Exam 3 (1/2)

Oral mucosa

The lining of the oral cavity.

What are the three divisions of the oral mucosa?

Masticatory

Lining

Specialized

Anatomic crown

Part of tooth covered by enamel

Clinical crown

Part of anatomical crown that is visible in the oral cavity and not covered by gingiva

Anatomic root

Part of tooth covered by cementum

Clinical root

part of anatomical root visible in the oral cavity and not

covered by gingiva. Recession

Masticatory Mucosa

• Covers the gingiva and hard palate

• Firmly attached to underlying tissue

• Not attached to free margin of the gingiva

• Keratinized

Lining Mucosa

• Epithelium is not generally keratinized

• Tissues not firmly attached

• Covers inner surface of lips, cheeks, floor of mouth

Specialized Mucosa

• Covers dorsum of tongue

• Contains papillae and taste buds

Types of papillae

• Filiform

• Fungiform

• Circumvallate

• Foliate

Where is filiform located & function?

Cover most of the dorsal (top) surface of the tongue.

Provide texture and friction to help with chewing and moving food; do NOT contain taste buds.

Fungiform papillae

Scattered on the anterior 2/3 of the tongue, look like red dots

Contain taste buds

Papillae circumvallate? 

Arranged in a V-shaped line in the posterior tongue (just in front of the sulcus terminalis).

Contain many taste buds; involved in bitter taste.

Where is foliatae located?

On the lateral (side) borders of the tongue in vertical folds.

Contain taste buds; sensitive to sour.

Periodontium

Tissues surrounding and supporting the teeth in two sections; Gingival unit & attachment apparatus

What are the two sections that make up the periodontium?

• Gingival unit

• Attachment apparatus

Gingiva

Masticatory mucosa that surrounds the neck of the teeth and is attached to teeth and alveolar bone

What does the gingiva consist of?

• Free gingiva

• Attached gingiva

• Interdental papilla

What is 1?

Free gingival margin

What is 2?

Free gingiva 

What is 3?

Free gingival groove

What is 4?

Attached gingiva

What is 5?

MGJ (Mucogingival junction)

What is 6?

Alveolar mucosa

Papillary

Pointed part of gingiva located between the teeth

Marginal (free)

Most coronal portion of gingiva

Col

• Connects facial and lingual gingiva

• non-keratinized, concavity; susceptible to disease

Gingival sulcus (gingival pocket)

Space between the tooth and internal portion of the free gingiva

Attached gingiva

• Extends from free gingival groove to alveolar mucosa

• width varies, not movable, firmly attached to underlying bone and cementum

Free gingival groove

shallow linear groove, demarcating the free gingiva from attached

Sulcular Epithelium

Non-keratinized epithelial tissue lining the gingival sulcus

Alveolar mucosa

Lining mucosa

Non keratinized

Movable, loosely attached

MGJ-mucogingival junction-separated

alveolar mucosa and attached gingiva

Darker red in color

Highly vascularized

Frena

Fold of mucus membrane, attached to movable tissue to more fixed

tissue.

Junctional Epithelium

Specialized tissue that attaches the gingiva (gums) to the tooth, forming the base of the gingival sulcus

Gingival Crevicular Fluid (GCF)

a fluid that flows from the gingival sulcus, part of “defense system”

Periodontal Ligament

The fibrous connective tissue that surrounds and attaches the tooth’s root to alveolar bone

What is the Gingival Fiber Group

fibers that hold the gingiva tight to the teeth and keep the tissue stable.

What makes up the Gingival Fiber Group

Dentogingival

Dentoperiosteal

Transeptal

Alveologingival

Circumferential

Dentogingival fibers

Attach from tooth → gingiva. Help keep the gingiva snug around the tooth.

Alveologingival fibers

From alveolar bone → gingiva. Help attach the gingiva to the bone.

Circumferential (circular) fibers

Wrap around the tooth like a belt. Help keep the gingiva firm and in place.

Dentoperiosteal fibers

From tooth → periosteum (bone covering). Help anchor the tooth to the bone area.

Transseptal fibers

Stretch from the cementum of one tooth across the interdental space to the cementum of the neighboring tooth. Keep teeth aligned and close together.

Principal Fiber Group (Dentoalveolar Fibers)

Fibers that anchor the tooth in the socket and resist forces.

Alveolar Crest fibers

From cementum → alveolar crest. Resist sideways (lateral) movement.

Horizontal fibers

From cementum → bone in a horizontal line. Resist lateral forces.

Oblique fibers

From cementum → bone, angled upward. Absorb chewing pressure.

Apical (Periapical) fibers

From cementum → bone at the root tip. Resist tipping of the tooth.

Interradicular fibers

From bone → cementum in furcations. Resist tooth loosening and tipping.

What is this?

Apical (Periapical) fibers

What is this?

Interradicular fibers

What is this?

Oblique fibers

What is this?

Horizontal fibers

What is this?

Alveolar crest fibers

Cementum

Thin, mineralized, bone-like substance (conn. tissue) covering roots from CEJ to apex; outer most layer of the roots

Function of the cementum

• Seals dentinal tubules

• Provides attachment for fibers of periodontal ligament

Alveolar Bone

• Surrounds the tooth socket and supporting bone

• Support the teeth

• Provide attachment for PL fibers

What should you look for during a gingival exam?

Color

Size

Contour (shape)

Consistency

Surface texture

Position

Exudate (fluid leakage)

Stippling

Orange peel texture of attached gingiva

Resiliency

When pressed with side of probe, how much indentation you get

Sponginess

Deeper impression left

What are some symptoms of a diseased periodontium?

Bleeding

Tender, sensitive gingiva

Food traps

Bad taste in mouth

Bad breath

What is the main cause of periodontal disease?

microorganisms in bacteria plaque (biofilm) that produce enzymes

and toxins that breakdown tissue

What are the 2 forms of periodontal disease?

Gingivitis & Periodontitis

Gingivits

Inflammation of the gingiva with no apparent attachment loss. Only the marginal gingiva involved

Periodontitis

Inflammation and infection involving supporting structures; apical

migration of junctional epithelium w/ loss of alveolar bone

Stages of Periodontal Development

1. Gingivitis - Initial lesion within 2 to 4 days (no clinical signs)

2. Early lesion - 7 to 14 days (reversible, first clinical sign)

3. Established Lesion, gingival pocketing 

4. Periodontitis, advanced legion

Pocketing

Formation of deep spaces between the gums and teeth

A pocket is a diseased sulcus

Pocket refers to ‘soft tissue’, not bone.

Periodontal pocket

Pocket formed by disease causing the junc. epithelium to migrate apically

Pocket refers to ‘soft tissue’, not bone.

Suprabony pockets

Pocket bottom (junctional epithelium) is above the alveolar bone.

Usually seen with horizontal bone loss

Infrabony pockets

Pocket bottom is below the alveolar bone.

Usually seen with vertical bone loss.

True or False: All gingival pockets are suprabony; periodontal

pockets can be either

True

Process of Pocket Formation

Bacteria destroy the junctional epithelium → PDL fibers detach → junctional epithelium moves down → cementum becomes exposed and rough → demineralization, calculus, and biofilm build up.

Class I Furcation

early, can probe anatomy of furcation entrance <3mm

Class II Furcation

moderate, probe can enter furca but can not pass thru

Class III Furcation

Severe, probe can pass thru

Class IV Furcation

Same as III, but furcation is exposed due to recession

Tooth Mobility

Degree to which tooth is able to move in a horizontal or vertical direction

Modifiable risk factors of periodontitis

Tobacco use

Diabetes Mellitus

Psychosocial factors

Medications

Poor home care

Possibly nutrition, alcohol, socioeconomic status

Non modifiable risk factors of periodontitis

Genetics

Host response

Osteoporosis

Immune deficiencies

Old Paradigm (Linear Theory)

Bone loss happens slowly, steadily, and at a constant rate.

Current Paradigm (Burst Theory)

Bone loss happens in short bursts of activity, with periods of no progression in between.

What is this?

Periodontal ligament

What is this?

Alveolar process

What is this?

Alveolar bone proper

What is this?

Root cementum 

What is this?

Gingiva

What is number 4?

Papilla circumvallatae 

What is number 3?

Papillae foliatae

What is number 1?

Papillae filiforms

What is number 2?

Papillae fungiforms

What is this?

Interarticular fibers

What is this?

Circumferen

What is this?

Horizontal fibers

What is this?

Oblique fibers

What is this?

Apical fibers

What is this?

Transseptal fibers

What is this?

Alveolar crest

What is rolled gingiva?

A rounded, thickened gingival margin caused by inflammation or edema, often from plaque or improper brushing.

Bulbous

What is festooned gingiva?

Gingiva with a “scalloped” or exaggerated, swollen collar shape around the tooth, often seen in chronic inflammation.