Week 2 [study1] Anatomy & Histology of the Gingival Unit and Basic Oral Hygiene

Apical

Towards root

Cementoenamel junction (CEJ)

Where cementum meets enamel (root + crown)

Coronal

Towards chewing surface or crown of tooth

Gingival margin

Free gingiva

Histology

Study of tissues

Interdental papilla

Gingiva extending between 2 adjacent teeth

Pellicle

Film made of saliva cells

• Bacteria that starts the plaque formation process

Periodontium

Structures that suport teeth

Periodontium structure (G-PAC)

Gingiva unit

• Free gingiva

• Attached gingiva

• Alveolar mucosa

Attachment Unit

• Cementum

• Alveolar bone/ process

• Periodontal ligament

Normal gingiva

• Salmon pink (except for ethnic ppl)

• Firmly attached to cementum and connective tissue

• probe depth < 3mm

• Does not bleed when probed

Sulcus

• Space between the free gingiva and tooth

• Measured by probe

Free gingiva

• Unattached

• Follows scalloped sahpe of cementoenamel junction (CEJ)

• Keratinized

Interdental papilla

• Gingival tissue — Fills triangular shape between teeth

Anterior teeth

• Smaller papilla

Posterior teeth

• Larger papilla

Attached gingiva

• Not movable

• Bound to bone and cementum

• Keratinized

Alveolar mucosa

• Movable

  • Loosely attached to underlying bone

• Non keratinized

• Darker in color

Masticatory mucosa

• Attached gingiva

• Free gingiva

  • Both keratinized

Lamina propria

• Collagen fibers

• Connective tissue — Under oral epithelium

Gingivitis

• First stage of disease

• After cleaning

  • Pellicles form within 30—90 mins

  • Bacteria — biofilm — hardens — calculus

Multiple factors for inflammation

• Calculus (biofilm)

• Anatomical factors

• Iatrogenic factors

  • Dental materials

• Traumatic factors

  • Food impact

Biofilm

• Bacteria attached to pellicle

• Can harden into calculus

2 types of toothbrushes

• Manual

  • Bass method recommended

  • 45° angle to gumline

  • 90° angle to occlusal surface

  • Soft bristle

• Power

  • More effective at removing plaque

  • Rotating better

  • Power brushing method

  • Place to gumline, move brush after few seconds around each tooth

2x a day for 2 mins each

Change head every 3 months or after sick

Flossing

• Best when interdental papillae are present

• No attachment loss

• No exposed root surfaces

• No difference between unwaxed and waxed floss to remove biofilm

• 18 inches wrap around middle finger

  • Use index and thumb to guide floss

  • 1x a day

Oral irrigation

• Good to reduce inflammation

• Good for braces, retainers, bridges, gingivitis

Toothpaste type

• Stannous fluoride most effective

• No stains