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85 Cards in this Set
- Front
- Back
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What are the five components of the stomatognathic system?
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Teeth, Gingiva and supporting structures, muscles of mastication, TMJ, Neurological components.
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What is the difference between the oral mucosa and the oral mucosa membrane?
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Oral mucosa includes all the tissues linings in the mouth whereas the oral mucosal membrane excludes the dorsum of the tongue which is termed specialized mucosa
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Where is the masticatory mucosa located?
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It includes the mucosa of the hard palate and it includes the attached and free gingival surrounding the teeth.
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What is the mucogingival junction?
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The meeting of the alveolar mucosa and the attached gingival.
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What is marginal gingival?
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Also called free gingival…it is the epithelial attachment to the free gingival margin.
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What is papillary gingival?
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Wedge of tissue that fills the interproximal space of adjoining tooth roots also called interdental gingival.
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Where could you find a Col?
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Posterior interproximal surfaces. There is no Col on anterior teeth.
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What is special about the Col?
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It is non-keratinized and thus is more susceptible to inflammation.
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How does keritinization affect the oral epithelium?
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Non-keratinized cells don’t have a granular layer or corneal layer which makes them more susceptible to inflammation from dental plaque. Keratinization decreases with age.
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What type epithelium is found in the sulcus?
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Non-keratinized stratified squamous epithelium.
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Can epithelial cell of the sulcus become keratinized?
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Yes, they have the genetic ability to do so but don’t due to local irritation of the sulcus.
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How do the clinical sulcus and the physiological sulcus differ?
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In a healthy state the clinical sulcus is 1-3mm but the physiological sulcus = 0 because the gingiva adheres to the tooth. The sulcus is only a potential sulcus until we stick a probe into it….
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What are some characteristics of the epithelial attachment?
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Formed during eruption by the fusion of the oral epithelium and the REE, average length is 1 mm., starts about 2 cells thick to around 20 near the junction with sulcular epithelium, these cells divide and move coronally, reforms without REE so cell differentiation is likely due to stimulation from contact with the tooth.
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What is the epithelial attachment?
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It is the organic union of the epithelial cells and the tooth.
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What does the internal basement lamina consist of?
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Lamina Densa against the tooth, the lamina lucida and hemidesmosomes that regulate cell proliferation and differentiation.
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What happens to Junctional Epithelial cells?
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They move coronally by cellular division, become sulcular cells and then are lost into the oral cavity with in a week.
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What type of cells attack bacteria on and in the epithelial layer?
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PMNs migrate into the epithelial attachment area and sometimes through the sulcular epithelium.
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What types of vessels supply the sulcus with immunologic response and epithelial turnover?
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The interdental artery, the supraperiosteal vessels these two vessel types together are called the sub-epithelial or gingival plexus.
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What are 4 things that the epithelial attachment can do?
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Firmly attach to tooth forming a physical bacterial barrier, Allow access of fluid and inflammatory host defense cells from gingiva into the sulcus, rapid turnover allows for rapid repair of damaged tissues, signaling capabilitied adds to host defense systems.
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What are the 5 types of fibers that make up the gingival apparatus?
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Free gingival fibers, dentogingival fibers, supraperiosteal fibers, circular fibers, and transseptal fibers
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What is the makeup of gingival CT?
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60% collagen, 5% fibroblasts, and 35% vessels, nerves, and matrix.
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What is the biological width?
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The junctional epithelium and CT attached directly to tooth are called the biological width or dentogingival unit. It is around 2mm apicocoronally and this width is maintained even in the presence of disease and if invade with a crown prep it will recreate this width at the expense of alveolar bone and PDL.
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What are sharpey fibers?
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They are type one collagen marked by periodic banding (640A) that insert into the cementum of the tooth.
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What is Type I Collagen?
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The most common type in the attached gingival. Crosslinking increases with the age of fiber. Collagen fibrils organized in bundles with periodic (640 A) banding. This type is protective in its function.
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What is Oxytalan?
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Small collagen fibers found primarily in the CT of the underlying alveolar mucosa it functions to give mobility to the tissues.
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What is Elastin?
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They are Oxytalan fibers with an amorphous component (elastin) that give the alveolar mucosa tissues mobility.
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What is the main function of the junctional epithelium and connecting CT?
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They serve as a barrier to oral challenges. Teeth are unique in that they start inside the body, penetrate the integument and end up outside the body.
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How can traumatizing the gingival tissues in dental procedures serve as a benefit?
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We take a chronic wound and turn it into an acute wound that will garnish the attention and proper cells that will be required to heal the area.
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What is the difference in cellular and acellular cementum and where are they each found?
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In cellular cementum cell are trapped in the matrix of the cementum. Acellular cementum is found in the cervical third of the tooth. Cellular cementum is found where the cementum is repaired. Cementum is added to the apex of the tooth throughout life and so the cementum is thicker near the apex.
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What are the five principle fibers of the PDL?
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Alveolar Crest, Oblique group (most common), Horizontal group, Apical group, and the interradicular group (in furcation areas of multirooted teeth)
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Where is the PDL the widest?
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At the coronal and apical portions…narrowest in the middle.
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Are the transseptal fibers a part of the PDL?
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No! They are part of the gingival fiber apparatus.
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What are the two theories for how the teeth resist occlusal forces?
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The tensional theory, and the viscoelastic System Theory. The latter is the pry the most correct.
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What does the viscoelastic theory suggest?
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Extracellular fluid moves from PDL into the marrow of the cancellous bone through the cribriform plate then the fibers absorb the slack and tighten to resist the forces of occlusion then arterial backpressure cause the replenishment of the PDL fluids.
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Proliferation of what leads to cystic transformation (AKA lateral periodontal cyst)?
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Rests of Malassez which are epithelial remnants of hertwig’s epithelial root sheath.
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What are 4 characteristics of Alveolar bone?
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1. Follows the CEJ curvatures in the normal state 2. Conforms to root prominences 3. Apical to the CEJ by a minimum of 2mm (area of biologic width) 4. Covered by cortical plate of dense lamellar bone.
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What is the name for a window in the cortical alveolar bone?
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Fenestration
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What is the name for a split in the alveolar bone?
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Dehiscence
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What is the normal minimum distance from the CEJ to the osseous interface?
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2mm
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What bony structure aids in resisting tooth deformation under pressure?
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Cribiform plate
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What kind of bone makes up the lamina dura (alveolar bone proper)?
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Bundle bone
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What attaches alveolar bone to the cementum?
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Sharpey’s fibers
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What part of alveolar bone is lamellar bone with haversian systems?
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Cortical bone
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How does the trabecular bone portion of the alveolar bone form?
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Intramembraneous formation from dental follicle
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What determines the pattern of trabecular bone?
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Forces on the tooth
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What does alveolar bone come from and when does it develop?
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It is formed from basal bone as the teeth erupt.
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What happens to alveolar bone when there are no teeth?
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It tends to regress
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How do tension and pressure affect the alveolar bone?
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Tension = apposition, Pressure = resorption
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How is the PDL affected when there is no occlusion?
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The PDL will narrow, the fibers become disoriented and cellular elements become less common. With excessive force the PDL widens
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How does aging effect periodontal tissues?
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Aging is clinically insignificant from a physiologic perspective in healthy individuals. Normal osseous filling of extraction sites and endosseous dental implants
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How does gingival CT change with aging?
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Increased density, more insoluble collagen, stronger but lower rate of collagen synthesis
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How does the PDL change with aging?
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Fewer fibroblasts, fivers less organized, more elastic fibers
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How does cementum change with aging?
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Increase cemental width especially on the apex and lingual root surface, resorption bays form,
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What are resorption bays?
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Cementum surface irregularities
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How does bone change with aging?
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No difference in healing rates with age but osteogenic potential of bone grafts from older donors is less. Implant integration success is not affected
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What are the 4 gingival margin alternatives associated with aging?
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1. Gingival margin in original position, periodontal health with minimal tooth wear. 2. Gingival margin migrated apically from periodontal disease, occlusal wear. 3. Gingival margin moves coronally during wear related eruption, no disease. 4. Gingival margin migrated apically from perio disease with minimal wear
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Is aging a strong risk factor for periodontal disease?
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NO. smoking and baseline attachment level of 6mm were significantly associated with disease
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What are the two major categories of perio disease?
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Gingival diseases and periodontal diseases
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What are the two major categories of gingival disease?
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Dental plaque induced gingival disease and Non-plaque induced gingival disease
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What are the 4 classes of dental plaque induced gingival disease?
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1. Associated with plaque only. 2. Modified by medications. 3. Modified by malnutrition. 4. Modified by systemic factors
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What two sub groups make up associated with plaque only?
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With local factors (calculus and overhangs) and without local factors
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What belongs in the modified by medications group?
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Drug influenced gingival enlargements and drug influenced gingivitis (ex. Oral contraceptives)
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What is an example of modified by malnutrition?
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Ascorbic acid deficiency gingivitis
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What sub groups belong to modified by systemic factors?
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Blood dyscrasias (ex. Leukemia) and Endocrine related (ex. Menstrual, diabetes, pregnancy, and puberty)
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What differentiates perio disease from gingivitis?
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Attachment loss in perio disease
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What are the causes of non-plaque induced gingival diseases?
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Viral origin, specific bacterial origin, fungal origin, traumatic lesions, foreign body reactions, allergic reactions, gingival manifestations of systemic conditions, and hereditary.
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What gingival conditions are viral in origin?
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Varicella zoster, hepetic gingivostomatitis herpes labialis.
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What specific bacterial cause gingival diseases?
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Strep. Species, neisseriae gonorrhoeae, treponema palladium
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What gingival diseases are of fungal origin?
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Linear gingival erythema, candidiasis, Histoplasmosis
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What types of traumatic lesions cause gingival disease?
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Physical injury, chemical injury, thermal injury
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What allergic reactions cause gingival diseases?
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Restorative materials (acrylic nickel, mercury), food and additives, chewing gum, toothpastes, mouth rinses
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What systemic conditions have gingival manifestations?
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Pemphigus vulgaris, Erythema multiforme, drug induced, pemphigoid, lupus erythromatosis, lichen planus
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What hereditary condition causes gingival disease?
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Hereditary gingival fibromatosis
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What are the periodontal disease categories?
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Chronic periodontitis, aggressive periodontitis,
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Periodontitis as a manifestation of systemic disease?
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Necrotizing periodontal disease, abscesses of the periodontium, periodontits associated with endodontic lesions, and developmental or acquired deformities
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How is chronic periodontitis classified?
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Either generalized of localized then as mild moderate or severe
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What types of systemic diseases cause periodontitis?
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Hematologic and hereditary
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What are the two types of necrotizing periodontal diseases?
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NUG and NUP
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What types of perio abscesses form?
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Periodontal, gingival , and pericoronal
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What groups of endodontic lesions are associated with perio diseases?
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Endo-perio, perio-endo, combined
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What deformities cause perio diseases?
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Conditions of edentulous ridges, occlusal trauma, conditions around teeth and localized tooth related factors
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What two categories of aggressive periodontitis are there?
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Localized and generalized
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How many teeth must be periodontally involved to consider the contition generalized?
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30% or more
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What determines mild, moderate, or severe periodontitis?
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Amount of attachment loss. Mild 0-2mm, Moderate 2-4mm, severe 5+mm
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How does furcation involvement affect periodontitis classification?
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Grade 2 furcation mandates minimum diagnosis of moderate, grade 3 furcation mandates minimum diagnosis of severe
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