Periodontal Ligament in Ensuring the Integrity of the Tooth - Case Study Example

Role of the periodontal ligament in the functioning of the tooth The tissues that surround and support the teeth are collectively called the periodontium. Their main functions   are   to   support,   protect,   and   provide nourishment to the teeth. Figure 1 illustrates the supporting tissues of the periodontium.  The periodontium consists of cementum, alveolar process of the maxillae and mandible, periodontal ligament, and gingiva. Figure 1—The periodontium. PERIODONTAL  LIGAMENT The periodontal ligament (fig.  1) is a thin, fibrous ligament that connects the tooth to the bony socket.  Normally, teeth do not contact the bone directly; a tooth is suspended in its socket by the fibers of the ligament. This arrangement allows each tooth limited individual movement. The fibers act as shock absorbers to cushion the force of the chewing impact of mastication (tpub.com, N.D). Functions of periodontal ligaments The periodontal ligaments are supporting tissue of a tooth. These ligaments are a specialized connective tissue that attaches teeth from the cementum to the surrounding alveolar bone. They are about 0.2 millimeters in width, which decreases with age. In view of the fact that teeth are not embedded in bone directly, large compressive forces can occur on teeth without destruction of the bone. Instead, the tooth, pulling downward on the periodontal ligaments, create tension which is actually the stimulus for bone growth. Periodontal ligaments also serve as a method for sensation. The receptors present within the periodontal ligaments sense differing amounts of tension. This helps the body discern the amount of force being placed on a tooth, during chewing for example, because enamel has no sensory receptors itself. Types of fibers of the periodontal ligament The periodontal ligament has fibers composed of Type I and Type III collagen. Compared to most other ligaments of the body, these are highly vascularized. Individually having a diameter of 55 nanometers, fibers of the periodontal ligament are categorized by their orientation to the teeth. They are organized together along the tooth and serve different functions. Transeptal fibers Transeptal fibers run between two adjacent teeth in the same arch. They attach from the cementum just apical to where the gums attach to one tooth and insert at the cementum of an adjacent tooth. Transeptal fibers are believed responsible for returning teeth to their original state after orthodontic therapy. Although technically part of the gingival ligament, it is frequently included in studies involving the periodontal ligament. Alveolar crest fibers Alveolar crest fibers attach to the cementum just apical to the cemento-enamel junction, run downward, and insert into the alveolar bone. Horizontal fibers Horizontal fibers attach to the cementum apical to the alveolar crest fibers and run perpendicularly from the root of the tooth to the alveolar bone. Oblique fibers Oblique fibers are the most numerous fibers in the periodontal ligament. They attach apical to the horizontal fibers and run diagonally toward the crown of the tooth inserting to the alveolar bone there. Because they are the most numerous, these fibers are believed to be the most responsible in compensating for the chewing forces directed on the teeth. Apical fibers Apical fibers are at the apex of a root. They attach from the cementum and insert to the surrounding bone at the base of the socket. Interradicular fibers Interradicular fibers are only found between the roots of a multi-rooted tooth, such as a molar. They also attach from the cementum and insert to the nearby alveolar bone (Answers.com, 2002). Occlusion in Periodontal Disease To understand the role of trauma from occlusion in periodontal disease, it is necessary to understand the relationship of occlusion to periodontal health. This starts with the development of the tooth. When the crown of the tooth is completed it is contained within a bony crypt in the jaw, protected from external environmental factors. On eruption into the oral cavity, the tooth suddenly becomes confronted with an entirely new world. Pressure from the lips, tongue, cheeks, fingers, the pacifier, and exposure to food are thrust on it. To enable the crown to withstand such forces, the custom-built periodontium develops around the root, as the tooth erupts. Support of the tooth is the sole purpose of the periodontium. Just as the tooth depends on periodontal tissues to keep it in the jaw, so do periodontal tissues depend on functional activity of the tooth to remain healthy. When there is insufficient functional stimulation the periodontal tissue atrophies; when the tooth is extracted the periodontium disappears. Occlusion is the lifeline of the periodontium. In periodontal health, it provides the mechanical stimulation that marshals the complex biologic mechanisms responsible for the well-being of the periodontium (Glickman, 199-204, 1971). Periodontal Disease Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Gum disease is a threat to your oral health.  Research is also pointing to possible health effects of periodontal diseases that go well beyond your mouth (more about this later). Whether it is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward. Causes Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque.  Plaque that is not removed can harden and form bacteria-harboring "tartar" that brushing doesnt clean.  Only a professional cleaning by a dentist or dental hygienist can remove tartar. The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called "gingivitis."  In gingivitis, the gums become red, swollen and can bleed easily.  Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place. When gingivitis is not treated, it can advance to "periodontitis" (which means "inflammation around the tooth.")  In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The bodys immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the bodys enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed.  The teeth may eventually become loose and have to be removed (NIDRC, 2006).  These problems are preventable by having good hygiene. For instance, brushing the teeth twice, eating a balanced diet, avoid chewing tobacco and smoking and last but not the least visit the dentist routinely for a check-up and professional cleaning. Work Cited Answers.com, periodontal ligament (2002) Medical definition of periodontal ligament The American Heritage® Stedmans Medical Dictionary Copyright by Houghton Mifflin Company. 3 December 2006. Glickman, I. Role of Occlusion in the Etiology and Treatment of Periodontal Disease. Jor Dent Res Supplement to No. 2 (1971) pp 199-204. NIDRC, Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. 6 September 2006. National Institute of Dental and Craniofacial Research. NIH Publication No. 02-1142. 3 December 2006. tpub.com, (N.D) Chapter  4: Oral Anatomy. Dental Technician, Volume 01. 3 December 2006. Read More