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LO 1 Flashcards

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1
Q

List the tissues of the periodontium

A
  1. Gingiva
  2. Cementum
  3. Periodontal ligament
  4. Alveolar bone
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2
Q

Describe the periodontium

A

Functional system of tissues that surrounds teeth and attaches them to jawbone

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3
Q

Describe the gingiva

A
  1. Part of mucosa that surrounds cervical portions of teeth and covers alveolar processes
  2. Protects underlying tooth-supporting structures of periodontium from oral environment
  3. Contour and shape of gingival margin approximates scalloped curvature of cementoenamel junction (CEJ)
  4. Position may be age dependent
  5. Attached by junctional epithelium
  6. Composed of thin outer layer of epithelium and underlying layer of connective tissue
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4
Q

What are the 4 anatomical areas of the gingiva?

A
  1. Free gingiva
  2. Gingival sulcus
  3. Interdental gingiva
  4. Attached gingiva
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5
Q

Describe free gingiva

A
  1. Unattached portion surrounding tooth in CEJ region
  2. Also called unattached gingiva or marginal gingiva
  3. Most coronal boundary of gingiva
  4. Surrounds tooth in turtleneck manner
  5. Attaches by junctional epithelium
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6
Q

What us the free gingival margin?

A
  1. Thin, rounded edge where free gingiva meets tooth
  2. Follows scalloped, curved contours of underlying CEJ
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7
Q

Describe attached gingiva

A
  1. Continuous with free gingiva
  2. Tightly bound to underlying cementum on cervical-third of root, periosteum of alveolar bone
  3. Widest in incisor and molar regions, narrowest in premolar regions, not measured on palate
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8
Q

What width of keratinized gingiva is necessary for periodontal health?

A
  1. Was once believed that a minimum 2-mm width of keratinized gingiva was necessary for periodontal health
  2. Concept currently being revisited - Amount of “necessary” keratinized tissue never established
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9
Q

What is the colour of healthy attached gingiva?

A
  1. Pale or light coral pink when healthy
  2. May have physiologic pigmentation - Caused by increased melanin production
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10
Q

What is the texture of healthy attached gingiva?

A

May exhibit stippling on healthy attached and interdental gingiva - not always present, absent in most periodontally healthy adults

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11
Q

What is the function of attached gingiva?

A
  1. Allows gingival tissue to withstand mechanical forces created during chewing, speaking, and toothbrushing
  2. Prevents free gingiva from being pulled apically from tooth when tension is applied to alveolar mucosa
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12
Q

Describe interdental gingiva

A
  1. Portion of gingiva that fills interdental embrasure between two adjacent teeth apical to contact area
  2. Consists of - facial papilla and lingual papilla; Interdental col (Depression apical to contact area of adjacent teeth that connects facial and lingual papillae)
  3. Function - Prevents food from packing between teeth when chewing
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13
Q

Describe the gingival sulcus

A
  1. V-shaped shallow space between free gingiva and tooth surface
  2. Encircles neck of tooth
  3. 1 to 3 mm deep when clinically healthy - Measured with periodontal probe
  4. Base interfaces with most coronal portion of junctional epithelium
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14
Q

Describe gingival crevicular fluid

A
  1. Also called gingival sulcular fluid
  2. Seeps from underlying connective tissue
  3. Little to none in healthy sulcus
  4. Flow increases in response to gingival stimulation - Greatly increases with inflammation
  5. Measured with filter strip
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15
Q

Describe the periodontal ligament

A
  1. Network of soft connective tissue fibers that attach root of tooth to bony walls of tooth socket
  2. Primarily composed of dense fibrous connective tissue - Fibers attach to root cementum and alveolar bone
  3. Serves to - Connect tooth to alveolar process; Support tooth in socket; Absorb mechanical loads placed on tooth
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16
Q

What are the 5 periodontal fiber groups of the PDL?

A
  1. Alveolar crest fibers
  2. Horizontal fibers
  3. Interradicular fibers
  4. Oblique fibers
  5. Apical fibers
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17
Q

What are the functions of the PDL?

A
  1. Supportive: Suspends and maintains tooth in socket
  2. Sensory: Nerve endings relay sensory information
  3. Nutritive: Blood vessels provide oxygen and nutrients
  4. Formative: Certain components build and maintain attachment apparatus and may aid periodontal regeneration
  5. Remodeling: Can remodel alveolar bone in response to pressure
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18
Q

Describe cementum

A
  1. Thin layer of hard, mineralized tissue that covers surface of root
  2. Overlies dentin
  3. Softer than dentin or enamel
  4. 55% organic, 45% inorganic
  5. More resistant to resorption than bone - Makes orthodontic treatment possible
  6. Undergoes continuous resorption and repair throughout lifetime of tooth
  7. Becomes thicker with age
  8. Two types: cellular and acellular
  9. Receives nutrients from PDL
  10. Relatively permeable to - Extrinsic dyes, Organic substances, Inorganic ions, Bacteria
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19
Q

What are the functions of cementum?

A
  1. Gives attachment to PDL collagen fibers (Via terminal endings known as Sharpey’s fibers)
  2. Outer layer protects underlying dentin (Seals ends of open dentinal tubules)
  3. Compensates for tooth wear at occlusal or incisal surface due to attrition
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20
Q

Describe the alveolar bone

A
  1. Bone of upper or lower jaw that surrounds and supports roots of teeth
  2. Mineralized connective tissue (60% inorganic, 25% organic, 15% water)
  3. Existence dependent on presence of teeth - Resorbs when teeth are extracted; Absent if teeth do not erupt
  4. Forms bony sockets that support and protect roots
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21
Q

Describe the alveolar bone proper (cribriform plate)

A
  1. Thin layer of bone lining socket surrounding root of tooth that contains - Alveolus, Foramina, Sharpey’s fibers
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22
Q

Describe cortical bone (cortical plate)

A
  1. Layer of compact bone that forms hard, outer wall of mandible and maxilla on facial and lingual aspects
  2. Surrounds alveolar bone proper and supports socket
  3. Buccal cortical bone - Thinner in incisor, canine, and premolar regions; Thicker in molar regions
  4. Does not appear on radiograph
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23
Q

Describe alveolar crests

A
  1. Coronal-most portion of alveolar process
  2. 1 to 2 mm apical to CEJs
  3. From facial or lingual aspect, meets teeth in scalloped form that follows CEJ contours
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24
Q

Describe cancellous bone (spongy bone)

A
  1. Fills interior portion of alveolar process
  2. Found mostly in interproximal areas
  3. Higher proportion in maxilla than in mandible
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25
Describe the periosteum
Layer of connective tissue covering outer surface of bone
26
How does the periodontium differ in children versus adults?
1. More red than pink 2. More rounded versus knife-edge FGM 3. Flabbier tissue consistency due to lack of organized fiber bundles 4. No stippling texture 5. Saddle-shaped versus triangular papillary gingiva 6. Narrower attached gingiva
27
Describe implant health
1. Characterized by absence of erythema, BOP, swelling, suppuration 2. Clinically no visual difference between healthy peri-implant tissues & healthy periodontal tissues 3. Probing depths may be deeper (4-5mm) - No probing for first 6 months!; Use flexible plastic probe! (ask at SteriCentre); se flexible plastic probe! (ask at SteriCentre) Use tufted floss in a “shoe-shine” method
28
What are the effects of aging on the periodontium?
1. Gingiva - Gingiva thins (fewer layers of epithelium); Less Keratinization; Flattening of rete pegs (epithelial extensions into connective tissue) 2. Connective Tissue (CT) - Decrease in number of cells; Gingival fibers become coarser and denser 3. Cementum - Increases in thickness, especially in apical area to compensate for tooth attrition 4. PDL - Decreased fibroblasts, more elastic fibers 5. Bone - Less vascularity and reduced healing
29
Define histology
Study of microscopic features of tissues (tissues are groups of interconnected cells that perform similar function)
30
Describe cells
1. Smallest structural unit capable of functioning independently 2. Group together to form tissue 3. Four basic types of tissue - Epithelial, connective, nerve, and muscle
31
Describe extracellular matrix
1. Mesh-like network surrounding cells 2. Physically supports cells within tissue 3. Provides biomechanical framework for cell migration and interaction 4. Composed mainly of ground substance and fibrous proteins 5. Sparse in epithelial tissue - Consists mainly of basal lamina 6. More plentiful in connective tissue
32
Describe the functions of epithelial tissue
1. Makes up outer surface of body 2. Lines body cavities 3. Skin and oral mucosa composed of stratified squamous epithelium
33
Describe the composition of epithelial tissue
1. Plentiful cells closely packed, bound together 2. Basal lamina - Thin mat of extracellular matrix secreted by epithelial cells supports overlying epithelium
34
Describe keratinization
1. Process by which surface epithelial cells become stronger and waterproof 2. Keratinized epithelial cells have no nuclei and form tough, resistant layer on skin 3. Nonkeratinized epithelial cells have nuclei and act as cushion
35
Describe the blood supply of epithelial cells
1. Epithelial cells are avascular (completely lack blood vessels) 2. Receive oxygen and nourishment from vessels in underlying connective tissue through diffusion
36
Describe the function of connective tissue
1. Fills spaces between tissues and organs in body 2. Supports or binds other tissues 3. Consists of sparse cells (fibroblasts, phagocytes, and lymphocytes) and abundant extracellular substance 4. Includes cementum, dentin, alveolar bone, pulp - Enamel considered epithelial tissue
37
What is Epithelial-Connective tissue interface?
1. Site where epithelial and connective tissues meet 2. Basal lamina not visible under light microscope - Aids attachment of epithelial cells to adjacent structures 3. Basement membrane - Thin layer visible with light microscope beneath epithelium; Combination of basal lamina and reticular lamina
38
Describe common Morphologic Patterns of the Epithelial-Connective Tissue Interface
1. Most common is tight interdigitation pattern in which tissues interdigitate like fingers of clasped hands 2. Smooth non-interdigitizing interface - No epithelial ridges or connective tissue papillae; Histologically seen in healthy sulcular epithelium and healthy junctional epithelium
39
How is the interdigitated pattern of Epithelial-Connective Tissue Interface created?
1. Epithelial ridges or rete pegs - Epithelial extensions reaching down into connective tissue 2. Connective tissue papillae - Finger-like extensions projecting up into epithelium 3. Gingival stippling in periodontally healthy individuals - Correlated to presence of rete pegs
40
What is the Function of the Epithelial-Connective Tissue Interface?
1. Enhances adhesion of epithelium to connective tissue by increasing surface area - Allows skin to resist mechanical forces 2. Provides larger area to receive nourishment from underlying connective tissue
41
Describe Epithelial Cell Junctions
1. Cellular structures that mechanically “lock” cell and its cytoskeleton to its neighbor or basal lamina 2. Binding cells form structurally strong unit 3. Tissues such as epithelium of skin have most abundant number of cell junctions - Can withstand severe mechanical stresses
42
Describe desmosomes
1. Create cell-to-cell connections 2. Important form of cell junction found in gingival epithelium
43
Describe hemidesmosomes
1. Create cell-to-basal lamina connection 2. Important form of cell junction found in gingival epithelium
44
Describe gingival epithelium
1. Specialized stratified squamous epithelium that functions well in wet oral cavity 2. Three anatomical areas - Oral epithelium; Sulcular epithelium; Junctional epithelium
45
Describe oral epithelium
1. Covers outer surface of free gingiva and attached gingiva from crest of gingival margin to mucogingival junction 2. Covered by keratin 3. Stratified squamous epithelium that can be divided into cell layers
46
List the cell layers of the oral epithelium
1. Basal cell layer - Stratum basale 2. Prickle cell layer - Stratum spinosum 3. Granular cell layer - Stratum granulosum 4. Keratinized cell layer - Stratum corneum
47
Healthy oral epithelium tightly _________ with underlying connective tissue
interdigitates
48
Describe sulcular epithelium
1. Epithelial lining of gingival sulcus continuous with oral epithelium, extending from crest of gingival margin to coronal edge of junctional epithelium 2. Thin, nonkeratinized, and has three layers - Basal cell layer, Prickle cell layer, Superficial cell layer 3. Permeable, allowing gingival crevicular fluid to flow from gingival connective tissue into sulcus - Flow is slight in health and increased in disease 4. Joins connective tissue at smooth, flush interface with no epithelial ridges - No interdigitation junction
49
Describe junctional epithelium
1. Forms base of sulcus and joins gingiva to tooth 2. In health, attaches to tooth slightly coronal to cementoenamel junction (CEJ) 3. Thin, nonkeratinized, and semipermeable 4. Easiest entry point for bacteria into connective tissue 5. Has only basal cell and prickle cell layers
50
Describe normal measurements of the junctional epithelium
1. 0.71 to 1.35 mm in length 2. 15 to 30 cells thick at coronal zone 3. Tapers from 4 to 5 cells thick at apical zone 4. In health, has smooth, flush interface with connective tissue
51
Why do teeth need a junctional epithelium?
1. Teeth create break in epithelial protective covering - Protective epithelial sheet covers body; Teeth erupt and puncture protective epithelial sheet 2. Body attempts to seal opening by attaching epithelium to tooth 3. Functions of JE - attachment, barrier, host defense
52
What are the components of the JE?
1. Closely packed epithelial cells 2. Desmosomes and hemidesmosomes 3. Sparse extracellular matrix with internal basal lamina and external basal lamina
53
Describe the attachment of the JE
1. Attach to tooth surface via hemidesmosomes and internal basal lamina 2. Attach to underlying gingival connective tissue via hemidesmosomes and external basal lamina
54
Describe gingival connective tissue
1. Function - Provides solidity to gingiva; Attaches gingiva to cementum of root and alveolar bone 2. Also known as lamina propria 3. Has abundance of extracellular matrix and few cells - Cells comprise about 5% of gingival connective tissue
55
What are the 3 types of cells in gingival connective tissue?
1. Fibroblasts 2. Mast cells 3. Immune cells, such as macrophages, neutrophils, and lymphocytes
56
Fibers of connective tissue produced by _________
fibroblasts
57
Describe Extracellular Matrix of the Gingival Connective Tissue
1. Collagen fibers, fibroblasts, vessels, and nerves embedded in extracellular matrix 2. 55% to 65% protein fibers 3. 30% to 35% gel-like material
58
The network of rope-like collagen fiber bundles located coronal to crest of alveolar bone are _________
Supragingival Fiber Bundles
59
Describe Supragingival Fiber Bundles
1. Embedded in gel-like extracellular matrix 2. Strengthen attachment of junctional epithelium to tooth by bracing gingiva against tooth surface
60
Describe the Dentogingival unit
1. Composed of junctional epithelium and supragingival fibers 2. Provides structural support to gingival tissue
61
List the functions of Supragingival Fiber Bundles
1. Brace gingiva firmly against tooth and reinforce attachment of junctional epithelium to tooth 2. Provide gingiva with rigidity to withstand mastication forces 3. Connect gingiva to cementum and alveolar bone 4. Stabilize adjacent teeth to one another
62
How are Supragingival Fiber Groups classified?
1. C: circular 2. AG: alveologingival 3. DG: dentogingival 4. PG: periosteogingival 5. IG: intergingival 6. IC: intercircular 7. IP: interpapillary 8. TG: transgingival 9. TS: transseptal
63
Describe the Periodontal Ligament Fibers of the Gingival Connective Tissue
1. Thin sheet of fibrous connective tissue that surrounds roots of teeth and joints root cementum to socket wall 2. 0.05 to 0.25 mm thick depending on patient’s age and function of tooth 3. Consists of connective tissue fibers, cells, and extracellular matrix
64
List the functions of the Periodontal Ligament Fibers of the Gingival Connective Tissue
1. Anchor tooth to socket and separate it from socket wall 2. House nerve endings and blood vessels 3. Perform formative functions with cells including fibroblasts, cementoblasts, osteoblasts, epithelial cell remnants of Hertwig’s epithelial root sheath, and undifferentiated cells 4. Resorption of bone and sometimes cementum
65
Describe Sharpey's fibers
1. Calcified terminal ends of periodontal ligament fibers embedded in cementum and alveolar bone 2. Attach when cementum and bone are forming
66
Describe cementum
1. Mineralized tissue covering tooth roots 2. Attaches tooth to bone via periodontal ligament collagen fibers 3. Maintains integrity of root, helps maintain tooth, and is involved in tooth repair and regeneration 4. Key component of periodontal tissues 5. May influence activities of periodontal cells
67
What are the components of mature cementum?
1. Organic portion composed of densely packed collagen fibers and groups of proteins 2. Mineralized portion made of hydroxyapatite crystals 3. No blood vessels or nerves 4. Biologic components include growth factor molecules produced during formation and stored in matrix
68
Is cementum conserved during perio instrumentation?
1. Historical - Bacterial products penetrate cementum, so aggressive cementum removal necessary to obtain treated root surface 2. Current - Bacterial products not located in cementum, and must preserve cementum for new attachment and growth factors
69
What are the 2 types of cementum?
1. Acellular (primary) 2. Cellular (secondary)
70
What are the 3 possible arrangements of enamel at the cementum?
1. Overlap the enamel 2. Meet the enamel 3. Gap * Arrangements often abbreviated to OMG * All 3 may be present
71
What are the parts of the alveolar bone?
1. Alveolar bone proper 2. Trabecular bone 3. Cortical (compact) bone 4. Periosteum (soft tissue covering)
72
What are the functions of the alveolar bone?
1. Protects roots of teeth 2. Responds to mechanical forces and inflammation
73
What are the characteristics of the alveolar bone?
1. Major cell types: osteoblasts and osteoclasts 2. Rigid extracellular matrix due to mineralization 3. Has blood vessels and nerve innervation
74
Describe the lamina dura
1. Thin layer of bone that lines socket 2. Has Foramina (numerous holes) to allow blood vessels from cancellous bone to connect with vessels of PDL 3. Sharpey fibers are embedded 4. No periosteum!
75
Describe trabecular/cancellous bone
1. Spongy, lattice-like bone filler between cortical bone & alveolar bone proper 2. Oriented around tooth to form support for alveolar bone proper
76
Describe cortical bone
1. Cortical Bone is a layer of compact bone that forms outer wall on facial & lingual 2. Alveolar crest is coronal-most portion of alveolar process - in health – alveolar crest is 2 mm apical to CEJ; Forms a scalloped border on facial/lingual
77
Describe the periosteum
Dense fibrous membrane covering surface of bones except at joints & alveoli & serving as an attachment for muscles and tendons

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