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Flashcards in Oral Soft Tissues I Deck (131):
1

What 5 types of fibers make up Gingival Tissue?

Circular

Dentogingival

Dentoperiosteal

Alveologingival

Transseptal

2

Where are the 5 types of fibers making up gingival tissue not seen?

Implants

3

What area the 3 fibers that make up the Gingivodental Group of Gingival Fibers?

Dentogingival

Dentoperiosteal

Alveologingival

4

What type of fibers make up the PDL?

Collagen

5

What is the width of the PDL?

0.2 mm

6

What are the 5 principal Fiber Groups that make up the PDL?

Alveolar Crest

Horizontal

Oblique

Apical

Interradicular

7

In the PDL, the Principal fibers insert into the ______ and _____

Cementum

Alveolar bone

8

Within the PDL, what are the fibers that exist at the terminal ends and insert into cementum and alveolar bone?

Sharpey's fibers

*again, not on implants

9

What are 4 categories of Plaque-Induced Gingival Disease?

Ental plaque

Modified by Systemic Factors (puberty, pregnancy, Leukemia)

Modified by medications

Modified by malnutrition

10

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

11

T/F
Oral contraceptives can cause Gingivitis

True

12

________ periodontitis is most prevalent in adults

Chronic

13

What 3 attributes do bacteria have that produce a perio immune-inflammatory response?

Antigens, LPS, and Virulence factors

14

Name 4 perio Immune-Inflammatory responses:

Antibodies

PMN's

Cytokines

Prostanoids

15

What cytokine breaks down connective tissue?

MMP (1 and 8)

16

T/F
Genetic risk factors and environmental acquired risk factors affect the host immune-inflammatory response including connective tissue and bone metabolism

True

17

Name 4 Risk categories of Periodontal disease:

Microbial

Systemic factors (diabetes, genetics, etc)

Behavioral

Local (restorations, malocclusion, etc)

18

What 2 processes cause Periodontal Disease?

Bacterial growth

Inflammatory response

19

T/F
In periodontal disease, the amount of destruction is generally equivalent to the amount of bacteria

True

20

Name 4 species of bacteria associated with chronic periodontitis
(red complex + 1)

***additional species most periodontitis is associated with

Porphyromonas gingivalis

Tannerella forsythia

Prevotella intermedia

*that's red complex

Aggregatibacter actinomycetemcomitans

***Prevotella intermedia

21

What is the average periodontal disease attachment loss per year?

0.1 - 0.2 mm/yr

22

What are 4 clinical signs of Periodontal Disease?

Redness, altered contours

Bleeding upon probing

CAL (clinical attachment loss)

Increased probing depth

23

T/F
Increased probing depth and CAL are associated with Periodontal disease progression

True

24

T/F
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

True

25

What is the most common form of Periodontal disease?

General Mild Periodontal Disease

(chronic?)

26

At what age does Gingivitis peak?

Puberty

*endocrine/hormonally mediated

**bacteria thrive on hormones/steroids

27

Proper diagnosis is very important in periodontal treatment - what 5 factors is this diagnosis based on?

Color

Contour

Consistency (density, tone)

Probing depths

Level of attachment (CAL)

28

What are the 4 tissues of the Periodontium?

Gingiva/Alveolar mucosa

Periodontal ligament

Cementum

Alveolar bone

29

What are the 3 tissues of the Attachment Apparatus?

PDL

Cementum

Alveolar bone

30

T/F
The mucogingival junction changes throughout a lifetime

False

31

What is the clinical importance of the MGJ?

(mucogingival junction)

Measuring width of attached gingiva

32

What does the MucoGingival Junction (MGJ) form the boundary between?

Attached Gingiva and Alveolar Mucosa

*exists at the line of the alveolar bone

33

3 types of Gingiva, starting at the top

Keratinized (Free Gingiva + Attached Gingiva)

Attached (from bottom of sulcular crevice to MGJ)

Alveolar (MGJ down)

34

Rank the teeth with the most amount of Gingival Width:

Incisors > Molars > premolars

35

T/F
Keratinized gingiva is a tough barrier, is less plaque sensitive, more resilient, and less likely to recede

True

36

What is the minimum clinically acceptable amount of Keratinized Gingiva on the Premolar?

2 mm

37

What are the 3 kinds of Oral Epithelium?

Outer

Sulcular

Junctional

38

T/F
The oral outer epithelium can be mostly keratinized (palate) or parakeratinized - have very little keratin (cheek)

True

39

How thick is the Oral Outer Epithelium?

How often does it turn over?

0.2 - 0.3 mm

10-12 days

40

Where is the Sulcular Epithelium?

Sulcus to coronal limit of the free gingiva

41

T/F
Sulcular Epithelium is Keratinized and resistant to fluid flow in a healthy mouth

False

*non-keratinized and thin

42

Describe Junctional epithelium:

Non-keratinized

1-6 day turnover

Sulcus to Cemento-enamel junction

43

How is the Junctional Epithelium attached?

Hemidesmosomes

Internal Basal Lamina > Junctional Epithelium

External Basal Lamina > connective tissue

44

2 Keratinized surfaces of the mouth:

Palate

Cheek

45

3 nonkeratinized surfaces of the mouth:

Alveolar mucosa

Sulcular Epithelium

Junctional Epithelium

46

What is the textured surface of gingiva?

Where is it found?

Stippling

Attached Gingiva bound to Alveolar bone

*fusion of epithelial ridges (rete pegs)

47

T/F
The Oral outer epithelium turns over every 10-12 days.

T/F
The Junctional epithelium turns over every 1-6 days.

True

True

48

T/F
The PDL functions to transmit physical forces, maintain attachment, remodel, and sense touch.

True

49

The ______ fibers support and form the contour of free gingiva

Circular

50

The ______ fibers support the gingiva

Dentogingival

51

The ______ fibers anchors tooth to bone

Dentoperiosteal

52

The _______ fibers attach gingiva to alveolar bone

Alvoelogingival

53

The ______ fibers keep teeth in alignment, protects bone, and continuously reforms as bone/fibers are destroyed and made.

Transseptal

54

Which 3 fibers aren't seen on implants?

Transseptal, Dentioperiosteal, Dentogingival

*also PDL

55

The natural seal that develops around the teeth protecting the alveolar bone from infection and disease is known as _______

Biological Width

56

What is found Coronoal to the crest of the Alveolar Bone?

Biological Width

57

Biological Width is measured between what 2 points?

Deepest point gingival sulcus

Alveolar Bone Crest

58

What is Biologic Width measurement?

2.04 mm

59

T/F
Biologic width is composed of epithelial attachment and the gingival connective tissue attachment

True

60

T/F
If Biologic width is violated, Inflammation, Increased probing depth, and Inconsistent resorption of Alveolar Bone results

True

61

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

62

What need to be subtracted when calculating CAL?

If Gingival Margin is above the Cemento-enamael junction

63

If CEJ = GM, CAL =

Distance to PDL

64

CAL = CEJ to GM (either +or-) + distance to PDL

True

65

What are the 2 types of Gingivitis?

Plaque-Induced

Non Plaque-Induced

66

What are the 3 types of Plaque-Induced gingivitis?

Systemic

Meds

Malnutrition

67

T/F
Non-plaque induced Gingivitis can be Specific Bacteria, Viral, Fungal, Genetic, Systemic, Traumatic, or Foreign body induced.

True

68

T/F
Ambisol, used to treat canker sores, can cause a Traumatically induced gingivitis

True

69

Give 4 examples of Systemic Plaque-Induced Gingivitis:

Endocrine Puberty

Endocrine Pregnancy

Endocrine Diabetes

Leukemia (blood dyscrasias)

70

Red Complex:

P. gingivalis

T. forsythia

T. denticola

71

T/F
Biofilm makes plaque resistant to normal host defense strategies (like PMN's)

True

72

T/F
The growth and pathogenicity of Subgingival plaque is influenced by Supragingival plaque

True

*this is why mechanical removal is important

73

T/F
Non-motile bacteria dominate the Subgingival population

False

74

Subgingival tooth-associated bacteria are generally ____, while Subgingival tissue-associated bacteria are generally _____.

G+

G-

75

Dental plaque can form what?

Calculus

76

What is calculus dependent on to form?

Calcium and Phosphate in our own saliva

77

T/F
Calculus is what causes periodontal disease

False

78

T/F
Calculus is a secondary contributing factor to periodontal disease

True

79

Inflammation defines ________, and loss of connective tissue defines _______

Gingivitis

Periodontitis

80

________ serves as a trap for increased plaque formation and retention

Calculus

81

What are the 4 modes of Calculus attachment?

Pellicle

Penetration to Cementum

Mechanical locking with surface irregularities (CEJ)

Undersurface depression/concavities in roots

82

Function of the following throughout inflammation:
PMN's

Mast Cell

Macrophage

T-lymphocytes

B-lymphocytes

1st responder

Increase vascular permeability and releases amines

Present antigen to T-cells (also release cytokines)

Delay hypersensitivity/Lymphokines

Plasma cell transformation/antibody formation

83

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

84

Name 3 cytokines involved in bone resorption:

Interleukins (IL beta)

TNF alpha

PGE2

85

What 2 factors are responsible for the degradation of the ECM and breakdown of collagen?

MMP (matris metalloproteinase)

Elastase

86

Early lesion =

Established lesion =

Advanced lesion =

T-cell

B-cell

B-cell

87

What type of cell-lesion is responsible for clinical signs of gingivitis, redness, bleeding, and edema?

Timeframe?

T-cell lesion

4-7 days

88

What type of cell-lesion has plasma cells and chronic gingivitis?

Timeframe?

B-cell Established lesion

2-3 weeks

89

What type of cell-lesion defines periodontitis (and is therefore irreversible)

B-cell Advanced lesion

(timeframe unknown)

90

T/F
Smoking has fewer signs of inflammation

True

91

T/F
Smokers still have gingival cervicular fluid that's being released as a result of vascular permeability

True

92

The junction between Alveolar Mucosa and Keratinized Attached Tissue

Muco Gingival Junction

MGJ

93

T/F
The Alveolar Mucosa is unattached and therefore moveable, which is why the MGJ doesn't move/change throughout life

True

94

Current smokers have ____ more periodontal disease and former smokers have _____ more periodontal disease

4x

1.6x

95

T/F
Smokers have increased pathogenic Macrophage in pockets, decreased PMN chemotaxis/phagocytosis, and increased cytokine activity

True

96

What type of therapy is designed to adjust the severity of the immune response and decrease the effects of periodontitis?

Host Modulatory Therapy

97

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)

98

What is the single most important factor to consider when diagnosing Periodontal Disease?

CAL - clinical attachment loss

99

T/F
Increasing probing depths, increasing CAL, and decreased cementum would all indicate increased disease severity

False

*only CAL/increased probing depths
**Cementum loss doesn't matter - it's attachment to the cementum

100

What does the "orange peel" texture to healthy gingiva indicate?

Stippling

101

T/F
Healthy gingiva is pink/salmon and unhealthy is red (edematious)

True

*also has no "tone"

102

Where is the width of the Cementum the largest?

Thinnest?

Apically

Coronal

103

Genetic polymorphism that can increase the severity of periodontal disease increase what cytokine in the inflammatory response?

IL-1

104

The untreated Periodontal Disease Attachment loss/yr

0.1 - 0.2 mm/yr

105

T/F
Diabetes can be either level 1 or 2 and is often comanaged, Smoking is level 2, and level 3 is severe

True

106

T/F
Alveolar Mucosa is keratinized, Gingiva is not

False

*opposite

107

In healthy gingiva, ____mm is unattached and ___ mm is attached

3

6

108

T/F
Interdental gingiva occupies the Col/embrasures, is pyramidal, and susceptible contact point

True

109

T/F
The Nonkeratinocytes are Melanocytes, Langerhan's cells, and Merkel cells

True

110

Describe Sulcular Epithelium
(3 things)

Nonkeratinized

Thin

no Rete pegs

111

What types of collagen are in Gingival Connective Tissue

I and III

112

T/F
The post-capillary venous plexus feeds the junctional epithelium

True

113

Width of the Periodontal Ligament:

0.2 mm

114

T/F
Rests of Malassez are isolated clusters of epithelium

True

115

Normal cementum can present as an Overlap, Butt, or Exposed Dentin. What are the %'s of each?

Overlap: 60-65%

Butt: 30%

Exposed Dentin: 5-10%

116

Bone layers from inside out:

Alveolar bone (cribiform plate/Lamina Dura)

Cancellous trabeculae

External plate

117

T/F
Age is not considered a true risk factor in Periodontal Disease

True

118

3 non-plaque producing species:

Streptococcal

Neisseria

Treponema

119

Aggressive periodontitis can be localized to the _____ and _____ or generalized to all the teeth.

Molars

Incisors

120

HIghly testable list: 8 disorders of the immune system associated with Periodontitis (with genetic component)

Familial/cyclic neutropienia

Down syndrome

Leukocyte adhesion deficiency syndrome

Pipillion-Lefevre syndrome

Chekiak-Higashi syndrome

Histocytosis syndromes

Cohen syndrome

Hypophosphatasia

121

The extent of Chronic Periodontitis is Localized when what % of sites are involved

Less than 30%

122

T/F

The severity of Chronic Perio is Slight (1 or 2 mm CAL), Moderate (3 or 4 mm CAL) and Severe (5 and above)

True

123

T/F
Tooth associated subgingivals are G+, cocci, and less virulent than other subgingivals (which are G-, spirochetes, and more virulent/motile)

True

124

Pregnancy associated gingivitis sees an increase in what species?

Prevotella intermedia

*uses steroids as growth factor

125

G- produce ____ that activates macrophage

A.a. produces ______

P.g. produces ______

LPS

leukotoxin

protease

126

T/F
Arachidonic acid metabolite is a class of Prostaglandin

True

127

T/F
Bacteria are essential but insufficient to cause Periodontitis

True

128

T/F
Aggressive Periodontitis is associated with the following Genetic/Inherited disorders:

LAD - laukocyte adhesion deficiency

Chekiak-Higashi Syndrome

Ehler-Danos Syndrome

Hypophosphatasia

Trisomy 21

True

129

T/F
Aggressive Periodontitis is associated with the follwoing Systemic Neutrophil Abnormalities:

Neutropenia

Chediak-Higashi

Papillon-Lefevre

LAD

True

130

T/F
MMP's break down collagen

True

131

T/F
Smokeless tobacco has no effect on periodontitis

True

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