Aetiology and pathogenesis of periodontal disease

Question 1

describe this picture

Answer 1

gingival health
* knife edge
* scalloped gingival margin
* stippling
* pink gingiva

Question 2

what is clinical gingival health defined as? what are its characteristsics?

Answer 2

• <10% bleeding sites with probing depths =< 3mm
• no probing attachment loss or radiological bone loss
• characterised by the absense of bleeding on probing, erythema and oedema, patient symptoms and attachment and bone loss

Question 3

what are the range of physiological bone levels?

Answer 3

• from 1.0 - 3.0mm apical to the ACJ

Question 4

what is gingivitis defined as? what are its characteristics?

Answer 4

• =>10% bleeding sites with probing depths =<3mm
• no probing attachment loss or radiological bone loss
• characterised by red, inflammed gums, rolling of gingival margin, no scalloping and absence of attachment and bone loss

Question 5

describe this picture and give a diagnosis

Answer 5

gingivitis
* swollen gums
* rolled margins
* redness

Question 6

describe this picture and give a diagnosis

Answer 6

plaque induced gingivitis
* plaque present
* no scalloping
* inflammation
* staining of teeth

Question 7

what are the characteristics of plaque induced gingivitis?

Answer 7

• intact periodontium
• no radiological bone loss
• no interdental recession
• bleeding on probing
• > 10% bleeding sites

Question 8

what is the difference between gingival health and gingivitis?

Answer 8

gingivitis has =>10% bleeding on probing and gingival health has <10% bleeding on probing

Question 9

what are the similarities with gingival health and gingivitis?

Answer 9

• no probing attachment loss
• no radiological bone loss
• =<3mm probing pocket depth

Question 10

what is the pathogenesis of gingivitis?

Answer 10

local plaque retention factors
* calculus
* restoring margins
* crowding
* mouth breathing

systemic modifying factors
* sex hormones
* medication

Question 12

describe this picture and give a diagnosis

Answer 12

periodontitis
* attached gingiva is pink
* stained teeth
* not much plaque
* more than 3.0mm bone loss
* inflammtion of gums

Question 13

describe the relationship between a patient with gingival health, gingivitis and periodontitis

Answer 13

• patient with gingivitis can reversably become a patient with gingival health
• patient with periodontitis cannot become a patient with gingival health or gingivitis as it is irreversible

Question 13

what is periodontitis characterised by?

Answer 13

• loss of periodontal attachment
• inflammation
• more than 3.0mm bone loss

Question 14

what are the symptoms of periodontitis?

7

Answer 14

• bleeding gums
• gingival recession
• tooth mobility
• halitosis
• bad taste in mouth
• tooth sensitivity
• abcesses associated with periodontitis

Question 15

what are the two types of pockets?

Answer 15

• true pocket - loss of attachment due to bone loss
• false pocket - gingival swelling gives illusion to a pocket but no loss of attachment present

Question 16

what are the three different types of bone loss?

Answer 16

• horizontal bone loss
• vertical (angular) bone loss
• furcation bone loss

Question 17

how does vertical bone loss arise?

Answer 17

plaque bacteria trapped in a pocket creates a 2mm zone of destruction which causes bone loss on one tooth surface compared with the other

Question 18

what is the host immune response to gingivitis?

Answer 18

• saliva
• epithelium - physical barrier, shedding cells, production of inflammatory mediators
• GCF - gingival crevicular fluid
• inflammatory and immune responses

Question 19

why does connective tissue matrix degradation occur in periodontitis?

Answer 19

MMPs (matrix metalloproteinases) are secreted by host inflammatory cells which break down connective tissue matrixes

Question 20

what are the local risk factors of periodontitis?

Answer 20

• anatomical risk factors - enamel pearls/projections, grooves, furcations, gingival recession
• tooth position - malalignment, crowding, tipping, migration, occlusal forces
• iatrogenic factors - restoration overhangs, defective crown margins, poorly designed partial dentures, orthodontic appliances

Question 21

why is smoking a behavioural risk factor of periodontitis?

Answer 21

• causes vasoconstriction of gingival vessels and increased gingival keritinisation
• impaired antibody production
• decreased numbers of Th lymphocytes
• impaired PMN (polymorphonuclear leukocyte) function
• increased production of pro-inflammatory cytokines

Question 22

what is the genetic risk for periodontitis?

Answer 22

• up to 50% of periodontal disease is likely to be the result of genetic factors
• some gene variants (IL-1 polymorphism) predispose to periodontitis
• environment/gene interactions e.g. smoking + IL-1 polymorphism increases risk

Question 22

what are the environmental risks for periodontal disease?

Answer 22

• local risk factors
• local microbiome
• stress

Question 23

what is the epidemiology of periodontitis?

Answer 23

• 50% of population have periodontitis
• 10% of population have severe periodontitis
• prevalence increases with increasing age
• more common in people who smoke, but common in people who don’t