Spring - Perio Flashcards

Health Care
Terms Definitions
Swollen tissue
bone builders
bone consumers
Aerobic bacteria
Requires oxygen
Made up of....
Periodontal ligament
Alveolar bone
Root cementum
Functions of the periodontium Provide a seal around the cervical portion of the tooth
Holds the tissue against the tooth during mastication
Suspends and maintains the tooth in its socket
Protect the dentin
Surrounds and supports the root
Bacteroides Forsythus
(Tannerella forsythensis)
found deep in periodontal pockets and is ass. w/ aggresive periodontal disease
Large leukocytes with one kidney-shaped nucleus and some granules found in the tissue
Chronic Inflammation
Long-lived inflammatory response lasting more than 2 weeks
Unattached Plaque
Free floating unattached bacteria
Area directly below the contact
E series prostaglandins
Most destructive to bone
A phagocytic vesicle that surrounds bacterium
leukocytes found in the blood stream
Virulence factors
Mechanisms that enable biofilm bacteria to colonize, invade, and demage the tissue of the periodontium virelence factors may be structural characterists of the bacterium itself or substances produced and relaesed into the environment bacteria
major component of gram -cell walls
Powerful mediators produced by immune cells that influence the behavior of other cells
Transmits Infomation
Periodontal disease
Bacertial infection of the periodontium
overlap, meet, gap
Overlap 60%
Meet 30%
Gap 10%
bacterial infection limited to the gingiva
A stage of periodontal disease effecting the gingiva, PDL, alveolar bone, and cementum
Disease site
An area  of tissue destruction
Cell junctions
Cellular structures that mechically attach a cell and its cytoskeleton to its neighboring cells or to the basal lamina
Gingival Epithelium
A specialized stratified squamous epithelium that functions well in the wet environment of the oral cavity.
Normally defect of bone during formation
Can be related to osteoporosis
Poor bone quality
Health bone relationship
Hard, mineralized tissue that is 45-50% inorganic hydroxyapatite. It covers the root (dentin) and is usually light yellow in color. MORE RESISTANT TO RESORPTION THAN BONE and devoid of nerve and blood supply. It must receive nutrients from ligament
Epithelial tissue

•Epithelial tissue has stratified squamous epithelium

• Lines oral cavity

•Keratinized or parakeratinized except in the Sulcular epithelium where it is nonkeratinized

•Contains rete pegs AKA epithelial ridges

•NO blood vessels

•More cells than extracellular matrix
Inflammatory mediators
Compounds secreted by immune cells that activate the body's inflammatory response
matrix metalloprpteinases
 Understand and be able to discuss the role of GCF in the periodontal disease process.
A thin coating of salvary protiens that attach to the tooth and form within minutes after cleaning
Process by which leukocytes engulf and digest microorganisms
the body's reaction to injury or invasion of pathogens or tissue injury
Edema fluid
Fluid that accumlates in the tissue
Simplest bacteria that can be seen through a microscope
An infected individual.  in the case of periodontitis, the host is an individual with periodontitis
Signs or sympotoms of a chronic infection at times that may partially or completely disappear
Lysosome granules that fuse within the vesicle digesting the bacterium
Periodontal pocket
pathological deepening of the gingival sulcus with apical migration of the junctional epithelium, distruction of PDL, and destruction alveolar bone
The sequence of events that occur during the development of a disease or abnormal condition
Cleft defect in the cortical bone which includes the margin of the bone.
Prominent root contour
Malalignment of teeth
Loss of attached gingiva
Severe periodontal disease
Defects of the cortical bone
Inactive disease site
Disease site that is stable
Free gingiva groove
Linear depression that separates free and attached gingiva. Clinically visible 24-43% of the time and most common in Mand. anteriors, premolars  Attached gingiva
Epithelial ridge
Deep extensions of epithelium that reaches down into the connective tissue.  The epithelia ridges are also known as rete pegs
Oral Epithelium
Epithelium that covers the outer surface of the free gingiva and attached gingiva....it extends from the gingival margin to the mucogingival junction
Keratinized Layer
Made up of Keratinized and Nonkertinized layers
Keratinized layers are stronger and waterproof
What type of tissue makes up enamel?
Anarobic bacteria
Cannot live in the presence of air
Bacterial enzymes
Agents that are harmful or destructive to host cells

increase permeability of the epithelial lining

breakdown of collegen fibers in the gingival

promote apical migration of JE

widening of the intercellular space

diminished ability of immunoglobulins and other body proteins
Gram postive bacteria
Bacteria w/ a thick single wall
Complement System
Series of proteins circulating in the blood that work to facilitate phagocytosis or kill bacteria by puncturing the cell membrane
Opsonization of pathogens
The process of coatinga microoragism with antibodies or a complement protient to make it easier for phagocytes to recognize, engulf, and destroy it.
small WBC that play an important role in  recognizing and controlling foreign invaders
Acute inflammation
Inflammation respose of 2 weeks or less
Understand and be able to discuss the role of saliva in the periodontal disease process.
Matrix metalloproteinases
12 different enzymes that breakdown connective tissue.  Produced by PMN's
A branch of anatomy concerned with the study of the microscoptic structure of tissue
Connective tissue
Fills the space between the tissues and organs in the body.  It is made up of a large amount of material that surrounds the cell
Free Gingiva
The unattached portion of the gingiva that surrounds the toothin the region of the cementoenamel junction
Gingival pocket
deeping pocket that is enlarged  due to inflammation
Alveolar crest
The most coronal portion of the alveolar process.  in health the crest is located 1 -2 mm apical to the CEJ
Gingival tissue is specialized to function in a wet environment because it is made up of......... and those 3 areas are called?
...........Stratified squamous epithelium
oral epithelial
sulcular epithelial
junctional epithelial
Name 2 types of cell junctions
Desmosomes: Cell to Cell
Hemidesmossomes: Cell to basal lamina
Extracellular slime layer
A protective layer that surriunds the microcolonies and protects them from antibodies
Tooth attached plaque
Bacteria that are attached to the tooth surface inner surface gram + , outer gram -
Distinguish between supragingival and subgingival plaque biofilm in relationship to composition, nutrient source and ease of removal.
Supragingival Above the gingival margin.
–    Can come in contact with the margin. 
–   Associated with gingivitis
–   Acquire most of nutrients from oral cavity
–   Composition:
◦       80% H2O
◦       20% solids-mainly bacteria
◦       Cocci, rods, filaments extracellular microbial products (endotoxins), salivary constituents
Subgingival: Undisturbed plaque will cause inflammation, gingival margin becomes inflamed, and sulcus deepens*. As biofilm grows deeper into the sulcus it becomes subgingival
◦       Subgingival plaque
–   Intiated by mature supra
–   Microflora more anaerobic, more gram -, more motile, more asaccharolytic
–   Nutrient source mainly from tissue breakdown, GCF
–   Inflammation DOES NOT appear until biofilm changes from mainly gram + to gram – anaerobes. 
–   Usually takes 3-12 weeks after initial formation of supragingival plaque for subgingival infestation and inflammation
Mushroom shaped microcolonies
Forms by the uneven distribution of bacteria that attaches to the surface by a stem or root
# of new disease cases in a population   that occur during a given interval.
External basal lamina
A thin mat of extracellular matrix between the epithelial cells of the JE and the gingival connective tissue
Periodontal Ligament
a layer of soft connective tissue that covers the root of the tooth it attaches it to the bone of the socket
Extracellular Ground Substance
Is a meshlike material that surrounds the cell
Epithelium-connective tissue interface

The boundary where the epithelial and connective tissue meet

Describe Alveolar mucosa
Located on the apical boundary or lower edge of the gingiva.  It can be distinguished easily from the gingiva by its dark red color and smooth shiny surface. Nonkertinized stratified squamous epithelium.  Loose, freely movable, highly vascular, made up of elastic fibers
List the 7 types of connective tissue
loose connective
bone marrow
tonsiles/lymph nodes
dental tissue(cementum, dentin, pulp)
What makes up subgingival biofilm
–   Microflora more anaerobic, more gram -, more motile, more asaccharolytic
Main cause of tissue  destruction related to periodontitis
Host response of inflammatory process
Be able to identify and discuss the 2 cells involved in the immune response that are responsible for phagocytosis
•          Polymorphonuclear (PMN) or neutrophils  and Macrophages
immune response
A complex system in the body that is responsible for fighting disease
Junctional Epithlium (JE)
Epithlium that forms the base of the sulcus and joins the gingiva to the tooth surface
Interproximal bone
The area of bone that lies between the proximal surfaces of two teeth surface.  The interproximal bone is also known as the interdental septum
What are Sharpey's fibers?
Fingerlike projections off of the PDL that adhear to the cementum and alveolar the harden when they become intrapped in the bone that forms around them
What is the CEJ %
overlap 60% cementum overlaps the enamel
meet 30% the cementum and enamel meet
gap 10% a small gap between the enamel and cementum
Of these three types of plaque whichis the easest to remove and which is the most diffucult: tooth-attached, epithelial-attached and unattached plaque?
Tooth-attached the most difficult
 Unattached plaque the easiest
What bacteria is responsible for lipopolysaccharides?
Gram - only after the lysis
Alveolar bone proper
The thin layer of bone that lines each alveolus
Apical migration of the junctional epithelium
Occurs when the PDL bundle is broken 
 Discuss the similarities and differences between acute and chronic inflammation.
Acute has symptoms and only lasts a few weeks/Chronic few to no symptoms and lasts more than a few weeks
Of the mostly extracellular matrix found in connective tissue what 2 materials make up 65% and #5% respectively? 
65% is protein fibers ie. collagen
35% gellike material
What is the benefit of a wavy boundary between epithelial and connective tissue?
Increase surface area.....
increasing adhesion
increasing nourishment
What is the hemidesmosomes in epithelial tissue around the coronal and apical portins of the teeth?
4-8 hemidesmosomes per micron in the coronal portion
2 hemidesmosomes in the apical region
Discuss the role of prostaglandins in the progression of periodontitis
Initiate most of the alveolar bone destruction in periodontitis
Trigger increased osteoclast activity
Increase the permeability and dilation of the blood vessel, leading to redness and edema of the connective tissue
Be able to discuss the signs of inflammation and how they relate to the immune response.
Heat: Increase of blood at the site
Redness: Increase blood at the area
Swelling: Fluid accumulation at the site in the form of leukocytes/plasma
Pain: Excess fluid build-up puts pressure on nerves
Loss of function: Swelling and pain
What are the functions of the periodontal ligament?
A soft connective layer of tissue that covers the root of the tooth and attaches it to the bone of the root socket.Support, sensory, nutritive, formative, resorptive
Of the 3 epithelial tissues which are keratinized and which are not?
JE and SE are nonkeratinized
OE is keratinized
Be able to identify the cytokines( cell protein) that play a role in the initiation and progression of periodontal disease.
Works as a signal to other cells to send additional phagocytic cells to the site of infectionThis increases the vascular permeability  that leads to increased movementHas the  potential to initiate tissue destruction and bone loss in chronic inflammatory disease such as periodontitisInterleukin-1 (IL-1), (IL-6), (IL-8), and tumor necrosis factor-α (TNF- α)
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