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Perio Midterm
| Question | Answer |
|---|---|
| Normal: Retrocuspid Papilla Gingival fibrous Nodules at MGJ | slightly raised sessile nodule lingual to the Mand. cuspid |
| PDL or "Double Periosteum" (creates/resorbs both cementum & bone) | soft CT between bone & tooth .4- 1.5mm space (4) Functions: SUPPORTIVE- suspends & maintains tooth in socket SENSORY- Pressure & Pain NUTRITIVE- nutrients to Cementum & Bone RESORPTIVE- 'remodel' the alveolar bone in response to pressure (Ortho) |
| Periodontium: | Gingiva, PDL, Cementum, Alveolar Bone |
| Gingiva: | Covers alveolar processes of jaw, cervical portions of teeth (4)Anatomical Areas: Free G., Gingival Sulcus, Interdental G., Attached G. |
| Interdental G. | 1 facial/1 lingual papilla- prevents food from getting stuck |
| Gingival Sulcus | Healthy: 1-3mm |
| Cementum (16-60microns) OMG Overlap 60%, Meet Margin 30%,Gap 10% 45-50% Organic + h20, 45-50% Inorganic | mesechimal CT 45-50% Inorganic *more resistant to resorption than bone(good for Ortho, root remains) Anchors PDL fibers to tooth (Sharpey's) Protects Dentin (seals Tubules), Compensates for occlusal attrition (forms at apical area of root |
| Alveolar Bone or Process | upper & lower jaw. surrounds & supports roots of teeth. Forms the Alveoli (sockets) NO teeth NO Alveolar Process |
| Cortical Bone: | Compact, outside wall, max. &mand. Thicker in molar regions, NOT seen radiographically |
| Alveolar Crest | Healthy: 1-2mm below CEJ, follow contours of CEJ |
| Cancellous Bone (Spongy) | Interior, between cribiform plate(alv. bone proper) and the Cortical bone |
| Alveolar Bone Proper OR Cribiform Plate OR Lamina Dura | thin, lines the socket aka Lamina Dura (radiographically) |
| Gingiva Innervation | MAX: Superior Alvolar, Infraorbital, greater Palantine, Nasopalantine Nerves MAND: Mental, Buccal, Subligual Nerves |
| PDL & Teeth Innervation | MAX: Superior Alveolar Nerves (Anterior, Middle, Posterior) MAND: Inferior Alveolar Nerve |
| Periodontium Vascular Supply (gingiva,PDL, Alveolar Bone) | MAX: Anterior & Posterior Alveolar Arteries, Infraorbital, Greater Palantine Artery MAND:Inferior Alveolar Artery- buccal,facial,mental,sublingual Arteries |
| Teeth & Periodontal Tissues Blood Supply | MAX: Superior Alveolar arteries MAND: Inferior Alveolar artery |
| Submandibular Lymph Nodes | drains MOST of the periodontal tissues |
| Deep Cervical Lymph nodes | Drains Palatal Gingiva of Maxilla |
| Submental Lymph Nodes | Drains gingiva in Mand. Incisors |
| Jugodigastric node | Drains gingiva in 3rd Molar area |
| Basal Lamina | separates epithelium sheets from underlying CT (thin, tough sheet) |
| Keratinized Epi cells | No Nuclei, tough |
| Non-keratinized Epi cells | Nuclei, soft/flexible cushion, *Epi. tissues receive blood supply from CT |
| Desmosomes | specialized cell junction-connects neighboring epi cells |
| Hemidesmosomes | cell junction connecting epi cells to basal lamina |
| Periapical Cemental Dysplasia (NOT true Cementoma) PULP test for vitality to avoid unecessary RCT | 1. Osteolitic-bone loss, replaced by ,appears as PA lesion 2. Cementoblastic-excessive cementoblastic activity, specule deposits(like matrix) 3. Mature- Excessive irregular cementum deposited Xray- well defined radiopacity w/ radiolucent border |
| Bundle bone | Alveolar bone proper w/ Sharpey's fibers inserted |
| Interdental Septum | indicator of bone health Perio Health: distance between CEJ & Interdental Septum (radiographically) .96mm->1.22mm (avg of 1.5mm) *Mand. Anterior 1.88->2.81mm Center is 'spongy' Trabeculae |
| Gingival Pocket (Pseudopocket) | deepening of sulcus-solely from gingival enlargement(tissue swelling or increased collagen fibers in CT). JE remains coronal to CEJ, No PDL destruction |
| Periodontal Pocket | Pathologic deepening of sulcus Suprabony-Horizontal bone loss Infrabony- Vertical bone loss (uneven) PDL & bone destroyed |
| Fenestrations | 'window' bone denuded over root NOT including the marginal bone |
| Dehiscence | bone denuded over root INCLUDING the marginal bone |
| Wolf's Law | bone will adapt to load placed |
| Mobility | Grade 1: up to 1mm Grade 2: more than 1mm grade 3: F,L,M,D horizontal & vertical displacement |
| Inactive/ Active Lesion or Periodontitis | Inactive: little or no bleeding, minimal fluid and bacterial flora Active: More bleeding, Large amounts of fluids/exudates and bacteria |
| Biofilm Marginal: Facultative | (4)Phases 1.adheres to glycoprotein pellicle 2. Initial colonization within 2dys w/ gram+ 3. Secondary Colonization- slime layer produced, bacteria multiply 4. Mature biofilm-Pedunculated,gram -,anaerobes *Must mature to cause perio damange |
| Epithelium attached biofilm | *most detrimental, bacteria invades g.,CT,bone surface |
| Biofilm Levels Distance from bone:Never<.5mm or>2.7mm less than 3mm is bone destruction | Healthy: 100-1000, 75%-80% gram+, non-motile, mostly Cocci Gingivitis: 1,000-100,000, Equal gram-& gram+ Periodontitis:100,000-100,000,000 more Gram- anaerobes,motile,asaccralytic small % are perio pathogens |
| Endotoxins | harmful proteins Gram - have Lipopolysaccharides (cell walls) |
| Etiology of Gingivitis & Periodontitis | Tooth Anatomy, Nutrition, Malocclusion, Medication i.e. Dilatin, Hormones/birthControl, xerostomia, Faulty dentistry, Disease i.e. diabetes, HIV |
| 1st changes/clinical signs of Gingivitis | 1st- increase in crevicular fluid MOST DETECTABLE- Bleeding |
| PDL cells | CT cells, Fibroblasts(collagen), Osteoblasts, osteoclasts, Cementoblasts -Epi Rest cells (Malassez)remnants of Hertwig's root sheath -Defense cells -Neurovascular Cells |
| 6 Principal fibers | *Apical:fully formed tooth resists vert.force*Interradicular:multirootvertical/lateral*Horizontal: 10-15% of coronal root *Oblique: 2/3 of fibers,80-85% of root *Transseptal:1st affected by disease/inflammation, under col*Alveolar Crest:counterbalance |
| Fremetus | Vibrations when occluding +slight ++barely visible +++clearly visible |
| Periodontal Disease Bacteria | AA:parent->child,aggressive perio (25%chronic) *Fusobacterium nucleatum: early stage gingivitis, subg plaque in perio w/ severe attach loss *Porphyromonas g-grows in JE, perio, destroy bone *Bacteroides forsythus-subg plaque,Deep pockets, aggressive pe |
| PMN (Neutrophils) | Acute, Anaerobic glycolysis=acidity leaves axial stream->pavementing Lysosomes- can kill/digest bacteria after phagocytosis |
| Hyperemia | 10X more blood increased permeability |
| Edema fluid (Exudate BEFORE Cellular Phase) | Leukocytes & Plasma proteins leak from capillaries into tissue at injury/infection site, Activates Lymphatic system, Dilutes toxins |
| Macrophages (in tissue) Monocytes (in blood) | not as many but live longer, no memory phagocytosis |
| B cells->plama cells->Antibodies | Antibodies:Neutralize bacteria, Coat bacteria for easier phagocytosis, Activate complement system |
| Cytokines (Produced by various cells) | powerful protein mediators: recruits cells, increase permeability, can cause tissue destruction in chronic cases |
| Prostaglandins (mainly PMNs and Macrophages produce) | powerful inflammatory mediators, trigger osteoclast activity-> Destroys Bone, Promotes overproduction of MMP |
| MMP (Matrix Metalloproteinases) produced by various cells | 12+ enzymes, collagen destruction |
| Complement System | proteins that facilitate phagocytosis, and puncture cell membranes |
| Gram + | Thick Single Cell Wall, Purple |
| Gram - | Double cell Wall, doesn't stain purple |
| Biofilm formation | 1. Initial Colonization, 2dys mainly Gram+ 2. Secondary Colonization: Slime layer (protects, adheres), bacteria multiplies 3. Mature- complex mushroom microcolonies, extremely resistant antibiotics/microbials- Mechanical Removal! |
| Exotoxins | harmful proteins i.e. leukotoxins (AA), hydrogen sulfide, ammonia |
| Furcation Class | I: curvature felt w/probe, penetrates<1mm II: penetrates, but not completely through, III: Completely through IV: same as III but visible because of recession |
| Oxytalin and Eulanin | immature elastin, parallel to root surface, regulates vascular flow |
| COL: | depression just apical to contact area- VERY susceptible to infection |
| Epi Cells | (rests of Malasssez) PDL latticework, diminish w/ age, close to cementum side of PDL,remneants of Hertwig's root sheath, cluster or interlacing strands, more in apical and cervical area |
| Primary, Acellular Cementum | more in coronal half of root, mostly calcified Sharpeys fibers |
| Secondary, Cellular Cementum | More apical root portion, Increases w/ age in apical and furcations |
| Physiologic Mesial Migration | age 40, 5mm loss in Q length from 3rd Molar to midline |
| Vascular Proliferation | capillaries from Endothelia cells (BV) feed/bring fibroblasts, fragile, Granulation tissue forming |
| Fibroblastic Proliferation | 'Star' shaped then elongates, creates collagen, Granulation tissue forms |
| Dark Field Microscopy | detects basic type and mobility-NOT specific or exact amount |
| Calculus | Ca, Phosphorus, carbonate, Sodium, Magnesium, Potassium...S |
| Saccrolytic Asaccrolytic | loves Carbs= caries loves proteins (more dangerous by products) |
| Unattached Plaque | Gram -, free floating, susceptible to Phag. |
| Tooth attached plaque | gingival margin almost to JE, Gram+, Caries |
| Virulence | Colonize, Invade, Damage |
| Vasodilation | 2nd, Kinin System, caused by histamines from Mast cells (basophils)---fragile |
| ARESTIN |
Created by:
michelleleigh33
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