Chapter 10: Gingival and Dentogingival Junctional Tissue

Superficial part of basement membrane; within dentogingival junction has both an external and internal basal lamina surrounding junctional epithelium

Basal Lamina

A structure similar to basal lamina that surrounds the sarcolemma of muscle cells. It is secreted by myocytes and consists primarily of Collagen type IV, lamina and perlecan

External Basal Lamina

Interdental gingiva apical to contact area assumes nonvisible concave form between facial and lingual gingival surfaces

Col

Junction between tooth surface and gingival tissue

Dentogingival Junction

Tissue that includes sulcular epithelium and junctional epithelium

Dentogingival junctional tissue

Device that attaches junctional epithelium to tooth surface

Epithelial Attachment (EA)

Basic tissue that covers and lines external and internal body surfaces

Epithelium

Deeper extension of sulcular epithelium

Junctional Epithelium (JE)

Epithelium lining periodontal pocket

Pocket Epithelium

Epithelium that stands away from the tooth creating gingival sulcus

Sulcular Epithelium

Most superficial part of marginal gingiva

Free Gingival Crest

Groove that separates attached gingiva from marginal gingiva.

Free Gingival Groove

Fluid in gingival sulcus

Gingival Crevicular Fluid

Overgrowth of mainly interproximal gingiva

Gingival Hyperplasia

Inferiorly placed margin of free gingival crest

Gingival recession

Inflammation of the gums

Gingivitis

Gingival and periodontal pockets are extensions of the gingival sulcus, which exists in health

Periodontal Pocket

Inflammation of the tissue around the teeth, often causing shrinkage of the gums and loosening of the teeth

Periodontitis

Surrounding the maxillary and mandibular teeth in the alveoli and covering the alveolar processes is the.....

Gingival Tissue

Gingival tissue that tightly adhered to the bone around the roots of the teeth.

Attached gingiva

The gingival tissue between adjacent teeth is an extension of attached gingiva and is the interdental gingiva, forming the what?

Interdental Papillae

What is the attached gingiva?

Masticatory Mucosa

At the gingival margin of each tooth is the free gingiva, or ________ ________, which is continuous with the attached gingiva.

Marginal Gingiva

The gingival tissue that faces the tooth, the _____________ __________tissue.

dentogingival junctional

The gingival margin, or _________ ________ ________, at the most superficial part of the marginal gingiva, is easily seen clinically, and its location should be recorded on a patients chart.

Free Gingival Crest

What separates the attached gingiva from the marginal gingiva?

Free Gingival Groove

Lacks the presence of stippling, and the tissue is mobile or free from the underlying tooth surface, as can be demonstrated with a periodontal probe.

Marginal Gingiva

Apical to the contact area, the ____________ ___________assumes a nonvisible concave shape between the facial and lingual gingival surfaces forming the gingival Col

Interdental gingiva

The epithelium covering the col consists of the marginal gingiva of the adjacent teeth, except that it is nonkeratinized, and mainly present in the broad interdental gingiva of the posterior teeth, and generally is not present with those interproximal tissue associated with anterior teeth because the latter tissue is narrower. T/F

True

The attached gingiva has a thick layer of mainly what type of epithelium, which obscures its extensive vascular supply in the lamina propira, making the tissue pinkish?

Parakeratinized stratified squamous epithelium

The lamina propria in attached gingiva has tall, narrow ____________ _________ __________ and _______ __________ giving the tissue its varying amounts of stippling.

Connective issue papillae and

Rete Ridges

The lamina propria of the attached gingiva is directly attached to the underlying jaws, making the attached gingiva firm and immobile, and serves as a what?

Mucoperiosteum

The Marginal gingiva is a masticatory mucosa but mainly has a surface layer of what type of epithelium?

Orthokeratinized stratified squamous epithelium

Unlike the attached gingiva, the marginal gingiva is not attached to the underlying jaws, making the tissue firm but mobile. T/F

True

What group of fibers are found in the lamina propria of the marginal gingiva?

Gingival fiber group

What fibers supports only the gingival tissue and not the tooth in relationship to the jaws?

Gingival Fiber Group

The lamina propria of the marginal gingiva is continuous with the adjacent connective tissue, which includes the lamina propria of the attached gingiva, as well as the periodontal ligament. T/F

True

What is the junction between the tooth surface and the gingival tissue?

Dentogingival junction

Together what do the sulcular epithelium and the junctional epithelium form?

Dentogingival junctional tissue

The crevicular epithelium also called what, stands away from the tooth creating a gingival sulcus, or space that is filled with what fluid?

Sulcular Epithelium

Gingival Crevicular Fluid(GCF)

The depth of healthy gingival sulcus varies from 0.5--3 mm, with an average of ______mm

1.8mm

The _______seeps between the epithelial cells and into the gingival sulcus, allowing the components of the blood to reach the tooth surface through the junctional epithelium from the blood vessels of the adjacent lamina propria.

Gingival Crevicular Fluid (GCF)

The GCF (Gingival crevicular fluid) contains both the immunological components and cells of the _________, although in lower amounts and in different proportions. It also contains sticky ________ proteins in the sulcus that serve as adhesive for its lining tissue, keeping it intact.

Blood

Plasma

The GCF also includes white blood cells (WBCs), especially what type, as well as the immunoglobulins of IgG, IgM and serum IgA from plasma cells, which all have a role in the specific defense mechanism against disease.

Polymorphonuclear Leuocytes (PMNs)

What is a deeper extension of the sulcular epithelium that lines the floor of the gingival sulcus and is attached to the tooth surface

Juntional epithelium (JE

The JE is attached to the tooth surface by way of what structure?

Epithelial attachment (EA)

The attachment of the JE to the tooth surface can occur on enamel, cementum or dentin.

True

With active ___________ _____________, both the marginal gingiva and attached gingiva can become enlarged, especially the interdental papillae. This enlargement results from edema occurring in the lamina propria of the tissue caused by the inflammatory response

Perodontal Disease

Tissue fluid from the ___________ __________of the lamina propria flows out to flush the area of its injurious agents.

The gingival tissue can also become redder with active periodontal disease, because hyperemia, or increased blood flow, occurs in the capillaries of the lamina propria.

Capillary Plexus

What can arise from periodontal disease, tooth position, abrasion by incorrect toothbrushing methods, abfraction from occlusal stresses (such as parafunctional habits), aging process, and possibly tight frenal attachements, making the gingival margin more apical?

Gingival Recession

Within the gingival tissue, ___________ __________can affect both the epithelium and lamina propria.

-This is an overgrowth of the interproximal gingiva resulting from the intake of drugs for seizure control (phenytoin sodium), certain antibiotics, and specific heart medications.

-According to some theories, these drugs either increase the output or even populations of certain types of fibroblasts.

Gingival Hyperplasia

The JE cells are loosely packed, with fewer intercellular junctions with desmosomes between cells, as compared with other types of gingival tissue. The number of intercellular spaces between the epithelial cells of the JE is also more than other types of gingival tissue and all are filled with tissue fluid. Overall, the JE is more permeable than other gingival tissue due to its fewer desmosomal junctions and increased intercellular spaces. T/F

True

The superfical or suprabasal, epithelial cells of the JE provide the _________________ and an internal basal lamina that create the EA, because this is a cell-to-noncellular type of intercellular junction.

Hemidesmosomes

The internal basal lamina of the EA is continuous with the external basal lamina between the junctional epithelium and the lamina propria at the apical extent of the JE. T/F

True

The deepest layer of the JE, or basal layer, undergoes constant and rapid cell division or......

Mitosis

The JE does not mature like keratinized tissue, such as the marginal gingiva or attached gingiva, which fills its matured superficial cells with what?

Keratin

Before the eruption of the tooth and after enamel maturation, the ___________ secrete a basal lamina on the tooth surface that serves as a part of the primary EA.

ameloblasts

As the tooth actively erupts, the coronal part of the fused _________ ____________ ____________ and surrounding epithelium peels back off the crown.

reduced enamel epithelium (REE)

What has the highest turnover time in the entire oral cavity, which is 4-6 days.

Junctional Epithelium (JE)

Periodontal inflammation is also accompanied by an increase in the amount of what, in order to fight the microbial attack, wither of a serous (clear) or suppurative nature, distending the tissue further.

Gingival Crevicular Fluid (GCF)

It is important to keep in mind that this type of fluid also supplies the minerals for subgingival calculus formation, as well as moist environment needed for dental biofilm growth.

Gingival Crevicular Fluid (GCF)

What type of epithelium lines the oral cavity and the respiratory cavity?

Stratifed squamous

Ciliated columnar

What are the 3 types of oral mucosa and where is each type found?

*LIning mucosa=Floor of the mouth, ventral surface of the tongue, soft palate, buccal mucosa, labial mucosa, alveolar mucosa

*Masticatory mucosa=Gingiva, hard palate, dorsal surface of the tongue

*Specialized mucosa=Lingual papilla

Name the 3 cellular layers of nonkeratinized epithelium and give a 2nd name to each layer.

Basal layer=Stratum Basale

Intermediate layer= Stratum intermedium

Superficial Layer=Stratum superficiale

Name the 4 cellular layers of keratinized epithelium and give a 2nd name to each layer

Basal Layer=Stratum Basale

Prickle Layer=Stratum Spinosum

Granular Layer=Stratum Granulosum

Keratin Layer=Stratum Corneum

What will the keratohyaline granules in the "granular layer" produce?

Keratin

What is hyperkeratinization and what causes it?

Increased output of keratin due to increased function (friction) to an area

In which cellular layer of epithelium does mitosis occur?

Basal Layer = Straum Basale

Desquamating cells of which types of epithelium have visible nuclei? In which type are are the nuclei pyknotic?

Lining (nonkeratinized) and paraepithelium

Not alive in paraepithelium

Name the "resident Cells" of epithelium

*Epithelial cell (Keratinocyte): Most abundant, protective barrier

*Melanocyte: Produces melanin near basement membrane

*Langerhans & Granstein Cells: Immune response with T cell lymphocytes (dendritic bone marrow)

*Merkel Cell: Neural cell responsible for sensory information

Epithelial cells are joined to one another by what?

Desmossomes

Epithelial cells are joined to the basement membrane by what?

Hemidesmosomes

What are 2 purposes of tall rete ridges and in which oral areas are they found?

Nutrition and strength. Found in all Masticatory mucosa

Sulcus=Not tall, nonkeratinized

Attached gingiva=Tall, parakeratinized

Free Gingiva=tall, parakeratinized

Alveolar Mucosa=not tall, nonkeratinized

Center of hard palate=Tall, othokeratinized

What is the difference between rete ridges and connective tissue papilla? Which is vascular and innervated?

*Rete Ridges=Stick down from epithelium

*Connective tisssue papilla stick up from connective tissue.

*Connective tissue papilla are vascular and innervated

What is another name for lamina propria?

Connective tissue proper

What are the 2 layers of the lamina propria and give a 2nd name for both

*Loose layer =papillary layer

*Dense layer= reticular layer

Where is the capillary plexus of oral mucosa located?

In the papillary layer of Connective tissue

What are the 3 "resident cells" of connective tissue?

Fibroblast

Macrophage

Mast cell

By volume, what is the largest component of connective tissue proper, cells, fibers, or intercellular substance?

Fibers

What would the layer of oral mucosa that is comparable to the hypodermis of the skin be called? What gives it a yellow color?

Submucosa

Adipose tissue

What gives various areas of oral mucosa different degrees of redness in color?

Increased vascularity=increased redness

Areas of oral mucosa that are keratinized are usually mixed ortho and parakaratinized. T/F

True

What type of epithelium predominates in the center of the hard palate and attached gingiva?

Hard Palate=Orthokeratinized

Attached Gingiva=Parakeratinized

Which keratinization type is the most common in the oral cavity and the least common?

*Most common=Nonkeratinized

*Least common=Orthokeratinized

All areas of lining mucosa are typically nonkeratinized but they can keratinize when placed under heavy funtion. T/F

True

What term describes the periosteum in oral areas where the lamina propria is acting as periosteum?

In which 2 oral areas does this occur?

Mucoperiosteum=occurs in the attached gingiva and center of the hard palate

What are the names of the 4 types of lingual papillae? What mucosa type do they have as a covering

Filiform

Fungiform

Circumvallate

Foliate

Specialized

All have taste buds except filiform

What are the names of the 2 types of cells making up the taste bud? Did they come from mesoderm or ectoderm?

Taste and support cells

Ectoderm

What causes geographic tongue and Black hairy tongue?

Early shedding of filiform (stress)

Filiform cells on tongue don't shed

What is turnover time and which are of oral epithelium has the fastest turnover time?

The time it takes for the tissue to renew itself

Juntional epithelium 4-6 days

In which area of oral mucosa does heavy pigmentation occur? What cell produces it

Attached gingiva

Melanocyte

Which cell is most responsible for repairing damaged connective tissue?

Fibroblast

The basal lamina (2 layers) which connects the JE to the enamel is called what?

Internal Basal Lamina

The basement membrane (3layers) that connects the epithelium to the lamina propria is called what?

External basil lamina

Why can tissue fluid and WBCs migrate through the JE so easily?

More permeable due to fewer desmosomes

As the tooth erupts, what forms the fist JE?

The REE

Where does GCF come from? Is the flow greater in health or inflammation?

Blood capillaries (basically blood plasma)

Inflammation

What type of Kertinization and type of rete ridges does Free gingiva have?

Perakeratinized and Orthokeratinized

Tall rete ridges

What type of Kertinization and type of rete ridges does Attached gingiva have?

Parakeratinized

Tall Rete Ridges

What type of Kertinization and type of rete ridges does Lining Mucosa have?

Nonkeratinized

Not tall Rete Ridges