3 - Gingival Diseases Flashcards
1
Q
what are the defense mechanisms of the gingiva
A
- JE
- GCF
- leukocytes
- saliva
2
Q
what is a frontline barrier against microbial challenge
A
JE
3
Q
how is JE a frontline barrier against microbial challenge
A
- cellular turnover (shedding)
- permeable
- cytokine production
4
Q
what cytokines do JE produce
A
IL-1beta and IL-8
5
Q
what is collected from sulcus in small amounts and analyzed
A
GCF
6
Q
what may be used to help detect or diagnose active periodontal disease and may help predict patients at risk for perio disease
A
GCF
7
Q
T/F: a critical challenge for clinicians is not the detection of perio disease but the indentification of patients with elevated risk of experiencing active and progressing disease
A
TRUE
8
Q
MMP-8 was found where?
A
GCF and saliva
9
Q
MMP-8 leads to what
A
- destruction of collagen in gingiva and alveolar bone
- associated with initiation and progression of periodontitis
- reflection of disease severity
10
Q
what is used to collect and analyze GCF
A
periotron
11
Q
what are the components of GCF
A
MMP-8, cells, electrolytes, and organic compounds
12
Q
what cells found in GCF
A
bacteria, desquamated epithelial cells, leukocytes
13
Q
what electrolytes found in GCF
A
potassium, sodium, and calcium
14
Q
what organic compounds found in GCF
A
cytokines, prostaglandins E2, and immuniglobulins (IgG, IgA, IgM)
15
Q
what are drugs secreted in GCF
A
- tetracycline - anti-collagenase effect
- metronidazole
16
Q
what is the clinical implication of drugs secreted in GCF
A
adjunct to treat aggressive forms of periodontitis
17
Q
what leukocytes are part of denfense mech of gingiva
A
PMN, B and T lymphocytes
18
Q
what is a major protective mechanism against bacterial plaque
A
luekocytes in gingiva
19
Q
how is saliva a defense mechanism of gingiva
A
- cleanses exposed oral surfaces
- buffering acids
- modulating bacterial activity with immune mediators
20
Q
what are antibacterial factors in saliva
A
- lysozyme
- lactoperoxidase-thiocyanate system
- lactoferrin
- myeloperoxidase
21
Q
what cleaves cell wall of Aggregatibacter actinomycetemcomitans
A
lysozyme
22
Q
what is bactericidal to some Lactobacillus and
Streptococcus strains
A
lactoperoxidase-thiocynate system
23
Q
what is effective against actinobacillus species
A
lactoferrin
24
Q
what is released by leukocytes, bactericidal for actinobacillus
A
myeloperoxidase
25
what are salivary antibodies? function
IgA (predominates), IgG, IgM
fn: impair bacterial attachment
26
what enzymes in saliva? function
parotid amylase and anti-proteases (cathepsins)
cathepsin fn: inhibit colagen degrading enzymes
27
what provides maintenance of pH at mucosal epithelial cell surface and tooth surface thru bicarbonate-carbonic acid system
salivary buffers
28
what hasten coagulation, protect wounds from bacterial invasion
coagulation factors
29
what are the coagulation factors
factors VII, IX, X, plasma thromboplastin antecedent, and hageman factor
30
decreased saliva is associated with what
1. inflammatory gingival conditions
2. dental caries
3. rapid tooth destruction
4. cervical, cemental caries
5. delayed wound healing
31
what are signs of gingivitis?
1. BOP
2. INCREASED GCF FLOW
3. erythema
4. edema
5. gingival enlargement
6. recession
32
what is an early detection of gingivitis? what is another early sign?
BOP; increased GCF flow
33
what are the effects of smoking on BOP
masks gingival inflammatory response
34
smoking [increased; decrease] BOP
decrease
35
can smoking disguise BOP
yes
36
warn patients who are quitting smoking that an [increase; decrease] in gingival bleeding may occur
increase
37
what are changes in gingival consistency
1. fibrotic
2. edematous
3. chronic gingivitis
38
what does it mean to be firm, relisient in health
fibrotic
39
what does it mean to be soft, firable, shiny, bleeds easily, swelling, and loss of stippling
edematous
40
what does it mean for gingiva to become fibrotic again with an increased accumulation of collagen (fibrosis)
chronic gingivitis
41
what is experimental gingivtis
non-specific accumulation of microbial plaque
42
is experimental gingivitis reversible with removal of plaque
yes
43
does experimental gingivitis always progress to perio
not always
44
increased plaque retention is due to
Caries
latrogenic factors (overhangs)
Malpositioned teeth
Mouth breathing
Partial dentures
Orthodontic appliances, fixed retainers
Recession, lack of attached gingiva, frenum pull
45
what are iatrogenic factors
oberhangs
46
what are types of gingival enlargement
1. inflammatory enlargement
2. acute inflammatory enlargement
3. drug influenced gingival enlargement
4. other forms
47
what are types of inflammatory enlargement
1. chronic or acute inflammation
2. plaque induced
48
what are types of acute inflammatory enlargement
periodontal absecess
49
what is:
Deep probing depth
Gingival margin is
coronal to CEJ
Not true attachment
loss
pseudopocket
50
what is increased # of cells
hyperplasia
51
what is increase in cell size
hypertrophy
52
gingival enlargement is the [clinical or histological] term
CLINICAL
53
gingival hyperplasia is the [clinical or histological term]
histological
54
what is localized drug influenced gingival enlargement
single tooth or group of teeth
55
what is generalized drug infuenced gingival enlargement
throughout mouth
56
mild vs. moderate vs. severe gingival enlargement
Mild ->Papilla
Moderate ->Papilla + Marginal Gingiva
Severe -> Papilla + Marginal Gingiva + Attached Gingiva
57
what are drugs associated with gingival enlargement
antiepilectic drugs, calcium channel-blocking drugs, and immunoregulating drugs
58
drug influenced gingival enlargement is a result of what
combination of drug and plaque induced inflammation
59
what are common characteristics of drug influenced gingival enlargement
1. anterior gingiva affected most often
2. first observed at papillae
3. higher prevalence in younger age groups
4. onset iwthin 1-3 months of druguse
60
what are examples of antiepileptic drugs
phenytoin and sodium valproate
61
what are examples of calcium channel blocking drugs
nifedipine, amlodipine, felodipine, verapamil, diltiazem
62
what are examples of immunoregulating drugs
cyclosporine, tacrolimus
63
how to tx drug influenced gingival enlargement
1. physician consult
2. plaque, calculus removal
3. oral hygience instruction
4. gingivectomy
64
is drug influenced gingival recurrence rate high
yes
65
gingival enlargements are associated with what SYSTEMIC CONDITIONS
puberty, pregnancy, leukemia, and plasma cell gingivitis
66
describe plasma cell gingivitis. what is it due to
gingiva is red, friable
due to allergic reaction
67
treatment of plasma cell gingivitis
cessation of exposure to allergen
68
what is a reactive process causing gingival enlargement?
tissue response to local irritation or trauma
69
gingival enlargement is due to what diseases
1. epulis
2. focal fibrous hyperplasia
3. papilloma
4. pyogenic granuloma
5. peripheral giant cell granuloma
6. peripheral ossifying fibroma
70
what is a firm nodule made of collagen
focal fibrous hyperplasia (irritation fibroma)
71
what is associated with HPV and wart like
papilloma
72
what is Red or purple
Firm or friable
Granulation tissue
Chronic inflammation
15% Recurrence rate
after surgical removal
pyogenic granuloma
73
what is the "pregnancy tumor" that can also occur on lips, buccal mucosa and tongue
pyogenic granuloma
74
what is:
Pink, red, or purplish
blue
Labial gingiva most
commonly
Sessile or
pedunculated
Firm or spongy
Multinuclear giant
cells
Chronic inflammation
peripheral giant cell granuloma
75
what is:
Similar to Peripheral
Giant Cell
Granuloma
Bone formation
within the lesion
Diagnose through
biopsy
Surgical excision
Curette base
peripheral ossifying fibroma
76
what are the 3 P's
Pyogenic Granuloma
Peripheral Giant Cell Granuloma
Peripheral Ossifying Fibroma (POF)
77
when removing gingival enlargements, what must you do?
curette base to bone
78
what is the most common malignant tumor of igngiva
squamous cell carcinoma
79
what is:
Exophytic, erosive, or verrucous
Erythematous and leukoplakic
Metastasis to other head/neck regions or lung,
liver, bone
squamous cell carcinoma
80
is squamous cell carcinoma part of the 3P
no (duh)
81
what is the second most commong oral malignangy
B and T cell non-Hodgkin lymphoma
82
where does lymphoma occur
soft tissue or bone
(Palate, gingiva, tongue, buccal mucosa, floor of
mouth, maxilla
Red, purplish boggy swellings- may mimic pyogenic
granuloma or PGCG)
83
what are acute periodontal lesions
NG, NP, NS, perimary herpetic gingivostomatitis, and periocoronitis
84
if ___ is untreated, may progress to NP or NS
necrotizing gingivitis
85
what is
Punched-out craterlike papillae
Pain
Fetid odor
Gray pseudomembranous slough, linear erythema
Bleeding
Fever, lymphadenopathy
necrotizing gingivitis
86
etiology of NG
Microbes: Spirochetes (Treponema sp.),
Fusobacterium sp., Selenomonas sp., Prevotella
intermedia
Stress
Smoking
Poor plaque control
Immunosuppression (HIV)
Poor nutrition
Inadequate rest
87
treatment of NG
- Gross supragingival debridement
- Systemic antibiotics (Amoxicillin or Metronidazole) if fever, lymphadenopathy present
- Antimicrobial rinses
Chlorhexidine (Peridex)
- Physician referral- if persistent or recurrent
Evaluate for underlying systemic disease (HIV, lymphoproliferative disease)
88
what is:
HSV-1
Most common in young children (≤6 yrs)
Primary infection is asymptomatic in most
Recurrent infection (Recurrent herpes)
perimary herpetic gingivostomatitis
89
what has:
Multiple vesicles
Clusters
located on: Gingiva, Mucosa, Soft palate, Tongue
primary herpetic gingivostomatitis
90
what is:
Course 7-10 days
Generalized soreness
Interferes with eating and drinking
Fever 101-105 degrees
Cervical lymphadenitis
Malaise
primary herpetic gingivostomatitis
91
treatment of primary herpetic gingivostomatitis
Anti-viral if diagnosed within 3 days of onset
Acyclovir- reduces duration of symptoms, viral
shedding and new lesions
92
palliative care for primary herpetic gingivostomatitis
Fluids
Pain reliever
Topical anesthetic (Orabase)
NO steroids!
93
what is:
Inflammation of
gingiva at crown of
incompletely erupted
tooth
Most commonly
mandibular 3rd molar
pericoronitis
94
etiology of periocoronitis
trauma, occlusion, foreign body
95
symptoms of periocoronitis
Pain, Swelling, Suppuration, Redness
Fever, lymphadenopathy possible
96
complications of periocoronitis
May spread to oropharyngeal area
Difficulty swallowing
Cellulitis
Ludwig's angina
97
treatment of pericoronitis
Debridement, Antibiotics (if fever, cellulitis)
Extract 3rd molar
98
what are systemic diseases affecting gingiva
Granulomatosis with Polyangiitis
Crohn's Disease
Leukemia
99
what was granulomatosis with polyangiitis formerly called
Wegener granulomatosis
100
what is:
Rare, immune-mediated systemic disease
Necrotizing vasculitis of upper and lower
respiratory tract, kidneys, arteries/veins
"Strawberry gingivitis"
granulomatosis with polyangiitis
101
what is:
Part of Inflammatory Bowel Disease (IBD)
Oral lesions may accompany
asymptomatic intestinal involvement
chron's disease
102
what is:
"Epulis-fissuratum-like"
lesion in mucobuccal fold,
erythema, mucogingivitis,
tissue tags
crohn's disease
103
what is abnormal proliferation of leukocytes
leukemia
104
what is:
90% present with oral manifestations
Petechiae, spontaneous bleeding, ulcers,
gingival enlargement, mucosal palor
acute myelogenous leukemia
105
primary etiology of gingival enalrgement is what
bacterial plaque
106
what are contributing etiologies to gingival enlargement
Medications
Pregnancy
Puberty
Systemic disease
Local irritant (restoration, cement, ortho wire)
