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ch 18 The Periodontium - Vocabulary Flashcards

The Periodontium

  • The Periodontium is the functional unit of tissues surrounding and supporting the tooth.

  • It consists of two main parts: the gingiva and the attachment apparatus (cementum, periodontal ligament, and alveolar bone).

  • Key terms to know:

    • Free gingival margin (FGM)

    • Base of the pocket (BP)

    • Suppuration (pus formation)

    • Cementoenamel junction (CEJ)

    • Recession (gingival margin migration apically)

    • Loss of attachment (LOA)

Learning Objectives (as outlined in the transcript)

  • Recognize normal tissues of the periodontium.

  • Identify clinical features of the periodontium.

  • Define key terms: FGM, BP, suppuration, CEJ, recession, LOA.

  • Describe characteristics of healthy gingiva.

  • Compare characteristics of gingiva in health vs disease and after periodontal surgery.

  • Recognize and describe gingival characteristics in health and disease.

  • Communicate gingival characteristics using the periodontal summary statement to a clinical instructor and discuss notable findings.

The Periodontium: Definition and Components

  • The periodontium surrounds and supports the tooth and includes:

    • Gingiva

    • Attachment apparatus: cementum, periodontal ligament (PDL), and alveolar bone

  • Supporting structures include the alveolar bone surrounding the tooth socket and the cementum covering tooth roots where not covered by enamel.

Gingiva

  • The gingiva is the part of the mucosa that covers the alveolar bone and surrounds the teeth in the maxilla and mandible.

  • It is subdivided into:

    • Free gingiva: the unattached portion surrounding the tooth, ending at the free gingival margin.

    • Attached gingiva: tightly bound to the underlying cementum and bone, contiguous with the alveolar mucosa and separated from the free gingiva by the mucogingival junction (MGJ).

    • Interdental gingiva (papilla): fills the interdental embrasure between adjacent teeth.

    • Col: a non-keratinized saddle-shaped area of interdental gingiva that junctions between the buccal and lingual interdental papillae under the contact point (more susceptible to infection).

    • Mucogingival junction (MGJ): the boundary between keratinized gingiva (above) and non-keratinized alveolar mucosa (below).

  • Landmarks in the gingiva include the gingival margin, gingival sulcus, and the junctional epithelium (JE).

Cementoenamel junction (CEJ)

  • The CEJ is the junction between the enamel covering the crown and the cementum covering the root.

  • Serves as an important reference point for evaluating recession and LOA.

Alveolar Bone, Cementum, and PDL

  • Cementum provides attachment for periodontal ligament fibers and helps seal dentinal tubules.

  • The periodontal ligament (PDL) anchors the tooth to the alveolar bone and contains various fiber groups.

  • Alveolar bone supports the teeth and undergoes remodeling throughout life (eruption, orthodontics, occlusal forces).

  • When teeth are lost, the alveolar bone resorbs over time.

The Gingival Sulcus and Junctional Epithelium

  • The gingival sulcus is the space between the free gingival margin and the tooth surface.

  • Components along the sulcus from tooth surface outward:

    • Sulcular epithelium (lines the sulcus)

    • Gingival crevicular fluid (GCF) that flows into the sulcus

    • Junctional epithelium at the base of the sulcus, attaching to the tooth

  • In a healthy situation, the location of these structures denotes a healthy periodontium.

Interdental Gingiva and Embrasures

  • Interdental gingiva (papilla) fills the interdental space between adjacent teeth.

  • Embrasures are the triangular spaces beneath the contact areas between teeth; classifications exist (Interdental Embrasure Classifications).

  • The Col lies apical to the contact area and sits between the buccal and lingual interdental papillae, often non-keratinized and more susceptible to infection.

The Col

  • The Col is the non-keratinized area located directly apical to the contact area between adjacent teeth.

  • It is not readily self-cleaning and is more prone to plaque accumulation and inflammation.

Junc­tional Epithelium (JE)

  • The JE forms a seal at the base of the sulcus, attaching to the tooth surface, contributing to the attachment apparatus.

  • In health, the JE maintains a barrier and participates in health maintenance; after periodontal surgery, the JE can migrate apically relative to the CEJ.

Attached Gingiva and Landmarks

  • Attached gingiva borders the alveolar mucosa and is continuous with the gingival sulcus; it is robust and keratinized.

  • The mucogingival junction (MGJ) marks the boundary between keratinized gingiva and non-keratinized alveolar mucosa.

  • A normal width of attached gingiva ranges from about 1-9 { mm}, varying among individuals and tooth type.

Periodontal Ligament (PDL) and Fiber Groups

  • The PDL is the connective tissue that anchors the tooth to the alveolar bone via collagen fibers.

  • Principal fiber groups within the periodontium:

    • Alveolar crest fibers

    • Horizontal fibers

    • Interradicular fibers

    • Oblique fibers

    • Apical fibers

  • Additional gingival fiber groups associated with gingival attachment:

    • Dentogingival fibers

    • Dentoperiosteal fibers

    • Alveologingival fibers

    • Circumferential fibers (around the tooth)

  • Cementum serves as the attachment surface for these PDL fibers.

Cementum

  • Cementum exists on the root surface and serves to attach PDL fibers and protect dentin by sealing dentinal tubules.

  • The gingiva covers cementum in a healthy mouth, except in exposed root surfaces where recession occurs.

Alveolar Bone

  • The primary function of alveolar bone is to support the teeth.

  • It remodels continuously due to:

    • Tooth eruption

    • Orthodontic movement

    • Occlusal forces

  • When teeth are lost, the surrounding alveolar bone undergoes resorption.

  • Key landmarks to know:

    • CEJ (cementoenamel junction)

    • Lamina dura (alveolar bone proper lines the tooth socket perceptibly on radiographs)

    • Alveolar bone proper

    • Alveolar crest

    • PDL space

Alveolar Bone in Health and Disease

  • In health, the normal alveolar bone crest is located about 1-2 { mm} from the CEJ toward the apex.

  • If bone loss occurs, the alveolar bone crest moves apically from the CEJ by approximately another 2 { mm} or more, resulting in crestal bone loss.

Gingival Description: Clinical Descriptors

  • The gingiva can be described by the following dimensions:

    • Color

    • Size

    • Shape (contour of margins and papilla)

    • Consistency

    • Surface texture

    • Position

    • Inflammation indicators (bleeding) and exudate

Healthy Gingiva Characteristics

  • Color: Pink; may have melanin pigmentation in darker individuals.

  • Size: Free gingiva fits snugly around the tooth; attached gingiva width varies.

  • Shape: Flat margins; interdental papillae may be pointed in health.

  • Texture: Free gingiva smooth; attached gingiva may be stippled (orange-peel appearance).

  • Consistency: Firm; no edema.

  • Bleeding: No bleeding on probing.

  • Example descriptors for healthy gingiva: Pointed papillae, knife-edge margins, stippled texture, firm consistency, no bleeding, color pink or pigmented in darker individuals.

Disease-Associated Characteristics (General Descriptors)

  • Color: Red, bluish purple, or pigmented changes may occur.

  • Size: Enlarged free gingiva and/or papillae; may be localized or generalized.

  • Margin/Position: Recession (margin apical to CEJ) or hyperplasia (margin coronal to CEJ).

  • Shape: Margins may be flat or knife-edge in health; diseased may be rolled, festooned, or irregular; papilla may be bulbous, cratered, blunted, or missing.

  • Texture: From smooth to stippled; in disease, surfaces may be smooth and shiny, or nodular (fibrotic).

  • Consistency: Ranges from firm and resilient to soft, spongy, or puffy; in disease, tissues may be soft and fibrous or edematous.

  • Inflammation/Exudate: Bleeding on probing may be spontaneous or on provocation; exudate (pus) may be present in some diseased states.

Gingival Descriptor Worksheet (Diagnostic Practice)

  • Normal descriptors include: color (pink, pigmented), size (fits snugly), margin position (near CEJ), margin shape (tapered or rounded), papilla shape (flat, pointed), texture (stippled), consistency (firm), no bleeding, no exudate.

  • Disease descriptors include: red color, enlarged margins, recession (apical to CEJ), ectopic margins (bulging or rolled), papillae that are bulbous or cratered, loss of papilla fill, smooth/shiny surface, soft or spongy consistency, spontaneous bleeding, presence of exudate.

  • The worksheet instructs to indicate whether a characteristic is localized or generalized and, if localized, to specify tooth number or aspect (facial/lingual) and the extent of bleeding (light, moderate, heavy).

Post-Periodontal Surgery: Gingival Changes

  • After periodontal surgery, the junctional epithelium may migrate apical to the CEJ.

  • In a healthy or stable patient, sulcus depth should be ≤ 4 { mm} with < 10 {%} bleeding on probing.

Clinical Application and Patient Education

  • Key roles for patients: self-management of periodontal disease, understanding normal gingival characteristics, recognizing the significance of bleeding, and connecting exam findings to self-care instructions.

  • Special attention should be given to areas of gingival recession to prevent abrasion, inflammation, and progression of recession.

  • Brushing method, brush filament stiffness, dentifrice abrasiveness, and brushing pressure can influence gingival recession.

Practical Assessment: How to Describe Gingiva

  • When examining the mouth, identify areas with the most tissue changes.

  • Assess and describe in terms of:

    • Color (normal vs pigmented, marginal vs papillary or diffuse changes)

    • Size (enlarged vs snug fit around tooth)

    • Margin position (near CEJ vs apical or coronal to CEJ)

    • Margin shape (tapered, rounded, rolled, irregular)

    • Papilla shape (flat, pointed, bulbous, cratered, missing)

    • Texture (stippled vs smooth; smooth and shiny or nodular)

    • Consistency (firm vs soft, spongy, puffy, non-resilient)

    • Bleeding/Exudate (no bleeding, bleeding on probing, spontaneous bleeding; presence of pus)

  • A gingival descriptor worksheet (Figure reference) is used to standardize these observations for communication with instructors.

Quick Reference: Key Distances and Landmarks (Summary)

  • Alveolar bone crest in health: 1-2 { mm} from CEJ toward the apex.

  • In bone loss: crest moves ≈2 { mm} apically from CEJ or more.

  • Healthy sulcus depth: ≤ 4 { mm} and bleeding on probing is less than 10 {%}.

  • Width of attached gingiva:1-9 { mm} (varies by individual and tooth location).

Notable References in the Transcript

  • The periodontal structure and relationships are depicted in standard texts (Weiss & Scheid; Woelfel's Dental Anatomy; Jones & Bartlett references) and are used to inform clinical practice.

  • Anatomical relationships: cementum, PDL, alveolar bone, JE, sulcus, MGJ, gingival margin, and FGMBP (free gingival margin and base of pocket) concepts.

Connections to Foundational Principles

  • The health of the periodontium depends on a stable balance among:

    • Structural integrity (bone height, PDL integrity, cementum surface)

    • Gingival health (color, contour, texture, and absence of inflammation)

    • Proper self-care and professional maintenance to minimize inflammation and progression of recession or LOA.

  • Understanding the standard descriptors allows reliable communication of periodontal status, guiding treatment planning and prognostic assessment.

Practical Implications for Exam Preparation

  • Be able to define key terms and describe normal gingival characteristics, including color, contour, texture, and consistency.

  • Be able to identify signs of disease: redness, edema, loss of stippling, enlarged papilla, recession, bleeding on probing, and exudate.

  • Remember the critical numerical references for health and disease: 1-2 { mm} (bone crest from CEJ in health), 2 { mm} (crest apical shift in bone loss), {pocket depth}\le4{ mm} , and $$< 10 % bleeding on probing.

  • Practice describing gingiva using the periodontal descriptor worksheet to ensure consistent communication with instructors.

Conclusion

  • The periodontium comprises gingival tissues and the attachment apparatus, each with specific landmarks and functional roles.

  • A thorough clinical assessment hinges on recognizing normal versus diseased characteristics across color, size, shape, contour, texture, and position, as well as understanding the underlying anatomy and how surgical changes may alter gingival and attachment relationships.

  • Patient education and consistent self-care are essential for maintaining periodontal health and preventing progression of recession and LOA.