1What is the purpose of the gingiva?
To protect underlying tooth structures and provide a seal around the tooth
2What is the unattached gingiva coronal to the CEJ called?
Free gingiva
3What is the space between the free gingiva and the tooth surface called?
Gingival Sulcus
4What forms the base of the sulcus?
JE
5What is contained within the gingival sulcus?
GCF
6What is located between free gingiva and the alveolar mucosa where stippling may be present?
Attached Gingiva
7What structure contains the col?
Interdental Gingiva
8What is the line that separates the attached gingiva from the alveolar mucosa?
Mucogingival Junction
9What happens to the production of GCF in the presence of disease?
Increases
10What is the layer of dense connective tissue that covers the root of the tooth and attaches it to the bone?
PDL
11What are the 5 main functions of the PDL?
Supportive, Sensory, Nutritive, Formative, and Remodeling
12What structures make up the periodontium?
Gingiva, Periodontal Ligament, Cementum, and Alveolar Bone
13What are the functions of the cementum?
Attachment from the PDL to the tooth, Protects Dentin and Seals Dentinal Tubules, Compensates for tooth wear due to Attrition
14How does the cementum attach the PDL to the tooth?
Sharpey Fibers
15What is the bone of the upper or lower jaw that surrounds and supports the dentition?
Alveolar Bone or Alveolar Process
16What happens to the alveolar bone when a tooth is extracted?
Bone is lost
17What are the 3 layers of the alveolar process?
Alveolar Bone Proper, Cortical Bone, and Cancellous Bone
18What is another name for the alveolar bone proper?
Cribriform Plate
19What is another name for the cortical bone?
Cortical Plate
20What are the alternative names for the cancellous bone?
Trabecular or Spongy Bone
21What layer of the alveolar process is the thin layer of bone that lines the socked surrounding the roots of teeth?
Alveolar Bone Proper or Cribriform Plate
22What layer of the alveolar process is the layer of compact bone that forms the outer wall on the facial and lingual aspects of the tooth?
Cortical Bone/Plate
23What is the lattice-like bone that fills the inner portion of the alveolar process?
Cancellous or Trabecular or Spongy Bone
24What is the layer of connective tissue covering the outer surface of the bone?
The Periosteum
25What happens to the periodontium in response to disease activity?
Proliferation
26What is the pale yellow liquid that oozes from a pocket in case of infection?
Exudate, Suppuration, or Pus
27What is exudate made up of?
Dead White Blood Cells
28How much movement is present Class I mobility?
Up to 1 mm horizontally in a facial-lingual direction
29How much movement is present in Class II mobility?
Greater than 1mm, but less than 2mm of horizontal displacement in a facial-lingual direction
30How much movement is present in Class III mobility?
Greater than 2mm displacement in a facial-lingual direction OR depressible into the socket
31In which furcation class is the curvature of concavity felt with a probe tip that enters no more than 1mm?
Class I
32In which furcation class does the probe enter more than 1mm into the furcation, but does not pass through?
Class II
33In which furcation class does the probe pass completely through the furcation?
Class III
34In which furcation class is the entire entrance to the furca clinically visible and recession is present?
Class IV
35What is the normal position of the free gingival margin?
SLIGHTLY coronal to the CEJ
36What is the position of the Free Gingival Margin in case of Gingival Enlargement?
Significantly coronal to the CEJ
37Where is the Free Gingival Margin Located in case of recession?
Apical to the CEJ
38What notation is used when the FGM is slightly coronal to the CEJ?
(O)
39What notation is used when the FGM significantly covers the CEJ?
(-)
40What notation is used when the FGM is apical to the CEJ?
(+)
41How is the CAL calculated?
Probe Depth + Recession OR Probe Depth±Gingival Margin Level
42If the gingival margin is significantly coronal to the CEJ do you add or subract the Gingingival Margin Level when calculating CAL?
Subract
43If the gingival margin is receded do you add or subract the Gingingival Margin Level when calculating CAL?
Add
44How do you calculate the width of the attached gingiva?
Subract the Probe Depth from the total width of the gingiva
45How much attached gingiva should be present for periodontal health?
At least 2-3mm
46Why is the width of attached gingiva not measured on the palate?
There is no Mucogingival Junction
47What are the 3 classes of periodontitis?
Necrotizing Periodontal Diseases, Periodontitis, Periodontitis as a Manifestation of Systemic Disease
48What is periodontitis?
Irreversible Tissue Damage
49When should you stage and grade a patient?
If a patient has active periodontitis or a history or periodontitis
50Does staging or grading classify the extent of perio?
Staging
51Does staging or grading indicate the risk of perio progression?
Grading
52When is a patient considered to have periodontitis?
Interdental CAL detectable at 2 or more non-adjacent teeth OR buccal or lingual CAL of 3mm or more with pocketing of more than 3mm detectable at 2 or more non-adjacent teeth. CAL cannot be due to traumatic forces, careis, WT ext, endodontic lesion, or vertical root fractures
53What are the classifications of the extent of periodontitis?
Localized or Generalized
54What is the interdental CAL of Stage I periodontitis?
1-2mm
55What is the interdental CAL present in Stage II periodontitis?
3-4mm
56What is the interdental CAL present in stage III periodontitis?
5 or more mm
57What is the interdental CAL present in stage IV periodontitis?
5 or more mm
58What RBL is present in Stage I periodontitis?
Less than 15%
59What RBL is present in stage II periodontitis?
15%-33%
60What RBL is present in Stage III periodontitis?
More than 33%
61What RBL is pesent in Stage IV periodontitis?
More than 33%
62What tooth loss due to perio is present in stage I and II of periodontitis?
None
63What tooth loss due to perio disease is present in stage III periodontitis
4 or less teeth
64What tooth loss due to perio disease is present in stage IV periodontitis?
5 or more teeth
65What is the max probe dept of stage I periodontitis?
4mm or less
66What is the max probe depth of Stage II periodontitis?
5mm or less
67What is the max probe depth of stage III periodontitis?
6mm or less
68What type of bone loss is present in stage I or II periodontitis?
Mostly Horizontal
69What type of bone loss is present in stage III periodontitis?
3mm or more of vertical bone loss
70In what stage of periodontitis is class II mobility present?
Stage IV
71What is localized periodontitis?
Less than 30% of teeth involved
72What is generalized periodontitis?
More than 30% of teeth involved
73What is the extent of periodontitis where only the 1st molars and anterior incisors are involved?
Molar/Incisor Pattern
74What calculation is used to determine periodontitis grade?
% bone loss/age
75What radiographic bone loss or CAL is present in Grade A periodontitis?
No loss over 5 years
76What radiographic bone loss or CAL is present in Grade B periodontitis?
More than 2mm over 5 years
77What RBL or CAL is present in Grade C periodontitis?
2mm or more over 5 years
78What %RBL/age is present in Grade A periodontitis?
Less than 0.25
79What %RBL/age is present in Grade B periodontitis?
0.24-1.0
80What %RBL/age is present in grade C periodontitis?
More than 1.0
81What is the periodontitis grade of a patient who smokes less than 10 cigarettes/day?
Grade B
82What is the periodontitis grade of a patient who smokes 10 or more cigarettes/day?
Grade C
83What is the periodontitis grade of a diabetic patient whose A1c is less than 7%
Grade B
84What is the periodontitis grade of a diabetic patient whose A1c is 7% or more?
Grade C
85What X-rays are used to evaluate bone loss?
BWX
86What are the classes of peri-implant disease?
Peri-Implant Health, Peri-Implant Mucositis, Peri-Implantitis
87What characteristics are present in peri-implant health?
No bone loss extending into the threads of the implant and healthy gingiva
88What characteristics are present in peri-implant mucositis?
RBL does not extend into the threads of the implant and surrounding gingiva is inflamed and irritated
89What characteristics are present in peri-implantitis?
Gingiva is irritated and inflamed, RBL extends to the threads of the implant
90What are the main characteristics of the epithelial tissue of the oral cavity?
Stratified Squamous Epithelium, Avascular, Sparse Extracellular Matrix in the Basal Lamina
91What type of epithelial cells have no nuclei, many stratified layers and form a tough resistant layer?
Keratinized Epithelial Cells
92Do Keratinized Epithelial cells have nuclei?
No
93Where are keratinized epithelial cells found in the mouth?
Hard Palate and Masticatory Mucosa
94What type of tissue contains nuclei and is a softer, more flexible tissue that allows movement?
Nonkeratinized Epithelial Cells
95Do keratinized epithelial cells have nuclei?
Yes
96Where are keratinized epithelial cells found in the mouth?
Lips, cheeks, and Floor of the Mouth
97What is another term for the connective tissue of the mouth?
Lamina Propria
98What tissue contains fibroblasts, immune cells, and protein fibers, sparse cells, and abundant extracellualr matrix?
Connective Tissue or Lamina Propria
99What is the function of the lamina propria?
Supports and Binds to Other Tissues
100What does ECM stand for?
Extracellular Matrix
101What is the ECM?
A gel-like substance surrounding the cells containing ground substance and fibrous proteins
102What are the funcitons of the ECM?
Physically supports cells, allows cells to migrate and interact, and aids in exhange of nutrients between cells and capillaries
103What are epithelial ridges?
Deep extensions of the epithelium that reach down into the connective tissue
104What are connective tissue papillae?
Finger-like extensions of CT that interlock with epithelium
105What is another name for the epithelial ridges?
Rete Pegs
106What is the epithelial-connective tissue interface of the oral epithelium?
The wavy boundary where epithelium and connective tissue meet
107What is the function of the Epithelial-CT Interface?
Allows for better adhesion and diffusion of nutrients
108Where is the wavy boundary of the Epithelial-CT Interface found?
Oral Epithelium
109What type of Epithelial-CT Interface is present in healthy SE and JE?
Smooth, Non-interdigitating interface with no epithelial ridges or CT papilla
110What epithelial cell juction is made in a cell-to-cell connection?
Desmosomes
111What epithelial cell junction is found in areas of cell-to-basal lamina connection?
Hemidesmosome
112Where is the oral epithelium found?
Crest of gingival margin to mucogingival junction (free and attached gingiva)
113What are the main characteristics of the oral epithelium?
Covered in keratin, made of stratified squamous epithelium, with a wavy interface with epithelial ridges that can be seen in health
114Where is Sulcular Epithelium found?
Lining of the gingival sulcus
115What are the characteristics of the sulcular epithelium?
Thin and non-keratinized, permeable stratified squamous epithelium with a smooth interface with no epithelial ridges in health
116Where is the junctional epithelium found?
Forms the base of the sulcus
117What are the main characteristics of the junctional epithelium?
Thin and non-keratinized stratified squamous epithelium with a smooth tissue interface seen in health
118What are the 3 most important characteristics of the JE?
Epithelial attachment, Barrier between Plaque and CT, and Host Defense
119How is the JE involved in host defense?
Epithelial cells can signial the immune response
120What are the functions of the gingival fiber bundles?
Brace the free gingiva girmly against the tooth, provide rigidity to withstand chewing, connect fingiva to the cementum and alveolar bone to provide stability, and stabalize adjacent teeth to one another to maintain tooth positioning within the arch
121Which fiber group encircles the tooth in a ring-like manner coronal to the alvealar crest and do not attach to the cementum of the teeth?
Transseptal
122Which fiber group attaches gingiva to bone, extending from the alveolar crest into the CT?
Alveologingival
123Which fiber group is embedded in the cementum near the CEJ and fan out into the connective tissue to attach the gingival to the teeth?
Dentogingival
124Which fiber group attaches the gingival to the periosteum of the alveolar bone, and embeds into the alveolar bone and fans out into the CT?
Periostogingival
125Which fiber group extends in a mesiodistal direction along the entire dental arch and around the last molars in the arch to link adjacent teeth into a dental arch unit?
Intergingival
126Which fiber group encircles several teetha dn link adjacent teeth into a dental arch unit?
Intercircular
127Which fiber group is located in the papillae coronal to the transseptal fiber bundles and connect interdental papillae of posterior teeth?
Interpapillary
128Which fiber group extends from the cementum near the CEJ and runs horizontally between the adjacent teeth to link adjacen teeth into the dental arch unit?
Transgingival
129Which fiber group passes from the cementum of one tooth, over the crest of alveolar bone, to the cementum of the adjacent tooth to connect adjacent teeth to one another and secure alignment of teeth in the arch?
Transseptal
130Which supragingival fiber group has the ability to undergo continuous regeneration?
Circular
131What are the 5 functions of the PDL?
Supportive, Sensory, Nutritive, Formative, and Resorptive
132What are the 5 PDL fiber groups?
Alveolar Crest Fibers, Horizontal Fibers, Interrradicular Fibers, Oblique Fibers, and Apical Fibers
133Which PDL Fiber group extends from the cervical cementum, running downward diagonally to the alveolar crest?
Alveolar crest fibers
134What is the function of the Alveolar Crest Fibers?
Resist Horizontal Movement of the Tooth and Prevents Extrusion
135Which PDL fiber group runs in a horizontal direction from the cementum to the bone?
Horizontal Fibers
136What is the function of the horizontal fiber group?
Resists horizontal pressure against the crown of the toth
137Which PDL fiber group runs in a diagonal direction upward from the cementum to the alveolar bone?
Oblique
138What is the function of the oblique fiber group?
Resists vertical pressure that threatens to drive the tooth into the socket
139Which fiber group extends form the apex of the tooth to the bone?
Apical
140What is the function of the apical fiber groups?
Resists forces that might lift the tooth out of its socket
141Which PDL fiber group occurs only in multirooted teeth and is located in between the roots?
Interradicular
142What is the function of the interradicular fiber groups?
Stabilize the tooth in its socket
143What are the ends of the PDL fibers that are embedded in the cementum and the alveolar bone called?
Sharpey's Fibers
144What are the functions of the cementum?
Attaches PDL fibers to the tooth, seals and covers open dentinal tubules, protects the underlying dentin, remodeling facilitates continuous reattachment of the PDL fibers, and Compensates for the loss of the tooth tissue caused by attrition
145Which type of cementum contains no living cells (cementocytes)?
Acelluar Cementum
146Which type of cementum is the first to be formed?
Acellular Cementum
147Which type of cementum covers the cervical third or half of the root?
Acellular Cementum
148Which type of cementum is not produced during the life of the tooth?
Acellular Cementum
149Which type of cementum consists mostly of Sharpey's Fibers?
Acellular Cementum
150What is another term for Acellular Cementum?
Primary Cementum
151Which type of cementum covers the apical and interradicular portions of the tooth?
Cellular Cementum
152Which type of cementum contains cementocytes and fibroblasts?
Cellular Cementum
153Which type of cementum continues to form throughout the life of the tooth?
Cellular Cementum
154Which type of cementum is less calcified?
Cellular Cementum
155Which type of cementum has less Sharpey's fibers?
Cellular Cementum
156What is another term for Cellular Cementum?
Secondary Cementum
157What are the main characteristics of alveolar bone?
Mineralized CT made by osteoblasts, rigid due to mineralization of calcium and phosphate, has blood vessels and nerves, and constantly undergoes periods of formation and resorption
158What is the function of the alveolar bone?
provides support and protection to the roots of the teeth
159Which cells initiate mineralization of bone?
Osteoblasts
160Which cells remove mineralized matrix and organic matrix?
osteoclasts
161What are the characteristics of healthy gingiva?
Pink, Firm, Stippled, Scalloped Margin, No BOP, Knife-Edged Papillae, PDs 1-3mm, Margin Coronal to CEJ
162What are the histological signs of healthy gingiva?
JE slightly coronal to CEJ, JE attached by hemidesmosomes, No epithelial ridges in JE, intact supragingival fiber bundles, intact PDL fibers, no attachment loss, no bone loss
163What are the clinical characteristics of gingivitis?
Red/Reddish-Blue Color, 3+ PD's (pseudopockets). Swelling, BOP, Bulbous Interdental Papilla, Edema
164What are the histilogical characteristics of gingivitis?
JE Coronal to CEJ, No Apical Migration of JE, JE, may become detached at coronal most portion, JE attached by hemidesmosomes, JE and SE has epithelial ridges, Possible supragingival fiber destruction, PDL intact, No bone loss
165What are the clinical characteristics of periodontitis?
Redluish/spongy/smooth/shiny edematous tissue, light pink/firm fibrotic tissue, gingival margin varies, embrasure spaceslunted papillae, BOP, suppuration, 4+ mm PDs, Possible mobility, absence of pain
166What are the histological characteristics of periodontitis?
Apical migration of the JE, extension of epithelial ridges from JE and SE, ulcerations of SE, supragingival fiber destruction, PDL fiber destruction, destruction of ECM, bone loss
167What are pseudopockets?
Gingival pockets of more than 3mm due to tissue enlargement
168What is another name for pseudopockets?
Gingival Pockets
169What are the 3 key characteristics of periodontitis?
Apical Migration of JE, Loss of CT Attachment, Loss of Alveolar Bone
170How does the destruction of tissue from periodontitis progress?
It is sporadic and progresses at different rates throughout the mouth. Untreated gingivitis does not always progress to periodontitis. Susceptibility to perio varies from patient to patient
171Which pattern of bone loss is most common?
Horizontal
172In what order does inflammation spread in horizontal bone loss?
Gingival CT, Alveolar Bone, Periodontal Ligament
173In what order does inflammation spread in vertical bone loss?
Gingival CT, Periodontal Ligament, Alveolar Bone
174What is an osseous defect?
A crater in the interdental bone that affects 2 teeth
175What type of perio pocket has horizontal bone loss present?
Suprabony
176What type of perio pocket has vertical bone loss?
Infrabony
177Where is the JE located in a suprabony perio pocket?
Coronal to the Crest of the Alveolar Bone
178Where is the JE located in case of infrabony perio pockets?
Apical to the alveolar crest
179What is a mucogingival deformity?
Deviation from the normal relationship btwn gingiva & alveolar mucosa
180What are the risk factors for recession?
Thin Tissue Biotype, Narrow Band of Keratinized TIssue, Reduced Thickness of Alveolar Bone due to Abnormal Tooth Position, Mechanical Trauma, Orthodontics
181What are the two ways that recession is classified?
Miller and Cairo Classification Systems
182Which recession classification system classes recession into classes I-IV?
Miller
183Which recession classification system classes recession into RT1-3?
Cairo
184Which of Miller's classes is characterized by marginal recession not extending to the MGJ with no interdental loss?
Class I
185Which of Miller's classes is characterized by marginal recession extending to the MGJ with no interdental loss?
Class II
186Which of Miller's classes is characterized by marginal recession extending to the MGJ and interdental loss?
Class III
187Which of Miller's classes is characterized by marginal recession extending to the MGJ, severe interdental loss, and root coverage not anticipated?
Class IV
188Which of Cairo's classes is characterized by recession with no interproximal loss from traumatic toothbrushing?
RT 1
189Which of Cairo's classes is characterized by recession with interproximal loss less than or equal to the loss on the buccal?
RT 2
190Which of Cairo's classes is characterized by recession with interproximal loss greater than the loss on the buccal?
RT 3
191Which of Cairo's classes are associated with periodontitis-induced horizontal bone loss?
RT2
192Which of Cairo's classes are associated with perio-induced infrabony defects?
RT3
193What are the 3 periodontal biotypes?
Thin-Scalloped, Thick-Scalloped, Thick-Flat
194What are the characteristics of the thin-scalloped biotype?
Slender, Triangular-Shaped Crown
Thin, Delicate, Friable Soft Tissue
Narrow Zone of Keratinized Tissue
Accentuated Scalloped Margin
Thin, Bony Architecture
195What are the possible ramifications associated with thin-scalloped biotype?
Low Resilience to Trauam and/or Inflammation and Greater Tendency for Mucogingival Deformity
196What are the characteristics of thick-scalloped biotype?
Slender Trianglular Shaped Crown
Thick Fibrotic Gingiva
Narrow-Moderate Zone of Keratinized Tissue
Accentuated Scalloped Margin
Thin, Bony Architecture
197What are the possible ramifications associated with the thick-scalloped biotype?
Prone to development of mucogingival deformity
198What are the characteristics of the thick-flat biotype?
Wide, square-shaped crown
Thick, Dense, and Fibrotic Tissue
Wide Band of Keratinized Tissue
Flat Gingival Margin Contour
199What are the possible ramifications associated with the thick-flat biotype?
More Resilient and Less Susceptible to Inflammation and Trauma
200What are the characteristics of periodontal health?
Uniform, Pink Tissue that is easily distinguished from darker alveolar mucosa. Smoothly scalloped gingival margin tapered slightly coronal to the CEJ with pointed papillae that completely fill the embrasure space. Stippled, smooth, resilient, and firm
201What are the categories of periodontal health?
Periodontal Health on an Intact Periodontium, Periodontal Health on a Reduced Periodontium (non-perio pt), Periodontal Health on a Reduced Periodontium (successfully treated/stable perio pt
202What is the most common form of periodontal disease?
Dental Biofilm-Induced Gingivitis
203What are the characteristics of gingivitis?
Red, Pink, Blue, or Purple, Bulbous, Blunted, or Cratered Papillae, Rolled/Thickened Margins, Spongy, Flaccid, Smooth/Stretched, and/or Shiny. BOP is seen clinically
204How much BOP can be present for a patient to still be considered healthy?
Less than 10% of sites in the mouth
205How much BOP can be present for a patient to be diagnosed with localized gingivitis?
10-30%
206How much BOP is present in generalized gingivitis?
More than 30%
207What distribution of inflammation is confined to the papilla?
Papillary
208What distribution of inflammation is confined to the gingival margin and papilla?
Marginal
209What distribution of inflammation is throughout the gingival margin, papilla, and attached gingiva extending to the mucogingival junction?
Diffuse
210What are the categories of biotin-induced gingivitis?
Biofilm-Induced Gingivitis on an Intact Periodontium, Biotin-Induced Gingivitis on a Reduced Periodontium (non-perio pt), Biofilm-Induced Gingivitis on a Reduced Periodontium (successfully treated/stable perio pt)
211What are the modifying factors for biofilm-induced gingivitis?
Sex/Steroid Hormones, Hyperglycemia, Leukemia, Smoking, Malnutrition, Prominent Subgingival Restorations, Hyposalivation, and Drug-Influenced Gingival Enlargement
212What is the technical term for a pregnancy tumor?
Pyogenic Granuloma
213What are the characteristics of a pyogenic granuloma?
Exaggerated response to biofilm, occurs after 1st trimester, generally painless, resolves spontaneously after childbirth
214What vitamin is essential for the formation of collagen?
Vitamin C
215Which non-biofilm induced gingival disease is a rare, benign, genetic condition characterized by the slow enlargement of the attached gingiva that affects both the maxillary and mandibular gingival tissue?
Hereditary Gingival Fibromatosis
216Which non-biofilm induced gingival disease is caused by toothpaste, mouthwash, gum, etc, is more commonly seen in patients with a history of allergic conditions, and presents as diffuse, fiery red gingivitis?
Allergic/Hypersensitivity Reaction
217Which non-biofilm induced gingival disease is an uncommon acute inflammatory autoimmune disorder that presents with red, bullseye blotches on the skin and intraorally with ulcerations and blisters?
Erythema Multiforme
218Which non-biofilm induced gingival disease is a common autoimmune inflammatory condition that affects the mucous membranes and presents as lacy white pathces and may have painful ulcerations?
Oral Lichen
219Which non-biofilm induced gingival disease is associated with a risk for developing oral cancer?
Oral Lichen
220What are possible names for the lesions associated with oral lichen planus?
Reticular Lesions or Wickham's Striae