Flashcards in Oral Soft Tissues I Deck (131):
What 5 types of fibers make up Gingival Tissue?
Where are the 5 types of fibers making up gingival tissue not seen?
What area the 3 fibers that make up the Gingivodental Group of Gingival Fibers?
What type of fibers make up the PDL?
What is the width of the PDL?
What are the 5 principal Fiber Groups that make up the PDL?
In the PDL, the Principal fibers insert into the ______ and _____
Within the PDL, what are the fibers that exist at the terminal ends and insert into cementum and alveolar bone?
*again, not on implants
What are 4 categories of Plaque-Induced Gingival Disease?
Modified by Systemic Factors (puberty, pregnancy, Leukemia)
Modified by medications
Modified by malnutrition
What are 3 drugs that can cause Gingivitis - (enalrgements)?
(class and name)
Anti-seizure medications - Dilantin
Calcium channel blockers - Nifedipine
Immunosuppressents - Cyclosporin
*Also Oral Contraceptives
Oral contraceptives can cause Gingivitis
________ periodontitis is most prevalent in adults
What 3 attributes do bacteria have that produce a perio immune-inflammatory response?
Antigens, LPS, and Virulence factors
Name 4 perio Immune-Inflammatory responses:
What cytokine breaks down connective tissue?
MMP (1 and 8)
Genetic risk factors and environmental acquired risk factors affect the host immune-inflammatory response including connective tissue and bone metabolism
Name 4 Risk categories of Periodontal disease:
Systemic factors (diabetes, genetics, etc)
Local (restorations, malocclusion, etc)
What 2 processes cause Periodontal Disease?
In periodontal disease, the amount of destruction is generally equivalent to the amount of bacteria
Name 4 species of bacteria associated with chronic periodontitis
(red complex + 1)
***additional species most periodontitis is associated with
*that's red complex
What is the average periodontal disease attachment loss per year?
0.1 - 0.2 mm/yr
What are 4 clinical signs of Periodontal Disease?
Redness, altered contours
Bleeding upon probing
CAL (clinical attachment loss)
Increased probing depth
Increased probing depth and CAL are associated with Periodontal disease progression
The 4 stages of Perio treatment are: Initial soft tissue Therapy, Re-evaluation after 4-6 weeks, If Periodontically Stable - maintenance, If Periodontically unstable - Surgery
What is the most common form of Periodontal disease?
General Mild Periodontal Disease
At what age does Gingivitis peak?
**bacteria thrive on hormones/steroids
Proper diagnosis is very important in periodontal treatment - what 5 factors is this diagnosis based on?
Consistency (density, tone)
Level of attachment (CAL)
What are the 4 tissues of the Periodontium?
What are the 3 tissues of the Attachment Apparatus?
The mucogingival junction changes throughout a lifetime
What is the clinical importance of the MGJ?
Measuring width of attached gingiva
What does the MucoGingival Junction (MGJ) form the boundary between?
Attached Gingiva and Alveolar Mucosa
*exists at the line of the alveolar bone
3 types of Gingiva, starting at the top
Keratinized (Free Gingiva + Attached Gingiva)
Attached (from bottom of sulcular crevice to MGJ)
Alveolar (MGJ down)
Rank the teeth with the most amount of Gingival Width:
Incisors > Molars > premolars
Keratinized gingiva is a tough barrier, is less plaque sensitive, more resilient, and less likely to recede
What is the minimum clinically acceptable amount of Keratinized Gingiva on the Premolar?
What are the 3 kinds of Oral Epithelium?
The oral outer epithelium can be mostly keratinized (palate) or parakeratinized - have very little keratin (cheek)
How thick is the Oral Outer Epithelium?
How often does it turn over?
0.2 - 0.3 mm
Where is the Sulcular Epithelium?
Sulcus to coronal limit of the free gingiva
Sulcular Epithelium is Keratinized and resistant to fluid flow in a healthy mouth
*non-keratinized and thin
Describe Junctional epithelium:
1-6 day turnover
Sulcus to Cemento-enamel junction
How is the Junctional Epithelium attached?
Internal Basal Lamina > Junctional Epithelium
External Basal Lamina > connective tissue
2 Keratinized surfaces of the mouth:
3 nonkeratinized surfaces of the mouth:
What is the textured surface of gingiva?
Where is it found?
Attached Gingiva bound to Alveolar bone
*fusion of epithelial ridges (rete pegs)
The Oral outer epithelium turns over every 10-12 days.
The Junctional epithelium turns over every 1-6 days.
The PDL functions to transmit physical forces, maintain attachment, remodel, and sense touch.
The ______ fibers support and form the contour of free gingiva
The ______ fibers support the gingiva
The ______ fibers anchors tooth to bone
The _______ fibers attach gingiva to alveolar bone
The ______ fibers keep teeth in alignment, protects bone, and continuously reforms as bone/fibers are destroyed and made.
Which 3 fibers aren't seen on implants?
Transseptal, Dentioperiosteal, Dentogingival
The natural seal that develops around the teeth protecting the alveolar bone from infection and disease is known as _______
What is found Coronoal to the crest of the Alveolar Bone?
Biological Width is measured between what 2 points?
Deepest point gingival sulcus
Alveolar Bone Crest
What is Biologic Width measurement?
Biologic width is composed of epithelial attachment and the gingival connective tissue attachment
If Biologic width is violated, Inflammation, Increased probing depth, and Inconsistent resorption of Alveolar Bone results
The 2.04 mm of Bioligic Width is made up of what 2 components?
What are their measurements?
Junctional Epithelium: 0.97 mm
Connective Tissue: 1.07 mm
What need to be subtracted when calculating CAL?
If Gingival Margin is above the Cemento-enamael junction
If CEJ = GM, CAL =
Distance to PDL
CAL = CEJ to GM (either +or-) + distance to PDL
What are the 2 types of Gingivitis?
What are the 3 types of Plaque-Induced gingivitis?
Non-plaque induced Gingivitis can be Specific Bacteria, Viral, Fungal, Genetic, Systemic, Traumatic, or Foreign body induced.
Ambisol, used to treat canker sores, can cause a Traumatically induced gingivitis
Give 4 examples of Systemic Plaque-Induced Gingivitis:
Leukemia (blood dyscrasias)
Biofilm makes plaque resistant to normal host defense strategies (like PMN's)
The growth and pathogenicity of Subgingival plaque is influenced by Supragingival plaque
*this is why mechanical removal is important
Non-motile bacteria dominate the Subgingival population
Subgingival tooth-associated bacteria are generally ____, while Subgingival tissue-associated bacteria are generally _____.
Dental plaque can form what?
What is calculus dependent on to form?
Calcium and Phosphate in our own saliva
Calculus is what causes periodontal disease
Calculus is a secondary contributing factor to periodontal disease
Inflammation defines ________, and loss of connective tissue defines _______
________ serves as a trap for increased plaque formation and retention
What are the 4 modes of Calculus attachment?
Penetration to Cementum
Mechanical locking with surface irregularities (CEJ)
Undersurface depression/concavities in roots
Function of the following throughout inflammation:
Increase vascular permeability and releases amines
Present antigen to T-cells (also release cytokines)
Plasma cell transformation/antibody formation
3 major cytokines involved in Perio disease and their function:
IL-beta (interleukin) = bone resorption
MMP (matrix metalloproteinase) = conn. tissue breakdown
TNF alpha = bone resorption with PGE
Name 3 cytokines involved in bone resorption:
Interleukins (IL beta)
What 2 factors are responsible for the degradation of the ECM and breakdown of collagen?
MMP (matris metalloproteinase)
Early lesion =
Established lesion =
Advanced lesion =
What type of cell-lesion is responsible for clinical signs of gingivitis, redness, bleeding, and edema?
What type of cell-lesion has plasma cells and chronic gingivitis?
B-cell Established lesion
What type of cell-lesion defines periodontitis (and is therefore irreversible)
B-cell Advanced lesion
Smoking has fewer signs of inflammation
Smokers still have gingival cervicular fluid that's being released as a result of vascular permeability
The junction between Alveolar Mucosa and Keratinized Attached Tissue
Muco Gingival Junction
The Alveolar Mucosa is unattached and therefore moveable, which is why the MGJ doesn't move/change throughout life
Current smokers have ____ more periodontal disease and former smokers have _____ more periodontal disease
Smokers have increased pathogenic Macrophage in pockets, decreased PMN chemotaxis/phagocytosis, and increased cytokine activity
What type of therapy is designed to adjust the severity of the immune response and decrease the effects of periodontitis?
Host Modulatory Therapy
What is prescribed in Host Modulatory Therapy?
What are 2 other meds that can have similar effects?
...cyclines like doxycycline (Periostat)
*decreased cytokines, MMP's, proteinase, etc
NSAIDS, bisphosphonates (systemic)
What is the single most important factor to consider when diagnosing Periodontal Disease?
CAL - clinical attachment loss
Increasing probing depths, increasing CAL, and decreased cementum would all indicate increased disease severity
*only CAL/increased probing depths
**Cementum loss doesn't matter - it's attachment to the cementum
What does the "orange peel" texture to healthy gingiva indicate?
Healthy gingiva is pink/salmon and unhealthy is red (edematious)
*also has no "tone"
Where is the width of the Cementum the largest?
Genetic polymorphism that can increase the severity of periodontal disease increase what cytokine in the inflammatory response?
The untreated Periodontal Disease Attachment loss/yr
0.1 - 0.2 mm/yr
Diabetes can be either level 1 or 2 and is often comanaged, Smoking is level 2, and level 3 is severe
Alveolar Mucosa is keratinized, Gingiva is not
In healthy gingiva, ____mm is unattached and ___ mm is attached
Interdental gingiva occupies the Col/embrasures, is pyramidal, and susceptible contact point
The Nonkeratinocytes are Melanocytes, Langerhan's cells, and Merkel cells
Describe Sulcular Epithelium
no Rete pegs
What types of collagen are in Gingival Connective Tissue
I and III
The post-capillary venous plexus feeds the junctional epithelium
Width of the Periodontal Ligament:
Rests of Malassez are isolated clusters of epithelium
Normal cementum can present as an Overlap, Butt, or Exposed Dentin. What are the %'s of each?
Exposed Dentin: 5-10%
Bone layers from inside out:
Alveolar bone (cribiform plate/Lamina Dura)
Age is not considered a true risk factor in Periodontal Disease
3 non-plaque producing species:
Aggressive periodontitis can be localized to the _____ and _____ or generalized to all the teeth.
HIghly testable list: 8 disorders of the immune system associated with Periodontitis (with genetic component)
Leukocyte adhesion deficiency syndrome
The extent of Chronic Periodontitis is Localized when what % of sites are involved
Less than 30%
The severity of Chronic Perio is Slight (1 or 2 mm CAL), Moderate (3 or 4 mm CAL) and Severe (5 and above)
Tooth associated subgingivals are G+, cocci, and less virulent than other subgingivals (which are G-, spirochetes, and more virulent/motile)
Pregnancy associated gingivitis sees an increase in what species?
*uses steroids as growth factor
G- produce ____ that activates macrophage
A.a. produces ______
P.g. produces ______
Arachidonic acid metabolite is a class of Prostaglandin
Bacteria are essential but insufficient to cause Periodontitis
Aggressive Periodontitis is associated with the following Genetic/Inherited disorders:
LAD - laukocyte adhesion deficiency
Aggressive Periodontitis is associated with the follwoing Systemic Neutrophil Abnormalities:
MMP's break down collagen