gingivitis and periodontitis semester 1 Flashcards
Describe the clinical and histological characteristics of gingivitis
Clinical Characteristics
– Erythemic
– Inflammed
– Bleeding present
– Pain
Histological Characteristics
– JE located at CEJ
– Supragingival fibre destruction
– Periodontal ligament intact
– Alveolar bone intact
Describe the stages of gingival inflammation
Initial Lesion:– Bacteria colonize the tooth near the gingival margin
– Bacteria initiate host response
– PMNs pass from bloodstream into the gingival connective tissue
– PMNs release cytokines that destroy gingival
– connective tissue, allowing PMNs to
– move quickly through the tissue
– PMNs migrate into the sulcus and phagocytise
– bacteria
– Peri-vascular collagen loss
– 2-4 days Lippincott, Williams & Wilkins,
Early Lesion (Early Gingivitis):
– JE & sulcus become densely
infiltrated with neutrophils
– JE may begin to show development
of rete pegs or ridges
– Increased collagen destruction; 70%
of collagen around infiltrate is
destroyed
– Circular and dentogingival fibre
groups affected
– Decrease in collagen production
– 4-7 days
Established Lesion
– Plaque biofilm extends subgingivally
and disrupts the attachment of the
coronal-most portion of the JE
– Macrophages and lymphocytes are
most numerous in the connective
tissue; PMNs continue to fight
bacteria in the sulcus
– Host cells produce more toxic
chemicals—cytokines, PGE2 and
MMPs
Describe the clinical and histological characteristics of periodontitis
Periodontitis
Clinical Characteristics
– Colour varies from red and
purplish-blue (may be pale
pink, if fibrotic)
– Bleeding on probing (often)
– Inflamed or fibrotic gingiva
– Increased pocket depths >
3mm
– Recession (often)
– Bone resorption (radiographic
finding)
– Drifting of teeth (possibly)
– Tooth mobility
– Suppuration on probing
(sometimes)
Histological Characteristics
– Coronal portion of JE detaches
from root surface
– Apical portion of JE moves
apically along surface of root
creating a periodontal pocket
– Collagen fibres are destroyed
– Permanent destruction of
alveolar bone
– Permanent destruction of
periodontal fibres
– Cementum is exposed to oral
environment
Explain the process of the periodontal pocket formation
– Starts as an inflammatory change in CT wall of gingival
sulcus
– Degeneration of surrounding CT
– Collagen fibres just apical to JE destroyed and replaced by
inflammatory cells and oedema
– Apical cells of JE proliferate along the root
– Coronal portion detaches as apical portion migrates
– Increased PMNs in coronal JE
With continued inflammation, JE continues to migrate along
the root and separate from it
Increasing pocket depth
Describe the clinical and histological patterns of the pocket formation
clinical:
- gingival wall of pockets varies in colour from red to bluish red
- appears smooth, shinny surface
-exhibits “pitting” on pressure
-displays flaccidity
- less frequent, gingiva wall is firm and pink
- bleeding present upon gentle probing of pockets
- inner aspect of pocket is painful when explored with probing
- exudate may be expressed by applying digital pressure
histological:
- colour change caused by circulatory stagnation
- atrophy epithelium and oedema
- oedema and degeneration
- fibrotic changes predominate in relation to the outer surface of pocket wall
-due to increase vascularity, thinning and degeneration of epithelium in addition to proximity of engorged vessels to inner surface
- due to ulceration of inner aspect of pockets walls.
-exudate occurs in pockets with suppurative inflammation of inner walls
Explain the pathways to inflammation involved in periodontal disease
two types of pathways; supra bony and infrabody pathway.
supra bony - Inflammation spreads within the
connective tissue into alveolar
bone then into the periodontal
space
infra bony - Pathway directly to
periodontal ligament (PDL)
space
Discuss the differences between suprabony and infrabony periodontal
pockets and the pattern of bone loss associated with each type
Suprabony Pocket
– Inflammation spreads within the
connective tissue into alveolar
bone then into the periodontal
space
– This pathway is least resistant due to
the periodontal fibres
– Base of the JE forming the pocket is
located above the coronal portion of
the alveolar crest (supracrestal)
– Results in an even pattern of bone
loss – horizontal bone loss
Infrabony Pocket
– Pathway directly to
periodontal ligament (PDL)
space
– Inflammation spreads from
gingiva to the periodontal space
then finally into alveolar bone
– This pathway results in uneven
pattern of bone loss – known as
vertical bone loss
– Base of JE forming the pocket is
located below the crest of alveolar
bone (subcrestal)
– Resulting in vertical bone loss
Explain the radiographic differences between horizontal and vertical
bone loss
Horizontal bone loss
– Most common pattern
– Even overall reduction in
height of alveolar bone
Vertical bone loss
– Less common
pattern
– Uneven overall
reduction in
height of
alveolar bone
– Progression is
– Explain the difference between an active and an inactive periodontal
pocket
– Presence of a periodontal
pocket does not indicate
active disease
– Active site -continued apical
migration of the JE over time;
bleeding on probing
– Inactive site- stabilised
periodontal pocket over time
– Regular periodontal analysis is
necessary to monitor
progression of disease
Gingivitis versus Periodontitis
Gingivitis
– Reversible inflammation confined to
the gingiva
Periodontitis
– Irreversible infection associated
with all parts of the periodontium
Stages of Gingival Inflammation
Stages of Gingival Inflammation
Healthy / Pristine Gingiva
Initial lesion
Early lesion
Established lesion
Healthy / Pristine Gingiva
Clinical Characteristics
– Pink or Pigmented
– Firm
– No bleeding
Histological Characteristics
– JE coronal to cemento-enamel junction
(CEJ)
– Supragingival fibres intact
– Alveolar bone intact
– Periodontal ligament intact
No plaque
Shallow gingival sulcus
JE firmly attached to root, sulcular epithelium and connective
tissue (CT)
Some gingival crevicular fluid (GCF)
