This document provides definitions and details about the anatomy and microscopic structure of gingiva. It begins with definitions of gingiva from several sources and discusses the development, macroscopic anatomy including the different types of gingiva, and microscopic anatomy. The microscopic anatomy section describes the layers of the gingival epithelium and cell types present. It also discusses the different types of gingival epithelium including oral, sulcular, and junctional epithelium. In summary, the document provides a comprehensive overview of the definitions, structures, and histology of gingival tissues.
seminar on gingiva
contents:
Introduction
Definition
Development of gingiva
Macroscopic anatomy
Microscopic anatomy
Blood supply
Lymphatic drainage
Nerve supply
Correlation of clinical and microscopic features
Repair/healing of gingiva
Age changes
Gingival diseases
Clinical considerations
Conclusion
References
seminar on gingiva
contents:
Introduction
Definition
Development of gingiva
Macroscopic anatomy
Microscopic anatomy
Blood supply
Lymphatic drainage
Nerve supply
Correlation of clinical and microscopic features
Repair/healing of gingiva
Age changes
Gingival diseases
Clinical considerations
Conclusion
References
Introduction
A sound knowledge of the anatomy of the periodontium and the surrounding hard and soft structures is essential to determine the scope and possibilities of surgical periodontal procedures and to minimize their risks.
Blood vessels, and nerves located in the vicinity of the periodontal surgical field, are particularly important during various surgical procedures.
Arterial Supply
Common Carotid Artery
Carotid Sinus & Carotid Body
Applied Anatomy of CCA
CAROTID PULSE :
CCA may be compressed against the carotid tubercle of transverse process of C6 vertebra about 4cm above the sternoclavicular joint.
External Carotid Artery
Generally it lies anterior to the Internal Carotid Artery.
It is the chief artery of supply to structures in the front of neck, oral cavity and in the face.
In carotid triangle
Crossed superficially by:
Cervical branch of facial nerve
Hypoglossal nerve
Facial, lingual &superior thyroid vein
Deep to artery lies:
Wall of pharynx
Superior laryngeal nerve
Ascending pharyngeal artery
Above the carotid triangle
ECA lies deep in the substance of parotid gland
Branches
Lingual Artery
Principal artery of tongue.
Arises anteromedially from ECA opposite the tip of greater cornu of hyoid bone.
Divided into three parts by hyoglossus muscle.
Applied anatomy
Sublingual artery injury occurs in premolar & molar region, when sharp instrument or rotating disks slips off a lower molar & injure the floor of mouth.
Sublingual and submental arteries may course anteriorly in close proximity to the lingual plate, and branches of these blood vessels enter accessory foramina along the lingual cortex.
Hofschneider et al (1999)
Inadvertent penetration through the lingual cortical plate into the floor of the mouth while preparing an osteotomy can cause arterial trauma, thereby resulting in development of a sublingual or submandibular hematoma
Flanagan D. et al.2003
Facial Artery
ORIGIN: Arises from the ECA just above the tip of greater cornua of hyoid bone.
COURSE:
Runs upwards in neck as cervical part ;
On face as facial part.
Tortuous course—
In neck allows free movements of pharynx during deglutition,
On face allows free movements of mandible , lips, & cheek during mastication & facial expressions, escapes traction & pressure during movements.
Cervical part :
Cervical part runs upwards on superior constrictor of pharynx deep to the posterior belly of digastric.
It grooves the posterior border of submandibular gland, makes S-bend [2 loops]
1st winding down over submandibular gland &
then up over the base of mandible.
Facial part:
The vessel enters the face by winding around the base of the mandible, and by piercing the deep cervical fascia,at the anteroinferior angle of the masseter muscle, here it can be palpated & is called as anaesthetist’s artery. Using contracted masseter as a landmark, pulse of facia
• Introduction
• Definitions
• Macroscopic Features
• Microscopic Features
• Blood supply
• Nerve supply
• Lymphatic drainage
• Role of epithelium in defence mechanism
• Oxygen consumption of gingiva
• Correlation of Macroscopic with microscopic features
• Conclusion
A presentation on the topic of microscopic section of gingiva. This topic is mostly looked on by periodontists. A very important chapter in the speciality in dentistry of periodontology and implantology department. Basic understanding of microscopic features and clinical features of gingiva is an important topic for post graduate as well as undergraduate students in the dental field.
Introduction
A sound knowledge of the anatomy of the periodontium and the surrounding hard and soft structures is essential to determine the scope and possibilities of surgical periodontal procedures and to minimize their risks.
Blood vessels, and nerves located in the vicinity of the periodontal surgical field, are particularly important during various surgical procedures.
Arterial Supply
Common Carotid Artery
Carotid Sinus & Carotid Body
Applied Anatomy of CCA
CAROTID PULSE :
CCA may be compressed against the carotid tubercle of transverse process of C6 vertebra about 4cm above the sternoclavicular joint.
External Carotid Artery
Generally it lies anterior to the Internal Carotid Artery.
It is the chief artery of supply to structures in the front of neck, oral cavity and in the face.
In carotid triangle
Crossed superficially by:
Cervical branch of facial nerve
Hypoglossal nerve
Facial, lingual &superior thyroid vein
Deep to artery lies:
Wall of pharynx
Superior laryngeal nerve
Ascending pharyngeal artery
Above the carotid triangle
ECA lies deep in the substance of parotid gland
Branches
Lingual Artery
Principal artery of tongue.
Arises anteromedially from ECA opposite the tip of greater cornu of hyoid bone.
Divided into three parts by hyoglossus muscle.
Applied anatomy
Sublingual artery injury occurs in premolar & molar region, when sharp instrument or rotating disks slips off a lower molar & injure the floor of mouth.
Sublingual and submental arteries may course anteriorly in close proximity to the lingual plate, and branches of these blood vessels enter accessory foramina along the lingual cortex.
Hofschneider et al (1999)
Inadvertent penetration through the lingual cortical plate into the floor of the mouth while preparing an osteotomy can cause arterial trauma, thereby resulting in development of a sublingual or submandibular hematoma
Flanagan D. et al.2003
Facial Artery
ORIGIN: Arises from the ECA just above the tip of greater cornua of hyoid bone.
COURSE:
Runs upwards in neck as cervical part ;
On face as facial part.
Tortuous course—
In neck allows free movements of pharynx during deglutition,
On face allows free movements of mandible , lips, & cheek during mastication & facial expressions, escapes traction & pressure during movements.
Cervical part :
Cervical part runs upwards on superior constrictor of pharynx deep to the posterior belly of digastric.
It grooves the posterior border of submandibular gland, makes S-bend [2 loops]
1st winding down over submandibular gland &
then up over the base of mandible.
Facial part:
The vessel enters the face by winding around the base of the mandible, and by piercing the deep cervical fascia,at the anteroinferior angle of the masseter muscle, here it can be palpated & is called as anaesthetist’s artery. Using contracted masseter as a landmark, pulse of facia
• Introduction
• Definitions
• Macroscopic Features
• Microscopic Features
• Blood supply
• Nerve supply
• Lymphatic drainage
• Role of epithelium in defence mechanism
• Oxygen consumption of gingiva
• Correlation of Macroscopic with microscopic features
• Conclusion
A presentation on the topic of microscopic section of gingiva. This topic is mostly looked on by periodontists. A very important chapter in the speciality in dentistry of periodontology and implantology department. Basic understanding of microscopic features and clinical features of gingiva is an important topic for post graduate as well as undergraduate students in the dental field.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
4. CARRANZA:
Gingiva is the part of oral mucosa that covers the alveolar
processes of jaws and surrounds the neck of teeth.
LINDHE:
Part of masticatory mucosa covering the alveolar processes of
the cervical portions of teeth.
GLOSSARY OF PERIODONTICS (AAP):
The fibrous investing tissue, covered by keratinized epithelium,
that immediately surrounds a tooth and is contiguous with its
periodontal ligament and with the mucosal tissues of the
mouth.
DEFINITIONS
5. SCHROEDER:
It is a combination of epithelium and connective tissue and it
defined as that portion of oral mucous membrane, which in
complete post eruptive dentition of a healthy young individual
surrounds and is attached to the teeth and the alveolar processes.
GRANT:
Gingiva is the part of oral mucous membrane attached to the teeth
and the alveolar processes.
GENCO:
Gingiva is that part of oral mucous membrane that covers the
alveolar processes of the cervical portions of the teeth.
10. 10 10
• Gingival crevice – Orban &
Mueller,1929
• Shallow crevice around the tooth
• V- shaped
• Significance:
Imp. Diagnostic parameter
Ideal conditions: 0/ close to 0mm
Biologic depth: 1.8mm
Probing depth: 2-3 mm
11. 11
• Occupies gingival embrasure
• Formed by:
Lateral borders & tip – marginal gingiva
Central intervening portion – attached
gingiva
• Shape: Pyramidal - Anteriors
Col – Posteriors
• Diastema: gingiva is firmly bound over
bone forming a smooth, rounded
surface without interdental papilla.
INTERDENTAL PAPILLA
12. ATTACHED GINGIVA
• Firm, resilient and tightly bound to
the underlying periosteum of alveolar
bone by connective tissue fibers.
• Coronally: marginal gingiva
• Apically: palatally-palatal mucosa
facially-alveolar mucosa
• Mucogingival junction
• Stippling
• Significance
• Width of attached gingiva
13. 13
Facial:
• Widest in incisor region
Maxilla: 3.5 – 4.5 mm
Mandible: 3.3 – 3.9 mm
• Most narrow adjacent to premolar
Maxilla: 1.9 mm
Mandible: 1.8 mm
Lingual:
• Wider in molar region
• Narrow in incisor region
Increases: by the age of 4yrs
supraerupted teeth
14. 14
HALL WB, 1982: the width of attached gingiva is determined by subtracting the
sulcus or pocket depth from total width of gingiva
Total width of gingiva: from MGJ to crest of marginal gingiva
⦿ Methods to determine mucogingival junction:
⚫ 1. Visual method.
⚫ 2. Functional method.
⚫ 3. Visual methods after histochemistry staining.
15. How much zone of attached gingiva is necessary to
maintain the health of Periodontium?
• Lang & Loe,1972: suggested that 2 mm of keratinized gingiva
(corresponding to 1 mm attached gingiva in this material) is adequate to
maintain gingival health.
• Bowers GM,1963: It is possible to maintain clinically healthy gingiva despite
a very narrow zone of attachment (less than 1 mm.).
• Mehta P et al,2010: width of attached gingiva is not significant to maintain
periodontal health in the presence of adequate oral hygiene.
• Wennstorm, 1987: the lack of minimum amount of attached Gingiva does
not necessarily result in a soft tissue recession. Proper plaque control
prevents soft tissue recession, even when it is out of adequate width.
17. GINGIVAL EPITHELIUM – GENERAL ASPECTS :
• Continuous lining of stratified squamous epithelium.
• Function:
Physical barrier to Infection
Participate actively in responding to infection in signaling
further host reactions in integrating innate and acquired
immune responses.
To protect deep structures
Allow a selective interchange with the oral environment.
18. • Layers of stratified squamous epithelium as seen by
electron microscopy:
19. Stratum basale:
• Cells: cylindric or cuboid.
• Found immediately adjacent to the connective tissue separated
by a basement membrane.
• Germinative layer: having the ability to divide.
• It takes approximately 1 month for a keratinocyte to reach the
outer epithelial surface, where it is shed from the stratum
corneum.
20. Stratum spinosum:
• Prickle cell layer.
• Large polyhedral cells with short cytoplasmic processes.
• Keratinosomes or odland bodies:
Modified lysosomes.
stratum
Present in the uppermost part of the
spinosum.
Contain a large amount of acid phosphatase.
21. Stratum granulosum:
• Flattened cells, in a plane parallel to the gingival surface.
• Keratohyaline granules :
• Associated with keratin formation are 1 μm in diameter)
round in shape and appear in the cytoplasm of the cell.
22. Stratum corneum:
• Closely packed, flattened cells that have lost nuclei and
most other organelles as they become keratinized.
• The cells are densely packed with tonofilaments.
• Clear, rounded bodies probably representing lipid droplets
appear within the cytoplasm of the cell.
23. Proliferation through mitosis occurs in the basal layer , less
frequently in the suprabasal layer and migration occurs.
Differentiation includes keratinisation in which main
morphologic changes seen are:
to the production of
• Progressive flattening of the cell.
• Increased prevalence of tonofilaments.
• Intercellular junctions coupled
keratohyaline granules.
• Disappearance of the nucleus
24. • Three types of surface keratinization can occur in the
gingival epithelium:
1. Orthokeratinization
2. Parakeratinization
3. Nonkeratinization
25. • Complete keratinization superficial
horny layer.
• No nuclei in stratum corneal layer.
• Well-defined stratum granulosum.
• Few areas of outer gingival epithelium.
ORTHOKERATINIZATION:
26. PARAKERATINIZATION:
• Intermediate stage of keratinization.
• Most prevalent surface area of the gingival
epithelium.
• Can progress to maturity or de- differentiate under
different physiologic or pathologic conditions.
• Stratum cornea retains PYKNOTIC NUCLEI.
• Keratohyaline granules are dispersed rather than
giving rise to a stratum granulosum.
27. NONKERATINIZATION:
• Viable nuclei in superficial layer.
• Has neither granulosum nor
corneum strata.
• Layers of nonkeratinized
epithelium:
1. Stratum superficiale
2. Stratum intermedia
3. Stratum basale
28. ULTRASTRUCTURE OF EPITHELIUM:
• Each epithelial type have characteristic pattern of cytokeratins.
• Keratin proteins are composed of different polypeptide subunits
characterized by their isoelectric points and molecular weights.
• Basal cells begin synthesis of low mol. Wt. keratins.
Ex.: K19 (40kD).
• High mol. Wt. keratins are expressed when they reach superficial
layers.
Ex.: K1 (68kD).
29. • Other proteins synthesized during maturation proess:
Keratolinin
Involucrin
Filaggrin
• Corneocyte:
Most differentiated epithelial cell
Composed of bundles of keratin tonofilaments in amorphous
matrix of filaggrin, surrounded by a resistant envelope made of
keratolinin and involucrin.
• These histochemical patterns change under normal or pathologic
stimuli, thereby modifying the keratinization process.
30. EPITHELIAL CELL CONNECTIONS:
• Together with intercellular protein-carbohydrate complexes,
cohesion between cells is provided by numerous structures
called “DESMOSOMES”.
• DESMOSOMES:
Located between the cytoplasmic processes of adjacent
cells.
Two hemidesmosomes facing each other.
Large number of desmosomes gives a solid cohesion
between cells.
31. A desmosome comprises the following structural components:
1. the outer leaflets (OL) of the cell membrane of two adjoining cells,
2. the thick inner leaflets (IL) of the cell membranes
3.the attachment plaques (AP), which represent granular and fibrillar
material in the cytoplasm.
32. • TONOFILAMENTS:
Cytoskeleton of keratin
proteins which radiate in
brush like fashion from the
attachment plaques into
cytoplasm of the cells.
• TIGHT JUNCTIONS
(ZONAE OCCLUDENS):
Rarely observed forms of
epithelial cell connections
where the membranes of the
adjoining cells are believed
to be fused
33. ULTRASTRUCTURE OF EPITHELIAL CELL:
• Cytoplasmic organelle concentration varies among different
epithelial layers.
• Mitochondria, endoplasmic reticulum, golgi complexes etc
are more numerous in deeper strata and decrease towards
the surface.
• Cytokeratins increase in number from basale to corneal
layers.
36. • 90% of the total gingival cell population.
• Originate from ectodermal germ layer.
• Cell organelles: nucleus, cytosol, ribosomes, Golgi apparatus etc
• Melanosomes: Pigment bearing granules
• Proliferation and differentiation of the keratinocytes
helps in the barrier action of the epithelium.
KERATINOCYTES
37. • Move from basal to superficial layers of the epithelium as the
process of differentiation occurs, forming a keratin barrier.
• The microfilaments present in the keratinocytes help in cell motility
and maintenance of the polarity.
38. The various nonkeratinocytes are :
• Langerhans cells,
• Merkel cells,
• Melanocytes,
• Inflammatory cells
NON-KERATINOCYTES/CLEAR CELLS:
39. • Dendritics cells - Modified monocytes belonging to RES.
• Paul Langerhans used gold impregnation technique to visualize LCs.
• Reside chiefly in suprabasal layers.
• Act as antigen -presenting cells for lymphocytes.
• Specific elongated g-specific granules called as Birbecks Granules.
• Have marked adenosine triphosphatase activity.
• Only epidermal cells which express receptors for C3 and Fc portion of IgG.
• Can move in and out of the epithelium unlike melanocytes.
• Found in oral ep. of normal gingiva.
• Smaller amounts in sulcular ep.
• Absent in healthy junctional ep.
Langerhans cells:
40. Merkel Cells:
• Located in deeper layers of epithelium.
• Not dendritic cells
• Possess keratin tonofilaments and
desmosomes.
• Harbor nerve endings.
• Sensory in nature - respond to touch – Tactile
Perceptors
41. Melanocytes:
• Originate from neural crest cells.
• Found in the stratum basale.
• Identified in gingiva by Laidlaw and Cahn, 1932.
• Have long dendritic processes, interspersed between the keratinocytes.
• Lack tonofilaments and desmosomal connections.
• Synthesize melanin, responsible for providing color to gingiva.
• Melanin is synthesized in organelle called premelanosomes/melanosomes,
which are transported along microtubules and actin filaments to the cell
periphery.
• Melanophores/Melanophages.
42. TYPES OF GINGIVAL EPITHELIUM
Oral or outer epithelium
Sulcular epithelium
Junctional epithelium
2mm
43. ORAL OR OUTER EPITHELIUM
• Covers the crest and outer surface of
the marginal gingiva and the surface
of the attached gingiva.
• 0.2 to 0.3 mm in thickness.
• Keratinized or parakeratinized, or it
may present combinations of these
conditions.
• The oral epithelium is composed of
four layers.
44. • K1, K2, K10-12 cytokeratins present are immunohistochemically
expressed with high intensity in orthokeratinized areas and with
less intensity in parakeratinized areas.
• K6 and K16 , characteristic of highly proliferative epithelia.
• K5 and K14, stratification-specific cytokeratins , also are present
45. SULCULAR EPITHELIUM
• Lines the gingival sulcus.
• Thin, nonkeratinized stratified
squamous epithelium
• No rete pegs.
• Extends from the coronal limit
of the junctional epithelium to
the crest of the gingival
margin.
• Hydropic degeneration of cells.
• Contains K4 and K13, K19.
• Don’t have merkel cells.
46. Sulcular epithelium has the potential to keratinize:
• If it is reflected and exposed to the oral cavity.
• If the bacterial flora of the sulcus is totally eliminated.
Outer epithelium loses its keratinization:
• When it is placed in contact with the tooth.
These findings suggest that the local irritation of the sulcus
prevents sulcular keratinization.
Sulcular epithelium is extremely important because it act as
a semi permeable membrane through which injurious
bacterial products pass into gingival fluid. Less permeable
than JE.
47. JUNCTIONAL EPITHELIUM
• Collarlike band of stratified squamous
non-keratinizing epithelium.
• 3 to 4 layers thick in early life, but the
number increases with age to 10 or even
20 layers.
• Tapers from end to apical
the
its coronal
located
junction
at
in healthy
termination,
cementoenamel
tissue.
• Length: 0.25 to 1.35 mm.
48. • These cells can be grouped in two strata:
The Basal layer: that face s the connective
tissue (External Basal Lamina)
• the suprabasal layer: that extends to
the tooth surface- DAT Cells (Internal
basal lamina)
• 3 zones of junctional epithelium:
1. Apical – germination
2. Middle – adhesion
3. Coronal- permeable.
49. THE DENTOGINGIVAL UNIT:
• The attachment of the junctional epithelium to the tooth is
reinforced by the gingival fibers, which brace the marginal gingiva
against the tooth surface.
• For this reason, the junctional epithelium and the gingival fibers
are considered together as a functional unit.
50. Hypothesis given to explain mode of attachment of epithelium to
tooth surface:
1. Gottlieb: gingiva is organically united to surface of enamel. He
termed it as epithelial attachment. (drawback- did not explain
how exactly it attaches.)
2. Waerhaug : in 1952 presented a concept of epithelial cuff, he
concluded that gingival tissues are closely adapted but not
organically united.
3. Stern: in 1962 showed the attachment to tooth is through
hemidesmosomes, supported by schroeder and listgarten.
51. Unique structural and functional features of JE that contribute to
preventing pathogenic bacterial flora from colonizing the subgingival
tooth surface:
First,
Firmly attached to the tooth surface forming an epithelial barrier against
plaque bacteria.
Second,
Allows access of gingival fluid, inflammatory cells, and components of the
immunologic host defense to the gingival margin.
Third,
Exhibits rapid turnover contributing to the host–parasite equilibrium and the
rapid repair of damaged tissue.
Have an endocytic capacity equal to that of macrophages and neutrophils and
that this activity may be protective in nature.
52. Development/Origin of Junctional Epithelium
REE surrounds the crown of tooth from the moment enamel is
properly mineralized till the tooth erupts .
Migratingepithelium produces an epithelial mass between oral
epithelium and REE so thattooth can erupt without bleeding.
When tooth has penetrated in oral cavity large portions
immediately apical to incisal area of enamel are covered
by junctional epithelium containing few layers of cell.
Duringlater phases of tooth eruption all
cells of REE is replaced by JE.
53. JE Functions:
• Provides attachment to the tooth.
• Forms an epithelial barrier against the plaque bacteria.
• Rapid cell division and funneling of cells towards the sulcus:
Hinder bacterial colonization and
Repair of damaged tissue occurs rapidly.
• Allow GCF:
From connective tissue into crevice – Gingival fluid exudates, PMNs,etc.
From crevice to connective tissue – Foreign material such as carbon particles,
• Produces active antimicrobial substances like defensins, lysosomal enzymes,
calprotectin and cathelicidin.
• Epithelial cells activated by microbial substances secrete chemokines, e.g. IL-1, IL-6, IL-
8 and TNF that attract and activate professional defense cells such as lymphocytes and
PMNs.
54.
55. • Represented as either as transudate or an exudate.
• Diagnostic or prognostic biomarker of the biologic state of the
periodontium in health and disease.
• GCF flow increases during inflammation and resembles that of
inflammatory exudates.
• Gingival fluid diffuses through the
basement membranes.
GINGIVAL CREVICULAR FLUID
56. • Functions:
Cleanse material from the sulcus.
Contain plasma proteins that may improve adhesion of epithelium
to the tooth
Possess antimicrobial properties
Expert antibody activity to defend the gingiva.
GINGIVAL CREVICULAR FLUID
57. Epithelium—Connective Tissue Interface
• Ultrastructurally the interface is
composed of 4 elements:
• Basal cell plasma membrane.
• Lamina lucida: 25 to 45 nm wide.
• Lamina densa: 40 to 60 nm
thickness.
• Reticular layer.
• From the lamina densa so called
anchoring fibrils project in a fan-
shaped fashion into the connective
tissue.
58. Various junctional complexes present in gingiva are:
• Tight junctions/Zonae occludens
• Adhesive junctions:
Cell to cell
– Zonula adherens
– Desmosomes: 30 nm.
Cell to matrix
– Focal adhesions
– Hemidesmosomes
• Gap junctions:
Intercellular pipes/channels bridge both adjacent membranes and
intercellular space.
Intercellular space in gap junction is approx. 3 nm.
Major pathway for direct intercellular communication.
61. GROUND SUBSTANCE:
• Fills space between fibers and cells
• Amorphous
• High water content
• Composed of:
Proteoglycans:
Hyaluronic acid
Chondroitin sulphate
Glycoproteins: (PAS positive)
Fibronectin
Laminin
62. CELLS:
The different types of cell present in the connective tissue
are:
Fibroblasts
Mast cells
Fixed Macrophages & Histiocytes
Inflammatory cells (Plasma cells, Lymphocytes,
Neutrophils)
Adipose cells
Eosinophils
63. Fibroblasts:
• Preponderant cellular element in the gingival connective tissue.
• Mesenchymal origin.
• Play a major role in the development, maintenance, and repair of gingival
connective tissue.
Synthesize: Collagen, elastic fibers, glycoproteins and glycosaminoglycan
• Regulate collagen degradation through phagocytosis and the secretion of
collagenases.
• Fibroblast heterogeneity is now a well-established feature of
fibroblasts in the periodontium which is necessary for the normal functioning
of tissues in health, disease, and repair
64. GINGIVAL FIBERS:
The connective tissue fibers are produced by the
fibroblasts and can be divided into:
• Collagen fibers
• Reticulin fibers
• Oxytalan fibers
• Elastic fibers..
65. Collagen type I:
forms the bulk of the lamina propria
provides the tensile strength to the gingival tissue.
Type IV collagen:
branches between the collagen type I bundles
continuous with fibers of the basement membrane and the blood vessel
walls.
Densely packed collagen bundles that are anchored into the acellular
extrinsic fiber cementum just below the terminal point of the junctional
epithelium form the connective tissue attachment.
The stability of this attachment is a key factor in the limitation of the
migration of junctional epithelium.
66. Reticulin fibres:
•Have argyrophilic property and are numerous in tissue adjacent to basement
membrane.
• Found in large number in loose CT surrounding blood vessel
• Hence found in endothelial-CT and epithelium-CT interface.
Elastic fibres:
• Only present in association with blood vessels.
•Gingiva seen coronal to mucogingival junction has no elastic fibres except in assocation
with blood vessels.
• Alveolar mucosa may have many elastic fibres.
Oxytalan fibres.
• Initially described by Fullmer.
• Modified type of elastic fibres.
• Scarce in gingiva but more in PDL.
• Have thin fibrils with 150 A0 dia.
67. Gingival Fibers:
• The connective tissue of the marginal gingiva is densely
collagenous, and it contains a prominent system of collagen fiber
bundles called the gingival fibers.
• These fibers consist of type I collagen.
• Functions:
To brace the marginal gingiva firmly against the tooth
To provide the rigidity necessary to withstand the forces of
mastication without being deflected away from the tooth
surface
To unite the free marginal gingiva with the cementum of the
root and the adjacent attached gingiva
68. The gingival fibers are arranged in three groups:
1. Gingivodental
2. Circular
3. Transseptal
According Page et.al:
Semicircular fibers:
Transgingival fibers
Lindhe: Dentoperiosteal fibers
69. • Originates from cementum and spreads laterally
into lamina propria
Dentogingival
• Orginates from periosteum and spreads into
lamina propria
Alveologingival
• Originates from cementum near CEJ into
periosteum of alveolar crest
Dentoperiosteal
• Originates from within the free marginal and
attached gingiva coronal to alveolar crest and
encircles each tooth
Circular
• Originates from interproximal cementum coronal
to crest and courses mesially and distally in the
interdental area into cementum of adjacent teeth
Transseptal
70. •Originates from the periosteum of the lateral aspect of alveolar
process and spreads into attached gingiva.
Periosteogingival
•Originates from within interdental gingiva and follows on orofacial
course
Interpapillary
•Originates within the attached gingiva interwing along dental arch
between and around teeth
Transgingival
•Originates from cementum on distal surface of tooth spreading
buccally and lingually around adjacent tooth and inserting on
mesial cementum of next tooth
Intercircular
•Originates from attached gingiva immediately subjacent to
basement membrane and courses mesiodistally
Intergingival
•Originates from cementum of the mesial surface of tooth and
courses distally and inserts on the cementum of distal surface of
same tooth
Semicircular
75. • Generally coral pink.
• Color is a result of:
Vascular supply
Thickness
Degree of keratinisation of epithelium,
Presence of pigment containing cells.
• Color to be correlated with cutaneous pigmentation
Color:
76. Physiologic Pigmentation(melanin)
• Melanin (non hemoglobin derived brown pigment)
• Prominent in blacks, diminished in albinos
• Distribution of Oral Pigmentations in blacks:
Gingiva -60%
Hard Palate -61%
Mucous membrane -22%
Tongue -15%
• As a diffuse , deep purplish discoloration or
as irregularly shaped brown and light brown patches
and may appear as early as 3 hours after birth.
77. Synthesis of Melanin pigmentation
• Tyrosine is hydroxylated into DOPA in presence of
Tyrosinase enzyme.
• DOPA (Dihydroxy Phenylalanine) is converted into
Melanin
• Melanin is phagocytosed to become Melanophages or
Melanophores.
78. • Sum total of the bulk of cellular
and intercellular elements and
their vascular supply.
• Alteration in size is a common
feature of gingival disease
Size
79. Contour
• Marginal gingiva envelops the teeth in collarlike fashion and follows a
scalloped outline on the facial and lingual surfaces.
• straight line - along teeth with relatively flat surfaces.
• accentuated - pronounced mesiodistal convexity (e.g., maxillary
canines) or teeth in labial version
• horizontal and thickened - in lingual version.
80. The shape of the interdental gingiva is governed by the contour of the
proximal tooth surfaces and the location and shape of the gingival
embrasures.
Anterior region of the dentition, the interdental papilla is pyramidal in form.
the papilla is more flattened in a buccolingual direction in the molar region.
Shape.
81. • Shape depends on:
Presence/absence of contact
Distance btw contact point and osseous crest
Course of CEJ
Width of the approximate tooth surfaces
Presence/absence of recession.
82. Consistency
• Firm and resilient
• Collagenous nature of the lamina propria and
its contiguity with the mucoperiosteum
determine the firmness of the attached
gingiva.
• The gingival fibers contribute to the firmness
of the gingival margin.
• If the gingiva is suppressed, the
proteoglycans become deformed and recoil
when the pressure is eliminated.
• Thus, the macromolecules are important for
the resilience of the gingiva.
83. • Orange peel – stippled,
• Stippling is best viewed by drying Gingiva.
• Attached Gingiva is stippled, marginal gingival is not.
• Central portion of interdental papilla is usually stippled, but marginal
borders are smooth.
• Less prominent on lingual surfaces and may be absent in some.
Surface Texture
84. • Stippling –produced by alternate round protuberance and
depressions in the gingival surface.
• Low magnification ; a stippled surface,
• Higher magnification; cell micropits
• A form of adaptive specialization or reinforcement for function
–feature of healthy gingiva
85. • Reduction of stippling – common sign of Gingival disease.
• Stippling returns when gingiva is restored to health.
• Keratinisation – protective adaptation , increased by tooth
brushing.
• In 40% of adults Gingiva show stippling.
• Generalized absence of stippling is seen in:
Infancy
Diseased conditions like gingival enlargements, mucocutaneous
lesions affecting gingiva, inflammation etc.,
86. Position
• The level at which the gingival margin is attached to the tooth.
• Continuous eruption, even after meeting their functional antagonists occurs
through out life
Active Eruption :Movement of teeth in the direction of occlusal plane
Passive Eruption: exposure of the tooth by apical migration of Gingiva
• Gottlieb : active and passive eruption go hand in hand.
• Active eruption is coordinated with attrition, to compensate for tooth
substance worn away.
• Attrition reduces the clinical crown and prevents it from becoming
disproportionately long in relation to the clinical root, thus avoiding excessive
leverage on periodontal tissue.
• Rate of active eruption is in pace with tooth wear in order to preserve vertical
dimension.
87.
88. • Exposure of the tooth via the apical migration of the gingiva is called
gingival recession or atrophy.
• According to the concept of continuous eruption, the gingival sulcus
may be located on the crown, the cementoenamel junction, or the
root, depending on the age of the patient and the stage of eruption.
• Therefore, some root exposure with age would be considered normal
and referred to as physiologic recession.
• Again, this concept is not accepted at present.
• Excessive exposure is termed pathologic recession
89. REPAIR/HEALING
OF GINGIVA
• Turnover rate is 10-12 days.
• It is one of the best healing tissues in the body with
little or no scarring.
• However the reparative capacity is lesser than that of
periodontal ligament and epithelial tissue.
90. AGE
CHANGES
Stippling usually disappears with age.
Width of the attached gingiva increases with age.
a. Gingival epithelium:
• Thinning and decreased keratinization
• Rete pegs flatten
• Migration of junctional epithelium apically.
• Reduced oxygen consumption.
b. Gingival connective tissue:
• Increased rate of conversion of soluble to insoluble collagen
• Increased mechanical strength of collagen
• Increased denaturing temperature of collagen
• Decreased rate of synthesis of collagen
• Greater collagen content.
91. GINGIVAL
DISEASES
Gingivitis associated with dental
plaque only
Gingival diseases modified by
systemic factors
Gingival diseases modified by
medications
Gingival diseases modified by
malnutrition
DENTAL-PLAQUE–
INDUCED
GINGIVAL
DISEASES
92. Gingival diseases of specific bacterial origin
Gingival diseases of viral origin
Gingival diseases of fungal origin
Gingival lesions of genetic origin
Gingival manifestations of systemic conditions
Traumatic lesions
Foreign-body reactions
Not otherwise specified
NONPLAQUE
INDUCED
GINGIVAL
DISEASES
93. CLINICAL
CONSIDERATIONS
• The biological width is defined as
the dimension of the soft tissue,
which is attached to the portion of
the tooth coronal to the crest of
the alveolar bone.
• Gargiulo et al.,:
• Established that there is a definite
proportional relationship between
the alveolar crest, the connective
tissue attachment, the epithelial
attachment, and the sulcus depth.
BIOLOGICAL WIDTH
94. • They reported the following mean dimensions:
A sulcus depth of 0.69 mm, (a)
an epithelial attachment of 0.97 mm,(b)
connective tissue attachment of 1.07 mm.(c)
The biologic width is commonly stated to be 2.04 mm,(b+c)
which represents the sum of the epithelial and connective tissue
measurements.
95. Biologic Width Evaluation:
1. Clinical (discomfort when the restoration margin levels are being assessed
with a periodontal probe)
2. Radiographs (for interproximjal violation but mesiofacial and distofacial line
angle not seen properly)
3. Bone sounding (probing under anesthesia)
If this distance is less than 2 mm or more at one or more locations, a diagnosis
of biologic width violation can be confirmed
Biologic width violation:
• Unpredictable bone loss
• Gingival recession
• Persistence of ginigivitis
96. GINGIVAL BIOTYPE
• Gingival biotype is described as the thickness of the gingiva in the
faciopalatal/ faciolingual dimension.
• Seibert and Lindhe categorized the gingiva into:
1. thick-flat: A gingival thickness of ≥ 2 mm
2. thin scalloped: a gingival thickness of <1.5 mm
• Significant impact on the outcome of the restorative, regenerative and
implant therapy.
• Direct co-relation exists with the susceptibility of gingival recession followed
by any surgical procedure.
97. Thick blunted:
Resists recession
reacts to surgical & restorative
insults with pocket formation
Thin scalloped:
Attached soft tissue is minimal
Bony dehiscence & fenestration defects
Reacts to surgical or restorative
interventions with ST recession, apical
migration of attachment & loss of
underlying alveolar volume .
98. Three primary types of oral mucosa:
1. lining mucosa
2. masticatory mucosa
3. specialized mucosa.
Of the types of lining mucosa, there are three kinds:
alveolar mucosa, labial mucosa, and buccal mucosa.
Oral Mucosa
Source: www.icoi.org glossary
99. Alveolar mucosa
is the soft, thin mucous membrane
that sits above the marginal gingiva
and the attached gingiva, and continues across the floor of the mouth, cheeks,
and lips. It is bright red in color due to being rich with blood vessels, and is
shiny and smooth in appearance.
it is made up of nonkeratinized stratified squamous epithelium, making it
delicate and sometimes difficult to work with.
In oral implantology, it’s crucial to keep the alveolar mucosa intact, particularly
when implants are done in the front of the mouth. Disruption of the alveolar
mucosa can impact the aesthetic results of the procedure, leading to implant
failure. The buccal flap should be made carefully so as to keep the alveolar
mucosa intact.
100. 99
• Clinical Periodontology By Carranza, 12th Edition
• Clinical Periodontology And Implant Dentistry By Jan
Lindhe, 4th Edition.
• Biology Of Periodontal Connective Tissue-bartold And
Sampath Narayana
• Oral Histology, Development, Structure And Function – A.R.
Tencate, 5th Edition
• PERIODONTICS REVISITED Shalu Bathla, 1st Edition
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of periodontics.
CONCLUSION
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