IntroToPerio - Midterm01

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  1. periodentium
    • A functional system of different tissues, investing and supporting the teeth, including cementum, periodontal ligament, alveolar bone, and gingiva.
    • Anatomically, the term is restricted to the connective tissue interposed between the teeth and their bony sockets. Called also Pefiosteum alveolare
  2. periodental disease
    any inflammation in the component of periodentium: cementum, PDL, alveolar bone, gingiva
  3. periodontology
    the study of the periodontal diseases.
  4. alveolar bone proper = ________ = __________
    • cribriform plate
    • lamina dura (usually used when discussing radiographs)
  5. Oral Mucosa
    • masticatory mucosa: gingiva, covers the hard palate
    • specialized mucosa: covers the tongue
    • lining mucosa: covers everything else; buccal mucosa, alveolar mucosa, lingual mucosa
  6. Functions of the Periodontium
    • formative – embryonic cell differentiation
    • attaches the tooth to the bony tissue of the jaw
    • maintains the integrity of the surface of the masticatory mucosa
    • provides nutrients
    • provides proprioception
  7. Gingiva is Demarcated by the tissue scalloped area (_________) and the apical end is denoted by _______, which separates gingiva from _______.
    • free gingival margin
    • mucogingival junction
    • alveolar mucosa
  8. Parts of the Gingiva
    • Free gingiva: Buccal & lingual/palatal aspects and the interdental papillae; Coral pink, Dull surface, Firm
    • Attached gingiva
  9. Free Ginigval Margin is at the junction between the ________ and the ________.
    • oral epithelium
    • oral sulcular epithelium
  10. Interdental Papilla Shape determined by
    • contact relationship of teeth
    • Width of interproximal teeth surfaces
    • Course of the cementoenamel junction
    • Anterior region – pyramidal
    • Molar region – more flattened in buccolingual direction
  11. Col: in _______ regions a concavity formed by ________, which conforms to outline of interdental contact ______, and is covered by __________.
    Posterior teeth have contact ______ rather contact points.
    • premolar and molar
    • interdental papilla
    • surfaces
    • thin non-keratinized epithelium
    • surfaces
  12. Attached Gingiva is demarcated in a coronal direction by ________ or _______, and demarcated in an apical direction by ________ where it becomes continuous with ________.
    • free gingival groove
    • horizontal plane placed at level of junctional epithelium
    • mucogingival junction
    • alveolar mucosa
  13. Attached Gingiva: texture, color, surface, attachment
    • Firm texture
    • Coral pink
    • Fine surface stippling – appearance of orange
    • peel (40% of adults)
    • Firmly attached to alveolar bone and cementum by connective tissue fibers; Comparatively immobile
  14. In gingiva there is no elastic tissue
    only elastic fibers in the gingiva are in the blood vessels that supply nutrients to the gingiva
  15. Alveolar Mucosa: color, border, attachment
    • Darker red
    • Located apical to mucogingival junction
    • Loosely bound to underlying bone - mobile, rich in elastic tissue
  16. Gingival Width
    • width of attached gingiva and free gingiva
    • varies by tooth, patient (genetics)
  17. How Gingival Width varies by tooth
    • maxillary buccal: incisors – widest; premolars – narrowest (due to attachment of frenum/muscle)
    • mandibular lingual: incisors – narrowest; molars - widest
  18. With Aging, Width of attached gingiva ______, mucogingval junction _______ relative to lower border of mandible, and teeth as a result of occlusal wear may ______ throughout life.
    • increases
    • remains stable
    • slowly erupt
  19. Gingiva consists of following tissue
    • Oral epithelium
    • Dentogingival epithelium: Junctional epithelium and Oral sulcular epithelium
    • Connective tissue in between
  20. Boundary between oral epithelium and connective tissue is a ________, separating ____________.
    • Wavy course
    • Connective tissue portion – connective tissue papillae
    • Epithelial ridges – rete pegs
  21. In Normal, non-inflammed gingiva, Rete pegs and connective tissue papilla are missing in ______ epithelium.
    dentogingival
  22. Oral Epithelium is made of Keratinized, stratified,
    • squamous epithelium, consisting of following layers
    • Basal layer (stratum basale or stratum germinativum)
    • Spinous cell layer (stratum spinosum)
    • Granular cell layer (stratum granulosum)
    • Keratinzed cell layer (stratum corneum)
  23. Outer Cell Layer has no
    • Cell nuclei
    • orthokeratinized (lacking) or parakeratinized (Remnants of nuclei)
    • no good for DNA swab
  24. Cell populations of Outer Cell Layer:
    • Keratin producing cells – 90%
    • Non-keratin producing cells – no stellate/cytoplasmic extensions:
    • Melanocytes – pigment synthesizing (gum may be dark)
    • Langerhans cells – defense mechanism; React with antigens penetrating the epithelium
    • Non-specific cells
  25. Basal Layer Cells are in contact with ________, _______ shaped, undergo ________, by which ________.
    • basement membrane
    • cylindric or cuboid
    • mitotic cell division
    • the epithelium is renewed
  26. Epithelium Renewal: ________ push ______ into ________ cell layer as a ________. Becomes ________ with its long axis parallel to the epithelial surface. Becomes ________ from stratum corneium.
    Takes 1 month for keratincoyte to reach outer epithelium surface
    Equilibrium normally exits between cell renewal and desquamation
    • 2 daughter cells
    • older basel cell
    • spinous
    • keratinocyte
    • flattened
    • desquamated
  27. Basement membrane is probably produced by _______, has positive reaction to ________, indicating presence of ________, consists of epithelial cells surrounded by ________.
    • basal cells
    • PAS (periodic acid Schiff stain)
    • carbohydrates (glycoproteins)
    • extracellular substance (containing protein-polysacharide complexes)
  28. epithelium is attached to basement membrane via _____.
    • Hemidesmosomes (HD) –
    • electron-dense, thicker zones in cell membrane of
    • epithelial cells facing the lamina lucida
  29. basement membrane contains two layers:
    • Lamina lucida (LL) - electron-lucent zone
    • Lamina densa (LD) – elecrtron dense zone
  30. ________ project from lamina _____ into connective tissue
    • Anchoring fibers (AF)
    • densa
  31. ________ is also found in basement membrane and converge towards the hemidesmosomes.
    Cytoplasmic tonofilaments (CT)
  32. Adhesion between Epithelial Cells is resulted from _________, which is less in the _____, and more in the ________.
    • desmosomes
    • sulcular epithelium
    • oral mucosae
  33. One Desmosome consists of ________ and __________.
    • 2 adjoining hemidesmosomes
    • a separating zone of electron dense granulated material (GM)
  34. Hemidesmosome components
    • Outer leaflets (OL)
    • Thick inner leaflets (IL)
    • Attachment plaques (AP) – granular and fibrillar
    • material in cytoplasm
  35. Melanocytes Produce ________.
    pigment - melanin
  36. Stratum Spinosum - histology
    • 10-20 layers of polyhedral cells
    • Have short cytoplasmic processes resembling spines
    • Attached to one another by desmosomes which are located between cytoplasmic processes of adjacent cells
  37. Stratum Granulosum & Stratum Corneum
    • abrupt transition
    • indicative of keratinization of cytoplasm in keratinocyte and conversion into “acellular” structure
    • Straum Corneium cytoplasm: Keratin; Apparatus for protein synthesis and energy production (nucleus,
    • mitochondria, ER and golgi complex) are lost; Contain remnents of nuclei
  38. Keratinization is a Process of _________ rather than _______.
    • differentiation
    • degeneration
  39. Keratinocytes are formed by _______, _________ divide, and maintains capacity to _________.
    In ______ layer – cell lost its energy and protein producing apparatus (by _______). Converted to keratin filled cell which via the stratum corneum is shed from the tissue surface.
    • basel cells in basement membrane
    • can no longer
    • produce protein (tonofilaments and keratohyalin granules)
    • granular
    • enzymatic breakdown
  40. Alveolar Mucosa Contains no stratum corneum
    True
  41. Cells with nuclei can be identified in ______ of Alveolar Mucosa.
    all layers
  42. Dentogingival Epithelium contains
    • Junctional epithelium
    • Oral sulcular epithelium
  43. Junctional Epithelium
    • One basal cell layer
    • Several suprabasal layers
  44. Junctional epithelium vs oral epithelium: size, intercellular space, desmosomes
    • larger
    • wider
    • fewer
  45. Oral Sulcular Epithelium
    • Cuboid
    • Surface is not keratinized but can be; won't be asked in the exams
  46. Connective Tissue Components
    • collagen fibers (60%)
    • fibroblasts (5%) - make collagen fibers
    • vessels, nerves and matrix (35%)
  47. Cells in connective tissue
    • fibroblasts
    • immunocells: Mast cells, Macrophages, Neutrophilic granulocytes, Lymphocytes, Plasma cells
  48. Fibroblast
    • Most predominant (65%)
    • Involved in synthesis of connective tissues matrix
  49. Fibers
    Found in _______ tissue
    Produced by ________
    Fiber types
    • connective
    • fibroblasts
    • Collagen fibers: everywhere
    • Reticulin fibers: around lining blood vessel
    • Oxytalan fibers: produced by cemotoblast in cementum
    • Elastic fibers: lining blood vessel; any mucosa that needs to be stretched
  50. Collagen Fibers
    • Predominate in the gingival connective tissue
    • Most essential component of the periodontium
    • Made by fibroblast, cementoblasts and osteoblasts
    • Consists of collagen molecules – tropocollagen
  51. Tropocollagen Consists of ___________
    3 polypeptide chains intertwined into a helix
  52. Synthesis of collagen fiber
    • Tropocollagen synthesized inside fibroblasts and secreted into extracellular space
    • Polymerization and aggregation:
    • longitudinally into protofibrils
    • Laterally into collagen fibrils
    • Bundled into collagen fibers
  53. Reticulin Fibers are Numerous in
    • tissue adjacent to basement membrane
    • loose connective tissue surrounding the blood vessels
  54. Oxytalan Fibers are present in _________. Orientation, composition, function.
    • Gingiva and Periodontal ligament
    • Parallels long axis of the tooth
    • Composed of long thin fibrils
    • Function is unknown
  55. Elastin Fibers - distribution
    • Present in connective tissue of
    • - Gingiva (only with blood vessels)
    • - Periodontal ligament (only with blood vessels)
    • - Alveolar mucosa
    • Not present coronal to mucogingival junction
  56. Major groups of Collagen Fibers in gingival connective tissue
    • circular fibers
    • dentogingival fibers
    • dentoperiosteal fibers
    • transeptal Fibers
    • All of these fibers form a weave that gives the gingiva its shape and holds it against the tooth surface
  57. circular fibers
    • in free gingiva
    • encircle the tooth
  58. dentogingival fibers
    • embedded in cementum of supra-alveolar portion of the root
    • project from cementum in fan-like configuration out into the free gingival tissue of the facial, lingual, and interproximal surfaces
  59. dentoperiosteal fibers
    • embedded in cementum (same as dentogingival fibers)
    • fan apically over vestibular and lingual bone crest
    • terminate in attached gingiva
    • free gingival groove – epithelium lacks support by underlying oriented collagen fiber bundles between the free and attached gingiva
  60. Attached gingiva is attached _______ to ________ by _________.
    • mechanically
    • the tooth surface and the periosteum
    • collagen fibers
  61. transeptal Fibers
    • extend between supraalveolar cementum of approximating teeth
    • run straight across
    • embedded in cementum of adjacent teeth
    • aka Interradicular fibers
  62. collagen fibers vs PDL
    • fibers go over the crest
    • PDL go into the bone
  63. Interdental Papilla
    • Reinforced by four groups of collagen fiber bundles
    • Provide resilience and tone for
    • - Maintaining architectural form
    • - Integrity of the dentogingival attachment
  64. Connective Tissue Matrix
    • Medium in which connective tissue cells are embedded
    • Essential for maintenance of normal function of connective tissue
    • - Transportation of water, electrolytes, nutrients, metabolites produced by fibroblasts
    • - Some constituents produced by: mast cells; Blood
  65. Epithelial Differentiation
    • specificity of gingival epithelium is determined by genetic factors inherent in the connective tissue
    • differentiates into keratinized epithelium due to stimuli from newly formed gingival connective tissue (gingival transplant)
    • characteristics are genetically determined rather than being the result of functional adaptation to environmental stimuli
    • newly formed gingival connective tissue posses the ability to induce changes in the differentiation of the epithelium originating from the alveolar mucosa
    • Epithelium - normally nonkeratinized
  66. Periodontal Ligament - functions, histology, shape
    • distributes and resorbs forces - elicited during masticatory function into the alveolar process
    • joins root cementum with lamina dura or alveolar bone proper
    • soft, richly vascular and cellular connective tissue with nerves
    • space has an hourglass appearance, narrowest at mid-root level, width - .25mm + 50%
  67. Alveolar Bone
    • surrounds tooth
    • starts approximately 1-2mm apical to CEJ
    • alveolar crest - coronal boarder of the bone
  68. Biological width
    • Distance between junctional epithelium and alveolar crest
    • Constant (~2mm) and self-corrected
  69. 2 types of bone in Alveolar Bone
    • Compact bone (lamina dura) – bone which covers alveolus
    • trabecular (medulary) bone – alveolar process which looks like meshwork
  70. Collagen fibers join alveolar bone proper and root cementum:
    • alveolar crest fibers
    • horizontal fibers
    • oblique fibers
    • apical fibers
    • All are Sharpey’s fibers
  71. Fibers of Periodontal Ligament
    • Run continuously from tooth to alveolar bone proper
    • Bundles are slightly wavy – allows tooth to move in its socket (physiologic mobility) despite inelastic nature of collagen
    • Also contains a few elastic fibers associated with blood vessels (oxytalan fibers)
  72. Cells of Periodontal Ligament
    • epithelial cells - remnants of Hertwig's root sheath
    • nerve cells - proprioception
    • cementobalsts - cementum
    • fibroblasts - collagen
    • osteoblasts - bone
    • osteoclasts
  73. Rests of Mallassez
    • small clusters of epithelial cells in periodontal ligament
    • remnants of the epithelial sheath of Hertwig
    • function is unknown
  74. Root Cementum
    • specialized mineralized tissue covering root surfaces and occasionally small portions of the crown of teeth
    • contains no blood, lymph vessels, innervation
    • does not undergo physiologic resorption or remodeling
  75. Root sensitivity because of __________.
    dentinal tubules in the cementum
  76. Types of Cementum
    • primary cementum or acellular cementum
    • secondary cementum or cellular cementum
  77. primary cementum or acellular cementum - forming
    • contains no cells
    • forms in conjunction with root formation and tooth eruption
    • produced by cementoblasts
  78. secondary cementum or cellular cementum - forming
    • contains cells
    • forms after tooth eruption and in response to functional demands
    • laid down on top of primary cementum
    • only found on intra-aveolar part of the root - from the crest of the bone to the apex of the root
    • cementocytes – cells incorporated in the cementum
    • produced by cementoblasts
  79. Cellular cementum ______ in thickness throughout life by _________, evidenced by _________.
    Cemetum is thicker in _______ (150-250 um thick) , thinner by ________ (20-50 um thick).
    ______ cementum is more mineralized than ______ cementum
    • increases
    • deposition of new layers
    • incremental lines
    • apical portion of root
    • cervical portion
    • Acellular
    • cellular
  80. Cementocytes reside in ______ in cellular cementum, communicate with each other through a network of cytoplasmic processes running in ______ in cementum and with _______ through cytoplasmic processes.

    Allows for _________ through cementum.

    Contributes to ________.
    • lacunae
    • canaliculi
    • cementoblasts on the surface 
    • the transportation of nutrients
    • the maintenance of the vitality of this mineralized tissue
  81. Fiber Systems
    • extrinsic system
    • intrinsic fiber system
  82. extrinsic system
    • In the cementum, Sharpey’s Fibers are the direct continuation of the collagen fibers in the periodontal ligament and in supra-alveolar cementum they are the direct continuation of the connective tissue.
    • perpendicular to the root surface
    • produced by fibroblasts in the periodontal ligament and supra-alveolar connective tissue
  83. intrinsic fiber system
    • produced by cementoblasts
    • composed of fibers oriented parallel to long axis of the root
    • oxytalan fibers
  84. Major portion of acellular cementum is ________, which is found in the ______ and embedded in root acellular cementum and _______. Start close to ________.
    • mineralized Sharpey’s fiber bundles
    • periodontal ligament
    • alveolar bone
    • cementodentin junction
  85. Fibers embed into bone and cementum. As the _______ becomes collagen fibers, they start attaching and building their way across. Eventually become continuous and look ______ in nature (shock absorber for teeth)
    • tropocollagen
    • wavy
  86. Alveolar process is part of ______ that ________ the sockets of the teeth. It's main function is to ___________ generated from __________.
    • maxilla and mandible
    • form and support
    • distribute and resorb forces
    • mastication and other tooth contacts
  87. Alveolar Process
    • compact bone – 2 types
    • - sockets lined with bundle bone, with bundles of collagen fibers embedded
    • - buccal and lingual aspects of the alveolar process lined with cortical bone
    • between sockets is cancellous bone, contains bone trabeculae
    • thickness of bone varies from one region to another
  88. Bone Defects occur when tooth _________.
    They are more frequent over ______ than _______ teeth.
    Defects often only covered by ________.
    • is displaced out of the arch
    • anterior
    • posterior
    • periodontal ligament and the overlying gingiva
  89. Types of Bone Defects
    • dehiscence – buccal bone missing at the coronal portion of roots (cleft)
    • fenestration – bone is present in the most coronal but missing further down the root, forming a window.
  90. Volkmann’s canals - passage way through which ________ pass from ________ to _______.
    • blood vessels, lymphatics and nerve fibers
    • alveolar bone
    • the periodontal ligament
  91. Alveolar bone proper is made of _______ and has many features in common with _______.
    • Bundle Bone
    • cementum
  92. Bone Formation:
    sites on outer surface of bone is lined with _________ and covered by ______ which contains ________.
    Marrow spaces inside bone is lined with ______.
    • non-mineralized tissue – osteoid
    • periosteum
    • collagen fibers and osteoblasts
    • endosteum
  93. Osteoclasts are responsible for resorption of ______ tissue (_________) and resorption of ________, which produces _______ – _______, and they are mobile and capable of ___________.
    • mineralized
    • bone, dentin, cementum
    • organic tissue
    • lacunar pits
    • Howship’s lacunae
    • migrating over the bone surface
  94. Canalicular-Lacunar System:
    essential for _______ - _______
    canaliculi (CAN) allow for _________
    lacunae: ______ reside in.
    • cell metabolism
    • diffusion of nutrients and waste products
    • communication between osteocytes in mineralized bone and osteoblasts on the bone surface
    • osteocytes
  95. Blood Supply to Teeth and Periodontal Tissues
    superior or inferior alveolar artery (a.a.i.) -> dental artery (a.d.) -> intraseptal artery (a.I.) -> rami perforantes (rr.p.)
  96. Blood supply of Free Gingiva
    vessels originating from periodontal ligament pass through alveolar bone crest
  97. gingiva receives blood supply through supraperiosteal blood vessels which are terminal branches of :
    • a.s. = sublingual artery
    • a.m. = mental artery
    • a.b. = buccal artery
    • a.f. = facial artery
    • a.p. = greater palatine artery
    • a.I. = infra orbital artery
    • a.ap. = posterior superior detnal artery
  98. Blood Supply to Oral Epithelium
    supraperiosteal blood vessels branches to subepithelial plexus located immediately beneath the oral epithelium of the free and attached gingiva

    plexus yields thin capillary loop to connective tissue papillae projecting into the oral epithelium
  99. Blood Supply to Dentogingival Epithelium
    supraperiosteal blood vessels

    anastomose with blood vessels from the periodontal ligament and bone

    beneath junctional epithelium is the dentogingival plexus - mainly venules, in healthy gingiva, no capillary loops occur in the dentogingval plexus (no rete pegs)
  100. Extravascular Circulation
    nutrients and other substances carried to cells by _________.
    metabolic waste removed from the tissue through _________.
    • hydraulic pressure
    • osmotic pressure
  101. Lymph is absorbed from ________, into lymph ________, larger lymph vessels, lymph ____, filtered and supplied with _________, then enters blood stream
    • tissue fluid
    • capillaries
    • nodes
    • lymphocytes
  102. Gingivocravicular Fluid is _______ that passes through the _______ into _________.
    • lymphatic fluid
    • junctional epithelium
    • the gingival sulcus
  103. Lymph Nodes
    • submental lymph nodes
    • deep cervical lymph nodes
    • submandibular lymph nodes
    • jugulodigastric lymph node
  104. submental lymph nodes
    • mandibular incisors
    • labial and lingual gingiva of the mandibular incisor region
  105. jugulodigastric lymph node
    third molars
  106. deep cervical lymph nodes
    palatal gingiva of the maxilla
  107. submandibular lymph nodes
    • buccal gingiva of the maxilla and buccal and lingual gingiva in mandibular posterior region
    • all remaining teeth and adjacent periodontal tissue
  108. Nerves of the Periodontium
    • periodontium contains receptors, autonomic nervous system, pain, touch, pressure
    • periodontal ligament only contain proprioceptors - movements and positions
  109. Nerve Innervation of Buccal Gingiva
    • max ant. - infraorbitalis
    • max post. - rr. alveolar superior posterior
    • man ant. - mentalis
    • man post. - buccalis
  110. Nerve Innervation of Palate
    n. palatinus major
  111. Nerve Innervation of Mandibular Lingual Gingiva
    n. sublingualis

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IntroToPerio - Midterm01
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2016-05-10 20:47:19
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