

A
  • initial elastic component
  • later, viscous ‘creep’ - due to viscoelastic properties
  • tension in PDL fibres
  • compression of ECF

BDS2 BAMS (54 decks)

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