Chapter 5 - histopathology of periodontal disease

Question 1

who devised the 5 histopathological states of periodontal disease?

Answer 1

lindhe et al 2003

Question 2

what are the 5 histopathological states?

Answer 2

• pristine gingiva
• normal healthy gingiva
• early gingivitis
• established gingivitis
• periodontitis

Question 3

what can be seen in the pristine gingiva?

Answer 3

(only really found in experimental animals) - very rare

• intact layer of epithelium lining the gingival crevice
• no/very few inflammatory cells in the connective tissue
• continuuous sparse migration of neutrophil leucocytes into the coronal part of the junctional epithelium & gingival crevice

Question 4

what can be seen in a normal healthy gingivae?

Answer 4

• small number of inflammatory cells in the junctional epithelium and connective tissue
• inflammatory changes seen microscopically but not yet clinically

Question 5

early gingivitis seen histopathologically?

Answer 5

10-20 days of plaque accumulation

• increased number of inflammatory cells in gingival tissues
• increased numbers of neutrophils emigrating into the gingival crevice
• the junctional epithelium becomes thicker
• the gingival connective tissue becomes more heavily infiltrated with inflammatory cells
• blood vessels dilate

Question 6

established gingivitis can be seen with…histologically

Answer 6

• has a more dence infiltration of inflammatory cells in the connective tissue
• plasma cells are becoming more evident (10-30%)
• collagen loss increases due to outpouring of the enzyme collegenase but no LOA yet
• epithelium lining the gingival crevice continues to get thicker

Question 7

histologically what does periodontitis look like?

Answer 7

• apical migration of the junctional epithelium (first stage of attachment loss)
• the same dence infiltrate of inflammatory cells can be seen with plasma cells now dominating (>50%)
• bone loss begins to occur

Question 8

what is the histopathology of necrotising ulcerative periodontal disease?

Answer 8

ulceration of the epithelium can be seen under the microscope with:

• necrosis ( tissue death )
• many inflammatory cells

the infecting organisms are:
- sprirochetes and fusiform bacilli bacteria
these can be found deep within the conncective tissue not just on the surface and also found in the slough