(3) Histopathology of Periodontal Disease - initial and early lesion Flashcards
What are the 4 stages of lesions?
Initial
Early
Established
Advanced lesions
What is gingivitis?
Confined to the marginal gingiva
Damage mainly cased by immune response
What is periodontitis?
Destruction of connective tissue attached and loss of alveolar bone
Pocket formation
Where does the junction all epithelium end?
At the cements-enamel junction
How do you differentiate the sulu liar and junctional epithelium histologically?
Junctional epithelium - completely smooth and thin , sometimes only 2 cell in thickness
Sulcular epithelium - rete ridges
What is the gingiva continuous with?
The periodontal ligament
Is stippling normally seen at the gingiva?
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
What response occurs to the initial lesion?
- plaque accumulation leads to an inflammatory response in the marginal gingiva
- dilation of blood vessels and increased vascular permeability
What is the initial lesion?
The initial response to the presence of plaque
Not a clinical disease
What stage of disease is shown here?
Initial lesion
How can you identify this as an initial lesion?
Inflammatory infiltrate - can see migration of neutrophils towards sulcus
The epithelial junction is still present
(Decalcified section)
Gingiva look healthy but slightly inflamed
What colour is the plaque in this image?
Purple
What is oedema?
a build-up of fluid in the body which causes the affected tissue to become swollen
What is the pink substance in this image?
Dilated blood vessels
What happens when blood vessels dilate?
Fluid exudate
Neutrophils move toward sulcus
Increased flow of gingival crevicular fluid
What does gingival crevicular fluid help with in the initial lesion?
Help flush out some of the bacteria but not enough to get rod of the plaque
When does the early lesion occur?
After 2 days of no brushing
What occurs in the early lesion?
More vasodilation
More increased vascular permeability
More GCF in the gingival sulcus
More immune cells coming into connective tissue and sulcus
What immune cells infiltrate into the sulcus and connective tissue in the early lesion?
Neutrophils
T cells
What is erythematous?
exhibiting abnormal redness of the skin or mucous membranes due to the accumulation of blood in dilated capillaries (as in inflammation)
What stage of lesion does this show?
Early lesion
What happens to fibroblasts in early lesion?
Degenerate through Apoptosis
Why is fibroblast apoptosis important in the early lesion?
Make room for immune cells
What happens to collagen in the early lesion?
Collagen destruction that results in collagen-dependent areas in the connective tissue
What do the sulcular and junctional epithelium do to the collagen depleted areas (early lesion)?
Proliferation of the junctional and sulcular epithelium into collagen-depleted areas
What is shown just under the junctional epithelium
Lots of inflammatory cells
Neutrophils
Is the junctional epithelium (thicker or thinner than a healthy individual here? (Image 2)
Thicker
Due to Proliferation of the junctional and
sulcular epithelium into collagen-depleted areas
What do the purple dots show?
Nuclei of inflammatory infiltrate
What happens to the sulcus in the early lesion?
Due to swollen gingiva, the sulcus becomes deeper
What is the consequence for the swollen gingiva and deepening of the sulcus? (Early lesion)
This leads to subgingival plaque formation
As there is more space for the biofilm to proliferate
What happens if the early lesion is not removed?
Leads to established gingivitis
What has changed about the junctional epithelium from healthy tissue?
Proliferating and thicker
What do the dots show in this histogram?
Heavy inflammatory infiltrate
Neutrophils and T lymphocytes
