D1 - Periodontology - Exam 1

Front 1

The four principal components of the periodontium are?

Back 1

1. Gingiva
2. PDL
3. Cementum
4. Alveolar Bone

Front 2

Gingiva is the portion of the masticatory mucosa that covers:

Back 2

The alveolar processes of the jaws and the cervical portion of the teeth.

Front 3

Attached Gingiva is attached to:

Back 3

Tooth and alveolar process

Front 4

The surface of oral epithelium is...

Back 4

keratinized or parakeratinized.

Has prominent ridges and stippling.

Front 5

The distance between the CEJ and the crest of the alveolar bone is:

Back 5

1-2 mm

Front 6

The surface of sulcular epithelium is...

Back 6

Non-keratinized...

BUT is relatively impermeable to fluid and cells.

Front 7

Junctional epithelium is more permeable to fluid and cells and forms the base of...

Back 7

The Sulcus

Front 8

The 4 layers of oral epithelium are:

Back 8

1. Stratum Basale
2. Stratum Spinosum
3. Stratum Granulosum
4. Stratum Corneum

Front 9

How does alveolar mucosa differ from gingiva?

Back 9

- Non-keratinized, stratified, squamous epithelium
- Subepithelial connective tissue is loosely attached to the periosteum (bone)
- Minor salivary glands may be present
- Does not support teeth

Front 10

The PDL occupies the space between...

Back 10

The tooth root and the alveolar bone.

Front 11

The Dentogingival Junction is a functional unit composed of...

Back 11

gingival connective tissue and the epithelium attachment.

The attachment of the junctional epithelium to tooth is reinforced by gingival fibers in the gingival connective tissue

Front 12

Junctional epithelium is attached to the tooth by what?

Back 12

Hemidesmosomes.

Front 13

Junctional epithelium has two...

Back 13

distinct basal laminas

Front 14

Separates the PDL from oral environment.
Adheres to the tooth
Stratified, squamous, non-keratinized
15-20 cells thick at bottom of sulcus, narrows apically to a few cells

Back 14

Junctional epithelium

Front 15

The ______ epithelium has the highest turnover rate in basal cells, compared to other epithelia in the oral cavity

Back 15

junctional

Front 16

The only gingival epithelium with two distinct basal laminas:

Back 16

Junctional epithelium

- Internal basal lamina: to tooth
- External basal lamina: to gingival connective tissue

Front 17

Gingival connective tissue is composed of

Back 17

A lamina propria of densely packed type I collagen (60%) and reticular fibers with a few elastic and oxytalan fibers.

Front 18

Does Gingival connective tissue have a submucosa?

Back 18

No

Front 19

The fiber bundles of the Gingival connective tissue are also referred to as:

Back 19

"Gingival Ligament"

They anchor the gingiva to the tooth and alveolar bone

Front 20

The five gingival fiber groups are:

Back 20

1. Alveologingival - arise from the alveolar crest and insert coronally into the lamina propria.
2. Dentogingival - extends from the cementum just apical to base of JE and CT of free and attached gingiva.
3. Dentoperiosteal - from cervical cementum to periosteum.
4. Circular - encircles tooth
5. Transeptal - horizontal fibers that extend between teeth

Front 21

The depth of the gingival sulcus in a healthy individual will vary from ___ __

Back 21

1-3 mm

Front 22

A periodontal pocket is...

Back 22

the space between the detached gingiva and the tooth. Only exists in disease

Front 23

What is the role of inflammation in fighting infection?

Back 23

1. Deliver effector molecules/cells
2. Physical barrier, counter spread of infection.
3. Promote and initiate repair.

Front 24

What are the classic signs of inflammation?

Back 24

- Redness (erythema)
- Swelling (edema)
- Heat
- Pain
- Loss of function

Front 25

What are the 3 initial major vascular events of inflammation?

Back 25

1. Increase in vascular diameter
2. Leukocyte emigration and accumulation
3. Increase in vascular permeability

Front 26

Examples of Pro-Inflammatory Cytokines

Back 26

IL-1 & TNF-alpha

Front 27

Mediators of inflammation

Back 27

- Macrophages
- LIPID Mediators
- Prostaglandins
- Leukotrienes
- PAF
- Cytokines
- Chemokines

Front 28

What is an Abscess?

Back 28

area walled off by inflammatory cells and eventually the tissue in the area is destroyed by products produced by neutrophils

Front 29

Pathogenesis of Periodontitis:

Back 29

Bacteria->> Host Immune + Inflammatory Response ->> Destruction of CT and Bone

Front 30

How extensive is the subgingival ulceration in patients w/ inflammatory periodontal disease?

Back 30

~ 72 cm^2 (NOT A SMALL AREA BY ANY MEANS!)

Front 31

Periodontal disease is associated with these diseases:

Back 31

- Diabetes
- Cardiovascular disease
- Pre-term or low-birth weight
- Respiratory/COPD in elderly

Inflammation is the proposed link

Front 32

The PDL occupies the space between...

Back 32

the root surface and the alveolar bone

Front 33

The PDL appears as a thin, dark line, between 0.1-0.25 mm thick, because it is

Back 33

radioluscent

Front 34

The PDL consists of:

Back 34

- Connective tissue fibers
- Cells
- Vasculature
- Nerves
- Ground Substance

Front 35

The functions of the PDL are:

Back 35

1. Formative: provides progenitor cells.
2. Supportive: anchors the tooth to the bone.
3. Nutritive: contains a blood supply and lymphatics
4. Sensory: capable of transmitting tactile pressure and pain by proprioceptive nerve endings.
5. Protective - cushions occlusal forces.

Front 36

What are the cells of the PDL?

Back 36

- Undifferentiated mesenchymal cells
- Fibroblasts
- Osteoblasts
- Cementoblasts
- Odontoblasts
- Epithelial cells: Rests of Malassez (remnants of Hertwig's epithelial root sheath)
- Immune cells

Front 37

What are Epithelial Rests of Malassez?

Back 37

Remnants of Hertwig's epithelial root sheath in the PDL

Front 38

What are the principle fiber groups of the PDL?

Back 38

- Alveolar Crestal group
- Horizontal group
- Oblique group
- Apical group
- Interradicular group

Front 39

What are Sharpey's Fibers?

Back 39

The mineralized ends of the principal collagen fibers embedded in cementum and bone.
Greater in number on cemental surface.

Front 40

The main function of cementum is...

Back 40

to anchor the periodontal ligament fibers to the tooth.

Front 41

Cementum is a type of _______ tissue

Back 41

connective

Front 42

What is cementum?

Back 42

The mineralized tissues covering the anatomic roots of teeth

Front 43

Cementum is derived from ___________ cells from the ______ ____

Back 43

Ectomesenchymal; Dental sac

Front 44

What is the inorganic, organic and water content of cementum?

Back 44

45-50% inorganic (hydroxyapatite)
50-55% organic + water

Front 45

What is more common for cementum to do: Leave exposed dentin at CEJ, be end to end with enamel, or overlap enamel?

Back 45

Overlap enamel ~60%

Front 46

What are the 3 cell types present in cementum?

Back 46

1. Cementoblasts
2. Cementocyte
3. Cementoclast

Front 47

Cementoblasts are ______ shaped

Back 47

Cuboidal

Front 48

These cells in cementum have numerous cytoplasmic extensions that occupy canaliculi

Back 48

Cementocyte

Front 49

Do cementocytes make cementum?

Back 49

No

Front 50

Cementoclasts are located where?

Back 50

In Howship's Lacunae

Front 51

What are the types of cementum?

Back 51

1. Acellular Cementum (Primary): located in the coronal 1/3. adjacent to dentin surface. Sharpey's fibers are embedded. Highly calcified.

2. Cellular Cementum (Secondary): at the apical aspect of the root. Bone-like. Cementocytes embedded within. Less calcified.

Front 52

Formation of cementum begins when?

Back 52

During root formation

Front 53

True/False?
Root dentin is deposited along Hertwig's epithelial root sheath leaving dentin exposed

Back 53

True

Front 54

Mineralization of cementum begins where?

Back 54

At the cemento-dentinal junction

Front 55

True/False?
Cementum can self-repair

Back 55

True

Front 56

Alveolar bone is derived from...

Back 56

ectomesenchymal cells from the dental sac.

Front 57

What are major differences between bone and cementum?

Back 57

1. Bone has a higher inorganic content (67% vs. 50%)

2. Bone is vascularized.

Front 58

Osteoblasts are derived from...

Back 58

Osteoprogenitor cells.

Front 59

In cancellous bone, the large marrow spaces are lined with...

Back 59

a layer of flattened endosteal cells

Front 60

True/False
Cancellous bone contains blood vessels.

Back 60

False.

Front 61

Woven bone is also called:

Back 61

Bundle bone

Front 62

Woven bone is adjacent to...

Back 62

the PDL

Front 63

In Woven bone, how are the collagen bundles arranged?

Back 63

Loosely and randomly arranged

Front 64

This type of bone has thin lamellae arranged parallel to the root.

Back 64

Woven bone

Front 65

Sharpey's fibers are embedded into what type of bone?

Back 65

Woven bone of the Alveolar bone proper

Front 66

Woven bone lines the...

Back 66

tooth socket.

Front 67

What are the components of the alveolar bone process?

Back 67

1. Alveolar Bone Proper
2. Supporting Bone
3. Interdental Septa

Front 68

The Alveolar bone proper is also known as...

Back 68

The cribiform plate or lamina dura

Front 69

This bone forms the bony sockets of the teeth.

Back 69

Alveolar bone proper

Front 70

Supporting bone contains an outer layer of cortical bone on the buccal and lingual surface of the ______ and ______

Back 70

maxilla; mandible

Front 71

Bone that separates the roots of adjacent teeth

Back 71

Interdental septa

Front 72

Narrow interdental septa are associated with ____ tooth surfaces while wide septa are associated with _____ tooth surfaces.

Back 72

Flat; Convex

Front 73

What is periosteum?

Back 73

Connective tissue that is closely bound to the bone.

Front 74

What are the steps in the bone mineralization process?

Back 74

1. Organic matrix is formed

2. Matrix vesicles bud off containing calcium and alkaline phosphate

3. Growth of calcium hydroxyapatite crystals

4. Organic matrix and the crystals are packed between collagen fibrils.

Front 75

Bone resorption occurs on the ______ side.
Bone apposition occurs on the _____ side

Back 75

Pressure; Tension

Front 76

Due to proximal contacts wearing over the lifetime, bone resorption is ______ along the mesial surfaces of the teeth.

Back 76

increased

Front 77

What is passive eruption?

Back 77

Apical shift of the dentogingival unit.

Front 78

What are the 4 stages of passive eruption?

Back 78

Stage 1: The teeth reach the line of occlusion. The junctional epithelium and the base of the gingival sulcus are on the enamel.

Stage 2: The junctional epithelium proliferates so that part is on the cementum and part is on the enamel. The base of the sulcus is still on the enamel.

Stage 3: The entire junctional epithelium is on the cementum, and the base of the sulcus is at the CEJ. As the junctional epithelium proliferates from the crown onto the root, it does not remain at the CEJ and longer than at any other area of the tooth.

Stage 4. The junctional epithelium has proliferated farther on the cementum. The base of the sulcus is on the cementum, a portion of which is exposed. Proliferation of the junctional epithelium onto the root is accompanied by degeneration of gingival and periodontal ligament fiber and their detachment from the tooth. The cause of this degeneration is not understood (probably inflammation).

Front 79

Reversal lines form as a result of what?

Back 79

resorption and apposition of bone or cementum

Front 80

The primary cause of gingivitis is...

Back 80

dental plaque

Front 81

What is calculus?

Back 81

Calcified dental plaque.

Not a direct source of inflammation, but provides a rough surface for plaque attachment and it may act a reservoir for irritating substances.

Front 82

What is an iatrogenic factor?

Back 82

Faults in dental restorations and prostheses caused by the practitioner.

Front 83

How might an overhanging restoration cause oral health problems?

Back 83

1. Provide ideal location for plaque accumulation
2. Change the ecological balance of the sulcus,

Front 84

A dental post that exits through the tooth and allows bacteria to enter would be classified as a...

Back 84

Perforation

Front 85

Orthodontics can cause iatrogenic factors in what 3 ways?

Back 85

1. Increase plaque retention
2. Irritation from orthodontic bands
3. Response to orthodontic force

Front 86

Anatomic Factors that can lead to increased oral disease include:

Back 86

1. Root Morphology: size. shape. concavities on root.
2. Tooth Position: size and position in the arch.
3. Root Proximity: Only becomes an issue when periodontal disease is already present. Area must be cleaned, but if the roots are too close, the practitioner won't be able to access the area.
4. Crowded Teeth: May make flossing and brushing difficult.
5. Tooth Form Factors: disto-lingual groove on maxillary lateral incisors is associated with periodontal pocket. Cervical projects don't allow proper soft tissue attachment.
6. Food Impaction: associated with open or abnormal proximal contacts.

Front 87

What is Factitious Disease?

Back 87

Scratching or gouging the gingiva.

Creates a Stillman's Cleft

Front 88

Toothbrush abrasion can cause....

Back 88

1. Recession
2. Root notching

Front 89

Unreplaced missing teeth can cause:

Back 89

1. Mesial drifting and tilting
2. Super Eruption

Front 90

Super eruption occurs most commonly in what dental arch?

Back 90

Maxillary

Front 91

Malocclusion can lead to...

Back 91

1. Difficult plaque control
2. Recession on facial displaced teeth

Front 92

Mouth breathing, where someone cannot close the mouth and seal the oral cavity, can cause...

Back 92

Inflamed gingiva

Gingival enlargement

Front 93

Etiological agents that can cause chemical irritation include:

Back 93

1. Aspirin
2. Mouth rinses
3. Toothpaste

Front 94

A bony exostosis can associated with...

Back 94

Tooth clenching/grinding

Front 95

On a radiograph, necrotic pulp will be demonstrated as what?

Back 95

Periapical Radiolucency

Front 96

The three types of inflammation:

Back 96

1. Acute
2. Chronic
3. Chronic granulomatous

Front 97

Acute inflammation is characterized by what?

Back 97

- Onset is abrupt
- Short duration
- Exudative response: pus forming

An abscess is usually considered to be acute inflammation

Front 98

Chronic inflammation is characterized by what?

Back 98

- Progressive
- Long Duration
- Usually a proliferative response
- Lymphocytes are primarily involved.

Periodontitis is a chronic inflammation

Front 99

Chronic granulomatous inflammation is characterized by what?

Back 99

- Associated with the recruitment of macrophages and an epitheliod and giant cell formation

Front 100

Degree of inflammation is dependent on what 3 things?

Back 100

1. Extent of the injury
2. Causative agent
3. Host response

Front 101

What are the stages of inflammation?

Back 101

- Vascular Response
- Cellular Response
- Chemical Mediators
- Immune Response

Front 102

The vascular response of inflammation is characterized by what?

Back 102

1. Increased blood flow
2. Sticking of WBCs to the capillary walls
3. Migration of leukocytes through the capillary walls and chemotaxis of granulocytes slowly replaced by monocytes

Front 103

What are some of the chemical mediators involved in inflammation?

Back 103

- Histamine
- Serotonin
- Bradykinins
- SRS-A

Front 104

Describe the appearance of healthy gingiva

Back 104

Color: Coral pink and can range to brown
Contour: Follows the teeth and has a knife-edge in the papilla
Consistency: Firm and resistant. May show stippling

Front 105

What are the 5 cardinal signs of inflammation?

Back 105

1. Erythema
2. Edema
3. Pain
4. Increased temperature
5. Loss of function