Gingival Disease Flashcards
What are the three main periodontal health determiants?
- Host
- Microbiological
- Environmental
What does the host determinant consist of ?
- Local predisposing factors like: Periodontal pockets, dental restorations, root anatomy and tooth position and crowding
- Systemic Modifying factors: Host immune function, systemic health, genetics
What does the Microbiological determinant consist of ?
Supragingival and subgingival biofilm
What does the Environmental determinant consist of ?
- Smoking
- Medications
- Stress
- Nutrition
What are the periodontal health four levels?
Pristine periodontal health
Clinical periodontal health
Periodontal disease stability
Periodontal disease remission/control
What does the pristine periodontal health consist of ?
- Total absence of clinical inflammation (not observable)
- normal support (bone level 1.0 - 3.0 mm apical to CEJ)
What does the Clinical periodontal health consist of ?
- Absense or minimal inflammation (<10 BOP; PDs <=3mm)
- Normal support (bone level 1.0 - 3.0 mm apical to CEJ)
What does the Periodontal disease stability consist of ?
- minimal inflammation
- control of modifiable risk factors
- Reduced periodontium
What does the periodontal disease remission/control consist of ?
- significant inflammation decrease
- some clinical improvements
- disease progession stability
- reduced periodontium
What is the AAP 2018 Two catergories?
- Clinical gingival Health on an intact periodontium- no history of destruction
- Clinical gingival health on a reduced periodontium- previous history of destruction
What are the subcategories ?
Clinical gingival health on a reduced periodontium
- Stable periodontitis (increased risk for recurrence)
- Non periodontitis ( no evidence of increased risk)
What are Gingivitis and gingival disease ?
- Plaque induced and non plaque induced
- Certain characterisitics must be present to be classifed as gingival disease
- Clinical diagnosis
What are the common characteristics ?
- Signs and symp of inflammation= gingiva
- Presence of plaque biofilm = aggravates inflammation
- Inflammation is reversible with plaque removal
- Untreated gingivitis = periodontitis
What are the clinical symptoms?
- Edema
- Erythema
- Pain
- Heat
- Loss of function
What are gingivitis manifestation ?
- enlarged contours
- red and or bluish tisue color
- bleeding on prob
- discomfort on prob
Patient reports?
- Bleeding gums
- Pain
- halitosis
- Difficulty eating
- Appearance
- Reduced oral health= quality of life
What is the description of extent of inflammation?
- Localized:10-30% bleeding sites
- Generalized: greater then 30%
Description of distribution of inflammation
- Papillary: interdental papilla
- Marginal: Gingival margin and papilla
- Diffused: Gingival margin, papilla and attached gingiva
Description of combination of descriptive terminology
Localized papillary inflammation
Generalized marginal inflammation
Generalized diffused inflammation
What are non dental plaque induced gingival diseases?
Genetic/developmental
Specific infections
Inflammatory and immune conditions
Reactive processes
Neoplasms
Endocrine nutritional metabolic disease
Traumatic leasons
Gingival pigmentation
Gingivitis with dental biofilm is?
The most common of the periodontal diseases induced by presence of plaque at gingival margin
What does gingivitis presents with?
- Plaque present at gingival margin
- Redness and tenderness
- Swollen Rolled margins
- Bleeding
- Reversible with plaque removal
Gingivitis must be associated with?
Stable Attachement levels
What are the classifications for Gingivitis with biofilm?
- intact periodontium- no histoyr of destruction
- Reduced Periodontium in non-periodontisits
- Reduced periodontium in successfully treated periodontitis: previous history
What is reduced periodontium in a successfully treated periodontistis?
- Patients sucessfully treated for periodontitis
- History of attachment loss which is not progressing
- Periodontitis is controlled no addition bone or attachment loss.
- Redeveloped gingivitis
What are the divisions of Gingivitis with biofilm?
- Associated with biofilm alone
- Modifying factors: Systemic factors, Oral (local) Factors.
- Drug: Influenced gingival enlargement
Gingivitis with biofilm systemic factors are?
- biofilm initate disease
- Systemic factors: Sex steroid hormones, hyperglycermia, hematological conditions, smoking, nutritional factors
What is the Sex Steroid Hormone systemic factor?
- It exaggerates inflammatory response to biofilm and hormones
- puberty
- menstrual cycle
- oral contraceptives= hormone replacement
- Pregnancy= 2nd and 3rd trimester= Pyogenic granuloma/preg tumor
What is the pyogenic granuloma/pregnancy tumor?
- Localized protuberantss gingival mass of granulation tissue
- Inflammatory reaction to irritation
- Margina or papilla
- Maxilla most common
- Bleed easiy
- Most resolve
- Some require surgery
What is Hypergycemia?
- Diabetes
- hormonal imbalances= exaggerates resposne to dental plaque
- Poorly controlled plasma glucose levels aggravated the inflammatory response
What is Hematological conditions?
- Gingivitis associated with abnormal functiomn or number of blood cells
- Cyclic neutripenia
- Leukemia
What is Cyclic neutropenia?
- Gingivaostomatitis
- Ulcerative gingivitis
- Crater like Ulcers
What is Leukemia within the oral cavity?
- Broad group of disorders characterized by overproduction of atypical WBC
- Move into circulating blood and tissues
- Diffuse gingival enlargement
- Persisten Bleeding
- Exaggerated response to plaque
Results of Smoking within the oral cavity?
- Major liefstyle risk for periodontitis
- Microvascular vasoconstriction and fibrosis
What masks the clinical signs of gingivitis?
Smoking
What does nutrition have to do with oral health?
Malnutrition leads to compromised host response and defense mechanisms
- increase susceptibility to infection
- Exacerbate gingival response to plaque
Who is affected/ population:
* Infants from low income families
* institutionalized elderly
* Alcoholics
What are the oral factors of gingivitis dental biofilm-induced
- Subgingival restoration margins: restorations placed marginally, increased biofilm retention
- Oral dryness: increase risk to gingivitis, inflammatory resposne to biofilm, hyposalivation=decrease sailvary flow.
What causes hyposalivation/decrease salivary flow?
- Sjogrens syndrome
- Anxiety
- Poorly controlled diabetes
- Medications: antihistamines, decongestants, antidepressants, antihypertensive
Drug influcended gingival enlargement
- Gingival enlargment from Systemic medications with no attachment loss
- Exaggerated inflammatory response to plaque and a systemic medication
What medications are most commonly associated with gingival enlargement?
Anticonvulsant
Clacium Channel BLockers
Cyclosporine
-Begins 1-3 months
What are the mechansims for action for gingival enlargment?
- Individual susceptibility
- Immunological and genetic factors
- Fibroblast sensitivity
Does plaque accumulation necessary for initiation of drug induced enlargement?
No, its not
Can the control of plaque reduce overgrowth?
Yes but will not eliminate it, gingivectomy often required.
Where does drug induced gingival enlargement normaly takes place?
- Starts in the interdental papilla
- Gradually involves marginal and attached gingiva
What does the degree of drug induced enlargement depend on?
Dose or serum concentration
Duration of therapy
State of oral hygiene
What is the description of drug induced gingival enlargement?
- Firm and lobulated
- Inflammation
- Anterior more affected
- Higher prevalence in children
What is gingivitis with nondental biofilm-induced?
Not cause by bacterial plaque
Does not disappear after plaque removal
Presence of plaque could increase inflammation
What causes gingivitis with nondental biofilm-induced?
- Genetic/developmental disorders
- Specific infections
- Inflammatory and immunce conditions
- Reactive processses
- Neoplasms
- Endocrine nutritional and metabolic disease
- Traumatic lesions
- Gingival pigmentation
What are gingivitis with nondental biofilm-induced Genteic/developmental disorders?
- Hereditary Gingival Fibromatosis
- Isolated or component of seral inherited syndromes
- develops early in life
- Firm, paler than normal gingiva
- Does not respond to plaque control
What are nondental biofilm specifici infections that are bacterial origin?
STDS: Nesseria Gonorrhea- Gonorrhea
Treponema Pallidum: Syphilis
Streptococci: Pharyngitis
Rare
Nondental biofilm induced
Specific Infections: Viral origin
- resembles plaque induced gingivitis
- Primary forms of HSV- I: contagious treatment deferred
- Secondary forms contagious but do not resemble gingivitis
What is Primary Herpectic Gingivostomatitis ?
- Initial Infection w/HSV
- Resembles NG
- Most common in Children and Young adults
- Low grade fever, headache, sore throat and malaise
- Lymphadenopathy
- Painful and firey red
- Swolen interdental papilla
- Diffuse vesicle formation on gingiva or mucosa
- Self-limiting 10-20 days
- no scarring
What is the treatment for Primary Herpic gingivostomatitis?
Fluid intake prevents dehydration
Dietary supplements
Antibiotics only if sepsis
Bacteria enter through sores
What are the specific infections: fungal origin when it comes to nondental biofim?
- Candidiasis- candida albicans (MOST COMMON)
- Coccidioidomycosis-coccidiodies immitits
- Histoplasmosis-Histoplasma capsulatum
What is the description for fungal orgins?
-Erythematous and fragile tissue
-Thrive in prosthesis
-Range from linear gingiva redness to sever redness and white patches.
What is candidiasis?
- Frequent Immunocompromised patients
- One of most commons lesions in HIV PT
- Early signs of developing immunodeficiency
- Also a predictor for developing AIDS
What are the different factors of inflammatory and immune hypersensitivity for non dental biofilm?
- Contact allergy: causation- dental restorative amterials, toothpastes and mouth rinses (causes cheilitis) , chewing gum and candies, food and additives.
- Good plaque control
- Stop products to resolve gingivitis
What are the oral manifestations for autoimmune disease of skin and mucosus membrane?
- Erythema multiforme
- Lichen planus
- Pemohigus vulgaris
- Benign mucous membrane pemohigoid
- can invole gingiva
What is lichen planus?
- Common benign, chronic disease
- Affects skin and mucosa
- middle age
What are the oral lesions of lichen planus?
- Lacelike network of white lines and circles- wickham straie
- Reticular, Erosive, Bullous
- Symptomatic
- Atrophic erythematous areas with central ulceration
- Periphery bordered by fine white radiatin striae
- Desquamativ gingivitits : role out pemohigus vulgaris and cicatricial pemphigoid.
Cicatrical pemphigoid
- chronic vesiculo-bullous disease
- Affects oral mucosa and other tissues
- Older
- Female predilection
- Erythema to painful ulcerations (nikolosky sign) peeling
What is the most common site fro cicatrical pemphigoid?
Gingiva (Desquamative gingivitis)
Endocrine
Vitamin C: Role int he function of fibro,osteo and odontoblasts.
What is Scurby?
Defective Collagen formation
Caused by: deficiency of ascorbic acid
Impaired would healing
Progression to periodontitis
What does Vitamin A and B do ?
A- maintains healthy sulcular epithelium
B- Maintains healhy mucosal tissue
What are traumatic lesions?
- Temp interferance with plaque control and contributes to periodontal inflammation
- Physical mechanical
- Chemical- asprin, alcohol
- Thermal
