Exam 2 perio

• Components of a Periodontal Assessment

  • Gingival assessment
  • Probing depth measurements
  • Bleeding on probing
  • Presence of exudate (suppuration)
  • Position of gingival margin
  • Clinical attachment level (CAL)
• Bleeding is a sign of disease
• Clinical attachment level (CAL) is measured from the CEJ to the base of the sulcus or junctional epithelium
• Periodontium


  The tooth-supporting structures

  
• Tissues of the Periodontium

  • Gingiva
  • Periodontal ligament
  • Cementum
  • Alveolar and supporting bone

  
• Functions of Periodontium


  • Provides a seal around cervical portion (neck) of tooth-gingiva
  • Holds tissue against tooth during mastication- pdl
  • Covers alveolar processes of jaw-gingiva
  • Suspends and maintains tooth in its socket-pdl
  • Anchors ends of the periodontal ligament fibers to the tooth, so as to maintain tooth in its socket-cementum
  • Protects underlying dentin-cementum
  • Surrounds and supports root (s) of tooth-alveolar bone

  
• Gingiva


  Protective covering over other components of periodontium, well adapted to protect against assaults, encircles cervical portion of teeth and covers alveolar process

  
• Anatomic Areas of the Gingiva

  • Free gingiva
  • Gingival sulcus
  • Interdental gingiva
  • Attached gingiva

  
• Free Gingiva (FG)

  Located slightly coronal to the CEJ, surrounds the tooth like a turtleneck, fits snugly around the tooth but is not attached, can be gently pulled away from the tooth with a probe, forms soft tissue wall of the gingival sulcus

  
• Free Gingival Margin (FGM)


  Free gingiva meets the tooth in a thin, rounded edge, follows the contours of the teeth, creating a wavy, scalloped outline, FGM is the most coronal part of free gingiva

  
• Free Gingival Groove (FGG)


  Shallow linear depression on outer surface of gingiva, separates free gingiva from attached gingiva, rarely visible to the naked eye

  
• Gingival Sulcus


  Space between free gingiva and tooth surface, V-shaped shallow space around the neck of the tooth

  
• Interdental Gingiva (IG)


  Portion of gingiva that fills the area (embrasure space) between two adjacent teeth apical to the contact area

  
• Gingival Embrasure Spaces


  Spaces between adjacent teeth apical to the contact area

  
• Col


  Valley-like depression in the interdental gingiva that lies directly apical to the contact area, absent if teeth are missing or gingival recession is present

  
• Attached Gingiva (AG)

  Located between the free gingiva and the alveolar mucosa, continuous with free gingiva and is firmly attached to underlying cementum and periosteum, covering alveolar process

  
• Mucogingival Junction (MGJ)


  Joins attached gingiva to alveolar mucosa

  
• Functions of Attached Gingiva (AG)

  Allows gingiva to withstand mechanical forces, prevents free gingiva from being pulled away from tooth when tension is applied to the alveolar mucosa

  
• Alveolar Mucosa


  From MGJ to mucous membrane of cheek, lip, and floor of mouth, thinner and redder in color than AG, has a smooth surface and is moveable, frenum attachments- folds of alveolar mucosa that attach lips and cheeks to maxillary and mandibular mucosa
• Periodontal Ligament


  Layer of soft connective tissue that covers root and attached bone to the tooth socket, supports tooth in socket and absorbs mechanical loads placed on tooth

  
• Functions of Periodontal Ligament

  • Support – suspends and maintains tooth in socket
  • Sensory – pressure and pain
  • Nutritive – nutrients to cementum and bone
  • Formative – builds and maintains cementum and bone
  • Remodeling – can remodel alveolar bone in response to pressure (braces)

  
• Cementum


  Thin hard layer of CT covers surface of tooth, overlies and is attached to dentin, undergoes continuous process of resorption and repair throughout the life of the tooth, does not have its owns blood or nutrient supply – nutrients received from...

  
• Alveolar Bone


  Surrounds and supports roots of teeth, forms bony sockets that provide support and protection for roots

  
• Extracellular matrix (ECM)


  Mesh-like material that surrounds cells acting as a structural scaffold for cells

  
• Basal lamina


  Thin layer of extracellular matrix
• Epithelial tissue

  • Avascular
• Stratified squamous epithelium


  • Flat cells arranged in multiple layers
• Connective tissue

  Fills spaces between tissues and organs to support and bind

  
• Gingival epithelium


  A type of stratified squamous epithelium with an underlying core of connective tissue called lamina propria
• Gingival epithelium is avascular and relies upon underlying lamina propria for its blood supply and nutrients
• Anatomical areas of the gingival epithelium

  • Oral epithelium (OE)
  • Sulcular epithelium (SE)
  • Junctional epithelium (JE)
• Cell layers of the gingival epithelium

  • Basal cell layer (stratum basale)
  • Prickle or spinous cell layer (stratum spinosum)
  • Granular/Superficial layer (stratum granulosum)
  • Keratinized/Cornified cell layer (stratum corneum)

  
• Keratinization


  Epithelium produces a pool of cells that migrate from basal layer to oral environment
• Oral epithelium (OE)

  Faces oral cavity on outer surface of free and attached gingiva, extends from crest of free gingival margin (FGM) to mucogingival junction (MGJ), may consist of keratinized or parakeratinized stratified squamous epithelium, protects underlying structures and forms a protective barrier

  
• Epithelial ridges/rete pegs


  • Ridge-like projections of epithelium that reach down into connective tissue (lamina propria), enhance adhesion, aid in resistance to mechanical forces, increase area where nourishment can be received
• Cells in oral epithelium

  • Keratinocytes
  • Melanocytes
  • Langerhans cells
  • Merkel cells
  • Inflammatory cells (mast cells)
• Sulcular epithelium (SE)

  Epithelial lining of gingival sulcus, not in contact with tooth, extends from GM to coronal edge of JE, generally thin and nonkeratinized, but can become parakeratinized
• Sulcular epithelium


  • Relatively permeable barrier that allows leukocytes to move from CT through sulcular epithelium and into sulcus, gingival cervicular fluid (GCF) flows into sulcus from CT
• Junctional epithelium (JE)


  Band of epithelial cells that surrounds tooth and creates a "seal" at gingival sulcus/crevice to hold it firmly in place, forms base of sulcus/pocket, attaches gingiva to tooth, nonkeratinized stratified squamous epithelium

  
• Junctional epithelium


  • Semipermeable membrane, more permeable than sulcular epithelium, serves as easiest path of entry for bacteria to invade CT, plays an important role in periodontal health and disease