Gingival Disease AAP article Flashcards
What are gingival diseases?
- Subset of periodontal diseases in which there
is damage to the gingival tissue, not involving
the underlying PDL, cementum, or
supporting bone - Have their own category in AAP classification
Histopathogenesis of Gingivitis
and the development of periodontal diseases happens in progression of 4 stages
Response to the presence of dental plaque
biofilms is inflammatory
- Initial lesion
- Early lesion
- Established lesion
- Advanced lesion- only one that is perio
Initial Lesion is __ Dominated
PMN
Explain what goes on in the initial lesion PMN dominated
- 2-4 days of plaque accumulation
- PMN wall is compromised
- Bacterial antigens cross semi-permeable JE
- Increased GCF
- Migration of PMNs from CT into JE and sulcus (gingival crevice)
- Some loss of collagen in LP/lamina propria
- NOT SEEN ClNICALLY
The early lesion is __ cell dominated
T-cell
Explain the process of of Early Lesion (T-Cell Dominated)
- 4-7 days
- PMNs continue to migrate into sulcus
- Increased GCF flow
- 60- 70 % of collagen is lost in CT
- Changes in JE begin
- Sulcus begins to deepen
- Clinically: Observable gingivitis
Established Lesion has an increase in ___ cells and __ plasma cells
B-cells/plasma cells
Established Lesion Increased in B cells and Plasma cells process
- 2/3 weeks of plaque accumulation
- Chronic or established gingivitis lesion
- More collagen is lost in CT
- Gingival fibers are still connected to root surfaces, no loss of CT attachment
- JE detaches laterally-> microulcerations
- Cliniclally: Gingival margin becomes swollen and can be separated from tooth easily, forming a gingival pocket or pseudo pocket
Advanced Lesion Periodontitis: Will this always happen
NO
There is loss of attachment bone loss
What is the most common periodontal disease
gingivitist associated iwth dental plaque
What is the most common periodontal disease
gingivitis associated iwth dental plaque
-Bacteria not specific
-Typically begins w/ interdental papillae
-Characterized by: redness, bleeding,
swelling, and tenderness § REVERSIBLE!!!!!!!
-Tx: adequate OH self care and professional
mechanical debridement
Gingivitis Associated w/ Dental Plaque
Gingival diseases mediated by systemic or local risk factors:
Systemic Factors:
Smoking Hyperglycemia Nutritional factors Pharmacological agents Sex steroid hormones Hematological condiitons
Gingival diseases mediated by systemic or local risk factors:
Local Risk Factors:
- Dental Plaque biofilm retention (ex. prominent margin restorations)
- Oral Dryness
are oral contraceptives associated with gingivitis
YES! but not as much now due to lower concentration in OC
Gingivitis modified by hematological conditions/ Leukemia-asscoaited gingivitis :
What is Leukemia?
What is the tx of pts with gingival diseases modified by a systemic factor?
- Leukemia- abnormal proliferation of leukocytes (WBCs) in the blood and bone marrow
Tx of pts with gingival diseases modified by systemic factors: get systemic disease under control, then professional debridement and maint. of adequate home care
Lots of medications can cause gingival overgrowth this is correlated with what class of gingivitis
Drug-Induced Gingival Enlargement
Lots of medications can cause gingival overgrowth this is correlated with what class of gingivitis
Drug-Induced Gingival Enlargement
what 3 medications are correlated with gingival overgrowth and give the examples of the last one
- Phenytoin
- Cyclosporine
- Calcium channel blockers
(nifedipine, amlodipine, diltiazem)
Drug-Induced Gingival Enlargement: If there is only gingival enlargement without bone loss you would
-surgery may be indicated gingivectomy
debridement and home care for tx
Case 4
- 28 yr old female
CC: bad breath
Med hx: pt is in 2nd trimester of her first
pregnancy
Meds: pre-natal vitamins § OH: brushes twice daily; pt reports inability
to floss the posterior teeth or clean tongue
due to gag reflex and vomiting
PI: 42%
Pregnancy induced gingivitis
- Offer mouth rinse OHI
- Floss holder/water pick
- Smaller tb to get back
Case 3 -15 yr old male CC: do you have to use the buzzy thing? Med hx: mild asthma, exercise induced. Rarely requires rescue inhaler Meds: albuterol inhaler, PRN
OH: brushes twice a day, flosses when mom makes
him
Clinical findings: generalized gingival inflammation,
no pocketing evident
PI: 23%
Puberty induced dental biofilm induced hormones making worse
Case 2
24 year old male
CC: wants to whiten teeth Med hx: no significant illnesses or findings Medications: Multivitamin daily
OHI: brushes once daily w/ manual TB
Clinical findings: localized 4mm pockets IP between
#2 and 3, #14 and 15, #18, and 19; gingiva is red and
swollen; no evidence of bone loss on radiographs ; PI= 72%
BIofilm Induced gingivitis Assume not nutritional def. No sig med hx finding alot plaque OHI: Recommend power toothbrush brush twice interdentally
Case 1
63 yr old female
CC: appearance of gingival overgrowth
Med hx: heart transplant 3 years ago due to
congenital defect that worsened with age
Meds: cyclosporine, nifedipine
OH: Brushes twice daily, flosses “sometimes”
Clinical findings: generalized gingival overgrowth
and inflammation; no radiographic evidence of bone
loss § PI: 53%
Medication induced
recommend home care debriedment
biofilm induced it should improve with home care
Cases for Practice/Critical thinking
Questions to think about for each case:
3
- What type of gingival disease are we
looking at? What is the causative agent? - Is there any additional information you
would like to hear? - What are your recommendations for the
patient? Specific OHI? - What is your treatment plan? Anything
special in terms of documentation?
§ Not part of the AAP classification, but you see
it often!
§ Anything that shouldn’t be there gets stuck § Popcorn kernels!!!!!!
Foreign Body Reactions
Mucocutaneous disorders in which there is sloughing or desquamation.
is associated with what category
Inflammatory and Immune conditions
3 conditions associated with Inflammatory and Immune Conditions
- Erosive Lichen planus
- Pemphigus
- Pemphigoid
oral candidiasis is “ “
thrush
Specific Infections: Fungal Origin
List 4 conditions
- Candidiasis
- Coccidiodomycosis
- Cryptococcosis
- Histoplasmosis
Specific Infections: VIral Origin: List 3
- Herpes simplex virus 1 and 2. Primary herpetic gingivostomatis (sever reaction to initial with HSV-)
- Varicella zoster virus
Gonorrhea bacteria origin
Neisseria Gonorrhea
Syphilis bacteria origin is
Treponema pallidum
Genetic/developmental disorders disease
Hereditary gingival fibromatosis
Specific Infections Bacterial origin
Necrotizing periodontal diseases (treponema, selenomonas, Fusobacterium, Prevotella, and others
- Treponema pallidum (syphilis )
- Mycobacterium tuberculosis (tuberculosis)
- Streptococcal gingivitis
Specific Infections : Viral Origin : 5 examples
- Coxsackie virus
- Herpes simplex virus
- Varicella-zoster virus
- Molloscum contagiosum virus
- HPV
Specific Infections : Fungal:
1.
2.
- Candidosis (candidiasis)
2. Other mycoses
Hereditary gingival fibromatosis is related to
Genetic/developmental disorders
Gingival Diseases: Non-Dental Biofilm-Induced
- Necrotizing periodontal diseases ( Treponema spp., Selenomonas
spp. , Fusobacterium Spp., Prevotella intermedia, and others) - Neisseria gonorrhea (gonorrhea)
- Treponema pallidum (syphilis) - Mycobacterium tuberculosis (tuberculosis)
- Streptococcal gingivitis
Bacterial Origin Specific Infections Gingival Diseases: Non dental biofilm induced
Coxsackie virus Herpes simplex virus Varicella-zoster virus Molloscum contagiosum virus HPV
Viral origin
Specific infections
Gingival Diseases: Non-Dental Biofilm-Induced
Fungal
Specific infections
Gingival Diseases: Non-Dental Biofilm-Induced
Candidosis (candidiasis)
Other mycoses
Contact allergy
Plasma cell gingivitis
Erythema multiforme
Hypersensitivity reactions
Inflammatory and immune conditions
Gingival Diseases: Non -Dental Biofilm-Induced (cont.)
Pemphigus vulgaris Pemphigoid
Lichen planus
Lupus erythematosus
Autoimmune diseases of skin and mucous membranes
Gingival Diseases: Non -Dental Biofilm-Induced (cont.)
Crohn’s disease
Sarcoidosis
Granulomatous inflammatory conditions (orofacial granulomatosis)
Inflammatory and immune conditions
- Fibrous epulis
- Calcifying fibroblastic granuloma
- Pyogenic granuloma (vascular epulis)
- Peripheral giant cell granuloma (or central)
Epulides
Reactive Processes
Gingival Diseases: Non -Dental Biofilm-Induced
Leukoplakia
Erythroplakia
Premalignant
Neoplasms
Gingival Diseases: Non -Dental Biofilm-Induced
Squamous cell carcinoma
Leukemia
Lymphoma
Malignant
Neoplasms
Gingival Diseases: Non -Dental Biofilm-Induced
Squamous cell carcinoma
Leukemia
Lymphoma
Malignant
Neoplasms
Gingival Diseases: Non -Dental Biofilm-Induced (cont.)
Vitamin C deficiency (scurvy)
Vitamin deficiencies
Endocrine, nutritional and metabolic diseases
Gingival Diseases: Non Dental Biofilm Induced
Frictional keratosis
Toothbrushing-induced gingival ulceration
- Factitious injury self harm
Physical/Mechanical insults
Traumatic Lesions
Gingival Diseases: Non Dental Biofilm Induced
Etching Chlorhexidine Acetylsalicylic acid cocaine hydrogen peroxide dentrifice detergents paraformaldehyde or calcium hydroxide
Chemical Insults
Gingival Diseases- Non Dental Biofilm Induced
- Gingival pigmentation/melanoplakia
- Smokers melanosis
- Drug-Induced pigmentation (anti-malarials, minocycline
- Amalgam tattoo
Gingival Pigmentation
Gingival Diseases : Non Dental BIofilm Induced
