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105 Cards in this Set

  • Front
  • Back
The four principal components of the periodontium are?
1. Gingiva
2. PDL
3. Cementum
4. Alveolar Bone
Gingiva is the portion of the masticatory mucosa that covers:
The alveolar processes of the jaws and the cervical portion of the teeth.
Attached Gingiva is attached to:
Tooth and alveolar process
The surface of oral epithelium is...
keratinized or parakeratinized.

Has prominent ridges and stippling.
The distance between the CEJ and the crest of the alveolar bone is:
1-2 mm
The surface of sulcular epithelium is...
Non-keratinized...

BUT is relatively impermeable to fluid and cells.
Junctional epithelium is more permeable to fluid and cells and forms the base of...
The Sulcus
The 4 layers of oral epithelium are:
1. Stratum Basale
2. Stratum Spinosum
3. Stratum Granulosum
4. Stratum Corneum
How does alveolar mucosa differ from gingiva?
- 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
The PDL occupies the space between...
The tooth root and the alveolar bone.
The Dentogingival Junction is a functional unit composed of...
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
Junctional epithelium is attached to the tooth by what?
Hemidesmosomes.
Junctional epithelium has two...
distinct basal laminas
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
Junctional epithelium
The ______ epithelium has the highest turnover rate in basal cells, compared to other epithelia in the oral cavity
junctional
The only gingival epithelium with two distinct basal laminas:
Junctional epithelium

- Internal basal lamina: to tooth
- External basal lamina: to gingival connective tissue
Gingival connective tissue is composed of
A lamina propria of densely packed type I collagen (60%) and reticular fibers with a few elastic and oxytalan fibers.
Does Gingival connective tissue have a submucosa?
No
The fiber bundles of the Gingival connective tissue are also referred to as:
"Gingival Ligament"

They anchor the gingiva to the tooth and alveolar bone
The five gingival fiber groups are:
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
The depth of the gingival sulcus in a healthy individual will vary from ___ __
1-3 mm
A periodontal pocket is...
the space between the detached gingiva and the tooth. Only exists in disease
What is the role of inflammation in fighting infection?
1. Deliver effector molecules/cells
2. Physical barrier, counter spread of infection.
3. Promote and initiate repair.
What are the classic signs of inflammation?
- Redness (erythema)
- Swelling (edema)
- Heat
- Pain
- Loss of function
What are the 3 initial major vascular events of inflammation?
1. Increase in vascular diameter
2. Leukocyte emigration and accumulation
3. Increase in vascular permeability
Examples of Pro-Inflammatory Cytokines
IL-1 & TNF-alpha
Mediators of inflammation
- Macrophages
- LIPID Mediators
- Prostaglandins
- Leukotrienes
- PAF
- Cytokines
- Chemokines
What is an Abscess?
area walled off by inflammatory cells and eventually the tissue in the area is destroyed by products produced by neutrophils
Pathogenesis of Periodontitis:
Bacteria->> Host Immune + Inflammatory Response ->> Destruction of CT and Bone
How extensive is the subgingival ulceration in patients w/ inflammatory periodontal disease?
~ 72 cm^2 (NOT A SMALL AREA BY ANY MEANS!)
Periodontal disease is associated with these diseases:
- Diabetes
- Cardiovascular disease
- Pre-term or low-birth weight
- Respiratory/COPD in elderly

Inflammation is the proposed link
The PDL occupies the space between...
the root surface and the alveolar bone
The PDL appears as a thin, dark line, between 0.1-0.25 mm thick, because it is
radioluscent
The PDL consists of:
- Connective tissue fibers
- Cells
- Vasculature
- Nerves
- Ground Substance
The functions of the PDL are:
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.
What are the cells of the PDL?
- Undifferentiated mesenchymal cells
- Fibroblasts
- Osteoblasts
- Cementoblasts
- Odontoblasts
- Epithelial cells: Rests of Malassez (remnants of Hertwig's epithelial root sheath)
- Immune cells
What are Epithelial Rests of Malassez?
Remnants of Hertwig's epithelial root sheath in the PDL
What are the principle fiber groups of the PDL?
- Alveolar Crestal group
- Horizontal group
- Oblique group
- Apical group
- Interradicular group
What are Sharpey's Fibers?
The mineralized ends of the principal collagen fibers embedded in cementum and bone.
Greater in number on cemental surface.
The main function of cementum is...
to anchor the periodontal ligament fibers to the tooth.
Cementum is a type of _______ tissue
connective
What is cementum?
The mineralized tissues covering the anatomic roots of teeth
Cementum is derived from ___________ cells from the ______ ____
Ectomesenchymal; Dental sac
What is the inorganic, organic and water content of cementum?
45-50% inorganic (hydroxyapatite)
50-55% organic + water
What is more common for cementum to do: Leave exposed dentin at CEJ, be end to end with enamel, or overlap enamel?
Overlap enamel ~60%
What are the 3 cell types present in cementum?
1. Cementoblasts
2. Cementocyte
3. Cementoclast
Cementoblasts are ______ shaped
Cuboidal
These cells in cementum have numerous cytoplasmic extensions that occupy canaliculi
Cementocyte
Do cementocytes make cementum?
No
Cementoclasts are located where?
In Howship's Lacunae
What are the types of cementum?
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.
Formation of cementum begins when?
During root formation
True/False?
Root dentin is deposited along Hertwig's epithelial root sheath leaving dentin exposed
True
Mineralization of cementum begins where?
At the cemento-dentinal junction
True/False?
Cementum can self-repair
True
Alveolar bone is derived from...
ectomesenchymal cells from the dental sac.
What are major differences between bone and cementum?
1. Bone has a higher inorganic content (67% vs. 50%)

2. Bone is vascularized.
Osteoblasts are derived from...
Osteoprogenitor cells.
In cancellous bone, the large marrow spaces are lined with...
a layer of flattened endosteal cells
True/False
Cancellous bone contains blood vessels.
False.
Woven bone is also called:
Bundle bone
Woven bone is adjacent to...
the PDL
In Woven bone, how are the collagen bundles arranged?
Loosely and randomly arranged
This type of bone has thin lamellae arranged parallel to the root.
Woven bone
Sharpey's fibers are embedded into what type of bone?
Woven bone of the Alveolar bone proper
Woven bone lines the...
tooth socket.
What are the components of the alveolar bone process?
1. Alveolar Bone Proper
2. Supporting Bone
3. Interdental Septa
The Alveolar bone proper is also known as...
The cribiform plate or lamina dura
This bone forms the bony sockets of the teeth.
Alveolar bone proper
Supporting bone contains an outer layer of cortical bone on the buccal and lingual surface of the ______ and ______
maxilla; mandible
Bone that separates the roots of adjacent teeth
Interdental septa
Narrow interdental septa are associated with ____ tooth surfaces while wide septa are associated with _____ tooth surfaces.
Flat; Convex
What is periosteum?
Connective tissue that is closely bound to the bone.
What are the steps in the bone mineralization process?
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.
Bone resorption occurs on the ______ side.
Bone apposition occurs on the _____ side
Pressure; Tension
Due to proximal contacts wearing over the lifetime, bone resorption is ______ along the mesial surfaces of the teeth.
increased
What is passive eruption?
Apical shift of the dentogingival unit.
What are the 4 stages of passive eruption?
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).
Reversal lines form as a result of what?
resorption and apposition of bone or cementum
The primary cause of gingivitis is...
dental plaque
What is calculus?
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.
What is an iatrogenic factor?
Faults in dental restorations and prostheses caused by the practitioner.
How might an overhanging restoration cause oral health problems?
1. Provide ideal location for plaque accumulation
2. Change the ecological balance of the sulcus,
A dental post that exits through the tooth and allows bacteria to enter would be classified as a...
Perforation
Orthodontics can cause iatrogenic factors in what 3 ways?
1. Increase plaque retention
2. Irritation from orthodontic bands
3. Response to orthodontic force
Anatomic Factors that can lead to increased oral disease include:
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.
What is Factitious Disease?
Scratching or gouging the gingiva.

Creates a Stillman's Cleft
Toothbrush abrasion can cause....
1. Recession
2. Root notching
Unreplaced missing teeth can cause:
1. Mesial drifting and tilting
2. Super Eruption
Super eruption occurs most commonly in what dental arch?
Maxillary
Malocclusion can lead to...
1. Difficult plaque control
2. Recession on facial displaced teeth
Mouth breathing, where someone cannot close the mouth and seal the oral cavity, can cause...
Inflamed gingiva

Gingival enlargement
Etiological agents that can cause chemical irritation include:
1. Aspirin
2. Mouth rinses
3. Toothpaste
A bony exostosis can associated with...
Tooth clenching/grinding
On a radiograph, necrotic pulp will be demonstrated as what?
Periapical Radiolucency
The three types of inflammation:
1. Acute
2. Chronic
3. Chronic granulomatous
Acute inflammation is characterized by what?
- Onset is abrupt
- Short duration
- Exudative response: pus forming

An abscess is usually considered to be acute inflammation
Chronic inflammation is characterized by what?
- Progressive
- Long Duration
- Usually a proliferative response
- Lymphocytes are primarily involved.

Periodontitis is a chronic inflammation
Chronic granulomatous inflammation is characterized by what?
- Associated with the recruitment of macrophages and an epitheliod and giant cell formation
Degree of inflammation is dependent on what 3 things?
1. Extent of the injury
2. Causative agent
3. Host response
What are the stages of inflammation?
- Vascular Response
- Cellular Response
- Chemical Mediators
- Immune Response
The vascular response of inflammation is characterized by what?
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
What are some of the chemical mediators involved in inflammation?
- Histamine
- Serotonin
- Bradykinins
- SRS-A
Describe the appearance of healthy gingiva
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
What are the 5 cardinal signs of inflammation?
1. Erythema
2. Edema
3. Pain
4. Increased temperature
5. Loss of function