Lecture 2 Flashcards by Brennan Stringam

T/F - The gingival connective tissue determines the differentiation of the epithelium.

TRUE

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The gingival connective tissue is also known as?

Lamina propria

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Lamina propria consists of 2 distinct layers. Name and describe.

Papillary Layer
-Forms finger-like extensions in the depressions delineated by the rete ridges

Reticular layer
-Beneath the rete ridges

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T/F - The oral mucoperiosteum has no submucosa.

TRUE

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Major gingival fiber groups are what? There are 3 groups. Name and describe them.

Bands of collagen fibers

Gingivodental group - Dentin into gingiva

Circular group - around the tooth

Transseptal group - Connects facial and lingual

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What build up and tear down tissue?

Fibroblasts

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Gingival CT - cells make up what %? Collagen fibers make up what %?

65%

-Remainder is proteoglycans, glycoproteins, and CT ground substance

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The vast majority of collagen int he gingival connective tissue is made up of what type?

Type I

*The reticular collagen is type III

Elastic fibers

Oxytalan fibers

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Periodontal ligament does what and is made up of what?

Suspends and maintains tooth in socket.

Type I collagen

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What has the thicker bundles of collagen, alveolar bone or cementum?

Alveolar bone

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PDL + cementum + alveolar bone = ?

Attachment apparatus

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Name 5 functions of the PDL.

1 - Suspends and maintains tooth in socket

2 - Provides pressure and pain sensory feeling to tooth

3 - Provides nutrients to cementum and bone

4 - Builds and maintains cementum and alveolar bone of tooth socket

5 - Remodels alveolar bone in response to pressure

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What are the 4 collagen fibers of the PDL?

Principle

Intermediate plexus fibers

Sharpey’s fibers (Alveolar bone)

Indifferent fiber plexus

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What are the elastic fibers of the PDL?

Oxytalan fibers

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How thick is the PDL?

Varies from 0.1-0.25 mm

Widest during heavy occlusion, thinner in nonfunctional teeth

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SA of socket wall?

150 - 275 sq mm of single root, 450 sq mm multirooted

2000/sq mm in non-functional
28,000 sq mm in functional

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The rest cells of Malassez are remnants of what?

Hurtwigs root sheath

*Contiguous w/ REE

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What are the cellular elements of the PDL?

Fibroblasts

Cementoblasts and cementoclasts

Osteoblasts and osteoclasts

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What are the defense cells of the PDL?

Mast cells

Macrophages

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What is cementum?

Thin layer of hard, mineralized tissue that covers root surface

Light yellow

Overlies dentin

Bone-like, but more resistant to resorption than bone

Does not have its own blood or nutrient supply

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Primary cementum is called what?

Acellular cementum

Secondary cementum is called what?

Cellular cementum

CEJ relationships:

% cementum overlaps enamel

% cementum does not meet enamel (No CEJ)

% cementum meets enamel at a butt joint

60-65

5-10

Cementum can be sensitive to cold/sweet due to what?

Underlying dentin is very sensitive

What does alveolar bone do?

Surrounds and supports roots of teeth in upper and lower jaws

T/F - Existence of alveolar bone is dependent on presence of teeth.

TRUE *EXTRACTIONS LEAD TO BONE RESORPTION* (Especially on the facial)

Why would we leave the root tip?

Prevent bone resorption *If root tip remains, bone loss does NOT occur

What are the 4 components of alveolar bone?

Alveolar bone proper (cribiform plate) Cortical bone Cancellous bone Periosteum

Alveolar bone proper is made up of what 2 types of bone?

Bundle bone Lamellar bone **This is dependent on PDL space**

Supporting alveolar bone has two parts. Name them.

Cortical plate - Outer (labial, buccal) - Inner (lingual) Supporting spongiosa

Tell me about the alveolar bone proper. What is the alveolus?

Bony socket that houses the root of the tooth Large pores where blood vessels connect Ends of PDL fibers are embedded in alveolar bone proper

Tell me about cortical bone.

Layer of compact bone that forms the hard outside wall of jaws on facial and lingual Surrounds alveolar bone proper and gives support to socket

Where is cortical bone the thinnest? Where is cortical bone the thickest?

Incisors, canine, premolar Molars

Does cortical bone show up on radiographs?

NO *Alveolar crest most coronal portion*

Tell me about cancellous/spongy bone?

Spongy, lattice-like bone filler b/t cortical bone and alveolar bone proper Oriented around tooth to form support for alveolar bone proper *Osteoporosis affects bone loss of this type of bone*

Tell me about periosteum.

Layer of connective tissue covering outer surface of bone Provides nutrient supply Consists of collagenous (type I) tissue and an inner layer of elastic fibers *Get in and get out with periosteal surgeries

What is the vascular supply of periodontal bone?

Apical vessels Penetration thru alveolar bone Anastomoses from the gingiva Type I fibers - Fast fibers - mechanical and pain *Also have lymphatic vessels and nerves present

When inflammation occurs, what happens with the blood vessels?

They get leaky to allow immune products in This leads to erythema as blood leaks into CT

T/F - Oral pigmentation is a relatively common condition that may involve any portion of the oral cavity.

TRUE

Multiple causes of pigmentation. Name some.

Physiologic (Genetic) Iatrogenic mechanisms - Bad dentistry Local irritants - smoking UV exposure - Frekeling Complex medical disorders - Peutz-Jeghers syndrome Cellular hyperplasia that can range from benign nevi to fatal oral melanoma

If pigmented lesions are diffuse and bilateral, then what do you think?

Early onset -If so, think genetic or Peutz-Jeghers Adult onset -Systemic? —If so, Addison’s disease, heavy metal, kaposis sarcoma, Peptobismal has heavy metal and can cause pigmented lesions -Not systemic? —Drug induced, post inflammatory, Smokers melanosis

If pigmented lesion is focal, look at the color.

``` Red-blue-purple -Blanching —Varix —Hemagioma -Non-blanching —Thrombus —Hematoma ``` Blue-grey - Amalgam tattoo - Foreign body tattoo - Blue nevus Brown - Melanotic macule - Pigmented nevus - Melanoma - Melanoacanthoma

T/F - In Caucasian’s, 60-70% of subjects have melanocytes. Where are they?

TRUE Stratum basale and the suprabasal stratum spinosum

Typically, physiologic pigmentation is found where?

Bilaterally, along attached gingiva

Freckling on gingiva can happen from what?

UV radiation

What is the diagnosis when there is pigmentation and bits of metal in the tissue surrounding the pigment?

Amalgam tattoo *If in doubt, take a biopsy

Tell me about smoker’s melanosis.

Melanin pigmentation occurring in the periodontium of heavy smokers Occurs in 1 of 5 smokers, especially females taking birth control pills or hormone replacement

T/F - Melanocytes are stimulated by nicotine.

TRUE

Why would smoker’s melanosis by found in children?

Usually environmental exposure

T/F - Gingival pigmentation can be nothing to worry about or life-threatening.

TRUE