Perio Midterm
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Normal: Retrocuspid Papilla Gingival fibrous Nodules at MGJ | show 🗑
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show | 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)
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show | Gingiva, PDL, Cementum, Alveolar Bone
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show | Covers alveolar processes of jaw, cervical portions of teeth (4)Anatomical Areas: Free G., Gingival Sulcus, Interdental G., Attached G.
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Interdental G. | show 🗑
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Gingival Sulcus | show 🗑
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Cementum (16-60microns) OMG Overlap 60%, Meet Margin 30%,Gap 10% 45-50% Organic + h20, 45-50% Inorganic | show 🗑
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show | upper & lower jaw. surrounds & supports roots of teeth. Forms the Alveoli (sockets) NO teeth NO Alveolar Process
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Cortical Bone: | show 🗑
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Alveolar Crest | show 🗑
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show | Interior, between cribiform plate(alv. bone proper) and the Cortical bone
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Alveolar Bone Proper OR Cribiform Plate OR Lamina Dura | show 🗑
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Gingiva Innervation | show 🗑
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show | MAX: Superior Alveolar Nerves (Anterior, Middle, Posterior) MAND: Inferior Alveolar Nerve
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Periodontium Vascular Supply (gingiva,PDL, Alveolar Bone) | show 🗑
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show | MAX: Superior Alveolar arteries
MAND: Inferior Alveolar artery
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show | drains MOST of the periodontal tissues
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show | Drains Palatal Gingiva of Maxilla
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show | Drains gingiva in Mand. Incisors
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show | Drains gingiva in 3rd Molar area
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show | separates epithelium sheets from underlying CT (thin, tough sheet)
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show | No Nuclei, tough
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show | Nuclei, soft/flexible cushion,
*Epi. tissues receive blood supply from CT
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show | specialized cell junction-connects neighboring epi cells
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show | cell junction connecting epi cells to basal lamina
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show | 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
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Bundle bone | show 🗑
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Interdental Septum | show 🗑
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show | deepening of sulcus-solely from gingival enlargement(tissue swelling or increased collagen fibers in CT). JE remains coronal to CEJ, No PDL destruction
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show | Pathologic deepening of sulcus
Suprabony-Horizontal bone loss
Infrabony- Vertical bone loss (uneven)
PDL & bone destroyed
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Fenestrations | show 🗑
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Dehiscence | show 🗑
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show | bone will adapt to load placed
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Mobility | show 🗑
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show | Inactive: little or no bleeding, minimal fluid and bacterial flora
Active: More bleeding, Large amounts of fluids/exudates and bacteria
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show | (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
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Epithelium attached biofilm | show 🗑
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show | 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
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Endotoxins | show 🗑
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show | Tooth Anatomy, Nutrition, Malocclusion, Medication i.e. Dilatin, Hormones/birthControl, xerostomia, Faulty dentistry, Disease i.e. diabetes, HIV
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1st changes/clinical signs of Gingivitis | show 🗑
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PDL cells | show 🗑
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6 Principal fibers | show 🗑
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show | Vibrations when occluding
+slight ++barely visible +++clearly visible
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show | 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
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show | Acute, Anaerobic glycolysis=acidity
leaves axial stream->pavementing
Lysosomes- can kill/digest bacteria after phagocytosis
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show | 10X more blood
increased permeability
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Edema fluid (Exudate BEFORE Cellular Phase) | show 🗑
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show | not as many but live longer, no memory
phagocytosis
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show | Antibodies:Neutralize bacteria, Coat bacteria for easier phagocytosis, Activate complement system
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show | powerful protein mediators: recruits cells, increase permeability, can cause tissue destruction in chronic cases
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Prostaglandins (mainly PMNs and Macrophages produce) | show 🗑
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show | 12+ enzymes, collagen destruction
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Complement System | show 🗑
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Gram + | show 🗑
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show | Double cell Wall, doesn't stain purple
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show | 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!
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Exotoxins | show 🗑
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show | 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
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show | immature elastin, parallel to root surface, regulates vascular flow
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COL: | show 🗑
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Epi Cells | show 🗑
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show | more in coronal half of root, mostly calcified Sharpeys fibers
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show | More apical root portion, Increases w/ age in apical and furcations
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show | age 40, 5mm loss in Q length from 3rd Molar to midline
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show | capillaries from Endothelia cells (BV) feed/bring fibroblasts, fragile, Granulation tissue forming
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Fibroblastic Proliferation | show 🗑
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Dark Field Microscopy | show 🗑
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Calculus | show 🗑
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show | loves Carbs= caries
loves proteins (more dangerous by products)
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Unattached Plaque | show 🗑
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show | gingival margin almost to JE, Gram+, Caries
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Virulence | show 🗑
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Vasodilation | show 🗑
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show |
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michelleleigh33
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