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These are lectures of The Gulfie Dentist Online Coaching
19 AGO 2020
19 AGO 2020 · PERIODONTIUM
1 Gingiva
2 Attachment apparatus*
a. Pdl
b. Alveolar bone
c. Cementum (has dead cells) acellular cementum
PERIODONTAL TISSUE : (has living cells)
a) Gingiva
b) Periodontal ligament
c) Alveolar bone
PARTS OF GINGIVA
Normal range of gingival sulcus depth is- 2-3mm
Colour of normal gingiva is an interplay between – keratin layer, melanine, blood vessels, epithelial thickness.**
FREE GINGIVA – Also known as unattached / marginal gingiva. From the gingival margin till the free gingival groove / base of the sulcus.
(sulcus is in healthy gums, whereas pocket is in unhealthy / diseased
gums) KERATINIZED
ATTACHED GINGIVA- From free gingival groove (base of the sulcus) to the
mucogingival junction. KERATIINIZED
o Healthy one shows stippling.
o Best views by drying the gingiva.
o Highest width is seen in incisors-
Maxillary : 3.4-4.5
Mand - 3.3-3.9**
o Narrowest seen in molars
Max 1.9mm
Mand 1.8mm
ALVEOLAR MUCOSA
o From mucogingival junc to fold
o Non keratinized
INTERDENTAL GINGIVA
a) Anterior – pyramidal
b) Posterior — col shape
c) Midline diastema — triangular
FREE GINGIVAL GROOVE
MUCOGINGIVAL JUNCTION
BIOLOGICAL WIDTH
Biological width — junctional epithelium + connective tissue = 2 mm***
19 AGO 2020 · ORAL MUCOUS MEMBRANE:-
KERATINIZED MUCOSA
Hard palate
Gingiva (70% para & 30% ortho)
NON – KERATINIZED (stratum cornea absent)
Soft palate
Floor of mouth
Alveolar mucosa
Sulcular epithelium
Buccal mucosa
SPECIALISED MUCOSA
Dorsum of tongue
LAYERS OF MUCOSA
EPITHELIUM
LAMINA LUCIDA
BASEMENT MEMBRANE (contains TYPE IV COLLAGEN)
LAMINA DENSA
CONNECTIVE TISSUE
Basement membrane connections to epithelium
Via — desmosoms and hemidesmosomes
LAYERS OF EPITHELIUM
Stratum cornea (surface layer)
Stratum granulosum
Stratum spinosum
Stratum basalis (innermost layer)
Most common epithelium – squamous epithelium
No blood supply
How does epithelium get Nutrition? By diffusion from connective tissue
a) Stratum basalis – highly dividing cells
b) Odland bodies (reserve bodies) – stratum spinosum
c) Stratum granulosm – contains granules that get activated from enzymes and produce keratin for the cornea layer of the epithelium
d) Stratum cornea – keratin deposition
KERATINIZATION
a) Para keratinized (with nuclei) — 70% gingiva
b) Ortho keratinized (devoid nuclei) — 30% gingiva
NON KERATINOCYTES:-
Free nerve cells
Melanocytes
Langerhan cells
19 AGO 2020 · CEMENTUM
With age cementum on root end become thicker & irregular.
This increase in the width of cementum is greater in the APICAL & LINGUAL areas.**
COLOUR
o VITAL – YELLOW
o NON – VITAL — GREY OR GREEN
Cementum starts formation from cervical area
Cementum in cervical2/3rd acellular extrinsic fiber,
In coronal acellular intrinsic,
In apical mixed cellular
Acellular – cervical region A x C
Cellular – apex region C x A
Thickness
o Thickest at apex
o Thin at CEJ
Age changes – content increases with age at apex
SHARPEY’S FIBRES – connection from cementum to
alveolar bone. Parallel to bone and parallel to
cementum?
Transseptal fibers are Fibers which completely
embedded in cementation and pass from cementum
of one tooth to the cementum of adjacent tooth.
HYPERCEMENTOSIS
o Low grade periapical infection
o Excessive occlusal force, bruxism
The end of PDL fibers that are embedded in the alveolar bone and cementum are called - Sharpey's
fiber is the dominant type of fibers found in cementum.
Nb: dental tissue similar to bone – DENTINE (histologically) not cementum
19 AGO 2020 · BONE
PDL attachment is to : alv. Bone proper or called bundle bone
The crest of INTERDENTAL BONE is said to be parallel to the marginal gingiva
Or you could also say it id parallel to the line drawn from the CEJ of adjacent teeth.
Now if the position of CEJ of the neighboring tooth is variable, then the bone will be angulated towards the line.***
PERIODONTAL LIGAMENT
Cells
o Fibroblast
o Osteoblast
o Cementoblast
o Cell rest of malassez
Lateral periodontal cyst from rest of serres ,while apical periodontal cyst from rest of malassez.
Fibres
o Collagen
o Elastic fibres
Cementoblasts present in pdl
Cell rest of malassez seen commonly at apex
FIBRES OF PDL
COLLAGEN 1,3,7
Most dental tissue type I collagen fibres
o Eg: pdl,alveolar bone, cementum, gingiva, dentin
o They are most abundant
Anchoring fibres are type 7, seen in pdl
Type 3 also seen in pdl
Ageing OF PDL
Elastic fibres increase and cells decreases
Function of pdl
Formative, nutritive, anchorage, cushioning (type 7)
19 AGO 2020 · PRINCIPLE GROUP OF PDL FIBRES:
a) Alveolocrestal fibres – prevents extrusion of teeth
b) Horizontal fibres – prevents lateral movement of teeth
c) Oblique fibres – withstands masticatory forces, most abundant
QN. Periodontal ligament fibers in middle third of root is oblique.
d) Apical fibres – absent in young permanent teeth , because of open apex
e) Intraradicular fibres – absent in single rooted teeth
TRANSEPTAL FIBRES
Transseptal fibers are Fibers which completely embedded in cementation and pass from cementation of one tooth to the cementation of adjacent tooth.
the only fibers present in cementum only
Not a pdl group of fibres
Responsible for orthodontic relapse
This fibre is removed in pericision(surgical Rx to prevent ortho relapse)
Dentogingival fibre — the 1st fibre lost during extraction
In pulp :- - Cell rich zone inner most pulp layer contain fibroblast
– Cell free zone rich in capillaries & nerve networks
- Odontoblastic layer contain odontoblast.
19 AGO 2020 · PATHOGENESIS
Subgingival plaque is the initiating factor her- the microorganism in it release toxins
Our immune system sends response in the form of white blood cells, cytokines,
prostaglandins, Matrix Metalo Protein (mmp)
Then cause tissue distruction
BLOOD CELLS
All born / formed in bone marrow
RBC
No nucleus
Life span is 120 days
PLATELETS
No nucleus
Below 80,000 — no surgery possible
Below 50,000 — no injury at all
o 50,000 cells/mg — critical count of platelets
WBC
GRANULOCYTES
o NEUTROPHIL
Predominant inflammatory cells in pdl pockets
o BASOPHIL
Allergy
o EOSINOPHIL
Allergy
Least abundant WBC
AGRANULOCYTES
o T
o B – plasm cells
1. NEUTROPHIL
a. POLYMORPHO NEUTROPHIL LEUKOCYTES
b. PMNL cells present in acute infection and suppurative cases-pdl abcess , while
chronic lymphocytes.
c. Most abundant WBC in pdl pockets
d. Acute inflammatory cell
e. It is the cell that will become defective in diabetes mellitus
f. Destroys PDL membrane in periodontitis
g. Diabetes condition, weak activity of PMNL
h. Action – phagocytosis eg: macrophage
OTHER NEUTROPHIL DEFECTIVE CONDITIONS:-
i. Neutropenia
j. Granulocytosis
k. Chediak – Higashi syndrome
l. Papillon – Lefevre syndrome
m. Leukocyte adhesion deficiency
n. DM most importantly!
Phagocytosis is the process of engulfing particles.
Chemotaxis is attraction of neutrophils to site of local injury.
2. CELLS OF SPECIFIC RESPONSE
a. T cells
b. B cell or Plasma cells
i. Produce immunoglobins Ig G A M E
ii. Most dominant in perio pockets.
3. INNATE IMMUNE CELLS
a. Neutrophils
b. Monocytes
c. Macrophages
d. Mast cells
e. Dentrite cells
4. LANGERHANS CELL DISEASE
a. Eosinophil infiltrate to pdl — cause early loss of 1° tooth
19 AGO 2020 · IMMUNOGLOBINS:- (produced by B lymphocytes) (G-A-M-E)
IgG
— most abundant Ig in blood and in GCF
— passive immunity through placenta
IgA
— all secretion of body contains this eg: saliva (lacrimal)
— passive immunity through milk (colestrum breast milk)
IgM
— first Ig to reach site of infection
IgE
— abundant in allergy and anaphylaxis
19 AGO 2020 · MMPS — MATRIX METALO PROTEINASES
Most important proteinase involved in destruction of
periodontal tissue
EG: MMP – 8, MMP – 13
GINGIVAL CREVICULAR FLUID
GCF has most abundance of IgG
CONTAINS
o Components of CT
o Epithelium
o Inflammatory cells
o Serum
o Microbial flora living there in the sulcus
More neutrophils to defend the gingiva.
Most drug concentration
o 1st tetracycline/doxycycline
o 2nd metronidazole
DOXYCYCLINE – similar to tetracycline
QN Tetracycline cause brownish discoloration in all teeth & appear yellowish with UV light
Pedo —20mg
Therapeutic value — 100mg /day (Antibacterial dose)
Sub antimicrobial dose = 20mg — bacteriostatic at GCF
19 AGO 2020 · PLAQUE INDUCED GINGIVITIS:-
STAGES ----------- FINDINGS ------------- CELLS INVOLVED
---------------------------------------------------------------------------
INITIAL GCF ----- 1ST sign of gingivitis --- PMNL or neutrophils
ACUTE ------------ bleeding on probing, definitive sign of gingivitis ---- T - lymphocytes
CHRONIC / ESTABLISHED ----- edematous or fibrous – smokers plasma / B – lymphocytes (7-
21 days)
ADVANCED -------- onset of PDL destruction plasma/B lymphocytes
CONDITIONAL GINGIVITIS :-
All these plaque induced gingivitis
Systemic conditions — pregnancy, DM, Leukemia, puberty
PREGNANCY GINGIVITIS:-
P.intermedia – orange complex
Begins 2nd/3rd
Disappears in 9th month.
PREGNANCY TUMOUR
EPULIS GRAVIDIUM:— kind of Angio-granuloma or pyogenic granuloma (old name) ie bleeding on touch
o Irritation of interdental papilla results in tumor like growth at papilla
Rx
o Scaling best time is 2nd trimester (remove irritant)
NB: safest antibiotic in pregnancy – Amoxycillin *
These are lectures of The Gulfie Dentist Online Coaching
Informazioni
| Autore | Dr.Mayakha Mariam |
| Organizzazione | Dr.Mayakha Mariam |
| Categorie | Corsi |
| Sito | - |
| thegulfiedentist@gmail.com |
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