Etiology of Periodontal Diseases Flashcards
describe gingival health
- coral pink in color
- free from inflammation/edema
- firm and resilient
- scalloped gingival margin that envelopes the teeth
- peaked and pointed interdental papilla
- stippled surface texture
- no bleeding upon probing
- consistent with good oral hygiene
how is gingival health achieved
- plaque free tooth surfaces
- healthy diet
- regular dental visits
what is plaque biofilm’s affect on healthy gingiva
- lingering biofilm on a clean tooth results in inflammatory process
- local inflammation persists as long as biofilm is present around gingival tissues
- inflammation resolves after removal of biofilm
describe gingivitis
-inflammation of the gingival tisues
- reversible
what is the primary etiologic factor of gingivitis
plaque
what percentage of the population is affected by plaque
more than 82% of adult population
what is gingivitis characterized by
-inflammation of gingival margins and interdental papilla, redness, bleeding on probing
- no attachment loss
- healthy bone levels
what is the most common form of gingival disease
dental plaque induced gingival disease
describe dental plaque induced gingival disease
- may occur without attachment loss or on a reduced periodontium
- inflammatory lesion is within the gingiva
- not associated with progressive attachment loss
what is gingivitis associated with dental plaque only a result of
microbial challenge between bacteria in plaque biofilm and host responses
how long does it take for gingivitis to ensue with cessation of oral hygiene
2-3 weeks
what is gingivitis associated with dental plaque histologically characterized by
- dense infiltrate of lymphocytes
- mononuclear cells fibroblast alterations
- increased vascular permeability
- continuing loss of collagen in response to the microbial challenge
what is the primary etiologic factor for gingivitis
plaque
how is the severity and duration of inflammatory response of gingivitis altered
modifying local or systemic factors
how is gingivitis reversible
in healthy people once local factors and decrease of the microbial load around teeth reduced
what systemic factors effect gingival diseases
- endocrine changes: puberty, menstrual cycle, pregnancy, diabetes
- results from effects of systemic conditions on host’s cellular and immunologic functions
what percentage of pregnancies get gingivitis
more than 30% of pregnancies
what is gingivitis in pregnancy characterized by
mild to severe gingival inflammation and pain
- some can have significant hyperplasia and bleeding
what bacteria is increased in pregnancy and why
P. intermedia because progesterone causes its growth
how long does gingivitis with pregnancy last
resolves itself after delivery
what drugs cause gingival enlargement
- phenytoin
- immunosuppressive drugs (cyclosporin)
- calcium channel blockers: nifedipine, verapamil, dilitiazem, sodium valproate
what does vitamin C deficiency cause
- bright red, swollen, bleeding gingiva
what part of the diet increases gingivitis
increased carbohydrate intake
what do non - plaque induced gingival diseases encompass
lesions of autoimmune or idiopathic etiology manifesting on the gingiva
what are examples of non plaque induced gingival diseases
benign mucous membrane pemphigoid
what viral diseases can cause gingivitis
gonorhhea
synphilis
herpetic stomatitis
what fungal diseases can cause gingivitis
candidiasis
what systemic diseases can cause gingival enlarment
DM or allergies
what traumatic origin can cause gingivitis
toothbrush or flossing trauma, fingernail biting
what is localized gingivitis
confined to the gingiva of single tooth or group of teeth affecting less than 30% of remaining teeth
what is generalized gingivitis
more than 30% of remaining teeth
what is marginal gingivitis
involves the gingival margin
what is papillary gingivitis
involves interdental papillae, often extending into adjacent portion of gingival margin
where do earliest signs of gingivitis occur
in the papillae
what is diffuse gingivitis
affects gingival margin, attached gingiva and interdental papillae
what are the 2 earliest signs of gingival inflammatino that precede established gingivitis
- increased GCF
- increased bleeding from the gingival sulcus on gentle probing
what appears earlier BOP or color change or visual signs of inflammation
BOP
what does BOP indicate
inflammatory lesion in the epithelium and connective tissue
what type of sign is BOP
objective
what does absence of BOP imply
low risk of attachment loss
how does cigarette smoke affect BOP
supressess gingival inflammation and BOP
what medications affect gingival bleeding
antiplatelet medications (aspirin)
- anticoagulatns (warfarin, eloquis)
- oral contraceptives
where is gingivitis common in mouth breathers
in maxillary buccal area
what does gingiva look like in mouth breathers
red, shiny, edematous
what is fibrosis
pathologic process in which disrupted wound healing is associated with defective cell proliferation
describe gingivitis compared to periodontitis
- inflammatory response only affecting gingiva
- occurs becuase of biofilm accumulatino that is not removed
- reversible
-precedes periodontitis but does not always progress to periodontitis
describe periodontitis compared to gingivitis
- follows gingivitis
- not reversible
- inflammatory process extends to affect the PDL and alveolar bone, resulting in clinical attachment loss
- can be stabilizied and maintained with gingival health on a reduced periodontium
describe periodontitis
- chronic inflammation of the gingival tissues resulting in breakdown of surrounding periodontal tissues
- complex and multifactorial
- initiated by a dysbiosis of biofilm and modulated by the host response
what is periodontitis characterized by
- bone loss
- apical migration of the JE
what are the steps involved in transitioning from gingival health to periodontitis
- plaque around gingival tissues cause microbial challenge for healtghy tissues
- inflammatory change of the gingival sulucs begins
- cellular and fluid inflammatory exudate causes degeneration of surrounding connective tissues including gingival fibers
- apical to JE, collagen fibers are destroyed and area if occupied by inflammatory cells and edema
what are the stages of periodontitis and decribe each
1: initial lesion: clinically healthy gingival tissues, develops within 2-4 days of accumulation of plaque
2: early lesion: early gingivitis, develops 1-2 weeks of continued plaque accumulation
3: established lesion: established chronic gingivitis, progression to this stage dependent on many factors
4: advanced lesion: transition from gingivitis to periodontitis, progression to this stage dependent on many factors
what are the features of the JE
- acts as physical barrier against plaque bacteria
- stratified squamous nonkeratinized in nature
- attached to the tooth by internal basal lamina and to the CT by external basal lamina
- exhibits higher permeability to cells, gingival fluid and host defense molecules to flow through
- high rate of cellular proliferatino and turnover
what is a periodontal pocket cause dby
bone loss associated with apical migration of the JE
what is a suprabony perio pocket
bottom of pocket is coronal to the crest of the alveolar bone
what is a infrabony pocket
bottom of pocket is apical to the crest of the alveolar bone
pseudo pockets are always”
suprabony
complete periodontal assessment requires:
- description of the clinical appearance of the soft tissues
- probing depths
- plaque and bleeding index
- recession/CAL
- radiographs
what are the causative factors for periodontal disease
primary etiology: plaque in a susceptible host
- secondary etiology: local/environmental factors
what are the local factors contributing to perio
- calculus
- carious lesions
- overhands
- malpositioned teeth
- xerostomia
- furcations
- food impaction
- occlusal truama
- orthodontics
- poor crown margins
what are the systemic factors with perio
- medication
- stress
- diabetes
- obesity
- CVD
- immunocompromised
-smoking - nutrional deficiencies
- age
- genetics
what are the primary bacteria associated with periodontitis
- Aa
- P. gingivalis
- P. intermedia
- T. forsythia
- T. denticola
