Review Perio 1 Flashcards
Main functions of PDL
- support: maintains tooth in socket
- sensory: provides feelings of pain/pressure
- nutritive: supplies nutrients to cementum and bone
- formative: builds and maintains cementum and alveolar bone of tooth socket
- resorptive: can remodel bone in response to pressure
Main functions of cementum
cementum covers root!
- attaches collagen fibers of the PDL
- protects the dentin and seals the dentin tubules
- continuous formation compensates for attrition
alveolar bone
AKA alveolar process: surrounds and supports roots of teeth
- main mineral component is calcium hydroxyapatite: bone like but more resistant to resorption, does not have its own blood supply, receives nutrients from PDL
- lines the tooth socket
- alveolus: singular bony pocket
- alveoli: plural sockets
- alveolar crest: most coronal aspect of the alveolar process and in health follows the contours of the CEJ
cancellous bone
AKA interdental bone: fills the interior space between the cortical bone and alveolar process.
-cancellous and cortical bone are less dense in the maxilla and are most dense in the posterior portion of the mandible
periosteum
layer of collagenous and fine elastic fibers making up the connective tissues that covers the cortical bone
periosteum innervation
provides masticatory sensations of pressure, touch, and pain. the maxilla is supplied by the second branch of the trigeminal nerve and the mandible is supplied by the third branch.
Periodontium health
- uniformly pink or pigmented
- fits snug and flat around teeth, gingival margin is scalloped, papillae is pyramidal in shape and fills embrasures
- firm, resilient consistency
- no bleeding, probe depths 1-3mm
- may or may not have stippling
- JE slightly coronal to CEJ, may be apical to CEJ with previous bone loss, supragingival fibers intact, PDL intact, JE has no epithelial ridges
- no bone loss, alveolar crest 2-3mm apical to JE
- 100-1,000 bacteria in sulci, nonmotile, 75-80% gram positive, the remaining are gram negative
AAP Type I: Plaque induced gingival diseases
inflammation of gingiva in response to plaque biofilm. Most common type of gingival disease.
Modified by: systemic factors (endocrine system, blood dyscrasias), medications (drug influenced gingival diseases), malnutrition.
S/S: redness, swelling, rolled gingival margins, interdental papillae may be bulbous/blunted/cratered, BOP, tenderness, no bone loss, no apical migration, probe depths > 3mm.
- JE at CEJ, supragingival fiber destruction, alveolar bone intact, PDL intact, JE extends epithelial ridges into connective tissue
- 1,000-100,000 bacteria, about equal portions of gram negative/gram positive bacteria.
- Initial lesion: gram positive cocci, Streptococcus anginosus, Streptococcus sanguis
- Early lesion: gram negative increase, Campylobacter concisus, Porphyromonas gingivalis, Neisseria gonorrheae
- Established lesion: spirochetes and gram negative rods, Treponema pallidum, Campylobacter concisus, Porphyromonas gingivalis
AAP I: non-plaque induced gingival diseases
inflammation of gingiva due to viral, bacterial, or fungal infections; allergic reactions, genetics, skin diseases, and trauma. The two most commonly seen are primary herpetic gingivostomatitis and allergic reactions.
S/S: painful ulcerations, chancres, mucous patches, vesicles, fiery red gums, and more.
- JE at CEJ, supragingival fiber destruction, alveolar bone intact, PDL intact, JE extends epithelial ridges into connective tissue.
- Neisseria gonorrhea, Treponema pallidum, streptococcal species, HSV-1, HIV, Candida
AAP Type II: Chronic Periodontitis
Inflammation that affects all parts of the periodontium including gingiva, PDL, bone, and cementum. Bacterial infection, most common form of perio. Progresses slow to moderate pace. Usually detected in people >35 yrs old.
- localized: <30% affected
- generalized: >30% affected (about 10 teeth depending on)
S/S: swelling, perio pockets, red/purple/pale pink gingiva, bone loss, furcation involvement, BOP, heavier calculus, halitosis, probe depths >4mm, often painless.
-Slight: no more than 1-2mm of CAL
- Moderate: 3-4 mm of CAL
- Severe: 5mm or greater of CAL
- JE on cementum and apical to CEJ, supragingival fiber destruction, alveolar bone destruction, pdl destruction
- 100,000-100,000,000 bacteria, higher proportions of gram negative anaerobic motile bacteria, Actinobacillis actinomycetemcomitans and more
AAP Type III: Aggressive Periodontitis
bacterial infection that results in rapid destruction of pdl and supporting bone, poor response to therapy, less common. Usually detected in people <30 years old.
- localized: affects 1st molars and/or incisors, involves no more than 2 teeth besides molars/incisors
- generalized: affects at least 3 permanent teeth besides molars/incisors
- tissue may appear normal, deep perio pockets, loss of bone, usually small amounts of calculus and plaque biofilm, Aggregatibacter actinomycetemcomitans
AAP Type IV: Periodontitis as Manifestation of Systemic Disease
systemic condition is main contributing factor, less common.
Modified by blood disorders, genetic factors, or not otherwise specified.
S/S: gingival enlargement, bleeding/ulceration, petechiae, linear gingival erythema, premature exfoliation of teeth
