Periodontics and Cariology Quiz

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Mid Semester Quiz Information

• It is an online quiz.
• The quiz contains 15 questions.
• The questions cover the topics of periodontics and cariology.
• The questions are multiple-choice style (labeling diagrams, multiple choice, multiple answer, matching, true/false).
• Some questions are worth more than one mark.
• The exam time is 15 minutes, with a reading time of 5 minutes.
• There is only one attempt to complete the quiz.
• The quiz opens on Wed 2nd April at 5pm and closes on Thurs 3rd April 2025 at 23.59pm.

Learning Outcomes

• Identify and describe the four anatomical areas of the gingiva.
• Identify and describe the clinical characteristics of healthy gingiva.
• Identify and describe the clinical characteristics of gingival inflammation.
• Identify and describe the extent and distribution of gingival inflammation.
• Identify some common misconceptions about aging and oral health.

Gingival Anatomy

• There are four anatomical areas: free gingiva, attached gingiva, interdental gingiva, and gingival sulcus.

Boundaries of Gingiva

• The coronal boundary is the gingival margin.
• The apical boundary is the alveolar mucosa.

Demarcations of Gingiva

• The free gingival groove is a shallow linear depression separating free from attached gingiva.
• The mucogingival junction is a clinically visible boundary where attached gingiva meets alveolar mucosa.

Free Gingiva

• The unattached portion of the gingiva surrounds the tooth near the CEJ.

Attached Gingiva

• The part of the gingiva connected tightly to the cementum cervical third of the root or the periosteum of the alveolar bone.

Interdental Gingiva

• Interdental gingiva is the portion of gingiva that fills the interdental embrasure between two adjacent teeth apical to the contact area.
• It consists of two interdental papillae, one on the facial aspect and one on the lingual or palatal.

Gingival Sulcus

• The gingival sulcus is the space between the free gingiva and tooth surface.
• The depth of a normal gingival sulcus ranges from 1 to 3mm.
• The junctional epithelium forms the sulcus base.
• Gingival crevicular fluid (GCF), or gingival sulcular fluid, seeps into the sulcular space from underlying connective tissue.

Periodontium in Health

• Healthy tissue is free of inflammation and has not been altered by disease or trauma.
• Healthy tissue does not bleed when stimulated by clinical procedures such as gentle probing.
• Healthy gingiva exhibits a uniform pink or pigmented colour, tapered margins, pointed papilla, and firm consistency.
• Gingiva is easily distinguished from darker alveolar mucosa.
• Gingiva is described using the "three C's": colour, contour, and consistency.

Healthy Tissue Colour

• Healthy tissue colour shows a uniform pink.
• Blondes with a light complexion have a lighter shade of pink, while brunettes with darker complexions have a darker shade of pink.
• Pink gingiva is easily distinguished from darker alveolar mucosa.
• Tissue may also be pigmented.

Healthy Tissue Contour (Size and Shape)

• Healthy tissue contour lies snugly around the tooth, firmly against the alveolar bone.
• The gingival margin appears smooth and evenly scalloped.
• The free gingival margin meets the tooth in a knife-like edge that is either flat or slightly rounded.
• Papillae come to a point and fill the interdental space; in large spaces between teeth, papillae will be flat.

Healthy Tissue Consistency

• Healthy tissue consistency sees attached gingiva firmly bound to the underlying cementum and bone.
• Healthy tissue is resilient and springs back quickly when pressed gently with the side of a probe.
• It does not pull away from the tooth when air is blown into the sulcus.

Healthy Tissue Texture

• Healthy tissue texture is firm and may appear dimpled (stippling).
• Stippling is detected by drying the tissue gently with an air syringe.
• Texture varies greatly from one individual to the next.

Healthy Tissue Margin

• A healthy tissue margin is at or slightly coronal to the CEJ.

Tissue Colour Change in Gingival Inflammation

• Subtle colour changes from light pink to darker pink or red (erythematous) begin to appear.
• Chronic inflammation can cause tissues to appear bluish-red to purplish-red (cyanotic).

Tissue Size Changes

• Increased tissue fluid enlarges the marginal and interproximal gingival tissue.
• Enlargement may be localised to a few areas, or it may involve the whole mouth.
• Changes in papillae - bulbous, blunted or cratered.

Change in Tissue Consistency

• Inflammation increases the fluid in the area.
• Tissue becomes soft, spongy, and non-elastic.
• Compression of tissue with the side of a probe leaves an indentation.
• Tissue deflects when air is gently blown into the sulcus (flaccid).

Change in Tissue Texture

• Increased fluid in the area of inflammation gives the tissue a smooth, shiny appearance.
• Texture appears like stretched plastic wrap.

Change in Marginal Position

• The margin may move coronally further above the CEJ due to swelling and enlargement.
• Bleeding may occur upon gentle probing.
• Sulcus lining becomes ulcerated, and blood vessels engorge, resulting in a direct relation between the degree of inflammation and amount of blood.

Extent of Inflammation

• Localized inflammation is confined to the tissue of a single tooth or group of teeth.
• Generalized inflammation occurs in all or most of the mouth.

Distribution of Inflammation

• Papillary inflammation is confined to the papilla.
• Marginal inflammation is confined to the gingival margin and papilla.
• Diffuse inflammation is throughout the gingival margin, papilla, and attached gingiva, extending to the mucogingival junction.

Case Study

• A 74-year-old male with a horizontal scrubbing technique.
• Gingival recession, retraction, and wedge-shaped defects were observed.
• No significant pocketing or signs of inflammation were present.

Common Misconceptions of Aging

• Tooth loss is an inevitable part of the normal aging process.
• Most teeth are lost as people become long in the tooth because of advancing periodontal disease.
• All adults are susceptible to severe periodontal disease.
• Dental caries is not a common oral disease in older patients and occurs mainly in the young.
• Salivary flow is decreased in all older adults.