Attached gingiva is narrowest where?
Premolar region
Is the attached gingiva measured on the palate?
No because its hard to distinguish from the palatal mucosa
What is the oral epithelium?
covers the outer surface of the gingiva
What is the sulcular epithelium?
lines the gingival sulcus, thin non-keratinized
What is the junctional epithelium?
forms the base of the sulcus, and attaches the gingival epithelium to the tooth
What fibers get distorted during gingivitis?
gingival connective
What are the functions of gingival fiber bundles?
1. brace the free gingiva firmly against the tooth
2. reinforce JE attachment
3. withstand chewing
4. unite free gingiva with the cemntum
5. connect adjacent teeth to each other
What are the 4 gingival fiber groups?
1. circular
2. alveologingival
3. dentogingival
4. periostogingival
What fibers are regenerated continuously across the crest of the bone?
transeptal
What are the 5 periodontal fibers
1. Alveolar crest
2. Horizontal
3. interradicular- only in multirooted teeth
4. Oblique- most numerous
5. Apical
Cementum has one of three relationships with the enamel of the crown, what are they?
1. Overlap- 60%
2. Meets- 30%
3. Gap- 10%
OMG
What is a healthy gingival sulcus?
JE attaches along its entire length to the enamel of the tooth
What is a gingival pocket?
A deepening of the gingival sulcus as a result of inflammation, the coronal portion of the JE detaches from the tooth resulting in a slight increase in probing but there is no apical migration of the JE
What is a periodontal pocket?
A pathologic deepening of the gingival sulcus as a result of apical migration of the JE, destruction of the perio ligament fibers, and destruction of alveolar bone
What are the two types of periodontal pockets?
Infrabony and suprabony
Suprabony pocket
Occurs when there is horizontal bone loss, JE is coronal to the crest of the alveolar bone
Infrabony pocket
Occurs when there is vertical bone loss, JE is apical to the crest of the alveolar bone, base of pocket is within the cratered out area
What is attachment loss?
the destruction of the fibers and alveolar bone
What is an active disease site?
shows continued apical migration of the JE over time
What is an inactive disease site?
a disease site that is stable with the attachment level of the JE remaining at the same level for a period of time
Does the presence of a periodontal pocket mean there is active disease?
No, most adult patients have inactive sites, a pocket is an indicator of past destruction
What does BOP mean?
bleeding from ulcerated soft tissue wall of the periodontal pocket, can occur immediately or be delayed
Exudate is also called
supperation or pus, represents dead WBCs and infections, does not mean attachment loss is next
What is the alveolar bone in health?
2mm apical to the CEJ
What is the alveolar bone in gingivitis?
2mm apical to the CEJ
Horizontal bone loss
practically even reduction in bone height and is most common
Vertical bone loss
less common, uneven reduction of bone height, trenchlike area of missing bone, occurs in more aggressive diseases
What are the two variations of normal bone structure?
dehiscense- resorbed area of bone over the facial surface of root
fenestration- an opening or window in the bone covering the facial surface of a root
What is the pathway of bone loss in horizontal?
gingival tissue, alveolar bone, perio ligament
What is the pathway of bone loss in vertical?
gingival tissue, PDL space, bone
occurs when the crestal perio ligament fibers are weakened and no longer can act as an effective barrier to inflammation
One wall intrabony defect
characterized by number of walls left
Two wall intrabony defect
three wall intrabony defect
The one you want if you had to choose
Interproximal osseous crater
common within families
MOST COMMON TYPE OF BONE LOSS CREATED BY PERIODONTITIS
Where does the attached gingiva extend?
the base of the sulcus to the mucogingival junction
How do you measure the width of the attached gingiva?
subtract the probing depth from the CAL
What is the most accurate indicator of the perio support around a tooth?
CAL
Horizontal tooth mobility
movement in the facial to lingual direction
Vertical tooth mobility
tooth up and down in socket
When does vertical mobility start?
Grade 3
What is fremitus?
individual tooth movement during biting
What is pathological migration of teeth?
teeth move due to loss of attachment
Can trauma from occlusion cause periodontitis?
No, need inflammation but it can make it go down quicker
How does healing occur?
Long JE