Periodontics

Gingival Enlargements

Gingival Enlargements Definitions

1. Periodontal abscess

• The periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket

Gingival Enlargements Important Notes

1. Gingival enlargement

1. Based on etiology
   • Inflammation – Acute
   • Chronic
2. Drug-induced
   • Phenytoin
   • Cyclosporins
3. Systemic diseases
   • Conditioned enlargements
     • Puberty
     • Pregnancy
     • Non-specific
   • Systemic diseases
     • Leukemia
   • Neoplastic
     • Benign tumors
     • Malignant tumors
   • False enlargements
     • Idiopathic
4. According to location
   • Localized-limited to one/more teeth
   • Generalized- involves the entire mouth
   • Papillary-confined to interdental papilla – Marginal- confined to marginal gingiva – Diffuse-involves entire gingiva
   • Discrete-isolated lesions
5. According to the degree
   • Grade 0- Normal gingiva
   • Grade 1- Involves interdental gingiva
   • Grade 2- Involves marginal and interdental papilla
   • Grade 3- Covers 3/4th of the crown of teeth

2. Leukemic gingival enlargement

• Occurs only in the acute type and not in the chronic type
• Mostly occurs in acute monocytic leukemia
• The gingival connective tissue is infiltrated with immature leukocytes

3. Gingival enlargements and their locations

4. Cyclosporine

• It is a potent immunosuppressive drug used to prevent organ transplant rejection and treat several autoimmune diseases
• Gingival enlargement, nephrotoxicity, hypertension, etc are its side effects
• Another immunosuppressive tacrolimus exhibits less severe gingival inflammation
• It is used as a substitute for cyclosporine

5. Phenytoin

• It is used to treat all forms of epilepsy
• Gingival enlargements occur in 50% of patients on this drug
• It often occurs in young patients
• Phenytoin stimulates the fibroblasts and reduces collagen degradation
• Ethosuximide, valproic acid, and mephenytoin are other antiepileptic drugs causing gingival enlargements

6. Plasma cell gingivitis

• Gingiva appears red, friable, granular
• It bleeds easily
• It may be associated with cheilitis and glossitis
• It is allergic in origin possibly related to components of chewing gums, denitrifies, or diet.

7. Gingival abscess

• It is a localized, painful rapidly expanding lesion of sudden onset
• It is limited to marginal gingiva or interdental papilla
• It is due to foreign substances carried deep into the tissues such as toothbrush bristle, a piece of apple core, or a lobster shell

Gingival Enlargements Long Essays

Question 1. Classify gingival enlargements. Discuss the history- theology and clinical features of drug-induced gingivitis.
Answer:

Gingival Enlargements Classification:

1. Based on etiology:

Inflammation:

• Acute
• Chronic

Drug-Induced:

• Phenytoin
• Cyclosporins

Gingival Enlargements Systemic diseases:

• Conditioned enlargements:
  • Puberty
  • Pregnancy
  • Non-specific
• Systemic diseases:
  • Leukemia
• Neoplastic:
  • Benign tumors
  • Malignant tumors
  • False enlargements:
  • Idiopathic:

Read And Learn More: Periodontics Question and Answers

3. According to the degree:

• Grade 0- Normal gingiva
• Grade 1- Involves interdental gingiva
• Grade 2- Involves marginal and interdental papilla
• Grade 3- Covers 3/4th of the crown of teeth

Drug-Induced Gingivitis:

Drug-Induced Gingivitis Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• The site involved- marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Drug-Induced Gingivitis Histopathology:

1. Epithelium:

• Shows varying degrees of acanthosis
• Elongated, thin rete pegs are present
• Increased epithelial pearls
• Presence of PMNs

2. Lamina propria:

• The proliferation of fibroblasts present
• There is an increase in collagen production

Question 2. Classify different gingival enlargements. Describe in detail acute inflammatory enlargement.
Answer:

Gingival enlargement Classification:

1. According to the etiology:

Inflammation:

• Acute
• Chronic

Drug-Induced:

• Phenytoin
• Cyclosporins
• CCB’s

Systemic diseases:

• Conditioned Vitamin C deficiency
• Puberty
• Pregnancy
• Non-specific
• Systemic diseases – Leukemia

Neoplastic:

• Benign
• Malignant
• False enlargements

2. According to Location:

Localized: limited to one/more teeth

• Generalized: Involves entire mouth
• Papillary: Confined to interdental papilla
• Marginal: Confined to the marginal gingiva
• Diffuse: involves the entire gingiva
• Discrete: Isolated lesions

3. According to the degree:

• Grade 0: Normal gingiva
• Grade 1: Involves interdental papilla
• Grade 2: Involves marginal and interdental papilla
• Grade 3: Covers 3/4th of the crown of teeth

Acute Inflammatory Enlargement:

• Sudden localized painful expanding lesion occurring on biting of hard objects like apple or fish thorns

Etio-Pathogenesis:

Gingival enlargement Features:

• Site – Localized to the marginal gingiva
• Color – Reddish
• Surface – Smooth and shiny
• Symptoms – Painful, expanding lesion
• Sign – Bleeding on probing
• Tender on percussion
• Exudation of purulent material
• Size – Swollen gums

Gingival enlargement Treatment:

• Removal of etiological factors
• Incision and drainage of abscess
• In persistent cases, prescribe antibiotics

Gingival Enlargements Short Essays

Question 1. Pericoronal Abscess.
Answer:

• It is a localized accumulation of pus covering the crown of unerupted/partially erupted teeth

Pericoronal Abscess Etiology:

• Plaque accumulation around the impacted teeth

Pericoronal Abscess Features:

• Red, swollen, erythematous gingiva around impacted teeth
• Interferes with occlusion

Pericoronal Abscess Radiographic Features:

• Radiograph shows impacted teeth

Pericoronal Abscess Treatment:

• Flap removal
• Impaction

Question 3. Dilantin sodium-induced hyperplasia.
Answer:

Dilantin Sodium-Induced Hyperplasia Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• Site involved-marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Dilantin Sodium-Induced Hyperplasia Histopathology:

1. Epithelium:

• Shows varying degrees of acanthosis
• Elongated, thin rete pegs are present
• Increased epithelial pearls
• Presence of PMNs

2. Lamina propria:

• The proliferation of fibroblasts present
• There is an increase in collagen production

Question 4. Differentiate Acute and Chronic Inflammatory Enlargement.
Answer:

Question 5. Differentiate periapical, periodontal, and gingival abscesses.
Answer:

Question 6. Drug-induced Gingival Enlargement.
Answer:

Drugs Causing Enlargement:

Drugs Causing Enlargement Features:

1. Duration – 3 months after initiation of drug therapy
2. Location – Generalized
   • Severe in maxilla
3. The site involved – Marginal gingiva and interdental papilla
4. Appearance – Painless, bead-like enlargement
5. Complication – Interferes with occlusion
   • Absence of inflammation
     • Mulberry shaped enlargement
     • Color-pale pink
   • Presence of inflammation
     • Color-red/bluish-red
     • Presence of increased bleeding
6. Consistency – Firm and resilient
7. Surface:
   • Lobulated
8. Bleeding:
   • Absent

Drugs Causing Enlargement Pathogenesis:

• The similarity in the structure of phenytoin and sub-population of fibroblasts
• Thus, fibroblasts become sensitive to phenytoin
• Results in increased collagen production

Drugs Causing Enlargement Treatment:

Step 1:

• Oral prophylaxis
• Substitute drug
• Recall

Step 2:

• Mild case – Gingivectomy
• Severe destruction – flap surgery

Question 7. Leukemic Gingival Enlargement.
Answer:

Leukemic Gingival Enlargement Distribution:

• Diffuse/marginal
• Localized/Generalized

Leukemic Gingival Enlargement Appearance:

• It increases in size gradually and covers the tooth crown
• Tumor like enlargement
• Color-bluish red
• Surface-shiny
• Consistency-moderately firm
• Bleeding on probing – positive
• Increased susceptibility to infections Associated symptoms: ANUG

Leukemic Gingival Enlargement Treatment:

• Consult physician
• Monitor hematological values
• Antibiotic prophylaxis
• Incision and drainage
• Cleanse the area with cotton pellets soaked in hydrogen peroxide
• Application of pressure with gauze

Question 8. Classify gingival enlargement. Add a note on idiopathic gingival enlargement.
Answer:

Gingival Enlargement:

• It is an increase in the size of the gingiva

Classification:

1. Based on etiology:

1. Inflammation
   • Acute
   • Chronic
2. Drug-induced
   • Phenytoin
   • Cyclosporins
3. Systemic diseases
   • Conditioned enlargements
     • Puberty
     • Pregnancy
     • Non-specific
4. Systemic diseases
   • Leukemia
5. Neoplastic
   • Benign tumors
   • Malignant tumors
6. False enlargements
7. Idiopathic

2. According to the location:

1. Localized-limited to one/more teeth
2. Generalized- involves the entire mouth
   • Papillary-confined to interdental papilla
   • Marginal- confined to the marginal gingiva
   • Diffuse- involves the entire gingiva
   • Discrete- Isolated lesions

Idiopathic Gingival Enlargement:

• It is a rare condition of unknown etiology

Clinical Features:

• It has diffuse involvement
• Involves attached gingiva, marginal gingiva, and inter-dental papilla
• The affected gingiva is firm, pink, and leathery in consistency and has a pebbled surface
• Facial and lingual surfaces of the mandible and maxilla are generally affected
• Teeth are almost completely covered by the gingival enlargement
• The enlargement projects into the oral vestibule
• Jaws appear distorted
• Secondary inflammatory changes occur

Question 9. How will you differentiate between scorbutic gingival enlargement and leukemic gingival enlargement?
Answer:

Question 10. Compare drug-induced gingival enlargement and leukemic gingival enlargement.
Answer:

Question 11. Compare drug Induced and Idiopathic gingival enlargement.
Answer:

Question 12. Benign tumors of the gingiva.
Answer:

Benign Tumours Of Gingiva:

1. Focal fibrous hyperplasia:

• It is present often in adults
• It is a nodular lesion
• Has dome-like growth with a smooth surface of normal color
• Surface keratosis occurs
• It is slow progressing lesion
• It may remain the same size for many years
• It is also known as peripheral fibroma

2. Peripheral ossifying fibroma:

• It is a gingival nodule consisting of reactive hyperplasia of connective tissue containing focal areas of bone

Peripheral ossifying fibroma Clinical Features:

• It represents a well-demarcated, encapsulated, ex-pantile, central jaw lesion
• It is localized, painless, non tendered bony hard swelling.
• It is a slow-growing lesion
• It leads to the expansion and distortion of cortical plates
• There may be displacement of regional teeth

3. Peripheral giant cell granuloma:

• It is the hyperplastic reaction of gingival connective tissue in which the histiocytic and endothelial cellular components predominate

Peripheral giant cell granuloma Clinical Features:

• Age- during the mixed dentition period
• Sex- common in females
• Site- interdental papilla
• Appears as a small, exophytic, well-circumscribed, pedunculated lesion on the gingival surface
• It is painless, firm, and lobulated
• Surface- smooth or granular
• Size-less than 2 cm in diameter
• Color-purplish-red to dark-red in color
• The overlying epithelium is ulcerated
• Consistency-firm
• Bleeding occurs spontaneously
• Some lesions may develop with hour-glass shapes located between teeth and lobulated extremities projecting both buccally and lingually

4. Gingival cyst:

• It is derived from the rest of the dental lamina

Gingival Cyst Clinical Features:

• It occurs as firm, compressible, fluid-filled swelling on the facial gingiva usually in the anterior or premolar region
• It usually develops as a solitary lesion
• Color remains normal
• Occurs on attached gingiva or interdental papilla

Question 13. Clinical features of drug-induced gingival enlargement.
Answer:

Drug-Induced Gingival Enlargement :

• Phenytoin
• Cyclosporins
• CCB’s
  • It occurs 3 months after initiation of phenytoin therapy
  • Common in younger individuals
  • Generalized distribution but severe in the maxilla
  • The site involved- marginal gingiva and interdental papilla
  • Appears as a painless, bead-like enlargement
  • Interferes with occlusion
  • Has lobulated surface
  • Firm to resilient in consistency
  • No tendency to bleed

Gingival Enlargements Short Answers

Question 1. Periodontal abscess.
Answer:

• The periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket

Periodontal abscess Etiology:

• Presence of plaque and calculus

Periodontal abscess Clinical Features:

• Involves deep periodontal structures
• Localized pain
• Deep pockets
• Vital tooth
• Tender on lateral percussion
• Tooth mobility
• Associated fistula

Periodontal abscess Treatment:

• Drainage
• Flap surgery

Question 2. Conditioned Gingival Enlargements.
Answer:

• Conditioned enlargements are caused by systemic conditions of the patient which exaggerates the usual ginger- val response to dental plaque

Conditioned Gingival Enlargements Types:

• Hormonal
• Nutritional
• Allergic

Question 3. Angiogranuloma.
Answer:

• Gingival enlargement in pregnancy is also known as angiogranuloma
• It is an inflammatory response to local irritation
• It is modified by the patient’s condition
• It usually appears after the first trimester

Question 4. Drug-induced gingival enlargements.
Answer:

Drug-Induced Gingival Enlargements Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• The site involved- marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Question 5. Write the difference between gingival and periodontal abscess.
Answer:

Question 6. Wegener’s Granulomatosis.
Answer:

• It is a disease of unknown etiology
• It basically involves the vascular, renal, and respiratory systems

Wegener’s Granulomatosis Clinical Features:

• Occurs at any age
• Common in males
• Initially, there is the development of rhinitis, sinusitis, and otitis
• The patient later develops cough and hemoptysis, fever, joint pain
• Hemorrhagic or vesicular skin lesions are common

Wegener’s Granulomatosis Oral Manifestations

• Affected gingiva is termed strawberry gingiva Gingival lesions may be ulcerations, friable granular lesions
• It starts in the interdental papilla and spreads rapidly
• This leads to bone loss and tooth mobility

Question 7. Developmental gingival enlargements.
Answer:

• These enlargements are physiologic
• During various stages of the eruption, the labial gingiva may show a bulbous marginal distortion caused by the superimposition of the bulk of the gingiva on normal enamel
• This enlargement is known as developmental enlargement

Question 8. Differential diagnosis of epulis.
Answer:

• Epulis refers to all discrete tumors and tumor-like masses of the gingiva
• Differential diagnosis of it includes oral fibroma

Question 9. Leukemic gingival enlargement.
Answer:

Leukemic Gingival Enlargement Clinical Features:

Distribution:

1. Diffuse or marginal
2. Localized or generalized

• • It increases in size and gradually covers the tooth crown
  • It appears as a tumor-like enlargement
  • Color-bluish red in color
  • Surface-shiny surface
  • Consistency-spongy-like and friable
  • Gingiva bleeds spontaneously
  • Increased susceptibility to infections

Gingival Enlargements Viva Voce

1. Three types of conditioned gingival enlargements are: hormonal, nutritional, and allergic
2. Fibrotic gingival enlargement is a side effect of some anticonvulsants, calcium channel blockers, and immunosuppressant drugs
3. Leukemic enlargement is generally bluish-red and has a shiny surface
4. Administration of phenytoin may precipitate mega-holoblastic anemia and folic acid deficiency.
5. Drug-induced gingival enlargement starts at the interdental papilla
6. Cyclosporine causes highly vascularized gingival enlargement
7. Systemic administration of phenytoin accelerates the healing of a gingival wound
8. Tacrolimus can replace Cyclosporine
9. Bacterial plaque is not necessary for the initiation of gingival enlargement in Wegener’s granulomatosis

 

Question 1. Specific plaque hypothesis.
Answer:

• The specific plaque hypothesis states that not all plaque is pathogenic and its pathogenicity depends on the presence of certain specific microbial pathogens in plaque
• Specific microorganisms responsible for periodontal diseases release certain damaging factors called virulence factors which lead to host tissue destruction

Example: A.a. contains causes aggressive periodontitis

Question 2. Define dental plaque.
Answer:

• It is soft deposits that form biofilm adhering to the tooth surface or other hard surface in the cavity including removable and fixed restoration

Question 3. Composition of dental plaque.
Answer:

1. Micro-organisms:

• Bacteria
• Mycoplasm
• Fungi
• Protozoa
• Virus

2. Intracellular matrix:

1. Organic:
   • Carbohydrates
   • Glycoproteins
   • Lipids
2. Inorganic:
   • Calcium
   • Phosphorous
   • Magnesium
   • Potassium
   • Sodium

Question 4. Difference between Supragingival and Subgin. It is for the identification of causative agents given Plaque.
Answer:

Question 5. Difference between Tooth associated and Epi- thelium-associated plaque.
Answer:

Question 6. Pellicle.
Answer:

Derived From:

• Components of saliva
• GCF
• Debris, bacterial, and host tissue cell products

Formed by: Selective adsorption of environment macromolecules

Functions:

• Acts as a protective barrier
• Lubricates surfaces to prevent tissue desiccation
• Provide substrate for bacterial attachment

Question 7. Socransky postulate.
Answer:

• It is for the identification of causative agents
• No. of etiologic organisms in the diseased site must be increased
• While it should be reduced in healthy sites
• If the etiologic organism is eliminated then disease pro-aggression ceases

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• Presence of antibodies in organisms
• Presence of virulence factors
• In vitro, experiments should demonstrate the disease process

Question 8. Nonspecific Plaque Hypothesis.
Answer:

• It states that it is the total bulk of plaque that determines the pathogenicity rather than the individual species in it
• According to it. If a small amount of plaque is present then the products released by it can be neutralized by the host
• But if it is present in large quantity then it alters the host response
• It forms the basis of recent treatment and prevention modalities

Question 9. P. Gingivalis.
Answer:

• Porphyromonas gingivalis is a Gram-negative, anaerobic non-motile organism
• It is coccal to short rod shape
• It possesses fimbriae that facilitate adhesion and coag- aggregation

Virulence Factors:

Question 10. A.a. contains.
Answer:

• Actinobaillus actinomycetemcomitans is also known as aggregatibacter actinomycetemcomitans
• It is gram-negative, capnophilic,non-motile saccharolytic
• It occurs singly, in clumps, or in pair
• It is a small, short straight, or curved rod in shape

Virulence Factors:

Question 11. Name the stages of plaque formation.
Answer:

Stages Of Plaque Formation:

• Formation of pellicle on the tooth surface
• Initial adhesion and attachment of bacteria
• Colonization and plaque maturation

Question 12. Normal oral bacterial flora.
Answer:

• Normal bacterial flora associated with clinically healthy periodontium comprises of
  • Gram-positive cocci
  • Fusiform bacilli
  • Motile rods
  • Filaments
  • Spirochaetes

Question 13. Coaggregation.
Answer:

• In the process of plaque formation, the bacterial adherence to one another is termed coaggregation
• In the early stages of plaque formation there is coaggre It leads to food impaction nation between gram-negative and gram-positive organisms such as F. nucleatum and A. viscous followed by coaggregation in later stages between gram-negative organisms,  F.nucleatum, and P. gingivalis

Question 14. Spirochaetes.
Answer:

• Spirochaetes are corkscrew-like gram-negative anaerobic bacteria
• They are capable of immunosuppression
• They contain endotoxin that contributes to their path- Tends to accumulate on a gingival third of teeth genericity
• Treponema vincentii is responsible for necrotizing ulcerative gingivitis
• Increased levels of spirochetes occur in chronic and aggressive periodontitis
• Treponema pallidum is important in the pathogenesis of periodontal diseases
• A decrease in the levels of spirochaetes results in im- improvement in periodontal health

Question 15. Prevotella intermedia.
Answer:

• It is a Gram-negative, anaerobic organism
• It has short rods with rounded ends
• Possess fimbriae

Virulence Factors:

Question 16. Plunger Cusps.
Answer:

• Cusps that tend to forcibly wedge food interproximal are called plunger cusps
• It leads to food impaction
• Further results in gingivitis, periodontitis, tooth mobility, and pocket formation

Question 17. Materia alba.
Answer:

• Yellow/grayish-white, soft, sticky deposit, less adherent

Composition:

• Micro-organisms, desquamated epithelial cells, leukocytes, a mixture of salivary proteins and lipids
  They are capable of immunosuppression cytes, a mixture of salivary proteins and lipids
• Clearly visible, flushed away easily with water
• Tends to accumulate on the gingival third of teeth

Question 18. Bacterial Adherence/Formation.
Answer:

1. Via Electrostatic Interactions:

Negatively charged bacteria 11 calcium
↓↑
Negatively charged pellicle

2. Via Hydrophobic Interactions:

• Based on the fit of molecules of pellicle and plaque
• Lipoteichoic acid is responsible for this interaction by providing a long hydrophobic area

3. Via Lectin-like Substances:

• Lectin recognizes specific carbohydrates in the pellicle and becomes linked to it.

Question 19. Plaque Hypothesis.
Answer:

Non-Specific Plaque Hypothesis:

• States that the total bulk of plaque determines pathogenic- city rather than the species
• When only a small amount of plaque is present, it gets neutralized
• When a large amount of plaque is present, it causes disease

Specific Plaque Hypothesis:

• States that not all plaque is pathogenic and its path- genericity depends on the presence of certain specific pathogens in plaque
• Specific micro-organisms responsible for periodontal diseases release certain damaging factors
• This mediates the destruction of host tissue

Proof: Presence of A.a. contains in localized juvenile periodontitis

Question 20. Red complex
Answer:

• Secondary colonizers form red complex
  • It consists of
  • P. gingivalis
  • T. denticola
  • B. forsythias
• It is responsible for bleeding on probing

Epidemiology Of Gingival And Periodontal Diseases Short Essays

Question 1. Plaque Index.
Answer:

• Selected tooth – entire dentition

1. Selected teeth

• Surfaces: Dissocial, facial, mesiofacial and lingual
• Site: Cervical third of the tooth

Plaque Index Scoring:

Plaque Index Calculation:

• Per tooth-Score/4
• Per person – Score per tooth/No. Of teeth

Question 2. OHI-S by Greene and Vermilion.
Answer:

• The oral hygiene index-simplified was described by John C. Greene and Jack R. Vermilion in 1964
• Tooth Examined:
• 16/17, 11, 26/27
• 46/47,31 36/37
• Surfaces: Facial of 16/17, 11, 26/27, 36/37 Lingual of 31

OHI-S Sites:

• D1-S – Incisal third to gingival third
• C1-S Distal gingival crevice subgingivally from distal to medial contact

OHI-S Scoring: For D1-S:

• 0-No debris
• 1-Debris covering 1/3rd of tooth surface
• 2-Debris covering more than 1/3rd and less than 2/3rd of tooth surface
• 3-Debris covering more than 2/3rd of tooth surface

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For CI-S:

• O-No calculus
• 1-Supragingival calculus covering 1/3rd of tooth surface
• 2-Supragingival calculus covering more than 1/3rd but less than 2/3rd of tooth surface
• 3-Supragingival calculus covering more than 2/3rd of the tooth surface, heavy bands of subgingival
  calculus also present

OHI-S Calculation:

• OH1 – S = D1-S+C1-S

OHI-S Interpretation:

• Good – 0.0 to 1.2
• Fair – 1.3 to 3.0
• Poor – 3.1 to 6.0

Question 3. Russel’s Periodontal Index.
Answer:

By Russell Al.

Teeth examined:

All

Surfaces:

Interpretation:

• 0-0.2 – Normal
• 0.3-0.9 – Simple Gingivitis
• 0.7-1.9 – Beginning of destructive disease
• 1.6-5.0 – Established destructive disease
• 3.8-8.0 – Terminal disease

Question 4. Gingival Index – by Loe and Stillness.
Answer:

• Teeth Examined: All or selected

Gingival Index Surfaces:

• Distal facial papillae
• Facial margin
• Mesial facial papillae
• Lingual margin

Gingival Index Scoring:

• 0-No inflammation
• 1-Mild inflammation, no bleeding on probing
• 2-Moderate inflammation, and bleeding on probing
• 3-Severe inflammation

Gingival Index Calculation:

• Per tooth-Score/4
• Per person\( -\frac{\text { TotalScore }}{\text { Total teeth examined }}\)

Gingival Index Interpretation:

• 0.1-1.0 – Mild gingivitis
• 1.1-2.0 – Moderate gingivitis
• 2.1-3.0 – Sever gingivitis

Question 5. CPITN.
Answer:

CPITN Objectives:

• Mild gingivitis Moderate gingivitis Severe gingivitis
• To survey and evaluate periodontal treatment needs, Identify actual and potential problems posed by periodontal diseases both in the community and in the individual

Teeth examined: Ten specified index teeth are

• 17-16  11  26-27
• 47-46  31  36-37

CPITN Scoring:

• Code X – When only one tooth or no teeth are present in the sextant
• Code 0 – Healthy periodontics
• Code 1 – Bleeding on probing
• Code 2 – Calculus present
• Code 3 – Pocket of 4-5 mm
• Code 4 – Pocket of more than 6 mm

CPITN Treatment Needs:

• TN-0 -No treatment
• TN-1 -Improvement of personal oral hygiene
• TN-2 -Professional scaling
• TN-3 Complex treatment involving deep scaling, root planning, and complex procedures

Question 6. Incidence and prevalence.
Answer:

Incidence:

• It is defined as the number of new cases of a specific disease occurring in a defined population during a specified period of time

Incidence Uses:

• Provide a clue for the etiology and pathogenesis of the disease
• Study the distribution of the study
• Control the disease

Incidence Types:

1. Episode incidence
   • It is the rate of occurrence of new episodes of a dis-case arising in the population
2. Cumulative incidence
   • Similar to incidence but the time interval is ex-presses as a fixed period

Prevalence:

• The total number of all individuals who have an attribute or disease at a particular time divided by the population at risk of having the attribute or disease at this point or midway through the period

Prevalence Uses:

• Estimate the magnitude of disease or health problems in the community
• Identify the potential high-risk population
• Useful in administrative and planning purposes like assessing manpower needs in health services

Prevalence Types:

1. Point prevalence:

• It is the number of all current cases of a specific disease at one point in time with a defined population

2. Period prevalence:

• It is defined as the total number of existing cases of a specific disease during a defined period of time expressed in relation to a defined population

Question 7. Describe the possible causes as to why the incidence, and prevalence of periodontal diseases are very high in India.
Answer:

• The prevalence of periodontal disease in India is high due to:
• Low socioeconomic group
• Poor oral hygiene practice
• Greater prevalence in mentally retarded children due to
  • Lack of awareness of oral hygiene
  • Nutritional deficiency
  • Malocclusion
  • Oral health habits like bruxism, tongue thrusting, mouth breathing
  • Low power of concentration
  • Low neuromuscular coordination
• Vegetarian diet
• Hereditary
• Presence of habits like smoking and betel nut chewing
• Evaluate the efficacy of preventive and therapeutic
• Malnutrition
• measures
• Presence of systemic disease

Question 8. Define index  uses and ideal requirements of an index.
Answer:

Index Definition:

• Numerical values describing the relative status of the population on a graduated scale with definite upper and lower limits designated to permit and facilitate comparisons with other populations that are classified by the same criteria and methods are referred to as index

Index Uses:

1. In the case of individual patients
   • Provides individual assessment
   • Reveals the degree of effectiveness
   • Motivates the patient
   • Evaluates the progress of treatment
2. In the case of research studies
   • Determines the baseline data before the introduction of experimental factors
   • Measures effectiveness of specific agents for pre-version control and treatment of oral conditions
   • Measures effectiveness of devices for personal care
3. In community health
   • Provides baseline data
   • Assesses the needs of a community
   • Evaluates the results

Index Ideal Requirements:

• Clarity simplicity
• The examiner should remember the rules of the index clearly
• The index should be simple & easy to apply
• The criteria should be objective
• Validity
• The index should measure what it is intended to measure
• It should correspond to the clinical stages of the disease under study
• Reliability
• The index should measure consistently at different times & under a variety of conditions
• Quantifiability
• The index should be amenable to statistical analysis so that the status can be expressed by a number
• Sensitivity
• The index should be able to detect small shifts in either direction
• Acceptability
• The use of an index should not be painful or demeaning to the subject

Smoking And Periodontal Diseases Short Essays

Question 1. Smoking and Periodontal diseases.
Answer:

Effects On Micro-Organisms:

• No effect on plaque accumulation
• Increased colonization in shallow pockets
• Increased pathogens in deep pockets
• Increased levels of B-forsythias, A.a. contains and P.gingivalis

Cytological Effects:

• Altered neutrophil mechanism
• Increased TNF-a and PGE2
• Reduced IgG2

Read And Learn More: Periodontics Question and Answers

• Altered fibroblastic activity
• Suppresses osteoblastic activity
• Altered repair and regeneration

Effects On Gingiva:

• Decreased gingivitis
• Decreased bleeding on probing
• Decreased GCF flow
• Decreased sub-gingival temperature

Effects On Periodontitis:

• Increased disease severity
• Increased pocket depth
• Attachment loss
• Bone loss
• Tooth loss

Effect On Treatment:

• Increased time to recover from anesthesia
• Reduced post-operative gain of attachment pocket depth
• Reduced post-treatment response
• Requires frequent re-treatment
• Increased refractory disease

Periodontal Structures in Aging Humans

Periodontal Structures In Aging Humans Important Notes

1. Aging in the gingiva

• Thinning and reduced keratinization
• Increase in epithelial permeability
• Flattening of recipes
• Increase in width of attached gingiva
• Migration of junctional epithelium apically

2. Aging in the periodontal ligament

• Decreased cellularity
• Decreased vascularity
• Decreased mitotic activity
• Decrease in the number of collagen fibers
• Increase in arteriosclerotic changes
• Decrease in the number of epithelial rests of Malassez
• Increase in diameter of a collagen fiber bundle
• Increase in cementless

3. Aging in cementum

• The smooth surface becomes irregular
• Hypercementosis
• The permeability of cementum decreases with age
• Increase in cemental width
• Accumulation of resorption bays

4. Aging in alveolar bone

• The irregular periodontal surface of a bone

Periodontal Structures In Aging Humans Short Essays

Question 1. Aging and Periodontium.
Answer:

Age Changes In Gingiva:

1. Epithelium:

• Thinning of epithelium
• Decreased Keratinization
  • Passage of bacteria into connective tissue
  • The greater amount of intracellular substance

2. Connective Tissue:

• ↓ connective tissue cellularity
• ↓oxygen consumption
• ↑ mast cell
• Atrophy of CT

3. Macroscopic:

• Gingival recession
• Passive eruption of the tooth
• ↑ denaturing temperature

Age Changes in Periodontal Ligament:

↓ Vasucalarity

Elastic fibers

↓ organic matrix

↑ width with less number of teeth present

↓ mitotic activity

↓ collagen fibers

↓ width with ↓ masticatory muscle strength

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Age changes in alveolar bone

Osteoporosis

↓ Vascularity

↓metabolic rate

↓ healing capacity

↓bone formation ↑ bone resorption

Age changes in cementum:

↑ cemental width, more apically and lingually

 

 

 

Classification And Epidemiology Of Periodontal Diseases Short Essays

Question 1. Classification of Periodontal diseases. (or) AAP Classification.
Answer:

• By AAP 1999 (International Workshop for Classification of Periodontal Disease)

Gingival Disease:

Dental Plaque – Induced gingival disease:

• These diseases may occur on a periodontium with no attachment loss or on one attachment loss that is stable and not progressing.

1. Gingivitis associated with dental plaque only

• Without local contributing factors
• With local contributing factors

2. Gingival diseases modified by systemic factors

• Associated with the endocrine system
  1. Puberty associated gingivitis
  2. Menstrual cycle – associated gingivitis
  3. Pregnancy-associated
     • Gingivitis
     • Pyogenic granuloma
  4. Diabetes mellitus-associated gingivitis
• Associated with blood dysplasias
  1. Leukemia-associated gingivitis
  2. Others

3. Gingival diseases modified by medication

• Drug-influenced gingival diseases
  1. Drug-induced gingival enlargement
  2. Drug-induced gingivitis
     • Oral contraceptive-associated gingivitis
     • Others

4. Gingival diseases modified by malnutrition

• Ascorbic acid deficiency gingivitis
• Others

Non-plaque-induced gingival lesion:

1. Gingival diseases of specific bacterial origin

• Neisseria gonorrhea
• Treponema palladium
• Streptococcal species
• Others

2. Gingival diseases of viral origin

• Herpes virus infection
  • Primary herpetic gingivostomatitis
  • Recurrent oral herpes
  • Varicella zoster
• Others

3. Gingival diseases of fungal origin

• Candida species infections, generalized gingival candidiasis
• Linear gingival erythema
• Histoplasmosis
• Others

4. Gingival lesions of genetic origin

• Hereditary gingival fibromatosis
• Others

5. Gingival manifestations of systemic conditions

• Subcutaneous lesions
  • Lichen Planus
  • Pemphigoid
  • Pemphigus Vulgaris
  • Erythema multiforme
  • Lupus erythematosus
  • Drug-induced
  • Others
• Allergic reactions

6. Traumatic lesions (factitious, iatrogenic, or accidental)

• Chemical injury
• Physical injury
• Thermal injury

7. Foreign body reactions

8. NOT otherwise specified (MOS)

Chronic Periodontitis:

• Localized – Less than 30% of sites involved
• Generalized – More than 30% of sites involve
• Slight – 1 to 2 mm clinical attachment loss
• Moderate – 3 to 4 mm clinical attachment loss
• Severe – More than 5 mm clinical attachment loss

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Aggressive Periodontitis:

• Localized – Slight, moderate, or severe
• Generalized -Periodontitis as a manifestation of systemic diseases.

1. Associated with hematological disease

• Acquired neutropenia
• Leukaemia
• Others

2. Associated with genetic disorders

• Familiar and cyclic neutropenia
• Down’s syndrome
• Cohen syndrome
• Hypophosphatasia

3. Necrotizing periodontal diseases:

• Necrotizing ulcerative gingivitis
• Necrotizing ulcerative periodontitis

4. Abscesses of the Periodontium:

• Gingival abscess
• Periodontal abscess
• Periocoronal abscess

Periodontitis associated with endodontic – Lesion End-period lesion:

Developmental/Acquired Deformities:

• Localized
• Mucogingival around teeth
• Mucogingival around edentulous ridges
• Occlusive trauma

Question 2. Plaque-induced gingival Inflammation.
Answer:

These diseases may occur on a periodontium with no attachment loss or on one attachment loss that is stable and not progressing.

1. Gingivitis associated with dental plaque only

• Without local contributing factors
• With local contributing factors

2. Gingival diseases modified by systemic factors

• Associated with the endocrine system
  • Puberty associated gingivitis
  • Menstrual cycle-associated gingivitis
  • Pregnancy-associated
    • Gingivitis
    • Pyogenic granuloma
  • Diabetes mellitus-associated gingivitis
• Associated with blood dysplasias
  • Leukemia associated gingivitis
  • Others

3. Gingival diseases modified by medication

• Drug-influenced gingival diseases
• Drug-induced gingival enlargement
• Drug-induced gingivitis
  • Oral contraceptive-associated gingivitis
  • Others

4. Gingival diseases modified by malnutrition

• Ascorbic acid deficiency gingivitis
• Others

Changes In Epithelium:

Presence of plaque bacteria → Destruction of intercell lar junctions → Loss of epithelium barrier → Entry of bacteria into connective tissue → Results in ulceration in the epithelium

Changes In Connective Tissue:

Periodontics Normal Periodontium Definitions

1. Gingiva
   • It is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the teeth
2. Gingival sulcus
   • The gingival sulcus is defined as the shallow crevice or space around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other side.
3. Stippling
   • It is a form of adaptive specialization or reinforcement for function
4. Periodontal ligament
   • It is a connective tissue that surrounds the root and connects it with the bone
5. Alveolar bone
   • It is that portion of the maxilla and mandible that forms and supports the tooth socket
6. Cementum
   • It is a calcified avascular mesenchymal tissue that forms the outer covering of the anatomic root
7. Fenestration
   • These are isolated areas in which the root surface is covered only by the periosteum and gingiva
8. Dehiscence
   • It is a defect involving the denudation of bone.

Periodontics Normal Periodontium Important Notes

1. Parts of the Gingiva

• Marginal Gingiva
  • Border of the gingiva surrounding the teeth in the collar-like fashion
  • Demarcated apically by a shallow depression called “free gingival groove”
• Attached Gingiva
  • Part of the gingiva that is firm, resilient, and tightly bound to the underlying periosteum of the alveolar bone
• Interdental Gingiva
  • Occupies gingival embrasure

2. Layers of Gingival Epithelium

• Basal layer – Cells are cylindrical/cuboidal Attach to the basement membrane
• Cells have the ability to divide
• Stratum Spinosum
• Large cells with short processes called spines
• Cells have a prickled appearance
• Cells are attached to one another with the help of desmosomes
• Stratum Granulosum – Keratohyalin granules are seen
• Stratum Corneum
• The cytoplasm of cells in this layer is filled with keratin
• It can be
• Orthokeratinized
• Parakeratinized

3. Interdental col is an area with more susceptibility to infection because

• It is non keratinized
• Nonaccessible area
• Area with food lodgement

4. Blood Supply of Gingiva

• Supraperiosteal arteries
  • Arises from above alveolar bone
  • Branches and supplies facial and lingual surfaces
• Vessels of the periodontal ligament
  • Anastomoses with the capillaries
• Arterioles emerging from the crest of the interdental septa

5. Gingival Fibers

• Dentogingival – From cervical cementum to lamina propria
• Alveologingival – From bone to lamina propria
• Circular – Around the neck of a tooth
• Dentoperiosteal – From cementum to alveolar process
• Transeptal – Runs interdentally

6. Blood supply to a periodontal ligament is through

• Apical vessels
• Transalveolar vessels
• Gingival vessels

7. Types of the cementoenamel junction

• 60-65%-Cementum overlaps enamel
• 30% End to end relationship
• 5-10%-Cementum and enamel fail to meet

8. Principal fibers of periodontal ligament

• Trans-septal group
  • Connects cementum of one tooth with that of other
• Alveolar crest
  • Extends from cementum to alveolar crest
• Function – Retains tooth in the socket, Retains lateral tooth movement
• Horizontal group – Extends from cementum to alveolar bone
• Oblique group
  • Extends coronally from the cementum to the bone
• Function – Resist axially directed forces
• Apical group
  • From the cementum to the bone of the alveolar fundus
• Function – Prevents tipping movement, Resists luxation
• Inter-radicular fibers
  • Presents between the cementum of a multi-rooted tooth.
• Function – Resists luxation, Resists tipping and torquing

9. Difference between acellular and cellular cementum.

Periodontics Normal Periodontium Short Answers

Question 1. Junctional Epithelium.
Answer:

• It is the tissue that joins the tooth on one side and the oral. sulcular epithelium and connective tissue to the other
• It forms the base of the sulcus

Junctional Epithelium Attachment:

• Attach to the tooth surface
• By internal basal lamina
• Reinforced by the gingival fibers
• Consists of lamina dens and lamina lucida
• Attach to gingival connective tissue By external basal lamina

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Junctional Epithelium Features:

• Consists of non-keratinizing epithelium
• Thickness
• Early life- 3-4 layers
• Later Increases
• Length- 0.25-1.35 mm

Question 2. Lamina dura.
Answer:

• This is the wall of the tooth socket that surrounds the tooth
• It is made up of dense cortical bone
• A thin radiopaque line surrounds the root of the tooth
• It is continuous with the shadow of the cortical bone at the alveolar crest
• It is slightly thicker than the trabeculae of the cancellous bone in the area
• The thickness and density of the lamina dura will vary. with the number of occlusal stresses
• It is wider and more dense around the roots of teeth. By alternate protruberances and depression heavy occlusion
• It is thinner and less dense around teeth not subjected to occlusion function
• The presence of intact lamina dura around the tooth indicates a vital pulp.

Question 3. Gingival Sulcus.
Answer:

• The gingival sulcus is defined as the shallow crevice or space around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other side.

Gingival Sulcus Boundaries:

• Tooth side- bounded by tooth surface
• Tissue side- Bounded by marginal gingiva
• Lateral wall- Formed by sulcular epithelium
• Bottom of sulcus- Formed by junctional epithelium

Gingival Sulcus Depth:

• It is a V-shaped crevice
• The depth of the gingival sulcus is determined by estimating the depth of penetration of the periodontal probe
• In normal or ideal conditions, the depth of the gingival sulcus is 0 mm
• The probing depth of clinically normal gingival sulcus is 2 to 3 mm.
• The histological depth of the sulcus is 1.8 mm with variations of 0 to 6 mm.

Pathological variations:

• A sulcus depth of about 3 mm leads to the appearance of pocket epithelium with irregular ridges and ulcerations
• Sulcus depth of more than 3 to 5 mm results in the period- dentists
• It is characterized by active bone resorption

Gingival Sulcus Significance:

• The soft tissue wall of the gingival sulcus is prone to infections.
• As the sulcus depth deepens it leads to the periodontal pocket
• which acts as a reservoir for the gingival crevicular fluid

Question 4. Stippling.
Answer:

• It is a form of adaptive specialization or reinforcement for function

Stippling Significance:

• Sign of healthy gingiva
• Loss or reduction – Denotes diseased condition

Stippling Formation:

• By alternate protruberances and depression
• A papillary layer of connective tissue projects into the epithelium

Stippling Diagnosis:

• By drying the gingiva

Question 5. Attached gingiva.
Answer:

Attached Gingiva Definition:

Attached gingiva is defined as that part of the gingiva that is firm, resilient & tightly bound to the underlying periosteum of the alveolar bone

Attached are Gingiva Features:

The surface of the attached gingiva is stippled like an orange peel

• This appearance is most prominent in the facial aspect
• On the facial aspect, the attached gingiva extends upto al- alveolar mucosa
• It is demarcated here by the mucogingival junction
• On the Lingual aspect of the mandible, the attached gingiva terminates at the junction of the lingual alveolar mucosa
• The palatal surface of the attached gingiva in the maxilla blends with the palatal mucosa

Question 6. How to measure attached gingiva?
Answer:

1. Histological test:

• Schiller’s potassium iodide solution stain
• In this test, Schiller’s potassium iodide solution is applied over gingiva
• This stains the total gingiva.
• Total gingiva is thus measured
• Next measure the pocket depth
• The attached gingiva is calculated by subtracting pocket depth from the total width of the gingiva

2. Anatomical test:

• It includes a measurement approach
• It first, the pocket depth is measured by probing
• Next, the total width of the gingiva is measured
• The attached gingiva is calculated by
• Total width-pocket depth

3. Functional tests:

Tension test:

• Initially, the lip/cheek is stretched
• Observe for the movement of marginal or free gin- give
• Movement of free gingiva indicates inadequate at-attached gingiva

Roll test:

• In this test, adjacent mucosa is pushed coronally
• If the gingiva moves along with it, it donates inadequate attached gingiva

Question 7. Roll test.
Answer:

• In this test, adjacent mucosa is pushed coronally
• If the gingiva moves along with it, it donates inadequate attached gingiva

Question 8. Periosteum.
Answer:

• It is the tissue covering the outer surface of the bone
• It consists of
  • Inner layers- cells differentiating into osteoblasts
  • Outer layer- Blood vessels, nerves, fibers
  • Collagen fibers- penetrate the bone

Question 9. Functions of the gingiva.
Answer:

1. Attached gingival:

• It braces marginal gingiva
• It allows for proper deflection of food
• It provides room for proper placement of toothbrush
• It is important for the overall maintenance of gingival health

2. Gingival crevicular fluid:

• It cleanses material from the sulcus
• It improves the adhesion of the epithelium to the tooth by plasma proteins
• It possesses antimicrobial properties
• It exerts antibody activity to defend gingiva
• It transports a variety of molecules

3. Gingival fibers:

• Provides support to the gingiva and attaches it to the bone
• It anchors the tooth to the bone
• Maintains relationship of adjacent teeth
• Secures alignment of teeth in the arch

Question 10. Functions of Gingival Fibers.
Answer:

• Adapts marginal gingiva to tooth
• Withstands forces of mastication
• Unites marginal gingiva to cementum

Question 11. Trans-septal fibers.
Answer:

Trans-septal fibers Location:

• Connects the cementum of one tooth to the cementum of the adjacent tooth

Trans-septal fibers Functions:

• Protect interproximal bone
• Maintain tooth to tooth contact

Trans-septal fibers Significance:

• These are the last to get destroyed due to disease condition
• They are the first to degenerate

Question 12. Blood supply to the gingiva.
Answer:

1. Supraperiosteal arteries:

• Arises from above alveolar bone
• Branches and supplies facial and lingual surfaces

2. Vessels of the periodontal ligament:

• Anastomoses with the capillaries

3. Arterioles emerging from the crest of the interdental septa:

Question 13. Fibroblasts.
Answer:

• They are spindle-shaped cells
• Synthesizes chondroitin sulfate, heparin sulfate, and hyaluronic sulfate
• Synthesizes connective tissue matrix
• It produces
  • Collagen fibers
  • Reticulin fibers
  • Oxytalalan fibers
  • Elastin fibers

Question 14. Epithelial cell rests on molasses.
Answer:

• It is a remnant of Hertwig’s epithelial root sheath
• Present near and parallel to root surfaces
• Attached to one another by desmosomes
• During disease conditions they undergo proliferation
• Persists as a network strand, island, or tubule
• Exhibits tonofilaments

Question 15. Gingival col.
Answer:

• Col is the depressed central concave area, which fits below the contact point

Gingival col Features:

• It lies directly below the contact points of the teeth
• It connects the facial and Lingual papilla
• It is derived from reduced enamel epithelium

Gingival col Histology:

• The epithelium of the col is non keratinized
• This epithelium is continuous with junctional epithe- lium on each side
• The connective tissue contains xylan fibers
• Its potential as a stagnant site makes it highly susceptible to inflammatory diseases

Question 16. Osteoclast.
Answer:

• They are multinucleated giant cells
• Precursor- Blood-borne monocytes

Osteoclast Functions:

• Resorption of bone
• Secretes hydrolytic enzymes

Question 17. Mechanism of tooth Support.
Answer:

1. Tensional theory:

Application of forces
↓
Straightening of principal fiber
↓
Transmission of forces to alveolar bone
↓
Causes elastic deformation of socket

2. Viscoelastic theory:

Transmission of forces to tooth
↓
Transportation of extracellular fluid into marrow spaces
↓
Bundle fibers absorb shock and tighten

Question 18. Difference between acellular and cellular cementum.
Answer:

Question 19. Sharpey’s fibers.
Answer:

• Sharpey’s fibers are contained in bundle bone
• Arranged parallel to the root
• Some fibers are completely calcified while most contain an uncalcified central core within a calcified outer layer

Question 20. Bundle Bone.
Answer:

• It is a bone adjacent to the periodontal ligament con- training a great number of Sharpey’s fibers
• Thin lamellae are arranged in layers parallel to the root
• Bundle bone occurs throughout the skeletal system wherever ligaments and muscles are attached

Question 21. Interdental Septum.
Answer:

Interdental Septum Consists of:

• Socket walls
• Facial and lingual plates

Interdental Septum Significance:

• Factors Affecting Its Dimensions:
• Size of adjacent teeth
• Convexity of crowns of adjacent teeth
• Position of teeth in the jaw
• Degree of the eruption of teeth

Question 22. Hypercementosis.
Answer:

• Prominent thickening of cementum

Hypercementosis Types:

1. Localized
2. Generalized

Hypercementosis Types Etiology:

Hypercementosis Types Localized:

• Excessive tension
• Excessive occlusal forces

Hypercementosis Types Generalized:

• Periapical infections
• Paget’s disease

Question 23. Cemento enamel junction.
Answer:

• It is a junction of the enamel of the crown and the cementum of the root

Cemento enamel junction Types:

• 60-65%-Cementum overlaps enamel
• 30%-End to end a relationship
• 5-10%-Cementum and enamel fail to meet

Question 24. Acellular cementum.
Answer:

• Acellular cementum is first formed cementum
• It is formed during root formation
• Covers approximately the cervical third or half of the root
• It does not contain cells
• If interdental space is narrow, the septum may consist
• It is formed before the tooth reaches the occlusal plane
• Its thickness ranges from 30-230 micrometers

Acellular cementum contains:

1. Sharpey’s fibers:

• It supports the tooth
• Inserted at an approximately right angle into root surfaces
• They are completely calcified

2. Intrinsic collagen fibrils:

1. Calcified fibers
2. Irregularly arranged or parallel to the surface

Question 25. Mast cells.
Answer:

• They are small, round, or oval cell
• Contains cytoplasmic granules
• These granules contain heparin and histamine
• During an inflammatory response, these cells release their- time causing the antigen-antibody formation

Question 26. Differences between attached gingiva and al-volar mucosa.
Answer:

Question 27. Palatogingival groove.
Answer:

• Palatogingival groove is found primarily on maxillary incisors
• It is associated with increased plaque accumulation, clinical attachment, and bone loss
• These are developmental grooves that sometimes appear in maxillary lateral incisors
• It leads to accessibility problems

Question 28. Define and classify embrasures.
Answer:

Embrasures:

• When two teeth in the same arch are in contact, their curvature adjacent to the contact areas forms spillway spaces called embrasures

Embrasures Functions:

• Provides spillway for food during mastication
• Prevents food from being forced through the contact area
• Make the teeth more self-cleansing

Embrasures Types

• Interproximal embrasure
• Embrasure with no gingival recession
• Larger spaces with exposed root surfaces

Question 29. Functions of cementum.
Answer:

1. Anchorage:

• Provides anchorage to the tooth in its alveolus

2. Occlusal maintenance:

• Continuous deposition helps in achieving the crown length lost due to attrition

3. Reparative:

• It serves as major reparative tissue for root surfaces
• It maintains the integrity of root surfaces

Question 30. Define periodontal ligament. What does it? There are small collagen fibers associated with the lar- comprise of?
Answer:

Periodontal Ligament:

• It is the specialized connective tissue that forms the inter. face between the tooth and the alveolar bone

1. Cellular components:

• Synthesizing cells:
  • Fibroblasts
  • Cementoblasts
  • Osteoblasts
• Resorptive cells:
  • Fibroblasts
  • Cementoclasts
  • Osteoclasts
• Epithelial cells:
  • Cell rests of Malassez
• Progenitor cells:
  • Undifferentiated mesenchymal cells
• Defense cells:
  • Mast cells
  • Macrophages

2. Extracellular components:

• Fibers:
  • Collagen fibers
  • Elastic fibers
  • Oxytalan fibers
  • Elaunin fibers
• Ground substances:
  • Protein polysaccharides
  • Glycosaminoglycans
  • Proteoglycan
  • Glycoprotein
  • Fibronectin

3. Connective tissue component:

• Blood vessels
• Nerves
• Lymphatics

Question 31. Define intermediate plexus.
Answer:

• There are small collagen fibers associated with the larger principal collagen fibers
• These fiber run in all directions forming a plexus called the intermediate plexus
• They are reticulate fibers which are fine, immature collagen fibers with the lattice-like arrangement

Question 32. Parts of the alveolar bone
Answer:

The alveolar bone contains two parts

1. Alveolar bone proper

• It is 0.1-0.4 mm thick
• It surrounds the root of the teeth
• Gives attachment to principal fibers of PDL
• Parts
• Lamellated bone
  • Contains osteon which contains blood vessel
  • Bundle bone
  • The bone directly lining the socket is referred to as bundle bone

2. Supporting alveolar bone

• The bone that surrounds the alveolar bone proper and gives support to the socket is called the supporting alveolar bone
• It consists of:
• Cortical plate
  • It forms the outer and inner plates of the alveolar processes
• Spongy bone
  • It is bone occupying the central part of the al-alveolar process

Question 33. Factors affecting the color of gingiva

• The color of the gingiva normally appears coral pink.
• It depends on
  • Degree of keratinization
  • Thickness of epithelium
  • Degree of pigmentation
  • Amount of circulation

Periodontics Normal Periodontium Viva Voce

1. The gradual increase occurs in GCF amount from 6:00 am to 10:00 pm and decreases afterward.
2. Non-keratinocytes present in the gingival epithelium are: melanocytes, Langerhans cells, Merkel cells
3. The junctional epithelium is collar like a band of non-keratinizing epithelium
4. Values:
   
5. Stippling is seen in the attached gingiva and central core of the interdental papilla.
6. It is absent in marginal gingiva
7. Sulcular epithelium is non-keratinized and without recipes
8. The junctional epithelium is widest in the coronal portion and thin towards the center
9. The turnover rate of junctional epithelium is about 5 days
10. The attachment apparatus of the tooth includes the periodontal ligament, cementum, and alveolar bone
11. Progenitor cells are undifferentiated mesenchymal cells.

Question 1. Enzymes in the gingiva.
Answer:

Question 2. Cells of Periodontal Ligaments.
Answer:

1. Synthetic Cells:

Osteoblasts:

• Covers the periodontal surface of the alveolar bone
• It actively synthesizes ribosomes
• Contains a largely open nucleus containing prominent nucleoli

2. Fibroblasts, spindle-shaped cells:

• Most prominent cell
• Synthesizes chondroitin sulfates, heparin sulfate, and hyaluronan sulfate
• Synthesizes connective tissue matrix

Fibroblasts, spindle-shaped cells Produces:

• Collagen fibers
• Reticulin fibers
• Oxytalan fibers
• Elastin fibers

1. Cementoblast:

• Seen lining cementum
• Lay down cementum

2. Resorptive cells:

• Osteoclast:
  • Multinucleated giant cell
  • Lies adjacent to the bone
  • Undergoes resorption of bone
  • Formed by monocytes
• Fibroblast:
  • Contain fragments of collagen
  • These undergoes digestion
  • Results in resorption of bone
• Cementoclast:
  • Located in Howships Lacunae
  • Causes resorption of cementum

3. Progenitor cells:

• Formed in the basal cell layer
• Basal cells have the ability to divide
• One of the divided cells migrates to the superficial layer and the other remains as a progenitor cell

4. Epithelial cell rests of Malassez:

• Remnants of Hertwig’s epithelial root sheath
• Present near and parallel to root surfaces Attached to one another by desmosomes
• During disease conditions, they undergo proliferation
• Persists as a network strand, island, or tubule
• Exhibits tonofilaments

5. Mast Cell:

• Small, round, or oval cell
• Contains cytoplasmic granules
• Contains heparin and histamine
• During an inflammatory response, these releases of histamine cause antigen-antibody formation

6. Macrophages:

• Capable of phagocytosis

Question 3. Functions of Periodontal ligament.
Answer:

1. Physical Functions of Periodontal ligament:

• Provide soft tissue casing
• Protect nerves and vessels from injury
• Transmit occlusal forces to the bone
  • By stretching of oblique fibers of PDL
  • Transmits tensional force to the bone
  • Results in bone formation
• Attaches tooth to the bone
• Maintains architecture of gingival tissue
• Shock absorbent

2. Formative and Remodelling function:

• Synthesis and resorption of cementum, PDL, and al-alveolar bone
• Old cells and fibers are replaced by a new one

3. Nutritional and Sensory function:

• Nutrition – Through blood supply
• Sensory – Transmits sensation of touch, pressure and pain to CNS

Neural Transmission Functions of Periodontal ligament :

• Apical area – Ruffini
• Apex Pressure and vibration endings
• Mid root – Meissners corpuscles

Question 5. Define alveolar bone and describe its composition.
Answer:

Alveolar Bone: H

• It is that portion of the maxilla and mandible that forms and supports the tooth socket

Composition:

Cells:

1. Osteoblast: Cuboidal cells

Osteoblast Contains:

• Rough endoplasmic reticulum
• Large Golgi apparatus
• Secretory vesicles

Osteoblast Functions:

• Synthesize osteoid, collage
• Regulate mineralization

Osteoblast Precursor: Progenitor cells

2. Osteoclasts: Multinucleated giant cells

Osteoclasts Precursor: blood-borne monocytes

Osteoclasts Functions: Resorptive cell, Secretes hydrolytic en-zymes

3. Osteocytes: These extend processes from lacunae to canaliculi

Osteocytes Function: Canaliculi bring oxygen and nutrients to osteocytes

4. Extracellular Matrix:

Extracellular Matrix Inorganic:

• Calcium, Hydroxyl
• Phosphate, Carbonate
• Citrate, Sodium
• Magnesium, Fluorine

Extracellular Matrix Organic:

• Osteocalcin
• Osteonectin
• BMP
• Proteoglycans
• Glycoproteins

Question 6. Dentogingival junction.
Answer:

• The junctional epithelium and the gingival fibers are together considered a dentogingival unit

Dentogingival Junction:

• It represents a unique anatomic feature concerned with the attachment of gingiva to the tooth
• It comprises an epithelial portion and a connective tissue portion

1. Epithelial portion:

• It can be divided into
  • Gingival epithelium
  • Sulcular epithelium
  • Junctional epithelium

2. Connective tissue component:

• It contains densely packed collagen fiber bundles.
• It includes

1. Dentogingival fibers
   • Extends from cementum into free and at-attached gingiva
2. Alveologingival fibres
   • Extends from the alveolar crest into free and at-attached gingiva
3. Circular fibers
   • Wrap around the tooth
4. Dentoperiosteal fibres
   • Run from cementum, over the alveolar crest, and insert into the alveolar process
5. Transseptal fibers
   • Runs interdentally from cementum to one tooth to the adjacent tooth

Question 7. Sulcular Epithelium.
Answer:

• Sulcular epithelium is the epithelium lining the gingival sulcus
• It is a thin,non-keratinized stratified squamous epithelium without recipes
• It extends from the coronal limit of the junctional epithelium to the crest of the gingival margin
• It usually shows many cells with hydropic degeneration
• It lacks granulosum and corneum strata
• Enzymes present have a lower degree of activity
• It has the potential to keratinize if
  1. It is exposed to the oral cavity or
  2. The bacterial flora of the sulcus is totally eliminated

Sulcular Epithelium Importance:

• It may act as a semipermeable membrane through which injurious bacterial products pass into the gingival and tissue fluid from the gingiva seeps into the sulcus

Question 8. Fenestrations and Dehiscences.
Answer:

Fenestration:

• These are isolated areas in which the root surface is covered only by the periosteum and gingiva
• Marginal bone is intact

Dehiscence:

• Defect involving denudation of marginal bone

Etiology:

• Root prominence
• Malposition
• Teeth in labial version

Common location:

• Site – Facial bone
• Teeth involve – Anterior

Importance:

• Affect the outcome of surgical treatment

Question 9. Define and classify cementum. (or) Schroeder’s classification of cementum
Answer:

Cementum:

• It is a calcified avascular mesenchymal tissue that forms the outer covering of the anatomic root

Cementum Classification:

1. Acellular fibrillar cementum:

• Contains a mineralized ground substance
• Does not contain fibres or cells

Acellular fibrillar cementum Site: On enamel near CEJ

2. Acellular extrinsic fiber cementum:

• Contains Sharpey’s fibers
• Does not contain cells

Acellular extrinsic fiber cementum Site: Coronal half of root surface

3. Cellular mixed stratified cementum:

• Contains cells and fibres

Cellular mixed stratified cementum Site: Apical third of root, apices, and furcation areas

4. Cellular Intrinsic Fiber cementum:

• Contains fibers but not cells

Cellular Intrinsic Fiber cementum Site: Resorption lacunae

5. Intermediate Cementum:

Intermediate Cementum Site: Apical 1/3rd of root

Intermediate Cementum Function: Attaches cementum to dentin

• This is removed during root planning

Question 10. Junctional epithelium.
Answer:

• It is the tissue that joins to the tooth on one side and the oral sulcular epithelium and connective tissue on the other
• It forms the base of the sulcus

Junctional epithelium Attachment:

• Attach to the tooth surface
  • By internal basal lamina
  • Reinforced by the gingival fibers
  • Consists of lamina dens and lamina lucida
• Attach to gingival connective tissue
  • By external basal lamina

Junctional epithelium Features:

• Consists of non-keratinizing epithelium
• Thickness
  • Early life- 3-4 layers
  • Later- Increases
• Length- 0.25-1.35 mm

Junctional epithelium Structure:

• Consists of basal and suprabasal layer
• Zones present are
  • Apical- germination
  • Middle- adhesion
  • Coronal-permeable
• Cells present are
  • Basal cells- cuboidal/flattened
  • Suprabasal cells
  • Complex microvilli formation and interdigitation
  • Presence of leukocytes and lymphocytes
  • Desmosomes interconnect the cells

Question 11. Oxytalan fibers.
Answer:

• The periodontal ligament contains two immature forms of fibers
• They are xylan and cleaning fibers
• The xylan fibers run parallel to the root surface in a vertical direction and bend to attach to the cementum. in the cervical third of the root
• These fibers are associated with blood vessels and nerves of the periodontal ligament
• They regulate the vascular flow
• An elastic meshwork in the periodontal ligament is composed of many elastic lamellae with peripheral oxy- talan fibers and cleaning fibers
• Oxytalan fibers develop de novo in the regenerated periodontal ligament

Question 12. Describe the mechanism by which ligament periodontal resists occlusal forces.
Answer:

1. Tensional theory:

• It states that the principal fibers of the periodontal ligament are major factors in supporting the tooth and transmitting forces to the underlying bone
• When a force is applied to the crown, the principal fibers first unfold and straighten and then transmit forces to the alveolar bone
• When the alveolar bone has reached its limit, the load is transmitted to the basal bone

2. Viscoelastic theory:

• It states that the displacement of the tooth is controlled by fluid movements with fibers having only a secondary role
• When forces are transmitted to the tooth, the ex-intracellular fluid passes from the periodontal ligament into the marrow spaces of bone through fo- the lamina

3. Thixotropic theory:

• According to this theory, the periodontal ligament has rheological behavior of thixotropic gel

Question 13. Significance of width of attached gingiva
Answer:

• The width of the attached gingiva is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket

• The width of the attached gingiva increases with age 4 and in supra-erupted teeth
• On the lingual aspect of the mandible, the attached gingiva terminates at the junction of the lingual alveolar mucosa which is continuous with the mucous membrane lining the floor of the mouth

Periodontics Normal Periodontium Long Essays

Question 1. Define Gingiva. Describe the microscopic and macroscopic features of the gingiva. Add a note on the importance of GCF.
Answer:

Gingiva:

• It is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the teeth

Macroscopic:

• Gingiva is divided into

1. Marginal Gingiva:

• Border of the gingiva surrounding the teeth in the collar-like fashion
• Demarcated apically by a shallow depression called “free gingival groove”

2. Attached Gingiva:

• Part of the gingiva that is firm, resilient, and tightly bound to the underlying periosteum of the alveolar bone
• The width of the attached gingiva is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket

3. Interdental Gingiva:

• Occupies gingival embrasure

Parts: Facial papilla, lingual papilla and col

• Lateral borders and tips of interdental papilla are formed by continuation of marginal gingiva.
• In diastema, interdental papilla is absent

Microscopic Features:

1. Oral/Outer Epithelium:

Outer Epithelium Layers:

1. Outer Epithelium Basal layer:
   • Cells are cylindrical/cuboidal
   • Attach to the basement membrane
   • Cells have the ability to divide
   • Stratum Spinosum:
   • Large cells with short processes called spines
   • Cells have a prickled appearance
   • Cells are attached to one another with the help of desmosomes
   • Stratum Granulosum:
   • Keratohyalin granules are seen
   • Stratum Corneum:
   • The cytoplasm of cells in this layer is filled with keratin
   • It can be
   • Orthokeratinized – In this cells are devoid of a nucleus
   • Parakeratinized – In this cells contains the pinpoint nucleus
2. Sulcular epithelium:
   • Extends from the gingival margin to the junctional epithelium
   • Made up of basal and prickle cell layer
3.  Junctional epithelium:

• • It is the tissue that joins to the tooth on one side and to sul- color epithelium and connective tissue on the other
  • It is attached to the tooth surface by the internal basal lamina and to the gingival connective tissue by an external basal lamina

Outer Epithelium Connective tissue:

• Termed as lamina propria
• Superficial papillary layer:
• Contains epithelial ridges
• Deeper Reticular layer:
• Contains collagen fibers

Outer Epithelium Cells:

• Fibroblast
• Mast cells
• Macrophages
• Inflammatory cells

Outer Epithelium Fibers present:

• Collagen fibers
• Reticulin fibers
• Oxytalan fibers
• Elastin fibers

Importance Of Gingival Crevicular Fluid:

1. Cicardian periodicity:

• There is a gradual increase in a gingival fluid amount from 6:00 am to 10:00 pm and decreases afterward
• This is called Cicardian periodicity

2. Sex hormones:

• Female sex hormones increase flow
• Pregnancy, ovulation, and hormonal contraceptives increase gingival fluid

3. Smoking:

• Causes an immediate transient increase in flow

4. Periodontal therapy:

• An increase in gingival fluid occurs during the healing period

Question 2. Define gingiva. Describe morphological, histo- logical, and functional features of normal gin- give.
Answer:

Gingiva:

• It is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the teeth.

Morphological Features:

• Gingiva is divided into

1. Marginal gingiva:
   • It is border of the gingiva surrounding the teeth in col- lar like fashion
   • It is demarcated apically by a shallow depression called a “free gingival groove”
2. Attached gingiva:
   • It is part of the gingiva that is firm, resilient, and tightly bound to the underlying periosteum of the alveolar hone
   • The width of the attached gingiva is the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or periodontal pocket
3. Interdental gingiva:
   • It occupies gingival embrasure
   • Its parts are facial papilla, lingual papilla, and col
   • Lateral borders and tips of interdental papilla are formed by the continuation of the marginal gingiva
   • In diastema, interdental papilla is absent

Histological Features:

1. Epithelium:

Epithelium Layers:

1. Basal layer:
   • Cells are cylindrical/cuboidal
   • Attach to the basement membrane
   • Cells have the ability to divide
   • One of the divided cells migrates to the superficial layer
   • Basal cells are separated from connective tissue by a basement membrane
   • Beneath the basal cell, the electro-lucent zone can be seen called lamina lucida
   • Beneath it, there is electron dense zone called lamina densa
   • Hemidesmosomes attach epithelium to the connective tissue.
2. Stratum Spinosum:
   • Large cells with short processes called spines
   • Cells have a prickled appearance
   • Cells are attached to one another with the help of desmosomes
3. Stratum Granulosum:
   • Keratohyalin granules are seen
4. Stratum Corneum:
   • The cytoplasm of cells in this layer are filled with keratin
   • It can be
   • Orthokeratinized – In this cells are devoid of a nucleus
   • Parakeratinized – In this cells contains pinpoint nucleus

2. Sulcular epithelium:

• Extends from the gingival margin to the junctional epithelium
• Made up of basal and prickle cell layer

3. Junctional epithelium:

• It is the tissue that joins to the tooth on one side and to sul- color epithelium and connective tissue on the other
• It is attached to the tooth surface by an internal basal lamina and to the gingival connective tissue by an external basal lamina

Connective tissue:

• Termed as lamina propria
• Superficial papillary layer:
  • Contains epithelial ridges
• Deeper Reticular layer:

Cells:

• Contains collagen fibers
• Fibroblast
• Mast cells
• Macrophages
• Inflammatory cells

Fibers present:

• Collagen fibers
• Reticulin fibers
• Oxytalan fibers
• Elastin fibers

Importance Of Gingival Crevicular Fluid:

1. Cicardian periodicity:

• There is a gradual increase in gingival fluid amount from 6:00 am to 10:00 pm and decreases afterward
• This is called Cicardian periodicity

2. Sex hormones:

• Female sex hormones increase flow
• Pregnancy, ovulation, and hormonal contraceptives increase gingival fluid

3. Smoking:

• Causes an immediate transient increase in flow

4. Periodontal therapy:

• An increase in gingival fluid occurs during the healing period

Gingival Crevicular Fluid Functions:

1. Attached gingival:

• It braces marginal gingiva
• It allows for proper deflection of food
• It provides room for proper placement of toothbrush
• It is important for the overall maintenance of gingival health

2. Gingival crevicular fluid:

• It cleanses material from the sulcus
• It improves the adhesion of the epithelium to the tooth by plasma proteins
• It possesses antimicrobial properties
• It exerts antibody activity to defend gingiva
• It transports a variety of molecules

3. Gingival fibers:

• Provides support to the gingiva and attaches it to the bone
• It anchors the tooth to the bone
• Maintains relationship of adjacent teeth
• Secures alignment of teeth in the arch

Question 3. Define PDL. Write in detail about its structure and function. (or) Enumerate principal groups of periodontal ligament fibers. Add a note on the cellular elements and functions of PDL. Principal Fibres of PDL. (Extra cellular components)
Answer:

Periodontal Ligaments:

• It is the connective tissue that surrounds the root and connects it with the bone

Periodontal Ligaments Structure:

Cells:

1. Synthetic Cells:

• Osteoblasts:
  • Covers the periodontal surface of alveolar bone
  • It actively synthesizes ribosomes
  • Contains a largely open nucleus containing prominent nucleoli
• Fibroblasts, spindle-shaped cells:
  • Most prominent cell
  • Synthesizes chondroitin sulfates, heparin sulfate and hyaluronan sulfate
  • Synthesizes connective tissue matrix
• Produces:
  • Collagen fibers
  • Reticulin fibers
  • Oxytalan fibers
  • Elastin fibers
• Cementoblast:
  • Seen lining cementum
  • Lay down cementum

2. Resorptive cells:

• Osteoclast:
  • Multinucleated giant cell
  • Lies adjacent to the bone
  • Undergoes resorption of bone – Formed by monocytes
• Fibroblast:
  • Contain fragments of collagen – These undergo digestion
  • Results in resorption of bone
• Cementoclast:
  • Located in Howships Lacunae
  • Causes resorption of cementum

3. Progenitor cells:

• Formed in the basal cell layer
• Basal cells have the ability to divide
• One of the divided cells migrates to the superficial layer and the other remains as a progenitor cell

4. Epithelial cell rests of Malassez:

• Remnants of Hertwig’s epithelial root sheath are Present near and parallel to root surfaces
• Attached to one another by desmosomes
• During disease condition, they undergo proliferation
• Persists as a network strand, island, or tubule
• Exhibits tonofilaments

5. Mast Cell:

• Small, round, or oval cell
• Contains cytoplasmic granules
• Contains heparin and histamine
• During an inflammatory response, these releases- time causes antigen- antibody formation

6. Macrophages:

• Capable of phagocytosis

Extracellular Components

1. Fibres:

• Collagen:
  • Synthesized by fibroblasts, chondroblasts, os
  • neoblasts, odontoblast, and other cells
  • Type 1,3 and 4 are common
• Oxytalin:
  • Provide elastic properties to PDL

Principal Fibres:

1. Trans-septal group:
   • Connects cementum of one tooth with that of other
2. Alveolar crest:
   • Extends from cementum to alveolar crest Function: Retains tooth in the socket, Retains lateral tooth movement
3. Horizontal group:
   • Extends from cementum to alveolar bone
4. Oblique group:
   • Extends coronally from the cementum to bone Function: Resist axially directed forces
5. Apical group:
   • From cementum to the bone of alveolar fundus Function: Prevents tipping movement, Resists luxation
6. Inter-radicular fibers:
   • Presents between cementum of a multi-rooted tooth.
   • Function: Resists luxation, Resists tipping and torquing

2. Ground substance:

• Glycosaminoglycan – hyaluronic acid, proteoglycan- cane
• Glycoproteins – fibronectin and laminin

Principal Fibres Functions:

1. Physical:

• Provide soft tissue casing
• Protect nerves and vessels from injury
• Transmit occlusal forces to the bone
  • By stretching of oblique fibers of PDL
  • Transmits tensional force to the bone
• Results in bone formation Attach tooth to the bone
• Maintains architecture of gingival tissue
• Shock absorbent

2. Formative and Remodelling function:

• Synthesis and resorption of cementum, PDL, and al- alveolar bone
• Old cells and fibers are replaced by a new one

3. Nutritional and Sensory function:

• Nutrition – Through blood supply
• Sensory Transmits sensation of touch, pressure, and pain to CNS

Neural Transmission

• Apical area – Ruffini
• Apex Pressure and vibration endings
• Mid root – Meissners corpuscles

Question 4. Discuss the role of alveolar bone in health and periodontal diseases.
Answer:

Alveolar Bone In Health:

• It is that portion of the maxilla and mandible that forms and supports the tooth socket
• The alveolar process is thickened ridge of bone that contains tooth sockets that bear teeth
• The alveolar bone proper is the thin layer that provides attachment to principal fibers of the periodontal ligament Alveolar bone is perforated with numerous openings for intra-alveolar nerves and blood vessels
• It consists of:

1. Cells:

1. Osteoblast:
   • Cuboidal cell
   • Contains
   • Rough endoplasmic reticulum
   • Large Golgi apparatus
   • Secretory vesicles
   • Functions:
   • Synthesizes osteoid and collagen
   • Regulates mineralization
   • Precursor:
   • Progenitor cell
2. Osteoclasts:
   • Multinucleated giant cells
   • Precursor- Blood-borne monocytes
   • Functions:
   • Resorption of bone
   • Secretes hydrolytic enzymes
3. Osteocytes:
   • These extend processes from lacunae to ca- canaliculi
   • Functions:
   • Canaliculi bring oxygen and nutrients to os- osteocytes

2. Extracellular matrix:

• Inorganic:
  • Calcium
  • Hydroxyl
  • Phosphate
  • Carbonate
  • Citrate
  • Sodium
  • Magnesium
  • Fluorine
• Organic:
  • Osteocalcin
  • Osteonectin
  • BMP
  • Proteoglycans
  • Glycoproteins
  • Parathyroid hormone regulates bone removed- selling by both bone formation and bone re- sorption

Alveolar Bone In Disease:

• Fenestration and dehiscence are seen during disease in relation to alveolar bone

Bone In Disease Fenestration:

• These are isolated areas in which the root surface is covered only by the periosteum and the gingiva Marginal bone is intact

Dehiscence:

• It is a defect involving the denudation of marginal bone

Bone In Disease Etiology:

• Root prominence
• Malposition
• Teeth in labial version

Bone In Disease Common Location:

• Site- Facial bone
• Teeth commonly involved- Anterior

Bone In Disease Importance:

• Affects the outcome of surgical treatment