DH302 Final Review Guide: Key Concepts and Terms

Dr. Alfred C Fones

Credited with creating the role of the dental hygienist

Periodontium

Tissues that surround, support, and attach to the teeth (gingiva, PDL, cementum, alveolar bone)

Gingiva

Visible component of the periodontium inside the mouth

Mucogingival junction

Line that indicates the transition from the loosely attached and movable oral mucosa to the attached gingiva

Attached gingiva

Firmly attached to the bone by collagen fibers and is the portion that extends from the free gingival groove to the mucogingival junction

Festooning

Rolling of the marginal gingiva

Rete pegs

Often create an orange peel appearance due to the protuberances of connective tissue into the epithelium

Keratinization

No cell nuclei present

Parakeratinized

Retain their nuclei

Masticatory mucosa

Keratinized stratified squamous epithelium firmly attached to the underlying bone; found on the dorsum of the tongue, hard palate, and attached gingiva

Lining Mucosa

Nonkeratinized stratified epithelium; covers the inner parts of the oral cavity; floor of mouth, ventral surface of tongue, inner lips, cheeks

Specialized mucosa

Specifically in regions of taste buds on dorsum of tongue

Junctional epithelium

Separates the periodontal ligament from the oral cavity

Gingival fibers

Fibers that support the gingiva

Dentogingival fibers

Cementum to gingiva

Alveologingival fibers

Periosteum into attached gingiva

Dentoperiosteal fibers

Cementum to alveolar crest

Circular fibers

Encircle tooth coronal to alveolar crest

Transseptal fibers

Span interdental space; cementum from one tooth to cementum of another

Cementum

Anchors the teeth, no vascular connections, cannot transmit pain, not sensitive to scaling

Alveolar Process

Crest is 2-3mm from CEJ; Crest follows CEJ of the teeth

Host Response

Individuals ability to react to the assault

Chemotaxis

Inflammatory cells are attached to areas of trauma or microbial influence by signaling process

Mast cells

Release histamine

Polymorphonuclear leukocytes

Attracted to periodontal lesions, phagocytize microorganisms

Neutropenia

Deficiency of neutrophils, first responder and most active with inflammatory response

Incidence Rate

Rate of occurrence of new cases of disease in a population over a given period of time

Risk factors for Periodontal Diseases

Do not necessarily cause the disease, but the disease is higher in these groups

Indices

Do not measure individual care

Simplified oral hygiene index of Greene and Vermillion (OHI-S)

Measures 6 teeth for plaque and calculus

Volpe Manhold Index

Measures only supragingival calculus and used in studies for tartar control products

Sulcus Bleeding Index (SBI)

Recorded 30 seconds after probing to allow time for bleeding to become visible

Gingival bleeding

Most does not progress to periodontitis

Russells periodontal index (PI)

More of historical interest, but still important and used throughout the world

Periodontal Disease Index of Ramfjord (PDI)

Probe depths and attachment loss measured; Evaluates six teeth to represent the entire dentition

Community Index of Periodontal Treatment Needs (CIPTN)

Developed by World Health Organization, assesses periodontal treatment needs in the community, not simply the level of disease

Periodontal Screening and Recording (PSR)

Identify which patients need a full examination and which patients require only a screening examination

Gingival Fluid Flow

Increased flow of crevicular fluid is one of the first measurable changes in the inflammatory process of the periodontium; Fluid is measured on filter paper strips and placed in the sulcus

Miller Index of Tooth Mobility

Two metal instrument handles are placed on either side of the tooth to be tested, and the tooth is moved in a facial lingual direction; Not advisable to assess mobility with a finger

Determinants and Risk Factors with Periodontal Disease

Gender, age, socioeconomic status, tobacco use, systemic use

Insulin dependent diabetes

Two to three times as likely to have periodontal diseases

Glycocalyx

Maintains the overall integrity of the biofilm

Bacteria

Classified as Morphotypes or shapes, Cell wall characteristics (gram positive or gram negative), Oxygen environment, Bacterial metabolism

Gram negative organism

Turn red; In gingivitis and periodontitis most bacteria are this; Contain endotoxins that cause tissue destruction; Rods, cocci, and spirochetes

Examples of Gram negative organisms

Actinobacillus actinomycetemocomitans, porphyromonas gingivalis, and treponema denticola

Gram positive organism

Turn purple; In health most of bacteria are this; Thicker layer; Rods and cocci; Anaerobic or facultative anaerobic

Antibodies

Prevent pathogens from settling in the oral cavity and inactivate bacteria so they can be engulfed by leukocytes

Enzymes

Attack and perforate the cell walls of harmful bacteria, eventually making them burst this inhibiting tissue breakdown

Bacterial coaggregation

Plaque accumulation results from the adherence of bacteria to previously attached cells to form complex aggregations

Microbial succession

Plaque ages, the composition of the flora changes

Gingival crevicular fluid (GCF)

Allows plasma to escape and the fluid leaks into the gingival crevice

Red complex bacteria

P.gingivalis, tannerella forsythensis, and treponema denticola, worst of the worst, BOP

BOP

Bleeding on probing

Orange complex bacteria

Contribute to pathogenesis but are less virulent in periodontal disease process; Loosely attached

Calcium phosphate

Present in bacterial plaque

Calculus

Serving as a reservoir for bacterial plaque biofilm, formed from calcium and phosphate

Supragingival Calculus

Yellowish white accumulation although it may darken with age, abundant near the openings of salivary ducts; Inorganic material makes up 80%, associated with gram positive

Hydroxyapatite

Main crystal type in calculus

Subgingival Calculus

Likely to be tenacious and is dark green or black (contains blood products); More calcium, magnesium, and fluoride; No salivary protein present, associated with gram negative

CalculoCementum

Calculus crystals grow deep into cemental irregularities and appear morphologically similar to cementum

Characteristics with calculus formation

Elevated salivary pH, concentration of calcium in saliva, concentration of salivary bacterial protein and lipid, low individual inhibitory factors, higher salivary urea and protein from submandibular glands, higher total salivary lipid levels

Parotid pyrophosphate

Light calculus formers have more of this

Chlorhexidine

Associated with dark staining and increased calculus deposition

Mouth Breathing

Labial gingiva of the maxillary anterior teeth, tissues become swollen and reddened, higher levels of plaque and gingivitis

Alcohol Use

Dose dependent

Acute gingivitis

Vascular, rapid development; Pain; Redness; Bulbous, festooned, edema

Chronic gingivitis

Long duration, slow development; May not cause pain; Pallor; Fibrotic tissue is highly stippled

Stage II gingivitis

Lesions begin to form in 4-7 days after plaque has accumulated in gingival tissues; BOP occurs

Pregnancy Gingivitis

Increased prevotella intermedia, campylobacter rectus, and progesterone hormone and is aggravated by poor plaque control

Pregnancy Tumor

Gingival lesion that is not a tumor, but a localized area of pyogenic granulation tissue, typically resolves after childbirth

Scurvy

Vitamin C deficiency

Necrotizing Gingivitis

Rapid onset of pain and development of necrotic ulcerative lesions of gingiva, no bone loss; Fusiform bacillus and spirochete; Distinct breath odor, trench mouth; Tips of papillae appear punched out and covered by

Trench Mouth

Tips of papillae appear punched out and covered by white necrotic pseudomembrane.

Primary Herpetic Gingivostomatitis

Vesicles that coalesce to form ulcerative lesions.

Candida Albicans

Most common fungi to affect the oral tissue and caused by yeast; easily rub off gingiva.

Lichen Planus

Characterized by lacy white lines (Wickham's striae).

Mucous Membrane Pemphigoid

Presence of Nikolsky sign.

Chronic Periodontitis

Most common form of periodontal disease characterized by bone resorption that progresses slowly and predominantly in a horizontal direction.

Clinical Attachment Loss (CAL)

Most reliable method of determining disease activity is to document the loss of periodontal attachment.

CEJ to Base of Pocket

Measures from CEJ to base of pocket including recession.

Subgingival Plaque

High levels of gram negative anaerobic and motile organisms (spirochetes).

Porphyromonas gingivalis

Most common species identified with periodontal diseases.

Advanced Periodontitis

Best treated in periodontics practice; all signs of the disease will still be evident to assist the periodontist in complete diagnosis and treatment planning.

Bacterial Pneumonia

Approximately 25% of nursing home deaths are related to this.

Aggressive Periodontitis

Progress exceedingly rapidly with massive bone loss; rapidly progressing periodontitis is an aggressive form of the disease in younger adults.

Healthy Tissue

Coral pink, melanin, pointed knife-like papilla, firm, smooth free gingiva and stippled attached gingiva.

Chronic Disease Tissue

Pallor, blunted, fibrotic, hyperplastic, leathery.

Acute Disease Tissue

Dark pink or red, cyanotic, edematous, blunted, bulbous, soft and spongy, smooth and loss of stippling.

Periodontal Abscess

Acute, localized infection and most often occurs with chronic periodontitis; may be confused with endodontic abscess.

Gingival Abscess

Most often caused by a foreign body being forced into the sulcus.

Pericoronal Abscess

Partially around erupted teeth, occurs as a flap of tissue partially covering the tooth.

Pericoronitis

Inflammation of the flap of tissue around a partially erupted tooth.

Endodontic Abscess

pulp becomes infected, Can drain out of periodontium; signs of infection can typically be seen on radiograph.

Failed Root Canal Therapy

Requires PA to diagnose.

Pseudopockets

Occur when the gingival margin is coronal to the cementoenamel junction and there is often no associated attachment loss.

Developmental Anomalies

Altered tooth developed resulting in a cemental spur.

Periodontal Effects of Lateral Developmental Groove

Tobacco use; smoking depresses the activity of oral PMNs, reducing their chemotactic response, mobility, and phagocytic ability.

Diapedesis

Process by which neutrophils squeeze between endothelial cells and emigrate into the tissue from the blood vessels.

Defective Neutrophils (PMNs)

Likely will have periodontitis.

Hemodynamic Changes

In the inflammatory process begin with transient vasoconstriction of blood vessels followed by vasodilation, which leads to hyperemia.