WRIGHT FULL EXAM STUDY GUIDE WINTER #2

Orthokeratinization

The process of cells developing into flattened mature cells in the outer stratum corneum layer.

Where is parakeratinized tissue found in the oral cavity?

Parts of the gingiva and hard palate.

Pyknotic nuceli

Nuclei that remain in the parakeratinized cells of the oral epithlium

What type of mucosa in the oral cavity has non-keratinized tissue?

Lining mucosa

What are the different layers of oral epithelium seen in non-keratinized mucosa?

-Instead of stratum ganulosum there is a stratum intermedium.

-Instead of a stratum corneum, there is a stratum superficiale

Squames

Flattened/keratinized epithelial cells that are found in the stratum corneum of some oral tissues.

What layer of tissue contains keratohyalin granules?

Stratum granulosum

What are the 3 key differences between keratinized and non-keratinized squamous cells?

-Keratinized tissue have bundles of tonofilaments called tonofibrils while the non-keratinized fibrils are dispersed

-There are different types of keratin in both cells

-A membrane coating organelle is more efficient and developed in keratinized cells.

Keratohylain Granules

Granules found in the stratum granulosum which contain 2 proteins (filaggrin and loricrin) which help aggregate keratin filaments to form bundles.

What are the two proteins of Keratohylain granlues?

-Filaggrin

-Loricrin

What layer are melanocytes found in the oral epithelium?

Stratum basale

Pterygomandibular Raphe

This is an important landmark in an inferior alveolar nerve block. It is a band like tendon that sits behind the molars and along the buccal mucosa.

What are the indications of performing an inferior alveolar nerve block?

Procedures involving ipsilateral mandibular teeth and their lingual tissues to the midline.

What is the target area/nerve and site of injection for an inferior alveolar nerve block?

We want to inject at the deepest concavity of the anterior border of the ramus, towards the lingula.

-Lateral to the pterygomandibular raphe.

What are the common complications of an IA nerve block?

-Lingual Shock

-Facial paralysis if the facial nerve is anesthetized

-Muscle soreness

-Hematoma

What is a Gow Gates IA nerve block?

A modified Inferior alveolar nerve block technique that has a higher success rate than the conventional injection.

-The site of injection is higher on the occlusal mandibular plane, closer to the neck of the condyle.

What are the disadvantages of doing an IA Gow Gates block?

A patient has to be able to remain open fully for at least 30s.

What is the target area/nerve and site of injection for an inferior alveolar Gow Gates nerve block?

Targeting the buccal, inferior alveolar, lingual, nerve to the mylohyoid, and auriculotemporal nerves.

-Injection should occur at anterior border of ramus, anterior to the condylar neck at the level of the 2nd maxillary molar.

What are some complications of giving a Gow Gates Inferior alveolar nerve block?

-Penetrate the pterygoid plexus

-Penetrate the maxillary artery

What are the cognitive benefits linked to chewing?

-Protection against the development of dementia

-Increases blood flow to the preforntal cortex and hipoocampus

In the nun study, surrounding chewing and cognition, what was seen in people that had less teeth at death?

Cranial tissues were associated with higher levels of dementia

What is the percent decrease in mortality for each remaining tooth in the occluding 20?

4% decrease in death

A person with no teeth, is how many times more likely to have cognitive decline?

2.39 times

What are the 4 stages of swallowing?

Preparatory Stage

Oral Stage

Pharyngeal Stage

Esophageal Transport Stage

What happens in the preparatory stage of swallowing?

Food is chewed until it is appropriate size for swallowing

What happens in the oral stage of swallowing?

-Marks the initiation of swallowing

-Takes 1-1.5s

-Food is suqeezed posteriorly

-Food passes over the tongue

What is the pharyngeal stage of swallowing?

Triggered by voluntary and reflex components

-Muscles contract the hyoid bone and larynx

-It moves superiorly and anteriorly

-Respiration is inhibited

What is the esophogeal transport stage of swallowing?

-Involves peristalsis

-Food is propagated at 2-4cm/s

-Moves through esophogus in 6-10s

What is the most pathogenic sublingual microbial complex?

P. gingivalis

-T. forsythia

-T. denticola

How are neutrophils related to development of periodontal disease?

-People with congenital deficiencies in neutrophils have a greater chance in developing periodontal disease.

-Excessive inflammatory and toxic substances can be released and cause tissue damage

-Chronic recruitment

What is a cleft of the primary palate?

Includes clefting of the maxillary lip and alveolus

What is a cleft of the secondary palate?

Includes clefting of the hard and soft palate

What is a main issue that can arise for an orthodontist that has a patient with a cleft palate?

They may have retrognathism of the maxilla

What are some of the main dental affects that occur when a person has cleft palate?

-Missing maxillary lateral incisor

-Supernumerary teeth

-Malpositioned teeth

-Delayed tooth eruption

-Anterior or Posterior Crossbite

What is the name of the neural crest cells that migrate to the facial region?

Ectomesenchymal cells

Ectomesenchyme

This is the immature, undifferentiated neural crest tissue in the face that develops into the periodontum and tissues.

Epithelial Bands

Thickened areas of epithelial tissue which will be where the dental arches are located within the oral cavity

What causes the thickening of the epithelial band in tooth development?

Restructuring of the cell orientation and increased mitotic division.

Dental Lamina

This is the ridge of cells that project into the underlying ectomesenchyme of the developing tooth bud

What are the layers of the developing tooth bud?

-Dental Lamina-Basement membrane-Ectomesenchyme-Meckels Cartilage

Successional Lamina

This is a ridge of cells that develops lingually to the dental lamina. It is the site where the permanent teeth will grow from with exception of molars.

Epithelial enamel organ

This is an epithelial layer that forms from the dental lamina. It will eventually become the enamel of the tooth

What are the features/layers of the enamel organ?

-Outer Enamel Epithelium

-Stellate Reticulum

-Stratum intermedium

-Inner Enamel Epithelium

-Enamel Knots

-Enamel Cord

Vestibular Lamina

A layer of oral epithelium that develops into the oral vestibule.

What is a tooth bud?

A small ball of epithelial cells that beings to appear at the dental lamina site. It is the first indication of a tooth developing.

How many tooth buds form during the bud stage?

-10 mandibular

-10 maxillary

When is the cap stage and when does it occur?

-The cap stage occurs at around week 9 of development

-The epithelial enamel organ forms and becomes concave

-Enamel cord and knot appear

When is the bud stage and what occurs?

-Bud stage happens at around week 8 of development

-The tooth bud grows downward from the dental lamina.

-The surrounding ectomesenchyme proliferates and condenses

-The basement membrane remains intact

What is the stellate reticulum?

This is the main population of cells in the epithelial enamel organ.

-It has space which has accumulation of glycosaminoglycans for nutrients

What is the stratum intermedium?

It is the thin layer of cells in the epithelial enamel organ which sits between the stellate reticulum and the inner enamel epithelium.

What is the dental follicle?

This is the condensed proliferating area of ectomesenchyme that surrounds the enamel organ and will develop into the rest of the tooth and periodontum.

What is the dental papillae?

This is the area of condensed ectomesenchyme below the concave area of the epithelial enamel organ. It will eventually become the pulp once the tooth mineralizes.

What is the purpose of the stratum intermedium?

Has high alkaline phosphates activity that may have a function in the formation of enamel.

Cervical Loop

This is the junction/transitional area between the developing crown and root in the tooth.

What type of junction anchors stellate reticular cells to other cells?

Desmosomes

What type of junction connects neighbouring cells of the stratum intermedium to eachother?

Tight junctions and desmosomes

What makes up the majority of the dental papilla?

Fine collagen fibrils

How do we distinguish the dental follicle from the dental papillae?

The dental follicle surrounds the developing tooth and has a higher number of collagen fibrils.

What is the process of reciprocal induction?

This is the process where ameloblasts and odontoblasts both stimulate the production of eachother.

1) Ameloblasts differentiate from inner enamel epithelial cells

2) Ameloblasts stimulate the odontoblasts to differentiate

3) Dentin is secreted/formed

4) The presence of dentin causes ameloblasts to secrete enamel

After hard tissue formation, what is the only source of blood supply to the developing tissue?

The dental follicle

Hertwigs Epithelial Root Sheath

This is an extension of the epithelial cells that proliferate from the cervical loop and encircle the papillae.

-This is where the formation of root odontoblasts occur.

Epithelial diaphragm

This is the distal portion that curves of the Hertwigs epithelial root sheath during root formation.

What happens to the Hertwigs epithelial root sheath after induction of the root?

The root sheath with migrate away and break up into cell clusters called epithelial rest cells which remain.

What is the main vascular supply to the TMJ?

Superficial Temporal Artery- Transverse facial artery

Maxillary Artery- Deep auricular, Masseteric, Posterior deep temporal

What is the normal articular disc position within the TMJ?

11-12 o'clock position

What are non-functional/parafunctional behaviours of the masticatory muscles?

Bruxism, clenching, empty mouth chewing

What are the main functions of the articular disc?

-Distributes loading forces

-Decreases wear

-Stabilizes condylar movement

What is the functions of the TMJ synovial joint?

-Lubricate

-Protect from direct contact

-Transport nutrient and waste

Voiced Sounds

Sounds that are produced by the closure of the vocal cords and air pushing through them to create a vibration. This is how many of the consonants and vowels are produced.

Unvoiced Sounds

Sounds that are produced with no vocal cord vibration. The closure of teeth and soft tissue help restrict airflow and create sounds like t, k, and s.

How are most consonant sounds produced?

-Produced via the complete or partial blockage of exhaled air.

-The manner that airflow is impeded creates the different sounds

Stops/Plosives

-A type of consonant production

-Includes PBD, GTC letters

-Complete closure of vocal tract followed by quick release

Fricatives

-A type of consonant production

-Includes SZV, F, Th, Sh letters

-Produced by forcing air through constricted passage to create high frequency

Nasals (Speech Production)

-A type of consonant production

-Includes M, N, -ing

-Produced with complete closure in the oral cavity and redirection of airflow through the velopharyngeal port to pass through the nasal cavity.

Bilabial Consonants

Sounds that require complete closure of the lips. P, B, M

Labial-Dental Consonants

These are sounds that are produced by the contact of maxillary central incisors and the dry line of the lower lip.

-V, F

Lingual-Dental Consonants

These are sounds that are produced by the tip of the tongue projecting through the maxillary and mandibular incisors.

-Produces th sounds

When a person has short incisors, what does a V end up sounding like?

F

When a person has too long of incisors what does an F sound like?

V

Lingual-Alveolar Consonants

These are sounds produced by contact between the tongue and the maxillary alveolar ridge

-szn, td, l

Lingual velar consonants

These are sounds produced by the back of the tongue moving up and back to make contact with the alveolar process near the soft palate and maxillary second premolars.

-k, g, ng

What speech sounds does the tongue interact with the palate and posterior teeth but not central area of the anterior palate?

Sh, Zh, Y

What speech sounds does the tongue interact with the palate and ALL teeth but not central area or anterior palate?

S and Z

What speech sounds does the tongue tip interact with the anterior palate?

L

What speech sounds does the tongue interact with the palate and teeth all around the arch followed by anterior release?

T, D, Ch, J

What speech sounds does the tongue interact with the palate and teeth all around the arch continuously?

N

What speech sound does the tongue interact with posterior palate and teeth but not the anterior?

R

What are the intracranial sources of orofacial pain?

-Vascular Pain (Headaches)

-Tumors

What are the extracranial sources of orofacial pain?

-Ears

-Eyes

-Nose and Paranasal sinus

-Throat and Tongue

-Lymph glands

-Neck

-Teeth and Gingiva

-Tumors

Myofascial Trigger Point

A hyper irritable spot in a band of skeletal muscle or fascia that is painful when compressed and can give rise to referred pain/tenderness and autonomic phenomena

What are two types of autonomic phemonena in oral pain?

Active and Latent

Hyperalgesia

An increased response to a stimulus that is normally painful

What are some symptoms that can accompany orofacial pain?

-Muscle stiffness

-Sensation of acute malocclusion

-Ear symptoms (Toothache, headache)

-Decreased mouth opening

-Hyperalgesia/referred pain

What are the 3 main temporomandibular disorders?

-Musculoskeletal disorders

-Articular Disc Disorders

-Inflammatory and non-inflammatory disorders