Chapter 6 Flashcards
How is periodontal health defined?
“A state free from inflammatory periodontal disease that allows an individual to function normally and avoid consequences (mental or physical) due to current or past disease”
How is periodontal health characterized?
Absence of bleeding upon probing, erythema, edema, attachment loss, bone loss
Can occur in intact or reduced periodontium
Reasons for reduced periodontium in a non-periodontitis patient
Recession from toothbrushing
Crown lengthening surgery
(no change to AB)
When do we see perio health iw/ reduced periodontium?
Successfully treated periodontitis patient (stable)
What bacteria may be seen in elevated levels in adolescents?
- Actinomyces
- Capnocytophaga
- Leptotrichia
- Selenomonas
What is the difference in plaque-induced gingivitis in adolescents vs. adults?
- Children have fewer pathologic bacteria and a less-developed immune response
- Inflammation in adults is more pronounced w/ similar amts of plaque biofilm
What are the 3 categories of plaque-induced gingivitis?
- Gingivitis on intact periodontium
- Gingivitis on reduced periodontium in non-periodontitis pt
- Gingivitis on reduced periodontium in successfully treated, STABLE perio pt (lack of ongoing AL)
Modifying factors for plaque-induced gingival disease
- Systemic conditions
- Oral factors that enhance plaque biofilm accumulation
Systemic conditions affecting plaque-induced gingival disease
Sex hormones
Diabetes
Leukemia
Smoking
Malnutrition
Oral factors that enhance plaque biofilm accumulation
Prominent subgingival margin restorations
Hyposalivation
How does pregnancy affect inflammation?
Exaggerated response to plaque-biofilm deposits
Enhanced inflammation
Increased bleeding on probing
May resolve post partum
What is pregnancy associated pyogenic granuloma?
Exaggerated tissue response after 1st trimester
Mushroom-like mass usually on interproximal anterior
Painless and benign but can get big enough to obstruct occlusion
Bleeds easily
May resolve after pregnancy
How can leukemia affect the gingiva?
Exaggerated inflammatory response
Tissue is swollen, spongy and friable, bleeds easily
Starts in papilla and spreads to margins
May be first signs of disease
Effects of smoking on the gingiva
Fewer clinical signs and symptoms
Constricts blood vessels so less bleeding
Gingival fibrosis
Inflammation is masked
Effects of malnutrition on the gingiva
Lack of vitamin C can reduce wound healing.
Hard to differentiate from plaque-induced gingivitis
Restorative margins effect on gingiva
Inflammation caused by biofilm retention under restorative margins
Compromised plaque control
Ex. amalgam overghangs, veneer margins
Hyposalivation/xerostomia effects on gingiva
Enhances inflammation
Can cause progressive caries, halitosis, inflammation of tongue, oral mucosa and gingiva
Can make homecare difficult
Drug-induced gingival enlargement
Usually occurs about 3 months after starting meds
Plaque-biofilm is also necessary for induction
Not everyone will experience
Severity affected by effectiveness of homecare
Prevalence higher in younger patients
Agents that cause drug-induced gingival inflammation
Anti-convulsants
Immunosuppressants
Calcium-channel blockers
Characteristics of drug-induced gingival inflamation
Anterior sextants most affected
Irregular patterns
Increased gingival crevicular flow
BOP without attachment loss
Bacteria involved in necrotizing PD
Treponema
Selenomonas
Fusobacterium
Prevotella intermedia
What is necrotizing PD?
Severe, acute infection encompassing gingivitis, periodontitis, stomatitis
What are risk factors for necrotizing PD?
Smoking
Poor nutrition
Poor home care
Compromised immune status
Clinical manifestation of necrotizing PD
Unique, characterized by ulcerated and necrotic papillae and gingival margins w/ cratered or punched out appearance
Painful and foul smelling
What causes thrush/Candidiasis (C. albicans)?
Use of wide-spectrum antibiotics, allowing overgrowth
Seen in immunocompromised pts, infants, elderly and dentured pts
What may cause hypersensitivity reactions?
Allergic rxns to ingredients in toothpaste, mouthwash, chewing gum
Most common when pts. have other allergies
Clinical manifestation of hypersensitivity rxns
Diffuse, fiery red gingiva
Possible ulceration
Possible bleeding
Treatment for hypersensitivity rxns
Discontinue use of product
Confirm with biopsy
What can cause chemical burn and why?
Listerine, chlorhexedine, aspirin
Used for longer than directed
Aspirin placed directly on tissue (acid burn)
What may cause drug-induced pigmentation?
Tetracycline
