Spring - Perio I Flashcards

Health Care
Terms Definitions
cell eaters
Partially Keratinized
Periodontal pathogens
Interdental papilla
Lipopolysaccaride (LPS)
A major component of the gram - bacteria
the LPS is onlt relaesed when the cell dies and the wall is broken up
The host reposes to this is what causes tissue destruction
Interdental gingiva
 AKA....interdental papillae.
Consists of facial and lingual papillae
Lateral borders and tip: free gingiva

 Center portion: attached gingiva

B lymphocytes
plasma cells---secreting antibodies
coat bacteria flagging them for for phagocytosis
Know the different classifications of bacteria based on their O2 requirements. 

Harmful proteins released from the bacterial cell that act on the host from a distance. 
 IE. Aa Actinobacillus actinomycetemcomitans
A specialized cell junction that connects  the epithelial cells to the basal lamina
Collagen fibers
Extracellular matrix
a dense network of strong, ropelike cables that secure and hold the gingival connective tissue together
smallest structural unit of living matter capable of functioning independently
100 trillion in the human body
Connective tissue
•AKA lamina propria •Beneath epithelium•Connective fibers•Fibroblasts•Blood vessels•Ground substance•More extracellular matrix than cells
Describe Masticatory mucosa
Kertinized stratified squamous epithelium.  Lighter shade of pink covering the hard palate.  Its also part of the periodontal ligament.
Bacterial blooms
Periods when specific groups of bacteria grow rapidly
found with in families with highly aggressive periodontal disease
Name 2 moderately pathogenic bacteria
Prevotella intermedia
Campylobacter rectus
Bacterial plaque
Biofilm that adheres tenaciously to teeth, restorations, prothetic appliances
Name 5 slightly pathogenic bacteria
Stretococcus intermedius
Prevotella nigrescens
Peptostreptococcus micros
Fusobacterium nucleatum
Eubactium species
Eikenella corrodens
A well organized community of bacteria that adheres to a surface and is embedded in a extracellular slime layer
Bacteria that connect to the pellicle and each other with hundreds of hairlike structures
The body's reaction to injury or invasion by disease-producing organism
mucogingiva junction
the clinically visible boundary where the pink attached gingiva meets the red, shiny alveolar mucosa
 Study of health and disease and associated factors in human populations*
Cancellous bone
AKA Spongy Bone.  The latticelike bone that fills the interior portion of the alveolar process.  Found between the cortical bone and the cortical bone and the alveolar bone proper
The joining together of blood vessels to create a complex system of vessels
The tissue that covers the cervical portions of the teeth and the alveolar processes of the jaws.  it is composed of a thin layer of epithelium and an underlaying core of connective tissue
Connective Tissue Papillae
Fingerlike extensions of connective tissue that extends up into the epithelium
The dimpling appearance, similar to an orange peal, that may be visible on the surface of the attached gingiva
Sulcular Epithelium
Epithelial lining of the gingival sulcus.... it extends from the crest of the gingival margin to the coronal edge of the JE
Keratinized Layers
No nuclei, tough, resistant,  the more keratinization the more wear the tissue gets ie. palms, soles. ect.
Supragingival Fiber Bundles
Gingival fibers-the network of ropelike collegen fiber bundles located cornal to above the crest of the alveolar bone
What 3 cells make up the PDL?
Gingival connective tissue is also known as.........
lamina propria
Epithelial attached plaque
Bacteria attached to epithelium most detrimental tot he periodontal tissue.
Motile gram - & spirochetes
Porphyromonas gingivalis
Can distroy gingiva and alveolar bone by entering at the JE and multiplying
Name 4 exotoxins and explain why exotoxins or harmful
Chondroitin sulfatase
These act on the host cells at a distance by releasing cytotoxic agents
T lymphocyte
Intensify the response of their immune cells
Leukocytes that play a vital role in combating the pathogenic bacteria responsible for periodontal disease
Sings and symptoms may recur in all their severity in an active period of disease
What types of bacteria are associated with calculus?

Streptococus sanguis

Actinomyces visosus

These are generally gram + on the inner care and gram -  the outer core.  Usually attached by calculus formation and root caries
Gram- negative bacteria
Bacteria with a double cell wall
Extracellular matrix
A meshlike material that surrounds a cell.  This material helps to hold cells and tissue together and provides a medium within which cells can migrate and interact with one another
Active disease site
disease state that shows continued apical migration
Bony socket. A cavity in the alveolar bone that houses the root of the tooth
Factors involved in the development of a disease.
What 3 things compose connective tissue
fibroblasts: fiber builders
macrophages/neutrophils: phagocytes 
lymphocytes: immune response
Host immune response
the reactions of the immune system that guard the body against infective microorganisms
what 3 bacteria can directly invade epithelial tissue?
P. gingivalis
Treponema denticola
Name the three types of biofilm attachment
tooth attached
epithelial attached
What types of bacteria are generally found in unattached plaque?

free floating biofilm-bacteria

usually found at the bottom of a pocket surounded by leukocytes
Periodontal ligament
Is a thin sheet of fibrous connective tissue located between the tooth and its bony socket.  Attaches the tooth and the bony wall of the tooth socket
Dentogingival fiber bundles
made up of JE and gingival fibers
provide structral support to the gingival tissue
Epithelial tissue
 makes up the outer surface of the body (skin) and line of the body cavities such as the mouth
Cortical Bone
The bone that forms the hard, outside wall of the mandible and max. on the facial and lingual aspects
Stratified squamous epithelium
A type od epithelium that comprises flat cells arranged in several layers
Gingival sullcus
Space between the free gingiva and the tooth surface
Recognize the different areas of the gingival
Free gingival…unattached
Gingival sulcus
 Interdental gingiva
Attached gingival
Normal gingival
Fenestration vs. Dehiscence
Fenestration: A round or oval defect or opening in the alveolar cortical plate of bone over the root surface caused by normally defect of bone during formation, can be related to osteoporosis, poor quality, health bone relationshipDehiscence: Cleft defect in the cortical bone which includes the margin of the bone caused by: Prominent root contour, malalignment of teeth, loss of attached gingiva, severe periodontal disease, abscess, cyst, defects of the cortical bone
What types of bacteria area associated with epithelial-attached plaque?

P. gingivalis


gram - and spirochetes

Name and distinguish between the 3 inflammatory mediators that play an important role in periodontal disease.
Cytokines: (cell protein)Recruit neutrophils and macrophages to come and join the “infection party”. Transmits signals and helps with communicationIncrease vascular permeabilityCan initiate tissue destruction and bone loss in chronic inflammatory diseases.Cytokines involved in periodontitis IL-1IL-6IL-8Tumor necrosis factorProstaglandin: Important in bone loss associated with periodontitis Increase vascular permeability and vasodilation Promote the overproduction of MMP’s Major mediators of alveolar bone loss Trigger osteoclastic activityNeutrophils Macrophages—main source from inflamed periodontal tissuesGingival fibroblastsMatrix metalloprotienases: They are 12 different enzymes that act together to break down the connective tissue matrixProduced by:Neutrophils and gingival fibroblasts are the biggest sourcesMacrophages, junctional epithelial cells  
What type of bacteria makes up the Unattached plaque?
◦       Free floating
◦       Gram – rods and spirochetes
Basal cell Layer
A thin tough sheet that separates the epithelial tissue from the underlying connective tissue.
It rests on a supporting bed of connective tissue
Sharpey's Fibers
Where the ends of the PDL fibers that are embedded in the cementum and alveolar bone attach.  The LITTLE fingers at the end of the PDL that attach to the alveolar bone and the cementum covering the dentin
Understand the difference between “thin” vs. “thick” tissue and the implications
Thick-The attached gingiva is widest in the incisor and the molar regions
 3.3 – 3.9mm Mand
3.5 – 4.5mm Max

Thinest-The attached gingiva is the thinnest at the premolar area

1.8mm mand
 1.9mm maxThe attached gingiva is not measured on the palate since its impossible to determine where the attached gingiva ends and the palate mucosa begins
What is cementum?
a calcified layer that covers the root surface
What are the names of the 5 fibers that make up the PDL?
Alveolar crest
Discuss virulence factors and how biofilm distance applies to periodontal pathogens.
This consistent distance between the biofilm and the crest of the alveolar bone indicates that the bacteria are capable of causing bone destruction only in alveolar bone located less than 3mm away from the dental plaque biofilm
Membrane attack complex
A protein unit that is part of the body's immune system and is capable of puncturingthe cell membranes of certain bacteria
Alveolar bone
alveolar process
The bone of the upper or lower jaw that surrounds and supports the roots of the teeth
Distinguish between free and attached gingival
The unattached portion (free gingiva) of the gingival that surrounds the tooth in the region of the cementoenamel junction (CEJ) this area is also known as the unattached or marginal gingival.  The free gingiva is made up of gum tissue between the gingival margin and the free gingival groove on the outer surface.  The outer surface that can be seen is called the free gingival well the inner surface is the sulcus.The attached gingiva is the part of gingiva that is tightly connected to the cementum on the cervical 1/3 of the root and to the periosteum (connective tissue that covers the alveolar bone).  The attached gingiva lay’s between the free gingiva and the alveolar mucosa.
What type of bacteria would you ass. with Epithelial-attached ?
AKA-epithelium associated plaque,
◦       Closest to the tissue will have gram-bacteria and spirochetes. ◦       Examples:  P. gingivalis, A. A.,
In health the interface between both the sulcular epithelium and junctional epithelium and the connective tissue is....?
Smooth with no wavy epithelial ridges
What is the biggest difference between epithelial tissue and connective tissue as far as tissue layout goes?
epithelial tissue is composed of mostly cells with just a few extracellular matrix
connective tissue is composed of mostly extracellular matrix (95%) and just a few cells(5%)
What makes up the inner and outer tooth-attached plaque and where is it gen. found?
◦       Attach to the tooth from the gingival margin apically and is associated with calculus formation and root caries
◦       Inner core mainly gram+.  Examples:  streptococcus sanguis, actinomyces viscosus
◦       Apical portion dominated by gram- rods with some filaments present.
Where would you find the internal basal lamina and the external basal lamina?
internal would be against the teeth external would be towards the connective tissue
Know the distance that biofilm and calculus can be from the alveolar to cause destruction.  Be able to apply this principle.
Distance from biofilm to the bone is never less than .5mm and never more than 2.7mm
These parameters limit the destructive ability of bacterial toxins on the bone
Recognize stippling and explain why it has the appearance
In healthy attached gingiva may have a dimpled appearance.  Healthy tissue may or may not appear stippled.  This is caused by the presence of the connective fibers that attach the gingival tissues to the cementum and bone.
Why is the gingiva not measuredon the palate?
 The attached gingiva is not measured on the palate since its impossible to determine where the attached gingiva ends and the palate mucosa begins
Discuss the 3 main functions of the complement system in relationship to periodontal disease.  Which one is considered the most important and why.
The Complement system is a series of proteins and glycoproteins in the blood that work to facilitate phagocytosis or kill bacteria directly by puncturing the bacterial cell wall.The complement system has 3 main functions: Recruitment of additional cellular defenders, opsonization of pathogens, direct killing(lysis) of bacterial (membrane attack complex)Opsonization of pathogens (the process of coating the surface of the bacterium so that phagocytes can recognize, engulf and destroy the bacterium).  Recruitment of additional phagocytic cells to the infection site Creation of the membrane attack complex, a protein unit which is capable of puncturing the cell membrane of certain bacteria.  This is done by forming pores in the cell membrane of these certain bacteria, a task accomplished by the membrane attack complex
Know the different aspects of the alveolar bone
Bone of the upper and lower jaw that surrounds and supports the roots of the teeth.  Dependent on the presences of teeth forming the dental sockets.  Made up of three layers alveolar bone or cribriform plate and 1 layer of connective tissue.
 1. alveolar bone proper
2. Cortical bone
3. Cancellous bone
4. Periosteum
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