study guide intro to perio

gingiva, PDL, alveolar bone, cementum

components of Periodontium

Marginal gingiva

Surrounds the tooth.

Attached gingiva

Attached to the alveolar bone.

Interdental papilla

Located between teeth

gingivodental, circular, and transseptal fibers

Gingival fibers

alveolar crest, oblique, transeptal, horizontal, interradicular, and apical fibers

PDL fibers

alveolar bone proper (lamina dura), trabecular bone, and compact bone

Alveolar bone components

lamina densa (type IV), cementum (type I and III), PDL (type I and III), and gingival fibers (type I)

collagen fiber locations

Acellular/primary cementum

Found in the cervical third, formed before tooth reaches occlusal plane, more calcified.

Cellular/secondary cementum

Found in the apical third, formed after tooth reaches occlusal plane, less calcified

Keratinized tissue

firm pink tissue that surround teeth

submandibular, submental, upper deep cervical, and lower deep cervical lymph nodes

lymphatic drainage

diabetes, smoking, and pathogenic bacteria

Risk factors

Background characteristics: genetic factors, age, gender, socioeconomic status, and stress

Risk determinants

previous history and bleeding on probing (BOP)

Risk markers

HIV/AIDS, osteoporosis, and infrequent dental visits.

Risk indicators

determine patient's risk of developing or progressing periodontal disease

Goal of risk assessment

Increases prevalence, extent, and severity

Smoking effects on periodontal diseease

E-cigarettes

Considered less harmful than traditional smoking.

Ask, Advise, Assess, Assist, Arrange

5 A’s of smoking cessation

Direct relationship with periodontitis, especially poorly controlled diabetes

relationship between Diabetes and oral health

oral hairy leukoplakia, oral candidiasis, linear gingival erythema, and Kaposi sarcoma

Oral manifestations of HIV

Continuous absence indicates periodontal stability and health

Bleeding on probing as a risk marker

Day 1 facultative/aerobic, Day 2 anaerobic, Day 14 mature microbiota, 2 years human microbiota.

bacteria colonization timeline

Commensal bacteria

Beneficial bacteria that help control pathogenic bacteria.

Pathogenic bacteria

Disease-causing bacteria.

Plaque

Resilient biofilm of bacteria and salivary glycoproteins, difficult to remove by rinsing.

Materia alba

Easily displaced white accumulation of salivary proteins and some bacteria.

Calculus

Hard deposit formed by mineralization of plaque, requires dental tools for removal.

Pellicle formation, initial adhesion, colonization, and maturation.

Phases of plaque formation

Supragingival plaque

Aerobic, found on tooth surfaces, contains gram-positive cocci.

Subgingival plaque

Anaerobic, found in gingiva, contains gram-negative rods and filaments.

tooth associated subgingival plaque

less filamentous bacteria deeper into sulcus

tissue associated subgingival plaque

gram neg rods and cocci

P. gingivalis, T. forsythia, and T. denticola

Red complex bacteria

decrease gingival inflammation decreases bleeding

effect of smoking on gingivitis

Organized structure, nutrient channels, and bacterial communication.

Biofilm characteristics

salivary flow, saliva aggregation, diet, chewing fibrous food, smoking

individual variables in plaque formation

non-specific plaque hypothesis

accumulation of plaque over time and amount of plaque is key to disease control

faster on low jaw, molars, buccal surface, and interproximally

plaque formation rates in dentition

specific plaque hypothesis

only certain plaque is pathogenic

ecological plaque hypothesis

both total amount of plaque and specific microbe contribute to disease

keystone plaque hypothesis

specific pathogen in low abundance can disrupt periodontal microbiota

Decrease in red complex bacteria, increase in Actinomyces.

Changes after SRP

Health has more facultative gram-positive rods; disease has more anaerobic gram-negative rods.

Microorganisms in health vs disease

Calculus content

70-90% inorganic, including calcium phosphate and hydroxypatite.

Calculus formation

Begins between the 1st and 14th day of plaque formation, calcification can start as early as 4-8 hours.

Supragingival calculus

above the gingival margin, heaviest near salviary ducts, mineral from saliva, easily removed

subgingival calculus

not site specific, mineral from GCF and inflammatory infiltrate, proximal surfaces, dense, hard tenacious

stratum corneum, stratum granulosu, sratum spinosum, stratum basale

layers of epithelium

ortho keratinized

no cell nuclei in stratum corneum

para-keratinized

cell nuclei in stratum corneum

non-keratinized

no stratum corneum and no statum granulosum

alveolar crest fiber

1) prevent tooth extrusion, resist lateral tooth movement

oblique fibers

2) bear and transform brunt of vertical masticatory stress

transeptal fibers

3) over the alveolar bone, no osseous attachment

apical fibers

6) do not occur on incomplete roots

buccal, mucosa, gingva, palate, dorsum of tongue, intraoral and supragingival hard surfaces, subgingival biofilm

oral ecosystem/niches

oral epithelium

faces oral cavity, gingival margin to MGJ, keratinocytes

sulcular epithelium

small in health, oral epithelium into sulcus, no stratum corneum or granulosum

junctional epithelium

attaches gingival epithelium to tooth, allows fluid to pass, defense from bacteria

keratinocytes

producing tonofilaments and soft tissue renewal

non-keratinocytes

langerhans cells (antigen-presenting cells), merkel cells (tactile preceptors), melanocyte

horizontal fibers

4

interadicular fibers

5

alveolar bone proper (lamina dura)

A)dense cortical plate of bone that forms the tooth socket direc tly contacts the tooth root (cribiform plate)

trabecular bone

B) spongy bone supporting alveolar bone

compact bone

C) towards facial formed by haveresian bone and bone lamellae