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Oral Boards Fall 2021 > Previous Oral Boards Questions/Topics #1 > Flashcards

Previous Oral Boards Questions/Topics #1 Flashcards

1
Q

Name 3 adverse Pregnancy Outcomes with perio and proposed mechanisms

A
  1. Pre-term birth <37 weeks, very pre-term <32 weeks (Chambrone)
  2. Low birth weight <2500g and <1500g is very low birth weight (Offenbacher)
  3. Pre-eclampsia (Kunnen)

Mechanism: elevation of Prostaglandin E2 (PGE2) stimulating contraction of amniotic sac rupture. Increase in perio inflammation can increase prostaglandin in amniotic sac by 4x (Offenbacher)

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2
Q

Does the Junctional Epithelium move apically and why?

A

Yes

  • In the established and advanced lesion – the JE seen moving laterally and apically (Page & Schroeder)

This is due to the advancing plaque front (Waerhaug 0.5-2.7mm) and a retreat of the junctional epithelium

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3
Q

What are the 3 branches of the Trigeminal Nerve?

A

V1- Ophthalmic Nerve

V2- Maxillary Nerve

V3- Mandibular Nerve

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4
Q

What goes through the Superior Orbital Fissure?

Name if it is sensory or motor

A

V1 - Ophthalmic

Sensory

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5
Q

What does the Opthalamic Nerve Innervate?

A

Sensory innervation to the skin, mucous membranes and sinuses of the upper face and scalp

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6
Q

What goes through the Foramen Rotundum?

Name if it is sensory or motor

A

V2 - Maxillary nerve

Sensory

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7
Q

What does the Maxillary Nerve Innervate?

A

Sensory cutaneous innervation to the face

Parasympathetic preganglionic fibers (sphenopalatine) and postganglionic fibers (zygomatic, greater and lesser palatine and nasopalatine) to and from the pterygopalatine ganglion

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8
Q

What goes through the Foramen Ovale?

Name if it is sensory or motor

A

V3 - mandibular

  • Sensory and motor components
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9
Q

What does the Mandibular Nerve Innervate?

A

Anterior Division

  • Motor- Muscles of Mastication
  • Sensory– Buccal Nerve– Buccal Mucosa

Posterior Division

  • Motor
    • Inferior Alveolar Nerve Split
      • Mylohyoid
      • Digastric (Anterior Belly)
  • Sensory
    • Lingual Nerve
      • Anterior ⅔ of tongue (Mucous Membrane)
    • Inferior Alveolar Nerve Split
      • Teeth and Mucoperiosteum of Mandibular teeth
      • Chin and Lower Lip
    • Auriculotemporal Nerve
      • Scalp/temporal region
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10
Q

What bone of the skull does the Foramen Ovale go through?

A

Sphenoid Bone

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11
Q

How would you perform a V2 block (two ways)?

A
  1. Greater Palatine Nerve Block
  2. Gow Gates
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12
Q

Name this Disorder and list potential differential diagnosis

A

Mucous membrane pemphigoid (MMP)

Histo = subepithelial clefting and intact basal cells

Differential Diagnosis:

  • Pemphigoid
  • Pemphigus
  • Lichen planus
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13
Q
  1. Name this diagnostic test
  2. Name the disorder
  3. Name what is “glowing” in the picture
A
  1. Direct immunofluorescence (DIF)
  2. Mucous Membrane Pemphigoid
  3. Linear deposition of IgG, IgA, or C3 along the epithelial basement membrane
    * (C3 = Complement 3, protein in innate immunity)*
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14
Q

What kinds of solution do you use for biopsy and what does H&E stand for?

A
  1. Michels solution
  2. H&E = Hematoxylin and Eosin Staining
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15
Q

Explain how H&E staining works and what structures stain each color?

A

Hematoxylin can be considered as a basic dye It is used to stain acidic/ basophilic structures a purplish blue

  • Cell Nuclei

Eosin is an acidic dye: it is negatively charged It stains basic/ acidophilic structures red or pink also termed Eosinophilic

  • Cytoplasm and Extracellular Matrix
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16
Q

Where do you take a Biopsy?

A

Lesions itself and include normal tissue

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17
Q

Can Orthodontics be a cause of Occlusal Trauma? If yes, explain

A

Yes- Due to pressure and tension zones

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18
Q

Name factors that can affect PDL widening in Radiographs (5)

A
  1. Root morphology
  2. Bony crest morphology
  3. KvP (Kilovoltage peak) for density/contrast
  4. Exposure time
  5. X-ray tube angulation
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19
Q

Tell me 5 things that can be radioopaque in the mouth and tell me about one

A

1. Sialoliths: (Calcified mass causes blockage of salivary gland- More than 80% of occur in the submandibular duct or gland) Tx: salivary massage & increase salivary flow

2. Tori: Benign bone growth in mand- 90% are bilateral. Genetic or local stresses (bruxism). Usually asymptomatic. Removal w/ denture fabrication

3. Odontoma: Benign. Most common odontogenic tumor. Asymptomatic. From epithelial/mesenchymal components of dental apparatus– produce enamel/dentin. Females. maxilla. incidental finding on x-ray

4. Condensing Osteitis: Increase in bone density at tooth root that may result from tooth inflammation or infections. Mand Molars. Asymptomatic. Benign. Treat the cause (RCT or EXT)

5. Cementoblastoma: rare benign neoplasm of the cementum (< 1% odontogenic tumors). Derived from ectomesenchyme of odontogenic origin. well-defined, radiopacity with a surrounding peripheral radiolucent zone. Tx- excise the mass and ext tooth

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20
Q

What is Dysbiosis?

A

Microbial shift– concept that there is a decrease in the # of beneficial symbiotic bacteria and overgrowth of subgingival bacteria/ pathogens that are normally present in low numbers

As periodontitis develops, the oral microbiota shifts from gram-positive aerobes to gram-negative anaerobes

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21
Q

Name some ways bacteria help each other in a biofilm (5)

A
  1. Strep species enable P. gingivalis to adhere to biofilm
  2. P. gingivalis in biofilms decreases metabolic rate but increases in virulence
  3. F. Nucleatum can create a reduced micro-environment optimal for P. gingivalis growth
  4. T. denticola and P. gingivalis engage in “nutritional crossfeeding” where metabolites of one serve as food sources for the other
  5. Bacteria in biofilms are more resistant to phagocytosis
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22
Q

What is the difference between the Cairo and Miller classification for gingival recession?

A

Cairo –> based on attachment

Miller –> based on bone

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23
Q

How are Biofilms protective?

A
  1. Trap nutrients
  2. Engage in the primary production of their own nutrients
  3. Form a Nutritional Crossfeeding/digest consortium– by-products of one organism serve as nutrients for another
  4. Protect other bacteria from antibacterial agents and phagocytosis
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24
Q

What is the Miller Classification for Gingival Recession?

A

Class 1: Recession does NOT extend to or beyond the MGJ and no loss of interdental bone or soft tissue – expect full root coverage

Class 2: Recession which does extend to or beyond the MGJ and no loss of interdental bone or soft tissue – expect full root coverage

Class 3: Recession which does extend to or beyond the mucogingival junction and loss of interdental bone or soft tissue, teeth may be severely malposed – full coverage not expected

Class 4: severe recession which extends to or beyond the MGJ and loss of interdental bone or soft tissue, teeth may be severely malposed – root coverage not likely

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25
Q

What is the Cairo Classification for Gingival Recession?

A

1. RT1

  • Recession with no loss of interproximal attachment
  • Interproximal CEJ clinically non-detectable
  • Overlaps with MIller Class I and II
  • 100% root coverage anticipated/predictable

2. RT2

  • Recession with loss of interproximal attachment ≤ buccal CAL
  • Overlaps with Miller Class III
  • 100% root coverage can be achieved but not in every case

3. RT3

  • Recession with loss of interproximal attachment > buccal CAL
  • Overlaps with Miller Class IV
  • 100% root coverage is not achievable
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26
Q

Are junctional epithelium cells smaller or bigger

& are their attachments more or less numerous compared to the other oral epithelial layers?

A
  • 3-4 cell layers thick, only stratum basale and spinosum, short turnover
  • Cells are more cuboidal so larger cells but fewer cell layers
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27
Q

Explain how Obesity affects Periodontal Mechanisms?

A

Obesity causes an Increase in TNF-alpha and other inflammatory markers, decrease anti-inflammatory cytokines

Suvan: increase in adipocytes produce more TNF-alpha and IL-6 which increase systemic inflammation and insulin resistance

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28
Q

What is Beta- Lactamase and Clavulanic acid?

A

Beta-lactamase = enzymes produced by bacteria inactivate beta-lactam antibiotics by hydrolyzing the peptide bond of the beta-lactam ring provide multi- resistance to β-lactam antibiotics such as penicillins & cephalosporins

Clavulanic acid is a β-lactam drug that functions as a mechanism-based β-lactamase inhibitor. While not effective by itself as an antibiotic, when combined with penicillin-group antibiotics, it can overcome antibiotic resistance in bacteria that secrete β-lactamase, which otherwise inactivates most penicillins

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29
Q

Name everything about one antibiotic (be specific on mechanism of action) and how beta Lactamase and clavulanic acid works with that antibiotic

A

Amoxicillin-broad spectrum penicillin, interferes with the structural crosslinking of peptidoglycans in bacterial cell walls by cleaving the beta lactam ring (inhibiting cell wall cross linking causing cell death by osmotic lysis)

Clavulanic acid-has an unprotected beta lactam ring. Bacteria more attracted to beta lactam ring on clavulanic acid then amoxicillin so the amoxicillin can destroy the bacteria

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30
Q

What are some Mechanisms of Smoking’s effect on Periodontium?

A
  1. Increased Cytokines (Decrease IgG response)
  2. Reduced Oxygen tension
  3. Decreased Neutrophil chemotaxis
  4. Reduced Fibroblast proliferation
  5. Immunosuppression
  6. Toxins
  7. Increased Bacterial adhesion
  8. Vasoconstriction

CONFIT BV

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31
Q

What are the 2 Layers of Epithelium & what are the differences between them?

A

1. Gingival:

  • Thick periosteum
  • Less glycogen
  • No elastin
  • Layers: Basale, Spinosum, Granulosum, Corneum
  • Vessels: few and large

2. Oral Mucosa:

  • Thin periosteum
  • More glycogen
  • Elastin
  • Layers: Basale, Spinosum
  • Vessels: more and thin
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32
Q

What is the definition of Biological Width?

A

Supracrestal Attached Tissue: combined heights of the connective tissue and epithelial attachments to a tooth

  • Natural barrier that develops around the teeth and dental implants to protect the alveolar bone from disease and infection
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33
Q

What is the measurement of the Biologic Width (Supracrestal Attached Tissues) of Teeth & Implants?

A

Teeth: Approx 2mm: (Gargulio)

  • 0.97 mm JE
  • 1.07 mm CT
  • Average facial sulcus depth to be 1 mm, leading to a total average gingival height above alveolar bone of 3 mm on the facial (Gargulio)

Implants:

  • 1.8 mm JE
  • 1.05 mm CT
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34
Q

How do you measure Biologic Width/Supracrestal Attached Tissue?

A

1. Clinical Method: If Patient has tissue discomfort when restoration margin levels are assessed with a periodontal probe

  • Common signs of a width violation include BoP, chronic gingival inflammation around the restoration, gingival recession, formation of pockets, and alveolar bone loss.

2. Bone Sounding: Done when the patient is under local anesthesia, probing to the bone level and then subtracting the sulcus depth from the measurement. Should the distance be less than 2 mm in one or multiple locations, a biologic width violation is confirmed.

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35
Q

Tell me how long till dentist can take impression after crown lengthening and explain how you make sure you placed your tissue in the right spot

A
  • 6-8 weeks minimum (Deas and Powell)
  • To make sure you placed your tissue in the right spot– bone sound, want it within 3mm of bony crest (Penner)
  • Remains stable approx 93% of the time
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36
Q

Is a certain amount of Keratinized Tissue (KT) compatible with health and why?

A

2mm of KT is necessary for health (Lang)

2mm was but good OH you can maintain less than 2mm (Freedman and Wennstrom)

KT is the part of the oral mucosa that covers the gingiva and hard palate

  1. Extends from the free gingival margin to the MGJ and consists of the free gingiva and the attached gingiva.
37
Q

What is the Function of Keratinized Tissue (KT)?

A
  • The band of keratinized tissue around natural dentition and implants is vital in maintaining oral health, preventing gingival recession, and maintaining overall esthetics

Function

  • Provide increased resistance of the periodontium to external injury
  • Contribute to the stabilization of the gingival margin position
  • Aid in the dissipation of physiological forces exerted by the muscular fibers of the alveolar mucosa and the gingival tissues
38
Q

For interproximal Papilla fill– what does are the dimensions required for

  1. Interroot width
  2. Height
  3. Horizontal Component
A

1. Interroot width = Tarnow’s 5mm rule does not apply if interradicular distance is >2.4mm (Martegani)

2. Height = 5mm or less, you get 100% fill of papilla (Tarnow)

3. Horizontal Component = if the distance (H) is 3mm, papilla is always absent, papilla is always there if horizontal x vertical is: 1x5mm, 0.5x5mm, 1x4mm (Kolte)

39
Q

Name a Periodontal Prognosis System and Why?

A

Kwok and Caton - based on the probability of obtaining stability of the periodontal supporting apparatus –> disease progression related to local and systemic factors

40
Q

What is the Kwok and Caton Prognosis System?

A

1. Favorable

  • Comprehensive periodontal treatment and maintenance will stabilize the status of the tooth
  • Future loss unlikely

2. Questionable

  • Local or systemic factors influencing the periodontal status of the tooth may or may not be controllable
  • If controlled, the periodontal status can be stabilized with comprehensive periodontal treatment
  • If not, periodontal breakdown may occur

3. Unfavorable

  • Local or systemic factors influencing the periodontal status cannot be controlled
  • Comprehensive periodontal treatment and maintenance are unlikely to prevent future periodontal breakdown

4. Hopeless prognosis

  • Tooth must be extracted
41
Q

Is Bleeding on Probing (BoP) important and why (name author)

A

Absence of BOP is better prediction of absence of disease (Lang)

42
Q

Asthma - scenario how do you treat it?

A

Questions to ask → do you have an inhaler, when was last attack, have you ever been hospitalized, whats your triggers

Things to do, have them bring inhaler

2 puffs of albuterol inhaler

Acts on beta 2 adrenergic receptor in the lungs, smooth muscle bronchodilation

Epinephrine: 0.3-0.5mg 1:1000 IM

43
Q

What receptors does Epinephrine act on?

A

Adrenergic Receptors:

  • Alpha- 1 (smooth muscle contraction; vasoconstriction of blood vessels
  • Alpha- 2 (inhibition of insulin and the induction of glucagon release)
  • Beta- 1 (Increases cardiac output, by raising heart rate, increasing impulse conduction, and increasing contraction, thus increasing the volume increased ejection fraction)
  • Beta- 2 (Smooth muscle relaxation in lungs (bronchodilation) and the GI tract (decreased motility)
44
Q

4 types of allergic reaction?

A

ACID

A: Allergic/anaphylactic (type 1)

C: Cytotoxic (type 2)

I: Immune complex deposition (type 3)

D: Delayed (type 4)

45
Q

Name the PDL fibers and which is the most numerous

A
  1. Apical
  2. Oblique – Most Numerous
  3. Radicular
  4. Trans Septal
  5. Alveolar
  6. Horizontal

AORTA H

46
Q

What is a Retrocuspid Papillae and what is it histologically?

A

Excess tissue on the lingual side behind the canine (Hirshfild)

Normal anatomic variant, vascular because it blanches (Levin)

Histo: Elongated rete petes, more vasculature and inflammation

47
Q

The position paper by AAOM for bisphosphonate, oral bisphosphonate effect. Patient took it for 6 years. What is the risk and what would you do?

A

Inform patient that there is a low risk for MRONJ of the jaw due to her bisphosphonate use however, this would be much more of a issue if it was IV

AAOM = American Academy of Oral Medicine

MRONJ= Medication-related osteonecrosis of the jaw (MRONJ)

48
Q

Compare root canal to an implant, success failure, patient who is 50 y/0, furcation grade 2, #3. What would you recommend implant or RCT and why and what would you consider

A
  • First we need more information about the patient, whats their hygiene like, what is there goals for their teeth, etc
  • To maintain the tooth, we know that Ross and Thompson showed that in maxillary teeth with furcations, 88% of them were still functioning up to 25 years.
    • However, we need to consider the effect that a furcation may have on adjacent teeth
  • Ehnveid found that teeth with grade 2 and 3 furcations interproximally have negative effect on the peiro status of adjacent teeth
  • In an ideal world, important to tell the pt that once you ext the natural tooth you cant go back.
  • Torbinjad: Review article implant vs RCT vs FDP
    • In 6 years, similar success and survival rate but higher with implants
49
Q

What is Critical Probing Depth?

A

The probing depth at which treatment of deeper sites will result in gain of clinical attachment and treatment of shallower sites will result in loss of attachment.

  • CRP for SCRP =2.9mm (+0.04mm)
  • CRP for Modified Widman Flap/SCRP (aka doing surgery) = 4.2mm (+ 0.2mm)

In patients with poor plaque control, CRP was significantly higher for both sc/rp and surgery than for patients with good plaque control.

50
Q

Where does Azithromycin get concentrated? What cell mostly affected?

A

Concentrates in intracellular compartments mainly in phagocytic cells (macrophages and PMNs)

51
Q

The effect of vitality on regeneration. What would be a better response to regeneration, a vital tooth or a RCT tooth and why ?

A

Teeth that have been endo treated with no signs of pathology respond similar to regeneration (Kao, AAP regeneration workshop)

52
Q

What are the key colonizers?

A

Red Complex (associated with periodontitis)

  • Porphyromonas gingivalis
  • Tannerella forsythia
  • Treponema denticola

Orange Complex (associated with gingivitis)

  • Provetella intermedia
  • Peptostreptococcus micros
  • Fusobacterium nucleatum
  • Fusobacterium vincenti
  • Fusobacterium polymorphum
  • Camplyobacter species
53
Q

What is the role of Gingival Crevicular Fluid (GCF)?

A

Inflammatory exudate rich in proteins and other nutrients: maintaining the structure of JE and the antimicrobial defense of periodontium

Composition: Serum, tissue breakdown products, inflammatory mediators, and antibodies directed against dental plaque bacteria

Constituents derived from: Serum, CT, and epithelium through which GCF passes on its way to the crevice

54
Q

Does Gingival Crevicular Fluid indicate severity of disease?

A

No, GCF doesn’t indicate severity of disease (Hancock)

55
Q

What are the differences in Supragingival and Subgingival Calculus Content?

A

Supra-gingival calculus

  • HA (58%)
  • Mg whitlockite (21%)
    • More commonly found in posterior regions
  • Octacalcium phosphate (12%)
  • Brushite (9%)
    • Dominant form in newly formed supra-g calculus
    • Most commonly found in mand anterior regions

Detected most frequently: HA, octacalcium phosphate

Sub-gingival calculus:

  • Most often lingual and interproximal areas
    • Found half way down the defect (Richardson)
  • Harder (greater ratio of calcium to phosphate)
  • Darker (iron heme pigments assoc with bleeding of inflamed tissue, hemosiderin
  • Same HA content as supra-g, greater whitlockite content
56
Q

Talk about some components of Subgingival Calculus

A
  • Supragingival dental plaque at the gingival margin can grow into the gingival crevice and contribute to the development of the subgingival biofilm
  • Plaque mass is pinned between tooth and gingival wall as opposed to open environment there is no unoccupied space in a periodontal pocket
  • Bacteria are bathed in GCF and derive their proteins from it.
  • The plaque mass regrows in 2-3 days after removal which is much faster than supragingival plaque.
  • pH increases (6.9 to 8.6) with subgingival plaque due to the ammonium and urea products of protein breakdown
  • There is a significant decrease in oxidative-reduction potential (Eh) as the subgingival biofilm matures
  • Microorganisms such as spirochetes prefer an environment that has a low Eh and high levels of byproducts from necrotic cells
  • Toxicity of subgingival environment increases with time
57
Q

What is the Composition of calculus?

A

Inorganic (70-90%)

  • Calcium Phosphate: 76%
  • Calcium Carbonate: 3%
  • Magnesium Phosphate: Traces

Crystals

  • Hydroxyapatite (58%)
  • Magnesium Whitlockite (21%)
  • Octacalcium Phosphate (12%)
  • Brushite (9%)

Organic (10-30%)—the components of plaque that mineralize

  • (1) Protein-Polysaccharide Complexes
  • (2) Epithelial Cells
  • (3) Leukocytes
  • (4) Microorganisms
  • (5) Carbohydrates
58
Q

Talk about the where different forms of calculus are most prevelant

A
  • Hydroxyapatite and octacalcium in 97-100% of supragingival calc
  • Brushite more common in man ant
  • Magnesium whitlockite more common in post
59
Q

What are the bacterial trends for the first colonizers of bacterial plaque?

A
  • Gram positive shift to gram negative
  • Motile shift to non-motile
  • Strep then F. nucleatum then P. gingivalis
60
Q

What is the Sphere of Influence (Name author)

A

The area that the bacteria can influence

  • In relation from distance of plaque to bone (0.5-2.7mm) and plaque to CT attachment (0.2-1.8mm)
  • (Waerhaug)
61
Q

What is evidence supporting bacteria plaque as etiological factor in gingivitis?

A

Loe: “Experimental Gingivitis”

1) Gingivitis occurred within 10-21 days after cessation of oral hygiene.
(2) Plaque accumulation produces gingival inflammation. There was an increase in number of bacteria as well as a shift in bacterial composition.
(3) Removal of bacterial plaque caused resolution of gingival inflammation within approximately 1 week.

62
Q

Does calculus cause periodontitis?

A

Loe’s study of Sri Lankens - No

showed us that 100% of the people with no normal oral hygiene had calculus, yet 11% did not have periodontitis

63
Q

How do you clinically detect calculus?

A
  1. Probe
  2. Visually
  3. Radiograph
64
Q

Talk about probing (force, inflammation, angulation, location on a tooth, diameter of probe, normal variation)

A

NORMAL VARIATION: (Glavind) showed that the normal variation in probing error is 1 mm.

FORCE: (Caton) showed that if you use a force >25 grams (0.25 N), you will penetrate the CT: (Mombelli and Lang) 25g

DEPTH: (Fowler)

  • BL: In health, probe tip is coronal to JE (0.73mm) and in disease it is past the apical portion of the JE (0.45mm).

LOCATION: (Persson) showed that if you probe at the line angle rather than the mid-proximal, the difference is about 1.0 mm = greater depth in the mid proximal but line angle = more reproducible but underestimates severity

In general, you want the probe as parallel to the tooth as possible, but under the contact you need to angle it about 10-15 degrees. If you do it at the line angle instead, you’ll underestimate the pocket by about 1 mm.

DIAMETER PROBE TIP: (Garnick) = 0.6 mm

  • showed that the pressure of the probe = force/area squared
  • So if you double the force, pressure is increased by a factor of 2
  • If you double the diameter, pressure is reduced by a factor of 4

ANGULATION: (Ziegler) - noted that 25 degree alteration of the angle of the probe gave 0.5 mm increase in depth

65
Q

Define Sensitivity vs Specificity

A

Sensitivity is the probability that a diseased individual will have a positive test

  • Tests with high sensitivity usually have few false negatives and more false positives
  • This is calculated as the TP/TP+FN
  • Likelihood that pt WITH the ds will have a POSITIVE test result

​​Specificity is the probability that someone without the disease will test negative

  • These tests have low false positive results but high false negatives
  • Highly specific for those who actually have the ds
  • This is calculated as the TN/TN+FP
  • Likelihood that pt WITHOUT the ds will have a NEGATIVE test result
66
Q

Fill in this Chart

A
67
Q

What are the Cell layers of Oral, Sulcular and Junctional Epithelium?

A
  1. Oral Epithelium: all layers
    * Prominent rete pegs
  2. Sulcular Epithelium: 2-4 cell layers of spinosum and basal (thicker than JE)
  3. Junctional Epithelium: 2-4 cell layers of spinosum and basal
68
Q

Tell me about the Junctional Epithelium

A
  • layers (2): thinner than crevicular epi (can be 3-4 cell layers)
    • Basale
    • spinous/prickle: parallel to tooth surface
  • attachment to tooth: internal basal lamina: hemidesmosomes
  • attachment to CT: external basal lamina: hemidesmosomes
  • Fastest turnover: cells migrate toward tooth surface up toward sulcus
    • 1-6 days (turnover depends on thickness of JE)
    • Protective barrier due to high turnoveer
  • health: attachment occurs at CEJ (most apical portion of enamel, most coronal portion of cementum)
69
Q

What are the Muscles of Mastication?

A

Primary Muscles:

  1. Masseter
  2. Temporalis
  3. Lateral pterygoid
  4. Medial pterygoid

Accessory muscles:

  1. Buccinator
  2. Suprahyoid muscles
  3. Infrahyoid muscles
70
Q

What are the Suprahyoid and Infrahyoid Muscles?

A

Suprahyoid muscles

  1. Digastric muscle
  2. Mylohyoid muscle
  3. Geniohyoid muscle

Infrahyoid muscles

  1. Sternohyoid
  2. Sternothyroid
  3. Thyrohyoid
  4. Omohyoid muscle
71
Q

What are the 3 Primary types of Oral Mucosa?

A

1. Lining

  • Epithelium of the lining mucosa is nonkeratinized stratified squamous

2. Masticatory

  • Epithelium of the masticatory mucosa is ortho- or parakeratinized, to protect it from the shearing forces of mastication

3. Specialized

72
Q

What are the 3 Types of Lining Mucosa?

A

1. Alveolar mucosa

2. Labial mucosa

3. Buccal mucosa

73
Q

Describe the Alveolar Mucosa

A
  • Soft, thin mucous membrane that sits above the marginal gingiva and the attached gingiva, and continues across the floor of the mouth, cheeks, and lips
  • Bright red in color due to being rich with blood vessels, and is shiny and smooth in appearance
  • Nonkeratinized stratified squamous epithelium
  • Disruption of the alveolar mucosa can impact the esthetic results of implants

The area of tissue beyond the mucogingival junction. It seems less firmly attached and redder than the attached gingiva. It is non-keratinized and provides a softer and more flexible area for the movement of the cheeks and lips.

74
Q

What is Gingiva?

A
  • Mucosal tissue surrounding portions of the maxillary and mandibular teeth and bone.
  • Gingiva is the the soft, pink tissue that surrounds and protects the bottom of the teeth
  • Attached to the tooth, which forms a seal between the mouth and the underlying bone
  • Poor oral hygiene causes a buildup of plaque in the crevices of the teeth and gingiva, which if left untreated, can cause gingivitis
  • Gingivitis is inflammation and weakens the seal, allowing bacteria to enter the tooth root and bone structure to progress to periodontitis
  • Integral role in overall oral health
75
Q

What is a Gingival Graft?

A

Gingival recession is common among adults and affects both men and women

Untreated severe gingival recession can cause damage to the underlying bone resulting in tooth loss

Gingival Graft = taking healthy oral tissue from one area of the mouth, usually the hard palate and transplanting it to the desired area (or using an allograft)

May be done in conjunction with bone graft or dental implant procedure

76
Q

What is Gingival Recession?

A
  • Exposure of the root of one or more teeth due to the retraction of the gingival margin or the loss of gingival tissue over time
  • Most common = Adults > 40 but can be seen in younger around the age of puberty or during teen years
  • May occur with the loss of alveolar bone underneath, which decreases the ratio of crown-to-root, affecting an individual’s cosmetic appearance and overall facial esthetics.
  • Classified using Miller’s or Cairo’s system
  • Causes:
    • Most often the result of gingival disease, or periodontal disease.
    • Genetics, poor flossing habits, tooth crowding, overaggressive brushing habits, and the use of dipping tobacco
77
Q

What is the Gingival Sulcus?

A
  • Point at which the tooth and gingiva meet, which is the primary component of the emergence profile

Ideally, the gingival sulcus is close to the tooth, with 3mm or less of space where food particles and bacteria can enter.

Beyond this depth, traditional brushing and flossing habits aren’t able to reach and plaque build up over time. –Results in bacterial overgrowth and periodontitis

As time progresses, the infection causes the sulcus to further deepen, compounding the issue and potentially resulting in tooth loss as the alveolar ridge degrades.

Depth of the sulcus is easily checked with a dental probe.

78
Q

Why does the Diameter of the Probe Tip matter?

A

Background: the pressure exerted by a probe is directly proportional to the force on the probe and inversely proportional to the area at the probe tip end (“think staccato heals”)
BL: According to the authors, probe tips need a diameter of 0.6mm and used with 20g (0.2N) of force to measure approximate pocket depth and reduction of clinical probing

Garnick

Mealey: ¾ aspects affecting probe penetration you can standardize… (force, tip diameter & probe location). The 4th you cannot standardize (CT inflammation).

79
Q

What is the relation between inflammed tissues and probing depth?

A

BL: In specimens with visible inflammation, there were significantly greater probing depths and the tip of the probe extended further into the junctional epithelium, as compared with specimens lacking inflammation.

Caton

80
Q

What happened when you measure at a line-angle with a probe

A

Persson 1991

BL: The mean probing depth differences seen between mid-proximal and line angle probing depths was approximately 1.0mm for both previously instrumented and untreated sites.

midproximal > line angle PDs by increase in 1 mm (line angle probing underestimates disease but is more reproducible)

81
Q

What is Attached Gingiva

A

This tissue is adjacent to the free gingiva and is keratinized and firmly attached to the bone structure. It can range from 3-12 mm in height.

82
Q

What is Free Gingiva?

A

This tissue is not attached and forms a collar around the tooth. The trough around the tooth is called the sulcus and its depth is normally 1-3 mm. It is lined with sulcular epithelium and attached to the tooth at its base by the epithelial attachment.

83
Q

What is Interdental papillae?

A

The region of gingival tissue that fills the space between adjacent teeth. In a healthy mouth this is usually knife-edged and fills the interdental space.

84
Q

What is the Muco-Gingival Junction?

A

The scalloped line that divides the attached gingiva from the alveolar mucosa.

85
Q

Describe the Alveolar Bone

A

The alveolar bone supports the teeth and is covered by gingival tissue. It contains several different types of bone.

The inner and outer surfaces of the bone are made up of dense cortical plates.

The portion between the cortical plates is called trabecular or cancellous bone. It resembles a sponge in appearance and has many irregular spaces within.

The wall of the tooth socket is made of lamina dura, which is a thin, dense bone where the periodontal ligament is attached.

86
Q

Describe the Attachment Mechanism of Teeth

A

The attachment of the tooth to the surrounding and supporting structures (bone) is accomplished through the cementum of the tooth, periodontal ligaments and the alveolar bone. The root of the tooth (cementum) is attached to the underlying bone by a series of periodontal fibers that make up the periodontal ligament and allow for minor movement of the tooth in the socket without damage to the tooth or the underlying structures. These fibers are classified apical, oblique, horizontal, alveolar crest and interradicular fibers.

87
Q

What is a Frenum?

A

Raised folds of tissue that extend from the alveolar and the buccal and labial mucosa.

88
Q

What is Mucosa?

A

Mucous membrane lines the oral cavity. It can be highly keratinized (such as what covers the hard palate), or lightly keratinized (such as what covers the floor of the mouth and the alveolar processes) or thinly keratinized (such as what covers the cheeks and inner surfaces of the lips).

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