Gingival diseases

Question 1

Compare and contrast dental plaque biofilm-induced gingivitis and non–dental plaque-induced gingival diseases

Answer 1

Biofilm- induced
• An inflammatory lesion resulting from interactions between the dental plaque biofilm and the host’s immune-inflammatory response
• It is only contained within the gingiva and does not extend to (cementum, periodontal ligament and alveolar bone)
• Is reversible by reducing levels of dental plaque
• Mediated by systemic and local risk factors
• Can be drug induced: contraceptives, calcium channel blockers, epilepsy meds, immunosuppressants

Non- biofilm induced
• Genetic/developmental disorders:
• Hereditary gingival fibromatosis

Question 2

Recognise the variety of sources responsible for non-dental plaque-induced gingival diseases (8)

Answer 2

Specific infections

Inflammatory and immune conditions

Granulomatous inflammatory lesions

Reactive processes

Neoplasms

Endocrine, nutritional & metabolic diseases

Traumatic lesions

Gingival pigmentation

Question 3

Describe specific infections as a source responsible for non-dental plaque-induced gingival diseases

Answer 3

1. Bacterial origin
   • Neisseria gonorrhoeae
   • Mycobacterium tuberculosis
   • Streptococcal gingivitis

2. Viral origin 
• Hand-foot-and-mouth disease
• Herpes 
• Chicken pox & shingles
• HPV

3. Fungal origin
   • Candidiasis
   Other mycoses, e.g., histoplasmosis, aspergillosis

Question 4

Describe inflammatory and immune conditions as a source responsible for non-dental plaque-induced gingival diseases

Answer 4

Hypersensitivity reactions
• Contact allergy
• Plasma cell gingivitis
• Erythema multiforme

Autoimmune diseases of skin and mucous membranes
• Lichen planus
• Lupus erythematosus
• Discoid lupus erythematosus

Question 5

Describe granulomatous inflammatory lesions as a source responsible for non-dental plaque-induced gingival diseases

Answer 5

• Crohn’s disease

* Sarcoidosis

Question 6

Describe reactive processes as a source responsible for non-dental plaque-induced gingival diseases

Answer 6

Epulides 
• Fibrous epulis
• Calcifying fibroblastic granuloma
• Vascular epulis (pyogenic granuloma) 
• Peripheral giant cell granuloma

Question 7

Describe neoplasms as a source responsible for non-dental plaque-induced gingival diseases

Answer 7

Premalignancy
• Leukoplakia
• Erythroplakia

Malignancy 
• Squamous cell carcinoma 
• Leukemic cell infiltration
• Lymphoma
• Hodgkin Non-Hodgkin

Question 8

Describe endocrine, nutritional & metabolic diseases as a source responsible for non-dental plaque-induced gingival diseases

Answer 8

• Vitamin C deficiency (scurvy)

Question 9

Describe gingival traumatic lesions

Answer 9

Physical/mechanical trauma 
		(a) Frictional keratosis
		(b) Mechanically induced gingival ulceration
		(c) Factitious injury (self-harm) 
	ii. Chemical (toxic) burn 
	iii. Thermal insults 
		Burns to gingiva

Question 10

Describe gingival pigmentation

Answer 10

Melanoplakia

ii. Smoker’s melanosis
iii. Drug-induced pigmentation (antimalarials, minocycline)
iv. Amalgam tattoo