Clinical and histological response to gingivitis Flashcards
What are the 2 potential clinical responses to gingivitis?
- Resolution of inflammation - favourable response to treatment by healing/treatment success
- Persistence of inflammation
What would you expect to see if inflammation has resolved? (4)
Reduction in redness
Reduction in swelling (shrinkage of tissues)
Reduction in bleeding (on probing/brushing)
Patients tell you “gums don’t bleed and feel firmer”
What are the specific clinical findings in resolved gingivitis? (6)
Changes in colour - pink Changes in gingival contour Presence of stippling Changes in texture - gingiva is more firm Reduction in plaque score Reduction in bleeding on probing
What would you expect histologically in pristine gingiva?
Continuous sparse neutrophil migration into the coronal part of junctional epithelium and crevice
What would you expect to see histologically in normal healthy gingiva? (3)
Microbial colonisation
Infiltrated connective tissue
Monocytes/macrophages, lymphocytes and neutrophils
What would you expect to see histologically in early gingivitis? (7)
Increased neutrophil emigration and proliferation of junctional epithelium
Marked proliferation of junctional epithelium
Increased infiltrate: neutrophils, lymphocytes, monocytes/macrophages
Dilated vessels
Vascular proliferation
Increased collagen loss
Very few plasma cells
What would you expect histologically in established gingivitis? (5)
Greatly increased neutrophil emigration
Greatly increased leukocytic infiltrate with plasma cells constituting 10-30%
Proliferation of junctional and sulcular epithelium; some loss of collagen, but no loss of attachment
New vessel formation: plasma cells are found adjacent to the vessels and gingival lesion. Mainly IgG and IgA but very little IgM present
Abundance of PMN; T cells dominate lesion, also non-specific polyclonal B cell mitogens
What do you expect to see histologically in the gingiva in periodontitis? (3)
Apical migration of the junctional epithelium
Plasma cells constitute >50%
Bone loss
What happens when you carry out supragingival scaling?
- Microbiological changes (2)
- Cellular events during healing (2)
Micro:
- Major disruption to the biofilm
- Converts a predominantly anaerobic flora to predominantly aerobic flora
Cellular:
- Initial acute inflam response
- Initiation of resolution of inflammation
What are the microbiological changes following instrumentation?
- Reduction in total number of organisms
- Changes from predominantly anaerobic flora to predominantly aerobic flora > proportion of gram -ve anaerobic is significantly reduced; residual flora is predominantly gram positive and aerobic
- Composition of flora changes from that which is generally associated with diseased sites towards one which is generally associated with health
What cellular events occur in the first 24-48 hours following non-surgical therapy?
Acute inflammatory response
What cellular events occur in week 1-4 following non-surgical therapy? (5)
Reduction in inflammation
Reduction in GCF
Reduction in inflammatory cells
Fibroblasts migrate into the area and proliferate, lay down ground substance and produce collagen fibres
Formation of new gingival connective tissues with time
What causes the changes in texture when gingivitis is resolved and the gingiva returns to health?
New gingival connective tissue is consistent with changes in texture (firmness) and presence of stippling
What are the reasons for persistence of inflammation (Clinician factors)? (3)
Wrong diagnosis
Inadequate removal of calculus and other plaque retentive factors
Other - failure to remove local plaque retentive factors
What are the reasons for persistence of inflammation (Patient factors)? (4)
Inadequate plaque control
Lack of compliance/motivation
Lack of dexterity
Poor/incorrect technique
