Periodontology Flashcards
Biological Width
Distance from the alveolar crest to the junctional epithelium and connective tissue attachment of the root surface
- at least 2mm of vertical space is needed for a restoration to be successful without damage to periodontium
Free Gingiva
Located at the crest of alveolus, not attached, outer boundary of sulcus
Free Gingival Groove
Slight depression that separates free and attached gingiva
Attached Gingiva
Located below free gingival groove, lies over underlying bone
Connected to cementum and periosteum
Keratinized tissues
Mucogingival Junction
Apical boundary where the attached gingiva (keratinized) meets the alveolar mucosa (non-keratinized)
Alveolar Mucosa
Located below mucogingival junction
Sulcular Epithelium
Non-Keratinized
lining of free gingival sulcus
extends from crest of gingival margin to junctional epithelium
Permeability allows GCF to flow through
Junctional Epithelium
forms the base of the sulcus and provides a seal between gingiva and tooth surface
Non-keratinized
Alveolar Crest Fibers
from cementum at apex to base of socket
PDL
Circular Fibers
encircles tooth like a ring, not attached to cementum or bone
gingival
Horizontal Fibers
extend at right angles to long axis of tooth
PDL
Oblique Fibers
from cementum in a coronal direction to bone
withstands masticatory stress in a vertical direction, largest and most significant fiber group*
PDL
Intergingival Fibers
extends in a mesiodistal direction
links adjacent teeth in arch
gingival
Interradicular Fibers
ONLY in multirooted teeth
extend from cementum at furcation to bone in furcation area
PDL
Interpapillary Fibers
connects interdental papillae of posterior teeth
gingival fiber
Transgingival Fibers
from the cementum near the CEJ and runs horizontally
links adjacent teeth in arch
gingival fiber
Transseptal Fibers
from cementum of one tooth over crest of alveolar bone to the cementum of adjacent tooth
connects adjacent teeth
fibers adjusted during orthodontic tx*
gingival fiber
Col
nonkeratinized tissue located between lingual and facial papillae
Epithelial Attachment
located at base of the sulcus where epithelium attaches to tooth
Functions of the Periodontal Ligament
Supportive - resist the impact of occlusal forces, shock absorber*
Sensory
Nutritive
Formative
Resorptive
Attach cementum to bone by Sharpeys Fibers
NOTE: PDL has nerve endings but no blood vessles
Most prominent cell type in PDL?
Fibroblasts
responsible for collagen synthesis and degradation
Cementum Formation
Arranged in layers (lamellae)
made up of hydroxyapatite crystals
frequently overlaps enamel
Receives nutrients from PDL, has no blood vessles or nerves
Acellular Cementum
Coronal
no cells present
contain calcified Sharpeys fibers
Cellular Cementum
Apical
contains cells
less calcification and fewer sharpeys fibers
CEJ Orientations
Overlap: cementum overlaps enamel in 60-65% of cases
Meets: Cementum meets enamel in 30% of cases
Gap: cementum and enamel dont meet - dentin is exposed in 5-10%
Alveolar Bone
Bone that surrounds and supports roots of the teeth
Alveolar Bone Proper
thin layer of bone lining the tooth socket
radiographically called lamina dura
Alveolus
hole in bone containing the tooth root
Cortical Bone
Compact hard bone
thicker in the mandible
comprises the facial and lingual aspects of alveolar bone
Cancellous Bone
Porous spongy bone
fills interior of alveolar process
contains many holes allowing blood vessels to travel
Alveolar Crest
most coronal portion of alveolar process
2mm apical to CEJ in health
Periosteum
connective soft tissue covering outer bone surface
Endosteum
Connective tissue covering inner bone surface
Osteoblasts
Build/make bone
Osteoclasts
Crush/resorb bone
Clinical Signs of Acute Gingivitis
Bleeding
Erythema (red. inflammed)
soft, stippled gingiva
Edematous consistency
Clinical Signs of Chronic Gingivitis
Bleeding
Fibrotic
stippled, hard gingiva
Suprabony Pocket
base of pocket is coronal to alveolar bone
Infrabony Pocket
Base of the pocket is apical to the crest of alveolar bone
What is the Cause of Gingivitis?
ulceration of the sulcular lining/base of the sulcus
Clinical Signs of Periodontitis
dark blue/purple
edamatous, smooth tissue
swollen gingival margin
BOP
4mm+ pocket depths
loss of CAL
Bacteria Associated with Periodontitis
P. gingivalis
T. forsythia
T. denticola
P. intermedia (pregnancy perio)
Which Medications are Used to Control Periodontitis?
tetracycline
chlorohexadine
metrondiazole
Microbes Necrotizing Periodontal Disease?
(NUG and NUP)
Spirochetes
Vibrios
Medications for Necrotizing Periodontal Disease?
(NUG and NUP)
Tetracycline
Antibiotic therapy
Necrotizing Ulcerative Gingivitis
(NUG)
- characteristic, symptoms
Primary sign: punched out papillae
affects interdental gingiva
strong odor
Symptoms: pain, fever, swollen lymph nodes, malaise
*in clients with no known systemic disease or immune dysfunction
Necrotizing Ulcerative Periodontitis
Similar to NUG
rapid loss of bone and soft tissue
occurs in immunocompromised patients
AAP Classification Periodontal Health
pink, firm, stippled gingiva
no BOP
1-3mm pockets
alveolar crest 2-3mm apical to base of CEJ
Gingivitis Modifying Factors
(5)
Sex steroid hormone
Puberty
Menstrual cycle
pregnancy
oral contraceptive
Plaque-Induced Gingivitis Exacerbating Conditions
(4)
hyperglycemia (T1 diabetes)
Leukemia
Smoking
Malnutrition
Infections/Disease Affecting Non-Plaque Induced Gingivitis
(5)
NUP
Cocksakie Virus
HPV
Herpetic Gingivostomitis
Candidiasis
Squamous Cell Carcinoma
Stage 1 Periodontitis
MILD DISEASE
Probe depth ≤4mm
CAL ≤1-2mm
horizontal bone loss
Non-surgical tx
Stage 2 Periodontitis
MODERATE DISEASE
Probe Depths ≤5mm
CAL ≤3-4mm
horizontal bone loss
non-surgical and surgical tx
Stage 3 Periodontitis
SEVERE DISEASE
Probe depths ≥6mm
CAL ≥5
Vertical bone loss
May be Class 1 or 2 furcations
≤4 teeth lost
Surgical tx
Stage 4 Periodontitis
VERY SEVERE DISEASE
Probe depths ≥6mm
CAL ≥5mm
5+ teeth lost
surgical and multi-specialty tx
*remains a stage 4 for life, S1-3 can become stable on a reduced periodontium
Grade A Periodontitis
No bone loss over 5 yrs
<0.25% bone loss/age
heavy biofilm, low destruction
Non-Smoker
No diagnosis of diabetes
Grade B Periodontitis
<2mm over 5 years
0.25%-1.0% bone loss/age
<10 cigarettes/day
Hb1c <7.0% in patients with diabetes
Grade C Periodontitis
≥2mm over 5 years
1.0%+ bone loss/age
≥10 cigarettes/day
Hb1c ≥7.0% in patients with diabetes
Periodontitis as a Manifestation of Systemic Disease (AAP)
*Down syndrome: higher prevalence and severity
*Papillon-Lefevre Syndrome: early onset, early loss of dentition
Congenital Neutropenia: severe
Systemic Lupus Erythematous: oral ulcers and increased prevalence
Primary Occlusal Trauma
injury resulting in tissue changes from excessive occlusal force on a tooth/teeth with normal periodontal support
Secondary Occlusal Trauma
injury resulting in tissue changes from excessive occlusal force on a tooth/teeth with reduced periodontal support
Systemic Diseases Affecting Periodontal Supporting tissues
Diabetes
Obesity
HIV
Arthritis
Tobacco
Peri-Implant Health
Absence of bleeding and inflammation
no tx
Peri-Implant Mucositis
Bleeding and Inflammation
caused by plaque
can be reversed
Peri-Implantitis
plaque-associated
inflammation, loss of supporting bone
irreversible if left untreated for too long
Primary Factor in Reduction of Gingival/Periodontal Diseases?
Plaque Control
Mineralization of Sub vs Supra Calculus
Supra: mineralized by saliva
Sub: mineralized by GCF
Tobacco Use
most significant risk factor of periodontal disease
gingiva can appear healthy
smoking does not increase risk of caries
not associated with hairy leukoplakia
Medications Causing Gingival Enlargement (3)
Phenytoin
Cyclosporin
Nifedipine
Type 1 Embrasure
Interdental papillae fills the space
can be cleaned with floss
Type 2 Embrasures
interdental papillae does not fill space
can be cleaned with tufted floss, interdental brush, wooden wedge, end tuft brush, toothpick
Type 3 Embrassures
interdental papillae is missing
cleaned with tufted floss, interdental brush, wooden wedge, end tuft brush, toothpick
Pseudopocket
Caused by gingival inflammation without loss of attachment
tx: gingivectomy
Grade 1 Mobility
<1mm in a buccolingual direction
Grade 2 Mobility
>1mm buccolingual but <2mm in a horizontal direction
Grade 3 Mobility
>2mm horizontal or vertical, can depress tooth in socket
Fremitus
Visible movement or vibration of tooth when in function, assessed by tapping instrument or placing finger while pt bites together
Class 1 Furcation
curvature of concavity can be detected with probe tip, but cannot enter the space
Class 2 Furcation
Probe enters furcation >1mm but does not pass through other side
Class 3 Furcation
Probe tip enters furcation and passes through other side
Class 4 Furcation
Visible entry of probe completely passing through furcation due to recession
How to Measure CAL
In recession ⇒ probe depth + measurement between gingival margin and CEJ
In tissue overgrowth ⇒ probe depth - measurement between gingival margin and CEJ
Dehiscence
loss of alveolar bone on the facial aspect of a tooth that leaves a root exposed defect from the CEJ apically
can be 1 or 2mm long, or the length of entire root
Fenestration
“window” of bone loss on the facial or lingual aspect of a tooth that places the exposed root surface directly in contact with the gingiva or alveolar mucosa
bordered by alveolar bone along its coronal aspect
Gingival Abscess
abscess limited to the gingival margin or interdental papilla
results from the injury to or infection of surface gingival tissue
Periodontal Abscess
usually occurs with pre existing periodontal disease
results when infection spreads deep into the periodontal pockets and drainage is blocked
may develop due to incomplete scaling
Pericoronal Abscess
flap of tissue called operculum, usually on distal of 8’s
Streptococci milleri are usually involved
develops and inflammed dental follicular tissue overlying the crown of a partially erupted tooth
Non-Surgical Periodontal Therapy
Patients with periodontal disease
Goals: reduce pathogens, address risk factors, arrest disease
- scaling and root planning
- periodontal debridement
- full mouth disinfection
Periostat
delivery of a 20mg capsule of doxycycline hyclate (oral administration)
Arestin
microspheres of minocycline are directed into pocket by cannula tip
Atridox
doxycycline gel inserted in pocket by cannula tip
gel dissolves
do not brush or floss site for 7 days
Periochip
chlorohexadine chip is inserted into pocket
pocket must be at least 5mm
chip dissolves
do not floss site for 10 days
Tetracycline HCL Fibers
tetracycline soaked cord is packed inside the pocket and retained with adhesive
time consuming, can be uncomfortable for patient
Osseous Flap Surgery
gums are lifted away from the tooth to allow access to deep clean the root surface
gum tissue is replaced to minimize pocket depth
Gum / Connective Tissue Graft
tissue is harvested from a donor site such as the palate, then placed on the desired area to provide strength and cover exposed root surfaces
can reduce sensitivity
Gingival Currettage
removes soft tissue lining of the periodontal pockets in order to eliminate bacteria and diseased tissue
can be used with scaling and root planning
Gingivectomy
pocket reduction by excision of the soft tissue pocket wall
Gingivoplasty
reshaping of gingiva to obtain better contours
Osseous Surgery
reshape alveolar bone for better contour
flap surgery may be used in conjunction
Allograft
from human cadaver
Alloplastic
synthetic material
Xenograft
from another species (usually cow)
Guided Tissue Regeneration
fabric is sewn into bone
gingiva is then sewn into fabric to prevent gum tissue from growing down
Crown Lengthening
excess gum and bone tissue are reshaped to expose more of the natural tooth
Fibrosis
results in an increase in cellular components, a hallmark sign of chronic inflammation
Hypertrophy
gingival enlargement due to an increase in cell size
Hyperplasia
gingival enlargement due to an increase in cell number
Endodontic Periodontal Lesions Treatment
DO NOT SCALE
refer to periodontist
Sulcular Fluid
cleanses the sulcus
a source of nutrients for subgingival bacteria
flow is minimum to absent in health
Rete Pegs
epithelial extensions that project into underlying connective tissue
increase strength between epithelium and connective tissue
NOTE: marginal tissue is not stippled
Masticatory Mucosa
KERATINIZED tissue
protect gingiva and hard palate
Lining Mucosa
NONKERATINIZED tissue
alveolar mucosa, soft palate, vestibule, buccal mucosa, sublingual area, sulcular and junctional epithelium
typically supports a removable partial denture
Specialized Mucosa
dorsum of the tongue
Connective Tissue
vascular, has nerve tissue
fibroblasts produce collagen and elastic fibers
encircles tooth
