Chapter 2 Perio
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| ______________ is the tissues that surround support, and attach to the teeth | Periodontium
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| Structures of the periodontium | Gingiva,Periodontal Ligament,Cementum,Alveolar bone
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| Visible component of periodontium inside the mouth. Described as coral pink, pink, pale pink and pigmented (darker when melanin pigmentation is present | Gingiva
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| Between the mucogingival junction and attached gingivaContains frenum and muscle attachmentsKeratinizedStippled or non-stippled | Gingiva
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| surrounds the tooth and creates a cuff or collar extending coronally about 1.5mm; MOST commonly in the mandibular anterior and bicuspid area | Free gingiva
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| slight depression on the gingiva corresponding to the depth of the sulcus | Free Gingival groove
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| gingiva that fills the embrasure | Papillae
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| proximal surfaces created below the contact area of teeth (aka.interdental gingiva) | Embrasures
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| slight depression of tissue between the buccal and lingual interdental papillae | Col
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| thin, flat plate that joins the gingival epithelium and underlying connective tissue. | Basal Lamina
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| ridges of epithelium that serve a connection between the free and attached gingiva and the underlying connective tissue | Rete pegs
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| makes up the surface tissue of the oral cavity | Stratified squamous epithelium
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| Keratinocytes, Langerhans cells, Merkel cells and melanocytes also included in the | tissue of the oral cavity
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| -when keratinocytes migrate from the basal layer to the surface. The cells become increasingly flattened, develop granules in the subsurface, and produce a superficial layer that is similar to skin where no cell nuclei are present | Keratinization
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| ___________are part of the phagocytic system (ingest or engulf micro-organisms, cells, or other substances by other cells | Langerhan cells
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| __________contain nerve endings and are associated with tactile sensitivity. | Merkel cells
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| ______________phagocytized and remains in the epithelium and gives the appearance of pigmentation to the epithelium | Melanin
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| extends from the free gingival groove to the mucogingival junction; It is attached to the bone by collagen fibers | Attached gingiva
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| Thin nonkeratinized or parakeritinizedFrom outer epithelium to gingival sulcusJunctional epithelium (forms the gingival wall of the sulcus); no rete pegs, permeable, gingival crevicular fluidHealthy; 1-3mm deep | Sulcular epithelium
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| __________ is believed to perform several functions: cleansing the sulcus, improving the epithelial cells adherence to the tooth surface, anti-microbial and immune properties. | Sulcular or Gingival Crevicular Fluid
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| Separates periodontal ligamentNonkeratinized, stratified squamous Protects attachment15 to 20 cells thickHealthy .25 to 1.35mmContinual renewingSupports free marginal gingivaConsidered the dentogingival unit | Junctional epithelium
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| 2 layers:Collagen fibrils & Fibroblasts | Lamina propria
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| form fiber bundles which make up 60% of the lamina propria | Collagen fibrils
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| undifferentiated mesenchymal cells, mast cells, macrophages, blood vessels, nerves are the other elements in CT | Fibroblasts
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| Gingival ligament=fiber bundles | -Protect, support, maintain tone
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| Five principal fiber groups: | Dentogingival, Alvelogingival, Dentoperiosteal, Circular, Transsepta
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| maintain relationship between teeth | Transsepta
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| support free gingiva | circular
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| anchor tooth to bone and protect PDL | dentoperiosteal
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| attach gingiva to bone | alvelogingival
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| support gingiva | Dentogingival
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| Cushion between the tooth and bone made up of CT, fiber bundles & cellsGenerate pericementum & periosteumCementicles form from calcified material in the PDL or from displaced bits of cementum or bone | Periodontal Ligament
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| Functions of Periodontal Lig. | tooth anchorage, Fibrous tissue development and maintenance, Calcified tissue development and maintenance, nutritive and metabolite transport, sensory functions (touch, pressure, pain, and proprioception(displacement sensitivity)
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| are made of collagen, and arranged in bundles with the other cellular, vascular, and nerve tissues | fibrous bundles
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| Attach tooth to bone, transmit occlusal forces to bone, resist occlusal forces, protect the vessels and nerves from injury | fibrous bundles
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| attached to the cementum as brush-like fibers | Sharpey’s fibers-
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| Movement throughout lifeWear of proximal and occlusal tooth surfaces1 cm in a lifetime | Physiologic Mesial Migration/Drift
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| Cover root surface, calcified, formed by cementoblastsAnchors teeth, maintains occlusal relationship, seals dentinal tubulesContains Sharpey’s fibersNo vascular or nerve connections so there is transmission of pain sensations5 types | perio. cementum
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| Support, extension of bone from body of mandible and maxilla, lines sockets of teethLamina dura- walls of socket when viewed on a radiographRadio-opaqueAlveoli-tooth sockets | Alveolar Process
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| Alveolar Process Components | 1. Alveolar bone2. Compact bone3. Trabecular & cancellous bone
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| Tooth socketsLined by cribriform plateThousands of poresSupplied with nerves and bloodEach root has its ownBone lining alveoli contain Sharpey’s fibers or “bundle bone” | Periodontium Alveoli
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| Cortical plates of the jawDepends on alignment of teethFollows contour of the rootHeight and thickness determined by alignment & angulation | Compact Bone
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| Between cortical plates & alveolar boneAKA-SpongiosumMore in the maxillaBlends without demarcation | Cancellous Bone
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| resorbed area; occurs in pt’s with labailly inclined roots | Dehiscences
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| opening or window in the bone covering the facial root surface or between two adjacent roots | Fenestrations
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| Superior alveolar arteries | maxilla
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| Inferior alveolar arteries | mandible
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| trigeminal | sensory
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| Clinical Conditions of Periodontal Tissue Characteristics | ColorTextureSizeShapeConsistencySulcus Depth
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| Gingiva; thinsConnective tissue; more dense & coarsePDL; thicker, irregular structureCementum; thicker 10xAlveolar Bone; less regular surfaceDecrease dexterity may affect care | Aging and the Healthy Periodontium
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| Signals inflammatory cells to areas of trauma or microbial influence | Chemotaxis
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| act of ingesting or engulfing micro-oraganisms, cells or other | Phagocytize
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| aka neutrophils, make up 70% of circulating leukocytes; have granules that are filled with enzymes that when released cause ts. destruction | Polymorphonuclear Leukocytes (PMN’s
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| important in mediating inflammatory response; permeability increase | Mast Cells-
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| scavenger, digest enzymes | Macrophages
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| react to cytokines, cause allergic reactions | Auxiliary Cells
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| Made up of protein, bacteriolysis (destruction of bacteria), promotion of immune response, mediates degranulation of mast cells | Complement
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| Communication that mediates disease & healing, resorption, can be cytotoxic when plaque bacteria antigens are present for long periods | Cytokines
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| Histamine, local or systemic, life threatening | Type I - Anaphylaxis
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| Break down of tissue or blood cells, product of AB reacting directly to AG | Type II – Cytotoxic
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| AG high, activates complement, local tissue damage | Type III – Immune complex
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| AG to T Lymphocytes, 2nd exposure increased | Type IV – Cell Mediated
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