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502 Cards in this Set
- Front
- Back
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Text 1
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Text 2
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The periodontium is composed of:
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"Cementum
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What does the periodontal ligament do?
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Connects the alveolar bone to the cementum of the root of a tooth
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What is the specialized joint that binds the teeth to bony sockets in the maxillary and mandible bone?
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Gomphosis
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What is cementum?
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A hard avascular connective tissue covering the roots of the teeth
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What are the 3 roles of Cementum?
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"1) Covers and protects the root dentin (covers the opening of dentinal tubules
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Describe the thickness of cementum
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"Thickest in the apex and inter-radicular areas of multi-rooted teeth
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What are the physical properties of cementum?
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"More permeable than other dental tissues
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What is the clinical significance of the physical properties of cementum?
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"Gingival recession exposing the thinnest cementum leads to root exposure and sensitivity
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Where does cementum formation occur?
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along the entire tooth
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What are Hertwig's epithelial root sheath (HERS)?
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extensions of the inner and outer dental epithelium
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What is the function of HERS?
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sends inductive signal to ectomesenchymal pulp cells to secrete predentin by differentiating into odontoblasts
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What happens with the interuption of HERS?
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ectomesenchymal cells from the inner portion of the dental follicle come in contact with predentin and differentiate into cementoblasts - formation of cementum
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What are the 3 theories of cementoblsts activation to lay down cementum?
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"1) infiltrating dental follicle cells recive reciprocal signal form the dentin or the surround HERS cells and differentiate into cementoblasts
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Describe the mineralization and formation of CDJ
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"Collagen fibrils of dentin and cementum blend together
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What are the 3 ways cementum is classified?
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"According to cellularity
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Is acellular or cellular cementum primary?
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"Acellular cementum is primary
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What are the properties of acellular cementum?
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"Covers root along adjacent dentin
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What are the properties of cellular cementum?
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"Apical, interradicular, and overlaying acellular cementum
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What are hyaline layers of Hopewell Smith?
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intermediate cementum
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Where do Hyaline layers of Hopewell Smith exist?
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between the granular lyar of Tomes and the cementum
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What does the first layer of cementum by the inner cells of HERS do?
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seals the dentinal tubules
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How does the Hyaline layer of Hopewell Smith mineralize compared to the adjacent dentin or the secondary cementum?
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More mineralized; approximately 10 micrometers thick
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Where do extrinsic and intrinsic collagen fibers originate?
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"Extrinsic = From PDL (Sharpey's fibers)
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What is the nature of extrinsic/intrinsic collagen fibers in cementum?
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"extrinsic = oriented same direction as PDL fibers (perpendicular to root surface)
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Where do extrinsic and intrinsic collagen fibers meet?
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mixed fiber cementum
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What type of fibers do AEFC, CIFC, alternating cellular and acellular, and acellular afibrillar have?
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"AEFC = extrinsic
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What type of location do AEFC, CIFC, alternating cellular and acellular, and acellular afibrillar have?
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"AEFC = bulk: from cervical margin to apical third increasing in thickness apically
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What function do AEFC, CIFC, alternating cellular and acellular, and acellular afibrillar have?
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"AEFC = anchorage
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The following are bone vs. cementum questions
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What is the difference between the function of bone and cementum?
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"skeleton = bone
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What is the difference between the structure of bone and cementum?
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"cementum = lacks lammellar organization of bone
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What is the difference between the cellular population involved with bone and cementum?
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"bone: osteoblasts, osteocytes, bone lining cells, and osteoclasts
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What is the difference between ECM composition of bone and cementum?
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"cementum:
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TGF-beta (BMP)
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promote cell differentiation and cementogenesis during development and regeneration
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PDGF / IGF
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promote cemetnum formation by altering cell cycle activity
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FGF
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promote cell proliferation, migration, and vasculogenesis in the periodontium in general
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BSP / OP
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regulate mineralization and extent of crystal growth. Balance is believed to maintin the non-mineralizing structure of PDL
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enamel proteins
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invovled in epithelial mesenchymal transition for cementoblasts differnetation
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collagen
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mainly type I, also type II, and XII
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Gla proteins
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"OC: mineralization regulation and crystals growth
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What is the difference between functional cell regulation of bone and cementum?
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"cementum does not undergo physiologic remodeling
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What is the difference between cell differentation mechanism of bone and cementum?
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Runx2, Epidermal GF, BMP, EMP
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What is the difference between origin of forming cells of bone and cementum?
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"alveolar osteoblasts arise from dental follicle, periosteum and bone marrow
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What are the 3 forms of the CEJ?
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"60-65% cementum overlaps enamel
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How does cementum age?
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"smooth surface becomes irregular due to calcification of ligament fiber bundles where they are attached to cementum
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Describe cemental repair
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protective function of cementoblasts after resorption of root dentin or cementum
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When does cemental repair occur?
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after trauma or loss of cementum accompanied by loss of attachment
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What happens following reparative cementum deposition?
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the attachment is restored
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describe cementicles
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"calcified ovoid or round nodule in PDL
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What is the origin of cementicles?
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"Calcifying nidus of epithelial cell
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What is hypercementosis?
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"abnormal thickening of normal cementum
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Causes of hypercementosis?
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pagets, ideopathic, acromegaly (gigantism), occlusal trauma, non-functional tooth trauma, periapical granuloma
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Describe the periodontal ligament
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soft specialized connetive tissue between cementum and alveolar bone proper
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What occurs to PDL with age?
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width decreases
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What is the turnover rate of the PDL?
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high turnover rate
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What is the function of the PDL?
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"supportive
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What is the origin of PDL?
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Mesenchymal from the dental follicle shortly after root development begins
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What is the PDL composed of?
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Cells, fibers, and ground substance (GAG, GP, GL)
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What are the most abundant cells in the PDL?
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Fibroblasts (65%)
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What are the properties of PDL fibroblasts?
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"high turnover rate --> prone to destruction and flexible adaptation to tooth movement
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What are the epithelial cells in the PDL?
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epithelial cell rests of Malassez (ERMS)
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location of cementoblasts and osteoblasts in PDL
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"cementoblasts: cover the periodontal surface of cementum
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What are 3 other cells found in PDL?
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"macrophages: derived from blood monocytes
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Function of undifferentiated cells in PDL
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"progenitors for fibroblasts, osteoblasts, and cementoblasts
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What are the fibers of the PDL?
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"Collagen I, II, and XII (principal fiber bundles)
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What are the 5 types of Dentoalveolar fiber groups?
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"alveolar crest group
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alveolar crest group
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below the CEJ
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horizontal group
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apical to ACG
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oblique group
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"most numerous
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apical group
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around the apex, base of socket
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interraddicular group
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multi-rooted teeth forming the crest of the interradicular septum
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What are the gingival ligament fibers?
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"principal fibers in the gingival area (not strictly related to periodontium)
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What are the five types of gingival ligament fibers?
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"dentogingival: most numerous, cervical cementum to gingiva
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What are oxytalan fibers?
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immature elastic fibers
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Where are oxytalan fibers located?
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restricted to walls of blood vessels and are oriented obliquely in an axial direciton from the cementum surface to the blood vessels
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Where are oxytalan fibers most numerous?
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in the cervical area
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What is the function of oxytalan fiber?
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support Blood vessels and regulate vascular flow in relation to tooth function
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How does blood get to the PDL?
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"from superior and inferior alveolar arteries
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What does the rich blood supply relect?
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a high turnover rate
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Which recieives more blood? The posterior/anterior or mandibular/maxillary?
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posterior and mandibular
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Where do the vessels occupy?
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the loose CT areas between the principle fibers (interstitial spaces)
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Where does the nerve suppply for the PDL occur?
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the inferior or superior alveolar nerves
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What do the nerves provide?
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sense of touch, pressure, pain, proprioception during mastication, and protective open jaw reflex
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Where do the fibers enter?
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from the apical region or lateral socket walls with the blood vessels
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Where are the nerve endings most populated?
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apical region (except upper incisors)
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What are the stages of tooth development leading to eruption?
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"Bud stage
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What happens during prefunctional eruption?
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"intraosseous: permanent grows under deciduous tooth
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postfucntional eruption
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last stage where permanent tooth is fully erupted
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When does preeruptive movement occur and how is it accomplished?
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"occurs before eruption places teeth in proper posiiotn for eruption
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what is eruptive movement?
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movement of the teeth into functional position within the jaws
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what is posteruptive movement?
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maintaining the tooth position during the period of growth and maturity
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describe pre-eruptive movement
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"initially developing teeth are small, but they grow at a more rapid rate than the jaw and become crowded
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What are the 3 distinct types of tooth eruption and corresponding preeruptive tooth movements?
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"deciduous teeth
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describe the growth of deciduous teeth
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"grow and preeruptive movement coincide with the jaw growth
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describe the growth of permanent molars
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"form in the accessional dental lamina (very crowed)
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describe succesional teeth movement
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"initially develop in the same bony crypt as their predessors, but later they come to occupy a posiiton in a separate crypt lingula to their predecessors
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How does crypt remodeling accommodate the changing shape of the tooth?
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"total bodily movement: remodeling of the crypt w/ resorption on one side and filling in of the other (overall crypt doesn't change)
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What are 5 things tooth eruption involves?
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"root formation
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When does eruption begin?
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after crown formation
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Do teeth move just along their main axis?
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no, they move in a 3-d space
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Describe the speed of eruption
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it is varying, characteristic, and stage-specific
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eruption and inheritability?
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teeth arrive at functional position that are inheritable
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Why does eruptive movement continue after the active eruptive phase?
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To compensate for tooth abrasion (wear)
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describe root formation
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proliferation of HERS, dentinogenesis, and cementogenesis as well as formation of the PDL occur coincident with the eruptive process
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How do connective tissues change in advance of the erupting tooth?
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"during eruption there is connective tissue destruction and bone resorption.
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How are PDL fibers formed and remodeled w/ tooth eruption?
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as the tooth erupts periodontal fibers are broken and new attachments may be formed
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How is the dental follicle involved with eruption
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it is a connective tissue investment which surrounds the tooth. It is intimately related to the enamel organ
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gubernacular cord
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extension of the dental follicle that extends through gubernacular canls in the overlying bone. Contractoin of the cord has been speculated to contribute to the eruptive process
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Following and during eruption what other forces influence tooth movement?
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weak muscular forces such as those from tongue, lips, and cheeks, and well as thumb sucking
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What causes submerged teeth?
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lack of continuity of the PDL and ankylosis (stiffness of joint) to the alvoelar bone
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What are embedded or impacted teeth?
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failure of eruption and teeth remain embedded in jaws (due to slow or inefficient growth of jaw)
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What does a picture of ankylosis look like?
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rigid dentin moving into bone
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Describe a mandibular incisor at 8 months?
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"deciduous tooth about to enter the oral cavity
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describe a mandibular incisor at 2 years?
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"Deciduous tooth is almost fully erupted
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Describe a mandibular incisor at 3.5 years?
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"Deciduous tooth is in occlusion
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incisor development at 4 years
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"Root resorption in the deciduous tooth is advanced
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Gubernaculum dentis
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"pathway where teet apparently erupt
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When does root formation occur?
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before and during eruption
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What is the evidence that root formation is not an essential part of the eruption process?
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"removal of roots does not inhibit eruption
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When does PDL formation occur?
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in concert with root formation
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What happens to the PDL during eruption?
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it undergoes constant development and remodeling
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What is the role of the PDL in the eruption process?
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"tractional forces generated by a population of PDL fibroblasts has been proposed to provide the force of eruption
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Do PDL fibroblasts have contractile properties?
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yes
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Evidence that PDL is unlikely to play a major role in eruption
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"patients with hypophosphatasia in which there is abnormal cementum deposition and lack of attachment have teeth which erupt and are quickly exfoliated
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CSF1 or M-CSF
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"colony stimulating factor 1 is a cytokine involved in macrophage lineage differentation
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When is CSF1 most strongly expressed and where?
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In the dental follicle during tooth eruption
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Radiographically what forms prior to eruption?
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an eruption pathway
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Why do teeth not erupt when bone resorption is inhibited?
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"blocking osteoclast activity halts eruption
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why are eruption and bone resorption independent of the tooth?
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"removal of the tooth from the dental follicle does not prevent the formaion of the eruptive pathway
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What are Howship's lacunae?
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sites of osteoclastic activity
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What is the transitional area?
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"area that lies between the coronal crypt and crypt base
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What is the base of crypt?
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"area of active bone formation
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How does the removal of the tooth from the dental follicle effect eruption?
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pupal tissue is destroyed. When replaced in the follice these teeth will erupt despite the lack of cell proliferation and root growth
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What if a stainless steel crown is inserted in the follicle?
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it will erupt
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What is one root is removed?
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the tooth will not tip; indicating that root growth is not involved
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What if the dental follicle is removed from the crypt?
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the tooth will not erupt and an eruptive pathway will not form
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What is eruption preceded by?
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infiltration of mononuclear cells (potential osteoblast precursors) into the coronal dental follicle and the appearance of osteoclasts on the coronal bone surface
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What does the dental follicle produce?
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"collagenolytic enzymes
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What is critical to eruption
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the dental follicle
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Describe the signaling events during eruption
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"EGF upregulates TGF-beta and IL-1alpha
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What is shedding?
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resorption of the roots leads to exfoliation of deciduous teeth
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Where does root resorption start?
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apical region
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What performs the root resorption?
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odontoclasts
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What is an odontoclast?
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"osteoclast that resorbs teeth.
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Ultrastructure difference between odontoclasts and osteoclasts?
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there is none
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What is the origin of odontoclasts?
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they differentiate from mononuclear cells of hempoetic origin migrating from blood vessels of the pulp into multinuclear mature odontoclasts
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What and where do odontoclast resorb?
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predentin and dentin on the pulpal side
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Does the resorption only occur on the inside?
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it occurs on the outside of the tooth as well
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What are the 3 components of the TMJ?
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"articular eminence
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What are the symptoms of TMJ problems and how many people suffer from them?
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"25% of population experience pain, 3-4% get treatment
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Describe the problems with TMJ implants
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"banned by FDA in early 90's
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What are TMJ implants like now?
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"3 approved implants
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Which way do the axis of the mandibular condyles point?
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medially and posteriorly and meet at an angle of 160-170 degrees
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Describe the development of the mandible
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"five processes join the body of the mandible during development
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What are the five processes of the mandible?
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"coronoid process
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What is the articular surface comprised of? And what does it lack?
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fibrocartilage and lacks a perichondrium
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Describe the 4 steps of mandible growth
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"1. Change in length of body
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How does the body of the mandible develop? (type of ossification)
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intramembranously
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How and where does the ramus develop from?
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Develops endochondrally from secondary cartialge process
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When does development of the condyle begin?
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around 12 weeks
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Describe the sequence of ossification between the temporal part of the joint and the condyle
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The temporal part of the joint ossifies slightly ahead of the condyle
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What type of osssification forms the condylar process and head?
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endochondral
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What type of ossifcation forms the ramus and what is it covered in?
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intramembranous and it is covered in periosteum
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Where do the fibers of the medial pterygoid insert?
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they insert into the lower medial border of the ramus
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Where do the lateral pterygoid muscles insert?
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on the condylar process and the disc of the TMJ
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What shape is the trabecular pattern of the condylar process?
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carrot shaped in the body of the mandible
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What covers the articular surface of the condylar head?
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A Fibrous layer
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What lies below this fibrous layer?
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reserve layer of cells or transitional zone
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what is the next layer?
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"hypertrophic cartilage
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what lies beneath the hypertropic cartilage?
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calcified cartilage and bone
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What are the surfaces of the joint and the disc?
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fibrous connective tissue
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What can the fibrocartilage transition into?
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dense fibrous tissue
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How is the articular tuberacle different from most joints?
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It is not hyaline cartilage. It is dense fibrous connective tissue
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What is the surface layer of the articular fossa?
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a thin layer of periosteum
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What does the fact that it is not thick like the articular tubercle indicate?
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it does not bear weight
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What covers the condylar head?
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"dense fibrous CT or fibrocartilage
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What comprises the disc of the TMJ
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dense fibrous connective tissue or fibrocartilage
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describe the thinner center of the biconcave disc
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"avascular
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What lines the capsule of the TMJ?
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an inner synovial membrane
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describe the inner synovial membrane
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"smooth glistening layer which lines the joint except over the articular surfaces.
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What are synovial cells?
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undifferentiated cells which lie along and among the collagen fibers
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Type 1 or A synovial cells
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fibroblastic and produce hyaluronic acid and lubricin
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What do hyaluronic acid and lubricin do?
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lubricate the joint
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type 2 or B synovial cells
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phagocytes
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What 3 things innervate the capsule?
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"1. masseteric and auriculotemporal branches of the mandibular nerve
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What is the most abundant cell types in synovial fluid?
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monocytes
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What comprises the ECM?
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proteoglycan / GAGs
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compared to hyaline knee cartilage how much is found in a TMJ disc?
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very little, only 1-10% of the dry weight
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What is the role of GAGs in TMJ?
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"the cartilages act like sponges
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What is the primary constituent of TMJ ECM
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"collagen
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describe the subunits of collagen
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polypeptide chain -> collagen molecule - > microfibril -> fibril -> collagenous fiber
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How is the collagen type I packed?
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tighly and organized in TMJ disc and other fibrocartilage
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describe the strength of collagen is pulled against or with it's grain
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against the grain it is like twine. With the grain it is very strong
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Describe normal jaw movement
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"rotation and translation in the inferior joint space
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Where is the disc typically displaced?
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anteriorly
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kinematic tracking
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used to match x-ray and uCT data for skull and mandible for each trial
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What are the 5 functions of the oral mucosa?
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"Mechanical protection against shearing and compressive forces; keratinization of epithelium
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what is the origin of epithelium?
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ectodermal
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What is masticatory mucosa / what type of keratinization?
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"resists the shearing and compressive forces of mastication
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what is lining mucosa / what type of keratinization?
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it is glandular and its epithelium is non-keratinized or parakeratinized. It contains glands
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What is specialized mucosa?
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"dorsal surface of the tongue is highly innervated
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What are the two types of oral mucosa and their subtypes?
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"Keratinized -> orthokeratinized and parakeratinized
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Where are keratinized and non-keratinized mucosa found, respectively?
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masticatory and linings
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What are the components of oral mucosa
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"epithelium
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Where is submucosa absent?
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in mucoperiosteum
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Oral mucosa combines the properties of 2 organs?
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skin (masticatroy) and endothelium (lining)
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name the 5 layers of keratinized epithelium
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"keratinized layer
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what is keratin
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cysteine rich proteins
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what does keratin assemble into?
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intermediate filaments
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What happens to the filaments during keratinization?
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"the fillament become crosslinked via disulfide bonds while cells undergo apoptosis
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What are the 4 layers of orthokeratinized epithelium?
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"Basal layer (stratum germinativum)
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stratum germinativum function and composition?
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"source of epithelial cells
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What does a pronounced thickening of the stratum germinativum evidence?
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precancerous lesion
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stratum spinosum function and composition?
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"beginning of maturation.
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stratum granulosum function and composition?
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"increased maturation.
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stratum corneum function and composition?
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"loss of nuclei
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Where is parakeratinized epithelium found?
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in gingiva
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What is different from orthokeratinized?
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squamous cells retain pyknotic nuclei and granular layer contains less keratohyalin granules
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Where is non keratinized epithelium found and what is different about it?
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"found in the lining mucosa
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What is a basal layer?
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a layer of proliferating cells
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What type of cells are a small portion of the basal cells?
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slow dividing epithelial stem cells
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How is proliferation rate in basal layer timed?
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"it is timed to turnover time of particular epithelial layers:
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|
|
how do cancer chemotherapies affect the basal layer?
|
they block mitotic division and interupt turnover causing ulcers
|
|
|
Do stem cells in basal layer divdie much slower than amplifying epithelial cells?
|
yes
|
|
|
why do they do this?
|
"protects the stem cell DNA from changes, since often mutations occur during the duplicaiton of DNA
|
|
|
What is the significance of mutations in the basal layer?
|
can alter their division rates causing tumors
|
|
|
How are premalignant lesions easily detected?
|
oral exams -> leucoplakia or white patches
|
|
|
What causes the prickly appearance of stratum spinosum?
|
presence of intracellular keratin filaments (tonofibrils) attached to the desmosomes connecting neighboring cells
|
|
|
What is the difference between keratinized and non-keratinized stratum spinosum?
|
nonkeratinized stratum spinosum lacks tonofibrils
|
|
|
What does the stratum spinosum have to limit permeability?
|
lipid containing membrane coating granules aligned beneath the plasma membrane
|
|
|
where is the granular layer found?
|
only in keratinized epithelium
|
|
|
What comprises the granular layer?
|
"keratohyaline granules associated with tonofibrils
|
|
|
What is the keratinized layer made of?
|
squamous cells which shed
|
|
|
What is the primary role of the squamous layer?
|
mechanical protection
|
|
|
What is the major differnce between ortho and parakeratinized layers?
|
parakeratinized mucsous still has nuclei
|
|
|
Where is non keratinized epithelium found?
|
in lining mucosa
|
|
|
How is it different from keratinized?
|
"surface layer contains nuclei (this why chick swabs used for genotyping)
|
|
|
What are melanocytes?
|
pigment cells
|
|
|
Where do melanocytes originate?
|
neural crest origin, migrate into the ectoderm 11 weeks post-gestation
|
|
|
Properties of melanocytes?
|
"dendritic but do not form desmosomes or tonofibrils
|
|
|
What determines the extent of pigmentation?
|
the activity and not the number of melanocytes
|
|
|
What are langerhans cells?
|
"dendritic cells that migrate in and out of epithelia
|
|
|
What are merckel cells?
|
"mechanotactic cells usually posiitoned next to nerve endings
|
|
|
What are the connective tissues of the oral mucosa?
|
lamina propria and submucosa (mucoperiosteum does not contain submucosa)
|
|
|
describe the papillary layer of the lamina propria
|
papillae and ridges penetrate deep into epithelial layer creating a large surface area interface providing better attachment between eipthelium and ectomesenchyme
|
|
|
how is the lamina propria attached to the epithelial basal lamina?
|
collagen fibrils attach the two while the basal cells form desmosomes. Strong bonds are establised between these 2 layers on the moleuclar level
|
|
|
What primarily composes the lamina propria?
|
fibroblast cells and elastic and collagen fibrils
|
|
|
describe functoin of macrophages in oral mucosa
|
responsible for destruction of foreign matter and induce fibroblast activity during wound healing
|
|
|
what are the two types of macrophages in oral mucosa?
|
"melanophages - contain melanin granules
|
|
|
what are mast cells?
|
large cells containing granules rich in heparin and histamine
|
|
|
what do mast cells do?
|
"involved in immune response, allergies and wound healing
|
|
|
immune cells in the oral mucosa
|
"lymphocytes - present in low quantities
|
|
|
ECM composition
|
"collagen type I fibrils, and other collagen types are associated with basal lamina
|
|
|
What is the boundary between the submucosa and the lamina propria?
|
it is indistinct
|
|
|
Composition of submucosa
|
"large quantities of adipocytes
|
|
|
where is lining mucosa found?
|
"buccal and labial mucosa of the vestibule
|
|
|
how is lining mucosa different from masticatory mucosa?
|
"mainly nonkeratinized
|
|
|
Where is masticatory mucosa found?
|
"hard palate
|
|
|
is masticatory mucosa ortho/parakeratinized?
|
orthokeratinized
|
|
|
Does masticatory mucosa have submucosa?
|
"usually not.
|
|
|
describe the cutaneous region of the lip
|
"thin layer of orthokeratinized epithelium with rete pegs
|
|
|
what is the color of the cutaneous region due to ?
|
melanin pigment and the closeness of the blood vessels which underlie the epithelium
|
|
|
describe the dermal layer of the cutaneous region
|
"consists of a papillary and reticular layer
|
|
|
what lies below the dermis?
|
hypodermis with some fat
|
|
|
where does the orbicularis oris muscle lie?
|
between the cutaneous and mucosal surfaces
|
|
|
describe the vermillion zone of the lips
|
"thinner layer of orthokeratinized epithelium
|
|
|
describe the mucosal surface of the lips
|
lining mucosa w/ a thick layer of nonkeratinized epi underneath which lies a lamina propria and a submucosa with salivary glands and adipose tissue
|
|
|
describe the intermediate zone of the lips
|
zone of parakeratinized epithelium between vermillion border and labial mucosa
|
|
|
how are hair follicles arranged in the cutaneous layer?
|
they are associated with sebaceous glands
|
|
|
what provides attachment of skin to muscles
|
collagen fibers
|
|
|
How does thickness change from vermillion zone to labial mucosa?
|
it gets thicker
|
|
|
describe the cheek or buccal mucosa
|
lining mucosa that is similar to the mucosa of the lip
|
|
|
differences between the lip and cheek
|
"no vermillion border
|
|
|
is the buccal mucosa keratinized or nonkeratinized
|
mainly nonkeratinized but can be parakeratinized
|
|
|
What occurs at the linea alba?
|
"a line of orthokeratinized epithelium
|
|
|
what are fordyce spots?
|
"yellowish bumps in the buccal mucosa
|
|
|
what is gingiva?
|
"the oral mucosa that surrounds and is attached to the teeth and alveolar bone.
|
|
|
define attached gingiva
|
"directly bound to tooth and alveolar bone.
|
|
|
define free gingiva
|
"apical portion of gingiva not attached to bone or tooth
|
|
|
define gingival margin
|
coronal limit of the free gingiva
|
|
|
define mucogingival junction
|
separates the nonkeratinized alveolar mucosa from the paler keratinized gingiva
|
|
|
describe histology of stippling
|
"indentations correspond to the position of rete pegs
|
|
|
define sulcular gingiva
|
"unattached gingiva facing the tooth surface
|
|
|
define interdental (interproximal) papillae
|
extensions of gingiva between the teeth on their facial and lingual aspects
|
|
|
define the col
|
valley like depression which lies between the region of the interdental papillae and below their points of contact
|
|
|
what makes up the interdental gingiva?
|
interdental papillae and col
|
|
|
Why is interdentinal gingiva more prone to periodontal infection?
|
it's more difficult to clean
|
|
|
define junctional epithelium
|
"portion of the sulcular epithelium attached to the tooth.
|
|
|
how is the junctional epithelium attached to the underlying CT and enamel surface?
|
"connective tissue -external basal lamina
|
|
|
how does the ultrastructure of the junctional epithelium differ from gingival epithelium?
|
"contains more prominent golgi and abundant rER
|
|
|
how is the turnover rate of junctional epithelium different than gingival epithelium?
|
"high turnover rate
|
|
|
What does accumulation of plaque in the gingival sulcus lead to?
|
"formation of calculus and severe periodontal disease
|
|
|
what are the two layers of lamina propria in the gingiva?
|
papillary and reticular layer
|
|
|
does a submucosa with glands exist/
|
no
|
|
|
describe papillary layer
|
superficial and lies between the epithelial ridges (rete pegs) and consists of loose irregular collagen bundles and ground substance
|
|
|
describe reticular layer
|
deep and contains thick parallel collagen bundles
|
|
|
what other type of cell is found in the gingiva?
|
"inflammatory cells in the lamina propria
|
|
|
What are the 3 sources of gingival blood supply?
|
"periosteal vessels surround the alveolar processes
|
|
|
where does the dentogingival fiber group run?
|
from tooth to gingiva
|
|
|
where does the circumferential fiber group run?
|
around the tooth like a cuff
|
|
|
where does the alveologingival fiber group run?
|
from alveolar bone to gingiva
|
|
|
where does the dentoperiosteal fiber group run?
|
joins periosteum and tooth
|
|
|
where does the transeptal fiber group run?
|
from tooth to tooth over the alveolar process
|
|
|
describe the epithelium of the palatal mucosa
|
orthokeratinized with all well defined layer with long epithelial papillae
|
|
|
describe the lamina propria of the palatal mucosa
|
"regular papillary structure near palatine raphe (midline structure)
|
|
|
What two directions do collagen fiber run?
|
"perpendicular (inserting into bone forming mucoperiosteum
|
|
|
describe the peripheral zone of the hard palate
|
"counterpart of the vestibular gingiva with no submucosa
|
|
|
describe the midline area or palatine raphe of the hard palate
|
similar to peripheral zone w/ no submucosa
|
|
|
describe the posterior (glandular) area of the hard palate
|
"lies between the palatine raphe and the peripheral zone
|
|
|
describe the anterior (fatty) zone of the hard palate
|
"similar to glandular area but submucosa has mostly fatty tissue
|
|
|
how can ducts be seen in the posterior of the hard palate?
|
as red spots on the epithelial surface
|
|
|
Does the presence of submucosa effect the attachment to the bone?
|
no the mucosa is firmly attached to the bone
|
|
|
does the soft palate have a submucosa
|
yes and it has glands
|
|
|
what type of mucosa is the soft palate?
|
lining type mucosa
|
|
|
What is located in the center of the soft palate?
|
mucslces and fibrous tissue
|
|
|
what is located at the edges of soft palate
|
respiratory type mucosa
|
|
|
describe the body of the tongue
|
makes up the anterior 2/3's
|
|
|
describe the root of the tongue
|
makes up the posterior 1/3 and lies posterior to the sulcus terminalis and contains lingual tonsils
|
|
|
What does the anterior tongue contain?
|
numerous papillae of 4 types
|
|
|
Where do the cirumvallate papillae lie?
|
anterior to the sulcus terminalis
|
|
|
does the tongue contain keratinized or non-keratinized epithelium?
|
both
|
|
|
describe taste buds
|
specialized chemoreceptory orans
|
|
|
What else does the tongue contain?
|
4 types of papillae and lingual tonsils
|
|
|
describe filiform papillae
|
most numerous on the dorsal surface on the anterior 2/3's of the tongue
|
|
|
describe fungiform papillae
|
"appear as red spots on the anterior 2/3's of the tongue
|
|
|
describe foliate papillae
|
"appear on the posterior lateral parts of the tongue and are leaf like
|
|
|
describe circumvallate papillae
|
"lie anterior to the sulcus terminalis and are surrounded by a wall and a moat
|
|
|
how keratinized are circumvallate papillae?
|
slightly
|
|
|
how do they lie in the posterior part of the tongue?
|
in a row
|
|
|
what do circumvallate papillae contain?
|
taste buds
|
|
|
what is the base of the furrow of a circumvallate papillae associated with?
|
von Ebner's glands, secreting lingual lipase
|
|
|
how keratinized are filiform papillae?
|
highly
|
|
|
filiform papillae are the only papillae to lack ___
|
taste buds
|
|
|
the taste bud has a ____ that opens onto the ____ surface
|
taste pore, external
|
|
|
Do taste buds have chemoreceptors?
|
yes, gustatory cells that have cilia
|
|
|
where do sensory nerves enter the taste bud?
|
at the proximal end
|
|
|
location of the submental lymph node
|
chin
|
|
|
location of the submandibular lymph node
|
under the mandible
|
|
|
location of the supraclavicular lymph node
|
above the clavicle
|
|
|
location of the retropharyngeal lymph node
|
behind the phayrnx
|
|
|
location of the buccal lymph node
|
by the maxilla
|
|
|
location of the superficial cervical and jugular lymph nodes
|
above the retropharyngeal
|
|
|
location of the parotid lymph node
|
in front of the ear
|
|
|
location of the retroauricular and occipital lymph node
|
back of the head
|
|
|
Job of epithelio-lymphatics
|
filter tissue fluid for antigens
|
|
|
what do the tonsils form around the opening of the pharynx to protect the body from antigens entering via the oral and nasal cavities?
|
waldeyer's ring
|
|
|
What protects the body from antigens in the gut?
|
peyer's patches and appendix
|
|
|
what protects the body from antigens in the urogenital and respiratory system
|
other lymphoid tissue
|
|
|
describe lingual tonsils
|
have single unbranched crypt
|
|
|
describe palatine tonsils
|
have a branching crypt
|
|
|
describe pharyngeal tonsils
|
"in the nasopharynx and have a respiratory epithelial covering
|
|
|
what is a non-encapsulated epitheliolymphoid organ and which tonsil is an example of this/
|
the palatine tonsil has an epithelial surface covering and some dense connective tissue on its deeper surface (a capsule)
|
|
|
What migrates through the lining of the branched crypts of palatine tonsils?
|
"leukocytes
|
|
|
do palatine tonsils have many germinal centers?
|
yes
|
|
|
what type of epithelium are the crypts and surface epithelium associated with?
|
nonkeratinized stratified squamous epithelium
|
|
|
where does an antigen enter a palatine tonsil and where does it encounter lymphoid tissue?
|
enters through epithelium and encounters lymphoid tissue in lamina propria
|
|
|
Where are lingual tonsils found?
|
in the pharyngeal portion of the tongue and are a collection of small rounded nodules each with a single pit
|
|
|
do mucous glands reside underneath the lingual tonsils?
|
yes
|
|
|
what is NOMA
|
periodontal infection that can erode through bone and tissue
|
|
|
how does saliva protect the mouth?
|
"lubrication
|
|
|
what is the active components in salivary protection?
|
glycoproteins and water
|
|
|
How does saliva buffer?
|
"pH for inhbiting colonization of bacteria
|
|
|
what are the active components of buffering?
|
phosphate and bicarbonate ions
|
|
|
how does saliva act in digestion?
|
"enzymes digest starch
|
|
|
what are the active components of digestion?
|
"amylase
|
|
|
how does saliva act with taste?
|
taste bud growth and maturation
|
|
|
what is the active component of taste?
|
gustin
|
|
|
how does saliva have antimicrobial action?
|
"barrier
|
|
|
what are the active components of antimicrobial action?
|
"glycoproteins
|
|
|
how does saliva help tooth integrity?
|
"maturation of enamel
|
|
|
what are the active components of tooth integrity?
|
"calcium, phosphate, and fluoride
|
|
|
What are the major salivary glands and where are they located?
|
"Parotid - anterior and inferior to the ears
|
|
|
What are the minor salivary glands and where are they located?
|
"glossopalatine - lie in the glossopalatine fold extending onto the soft palate
|
|
|
how do major and minor glands differ in distance from secretory surface?
|
"major glands are located far from surface
|
|
|
3 ways salivary glands are classified by secretory products
|
"serous - thin watery, and protein rich with small amounts of polysaccharides (amylase, glycoproteins)
|
|
|
Describe location and muscular attachment of parotid gland
|
"located along posterior aspect of the ramus of the mandible
|
|
|
what is the parotid papilla?
|
"the hard and enlarged opening (stensons duct) of the parotid gland
|
|
|
What two types of heads does the submandibular gland have?
|
superficial and deep heads
|
|
|
What does the submandibular gland curve aroudn?
|
the posterior aspect of the mylohyoid muscle
|
|
|
where does the submandibular (wartons) duct open?
|
at the sublingual caruncle
|
|
|
what is the smallest major salivary gland and where is it located?
|
sublingual gland is located in the sublingual fold
|
|
|
What is the name of it's duct and what does it share an opening with?
|
the Bartholin's duct shares an opening with the submandibular gland
|
|
|
ducts of rivinus?
|
minor sublingual glands that have openings along the sublingual fold
|
|
|
what type of glands are vallate papilla and von ebners glands?
|
"serous - thin watery, and protein rich with small amounts of polysaccharides (amylase, glycoproteins)
|
|
|
describe the induction stage of the development of a salivary gland
|
mesenchyme induces the proliferation of the epithelium and a bud is found amid a condensed mesenchyme
|
|
|
describe the formation and growth of the epithelial cord
|
an elongated cord of epithelial cells grows into the underlying matrix
|
|
|
describe the initiation of branching
|
the primary cord proliferates rapidly and branches
|
|
|
describe the repetitive branching of the epithelial cord
|
the end or terminal bulbs of the cord branches repeatedly
|
|
|
describe the canalization
|
the solid epithelial cord becomes a tube by either differential proliferation or fluid secretion by duct cells. Further branching also occurs at this time
|
|
|
describe cytodifferentiation
|
differentiation of the acini into acinar and myoepithelial cells
|
|
|
What regulates the branching patterns?
|
FGF and TGF beta
|
|
|
what is the gland structure of salivary glands
|
alveolar or tubuloalveolar glands with mucous and mixed endpieces
|
|
|
describe the initial ducts
|
intercalculated - lying between the acini and striated ducts
|
|
|
describe the interlobular ducts
|
larger and in the connective tissue septa
|
|
|
describe the nuclei differenece in serious acinus and mucous acinus
|
"serous acinus - round nuclei in the middle of cell
|
|
|
describe a serous acinar cell
|
"columnar or pyramidal shape
|
|
|
what is the function of a serous acinar cell
|
formation of serous primary saliva
|
|
|
describe the structure of a mucous cell
|
"fund in tubular acini
|
|
|
what is the function of the mucous cells?
|
formation of primary saliva
|
|
|
describe the structure of a serous demilune cell
|
"crescent-shaped cell
|
|
|
what is the function of a serou demilune cell?
|
formation of primary saliva
|
|
|
describe the structure of myoepithelial cells
|
"basket-shaped around acini
|
|
|
describe the function of myoepithelial cell
|
"contractile
|
|
|
Where do myoepithelial cells lie and why?
|
inside the basal lamina because they are epithelial cells
|
|
|
describe the structure of an intercalated duct cell
|
single layer of squamous to cuboidal cells
|
|
|
what is the function of an intercalated duct?
|
"primarily a conduit
|
|
|
describe the structure of a striated duct cell
|
"single layer of columnar cells
|
|
|
what is the function of striated duct cells?
|
"reabsorption of Na+, Cl-
|
|
|
what is the structure of excretory duct cells?
|
"psuedostratified epithelium with goblet cells
|
|
|
what is the function of excretory duct cell?
|
reabsorption (mainly Na+)
|
|
|
describe the parotid gland
|
"pure serous gland that produces 25% of the total saliva
|
|
|
What is present in th serous cells of the parotid gland?
|
zymogen granules
|
|
|
What is 3 things are present in the submandibular gland?
|
"Mucous acini
|
|
|
the sublingual gland has what type of serous cells that cap a mucous endpiece?
|
serous demilunes
|
|
|
define mixed acinus
|
has both mucous and serous components
|
|
|
what organelles are required for protein synthesis in the formation of saliva?
|
"ribosomes
|
|
|
Are chaperones required?
|
yes to ensure proper folding and post-translational modifications
|
|
|
How does sympathetic stimulation effect saliva
|
produce less profuse more protein-rich and mucus rich secretion
|
|
|
What is the neurotransmitter/receptor used with sympathetic stimulation?
|
norepinephrine / adrenergic
|
|
|
how does parasympathetic stimulation effect saliva?
|
produces profuse watery secretion
|
|
|
what is the neurotransmitter / receptor used in parasympathetic stimulation?
|
acetylcholine / cholinergic receptors
|
|
|
describe the norepinephrine (sympathetic) pathway
|
"beta adrenergic receptors, g-proteins, cAMP
|
|
|
describe the acetylcoline (parasympathetic) pathway
|
"muscarinic colinergic receptors
|
|
|
describe the saliva in secretory endpieces and intercalated ducts
|
isotonic
|
|
|
describe the saliva in striated and excretory ducts
|
hypotonic
|
|
|
what is reabsobed and secreted in the striated and excretory ducts?
|
"reabsorbed Na+ and Cl-
|
|
|
What glands contribute the most and least to saliva
|
"most - submandibular
|
|
|
what gland have the longest and shortest striated ducts
|
"longest - submandibular
|
|
|
what glands have the longest and shortest intercalated ducts?
|
"longest - parotid
|
|
|
describe Heidenhain's law
|
"composition changes with changes in flow rate
|
|
|
describe IgA and what it is produce by
|
dimeric and is produced by mucosal plasma cells
|
|
|
Where and to what does IgA bind
|
to a receptor on the basal membrane
|
|
|
What happens to IgA after it binds to the basal membrane?
|
it is translocated to the acinar cell membrane
|
|
|
How is IgA released?
|
" it is released with part of the secretory component intact.
|
|
|
What can saliva be used to detect?
|
HIV, type 2 diabetes, periodontal disease, cancer, and drug levels
|
|
|
How does saliva protect soft tissue?
|
from infection and inflammatory reactoins
|
|
|
xerostomia
|
dry mouth
|
|
|
what can radiation do to the salivary glands and what is the result?
|
"destroys them
|
|
|
describe nicotin somatitis
|
red dots on the hard palate
|
|
|
What does it form?"
|
"salivary gland stone
|
|
|
how do you check the sublingual glands?
|
"palpated using fingers of both hands.
|
|
|
what is the inflammatory response closely intertwined with?
|
the process of repair
|
|
|
inflammation is fundementally a ___ response
|
protective
|
|
|
When may inflammation and repair be potentially harmful
|
when they underlie chronic disease like rheumatoid arthritis
|
|
|
what are the two main components of inflammatory response?
|
"vascular response
|
|
|
describe the 5 steps of the mechanism of inflammation
|
"vasodilation
|
|
|
what is the speed difference between acute and chronic inflammation?
|
"acute - rapid
|
|
|
what are the chemical factors that mediate both types of inflammation derived from?
|
plasma proteins
|
|
|
When is inflammation terminated?
|
when the offending agent is eliminated and the secreted mediators are broken down or dissipated
|
|
|
what induces vasodilation
|
histamine and nitric oxide on vascular smooth muscle cells
|
|
|
what is stasis
|
loss of fluid results in concentration of RBCs in small vessels
|
|
|
effects of vasodilation on permeability
|
increased
|
|
|
describe the movement of neutrophils
|
migrate toward the vascular wall and then migrate through the vascular wall into the interstitial tissue
|
|
|
describe the sequence of events in the journey of leukocytes from the vessel lumen to the interstitial tissue
|
"margination, rolling and adhesion to endothelium
|
|
|
What is leukocytes adhesion and transmigration regulated by?
|
the binding of complementary adhesion molecules on the leukocyte and endothelial surface, and chemical mediators
|
|
|
what 4 families do adhesion molecules belong to ?
|
"selectins
|
|
|
how does the type of emigrating leukocytes vary?
|
"with age of the inflammatory response
|
|
|
first 6-24 hours dominated by ?
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neutrophils
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|
|
24-48 hours dominated by?
|
monocytes
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|
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why do neutrophils respond more rapidly?
|
more numerous in the blood
|
|
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What are the 3 steps of phagocytosis?
|
"recognition and attachment
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|
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what are locally produce mediators of inflammation?
|
"histamine
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|
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What are plasma derived mediators of inflammation?
|
"kinins
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|
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what regulates vasodilation?
|
"histamine
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|
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what regulates BV permeability?
|
"histmamine
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|
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what regulates leukocyte adhesion
|
"IL8
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|
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what regulates chemotaxis?
|
"LB4
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|
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what regulates pain?
|
prostaglandins and bradykinin
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|
|
what are the 5 things acute inflammation can lead to?
|
"chronic inflammation
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|
|
is wound healing multiple steps or a continuum?
|
continuum
|
|
|
where are macrophages activated?
|
in the bloodstream
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|
|
When does remodeling start?
|
around 3-10 days
|
|
|
When does tissue granulation occur?
|
0.3-10 days
|
|
|
when does wound contraction occur?
|
3-30 days
|
|
|
when does inflammation occur?
|
0.1-3 days
|
|
|
describe macrophage activation
|
"adheres
|
|
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When suture are removed at the end of the first week what is the wound strengh?
|
approx 10%
|
|
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Strength increases rapidly for how long?
|
next 4 weeks
|
|
|
When does the rate slow?
|
approx 3rd month and reaches platue at 70-80%
|
|
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What does the recovery of the tensile strength result from
|
the excess of collagen synthesis and remodeling
|
|
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what stimulates tissue remodeling
|
"PDGF
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|
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what inhibits tissue remodeling
|
"TGF-beta
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|
|
describe tissue remodeling pathway
|
"initiation
|
|
|
what inhibits ECM degradation?
|
TIMPS
|
|
|
What is osseous, graft, and GTR periodontal treatment?
|
"osseous - remove calculus reattach gingiva
|
|
|
repair of a periodontal defect can be mediated by?
|
formation of a long junctional epithelium and bone fill
|
|
|
what does periodontal regeneration include?
|
formation of a new apparatus including: cementum, periodontal ligament, and alveolar bone
|
|
|
What happens after wound to the cells of the PDL?
|
they begin to divide and migrate into the site of injury
|
|
|
what type of cells are they?
|
progenitor cells that are closely associated with blood vessels in the PDL and the adjacent alveolar bone marrow spaces
|
|
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what is responsible for the maintenance of the homeostasis of the periodontium and it's interface with the root surface (cementum) and the alveolar bone
|
reservoir of undifferentiated cells
|
|
|
What are the 3 complex processes involved with GTR?
|
"tissue exclusion
|
|
|
describe the BMP-2 signaling pathway
|
look at slide 36
|
|
|
look at slide 37 and 38 for the effect of growth factors on PDL cell activity
|
|
|
|
look at slide 39 for growth factors of platlets
|
|
|
|
What is the problem with Medtronic?
|
"worked great in trials until they reached monkeys and humans
|
|
|
What growth factors does Gem 215 utilize?
|
BMP + PDGF
|
|
|
What does PDGF do?
|
strong stimulation of proliferation effect
|
|
|
What does emdogain consist of?
|
hydrophobic enamel matrix proteins extracted from developing embryonal enamel of procine origin
|
|
|
once cementogenesis begins what happens to the cells of the remaining dental follicle?
|
they become obliquely oriented along the root surface and become the fibroblasts of the PDL
|
|
|
what do these fibroblasts secrete into the ECM?
|
collagen which becomes embedded in the developing cementum at the tooth surface and in the bone at the alveolar surface
|
|
|
How do you use emdogain?
|
"remove smear layer
|
