Gingival Diseases

Question 1

Gingival lesions of bacterial origin

Answer 1

Infective gingivits and stomatitis. Lesions may be due to bacteria and may have lesions elsewhere

Ex: Step or Myobacterium chelonae

Clinical presentation... Variations
Fiery red edematous painful ulcerations
Asymptomatic chancres
Mucous pates
Atypical highly inflamed gingivitis

Diagnosis: biopsy and microbiologic examination

Question 2

Gingival lesions of viral origin:

Answer 2

Herpes virus 1, 2 and Varicella zoster virus

Herpes 1 usually causes oral manisfestations

Question 3

Primary herpetic gingivostomatitis

Answer 3

Symptoms: painful severe gingivitis
ulcerations with serofibrinous exudate
edema w/ stomatitis
Characterizations: incubation is one week
vesicles that fupture and coalesce and
covered in fibrin
heal in 10-14 days
Stays latent in trigeminal ganglion for years
Found in gingivits, NUG/NUP, and periodontitis
More primary infections in older ages in industrial societies

Question 4

Recurrent herpetic infections

Answer 4

Herpes labialis:
vermllion border and or skin adjacent to it
caused from trauma, UV light, fever, or menstration

Aphtous ulceration in attached gngiva and hard palate

Question 5

Herpes Zoster

Answer 5

Virocella-zoster virus causes varicella
Small ulcers on tongue, palate and gingiva
Latent in dorsal root ganglion
Unilateral
2nd and 3rd branch of trigemnial ganglion

Question 6

Fungal Origin

Answer 6

Candidosis
Linear gingival erythema
Histoplamsosis

Question 7

Candidosis

Answer 7

Candida but mostly albicans
Most adults have it
Reduced host defense posture
Often isolated in subgingival flora of severe periodontitis

Pseudomembranous candidosis that if the specs are white can be swiped out
Erthematous candidosis

Culture and look under microscope

Question 8

Linear Gingival Erythema

Answer 8

Distinct linear red band only in free gingiva
Lack of bleeding
Have c. albicans in culture
50% of HIV associated gingivits sites
26% of unaffected sites of HIV
3% of healthy sites of HIV negative people

Question 9

Histoplasmosis

Answer 9

caused by histoplasma capsulatum
Acute and chronic pulmonary histoplasmosis and a disseminated form…. immunocomrpomised patients
Any area of mucosa
Nodular or papillary and later may become ulcerative with pain

Question 10

Lichen Planus

Answer 10

Often only oral
Rare in kids
Premalignant potential
Characteristic Wicham striae lesions
Subepithelial band-like accumulation of lymphocytes and macrophages characteristic of type IV hypersensitivity reaction
Fibrin in basement membrane
Deposits of IgM, C3, C4, C5

Question 11

Papula

Answer 11

the skin; a pimple

asymptomatic

Question 12

reticular

Answer 12

mesh in form of network

asymptomatic

Question 13

Plaque

Answer 13

patch on skin or on mucous surface

asymptomatic

Question 14

atrophy

Answer 14

decrease in size of tissue

symptomatic

Question 15

ulcerative

Answer 15

affected with an ulcer aka open sore or lesion w/ sloughing of inflamed necrotic tissue
symptomatic

Question 16

bulla

Answer 16

large blister or skin vesicle w/ fluid

symptomatic

Question 17

Oral Lichenoid Lesions

Answer 17

Uncertain background:
Examples: lesions in contact w/ dental restorations or various types of medication or liver diseases

Treatment: take biopsy and take sample if think its candida
traumatic dental plaque control and give corticosteroids for pain

Question 18

Pemphigoid

Answer 18

Autoantibodies towards components of basement membrane result in the detatchment of the epithelium from the connective tissue
Histology: autoantibody reactions against hemidesmosomes and lamina lucida.
complement-mediated cell destructive processes may be involved

Female predominance over 50
Nicholsky Sign: rubbing of gingiva creates bulla

Question 19

Three types of Pemphigoid

Answer 19

Bullous,
Benign Mucous Membrane
Cicatricial (scar formaton in eye)

Question 20

Treatment of pemphigoid

Answer 20

Plaque removal w/ daily use of chlorhexidine and or topical corticosteroid

Question 21

Pemphigus vulgaris

Answer 21

formation of intraepithelial bullae in skin and mucous membranes
Strong genetic background
painful desquamative lesions, erosions, or ulcerations
chronic w/ recurrent bullas

Histology: acantholysis (due to destruction of demosomes
which can cause bleeding)
Pericellular epithelial deopsists of IgG and C3
Circulating autoantibodies against interepithelial adhesion molecules

Question 22

Leukemia:

Answer 22

Malignant hematological disorder w/ abnormal proliferaion and development of leukocytes and their precursors in blood and bone marrow. Often in kids so try to catch acute early cuz Majority of those w/ acute have oral signs.

Swelling, ulceration, ptetecchia and erythema of gingiva