23. Clicial And Histological Responses To Treatment In Gingivitis Flashcards
LOs
Clinical responses to treatment (plaque removal)?
Clinical responses
• Resolution of inflammation (favourable response to treatment by healing/ treatment success)
• Persistence of inflammation
What happens during resolution of inflammation?
(Overall)
(Specific clinical findings)
What’s happening histologically (at a cellular level) during pristine gingiva, health, gingivitis, periodontitis
PRISTINE GINGIVA
- Free inflammation
- Clinically very hard to achieve unless you have extreme plaque control measures
- stage which you wouldn’t normally see in patients
HEALTH
- initial lesion is seen in the first 24-48 hrs following plaque accumulation
- localised to gingival solcus
- have good plaque control
- presence of some neutrophils and monocytes
- some vasodilation happening
- however, crucial to note that clinical appearance of gingiva is healthy
ESTABLISHED GINGIVITIS
- happens 2-3 weeks following plaque accumulation
- some proliferation of the junction epithelium
- greater increased neutrophils coming into the area
- significant n.o plasma cells migrating into the area
- also an increase in the GCF
- clinically you’ll see this links with marginal inflammation of the gingivae
PERIODONTITIS
- if established gingivitis isn’t treated, may progress to periodontitis
- pocket formation
- loss of attachment and collagen and bone loss
- apical migration of junctional epithelium
- a lot more cells coming into area
- clinically you’ll see inflammation, gingival recession (secondary to bone loss or attachment loss)
What happens during established gingivitis?
Established gingivitis
• Proliferation of junctional and sulcular epithelium; some loss of collagen, but no loss of attachment
• New vessel formation: plasma cells are found adjacent to the vessels and gingival lesion. There is mainly IgG and IgA but very little IgM present
• An abundance of PMN ; T cells dominate the lesion; also non-specific polyclonal B cell mitogens
What happens when you carry out supra gingival scaling :
-Microbiological changes?
- cellular events during healing?
Microbiological changes following instrumentation?
Cellular events following Non-surgical therapy
- basically reverse of what described in progression histologically
Histological and clinical responses to treatment of gingivitis
Reasons for persistence of inflammation following instrumentation
- clinician factors?
- patient factors?
