Gingival inflammation Flashcards
Describe the clinical characteristics of pristine gingiva and gingivitis
Healthy/ pristine: • No plaque • Shallow sulcus • Pink and firm • No bleeding * Little gingival crevicular fluid
Gingivitis • Erythemic (redness) • Inflammed • Bleeding * Pain
Describe the histological characteristics of pristine gingiva and gingivitis
Healthy/ pristine: • JE above the CEJ • Supragingival fibres intact • Alveolar bone intact * PDL intact
Gingivitis • JE located at CEJ • Supragingival fibre destruction • PDL intact * Alveolar bone intact
List the stages of gingival inflammation
- Initial lesion
- Early lesion
- Established lesion
Describe the initial lesion stage of gingival inflammation, including how many days it takes to form.
• 2-4 days
* Bacteria colonise tooth near gingival margin, initiating host response
• PMN’s migrate into sulcus and phagocytise bacteria
• PMN’s release cytokines (Interleukins which stimulate adhesion of neutrophils onto endothelial cells and increase chemotaxis)
• Perivascular collagen loss because cytokines destroy gingival connective tissue to enable PMN’s to move more quickly through tissue
Describe the early lesion stage of gingival inflammation, including how many days it takes to form.
• 4-7 days
* Bacteria penetrate into connective tissue
• More PMN’s are attracted to site causing more destruction of connective tissue
• Macrophages (become antigen presenting cells) are recruited to tissue which release more cytokines, PGE2 (perio bone destruction) and MMPs (enzymes that breakdown connective tissue)
• JE and sulcus have a dense concentration of neutrophils
• JE may develop rete pegs
• Circular and dentogingival fibre groups are affected
Describe the established lesion stage of gingival inflammation, including how many days it takes to form.
• 14- 21 days
* Plaque biofilm extends Subgingivally and disrupts JE attachment at the most coronal part
• Macrophages and neutrophils are most numerous in connective tissue, PMN’s continue to fight bacteria
• More toxic chemicals produced by host cells: cytokines, MMPs, PGE2
• Deepened sulcus
* Abnormal oxygen in blood flow within gingiva makes colour bluish
Define periodontitis
Periodontitis is irreversible infection associated with all parts of the periodontium. It is associated with the body’s response to bacterial invasion of JE and connective tissue
Describe the clinical characteristics of periodontitis.
• Colour varies from red and purple blue, even light pink • Bleeding upon probing • Inflammed gingiva • Increased pocket depths • Bone resorption seen in radiographs • Drifting of teeth and tooth mobility * Tooth loss
Describe the histological characteristics of periodontitis.
• Coronal portion of JE detaches from root surface
• Apical portion of JE moves apically along root surface, creating a perio pocket
• Collagen fibres destroyed
• Permanent destruction of alveolar bone and periodontal fibred
* Cementum is exposed
Explain the process of the periodontal pocket formation
• Starts as an inflammation change in the connective tissue wall of JE
• Degeneration of connective tissue
• Collagen fibres apical to JE destroyed
• With coronal recession of JE, apical cells of JE proliferate/ migrate along root
• Increased PMN’s in coronal JE
* JE will eventually separate from root, thus increased pocket depth
Describe the clinical patterns (characteristics) of a peridontal pocket
• Gingival wall of pocket varies in colour; red or bluish red
• Appears smooth and shiny
• Bleeding upon probing
• Inner aspect of pocket is painful when probed
• Exudate (released fluid) may seep out with application of pressure
• Very loose gingiva
* May cave in when pressure is applied
Describe the histological patterns (characteristics) of the periodontal pocket
• Colour changes caused by circulatory stagnation
• Atrophy of epithelium
• Oedema (accumulation of fluid) and degeneration of fibres
* Exudate released within pockets when there are suppurative inflammation of the pocket wall
Describe suprabony pockets
- Alveolar bone, then into periodontal space
• Base of JE is located above alveolar crest - Horizontal bone loss, even loss of bone
Describe infrabony pockets
• Inflammation from gingiva to perio space and then into alveolar bone
• Vertical bone loss because uneven pattern of bone loss
* Base of JE is below crest of alveolar bone
Explain the difference between an active and an inactive periodontal pocket
• Active pocket: continued apical migration of JE over time, bleeding upon probing
• Inactive pocket: stabilised periodontal pocket over time
Determined through regular periodontal analysis
