10. Gingivitis: Microbial Mechanisms & Contributing Factors

Question 1

78. What differentiates gingivitis from periodontitis?
    (Describe in terms of what happens in peridontitis to: periodontal ligament, bone levels, the junctional epithelium, and bleeding levels)

Answer 1

Periodontitis - Destruction of periodontal ligament, bone loss, apical migration of the junctional epithelium, and bleeding will increase

Question 2

79. Gingivitis is a _________ (REVERSIBLE/IRREVERSIBLE) host inflammatory response to _______________.

Answer 2

1. Reversible

2. Plaque microbial products

Question 3

79. What are some of the causes of gingivitis?

Answer 3

1. Stress (leading to an invasive infection)
2. Hormonal (Pregnancy or puberty)
3. Drugs (Dilantin, cyclospoin-A, calcium channel blockers)
4. Diseases (Diabetes, leukemia, HIV)
5. Oral Habits (Smoking, chewing, mouth breathing, dry mouth, sleep apnea)

Question 4

79. What are the two forms of periodontitis and who is generally affected by each?

Answer 4

1. Chronic (adults) - localized and general (general being the most common)
2. Aggressive (juvenile and adults) - localized and general

Question 5

80. The progression of the plaque community to one with what type of bacteria appears to be key to the induction of exudate and bleeding in gingivitis (as well as periodontitis)?

Answer 5

Progression to a community with more: Anaerobic, gram negative bacteria

Question 6

81. Chronic marginal gingivitis is the normal state of affairs for most of us. It is a ____________ response to supra-gingival plaque. As the plaque builds up, relatively __________ (aerobic or anaerobic) environments can develop.

Answer 6

1. Non-specific inflammatory response

2. Anaerobic environments

Question 7

81. Dr. H Loe carried out experiments to show the relationship between plaque build-up and gingivitis progression. Describe his findings.
    (Key terms: brushing, plaque level, gingivitis index, level of gram- bacteria, reversibility)

Answer 7

When people stop brushing their teeth, their plaque level, gingivitis index, and level of gram- bacteria increase.

Once they brush again, the levels go back down. Gingivitis is reversible!

Question 8

83. Describe NUG
    - What does its name stand for?
    - Painful gingival lesion characterized by what?
    - The lesion readily sloughs off to reveal what?
    - Lesions are limited to the tips of what?

Answer 8

Necrotizing ulcerative gingivitis (Vincent’s infection)

Characterized by a gray pseudo-membrane on the gingiva

Readily sloughs off revealing a bleeding, necrotic area

Lesions limited to the tips of the gingival papillae

Question 9

83. What type (gram+ or -) bacteria are implicated in NUG? Give two examples
    - What age group is primarily afflicted with NUG?
    - What is a more more severe version of this disease that is ravaging children in Nigeria?

Answer 9

Gram- : Spirochetes and Rods - Treponema spp, Prevotella intermedia, Porphyromonas gingivalis, and Fusobacterium nucleatum

Age group: 16-30 yrs

Much more severe: NOMA

Question 10

84. Does NUG have a slow or rapid onset?

What are four symptoms of NUG?

Answer 10

Rapid onset

1. Pain
2. Bleeding
3. Bad breath
4. Pseudo necrotic membrane (ulcerated papillae)

Question 11

84. What are two predisposing factors for NUG concerning pathology of flora?

Answer 11

1. Poor oral hygiene

2. Gingivitis

Question 12

84. What are four predisposing factors for NUG concerning decrease in host defense?

Answer 12

1. Stress (battle, exams, sleep, nutrition, corticosteroids)
2. Smoking
3. Malnutrition
4. Systemic disease (measles, HIV) - Decrease in PMNs

Question 13

85. What are the three main zones for a NUG lesion?

Answer 13

1. Grayish psuedomembrane made up of bacteria and PMNs
2. A red, bleeding necrotic zone (consisting of dead/dying epithelial cells, bacteria, and PMNs)
3. Deeper tissues (have +++ numbers of invasive gram- bacteria)