Types & Composition

• Supragingival: White/whitish – yellow, mineral source = saliva
• Subgingival: Dark brown/greenish – black, mineral source = GCF

Crystal Composition

1. Hydroxyapatite: 58%
2. Magnesium whitelockite: 21%
3. Octacalcium phosphate: 12%
4. Brushite: 8%

Epithelium Types

• Parakeratinized: Retains pyknotic nuclei in stratum corneum
• Orthokeratinized: No nuclei in stratum corneum
• Keratinization order: Palate > Gingiva > Tongue > Cheek (most to least)

Keratin Distribution

• K 1, 2, 10, 12: Orthokeratinized areas
• K 6, 16: Highly proliferative areas
• K 5, 14: Stratification specific
• K 19: Parakeratinized areas

Structural Components

• Stratum spinosum: Contains keratinosomes/Odland bodies (modified lysosomes)
• Basal lamina: 300 – 400 Å thick, joins epithelium to connective tissue
  • Lamina lucida (rich in laminin)
  • Lamina densa (rich in collagen type IV)
• Junctional epithelium: 0.25 – 1.35 mm long, formed by oral + reduced enamel epithelium

Clinical Probing

• Normal probing depth: 2 – 3 mm (requires apical penetration)
• Stippling: Orange peel appearance, restricted to attached gingiva
• Loss of stippling: Early sign of gingivitis

Classification by Extent

• Generalized: >30% sites affected

Classification by Severity

• Moderate: 3 – 4 mm bone loss
• Severe: >5 mm bone loss

Aggressive Periodontitis

• Rate: 3 – 4 times faster bone loss than chronic
• Classic sign: Arc – shaped bone loss (distal 2nd premolar to mesial 2nd molar)
• Associated: HLA A9 and B15 antigens
• Receptor defect: Poorly functional monocyte FcγR2

Pain Characteristics

• Periodontal pocket pain: "Deep in bone" feeling

Bone Loss Patterns

• Radius of action: 1.5 – 2.5 mm (Page & Schroeder)
• Reverse architecture: Facial/lingual plates lost, radicular bone preserved
• TFO signs: Increased mobility (first clinical sign)

Flossing Technique

Flossing is an essential part of oral hygiene that helps remove plaque and food particles from between the teeth and along the gumline, areas that toothbrushes may not effectively clean. Proper flossing technique is crucial for maintaining gum health and preventing cavities.

Flossing Technique

1. Preparation:

   • Length of Floss: Take 12 to 18 inches of dental floss. This length allows for adequate maneuverability and ensures that you can use a clean section of floss for each tooth.
   • Grasping the Floss: Hold the floss taut between your hands, leaving a couple of inches of floss between your fingers. This tension helps control the floss as you maneuver it between your teeth.

2. Inserting the Floss:

   • Slip Between Teeth: Gently slide the floss between your teeth. Be careful not to snap the floss, as this can cause trauma to the gums.
   • Positioning: Insert the floss into the area between your teeth and gums as far as it will comfortably go, ensuring that you reach the gumline.

3. Flossing Motion:

   • Vertical Strokes: Use 8 to 10 vertical strokes with the floss to dislodge food particles and plaque. Move the floss up and down against the sides of each tooth, making sure to clean both the front and back surfaces.
   • C-Shaped Motion: For optimal cleaning, wrap the floss around the tooth in a C-shape and gently slide it beneath the gumline.

4. Frequency:

   • Daily Flossing: Aim to floss at least once a day. Consistency is key to maintaining good oral hygiene.
   • Best Time to Floss: The most important time to floss is before going to bed, as this helps remove debris and plaque that can accumulate throughout the day.

5. Flossing and Brushing:

   • Order of Operations: Flossing can be done either before or after brushing your teeth. Both methods are effective, so choose the one that fits best into your routine.

• Papillon-Lefevre Syndrome: Periodontitis, hyperkeratosis, dural calcification.
• Chediak-Higashi Disease: Neutrophil function defect.
• Iron Deficiency Anemia: Moderate bone loss with periodontitis.

Treatment Phases

1. Phase 1: Non – surgical
2. Phase 2: Surgical
3. Phase 3: Restorative
4. Phase 4: Maintenance Must progress through Phase 1 → 4 before Phase 2 or 3

Merin's Classification

• Class A: 6 months – 1 year recall
• Class B: 3 – 4 months recall
• Class C: 1 – 3 months recall