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Spring 2020 Perio > Gingival Disease AAP article > Flashcards

Gingival Disease AAP article Flashcards

1
Q

What are gingival diseases?

A
  • 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
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2
Q

Histopathogenesis of Gingivitis

and the development of periodontal diseases happens in progression of 4 stages

A

Response to the presence of dental plaque
biofilms is inflammatory

  1. Initial lesion
  2. Early lesion
  3. Established lesion
  4. Advanced lesion- only one that is perio
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3
Q

Initial Lesion is __ Dominated

A

PMN

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4
Q

Explain what goes on in the initial lesion PMN dominated

A
  • 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
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5
Q

The early lesion is __ cell dominated

A

T-cell

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6
Q

Explain the process of of Early Lesion (T-Cell Dominated)

A
  • 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
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7
Q

Established Lesion has an increase in ___ cells and __ plasma cells

A

B-cells/plasma cells

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8
Q

Established Lesion Increased in B cells and Plasma cells process

A
  • 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
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9
Q

Advanced Lesion Periodontitis: Will this always happen

A

NO

There is loss of attachment bone loss

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10
Q

What is the most common periodontal disease

A

gingivitist associated iwth dental plaque

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11
Q

What is the most common periodontal disease

A

gingivitis associated iwth dental plaque

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12
Q

-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

A

Gingivitis Associated w/ Dental Plaque

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13
Q

Gingival diseases mediated by systemic or local risk factors:
Systemic Factors:

A 
Smoking 
Hyperglycemia
Nutritional factors
Pharmacological agents
Sex steroid hormones
Hematological condiitons
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14
Q

Gingival diseases mediated by systemic or local risk factors:
Local Risk Factors:

A
  • Dental Plaque biofilm retention (ex. prominent margin restorations)
  • Oral Dryness
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15
Q

are oral contraceptives associated with gingivitis

A

YES! but not as much now due to lower concentration in OC

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16
Q

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?

A
  • 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

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17
Q

Lots of medications can cause gingival overgrowth this is correlated with what class of gingivitis

A

Drug-Induced Gingival Enlargement

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18
Q

Lots of medications can cause gingival overgrowth this is correlated with what class of gingivitis

A

Drug-Induced Gingival Enlargement

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19
Q

what 3 medications are correlated with gingival overgrowth and give the examples of the last one

A
  1. Phenytoin
  2. Cyclosporine
  3. Calcium channel blockers
    (nifedipine, amlodipine, diltiazem)
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20
Q

Drug-Induced Gingival Enlargement: If there is only gingival enlargement without bone loss you would

-surgery may be indicated gingivectomy

A

debridement and home care for tx

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21
Q

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%

A

Pregnancy induced gingivitis

  • Offer mouth rinse OHI
  • Floss holder/water pick
  • Smaller tb to get back
22
Q 
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%

A

Puberty induced dental biofilm induced hormones making worse

23
Q

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%

A 
BIofilm Induced gingivitis 
Assume not nutritional def.
No sig med hx finding
alot plaque
OHI: Recommend power toothbrush
brush twice interdentally
24
Q

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%

A

Medication induced
recommend home care debriedment
biofilm induced it should improve with home care

25
Q

Cases for Practice/Critical thinking
Questions to think about for each case:
3

A
  1. What type of gingival disease are we
    looking at? What is the causative agent?
  2. Is there any additional information you
    would like to hear?
  3. What are your recommendations for the
    patient? Specific OHI?
  4. What is your treatment plan? Anything
    special in terms of documentation?
26
Q

§ Not part of the AAP classification, but you see
it often!
§ Anything that shouldn’t be there gets stuck § Popcorn kernels!!!!!!

A

Foreign Body Reactions

27
Q

Mucocutaneous disorders in which there is sloughing or desquamation.
is associated with what category

A

Inflammatory and Immune conditions

28
Q

3 conditions associated with Inflammatory and Immune Conditions

A
  1. Erosive Lichen planus
  2. Pemphigus
  3. Pemphigoid
29
Q

oral candidiasis is “ “

A

thrush

30
Q

Specific Infections: Fungal Origin

List 4 conditions

A
  1. Candidiasis
  2. Coccidiodomycosis
  3. Cryptococcosis
  4. Histoplasmosis
31
Q

Specific Infections: VIral Origin: List 3

A
  1. Herpes simplex virus 1 and 2. Primary herpetic gingivostomatis (sever reaction to initial with HSV-)
  2. Varicella zoster virus
32
Q

Gonorrhea bacteria origin

A

Neisseria Gonorrhea

33
Q

Syphilis bacteria origin is

A

Treponema pallidum

34
Q

Genetic/developmental disorders disease

A

Hereditary gingival fibromatosis

35
Q

Specific Infections Bacterial origin

A

Necrotizing periodontal diseases (treponema, selenomonas, Fusobacterium, Prevotella, and others

  • Treponema pallidum (syphilis )
  • Mycobacterium tuberculosis (tuberculosis)
  • Streptococcal gingivitis
36
Q

Specific Infections : Viral Origin : 5 examples

A
  1. Coxsackie virus
  2. Herpes simplex virus
  3. Varicella-zoster virus
  4. Molloscum contagiosum virus
  5. HPV
37
Q

Specific Infections : Fungal:
1.
2.

A
  1. Candidosis (candidiasis)

2. Other mycoses

38
Q

Hereditary gingival fibromatosis is related to

A

Genetic/developmental disorders

Gingival Diseases: Non-Dental Biofilm-Induced

39
Q
  • Necrotizing periodontal diseases ( Treponema spp., Selenomonas
    spp. , Fusobacterium Spp., Prevotella intermedia, and others)
  • Neisseria gonorrhea (gonorrhea)
  • Treponema pallidum (syphilis) - Mycobacterium tuberculosis (tuberculosis)
  • Streptococcal gingivitis
A

Bacterial Origin Specific Infections Gingival Diseases: Non dental biofilm induced

40
Q 
 Coxsackie virus
 Herpes simplex virus
 Varicella-zoster virus
 Molloscum contagiosum virus
 HPV
A

Viral origin
Specific infections
Gingival Diseases: Non-Dental Biofilm-Induced

41
Q

Fungal
Specific infections
Gingival Diseases: Non-Dental Biofilm-Induced

A

Candidosis (candidiasis)

Other mycoses

42
Q

Contact allergy
Plasma cell gingivitis
Erythema multiforme

A

Hypersensitivity reactions
Inflammatory and immune conditions
Gingival Diseases: Non -Dental Biofilm-Induced (cont.)

43
Q

Pemphigus vulgaris Pemphigoid
Lichen planus
Lupus erythematosus

A

Autoimmune diseases of skin and mucous membranes

Gingival Diseases: Non -Dental Biofilm-Induced (cont.)

44
Q

Crohn’s disease

Sarcoidosis

A

Granulomatous inflammatory conditions (orofacial granulomatosis)
Inflammatory and immune conditions

45
Q
  • Fibrous epulis
  • Calcifying fibroblastic granuloma
  • Pyogenic granuloma (vascular epulis)
  • Peripheral giant cell granuloma (or central)
A

Epulides
Reactive Processes
Gingival Diseases: Non -Dental Biofilm-Induced

46
Q

Leukoplakia

Erythroplakia

A

Premalignant
Neoplasms
Gingival Diseases: Non -Dental Biofilm-Induced

47
Q

Squamous cell carcinoma
Leukemia
Lymphoma

A

Malignant
Neoplasms
Gingival Diseases: Non -Dental Biofilm-Induced

48
Q

Squamous cell carcinoma
Leukemia
Lymphoma

A

Malignant
Neoplasms
Gingival Diseases: Non -Dental Biofilm-Induced (cont.)

49
Q

Vitamin C deficiency (scurvy)

A

Vitamin deficiencies
Endocrine, nutritional and metabolic diseases
Gingival Diseases: Non Dental Biofilm Induced

50
Q

Frictional keratosis
Toothbrushing-induced gingival ulceration
- Factitious injury self harm

A

Physical/Mechanical insults
Traumatic Lesions
Gingival Diseases: Non Dental Biofilm Induced

51
Q 
Etching
Chlorhexidine
Acetylsalicylic acid
cocaine
hydrogen peroxide
dentrifice detergents
paraformaldehyde or calcium hydroxide
A

Chemical Insults

Gingival Diseases- Non Dental Biofilm Induced

52
Q
  • Gingival pigmentation/melanoplakia
  • Smokers melanosis
  • Drug-Induced pigmentation (anti-malarials, minocycline
  • Amalgam tattoo
A

Gingival Pigmentation

Gingival Diseases : Non Dental BIofilm Induced

Spring 2020 Perio (12 decks)

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