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Chapter 2 Perio

______________ is the tissues that surround support, and attach to the teeth Periodontium
Structures of the periodontium Gingiva,Periodontal Ligament,Cementum,Alveolar bone
Visible component of periodontium inside the mouth. Described as coral pink, pink, pale pink and pigmented (darker when melanin pigmentation is present Gingiva
Between the mucogingival junction and attached gingivaContains frenum and muscle attachmentsKeratinizedStippled or non-stippled Gingiva
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
slight depression on the gingiva corresponding to the depth of the sulcus Free Gingival groove
gingiva that fills the embrasure Papillae
proximal surfaces created below the contact area of teeth (aka.interdental gingiva) Embrasures
slight depression of tissue between the buccal and lingual interdental papillae Col
thin, flat plate that joins the gingival epithelium and underlying connective tissue. Basal Lamina
ridges of epithelium that serve a connection between the free and attached gingiva and the underlying connective tissue Rete pegs
makes up the surface tissue of the oral cavity Stratified squamous epithelium
Keratinocytes, Langerhans cells, Merkel cells and melanocytes also included in the tissue of the oral cavity
-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
___________are part of the phagocytic system (ingest or engulf micro-organisms, cells, or other substances by other cells Langerhan cells
__________contain nerve endings and are associated with tactile sensitivity. Merkel cells
______________phagocytized and remains in the epithelium and gives the appearance of pigmentation to the epithelium Melanin
extends from the free gingival groove to the mucogingival junction; It is attached to the bone by collagen fibers Attached gingiva
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
__________ 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
Separates periodontal ligamentNonkeratinized, stratified squamous Protects attachment15 to 20 cells thickHealthy .25 to 1.35mmContinual renewingSupports free marginal gingivaConsidered the dentogingival unit Junctional epithelium
2 layers:Collagen fibrils & Fibroblasts Lamina propria
form fiber bundles which make up 60% of the lamina propria Collagen fibrils
undifferentiated mesenchymal cells, mast cells, macrophages, blood vessels, nerves are the other elements in CT Fibroblasts
Gingival ligament=fiber bundles -Protect, support, maintain tone
Five principal fiber groups: Dentogingival, Alvelogingival, Dentoperiosteal, Circular, Transsepta
maintain relationship between teeth Transsepta
support free gingiva circular
anchor tooth to bone and protect PDL dentoperiosteal
attach gingiva to bone alvelogingival
support gingiva Dentogingival
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
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)
are made of collagen, and arranged in bundles with the other cellular, vascular, and nerve tissues fibrous bundles
Attach tooth to bone, transmit occlusal forces to bone, resist occlusal forces, protect the vessels and nerves from injury fibrous bundles
attached to the cementum as brush-like fibers Sharpey’s fibers-
Movement throughout lifeWear of proximal and occlusal tooth surfaces1 cm in a lifetime Physiologic Mesial Migration/Drift
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
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
Alveolar Process Components 1. Alveolar bone2. Compact bone3. Trabecular & cancellous bone
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
Cortical plates of the jawDepends on alignment of teethFollows contour of the rootHeight and thickness determined by alignment & angulation Compact Bone
Between cortical plates & alveolar boneAKA-SpongiosumMore in the maxillaBlends without demarcation Cancellous Bone
resorbed area; occurs in pt’s with labailly inclined roots Dehiscences
opening or window in the bone covering the facial root surface or between two adjacent roots Fenestrations
Superior alveolar arteries maxilla
Inferior alveolar arteries mandible
trigeminal sensory
Clinical Conditions of Periodontal Tissue Characteristics ColorTextureSizeShapeConsistencySulcus Depth
Gingiva; thinsConnective tissue; more dense & coarsePDL; thicker, irregular structureCementum; thicker 10xAlveolar Bone; less regular surfaceDecrease dexterity may affect care Aging and the Healthy Periodontium
Signals inflammatory cells to areas of trauma or microbial influence Chemotaxis
act of ingesting or engulfing micro-oraganisms, cells or other Phagocytize
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
important in mediating inflammatory response; permeability increase Mast Cells-
scavenger, digest enzymes Macrophages
react to cytokines, cause allergic reactions Auxiliary Cells
Made up of protein, bacteriolysis (destruction of bacteria), promotion of immune response, mediates degranulation of mast cells Complement
Communication that mediates disease & healing, resorption, can be cytotoxic when plaque bacteria antigens are present for long periods Cytokines
Histamine, local or systemic, life threatening Type I - Anaphylaxis
Break down of tissue or blood cells, product of AB reacting directly to AG Type II – Cytotoxic
AG high, activates complement, local tissue damage Type III – Immune complex
AG to T Lymphocytes, 2nd exposure increased Type IV – Cell Mediated
Created by: TinaHygiene
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