DHE119 Exam#1

  1. PERI-
  2. Odontos-
  3. Periodontium and purpose?
    • Tissues that surround the teeth Attaches them to the jaw bone.
    • Around tooth.
  4. **Tissues of the Periodontium:4
    • Gingiva
    • Cementum
    • Periodontal ligament
    • Alveolar bone
  5. **Gingiva and purpose:
    • Covers- cervical portion of the tooth and alveolar processes
    • Holds tissue against tooth during mastication
    • Composed of a thin outer layer of epithelium and an underlying core of connective tissue
  6. **Anatomical Areas of the Gingiva:4
    • 1.Free gingiva
    • 2.Gingival sulcus
    • 3.Interdental gingiva
    • 4.Attached gingiva
  7. Gingival Boundaries:
    Upper edge (coronal) is the ______.
    • Gingival margin
    • Image Upload 1
  8. Gingival Boundaries:
    Lower edge (apical) is the _____.
    • Alveolar mucosa
    • Image Upload 2
  9. Gingival Demarcations:
    Depression that separates free and attached gingiva is the ______
    • free gingival groove
    • Image Upload 3
  10. Gingival Demarcations:
    Boundary visible clinically where pink gingiva meets red alveolar mucosa is the ______
    • mucogingival junction
    • Image Upload 4
  11. Free Gingiva:
    • Located coronal to the CEJ
    • žSurrounds the tooth like a turtleneck
    • Fits snugly around the tooth but is not attached
    • Can be pulled away from the tooth with a probe
    • Forms soft tissue wall of gingival sulcus
    • Image Upload 5
  12. Free gingiva tissue meets tooth in a thin, rounded edge called _____
    the gingival margin
  13. žThe ______ follows the contours of the teeth, creating a wavy outline
    gingival margin
  14. Attached Gingiva is between?
    free gingiva and alveolar mucosa ATTACHED TO BONE!
  15. attached gingiva is widest in?
    Widest ------incisor and molar regions
  16. attached gingiva is narrowest in?
    Narrowest----- premolar regions
  17. Attached gingiva is not measured on?
    • Width not measured on palate because difficult to distinguish between palatal mucosa (no mucoging. junction)
    • Image Upload 6
  18. Attached gingiva color is?
    • Color is pale or coral pink
    • May be pigmented
    • More frequent in dark-skinned individuals
    • Color ranges from light brown to black
  19. Attached gingiva texture in health is?
    • stippled 
    • Connective fibers that attach gingival tissue to cementum and bone
    • Image Upload 7
  20. Functions of the attached gingiva?
    • žFunctions to allow gingival tissue to withstand mechanical forces created during chewing, speaking, and toothbrushing
    • Prevents free gingiva from being pulled away from tooth when tension is applied to alveolar mucosa
  21. Interdental Gingiva:
    • Part of gingiva that fills the area between two adjacent teeth apical to the contact area
    • Image Upload 8
  22. Interdental Gingiva consists of two interdental papillae called?
    • Facial
    • Lingual
  23. **The Col is ?
    • a valley-like depression interproximally directly apical to contact
    • Absent if teeth are missing or recession is present
  24. Function of Interdental Gingiva?
    Function is to prevent food from becoming packed between teeth during mastication
  25. Gingival Sulcus:
    • žSpace between free gingiva and tooth surface
    • V-shaped shallow space around the tooth
    • Image Upload 9
  26. **Clinically normal sulcus is?mm
    1 to 3 mm as measured by a probe
  27. **žBase of sulcus is formed by?
    • junctional epithelium:
    • attaches the gingiva to tooth. 

    Image Upload 10
  28. Cementum:
    • Thin layer of hard, mineralized tissue that covers the surface of the root
    • Light yellow
    • Overlies the dentin
    • Bonelike but more resistant to resorption than bone
    • Does not have its own blood or nutrient supply
    • Image Upload 11
  29. Functions of Cementum:
    • žGive attachment to collagen fibers of the periodontal ligament
    • Without cementum the tooth would fall out of the socket
    • Protects the underlying dentin
  30. Periodontal Ligament and purpose:
    • Soft dense fibrous connective tissue that covers the root of the tooth and attaches it to the bone of the tooth socket
    • Image Upload 12
  31. Periodontal Ligament is composed of?
    • fiber bundles
    • Sharpey’s Fibers
    • žFibers attach to root cementum on one side and alveolar bone of tooth socket on other side
  32. Sharpey’s Fibers:
    matrix of connective tissue consisting of bundles of strong collagenous fibers connecting periosteum to bone
  33. **Five Functions of PDL
    • 1.Suspends and maintains tooth in socket
    • 2.Provides pressure and pain sensory feeling to tooth
    • 3.Provides nutrients to cementum and bone
    • 4.Builds and maintains cementum and alveolar bone of tooth socket
    • 5.Remodels alveolar bone in response to pressure
  34. Image Upload 13
    Image Upload 14
  35. Alveolar Bone:
    • žSurrounds and supports roots of teeth in upper and lower jaws
    • žExistence of alveolar bone is dependent on presence of teeth
    • Extractions lead to bone resorption
    Image Upload 15
  37. Alveolar Bone Proper (aka: Lamina Dura) and purpose?
    • Alveolus: bony socket that houses the root of the tooth
    • Appears to have large pores where blood vessels connect structures
    • žEnds of periodontal ligament fibers are embedded in alveolar bone proper
    • Image Upload 16
  38. Cortical Bone:
    • Layer of compact bone that forms the hard outside wall of jaws on facial and lingual
    • Surrounds alveolar bone proper and gives support to socket
    • Thinnest in incisor, canine, premolar area and thickest in molars
    • Does not show up on radiographs
    • Alveolar crest most coronal portion
    • Image Upload 17
  39. Cancellous Bone:
    • žSpongy, lattice-like bone filler between cortical bone and alveolar bone proper
    • žOriented around tooth to form support for alveolar bone proper
    • Image Upload 18
  40. Periosteum:
    • žLayer of connective soft tissue covering outer surface of bone
    • Consists of collagenous tissue and an inner layer of elastic fibers
  41. If scaling tooth surface subgingival what are you scaling?
    What part of the tooth structure are you scaling?
    The root= cementum
  42. **Which lymph node drains most of the periodontal tissue?
  43. The Trigeminal nerve branches to?
    • Opthalmic Nerve
    • Maxillary Nerve
    • Mandibular Nerve
  44. **Innervation of the gingiva of the maxillary arch is from the?
    • Anterior, Middle, and Posterior branches of superior alveolar nerves
    • Infraorbital nerve
    • Greater palatine nerve
    • Nasopalatine nerve
  45. **Innervation of the gingiva of the mandibular arch is from the?
    • Mental nerve
    • Buccal nerve
    • Sublingual branch of lingual nerve
  46. **Innervation of the teeth and PDL of the maxillary arch is from the?
    superior alveolar nerves(Anterior, middle, and posterior)
  47. **Innervation of the teeth and PDL of the mandibular arch is from the?
    Inferior alveolar nerve
  48. What is the Function of Blood Vessel Network?
    • žTransports oxygen and nutrients to tissue cell
    • Removes carbon dioxide and other waste products: Detoxification, Elimination
  49. What arteries are the vascular supply to the periodontium of the maxillary gingiva, periodontal ligament, and alveolar bone?
    • Anterior and posterior superior alveolar arteries
    • Infraorbital artery
    • Greater palatine artery
  50. What arteries are the vascular supply to the Vascular Supply to Periodontium Mandibular gingiva, periodontal ligament, and alveolar bone?
    • Inferior alveolar artery
    • Branches of inferior alveolar arteryBuccal, facial, mental, and sublingual arteries
  51. What are the two major arteries that are the vascular supply to the teeth and periodontal tissues?
    • Superior alveolar arteries:Maxillary periodontal tissues
    • Inferior alveolar artery: Mandibular periodontal tissues
  52. What artery is a branch of the superior or inferior alveolar artery?
    the dental artery
  53. What artery enters the tooth socket?
    Intraseptal artery
  54. **Terminal branches of the intraseptal artery; they penetrate the tooth socket and enter the periodontal ligament space where they anastomose(join) with the blood vessels from the alveolar bone and peridontal ligament?
    Rami perforantes
  55. These blood vessels are located in the free gingiva and are the main supply of the blood to the free gingiva; these vessels anastomose with blood vessels from the alveolar bone and periodontal ligament?
    Supraperiosteal blood vessels
  56. These are branches of the supraperiosteal blood vessels located in the connective tissue beneath the free and attached gingiva.
    Subepithelial plexus
  57. These vessels supply the PDL and form a complex network of vessels that surround the root?
    PDL vessels
  58. This is a fine- meshed network of blood vessels located in the connective tissue beneath the gingival sulcus?
    Dentogingival plexus
  59. This is a network of lymph nodes connected by lymphatic vessels that plays an important role in the body's defense against infection?
    • lymphatic system
    • žFilter, trap, and eliminate:
    • Bacteria
    • Fungi
    • Viruses
    • Unwanted substances
  60. What lymph nodes drain the palatal gingiva of the maxilla?
    Deep cervical lymph nodes
  61. What lymph nodes drain the gingiva in the region of the mandibular incisors?
    Submental lymph nodes
  62. What lymph nodes drain the gingiva in the third molar region?
    Jugulodigastric lymph nodes
  63. Image Upload 19
    Image Upload 20
  64. If a dentist extracted a third molar tooth and looks in,what is she looking at?
    tooth socket
  65. Gingiva in Health:
    • Healthy tissue is free of inflammation and has not been altered by disease or trauma.
    • Image Upload 21
  66. Color in Healthy gingiva:
    • Tissue appears uniformly pink: Blondes with a light complexion have a lighter shade of pink, Brunettes with darker complexion have a darker shade of pink.
    • Pink gingiva is easily distinguished from darker alveolar mucosa.
    • Tissue may also be pigmented.
    • Image Upload 22
  67. Contours of Healthy Gingiva:
    • Smoothly scalloped gingival margin
    • Tapered margin slightly coronal to the CEJ
    • Pointed papillae that completely fill the space between the teeth
    • Image Upload 23
  68. Tissue Stippling in Health:
    • Stippling varies greatly from individual to individual, and in some patients, healthy tissue may not exhibit a stippled appearance.
    • Image Upload 24
  69. The Position of the Margin in Health is?
    • The margin is at or slightly coronal to the CEJ.
    • Image Upload 25
  70. Image Upload 26
    • Healthy Gingiva in Posterior Sextants
    • Tissue has gently scalloped margin
  71. Gingiva in Disease
    • Plaque biofilm at the gingival margin stimulates the host immune response.
    • Inflammatory response to bacteria results in clinical changes. Changes involve free and attached gingiva and papilla.
  72. Acute gingivitis:
    short duration; resolves upon professional and good self-care
  73. When do we find BOP?
  74. **Chronic gingivitis—
    may exist for years without ever progressing to periodontitis; resolves upon professional and good self-care
  75. Color in Gingivitis of Acute gingivitis is?
    increased blood flow causes tissue to appear bright red
  76. **Color in Gingivitis of Chronic gingivitis tissue appears?
    bluish red or purplish red
  77. Slight Marginal Redness—Early Gingivitis
    Image Upload 27
  78. Image Upload 28
    Slight Marginal and Papillary Redness
  79. Image Upload 29
    Fiery Red Marginal Gingiva and Papillae
  80. Size in Gingivitis:
    • Increased tissue fluid enlarges marginal and interproximal gingival tissue.
    • It can be localized to a few areas or involve the whole mouth.
  81. Image Upload 30
    Bulbous Papillae
  82. Image Upload 31
    Blunted Papillae
  83. Image Upload 32
    Cratered Papillae
  84. Appearance of tissue?
    Image Upload 33
    • Soft, Spongy Tissue
    • localized diffused with marginal redness
  85. Image Upload 34
    Smooth, Shiny Tissue
  86. Local Factors in gingivitis? example
    Bulbous papillaImage Upload 35
  87. Inflammation causes
    • the gingival tissues to bleed easily.
    • Image Upload 36

    • Inflammation results in ulceration of the pocket wall.  Bleeding is an important indicator of inflammation
    • stillman cleft
    • Image Upload 37
  88. Localized inflammation
    • confined to tissue of a single tooth or group of teeth
    • Image Upload 38
  89. Diffuse Inflammation
    • Whole area is inflamed 
    • Image Upload 39
  90. Generalized inflammation—
    • occurring in all or most of the mouth
    • Image Upload 40
  91. Papillary Inflammation
    is confined to the papilla
  92. Marginal Inflammation
    is confined to the gingival margin and papilla.
  93. Diffuse Inflammation
    is throughout the gingival margin, papilla, and attached gingiva; extending to the mucogingival junction.
  94. Description of healthy Gingival Tissues
    • the gingiva is a uniform pink color, with tapered margins, pointed papilla, and a firm consistency.
    • Healthy tissue does not bleed.
  95. Description of tissue in gingivitis?
    the gingiva is red to purplish red, with rolled margins, altered papillae, and a spongy consistency.
  96. What is horizontal bone loss?
    Results in a fairly even, overall reduction in the height of bone.
  97. What is vertical bone loss?
    • Results in an uneven reduction in bone height.
    • Leaves a trenchlike area of missing bone alongside the root.
  98. How does the inflammation spread into the bone?
    • Pathway in Horizontal Bone Loss —G+B+PDL= H
    • Pathway in Vertical Bone Loss —G+PDL+B=V
  99. In health, the crest of the alveolar bone is located approximately _____mm apical to (below) the CEJs.
  100. —In gingivitis, the crest of the alveolar bone is located approximately ____mm apical to (below) the CEJs.
    • —2mm
    • Image Upload 41
  101. External basal lamina:
    • Thin mat of extracellular matrix
    • Between epithelial cells of junctional epithelium and gingival connective tissue
  102. Internal basal lamina
    • Thin mat of extracellular matrix
    • Between epithelial cells of junctional epithelium and tooth
  103. is the JE is at its normal level in gingivitis?
  104. —In periodontitis, bone destruction may be severe and the crest of the alveolar bone is located approximately ____mm apical to (below) the CEJs.
    • More than 3
    • Image Upload 42
  105. Is Pain is considered a symptom of periodontitis?
  106. Alveolar bone loss in periodontitis:
    • —there is a progressive loss of bone.
    • Bone destruction may eventually lead to tooth loss
  107. What are the two Patterns of Bone Loss?
    • Horizontal bone loss
    • Vertical bone loss
  108. Which Is the most common pattern of bone loss?
    Horizontal bone loss
  109. Where is bone loss measure?
    Measure from the CEJ(our marker)
  110. Which —Is the less common pattern of bone loss?
    vertical bone loss
  111. what pattern of bone loss is results in more rapid progression?
    vertical bone loss
  112. What is the Pathway in Horizontal Bone Loss?
    • G+B+PDL= H
    • Into the gingival connective tissue(1)
    • Into the alveolar bone(2)
    • Into the periodontal ligament(3)
    • Image Upload 43
  113. When does Vertical bone loss occur?
    when the crestal periodontal ligament fibers are weakened and no longer act as an effective barrier to inflammation (patient can’t clean it out)
  114. What is the Pathway in Vertical Bone Loss?
    • G+PDL+B=V
    • 1. —Into the gingival connective tissue
    • 2. Directly into the PDL space
    • 3. Into the alveolar bone
    • Image Upload 44
  115. How are Infrabony defects classified?
    • on the basis of the number of osseous (bony) walls.
    • Image Upload 45
  116. One-Wall Intrabony Defect
    Image Upload 46
  117. Two-Wall Intrabony Defect
    Image Upload 47
  118. Three-Wall Intrabony Defect
    Image Upload 48
  119. Interproximal Osseous Crater:
    • Concavities in the crest of the interdental bone confined within the facial and lingual walls.
    • High frequency of occurrence is the difficulty to clean plaque and bacteria from these areas
  120. Contour of Interdental Bone
    Image Upload 49
  121. Contour of Interdental Bone
    Osseous Crater:
    Image Upload 50
  122. Furcation involvement occurs on?
    • a multirooted tooth when the periodontal infection invades the area between and around the roots.
    • This results in a loss of alveolar bone between the roots of the tooth.
    • 1-feel it
    • 2-feel it and tip goes in
    • 3-tip goes thru and can see it
  123. There is no bone loss in?
  124. Bone loss only occurs in?
  125. —Bone loss in periodontitis can result in the loss of ______.


  126. What is this?
    Image Upload 51
  127. what type of bone loss?
    Image Upload 52
  128. what type of bone loss?
    Image Upload 53
  129. What type of bone loss?
    Image Upload 54
  130. What type of bone loss?
    Image Upload 55
  131. **What is difference between the gingival pocket and periodontal pocket?
    NO apical migration of the JE on gingival pocket
  132. **Pathologic deepening of the gingival sulcus due to periodontal bacteria is termed what?
    periodontal pocket
  133. What is a periodontal pocket?
    • —a pathologic deepening of the gingival sulcus as a result of:
    •    Apical migration of the JE
    •    —Destruction of periodontal ligament fibers
    •    Destruction of the alveolar bone
  134. —Are there different types of periodontal pockets?
    • —Gingival pocket
    • Periodontal pocket
  135. What is the bone loss like in a periodontal pocket?
    Destruction of the alveolar bone
  136. What is a —Gingival pocket?
    • a deepening of the gingival sulcus as a result of inflammation.
    • NO apical migration of the JE.
    • The coronal portion of the JE detaches from the tooth resulting in a slight increase in probing depth.
    • —In many cases, swelling of the gingival tissue also contributes to an increased probing depth.
    • BOP
  137. in a Healthy Gingival Sulcus:
    the JE attaches along its entire length to the enamel of the tooth.
  138. Gingival pockets are also called?
    • pseudopockets
    • meaning false pocket: because there is no destruction of PDL fibers or alveolar bone.
  139. Periodontal pocket:
    • a pathologic deepening of the gingival sulcus as a result of:
    •   Apical migration of the JE
    •   Destruction of periodontal ligament fibers
    •   Destruction of the alveolar bone
  140. Two Types of Periodontal Pockets:
    • —Suprabony periodontal pocket
    • Infrabony periodontal pocket
  141. Suprabony Pocket occurs when?
    • —there is horizontal bone loss.
    • —JE is located coronal to the crest of the alveolar bone (above the crest of bone).
    • Image Upload 56
  142. Infrabony Pocket occur when?
    • —there is vertical bone loss.
    • —JE is located apical to the crest of the alveolar bone (below the crest of bone)
    • Base of the pocket is located within the cratered-out area of bone alongside the root surface.
    • Image Upload 57
  143. Attachment loss is?
    • the destruction of the fibers and alveolar bone that support the teeth.
    • —The base of a pocket may exhibit a very irregular pattern of tissue destruction.
  144. What do you see?Image Upload 58
    —There is irregular pattern of tissue destruction.
  145. —A disease site is ?
    • an area of tissue destruction.
    • may involve only one surface of the tooth, such as the distal surface, or several surfaces, or all four surfaces of the tooth.
  146. Active disease site is?
    • a disease site that shows continued apical migration of the junctional epithelium over time.
    • For example, 3 months ago the deepest reading on the distal surface of the mandibular right first molar was 5 mm. Today, it is 6 mm.
  147. Inactive disease site is?
    • —a disease site that is stable, with the attachment level of the JE remaining at the same level for a period of time
    • —For example, the deepest reading on the distal surface of the mandibular right first molar has remained at 5 mm for 12 months.
  148. How to assess Disease Sites?
    —Disease activity should be assessed with a periodontal probe at regular intervals and recorded in the patient chart or computerized record.
  149. ______ is an area of tissue destruction left by the periodontal disease process.
    Periodontal pocket
  150. The majority of periodontal pockets in most adult patients with periodontitis are ______.
    inactive sites.
  151. The periodontal pocket is an indicator of
    past destruction from periodontitis.
  152. ____ is the destruction of the fibers and alveolar bone that support the teeth.
    Attachment loss
  153. A ______ is an area of tissue destruction.
    disease site
  154. ______an area of tissue destruction left by the disease process
    —Periodontal pocket
  155. Aggregatibacter Actinomycetemcomitans (Aa):
    • Recently was renamed from its former name of Actinobacillus actinomycetemcomitans
    • Aggressive periodontitis
    • Evading normal host immune response
    • Destroy the gingival connective tissue and bone
    • Gram-
    • anaerobic 
  156. Tannerella Forsythia (Tf):
    • Was renamed from its former name Bacteroides forsythus
    • Is considered to be the most significant risk factor that distinguishes individuals with periodontitis from those who are periodontally healthy
    • Is the most common species detected on or in epithelial cells recovered from periodontal pockets
    • Gram-
    • Anaerobic
  157. Porphyromonas Gingivalis (Pg):
    • Can be found in low numbers in health and gingivitis
    • Is found more frequently in aggressive forms of periodontitis
    • Is commonly seen in disease sites that are worsening (i.e., pockets getting deeper, more bone loss)
    • Can inhibit migration of PMNs across the epithelial barrier
    • Gram- 
    • Anaerobic
  158. Gram Positive +:
    • Retain purple color when stained
    • Have a single, thick cell membrane
    • Are usually associated with ***periodontal health
  159. **What bacteria has a single wall membrane?
    Gram positive +
  160. Gram Negative -:
    • Show a red stain under the microscope
    • Have double cell membranes
    • Play an important role in periodontitis
  161. Which bacteria is the destructor?
    Gram negative -
  162. Biofilms—
    • a living film—containing a well-organized community of bacteria—that grows on a surface
    • Components = species of bacteria as well as other organisms and debris
    • Form rapidly on almost any surface that is wet
    • Found nearly everywhere in natureHave  major impact on human health
  163. Free-Floating Bacteria
    • Known as planktonic bacteria
    • New to research
    • This new approach led to some misunderstandings about characteristics of bacteria
  164. Attached Bacteria
    • Bacteria attach to each other and surfaces
    • Once attached to a surface, the bacterium’s characteristics change (different) than what it was like as a free-floating bacterium
    • More than 99% of all bacteria on earth live as attached bacteria.
  165. Biofilms can be found on:
    • Medical and dental implants
    • Contact lens cases
    • Pacemakers
    • Artificial joints
    • Teeth
  166. Which bacteria can colonize in the mouth?
    Approximately 700 different bacterial species and subspecies are capable of colonizing the mouth
  167. Bacteria Associated with Health:
    • Health = 100 and 1000 bacteria can be cultured from one individual healthy sulci.
    • 75% are Gram-positive facultative rods and cocci.
    • Most are nonmotile (not capable of movement).
  168. Bacteria Associated with Gingivitis:
    • Gingivitis = 1,000 to 100,000 bacteria can be cultured from an individual site
    • Bacteria in chronic gingivitis consist
    • Almost equal portions of + & - bacteria
    • Gram-negative rods comprise about 40% of the bacteria found in gingivitis.
  169. Bacteria Associated with Periodontitis
    • Periodontitis = 100,000 to 100,000,000 bacteria can be cultured from an individual tooth surface
    • Associated with an enormous number of bacteria
    • Chronic periodontitis is associated with high proportions of Gram-negative and motile bacteria.
  170. What is a pathogen?
    • A microorganism that causes or can cause a disease
    • A microbe that can cause damage in a host
  171. Transmission of Periodontal Pathogens:
    • Transmission is the transfer of periodontal pathogens from the oral cavity of one person to another.
    • Kissing is the primary means by which saliva and its bacterial contents are transmitted.
    • Parents and children in the same family have been shown to have the identical strains of Aa and Pg.
  172. 5 Phases of Biofilm Development / Life Cycle?
    Image Upload 59
  173. ______ bacteria attach to surface that is  wet.
    • Planktonic (individual)
    • free-floater
  174. Phase 1 of Biofilm Development?
    • Film Coating / Acquired pellicle:
    • Within minutes after cleaning Acquired pellicle film forms over the tooth surface 
    • Film is composed of a variety of salivary glycoproteins (mucins) and antibodies
    • Purpose = to protect enamel from acids
    • However: facilitating bacterial adhesion to the tooth surface
    • alters the charge and energy of the tooth surface
  175. Phase 2 of Biofilm Development?
    • Initial Attachment of Bacteria to Pellicle
    • Within a few hours after pellicle formation, bacteria begin to attach to the surface of the pellicle.
    • Some bacteria have fimbriae = hair-like attachment structures = enable attachment rapidly upon contact
  176. Phase 3 of Biofilm Development?
    • New Bacteria Join In
    • Bacteria attached to the tooth
    • produce substances that stimulate other free-floating bacteria to join
    • chemical communication occurs between/among cells.
  177. Phase 4 of Biofilm Development?
    • Extracellular Slime Layer & Microcolony Formation
    • Bacteria attract other free-floating bacteria to the biofilm.
    • The attached bacteria secrete film = extracellular polymer slime layer. (EPS)
    • (EPS) acts as a protective shield / dome for the bacteria in the biofilm.
    • The bacteria grow to form mushroom-shaped biofilms that attach to a surface at a narrow base.
  178. Phase 5 of Biofilm Development?
    • Mature Biofilm
    • The bacteria cluster to form mushroom-shaped microcolonies that attach to the tooth surface at a narrow base.
    • The microcolonies are complex collections of different bacteria linked to one another.
  179. Extracellular slime layer:
    • (phase 4 of biofilm development)
    • Comprised of  polysaccharides, proteins, nucleic acids and lipids
    • Helps anchor bacteria to tooth / provides protection for attached bacteria
  180. Cell division:
    • (phase 4 of biofilm development)
    • microcolony
    • bacteria multiply and begin to grow away from the tooth surface
  181. Bacterial blooms:
    • (phase 4 of biofilm development)
    • periods when specific species grow at rapidly accelerated rates
  182. Structural Elements of Mature Biofilm:
    • Bacterial microcolonies
    • Extracellular slime layer
    • Fluid forces of the surrounding saliva
    • Fluid channels
    • Cell-to-cell communication system
    • Bacterial signaling
  183. Bacterial Microcolonies:
    • Microcolony- tiny independent community containing thousands of compatible bacteria.
    • Different microcolonies may contain different combinations of bacterial species.
  184. Extracellular Slime Layer:
    • Dense protective barrier- surrounds the bacterial microcolonies
    • Shield protecting the bacteria from:
    •    Antibiotics
    •    Antimicrobials
    •    Body’s immune system
  185. Effect of Fluid Forces of Saliva on the Biofilm:
    • influence the shape
    • result in the development of extensions from the main body of the biofilm: Extensions can break free and be swallowed, expectorated, or form new biofilm colonies in other areas of the mouth.
    • result in cell-to-cell collisions of the bacteria within the biofilm.
    • Collisions = to a more rapid spread of genes among the bacteria.
    • This continuous exchange of genetic information among bacteria means that the bacteria are constantly evolving
  186. Fluid Channels:
    • Penetrate the extracellular slime layer.
    • Transport Nutrients and oxygen to the bacteria.
    • Carry bacterial waste products away.
  187. Cell-to-cell Communication System:
    • Direct cell-to-cell interaction occurs among the bacteria in the biofilm.
    • Bacteria use chemical signals to communicate with each other.
    • This communication also results in the transfer of genes among bacteria.
  188. Bacterial Signaling:
    • Attached Bacteria within a biofilm produce 100s of proteins that free-floating bacteria do not.
    • Some of these proteins trigger the adhesion of additional bacteria and formation of the extracellular slime layer.
  189. Coaggregation:
    • the cell-to-cell adherence of one oral bacterium to another.
    • Coaggregation is NOT random: each bacterial strain only has a limited set of bacteria to which they are able to adhere
    • The ability to adhere and coaggregate is important in the development of the bacterial biofilm.
  190. Nonpathogenic:
    • (purple+)first bacteria to colonize the tooth surface
    • The ability of early colonizers to attach to the tooth surface lays the foundation for the growth of the biofilm
    • nonpathogenic species must be attached before Periodontal pathogens are ABLE to colonize in the biofilm
    • Periodontal pathogens remain freely floating in the mouth until the early colonizers attach to the tooth.
  191. Many _____ species have the ability to attach to the tooth pellicle and to each other.
  192. ______ adhere to the pellicle coating of the tooth.
    Early colonizers
  193. _____ coaggregate with the early colonizers.
    (still in gingivitis)
    Intermediate colonizers
  194. _____ coaggregate with the intermediate colonizers.
    Late colonizers
  195. ______ periodontal pathogens cannot cause disease.
  196. Every time the biofilm is disrupted, the process must start all over again with the ____ colonizers.
  197. Dental plaque biofilm development ___begins supragingivally and progresses subgingivally.
  198. Gram +(names):
    • Actinomyces viscosus
    • Streptococcus sanguis
  199. Gram -(names):
    • Fusobacterium nucleatum
    • Prevotella intermedia
    • Porphyromonas gingivalis
    • Capnocytophaga gingivalis
  200. Bacterial Attachment(sequence):
    • Within hours
    • Pellicle film forms over the crown of the tooth
    • Early colonizers attach supragingivally
    • 6 Hours
    • Surface of tooth crown becomes covered
    • Day 7
    • Mature supragingival biofilm forms
    • 3 to 12 weeks
    • Subgingival biofilm starts to form
  201. Tooth Associated Bacteria
    • Attach from just below the gingival margin almost to the junctional epithelium
    • ability to invade the dentinal tubules of the cementum
  202. Tissue associated bacteria:
    • Adhere to the epithelium of the pocket wall
    • Can invade the gingival connective tissue and be found on the surface of the alveolar bone
    • Large numbers of SPIROCHETES AND FLAGELLATED BACTERIA(soft tissue)
  203. Unattached Bacteria:
    the periodontal pocket contains free-floating bacteria that are not part of the biofilm
  204. Socransky's Colors:
    • Colors are assigned based on the association with health or disease:
    • - Yellow and green complexes are early colonizers = compatible with gingival health.
    • - Orange and red complexes are thought to be major etiologic agents of periodontal disease.
  205. Hemidesmosome:
    • cell - to - basal lamina connection
    • - important cell junction found in gingival epithelium
  206. Desmosome
    • - cell - to - cell connection
    • - important cell junction found in gingival epithelium
  207. Radiographs do not reveal the Following:
    • Presence or absence of periodontal pockets
    • Early bone loss
    • Exact morphology of bone destruction
    • Tooth mobility
    • Early furcation involvement
    • Condition of the bone on the buccal and lingual surfaces 
    • Level of the epithelial attachment
  208. Local Risk Factors in radiographs:
    • Early bony changes
    • Horizontal bone loss
    • Vertical bone loss
    • Bone defects
    • Furcation involvement
    • Calculus deposits
    • Faulty restorations
    • Trauma from occlusion
  209. Radiographic examination is ______ a satisfactory substitute for a clinical periodontal assessment.
  210. Early Bone Loss must first be detected _____.
    clinically, not radiographically.
  211. Components of the periodontium that can be identified radiographically include the:
    alveolar bone, periodontal ligament space, lamina dura, and cementum.
  212. A periodontal assessment is incomplete without ______.
    accurate radiographs.
  213. What are the benefits of using radiographs in a periodontal examination?
    • Radiographs illustrate: ¨
    • -Bony changes caused by disease
    • ¨-Tooth root morphology
    • ¨-Relationship of the maxillary sinus to the periodontal deformity
    • ¨-Widening of the PDL space
    • ¨-Advanced furcation involvement
    • ¨-Periodontal abscess
    • ¨-Local factors (crown, overhang)
  214. Triangulation?
    • Widening of the PDL space
    • caused by bone resorption on either the mesial or the distal of the interdental crestal bone
    • Also called funneling
  215. What is the most common type of periodontal disease?
  216. Periodontal disease:
    bacterial infection of the periodontium
  217. —There are two types of periodontal disease?
    • —Gingivitis
    • Periodontitis
  218. Gingivitis:
    • A bacterial infection that is confined to the gingiva
    • Results in reversible destruction to the tissues of the periodontium
  219. Periodontitis:
    • A bacterial infection of all parts of the periodontium, including the:
    • Gingiva
    • —Periodontal ligament
    • —Bone
    • Cementum
    • Results in irreversible tissue damage
  220. Periodontitis is a type of periodontal disease characterized by the
    • Apical migration of the JE
    • Loss of connective tissue attachment
    • Loss of alveolar bone
  221. **NSPT?
    • Non-surgical periodontal therapy
    • Steps used to describe many nonsurgical steps used to eliminate inflammation in the periodontium to a healthy state thatch be maintained by a combination of both professional care and patient self-care.
  222. **What are the goals Of non-surgical therapy(NSPT)?
    • 1. To minimize the bacterial challenge to the patient
    • 2. To eliminate or control local environmental risk factors for periodontal disease
    • 3. To minimize the impact of systemic risk factors for periodontal disease
    • 4. To stabilize the attachment level by eliminating inflammation
  223. Dentinal hypersensitivity:
    • Not really associated with periodontal disease or periodontal condition.
    • Appears during successful NSPT
    • is a short, sharp, painful reaction that occurs when areas of exposed dentin are subjected to mechanical, thermal, or chemical stimuli.
  224. dentinal tubules:
    penetrate the dentin like long, miniature tunnels extending throughout the thickness of the dentin.
  225. The part of a dentinal tubule closest to the pulp normally contains an _______, which is a thin tail of cytoplasm from a cell in the pulp called an odontoblast.
    odontoblastic process
  226. The part of a dentinal tubule not filled by an odontoblastic process is filled by ____.  Stimulation of the root surface may result in ______within the tubules which is theorized to activate the nerve endings near the pulp leading to painful sensation experienced by the patient.
    • fluid
    • fluid flow
  227. The Hydrodynamic or Fluid Movement theory:
    is one of the main theories in dentistry to explain the mechanism by which a tooth perceives the sensation of pain.
  228. _______ replaces the term adult periodontist in 1989 AAP classification since epidemiological evidence suggest that chronic periodontitis is also seen in some adolescence.
    Chronic periodontitis
  229. _______ replaces the term early onset periodontitis in 1989 AAP classification  because it is difficult to determine the age of onset periodontitis in many cases.
    Aggressive periodontitis
  230. _______ replaces necrotizing ulcerative periodontitis in 1989 AAP classification.
    Necrotizing periodontal disease
  231. According to AAP classification of periodontal diseases and conditions 1999 the main categories of gingival disease are?
    • Plaque-induced gingival disease
    • Non-plaque-induced gingival lesions
  232. According to AAP classification of periodontal diseases and conditions 1999 the main categories of Chronic periodontitis are?
    • Localized
    • Generalized
  233. According to AAP classification of periodontal diseases and conditions 1999 the main categories of Aggressive periodontitis are?
    • Localized 
    • Generalized
  234. Acellular Cementum:
    • First to be formed
    • Covers cervical third or half of root
    • Not produced during the life of the tooth
    • Thickness ranges from 30 to 60 µm(microns)
    • Consists of mostly Sharpey’s fibers
  235. Cellular Cementum
    • Contains cementoblasts and fibroblasts within mineralized tissue
    • Formed after tooth eruption
    • Less calcified than acellular cementum
    • Deposited at intervals throughout the life of the tooth
    • Thickness ranges from 150 to 200 µm
  236. Image Upload 60
    Image Upload 61
  237. name the Fiber Bundles of PDL:5
    1.Alveolar crest




  238. Fiber Bundles of PDL
    Alveolar Crest
    • Extend from cervical cementum
    • Run downward in diagonal direction to alveolar crest
    • Fiber group resists horizontal tooth movements
  239. Fiber Bundles of PDL
    • Located apical to alveolar crest fibers
    • Extend from cementum to bone at right angles to long axis of root
    • Fiber group resists horizontal pressure against crown of tooth
  240. Fiber Bundle of PDL
    • Located apical to horizontal group
    • Extend from cementum to the bone running diagonally
    • Fiber group resists vertical pressures that threaten to drive the root into its socket
  241. Fiber Bundle of PDL
    • Extend from apex of tooth to bone
    • Fiber group secures tooth in its socket and resists forces that might lift the tooth from its socket
  242. Fiber Bundle of PDL
    • Only on multirooted teeth
    • Extends from cementum in furcation area of tooth to interradicular septum of alveolar bone
    • Fiber groups help stabilize tooth in its socket
  243. Components of PDL
    • -Cells:
    •   Fibroblasts
    •   Cementoblasts
    •   Osteoblasts
    • -Extracellular matrix
    • -Blood vessels
    • -Nerve supply
  244. Components in PDL In Health
    • PDL surrounds entire tooth root and fills space between root and bony tooth socket
    • Thickness of PDL varies by age and function:
    • 0.05 to 0.25 mm
  245. Biologic width is an important consideration in design of dental restorations and crowns
    • Margin of restoration or crown must never be placed so close to alveolar bone that it encroaches on biologic width
    • Image Upload 62
  246. Function of Fiber Bundles?
    • Brace free gingiva firmly against tooth
    • Reinforce attachment of junctional epithelium to tooth
    • Provide free gingiva rigidity to withstand chewing
    • Unite free gingiva with cementum of root and bone
    • Connect adjacent teeth to each other
  247. (gingival fiber group) Alveologingival (AG)
    Image Upload 63
    • Extend from periosteum of alveolar crest into gingival connective tissue
    • Fiber bundles attach gingiva to bone
  248. (gingival fiber group)circular
    • Encircle the tooth in a ring-like manner coronal to alveolar crest
    • Not attached to cementum of tooth
    • Fiber bundles connect adjacent teeth to each other
    • Image Upload 64 Image Upload 65
  249. (gingival fiber group)dentogingival
    • Embedded in cementum near CEJ
    • Fan out into lingual connective tissue
    • Fibers act to attach gingiva to teeth
    • Image Upload 66
  250. (gingival fiber group) Periostogingival
    • Extend laterally from periosteum of alveolar bone
    • Fibers attach gingiva to bone
    • Image Upload 67
  251. (gingival fiber group) Intergingival
    • Extend in a mesiodistal direction along entire dental arch and around last molars in arch
    • Fiber bundles link adjacent teeth into dental arch unit
    • Wave
    • Image Upload 68 Image Upload 69
  252. (gingival fiber group) Intercircular
    • Encircle several teeth
    • Fiber groups link adjacent teeth into a dental arch unit
    • Image Upload 70 Image Upload 71
  253. (gingival fiber group) Interpapillary
    • Located in papillae coronal to transseptal fiber bundles
    • Fiber groups connect oral and vestibular interdental papillae of posterior teeth
    • Image Upload 72 Image Upload 73
  254. (gingival fiber group) Transgingival
    • Extend from cementum near the CEJ and run horizontally between adjacent teeth
    • Fiber bundles link adjacent teeth into a dental arch unit
    • Image Upload 74 Image Upload 75
  255. (gingival fiber group)Transseptal
    • Pass from cementum of one tooth over the crest of alveolar bone to cementum of adjacent tooth
    • Fiber bundles connect adjacent teeth to one another and secure alignment of teeth in arch
    • Image Upload 76 Image Upload 77
  256. Cemento-Enamel Junction (CEJ)
    60% cementum ________enamel
    • overlap
    • Image Upload 78
  257. Cemento-Enamel Junction (CEJ)

    30% cementum ________ enamel
    • meet
    • Image Upload 79
  258. Cemento-Enamel Junction (CEJ)
    10% ________cementum and enamel
    • gap
    • Image Upload 80
Card Set
DHE119 Exam#1