Gingivitis and gingival disease Flashcards
How can periodontal diseases and conditions be classified in the 2017 classification system?
Periodontal health, Gingival disease and conditions
Periodontitis
Other conditions affecting the periodontium
Peri-implant diseases and conditions
Name the 4 periodontal structures
Gingivae
PDL
Cementum
Alveolar bone
What type of gingiva sits between the gingival margin and the gingival groove?
Free gingiva
Where is the gingival sulcus found. What type of epithelium lines this?
Found in the sulcus between tooth and free gingiva.
Lined by sulcular epithelium
What structure demarcated the attachment of attached gingiva to alveolar musocsa?
Mucogingival junction
Function of the junctional epithelium?
Forms attachment of gingiva to tooh
4 signs of gingival health
Gingiva are firm and pink
Stippling may be present
Interdental papillae are pyramidal
Gingival crevice less than or equal to 3mm
How does the body ensure an intact epithelial barrier is maintained?
Shedding of epithelial cells - replaced by new cells. Junctional epithelium has a very high turnover rate
Outflow of GCF
Antimicrobial effects of antibodies
Phagocytic functions of neutrophils and macrophages
Complement activity
Signs of periodontal disease?
Plaque around gingival margin Bleeding Swelling Redness Halitosis Papillae more blunt increased GCF
5 signs of inflammation
Pain Redness Swelling Temperature Loss of function
First disease processes involved with gingivitis?
Dental plaque related gingivitis
Define dental plaque biofilm
Collection of microorganisms, held together within a matrix structure, on a surface or interface
What are early dental plaque biofilm colonisers?
Streptococcus
What are the later colonisers of plaque biofilm?
Rod shaped (G +ve) e.g. actinomyces
What is the ecological plaque hypothesis?
Non specific pathogenic species of bacteria cause disease due to a shift in bacteria population and biofilm balance
How is gingivitis diagnosed?
Clinical appearance
BOP
Plaque indices
How is initial examination of the gingiva carried out?
BPE - a screening tool
BPE score 0
Pockets <3.5mm
No calculus/overhangs
No BOP
BPE score 1
Pockets <3.5mm
No calculus/overhang
BOP
BPE score 2
Pockets <3.5mm
Supra or sub gingival calculus/overhangs
BPE score 3
Pockets 3.5-5.5mm
BPE score 4
Pockets >5.5mm
Patient has code 0/1/2 and <10% BOP. What is the diagnosis?
Clinical gingival health
Patient has code 0/1/2 and 10-30% BOP. What is the diagnosis?
Localised gingivitis
Patient has code 0/1/2 and more than 30% BOP. What is the diagnosis?
Generalised gingivitis
What are false pockets?
Present when junctional epithelium is still at CEJ but the sulcus is deepened to more than 3mm due to changes in gingival swelling
Diagnosis of gingivitis
No pocket depths >3mm - BPE code 0/1/2
BOP - amount dictates severity of disease
Redness, swelling, heat
NO bone destruction or breakdown of PDL
Consequence of necrotising gingivitis?
Sloughing of gingival margin, ulceration, painful
Aetiology of necrotising gingivitis?
Poor OH immunocompromised Poor diet and general health Smokers Stress
List 8 local contributing factors of gingivitis
Dental plaque Supra/subgingival calculus Suboptimal restoration margins Tooth anatomical factors Malocclusion/crowding Fixed/removable prosthodontics/ortho Incompetent lips/lack of seal oral dryness (mouth breathers, xerostomia)
List 8 systemic factors that can contribute to gingival disease?
Puberty Pregnancy Menstrual cycle Diabetes Blood dyscrasia (leukaemia) Medications - amlodipine malnutrition (Vit C deficiency) Smoking - vasoconstriction
Why might smokers not notice signs of gingival disease as soon as non-smokers?
Causes vasoconstriction so stops bleeding.
Non-smokers will notice more bleeding sooner
How is plaque-induced gingivitis managed?
OHI
Biofilm destruction - scale, toothbrushing
Removal of retentive features
Describe how pregnancy-associated gingivitis occurs?
Increased hormone levels increasing vascular permeability into gingival tissues
How should pregnant patients be managed?
OHI
Recall - every 3 months
identify stage of pregnancy - should get better in 3rd trimester
How does hereditary gingival fibrzomatosis present?
Gingival overgrowth
How can infections of bacterial origin cause gingivitis?
Necrotising gingivitis –> fusobacterium, treponema infection
Associated with ulceration and sloughing of gingival margin
Name 4 bacterias that can cause gingivitis?
Neisseria gonorrhoea
Treponema pallidum
Mycobacterium tuberculosis
Streptococcal gingivitis
How can gingivitis occur as a result of viral infections?
Hand, foot and mouth disease - cocksackie virus
Primary herpetic gingivostomatits - HSV1 and 2
Chicken pox, shingles - VZV
Human papilloma virus
How does hand, foot and mouth disease present?
Usually in children
Vesicles that rupture and ulcerate
Similar lesions in mouth, hand and feet
How does primary herpetic gingivostomatitis present?
Primary infection
Usually in children/pregnant women
Aggressive gingivitis and multiple fluid filled vesicles which burst and leave ulcers
How can fungal infections case gingivitis?
Oral candidiasis = opportunistic pathogen
How does human papilloma virus present in the mouth?
Cauliflower like lesion
Usually asymptomatic
Refer to oral surgery to remove
How can gingivitis occur in hypersensitivity reactions?
Type IV hypersensitivity reaction
How can autoimmune diseases cause gingivitis?
Lichen planus
Pemphigus vulgaris
Bullous pemphigoid
How can pre-malignant neoplasms cause gingivits?
Leukoplakia (white patch)
Erythroplakia (red patch)
Refer to oral medicine
How can malignant neoplasms cause gingivitis
Squamous cell carcinoma
Leukaemia - bleeding, swelling
Lymphoma
How can traumatic lesions cause gingivitis?
Physical/mechanical - function keratosis - zealous toothbrushing
chemical - etching
Thermal - food/drink
How can endocrine/nutritional and metabolic disease cause gingivitis?
Diabetes
Vit C deficiency
