Chronic periodontitis

Question 1

Name 2 periodontopathogens:

Answer 1

• Aggregatibacter actinomycetemcomitans

- Porphyromonas gingivalis

Question 2

What steps are involved in the development of a periodontal pocket?

Answer 2

1. Plaque collects at & below gingival margin
   - Bacterial products (enyzmes & toxins) form
   - breakdown epithelial intercelllular substances
   - Lead to ulceration of sulcular epithelium
2. Widening intercellular spaces
   - causes injurious agents (bacteria & by products) to penetrate into connective tissue beneath epithelium.
3. Continued exposure to plaque organisms continues inflammatory reaction & increased pocket depth
   - chronic gingivitis (established lesion)
4. Inflammatory reaction in the connective tissue:
   - blood vessel dilate (increase blood flow - erythema)
   - Increase permeability
   - Increase in inflammatory exudate- BOP
   - Oedema leakage into tissue - increase gingival tissue size
5. Destruction (inflammation) + healing (production of collagen fibres & blood vessels) - simultaneously
   - fibrosis results = thickening
   - Established lesion may be stable or active thus become periodontitis

Question 3

What is the difference between bacteria in the aerobic environment and anaerobic plaque?

Answer 3

Aerobic

• gram positive
• pink stain
• single/ think layer peptidoglycan layer
• high lipopolysaccharide content
• resistance to physical disturbances is high
• more resistant to antibiotics

Question 4

What is the difference between gingival and periodontal pocket?

Answer 4

• Gingival pocket - formed by enlargement without apical migration of junctional epithelium.
• Periodontal pocket = formed as a result of disease or degeneration that caused the junctional epithelium to migrate apically long the cementum. (True pocket/ absolute pocket.)

Question 5

Name drug induced enlargement condition:

Answer 5

• Antihypertensives (ca2+ channel blockers, Nifedipine, Amlodipiine)
• Immunosuppresent for rheumatoid arthritis or psoriasis (e.g. cyclosporin- appears more vascularised)
• Antiepileptic (e.g. epanutin - phenytoin)

Question 6

Describe a development disorder that causes gingival enlargement:

Answer 6

Hereditary gingival fibromatosis:

• isolated disorder caused by gene mutation
• thus multi-system syndrome
• fibrotic tissue enlargement (generalised/localised) at maxillary tuberosities or retromolar region
• Diagnosis made by pos FH but can be sporadic

Question 7

Name and describe 3 granulamatous disorders that can result in ginigval enlargement:

Answer 7

• Chron’s disease (firm leathery, ginigivae with characteristic minutely pebbled surface)
• Orofacial granulomatosis (ulcerative lesions of oral mucosa)
• Sarcoidosis (multi-organ disorder, diagnosis in mouth needs elimination of other granulomatous disorders)

Question 8

Name 3 blood dyscrasias that can cause gingival enlargement and false pocketing:

Answer 8

• Acute leukaemia (enlargement due to massive infiltration of leukemic cells in ginigival connective tissue)
• Neutropenia (normal side effect of side of radio/chemo therapy)
• Agranulocytosis (drug induced disorder)

Question 9

Histological charcteristics of an established lesion(gingiviyis)

Answer 9

• acute inflammation
• continued loss of connective tissue
• B cells > T cells with predominance of plasma cells
• PMNL macrophages (account for <5% of cells)
• Microulceration of junctional epithelium
• Proliferation, apical migration and lateral extension of junctional epithelium
• early pocket formation may commence but no significant bone loss

Question 10

Histological charcteristics of an advanced lesion (periodontitis)

Answer 10

perisistant feature as those in established lesion

• extension of lesion into alveolar bone & PDL
• Contiuned loss of collagen with fibrosis
• Formation of pocket as loss of alveloar bone
• Type III & IV hypersenistivity
• Wide spread manifestations of immunopathologic tissue reactions