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DMD2 sem 2 > Gingival Disease > Flashcards

Gingival Disease Flashcards

1
Q

What are the classes of periodontal health?

A

Periodontal health and gingival health

Gingivitis induced by dental biofilm

Gingival diseases not induced by dental biofilm

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2
Q

What are the causes of gingivitis induced by dental biofilm?

A

Associated with dental biofilm alone

Mediated by systemic or local risk factors

Drug influenced gingival enlargement

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3
Q

What are the types of periodontal and gingival health?

A

Clinical gingival health on an intact periodontium

Clinical gingival health on a reduced periodontium (stable or non-periodontitis patient)

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4
Q

What are the causes of gingival diseases not induced by dental biofilm?

A

Genetic/developmental disorders

Specific infections

Inflammatory and immune conditions

Reactive processes

Neoplasms

Endocrine, nutritional, and metabolic diseases

Traumatic lesions

Gingival pigmentation

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5
Q

What are the risk factors to periodontal and gingival diseases/conditions?

A

Local:

Plaque-retention factors

Oral dryness

Systemic:

Smoking

Hyperglycaemia

Low antioxidant micronutrient intake

Drugs - Especially immune-modulating drugs

Sex steroids - elevated levels

Haematological disorders

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6
Q

What is gingivitis defined as?

A

Dental plaque biofilm-induced gingivitis is defined as an inflammatory lesion resulting from itneractions between the dental plaque biofilm and the host’s inflammatory-immune response which remains contained within the gingiva and does not extend to the periodontal attachment.

This inflammation does not extend beyond the mucogingival junction and is reversible by reducing levels of dental plaque at and apical to the gingival margin.

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7
Q

What can gingivitis be classified as?

A

Gingivitis on an intact periodontium

Gingivitis on a reduced periodontium

Gingival inflammation on a reduced periodontium in a successfully treated periodontitis patient.

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8
Q

What causes gingival inflammation?

A

CHANGES ASSOCIATED TO PRESENCE OF MICROORGANISMS

PRODUCT RELEASE (COLLAGENASE, PROTEASE, SULPHATASE ENDOTOXINS, HYALURONIDASE)

POTENTIAL DAMAGE TO EPITHELIUM AND CONNECTIVE TISSUES

BACTERIA OR BACTERIAL PRODUCTS GAIN ACCESS TO CONNECTIVE

ACTIVATION OF MONOCYTES/MACROPHAGES

RELEASE OF VASOACTIVE SUBSTANCES PGE2, IFN, TNF, IL-1

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9
Q

What are the histopathological classifications of gingival and periodontal inflammation?

A

Pristine gingiva

Initial (clinically healthy gingiva)

Early gingivitis

Established gingivitis

Advanced periodontitis

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10
Q

What does pristine gingiva look like?

A

Histological perfection

Continuous neutrophil migration

Coronal part of JE

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11
Q

What happens in initial lesions?

A

Vascular changes, dilated capillaries and increased blood flow

Microbial activation of resident leukocytes and stimulation of endothelial cells

Clinically not apparent response

Subclinical gingivitis

No manifestation of tissue damage

Light or ultrastructureal SEM

Not pathological

Subtle changes in JE and perivascular connective tissue

Increased migration of PMNs

Increase in gingival fluid

Intensity resolves rapidly

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12
Q

What are the clinical features of an early lesion?

A

Occurs 1 week after plaque accumulation

Clinically appears as early gingivitis

Follows the initial lesion

Clinical signs of erythema appear

Bleeding on probing may be evident

Increased GCF

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13
Q

What are the histological features of an early lesion?

A

Capillary proliferation

Increased capillary loops between rete pegs and rete ridges

Maximum number of migrating PMNs at 6 - 12 days of gingivitis

Increased collagen destruction 70% around infiltrate

Circular and dentogingival fibers affected

Blood vessel morphology alteration

PMNs migrating to JE and phagocytosis of bacteria

Cytotoxic alteration of fibroblasts

Decreased collagen production

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14
Q

What are the clinical features of an established lesion?

A

Chronic gingivitis 2- 3 weeks of plaque accumulation

Blood vessels enlarged and congested

Blood flow slow

Venous return impaired

Anoxemia reddness or bluish gingiva

Moderate to severely inflamed gingiva

Haemoglobin breakdown

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15
Q

What are the physiological changes seen in established lesions?

A

Predominate plasma cells and B lymphocytes

B cells of G1 and G3 (IG1 and IG3)

Venous return impaired

Blood flow slowed down

Extravasation of erythrocytes and breakdown of haemoglobin

Increase in collagenolytic activity thus creating an inverse relationship between collagen and inflammatory cells

Collagenase enzyme from bacteria

Neutral mucopolysaccharides are reduced

Reversible reduction in plasma cells and increase in lymphocytes

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16
Q

What is an advanced lesion?

A

Extension of lesion into alveolar bone

A phase of periodontal breakdown

Fibrisis of gingiva

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17
Q

What happens to gingiva in an advanced lesion?

A

Plasma cells dominate infiltrate

Neutrophils dominate JE

Gingivitis progresses to periodontitis but not known if this is ALWAYS the case. It has been shown to do so in dogs but unknown in humans.

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18
Q

What are the clinical features of gingivitis induced by dental biofilm?

A

Plaque removal results in resolution of gingivitis

Redness, sponginess, bleeding, contour change, calculus, and plaque presence

Ulcerated epithelium

Altered epithelial function

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19
Q

What is the course and duration of gingivitis?

A

Acute sudden onset

Short duration

May be acute and painful

Recurrent gingivitis

Chronic gingivitis slow onset long duration (most common)

Painless

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20
Q

What is the difference between localized and generalized gingivitis?

A

Localized involves 10 to 30% of the teeth

Generalized involves more than 30% of teeth or entire dentition

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21
Q

What are the types of gingivitis in terms of location?

A

Marginal gingivitis

Diffuse gingivitis

Papillary gingivitis

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22
Q

What does Bleeding on Probing indicate?

A

EARLY SIGNS OF INFLAMMATION: GCF FLUID INCREMENT AND BLEEDING FROM GENTLE PROBING

BOP EARLIEST SIGN THAN COLOUR CHANGE

BOP WIDELY USED TO MEASSURE PREVALENCE, PROGRESSION TREATMENT OUTCOME

SUGGEST INFLAMMATORY LESION OF EPITHELIUM AND CONNECTIVE

BOP NOT GOOD PREDICTOR OF ATTACHMENT LOSS

ABSENCE OF BOP EXCELLENT NEGATIVE PREDICTOR OF ATTACHMENT LOSS (STABILITY)

AIM FOR ABSENCE ON BOP AND IMPLY LOW RISK FOR CAL

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23
Q

What kind of metals can cause pigmentation on gingiva?

A

Heavy metals

Bismuth

Arsenic

Mercury

Lead

Silver

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24
Q

What does metal staining look like on periodontium?

A

Black bluish line following the margin contour

Isolated black path on interdental or attached gingiva

Perivascular precipitation of metal sulphide into subepithelial connective tissue

Tattoing is different localised

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25
Q

What factors can cause colour changes in periodontium?

A

ADDISON’S DISEASE ADRENAL DYSFUNCTION ISOLATED PATCHES

PEUTZ-JEGHERS SYNDROME MELANIN PIGMENTATION

ALBRIGHT’S SYNDROME ORAL MELANIN PIGMENTATION

BILE PIGMENTS ON MUCOSA

IRON DEPOSITION BLUE-GRAY COLORATION

TOBACCO HYPERKERATOSIS AND MELANIN AREAS

AMALGAM IMPLANTED BLUISH-BLACK

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26
Q

What is the consistency of normal gingiva? What changes in gingivitis?

A

Normal is firm and resilient

Becomes:

Edematous and fibrotic

Soggy puffiness pits on pressure

Soft and friable

firm and leathery on fibrosis

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27
Q

What is the texture of diseased gingiva like?

A

ORANGE PEEL APPEARANCE STTIPLING (ATTACHED GINGIVA)

CHRONIC INFLAMMATION SMOOTH AND SHINING SURFACE

HYPERKERATOSIS LEATHERY

DRUG INDUCED OVERGROWTH NODULAR SURFACE

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28
Q

What can cause gingival recession?

A

Brushing technique hard technique or hard bristles

Lacerations, abrasions, keratosis and recession

Tooth malposition with excessive buccal orientation

Friction from tissues

Gingival inflammation

Abnormal frenum attachment

Iatrogenic dentistry dentrure clasps and overhangs

Smoking by reduction in irrigation to gingival sulcus

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29
Q

What are the features of a gingival contour?

A

Gingival enlargement

Stillman’s cleft and mccall festoons

Particular inflammatory changes

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30
Q

What local factors cause gingivitis?

A

Plaque retention by tooth crowding, caries, overhangs, partial dentures, mouth breathing, recession, and frenum attachment

Chronic inflammation or mechanical trauma

Acute bleeding from injury or burn.

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31
Q

What systemic factors can cause gingivitis?

A

Some cases are caused by spontaneous bleeding

Platelet disorders, thrombocytopaenia

Haemophilia, leukemia

Vitamin K deficiency, liver disease

Multiple myeloma

Hormonal changes estrogen/progesterone levels

32
Q

What are the features of drug-induced gingival enlargement?

A

Increase in the size of the gingiva, gingival enlargement or overgrowth

Localized generalized, marginal papillary, diffuse and discrete

33
Q

What are the grades of gingival enlargement?

A

Grade 0 No enlargement

Grade 1 Enlargement confined to interdental papilla

Grade 2 Enlargement involves papilla and margin

Grade 3 Enlargement covers 3/4 of the crown

34
Q

What are the types of enlargement of the gingiva?

A

Inflammatory enlargement: Can be acute or chronic

Drug induced enlargement: Associated with systemic conditions

Neoplastic enlargement: Both benign and malignant

False enlargement

35
Q

What are the features of chronic inflammatory enlargement?

A

Ballooning of interdental papilla and marginal gingiva

Discrete sessile or pedunculated mass

Slow growing masses

Painless

Caused by prolonged exposure to dental plaque

Mouth breathers from dehydration

36
Q

What are the features of acute inflammatory enlargement?

A

Gingival abscesses

Periodontal or lateral abscess

37
Q

What kind of drugs cause gingival enlargement?

A

Anticonvulsivants

Immunosuppressants

Calcium channel blockers

38
Q

What kind of growth is induced by drugs?

A

Extends facially and lingually at joint of marginal and papilla.

Massive tissue fold covering the crowns

Uncomplicated muldberry shape firm, pale pink.

39
Q

What are the complications that can arise from drug induced gingival growth?

A

Enlargement can complicate oral hygieve

Secondary inflammation due to plaque buildup

Inflammation can lead to red bluish discolouration

Hyperplasia of connective tissue can occur

40
Q

What drug was first reported to cause drug induced gingival overgrowth?

A

Phenytoin: An epilepsy drug.

Other hydantoins also cause gingival overgrowth such as ethotoin and mephenytoin

50% of users develop gingival overgrowth

Pathogenesis is not known

41
Q

What do immunosuppressants usually do?

A

Cyclosporine is used as an agent to prevent transplant rejection

Reversibly inhibit Th cells

42
Q

What kind of enlargement do immunosuppressants such as cyclosporins and calcium channel blockers lead to?

A

> 500mg/day leads to more vascularized enlargement than phenytoin

43
Q

What percentage of users of immunosuppressants such as cyclosporins and calcium channel blockers end up with gingival overgrowth?

A

25 - 70%

44
Q

What alternative drug is used to suppress the immune system?

A

tacrolimus

45
Q

What are calcium channel blockers used for?

A

CVD treatment (Hypertension, angina, coronary artery spasm, and arrhythmias)

46
Q

What is the mechanism of action of calcium channel blockers?

A

Block intracellular mobilization of calcium

47
Q

What are some examples of calcium channel blockers?

A

Diltiazem

Verapamil

Amlopdipine

Nifedipine

Felodipine

Nicardipine

48
Q

Which calcium channel blocker has a 20% chance of causing gingival overgrowth?

A

Nifedipine

49
Q

Nifedipine is used in conjunction with cyclosponine for a kidney transplant; what happens to gingiva as a result?

A

A larger overgrowth results

50
Q

Which systemic conditions involving gingival overgrowth become magnified by plaque?

A

Enlargement in pregnancy

Enlargement in puberty

Vitamin C deficiency

Plasma cell gingivitis

Pyogenic granuloma

51
Q

Which systemic diseases commonly result in gingival overgrowth?

A

Granulomatous diseases

Leukemia

52
Q

What are the types of benign tumours of the gingiva?

A

Fibroma

Papilloma

Peripheral giant cell granuloma

Central giant cell granuloma

Leukoplakia

Gingival cyst

53
Q

What are the malignant tumours of the gingiva?

A

Carcinoma

SCC

Malignant melanoma

54
Q

What is idippathic gingival enlargement?

A

Rare condition with an unknown cause assocaited with congenital familial fibromatosis.

Enlargement occurs in both the facial and lingual direction up to the attached gingiva, margin and papilla.

55
Q

What does idiopathic gingival enlargement look like typically?

A

Pink firm enlargement with leathery consistency

Severe cases crowns are completely crowded

56
Q

What causes idiopathic gingival enlargement

A

Hereditary and can be complicated by presence of bacterial plaque.

57
Q

What are the common gingival diseases seen in childhood?

A

Chronic marginal gingivitis (Most prevalent)

Acute gingival infections

58
Q

What are the features and causes of chronic marginal gingivitis?

A

It is the most prevalent form of gingivitis of childhood called also puberty gingivitis and is caused by hormonal changes in males and females.

It is caused and amplified by plaque

59
Q

What are common acute gingival infections?

A

Primary herpetic gingivo stomatitis (viral)

Candidiasis (antibiotics and immunodeficiencies)

Necrotizing ulcerative gingivitis (Malnutrition)

60
Q

What are the features of desquamative gingivitis?

A

Intense erythema

Desquamation

Ulceration of free and attached gingiva

May be asymptomatic and causes mild burning or intense pain when symptomatic

61
Q

What causes desquamative gingivitis?

A

75% by dermatological genesis

Cicatrical pemphigoid and lichen planus in 95% of cases

62
Q

What are the differential diagnoses for desquamative gingivitis?

A

Bacterial infections

Fungal infections

Viral infections

63
Q

How is desquamative gingivitis diagnosed?

A

Clinical history

Clinical examination

Biopsy

Microscopic examination

Immunofluorescence

Management and treatment

64
Q

What is lichen planus?

A

A type of desquamative gingivitis that is an inflammatory mucocutaneous disorder of the mucosa and skin.

Reticular, atrophic, erosive, path and bullous

It is an ulcerative condition

65
Q

How is lichen planus identified?

A

Immunofluorescence fibrin identification of basement membrane

66
Q

How is lichen planus treated?

A

High potency steroids (Bethamethasone 0.05%)

67
Q

What is pemphigoid?

A

Cutaneous immune mediated subepithelial bullous diseases

Basal membrane separation

68
Q

What are the complications of pemphigoid?

A

Mucous membrane pemphigoid

Cicatrical pemphigoid

Desquamative gingivitis

Ocular lesions

69
Q

How is pemphigoid treated?

A

Topical steroids

70
Q

What is pemphigus vulgaris?

A

Autoimmune bullous disorder

Forms cutaneous and mucous blisters

Potentially lethal

Causes damage to cell to cell adhesion (desmosomes)

71
Q

How is pemphigoid vulgaris treated?

A

Systemic steroids

72
Q

How is lupus erythematosus identified and diagnosed?

A

Affects kidneys heart and skin

Causes ulceration of oral mucosa

Causes rash on malar area

It is systemic and is chronic mucocutaneous

Diagnosed by histopathology

73
Q

How is lupus erythematosus treated?

A

Systemic or topical steroids

74
Q

How is erythema multiforme identified and diagnosed?

A

ACUTE BULLOUS AND MACULAR MUCOCUTANEOUS DISEASE

IMMUNE COMPLEX VASCULITIS

ISCHEMIC NECROSIS OF EPITHELIUM

DESTRUCTION OF VASCULAR WALLS

NECROSIS OF EPITHELIUM AND CONNECTIVE TISSUES

LARGE ERYTHEMATOUS PAINFUL LESIONS IN THE MOUTH

75
Q

What causes erythema multiforme?

A

Herpes simplex virus

Antibiotics

Mycoplasma infection

DMD2 sem 2 (97 decks)

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