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What is periodontium? The functional system of tissues that surrounds the teeth and attaches them to the jaw bone What is the periodontium also called? "Supporting tissues of the teeth" and "the attachment apparatus" What do the tissues of the periodontium include? Gingiva, periodontal ligaments (PDL), cementum, and alveolar bone What is the gingiva? Tissue that covers the cervical portions of the teeth and the alveolar processes of the jaws What is the periodontal ligament (PDL)? Fibers that surround the root of the tooth What does the PDL attach to? the bone socket on one side and the cementum of the root on the other What is the cementum? Thin layer of mineralized tissue that covers the root of the mouth What is alveolar bone? Bone that surrounds the roots of the teeth What does the alveolar bone form that support and protect the roots of the teeth? Bony sockets What does the bony sockets help do? Support and protect the roots of the teeth What is the function of a periodontal ligament? Suspends and maintains the tooth in its socket What is the function of the cementum? Anchors the ends of the periodontal ligament fibers to the tooth so that the tooth stays in its socket What is the function of the alveolar bone? Surrounds and supports the roots of the tooth Knowledge of the periodontal tissues in health is a necessary foundation for understanding the concepts of what? Normal function of the periodontium, disease prevention, and periodontal disease process Where does the gingiva end? Coronal to the cementoenamel junction (CEJ) of each tooth How does the gingiva attach to the tooth? By a specialized type of epithelial tissue called the junctional epithelium What is the specialized type of epithelial tissue that attaches the gingiva to the tooth called? Junctional epithelium What is the gingiva composed of? A thin outer layer of epithelium and an underlying core of connective tissue What are the four anatomical areas of the gingiva? Free gingiva, gingival sulcus, interdental gingiva, and attached gingiva What is the function of the gingiva? Protects the underlying tooth supporting structures of the periodontium from the oral environment What is the oral environment exposed to? A wide range of temperatures in food and drink, mechanical forces, and a large number of oral bacteria What are some of the defense mechanisms of the gingiva? Saliva and immune system defense mechanism What is the coronal boundary of the gingiva? Gingival margin What is the apical boundary of the gingiva? Alveolar mucosa How is the alveolar mucosa distinguished from the gingiva? By its dark red color and smooth shiny surface What is the free gingival groove? A shallow linear depression that separates the free and attached gingiva What is the mucogingival junction? The clinically visible boundary where the pink attached gingiva meets the red shiny alveolar mucosa What is the free gingiva? Unattached portion of the gingiva that surrounds the tooth in the region of the CEJ What is the free gingiva also known as? The unattached gingiva or the marginal gingiva Where is the free gingiva located? Coronal to the CEJ and surrounds the tooth in a cufflike manner What does the free gingiva attach to the tooth by means of? A specialized epithelium called the junctional epithelium What is the specialized epithelium that attached the free gingiva to the tooth? Junctional epithelium Is the free gingiva directly attached to the tooth? No, it fits closely What can be used to stretch the unattached gingiva away from the tooth surface with a periodontal probe? A periodontal probe What does the free gingiva form the soft tissue wall of? The gingival sulcus The tissue of the free gingiva meets the tooth where? In an edge called the gingival margin What does the gingival margin look like? A thin rounded edge or knife edge like What does the gingival margin follow? The contours of the teeth What sort of outline does the gingival margin create? A scalloped wavy outline What is the attached gingiva? The part of the gingiva that is tightly connected to the cementum on the cervical third of the root and to the periosteum of the alveolar bone Where is the attached gingiva? Between the free gingiva and the alveolar mucosa Where is the attached gingiva widest? In the incisor and molar regions What is the range of the attached gingiva in the mandible? 3.3 to 3.9 mm on the mandible What is the range of the attached gingiva in the maxilla? 3.5 to 4.5 mm on the maxilla Where is the attached gingiva narrowest? In premolar regions What is the measurement of the attached gingiva in the narrowest regions? 1.8 mm in the mandible and 1.9 in the maxilla Where is the width of the attached gingiva not measured? On the palate Why is the width of the attached gingiva not measured on the palate? Because it is clinically not possible to determine where the attached gingiva ends and the palatal mucosa begins What concept was once believed but no longer accepted today? A minimum of 2 mm width of the attached gingiva is necessary to maintain the health of periodontium What is the color of the attached gingiva? Pale or coral pink When does pigmentation occur frequently in the attached gingiva? Dark skinned individuals What color is the pigmented areas of the attached gingiva? can range from light brown to black What is the texture of the attached gingiva? A dimpled appearance similar to the skin of an orange peel What is the dimple appearance similar to the skin of an orange peel known as? Stippling Stippling appears in what percent of adults? 40% Does stippling occur in healthy tissue? It may or may not occur, varies from individual to individual What does attached gingiva allow for? The gingival tissue to withstand the mechanical forces created during activities such as mastication, speaking, and toothbrushing What does the attached gingiva prevent from happening? The free gingiva being pulled away from the tooth when tension is applied to the alveolar mucosa What allows the gingival tissue to withstand the mechanical forces created during activities such as mastication, speaking, and toothbrushing? The attached gingiva What prevents the free gingiva from being pulled away from the tooth when tension is applied to the alveolar mucosa? Attached gingiva What is the interdental gingiva? The portion of the gingiva that fills the interdental embrasure between two adjacent teeth apical to the contact area What does the interdental gingiva consists of what? Two interdental papillae What are the two interdental papillae of the interdental gingiva? One facial papilla and one lingual papilla What are the lateral borders and tip of an interdental papillae formed by? The free gingiva from the adjacent teeth What is the center portion of the interdental papilla formed by? The attached gingva What is the col? A valleylike depression in the portion of the interdental gingiva that lies directly apical to the contact area Where is the col located? Directly apical to the contact area When is the col not present? If the adjacent teeth are not in contact or if the gingiva has receded What is the function of the intergingival gingiva? Prevents food from becoming packed between the teeth during mastification What is the gingival sulcus? The space between the free gingiva and the tooth surface What is the shape of the gingival sulcus? V-shaped, shallow space around the tooth What is the depth of a clinically normal gingival sulcus? 1 to 3 mm as measured using a periodontal probe What is the base of the gingival sulcus formed by? The junctional epithelium What is a junctional epithelium? A specialized type of epithelium that attaches to the tooth surface What is the gingival crevicular fluid? A fluid that seeps from the underlying connective tissue into the sulcular space What is another name for the gingival crevicular fluid? Gingival sulcular fluid How much fluid is found in the healthy gingival sulcus? Little or no fluid When does fluid flow increase in the gingival sulcus? In the presence of dental plaque biofilm and the resulting gingival inflammation; in response to toothbrushing, mastication, or other stimulation of the gingiva; flow is greatly increased when the gingiva are inflamed What does a filter strip do when inserted into the gingival sulcus? It absorbs the fluid in the sulcus What can the filter strip measure? The amount of gingival crevicular fluid can be measured and used as an index of gingival inflammation What is a Periotron? Used to measure how much fluid was on filter strip to indicate inflammation What is a periodontal ligament? A layer of soft connective tissue that covers the root of the tooth and attaches it to the bone of the tooth socket What is the periodontal ligament composed mainly of? Dense fibrous connective tissue Where do the fibers of periodontal ligament attach? On one side of the root cementum and on the other side to the alveolar bone of the tooth socket How does the periodontal ligament protect the tooth in its socket? The periodontal ligament not only connects the tooth to the alveolar process but also supports the tooth in the socket and absorbs mechanical loads placed on the tooth, thus protecting the tooth in its socket What are the five functions of the periodontal ligament in the periodontium? 1. Supportive function 2. Sensory function 3. Nutritive function 4. Formative function 5. Resorptive function What is the supportive function of the periodontal ligament in the periodontium? Suspends and maintains the tooth in its socket What is the sensory function of the periodontal ligament in the periodontium? Provides sensory feeling to the tooth, such as pressure and pain sensations What is the nutritive function of the periodontal ligament in the periodontium? Provides nutrients to the cementum and bone What is the formative function of the periodontal ligament in the periodontium? Builds and maintains cementum and the alveolar bone of the tooth socket What is the resorptive function of the periodontal ligament in the periodontium? Can remodel the alveolar bone in response to pressure, such as that applied during orthodontic treatment What is proprioception? Sensitive to pressure or touch What is cementum? A thin layer of hard, mineralized connective tissue that covers the surface of the tooth root What is cementum attached to? Cementum overlies and is attached to the dentin of the root What color is cementum? Light yellow in color and softer than dentin or enamel What is an important characteristic of cementum? Resistance to resorption (loss of substance) is an important characteristic of cementum that makes it possible for the teeth to be moved during orthodontic treatment What does the high resistance of cementum to resorption allows for? The pressure applied during orthodontics to cause resorption of the alveolar bone, for tooth movement, without resulting in root resorption What are the types of cementum? Acellular and cellular How does cementum receive nutrients? Cementum does not have its own blood or nutrient supply; it receives its nutrients from the periodontal ligament Why is conservation of cementum a goal of periodontal instrumentation? Because cementum performs several important roles in the periodontium What is the primary function of cementum? To give attachment to the collagen fibers of the periodontal instrumentation What does cementum anchor to the tooth? The ends of the periodontal ligament fibers What happens if there is no cementum? The tooth would fall out of its socket What is the function of the outer layer of cementum? Protects the underlying dentin and seals the ends of the open dentinal tubules What does cementum formation compensate for? Tooth wear at the occlusal or incisal surface due to attrition Cementum is formed at the apical area of the root to compensate for what? Occlusal attrition What is another name for alveolar process? Alveolar bone What is alveolar process? The bone of the upper or lower jaw that surrounds and supports the roots of the teeth What is alveolar bone composed of? Mineralized connective tissue and consists, by weight, of about 60% inorganic material, 25% organic material, and about 15% water What is the existence of the alveolar bone is dependent on? The presence of teeth What happens when teeth are extracted? Alveolar bone resorbs What happens if teeth do not develop? Alveolar bone does not develop What is the function of alveolar bone in the periodontium? Alveolar bone forms the bony socket that provide support and protection for the roots of the teeth What tissues is the alveolar process composed of? Three layers of hard tissue and covered by a thin layer of connective tissue What is the alveolar bone proper? The thin layer of bone that lines the socket to surround the root of the tooth What is another term for alveolar bone proper? Cribriform plate, lamina dura in radiographs What is the alveolus? The bony socket, a cavity in the alveolar bone that houses the root of a tooth What do the numerous holes in the alveolar bone proper allow for? Blood vessels from the cancellous bone to connect with the vessels of the periodontal ligament space What is embedded in the alveolar bone proper? Ends of the periodontal ligament fibers What is the cortical bone? A layer of compact bone that forms the hard, outside wall of the mandible and maxilla on the facial and lingual aspects What does the cortical bone surround? The alveolar bone proper and gives support to the socket Where is the buccal cortical bone thin? In the incisor, canine, and premolar regions Where is the cortical bone thick? In molar regions Why won't the cortical plate appear in radiograph? Because it is only on the lingual and facial sides of the jaw Which bones can be seen in a radiograph? cancellous bone and alveolar bone proper What is the most coronal portion of the alveolar process? Alveolar crest In health, where is the alveolar crest located? 1 to 2 mm apical to the CEJ of the teeth When viewed from the facial or lingual aspect, how does the alveolar crest appear? The alveolar crest meets the teeth in a scalloped/wavy line that follows the contours of the CEJs What is another name for cancellous bone? Spongy bone What is cancellous bone? The latticelike bone that fills the anterior portion of the alveolar process Where is the cancellous bone oriented? Around the tooth to form support for alveolar bone proper What is the function of cancellous bone? To form support for alveolar bone proper What is periosteum? A layer of connective soft tissue covering the outer surface of bone What does the periosteum consist of? An outer layer of collagenous tissue and an inner layer of fine elastic fiber