ORAL MUCOSA REVIEW

What are the three types of oral mucosa?

ORAL MUCOSA REVIEW: masticatory mucosa

1. Masticatory mucosa is the external cover to what oral structures?

2. In health, masticatory mucosa is attached? [*Except one location is not attached, where?]

3. Keratinized Statified Squamous Epitherlim with underlying CT = ?

1. External cover of gingiva & hard palate

2. Attached in health to underlying bone, except the free gingiva

3. lamina propria

ORAL MUCOSA REVIEW: specialized mucosa

1. Specialized Mucosa is located where in the oral cavity?

2. Is specialized mucosa non-keratinized, parakeratinized, or keratinized? [choose all that apply]

1. Dorsum of the tongue

2. Parakeratinized, keratinized

ORAL MUCOSA REVIEW: Lining Mucosa

1. What oral structures make up the lining mucosa?

2. True or False: Lining Mucosa is attached to underlying alveolar bone

3. Nonkeratinized epithelium with underlying CT = ?

1. Alveolar mucosa, inner lips, cheeks, vestibules, soft palate, sulcus

2. False: Lining mucosa is not attached to underlying alveolar bone

3. Lamina propria

Gingival Boundaries

1. What is the upper edge [coronal] gingival boundary?

2. What is the lower edge [apical] gingival boundary?

1. Coronal- gingival margin

2. Apical- alveolar mucosa/mucogingival junction/line

Gingiva

1. True or False: All attached gingiva is keratinized BUT not all keratinized gingiva is attached to bone/tooth.

2. Is free gingiva keratinized/nonkeratinized?

3. Does free gingiva attach to underlying bone/tooth?

4. What is the definition of clinical attachment loss? 

1. TRUE

2. Free gingiva= keratinized

3. free gingiva= NOT attached to underlying tooth/bone

4. In areas of disease, keratinized gingiva is no longer attached to cementum

Gingiva Cont.

1. In health, attached gingiva is keratinized epithelium with underlying CT [Lamina Propria] that is firmly attached to what underlying structures?

2. Where is the bottom of the sulcus/start of attached gingiva?

3. What percent of adults have a free gingival groove that marks the area? [Around what teeth is this most common?]

4. Attached gingiva extends apically to where and is marked by what landmark in the oral cavity?

1. Firmly attached to the cementum & alveolar bone & slightly on the enamel

2. Attached gingiva starts at the end of the free gingiva at the epithelial clinical attachment [AKA bottom of sulcus]

3. 30-40%; most common in MN anteriors & premolars

4. Extends apically to alveolar mucosa marked by the mucogingival junction/line [except in max lingual]

Gingiva Cont. : "Attached gingiva" no longer attached

1. Is the attached gingiva still keratinized epithelium with underlying CT [lamina propria] in disease?

2. BUT, part of it is no longer attached to cementum...this is defined as what type of loss? 

1. YES

2. Clinical attachment loss

Keratinized Gingiva

1. In health, what is the range of width of keratinized gingiva?

2. What are some factors that contribute to the width of keratinized gingiva?

3. Facially, where is the keratinized ging. widest/narrowest?

4. Lingually where is the keratinized ging. widest/narrowest?

1. 1mm - 9mm in health

2. frenum & muscle attachments, recession, self-care

3. Facially: widest = incisor region & narrowest = 1st premolar

4. Lingually: widest = molar region & narrowest = incisor region

Keratinized Gingiva Cont.

1. What is a "tension test"?

2. When must the keratinized gingiva be recorded as inadequate in a tension test?

3. When must the keratinized gingiva be recorded as limited during a tension test?

1. In clinic, a tension test is done in the areas of the frena

2. An area of 1 mm or less of keratinized gingiva must be recorded at inadequate

3. Ares of 1 mm/less NOT by frena or in an area where there is apparent recession [especially if there is poor biofilm control] should be recorded as limited.

Determine how much Keratinized Gingiva is Attached Gingiva

1. Are changed in the width due to the coronal end receding or the mucogingival line receding?

2. What is the TRUE attached gingiva measurement?

3. What does it mean if the probe extends beyong the MGJ?

1. Changes in width are due to the CORONAL end receding

2. True attached gingiva measurement = keratinized gingiva amount minus the probing depth

3. Mucogingival Involvement/Problem

Free Gingiva

1. In health, where is free ging. located?

2. True or False: Free gingiva fits loosely around the tooth and not attached in health

3. What instrument do we use to pull the free gingiva away from the tooth?

4. Forms the soft tissue wall of what structure?

1. Located coronal to the CEJ in health

2. FALSE: fits snugly around the tooth but is not attached

3. Probe

4. forms soft tissue wall of the gingival sulcus

Free Gingiva Cont.

1. Is the external surface keratinized or non-keratinized epithelium?

2. Is the inside wall keratininzed or non-keratinized?

3. Does the free gingiva have underlying CT?

4. Can the free gingiva be stippled?

5. What two measurements make up the width of keratinized tissue?

1. External = keratinized

2. Inside = nonkeratinized

3. Yes

4. Smooth, never stippled

5. Width of keratinized tissue = free + "attached" gingiva

Papillae

1. Does papillae have both free & attached gingiva?

2. What attaches papillae to tooth?

3. Shape is determined by what factor? Generally, papillae is shaped how in the anteriors vs. posteriors?

4. Which part of the triangle is attached gingiva, which part is free gingiva?

5. Which part of the papillae can be stippled? 

1. Yes

2. Attached to tooth by junctional epithelium & underlying CT

3. Shape determined by dimensions of the embrasure space [detemined by tooth alignment]; Generally, triangular shape in anteriors and more broad in the posteriors

4. Attached gingiva = internal part of triangle, Free gingiva = external portion

5. Internal part= may be stippled, External part = never stippled

COL

1. What is the col area?

2. Is the col keratinized or non-keratinized?

3. If there is no adjacent tooth, does col/papilla exist?

1. Col area is the slight depression of tissue between the buccal & lingual papillae, generally not prominent in the anterior region

2. Non-keratininzed

3. There is no col or papilla if no adjacent tooth, there is only keratinized "attached" gingiva

Stippling

1. Clinically, keratinized gingiva may/may not be stippled with the exception of where?

2. When would the absence of stippling indicate disease?

3. Why is fibrotic tissue usually stippled?

4. Stippling occurs in what % of adults? Abscent in kids under what age? Greatest/least in what regions? 

1. Free gingiva is never stippled

2. If stippling was previously present and inflammation has caused the abscence

3. Due to chronic disease and oral manifestations of medications or systemic conditions

4. 40% of adults; absent in kids under 5; greatest in the anteriors/facials generally more than linguals, absent in the molars

Stippling Cont.

1. Histologically, what is the only place in health that has epitherlial ridges that extend ingto the CT [AKA lamina propria]?

2. Intersections between the ridges correspond to what feature?

3. CT extensions that mix in with the epithelial ridges are called what?

1. only the oral epithelium has connecting epitherlial ridges that extend into the CT

2. corresponds to stippling

3. CT papillae

Wavy vs. Smooth Boundary

1. What tissues are wavy in health?

2. What tissues are not wavy in health?

1. Oral epithelium & CT

2. Sulcular & Junction epithelium

Stippling Cont.

1. What are the main functions of stippling?

2. Epithelium is avascular and must obtain its blood and nutrient supple through what?

1. Increase the strength between the epithelium & CT, enhance blood supply to the epithelium from the CT

2. From the CT

Oral Epithelium

1. Oral epithelium covers what?

2. Extends from where-to-where?

3. Is oral epithelium keratinized, parakeratinized, or non? [choose all that apply]

4. Histologically, the oral epithelium resembles what oral structure?

5. True or False: Interface with CT is usually wavy in health and disease

1. free gingiva and attached gingiva

2. extends from crest of ging. margin to mucogingival junction

3. keratinized and partially keratinized

4. resembles the hard palate

5. TRUE

Sulcular Epithelium

1. Where is sulcular epi located?

2. Extends from where to where? This is also known as what level?

3. Thin/Thick Keratinized/Nonkeratinized?

4. Is sulcular epi permeable?

5. In health, is it smooth or wavy interface with CT?

1. Epithelial lining of gingival sulcus

2. Extends from crest of gingival margin to coronal edge of JE; AKA Epithelial attachment or Clinical attachment level [CAL]

3. Thin and nonkeratinized

4. Yes, Fluid flows from CT to sulcus and vise verse...critical in the disease process

5. smooth interfact with CT in health

Gingival Sulcus

1. What is the gingival sulcus?

2. In health, usually what measurement?

3. What forms the base of the sulcus?

4. What is gingival crevicular/sulcular fluid?

5. How much fluid in health? 

6. What increases the flow of fluid?

1. Space b/t free gingiva & tooth

2. In health, usually (.5) 1-3 mm probing depth [varies depending on whether it's interproximal/facial&lingual

3. Base formed by JE

4. Fluid that comes from underlying CT

5. In health: Little to none

6. Increases with disease, provocation: TB/interproximal cleaning, mastication, etc.

Junctionial Epithelium

1. Located where in relation to the CEJ?

2. The most coronal aspect is where in relation to the CEJ?

3. The bottom of the sulcus = what level?

4. How many days for the cells to turnover?

5. Keratinized/ non?

1. Located coronal & apical to CEJ

2. The most coronal aspect is at or coronal to the CEJ about .5 mm

3. Epithelial attachment/ clinical attachment level

4. 4-7 days

5. Nonkeratinized

Junctional Epithelium

1. In health, how many mm long?

2. True or False: JE has a smooth interface with CT in health

3. Composed of what type of cells?

4. What is the function of hemidesmesomes?

5. What is the function of desmosomes?

1. .25, 1.35 mm long

2. TRUE

3. special epithelial cells, basal lamina, and hemidesmesomes

4. Adhere to tooth protecting the attachment of the surrounding tissues to the tooth

5. Attach epithelial cells to other epithelial cells

Junctional Epithlium cont.

1. Is JE more or less permeable to cells & fluid than the oral epithelium?

2. This creates a route for cells & fluid from the CT to the sulcus, why is this very critical in the disease process?

1. More permeable [it is a semi-permeable membrane] 

2. Bacteria can also flow from sulcus to CT

Connective Tissue/Lamina Propria

1. The CT component underneath the gingival epithelium is composed of 60% ---?--- fibers

2. The collagenous tissue gives the gingiva what qualities?

1. collagen fibers

2. resilience & firmness

Connective Tissue/Lamina Propria

1. What is the majoy cell that makes up CT?

2. What are some of the cell types that come up through the blood supply from the CT [lamina propria]

3. What is the extracellular matrix?

1. Fibroblasts

2. undifferentiated mesenchymal cells, mast cells, lymphocytes, macrophages, polymorphonuclear leukocytes [PMNs]

3. Gel-like material that holds the tissue together; essential for normal function; transportation of H2O, nutrients, and oxygen

Gingival Fibers

What are gingival fibers?

Classification of Fiber Groups

1. What are AG fibers? What is their function?

2. What are C fibers? What is their function?

3. What are DG fibers? What is their function?

4. What are PG fibers? What is their function?

5. What are TG fibers? What is their function?

1. AG = Alveologingival; periodsteum of crestal bone to CT

2. C = Circular; encircles free gingiva

3. DG = Dentogingival; cementum to CT

4. PG = Periostogingival; Periosteum to gingiva

5. TG = Transseptal; Interdental cementum of one tooth, across crestal bone to cementum of adjacent tooth

Attachment Apparatus

What three components of the periodontium make up the attachment apparatus?

Periodontal Ligament PDL

1. TRUE or FALSE CT is primarily filled with collagen fiber bundles & cells

2. What is the function of fibroblasts?

3. The PDL provides biologic activity for what structures of the periodontium?

4. The PDL fills what space? How does this appear on a radiographic image?

1. TRUE

2. The majority of the cells in CT; synthesize collagen [& collagenase] that perform an important formative function for the tissues

3. Forms layers for cementum [cementoblasts] & bone [osteoblasts] providing biologic activity

4. Fills a space [PDL space] between tooth & bone; radiolucent on radiographs

PDL

1. What does the absence of PDL result it?

2. Is the absence of PDL an issue involved with disease destruction?

1. Ankylosis

2. This anatomical issue is NOT one of disease destruction

Fiber Bundles of PDL

What are the five types of fiber bundles of the PDL?

Alveolar Crest Fibers

1. Alveolar crest fibers extend from where to where?

2. In which direction are they positioned?

3. This fiber group resists what type of tooth movements?

4. How does periodontitis affect these fibers?

1. Extend from cementum to alveolar bone at the most cervical third

2. Run downward in a diagonal direction to alveolar crest

3. Fiber group resists horizontal tooth movements

4. First fibers to be damaged in periodontitis

Horizontal Fibers

1. Where are horizontal fibers located?

2. Extend from where to where?

3. This fiber group resists what type of forces?

1. Located apical to the alveolar crest fibers

2. Extend from cementum to bone at right angles to long axis of root

3. Fiber group resists horizontal pressure against crown of tooth

Oblique Fibers

1. Located where?

2. Extend in what direction?

3. These fibers resist what type of pressure?

4. How are they affected by periodontitis?

1. Located apical to horizontal group

2. Extend from cementum to the bone running diagonally

3. Fiber group resists vertical pressures that threaten to drive the root to its socket

4. The most abundant and the most damaged in periodontitis

Apical Fibers 

1. Extend from where to where?

2. Fiber group resists what forces?

1. Extend from apex of tooth to bone

2. Fiber group secures tooth in its socket and resists forces that might lift the tooth from its socket

Interradicular Fibers 

1. Only on what type of teeth?

2. Extends from where to where?

3. Fiber groups functions how?

1. multi-rooted teeth

2. extends from cementum in furcation area of tooth to interradicular septum of alveolar bone

3. fiber groups help stabilize tooth in its socket

Sharpey's Fibers

What are Sharpey's fibers?

Cementum 

1. What is cementum?

2. What is cementoid?

3. Cementum contains what type of fibers?

4. Cementum acts as an attachment for what?

1. calcified structure, produced by elements in the PDL, that is .1 mm thick near CEJ & > .5 mm at the apex

2. the precementum that is still uncalcified

3. contain's sharpey's fibers, embedded in the cementoid

4. is the attachment forr the fiber bundles from the PDL

Cementum 

1. True or False: The surface is non-permeable which allows bacterial byproducts & toxins to [easily but not deeply] penetrate

2. Past vs. current theories on removal of cementum?

3. How does cementum get its nutrients?

1. TRUE

2. Past: removal of cementum to glassy/smooth surface promoted healing; Current: removal of surface necrotic cementum/surface roughness facilitates reattachment to the tooth surface...over instrumentation on cementum is detrimental to the health of the periodontium

3. from the PDL

Cementum 

1. Which portion of the cementum is cellular vs. acellular?