aetiology and pathogenesis of periodontal disease Flashcards
describe gingvival health
clearly defined gingival margin, knife edge, scalloped
possible stippling
pink
what is the clinical definition of gingival health?
absence of bleeding on probing, erythema and edema, patient symptoms, attachment and bone loss, bone level range from 1-3mm apical to ACJ
<10% bleeding sites w/ probing depths
describe plaque induced gingivitis (intact periodontium)
red margin
rolled
-lost knife edge
what are the local plaque retention factors?
calculus
restoration margins
crowding
mouth breathing
what are the systemic modifying factors?
sex hormones
medication
what happens to neutrophils, lymphocytes etc. gin gingiivitis?
influx higher than normal
is periodontitis reversible?
no
is gingivitis reversible?
yes
what is periodontitis?
inflammation
loss of periodontal attachment
bone >3mm away from ACJ
describe a periodontal pocket
probe disappears
bleeding
what is a false pocket?
proliferation of sulcular epithelium leads to enlarged gingivae
probe disappears but no loss of attachment
in what group are pockets without inflammation common?
smokers
what is the normal bone level from the ACJ?
1-2mm
how do you determine if there has been bone loss?
check if bone level consistent on radiographs
how much bone loss relative to root length
-apex -> ACJ
-give %
what determines horizontal vs vertical bone loss?
how thick alveolar bone is between teeth
describe the progression from gingivitis -> periodontitis
once initiated, progression of attachment loss may be episodic, different sites may be affected differently
generally very slow but variable
2mm loss over 5 years = rapid progression
what happens when the biofilm migrates apically?
severe inflammation
bone loss
what is the host immune response?
saliva epithelium -physical barrier -shedding of cells -production of inflammatory mediators GCF inflammatory and immune responses
describe connective tissue matrix degradation
matrix malloproteinases are a family of zinc & ca dependent proteolytic enzymes which include collagenases
matrix degradation largely a result of MMP’s secreted by host inflammatory cells
immune cell activation of osteoclasts via RANK/RANKL/ other cytokine
what are anatomical risk factors?
enamel pearls/projections
grooves
furcations
gingival recession
what are tooth position risk factors?
malalignment crowding tipping migration occlusal forces
what are iatrogenic risk factors?
restoration overhangs
defective crown margins
poorly designed partial dentures
orthodontic appliances
why is smoking a risk factor?
vasoconstriction of gingival vessels and increased gingival keratinisation
impaired antibody production
depressed numbers of Th lymphocytes
impaired PMN function
increased prod. pro-inflammatory cytokines
what are environmental risk factors?
local risk factors
local microbiome
stress
what is the impact of periodontitis?
most common cause of bone loss
50% population affected
what is the extent and severity dependant on?
interaction between microbiome and host
what is the primary aetiological agent?
microbial plaque
