(3) Histopathology of Periodontal Disease - initial and early lesion

Question 1

What are the 4 stages of lesions?

Answer 1

Initial
Early
Established
Advanced lesions

Question 2

What is gingivitis?

Answer 2

Confined to the marginal gingiva

Damage mainly cased by immune response

Question 3

What is periodontitis?

Answer 3

Destruction of connective tissue attached and loss of alveolar bone

Pocket formation

Question 4

Where does the junction all epithelium end?

Answer 4

At the cements-enamel junction

Question 5

How do you differentiate the sulu liar and junctional epithelium histologically?

Answer 5

Junctional epithelium - completely smooth and thin , sometimes only 2 cell in thickness

Sulcular epithelium - rete ridges

Question 6

What is the gingiva continuous with?

Answer 6

The periodontal ligament

Question 7

Is stippling normally seen at the gingiva?

Answer 7

Yes

Stippling is typically seen in the attached gingiva as it is firmly attached to the underlying cementum and alveolar bone with the help of the collagen fibers of the connective tissue

Question 8

What response occurs to the initial lesion?

Answer 8

• plaque accumulation leads to an inflammatory response in the marginal gingiva
• dilation of blood vessels and increased vascular permeability

Question 9

What is the initial lesion?

Answer 9

The initial response to the presence of plaque

Not a clinical disease

Question 10

What stage of disease is shown here?

Answer 10

Initial lesion

Question 11

How can you identify this as an initial lesion?

Answer 11

Inflammatory infiltrate - can see migration of neutrophils towards sulcus

The epithelial junction is still present

(Decalcified section)

Gingiva look healthy but slightly inflamed

Question 12

What colour is the plaque in this image?

Answer 12

Purple

Question 13

What is oedema?

Answer 13

a build-up of fluid in the body which causes the affected tissue to become swollen

Question 14

What is the pink substance in this image?

Answer 14

Dilated blood vessels

Question 15

What happens when blood vessels dilate?

Answer 15

Fluid exudate

Neutrophils move toward sulcus

Increased flow of gingival crevicular fluid

Question 16

What does gingival crevicular fluid help with in the initial lesion?

Answer 16

Help flush out some of the bacteria but not enough to get rod of the plaque

Question 17

When does the early lesion occur?

Answer 17

After 2 days of no brushing

Question 18

What occurs in the early lesion?

Answer 18

More vasodilation

More increased vascular permeability

More GCF in the gingival sulcus

More immune cells coming into connective tissue and sulcus

Question 19

What immune cells infiltrate into the sulcus and connective tissue in the early lesion?

Answer 19

Neutrophils
T cells

Question 20

What is erythematous?

Answer 20

exhibiting abnormal redness of the skin or mucous membranes due to the accumulation of blood in dilated capillaries (as in inflammation)

Question 21

What stage of lesion does this show?

Answer 21

Early lesion

Question 22

What happens to fibroblasts in early lesion?

Answer 22

Degenerate through Apoptosis

Question 23

Why is fibroblast apoptosis important in the early lesion?

Answer 23

Make room for immune cells

Question 24

What happens to collagen in the early lesion?

Answer 24

Collagen destruction that results in collagen-dependent areas in the connective tissue

Question 25

What do the sulcular and junctional epithelium do to the collagen depleted areas (early lesion)?

Answer 25

Proliferation of the junctional and sulcular epithelium into collagen-depleted areas

Question 26

What is shown just under the junctional epithelium

Answer 26

Lots of inflammatory cells

Neutrophils

Question 27

Is the junctional epithelium (thicker or thinner than a healthy individual here? (Image 2)

Answer 27

Thicker

Due to Proliferation of the junctional and

sulcular epithelium into collagen-depleted areas

Question 28

What do the purple dots show?

Answer 28

Nuclei of inflammatory infiltrate

Question 29

What happens to the sulcus in the early lesion?

Answer 29

Due to swollen gingiva, the sulcus becomes deeper

Question 30

What is the consequence for the swollen gingiva and deepening of the sulcus? (Early lesion)

Answer 30

This leads to subgingival plaque formation

As there is more space for the biofilm to proliferate

Question 31

What happens if the early lesion is not removed?

Answer 31

Leads to established gingivitis

Question 32

What has changed about the junctional epithelium from healthy tissue?

Answer 32

Proliferating and thicker

Question 33

What do the dots show in this histogram?

Answer 33

Heavy inflammatory infiltrate

Neutrophils and T lymphocytes