Gingivitis Flashcards
OVERVIEW
review
describe
diagnose
correlate
REVIEW: anatomy of periodontium
DESCRIBE: biofilm induced or non-biofilm-induced gingivitis
DIAGNOSE: type and severity of gingivitis
CORRELATE: histological and clinical signs of biofilm induced gingivitis
PERIODONTIUM
the _______ system of tissues that ________ the teeth and attaches them to the _____
what are the four components
the FUNCTIONAL system of tissues that SURROUND the teeth and attaches them to the BONE
Gingiva, cementum, PDL, and alveolar bone
GINGIVA
provides a ________ around the cervical portion of the tooth and covers the __________
holds tissues against the tooth during __________
composed of thin outer layer of _________ and an underlying core of ___________
provides a TISSUE SEAL around the cervical portion of the tooth and covers the ALVEOLAR PROCESSES
holds tissues against the tooth during MASTICATION
composed of thin outer layer of EPITHELIUM and an underlying core of CONNECTIVE TISSUE
FREE GINGIVA
- non __________ gingiva: fits snuggly around the _____ but it is not ________
- free gingival tissue: meets the tooth in a ____, rounded edge called the _______, should be coronal to the ____
- gingival margin follows the contours of the _____ (wavy outline)
- the FGM can be pulled away from the tooth with a ____ > forms a soft tissue wall: the ____________
- non ATTACHED gingiva: fits snuggly around the TOOTH but it is not ATTACHED
- free gingival tissue: meets the tooth in a THIN, rounded edge called the GINGIVAL MARGIN, should be coronal to the CEJ
- gingival margin follows the contours of the TOOTH (wavy outline)
- the FGM can be pulled away from the tooth with a PROBE > forms a soft tissue wall: the GINGIVAL SULCUS
GINGIVAL SULCUS
__ shaped, shallow space around the tooth
normal sulcus =
base of the sulcus is formed by the __________
U-shaped, SHALLOW space around the tooth
normal sulcus = 1-3mm
the base of the sulcus is formed by the JUNCTIONAL EPITHELIUM
GINGIVAL BOUNDARIES
coronal edge
apical edge
which mucosa is darker
what demarcates the attached gingiva from the alveolar mucosa
coronal edge - gingival margin
apical edge - alveolar mucosa
which mucosa is darker - alveolar (BVs)
what demarcates the attached gingiva from the alveolar mucosa - mucogingival junction
ATTACHED GINGIVA
prevents _______ from being pulled away
located between ______ and ______
widest in _______; narrowest in _____
width is not measured in the ______ because it’s difficult to distinguish between ________ mucosa
the color is ____ or _______, may be _________
prevents FREE GINGIVA from being pulled away
located between FREE GINGIVA and ALVEOLAR MUCOSA
widest in INCISOR & MOLAR REGIONS; narrowest in PREMOLAR REGIONS
width is not measured in the PALATE because it’s difficult to distinguish between PALATAL mucosa
the color is PALE or CORAL PINK, may be PIGMENTED
What would be “inadequate attached gingiva”
why is it bad?
2 mm with bleeding or 1 mm with or without bleeding
makes teeth more mobile, indicates bone loss
equation for amount of attached gingiva
(FGM-MGJ) - PD = amount of attached gingiva
INTERDENTAL PAPILLA/GINGIVA
part of gingiva that fills the area between two _________ teeth
________ to the ________
prevents _________
how many papillae does each tooth have
what is the COL; when is it absent
part of the gingiva that fills the area between two ADJACENT teeth
APICAL to the CONTACT AREA
prevents FOOD IMPACTION
teeth consist of TWO interdental papillae: FACIAL AND LINGUAL
col: valley-like depression in the interdental gingiva that lies directly apical to the contact area; absent if teeth are missing or recession is present
PERIODONTAL LIGAMENT (PDL)
____ connective tissue that covers the _____ and attaches it to the _____ of tooth socket
Composed of _____ bundles
Fibers attach to the _______ on one side and the ________ of the tooth socket on the other side
SOFT connective tissue that covers the ROOT and attaches it to the BONE of the tooth socket
Composed of FIBER bundles
Fibers attach to the ROOT CEMENTUM on one side and the ALVEOLAR BONE of the tooth socket on the other side
what are the 5 functions of the PDL
- suspends and maintains the tooth in the socket
- provides pressure/pain/sensory to the tooth
- provides nutrients to the cementum and bone
- builds and maintains cementum and alveolar bone
- remodels alveolar bone in response to pressure
CEMENTUM
thin layer of ______, ________ tissue that covers the surface of the ____
what color is it
overlies and protects _____
“bone-like” but more resistant to _________ than bone
does it have a blood/nutrient supply?
THIN layer of HARD, MINERALIZED tissue that covers the surface of the ROOT
LIGHT YELLOW
overlies and protects DENTIN
“bone-like” but more resistant to RESORPTION than bone
DOES NOT HAVE ITS OWN BLOOD/NUTRIENT SUPPLY
ALVEOLAR BONE
surrounds and supports ______ in the upper and lower jaws
AKA alveolar bone ______
existence of alveolar bone is dependent on ________
extractions lead to ________
surrounds and supports ROOTS in the upper and lower jaws
AKA alveolar bone PROPER
existence of alveolar bone is dependent on the PRESENCE OF TEETH
extractions lead to RESORPTION
what are the 4 functions of alveolar bone
- protection - sockets for teeth
- attachment - PDL fiber
- support - tooth roots
- shock absorption - forces placed on the tooth
CLINICAL GINGIVAL HEALTH ON AN INTACT PERIODONTIUM
BOP
PD
probing attachment loss
RBL
BOP - less than 10%
PD - 1-3 mm
probing/clinical attachment loss - none
RBL - none
CLINICAL GINGIVAL HEALTH ON A REDUCED PERIODONTIUM (stable periodontitis patient)
BOP
PD
probing attachment loss
RBL
BOP - less than 10%
PD - 4mm or less (no site over 4 mm with bleeding)
probing attachment loss - yes
RBL - yes
CLINICAL GINGIVAL HEALTH ON A REDUCED PERIODONTIUM (non-periodontitis patient/recession/bad brushing habit/crown lengthening)
BOP
PD
probing attachment loss
RBL
BOP - less than 10% bleeding
PD - 1-3mm
probing attachment loss - yes
RBL - possible
COLOR IN HEALTH
- uniformly _____ (lighter hair/skin = usually lighter gingiva)(darker hair/complexion = darker shade)
- pink gingiva is easily distinguished from ________
- tissue may be _______
- uniformly PINK (lighter hair/skin = usually lighter gingiva)(darker hair/complexion = darker shade)
- pink gingiva is easily distinguished from DARKER ALVEOLAR MUCOSA
- tissue may be PIGMENTED
3 basic states of periodontal tissues
- health (fills embrasures, no inflammation, coral pink)
- gingivitis (reversible, inflammation, BOP, rolled, edema)
- periodontitis (mobility, inflammation, loss of attachment, irreversible damage, working toward stability)
t/f: periodontal disease and periodontitis are the same thing
FALSE periodontitis is a TYPE of periodontal disease
periodontal disease is a _________ of the periodontium
what are the 2 types of periodontal disease
periodontal disease is a BACTERIAL INFECTION of the periodontium
gingivitis and periodontitis
CLINICAL(3) vs HISTOLOGICAL(4) HEALTH
CLINICAL
- pink
- firm
- less than 10% bleeding
HISTOLOGICAL
- Junctional epithelium coronal to CEJ
- supragingival fibers intact
- alveolar bone intact
- periodontal ligament intact
Pristine gingival health VS clinically health VS incipient gingivitis
PRISTINE GINGIVAL HEALTH
- no BOP or attachment loss
- 1-3mm PD
- no clinical signs of inflammation
CLINICALLY HEALTHY
- absence/low levels of inflammation
INCIPIENT GINGIVITIS
- less than 10% BOP
- variant of gingival health
- if left untreated, can rapidly progress to gingivitis
clinical (3) VS histological (4)
dental biofilm-induced gingivitis
CLINICAL
- red
- swollen
- bleeding likely (more than 10% BOP)
HISTOLOGICAL
- JE is at the CEJ
- supragingival fiber destruction
- alveolar bone intact
- periodontal ligament
prevalence of gingivitis
____ in the population
____ in ages 65+
____ in men
_____ in women
47.2% of the population
70.1% in ages 65+
56.4% in men
38.4% in women
INFLAMMATORY PROCESS OF PATHOGENESIS (7 steps)
- invasion of pathogens, injury or irritant to tissues produces transient vasoconstriction of BVs
- biochemical mediators released causing vascular wall changes which increases BV permeability and flow
- delivers defense supplies
- fluid leakage - inflammatory exudate
- defense cells migrate
- plasma cells and leukocytes leak from capillaries into the tissues
- disease signs followed by tissue destruction and healing
VASOCONSTRICTION, VASODILATION, AND EXUDATION
________ and ______ chain of events
Injured or dying cell releases ______ breakdown products such as _______
Cause release of enzymes found along ______ cells
Enzymes are activated and cause break in mast cell wall and release of _______
Histamine granules escape into tissue and cause ________
INTERDEPENDANT and INTERRELATED chain of events
Injured or dying cell releases CHRONIC breakdown products such as POLYPEPTIDES
Cause release of enzymes found along MAST cells
Enzymes are activated and cause break in mast cell wall and release of HISTAMINE
Histamine granules escape into tissue and cause DAMAGE
AS THE INFLAMMATORY PROCESS CONTINUES
_______ in vessel permeability and _______
carry ______ supplies
_______ of BV with ________ or pooling of blood in the capillaries
_______
________ causes a break in endothelial cells lining BV’s
INCREASE in vessel permeability and BLOOD FLOW
carry DEFENSE supplies
VASODILATION of BV with HYPERMIA or pooling of blood in the capillaries
ENGORGED
HISTAMINE causes a break in endothelial cells lining BV’s
What’s really happening?
________ form
Blood enters the ____ carrying: ____, _____ cells, ______
Inflammatory _____ enters the tissue
MICROULCERATIONS form
Blood enters the SULCUS carrying: PMNs, PLASMA cells, AND MACROPHAGES
Inflammatory EXUDATE enters the tissue
WHAT ARE PMNS
___ line of _____
engulf and destroy ______
type of ______
Most _______ circulating immune cell
Plays a key role in _______
FIRST line of DEFENSE
engulf and destroy PATHOGENS
type of LEUKOCYTE
Most ABUNDANT circulating immune cell
Plays a key role in INFLAMMATION
gingival inflammation
___, ______, and ______
repaired by _______
redness, swelling, bleeding
repaired by firbroblasts
tissue invasion by bacteria results in _____ to the body
inflammatory response: increased blood flow delivers defense cells:
- _____ and _______ leak from blood vessel into the tissue
- _______ fight invading bacteria
- some tissue destruction occurs surrounding the infection site, this is a ________ of the inflammatory repsone
tissue invasion by bacteria results in INJURY to the body
inflammatory response: increased blood flow delivers defense cells:
- LEUKOCYTES and PLASMA PROTEINS leak from blood vessel into the tissue
- LEUKOCYTES fight invading bacteria
- some tissue destruction occurs surrounding the infection site, this is a SIDE EFFECT of the inflammatory repsone
ACUTE INFLAMMATION
- bacterial infection of ____ or less
- ____, heat, ______, swelling, loss of ______
CHRONIC INFLMMATION
- no ______
- ______ onslaught of bacteria
chronic inflammation causes an ______ host inflammatory repsonse
ACUTE INFLAMMATION
- bacterial infection of 2 WEEKS or less
- REDNESS, heat, PAIN, swelling, loss of FUNCTION
CHRONIC INFLMMATION
- no SYMPTOMS
- PERSISTANT onslaught of bacteria (longer than 2 weeks)
chronic inflammation causes an EXAGGERATED host inflammatory repsonse
GINGIVAL INFLAMMATION
Biofilm stimulates _______
Inflammatory response results in _________
Changes involve ____ and ____ gingiva
_______ papilla also impacted
Patients are generally _____ as there is no _____ associated
Biofilm stimulates IMMUNE REPOSNE
Inflammatory response results in CLINICAL CHANGES
Changes involve FREE and ATTACHED gingiva
INTERDENAL papilla also impacted
Patients are generally UNAWARE as there is no PAIN associated
what is considered the key risk factor for the onset of periodontitis
gingival inflammation in reponse to bacterial plaque accumulation
we must remove the irritant, control of gingival inflammation is essential for the primary prevention of periodontitis
what part of the periodontium does gingivitis affect first?
what is the number one risk factor of PD
gingivitis affect the interdental papilla and the margins first (bulbous)
individual host reposne to biofilm
slight gingivitis can be described as:
moderate can be described as
severe can be described as
- less than 30% BOP, confined to the margins/ acute range, bulbous papilla
- more than 30% BOP, diffuse redness, bulbous, rolled margins
- can’t see the MGJ, red/bulbous
if inflammation AND recession is present on one tooth, how do we record this
if bulbous and blunted what do we do
- record recession on the perio chart (+1)
- describe the papilla as bulbous on the gingival descriptors
we would mark the blunted because that is attachment loss
does color variation always mean disease
NO, color change can occur for reasons other than inflammation. injury such as brushing too hard can cause a color change. Intraoral tattoos.
CONTOURS OF HELATHY GINGIVA
smooth, even _____ margin
at or slightly _____ to the ___
_____ margin slightly coronal to the CEJ
pointed papilla that fills the _____
FGM is ____
smooth, even SCALLOPED margin
at or slightly CORONAL to the CEJ
TAPERED margin slightly coronal to the CEJ
pointed papilla that fills the SPACE
FGM is 000
tissue size in gingivitis
Increased tissue ____ enlarges _______ and _______ gingival tissue
Enlargement can be _____ or involve the ____ mouth
Increased tissue FLUID enlarges MARGINAL and INTERPROXIMAL gingival tissue
Enlargement can be LOCALIZED or involve the WHOLE mouth
stippling
____ of health
Disappears with ______, giving tissue a more ____/____ appearance (Stretched plastic wrap)
____ Gingiva is still ____
Tissue is not ________ with air
SIGN of health
Disappears with INFLAMMATION, giving tissue a more SMOOTH/SHINY appearance (Stretched plastic wrap)
ATTACHED Gingiva is still BOUND
Tissue is not RETRACTABLE with air (FLACCID)
healthy vs gingivitis texture
healthy:
- firm
- maybe stippled (varys)
gingivitis
- spongy
- stipping disappears (varies)
what is each papilla assciated with
bulbous: gingivitis
blunted and cratered: periodontitis or trauma
does bleeding = disease
not always, less than 10% is healthy, but still talk with the patient
BLEEDING
- sulcus lining becomes ______
- BVs ______
- direct relation between the ________ and _______
- absence of bleeding indicates _____
- ______ means active disease
- _______ technique can bleeding
- no ________ despite bleeding (gingivitis)
- sulcus lining becomes ULCERATED
- BVs ENGORGE
- direct relation between the DEGREE OF INFLAMMATION and AMOUNT OF BLOOD
- absence of bleeding indicates HEALTH
- TYPICALLY means active disease
- PROBING technique can bleeding
- no ATTACHMENT LOSS despite bleeding (gingivitis)
PSUEDOPOCKETS
- no _______ of the ___, remains _____ to the CEJ
- no permanent destruction of the ____ or _____
- no APICAL MIGRATION of the JE, remains CORONAL to the CEJ
- no permanent destruction of the PDL FIBERS or ALVEOLAR BONE
PERIODONTAL POCKET
a _______ deepening of the gingival sulcus as a result of:
-__________ of the JE
-Destruction of ___ fibers and _____
The presence of a periodontal pocket does ___ indicate necessarily that there is ____ disease at the site.
The majority of periodontal pockets in most adult patients with periodontitis are ______ sites.
The pocket is an indicator of ____ destruction from periodontitis.
a PATHOLOGIC deepening of the gingival sulcus as a result of:
- APICAL MIGRATION of the JE
- Destruction of PDL fibers and ALVEOLAR BONE
The presence of a periodontal pocket does NOT indicate necessarily that there is ACTIVE disease at the site.
The majority of periodontal pockets in most adult patients with periodontitis are INACTIVE sites.
The pocket is an indicator of PAST destruction from periodontitis.
in gingivitis the JE stays ______ while the ________ moves coronally
in gingivitis the JE stays STILL while the GINGIVAL MARGIN moves coronally
CHRONIC GINGIVITIS: GINGIVAL FLUID
Inflammatory product secreted from ____ that exhibits pathologically-induced increased _______
____ sign of inflammation
Appears prior to ________
Provides _____ for the growth of subgingival plaque biofilm causing disease to increase
Chronic: continues to feed and could progress to ________
Inflammatory product secreted from the SULCUS that exhibits pathologically-induced increased PERMEABILITY
FIRST sign of inflammation
Appears prior to BLEEDING
Provides NUTRIENTS for the growth of subgingival plaque biofilm causing disease to increase
Chronic: continues to feed and could progress to PERIODONTITIS
BIOFILM INDUCED GINGIVITIS
- Gingival diseases with ______ factors
- Most ______ disease
- ____ relationship between inflammation and _____
NONBIOFILM INDUCED GINGIVITIS
- ____, ____, ___, induced gingival diseases (different bacteria from gingivitis, not ____ bacteria)
- ____ causes
- _____
- Patient _____
BIOFILM INDUCED GINGIVITIS
- Gingival diseases with MODIFYING factors
- Most COMMON disease
- LINEAR relationship between inflammation and BIOFILM
NONBIOFILM INDUCED GINGIVITIS
- BACTERIAL, VIRAL, FUNGAL, induced gingival diseases (different bacteria from gingivitis, not ORAL bacteria)
- SYSTEMIC causes
- MALNUTRITION
- Patient SYMPTOMS
COMMON CHARACTERISTICS OF BOTH GINGIVITIS TYPES (4)
- Signs of inflammation confined to the gingiva
- No attachment loss bone loss associated with the inflammation
- Inflammation is REVERSIBLE with biofilm removal
- May progress to PERIODONTITIS if left untreated
SUBTYPE: BIOFILM-INDUCED GINGIVITIS ON A REDUCED PERIODONTIUM (stable perio patient with over 10% bleeding)
- BOP must be on _____ sites
- when the gingivitis occurs, active ______ sites are NOT present
- Preexisting _______ from a previous history of periodontitis
- ______ at the gingival margin
- very ____
- BOP must be on NON PERIO sites
- when the gingivitis occurs, active PERIODONTITIS sites are NOT present
- Preexisting BONE AND ATTACHMENT LOSS from a previous history of periodontitis
- PLAQUE at the gingival margin
- very RARE
LOCAL COMPLICATING FACTORS
- factors that ____ or ______ localized areas of gingivitis
- the most common local complicating factor for gingivitis would be ______
- list 4 examples
- factors that MODIFY or PREDISPOSE localized areas of gingivitis
- the most common local complicating factor for gingivitis would be BIOFILM TRAPS:
- malposition of teeth
- overhanging restorations
- orthodontics/braces
- calculus
MODIFIED BY SYSTEMIC FACTORS
_____ initiates the disease- _________ will modify/intensify the disease
________ system and fluctuations in ______ hormones cause more ______ species of microbes such as __________
Example causes:
(3)
PLAQUE/BIOFILM initiates the disease- HOST SYSTEMIC FACTORS will modify/intensify the disease
ENDOCRINE system and fluctuations in FEMALE hormones cause more BACTEROIDES species of microbes such as PREVETELLA INTERMEDIA
Example causes:
- PREGNANCY
- PUBERTY
- MENOPAUSE
MODIFIED BY MEDICATIONS
________ inflammation of the gingiva related to plaque biofilm and systemic _____
The cause is likely overstimulation of _____
Biofilm _______ the disease and is _____ by medications
Xerostomia- over ___ meds
___________: an increase in the size of the gingiva resulting from systemic medications (e.g. ______)
EXAGGERATED inflammation of the gingiva related to plaque biofilm and systemic MEDICATIONS
The cause is likely overstimulation of FIBROBLASTS
Biofilm INITIATES the disease and is MODIFIED by medications
Xerostomia- over 400 meds
DRUG INFLUENCED GINGIVAL ENLARGMENT: an increase in the size of the gingiva resulting from systemic medications (e.g. DILANTIN)
is plaque accumulation necessary for the initiation of gingival enlargement?
what can reduce (but not eliminate) gingival overgrowth, why doesn’t it eliminate it
which teeth are typically affected most, give 3 terms to describe the gingiva
Plaque accumulation is NOT necessary for initiation of gingival enlargement, but it will exacerbate the gingival disease.
METICULOUS PLAQUE CONTROL can reduce but will not eliminate gingival overgrowth (fibrotic tissue remains forever, and needs to be removed via surgery)
MAXILLARY TEETH are most affected; fibrotic, lobular, pink
what drugs are associated with gingival overgrowth (3)
- calcium channel blockers (nifedipine)
- anti-convulsive (dilantin)
- immunosuppressive (cyclosporine)
does medication impact someone plaque level?
no, it alters the hosts immune response which sends more fibroblasts to the area making the tissue firmer and overgrown. The best thing we can do is remove the plaque and put the pt. on 3 month recare
MODIFIED BY MALNUTRITION (3rd world countries typically)
-Dental biofilm aggravated by nutritional ________
- although rare, vitamin __ def. predominates
- ______ acid; spontaneous _____
-Vitamins __, __, __
-At risk for vitamin deficiencies:
(3)
-Dental biofilm aggravated by nutritional DEFICIENCEIES
- although rare, vitamin C def. predominates
- ASCORBIC acid; spontaneous BLEEDING
-Vitamins A, B, C
-At risk for vitamin deficiencies: INFANTS, INSTITUTIONALIZED ELDERLY, ALCOHOLICS
NON BIOFILM INDUCED
Viral, fungal or non-periodontal associated bacterial origin, ______ process
Viral - ______
Fungal- _______
Fungal- _______
Reactive- _________
Viral, fungal or non-periodontal associated bacterial origin, FUNGAL process
Viral - PRIMARY HERPES
Fungal- CANDIDIASIS/THRUSH
Fungal- HISTOPLASMOSIS
Reactive- ALLERGIES (ex- toothpaste allergy would have no bleeding but inflammation)
description of the mouth during PRIMARY HERPETIC GINGIVOSTOMATITIS (PHG) (6)
this occurs when you are first exposed to the herpes virus
- fiery red marginal gingiva
- swollen papilla that bleed
- painful
- yellowish ulcers with red halo
- fever
- dehydration
non biofilm induced gingivitis: example of a viral origin
PHG
- usually affect _______
- HSV1: severe reaction to _______
- gingiva: rapidly ____, burst and form painful _____
- ____ manisfestations
- _______! use caution with touching
- after being infected you develop _______
- ______
- usually affects YOUNG CHILDREN
- HSV1: severe reaction to INITIAL EXPOSURE
- gingiva: rapidly ERUPT, burst and form painful ULCERS
- SYSTEMIC manisfestations
- TRANSMISSIBLE! use caution with touching
- after being infected you develop IMMUNITY
- RECURRENT
Dermatologic oral lichen planus
- intense _____ of gingiva
- u_______
- interlacing _______ may be present
- raised _____ may be present
- disease of ________
- characterized by ______, swollen ____ on skin and/or _____
- cause:
- intense REDNESS of gingiva
- ULCERCATIONS
- interlacing WHITE LINES may be present
- raised WHITE LESIONS may be present
- disease of SKIN AND MUCOUS MEMBRANES
- characterized by ITCHY, swollen RASH on skin and/or MOUTH
- cause: unknown, maybe allergic or immune reactoin
ALLERGIC REACTION TO TOOTHPASTE
Reaction to _____ in toothpaste
what ingredient is most commonly seen with allergic reactions
Most common in those with _________
Fiery red ___
Tissue ______ of mucosa
is there bleeding?
what should the patient do?
Reaction to ADDITIVE in toothpaste
SODIUM LAURYL SULPHATE
Most common in those with OTHER ALLERGIES
Fiery red GINGIVA
Tissue SLOUGHING of mucosa
no
change brands
IAG can only be determined on the _____
how to calculate IAG
facial
MGJ-GM - PD = IAG
what are the 2 codes for planning gingivitis treatment
D1110: adult prophylaxis (slight)
D4346: scaling in the presence of mod/severe gingivitis
