Intro to periodontics Flashcards
1
Q
List the macroscopic features of the gingiva: (4)
A
- marginal gingiva
- gingival sulcus
- attached gingiva
- interdental gingiva
2
Q
List the microscopic features of the gingiva: (3)
A
- oral epithelium
- sulcular epithelium
- junctional epithelium
3
Q
Unattached gingiva may also be called:
A
free gingiva
4
Q
What is considered a normal measurement of free/unattached gingiva?
A
1-3 mm
5
Q
In ___% of cases, the free gingiva is demarcated from the attached gingiva by a free gingival groove
A
50%
6
Q
What is being measured? What can be seen?
A
free/unattached gingiva; free gingival groove
7
Q
Attached gingiva is bound to:
A
underlying periosteum of alveolar bone
8
Q
Describe the attached gingiva:
A
firm & resilient
9
Q
The attached gingiva is bordered apically by:
A
the mucogingival junction (MGJ)
10
Q
The attached gingiva varies in width being widest at the _____ and narrowest at the _____
A
widest: max anterior facial
narrowest: mandibular premolar (mandibular posterior)
11
Q
Any changes in attached gingiva occurs at the:
A
coronal end
(because the apical end does not change)
12
Q
The ____ is not attached to enamel or cementum:
A
gingival sulcus
13
Q
The gingival sulcus is bounded apically by the _____ on the ____
A
free gingival groove; oral epithelium
14
Q
Results from attachment loss of the gingival sulcus:
A
periodontal pocket
15
Q
T/F: Whenever you see a periodontal pocket, you don’t know clinically if there is bone loss so you have to refer to radiographs
A
True
16
Q
Equation for attached gingiva:
A
(keratinized gingiva) - (probing depth) = attached gingiva
17
Q
When the teeth come together, you have facial papilla and lingual papilla; where this meets =
A
gingival col
18
Q
What is the significance of the gingival col?
A
Its lined by unkeratinized epithelium making it susceptible to inflammation
19
Q
The gingival col is only seen in:
A
posterior teeth
20
Q
What makes the gingival col susceptible to disease?
A
lined by unkeratinized epithelium
21
Q
Pyramidal or col shaped; occupies the embrasure:
A
interdental gingiva
22
Q
Describe the make up & turnover of the oral epithelium:
A
- keratinized stratified squamous epithelium
- turnover of 30 days
23
Q
Describe the make up & measurement of the sulcular epithelium:
A
- ~1mm
- unattached to enamel
- non-keratinized stratified squamous epithelium
24
Q
Describe the make up, measurement & turnover of the junctional epithelium:
A
- ~1mm
- attached by hemidesmosomes
- non-keratinized stratified squamous epithelium
- high rate of turnover (7-10 days)
25
What portion of epithelium is keratinized?
What portion of epithelium is non-keratinized?
oral epithelium
sulcular & junctional epithelium
26
What portion of epithelium is attached by hemidesmosomes?
junctional epithelium
27
What is shown by the blue line in the following image?
oral epithelium
28
What is the main goal of the oral epithelium?
protection
29
The oral epithelium is keratinized stratified squamous epithelium comprised of the following layers: (4)
- stratum corneum
- stratum granulosum
- stratum spinosum
- stratum basale
30
The rate of turnover within the oral epithelium is:
30 days
31
Keratinized gingiva is designed to:
withstand frictional forces
32
What are the main cells of the oral epithelium?
keratinocytes (which produce keratin)
33
Although the majority of cells in the oral epithelium are keratinocytes, there are also non-keratinocytes that comprise this including:
- melanocytes
- langerhans cells
- merkel cells
34
What is the function of the melanocytes found within the oral epithelium?
production of melanin
35
What is the function of the Langerhans cells found within the oral epithelium?
these cells capture, uptake and process antigens
36
What is the function of the Merkel Cells found within the oral epithelium?
sense of touch & found within the stratum basal
37
What is the function of the keratinocytes (majority of cells) found within the oral epithelium?
production of keratin
38
What is lined by green in the following image?
Sulcular epithelium
39
What causes BOP?
microscopic ulceration of the sulcular epithelium
40
Is the sulcular epithelium keratinized or non-keratinized?
non-keratinized (& semi-permeable)
41
The sulcular epithelium is comprised of:
stratified squamous epithelium
42
What does the sulcular epithelium lack? (compared to the oral epithelium)
- stratum corneum
- stratum granulosum
- Langerhan's Cells
43
What is the importance of the sulcular epithelium?
It is a semi-permeable membrane against bacterial products passing into underlying tissue
44
What is represented by the yellow line?
junctional epithelium
45
Is the junctional epithelium keratnizied or non-keratinized?
non-keratinized
46
What comprises the junctional epithelium?
Stratified squamous epithelium
47
Describe the rate of turnover of the junctional epithelium:
Rapid turnover ~10.4 days
48
Describe the attachments of junctional epithelium:
attachment to the tooth surface via hemidesmosomes & non-collagenous proteins (proteoglycans & glycosaminoglycans)
49
The clinical probing depth/sulcus depends on where the probe actually stops, which is dependent on many factors including: (3)
1. tissue inflammation
2. probe diameter
3. probing pressure
50
What are the components of the supracrestal attachment?
1. JE
2. Connective tissue attachments
(together around 2mm total)
51
What microscopic feature of the gingiva functions to keep the gingiva in place?
connective tissue attachment
52
The connective tissue attachment may also be referred to as:
supracrestal attachment
53
If you impede on biologic width (supracrestal attachment) this will result in:
bone loss
54
Removing bone to bring down the JE and connective tissue to create a larger biologic width; controlled removal of bone to re-establish a deeper margin:
crown lengthening
55
List the three groups of gingival fibers:
1. gingivodental (dentogingival)
2. circular
3. transeptal
56
What gingival fiber group attaches the cementum to the gingiva?
gingivodental group
57
What gingival fiber group is present around the tooth in the gingiva?
circular group
58
What gingival fiber group attaches cementum to the cementum of the adjacent tooth?
transeptal
59
Main type of collagen present in the gingiva:
type 1 collagen
60
The gingival fibers are critical in:
keeping the gingiva attached to the tooth
61
The gingival fibers that are in close proximity to the alveolar crest contribute to the connective tissue attachment component of the:
supracrestal attachment
62
What are some clinical features of the gingiva to be noted? (4)
1. color
2. contour
3. consistency
4. texture
63
Is a form of adaptive specialization or reinforcement for function:
stippling
64
What percent of the population has stippling of the gingiva?
40%
65
Suspensory mechanisms attaching tooth to alveolar bone:
PDL
66
The PDL absorbs:
occlusal forces
67
What is responsible for transmitting occlusal forces to bone?
PDL
68
Describe what components make up the PDL: (3)
1. blood vessels
2. collagen (type I, III, IV)
3. proprioceptive nerve endings
69
The PDL contains proprioceptive nerve endings that:
transmit pressure & pain via trigeminal nerve
70
List the cells present in the PDL:
1. undifferentiatied mesenchymal cells
2. fibroblasts
3. cementoblasts/clasts
4. osteoblasts/clasts
5. inflammatory cells (in disease)
6. epithelial rests of malassesz (remnants of henrtwigs root sheath)
71
List the groups of PDL: (5)
1. alveolar crest
2. horizontal
3. oblique
4. apical
5. interradicular
72
PDL fiber group that connects the cementum to the crest of the alveolar bone; prevents extrusion & lateral movements:
Alveolar crest
73
PDL fiber group that connects the cementum to the alveolar bone @ 90 degrees; opposes lateral forces:
Horizontal
74
PDL fiber group that connects the cementum to the coronal end of alveolar bone; resists the vertical masticatory forces:
oblique
75
PDL fiber group that connects cementum to the apical alveolar bone; resists tipping:
apical
76
PDL fiber group that connects cementum to the furcation bone; resists lunation & tipping:
Interradicular
77
Label the PDL fiber group that matches the prompt:
1. prevents extrusion and lateral movements
2. opposes lateral forces
3. resists vertical masticatory forces
4. resists tipping
5. resists luxation & tipping
1. alveolar crest
2. horizontal
3. oblique
4. apical
5. interradicular
78
What PDL fiber group is the "largest"?
oblique
79
Calcified mesenchymal tissue that contains 45-50% hydroxyapatite:
cementum
80
Describe the vascularity of cementum:
non-vascularized; no nerves & no lymphatics
81
How does cementum grow?
apposition
82
Cementum is attached to fibers of the:
PDL
83
What is the specific type of PDL fibers that are extended into the cementum to provide attachment?
Sharpey's Fibers
84
What is the significance of a patient who has exposed cementum?
1. rough surface facilities plaque adherence
2. porosities facilitate attachment of calculus
3. porosities facilitate absorption of bacterial enzymes
4. smear layer inhibits attachment of connective tissue
85
With exposed cementum the rough surface facilitates:
plaque adherence
86
With exposed cementum the porosities facilitate: (2)
1. attachment of calculus
2. absorption o bacterial enzymes (i.e. endotoxin)
87
With exposed cementum the smear layer:
inhibits attachment of connective tissue
88
What is the main function of the alveolar process?
supports the tooth
89
Describe the vascularity of the alveolar process:
Vascularized- lymphatics + nerves (but nerves are in the periosteum & not bone)
90
The alveolar process is attached via:
sharpey's fibers
91
Portion of PDL fibers inserting into the alveolar process:
Sharpey's fibers
92
List the components of the alveolar process: (3)
1. external plate
2. inner socket wall
3. cancellous trabeculae
93
In regards to the alveolar process, the inner socket wall is the:
alveolar bone proper
94
In regards to the alveolar process; the bundle bone is the:
attachment of PDL fibers into the bone
95
Where do we have the best quality of bone for implant placement?
1. mandibular posterior
2. maxillary anterior
because good balance between dense cortical bone & spongy trabecular bone
96
Where is the bone extremely dense thus making it a non-ideal area to place implants?
mandibular anterior
DENSEEEEEE
97
What is the shape of the alveolar process in the following areas?
Anterior:
Posterior
Anterior: scalloped
Posterior: Flattened scallop
98
The shape of the alveolar process is dependent on:
interdental distance, tooth controls, & root contours
99
The alveolar process distance from the CEJ in health is:
1 to 1.5mm
100
The alveolar process distance from CEJ in health is ____ in an adult (taking into account the concept of supracrestal attachment)
1.5 - 2.0mm
101
T/F: Bone loss precedes attachment loss
False- attachment loss precedes bone loss
102
Lack of bone on the facial or lingual of the tooth but with interproximal bone:
Dehiscence
103
Lack of bone on the facial or lingual of the tooth resembling a "window":
fenestration
104
"marginal bone is missing":
dehiscence
105
Occurs due to the "thinness" of bone:
fenestration
106
Which line is pointing to dehiscence? Which line is pointing to fenestration?
Left: Fenstration
Right: Dehiscence
107
Thin facial and lingual cortical plates overlying root surfaces:
alveolar process
108
What occurs in the alveolar process in adults over the age of 40 years?
increased fibrosis and increased lipid cell content in marrow spaces (therefore a decrease in progenitor cell populations)
109
In adults over the age of 40 years old, the alveolar process experiences increased ____ and increased ___ in the marrow spaces (and therefore a decrease in progenitor cell populations)
increased fibrosis & increased lipid cell content
110
List the top 4 reasons of adult tooth loss & include percentages:
1. Periodontal disease (70%)
2. Caries (20%)
3. Prosthetics (9%)
4. Other (1%)
111
Atleast ____% of dentate U.S. adults aged 30-90 have periodontitis
Of these adults, ____ % have a mild form; while ___ % have a moderate or severe form
48%; 30.5%; 17.7%
112
List the Five F's of periodontics:
1. Failure to diagnose
2. Failure to treat
3. Failure to refer for treatment
4. Failure to establish and follow an appropriate maintenance schedule
5. Failure to accept treatment (patient)
113
List the court dictated role for general dentists in regards to perio: (4)
1. must DIAGNOSE periodontal disease
2. must INFORM the patient of clinical findings
3. must REFER patient to periodontist or treat them yourself
4. must TREAT to the current standard of care
114
According to the 2017 classification, periodontal diseases & conditions include:
1. Periodontal health and gingival conditions
2. Periodontitis
3. Other conditions affecting the periodontium
115
According to the 2017 classification, peri-implant diseases & conditions include:
1. Peri-implant health
2. Peri-implant mucositis
3. Peri-imiplantitis
4. Peri-implant hard and soft tissue defects
116
Stage of periodontitis characterized by 1-2 mm CAL:
Stage 1: Initial
117
Stage of periodontitis characterized by LESS than 15% bone loss (RBL):
Stage 1: Initial
118
Stage of periodontitis characterized by NO tooth loss due to periodontal disease:
Stage 1: Initial & Stage 2: Moderate
119
Stage of periodontitis characterized by probing depth of 4mm or less:
Stage 1: Initial
120
Stage of periodontitis characterized by mostly horizontal bone loss:
Stage 1: Initial & Stage 2: Moderate
121
- 1-2 mm CAL
- less than 15% RBL
- No tooth loss due to periodontal disease
- PD 4mm or less
- mostly horizontal BL
Stage 1: Initial
122
Stage of periodontitis characterized by 3-4 mm CAL:
Stage 2: Moderate
123
Stage of periodontitis characterized by 15-33% BL:
Stage 2: Moderate
124
Stage of periodontitis characterized by PD of 5mm or less:
Stage 2: Moderate
125
What is similar between Stage 1 and Stage 2 of periodontitis?
- no teeth lost due to periodontal disease
- mostly horizontal bone loss
126
Stage of periodontitis considered severe with potential for additional tooth loss:
Stage 3
127
Stage of periodontitis characterized by 5mm or more of CAL:
Stage 3: Severe
128
Stage of periodontitis characterized by RBL beyond 33%:
Stage 3: Severe
129
Stage of periodontitis characterized by loss of 4 teeth or less due periodontal disease:
Stage 3: Severe
130
Stage of periodontitis characterized by complexity factors such as PD of 6mm or more:
Stage 3: Severe
131
Stage of periodontitis characterized by vertical bone loss of 3mm or more:
Stage 3: Severe
132
Stage of periodontitis characterized by Class II & Class III furcations:
Stage 3: Severe
133
Stage of periodontitis characterized by moderate ridge defects:
Stage 3: Severe
134
Stage of periodontitis characterized by the need for complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma, severe ridge defects, bite collapse, pathologic migration of teeth, and less than 20 remaining teeth:
Stave 4: Severe with potential for loss of dentition
135
At what stage of periodontitis should you automatically refer to perio?
Stage III & IV
136
Why is grading used?
used to indicate the risk of progression
137
What grade would given to someone with low risk of progression?
Grade A
138
What grade would be given to someone with moderate risk of progression?
Grade B
139
What grade would be given to someone with high risk of progression?
Grade C
140
You should initially assume grade ___ then seek specific evidence to shift to other grades
Grade B
141
Describe the DIRECT evidence used in grading:
1. historical radiographic bone loss
2. clinical attachment loss
142
Describe the INDIRECT evidence used in grading:
1. % bone loss per patient age
2. case phenotype
3. heavy plaque accumulation but minimal destruction
4. minimal plaque accumulation but major destruction
143
What grade would be given for the following example:
No loss over 5 years
Grade A
144
What grade would be given for the following example:
Less than 2mm of loss over 5 years
Grade B
145
What grade would be given for the following example:
Greater than 2 mm of loss over 5 years
Grade C
146
How do you calculate bone loss per age of individual. Include the category ranges:
Bone loss % divided by age
40%/ 60 years old = 0.66 (B)
A: Less than or equal to 0.25
B: 0.25-1.0
C: Greater than or equal to 1.0
147
List some examples of things that would be considered grade modifiers:
smoking & diabetes
148
Describe the smoking and diabetic status for someone considered grade A:
Non-smoker; non-diabetic
149
Describe the smoking and diabetic status for someone considered grade B:
less than 10 cigs per day; HBA1C = less than 7%
150
Describe the smoking and diabetic status for someone considered grade C:
Greater than or equal to 10 cigs per day; HBA1C greater than 7.0%
151
What are the goals of the new staging and grading system? (3)
1. easy to use
2. better communication
3. identify response to treatment
152
