healthy gingiva and defense mechanisms Flashcards
What are the defense mechanisms of the oral cavity?
Epithelial Surface.
Gingival Crevicular Fluid [GCF].
Saliva.
Cells involved in the initial stages of inflammation.
How does the epithelial surface protect the mouth?
keratin - thick layer of dead cells
This helps protect the underlying structure.
Turn over rate - the bacteria cling on to the surface of the epithelium but as this is disloged because of the shedding of cells, it provides protection.
What is the Gingival Crevicular Fluid? What is the clinical significance of this?
An inflammatory exudate found in small amounts within the crevice/sulcus.
Is an inflammatory exudate.
From the BV»_space;> soft tissue»_space;» crevice/sulcus
Composition: Cellular elements: MO, epith.cells, PMN,lympho etc.
Electrolytes: Na, K, Ca (more K and less Na than serum)
Org.Cpds: Glucose, Prt
Enzymes: Collagenase, lysozymes etc (if there are large amounts of enzymes in the GCF you might be able to know that there is inflammation occurring)
Bact.products: Lactic acid, endotoxins,H2S etc
Clinical significance: * A positive correlation exists between severity of inflammation (gingivitis) and the amount of GCF.
* * Certain drugs are secreted via the GCF. (such as tetracylcine)
what are exudates? What are transudates?
Exudates are fluids, cells, or other cellular substances that are slowly discharged from blood vessels usually from inflamed tissues. Transudates are fluids that pass through a membrane or squeeze through tissue or into the extracellular space of tissues. Transudates are thin and watery and contain few cells or proteins. Transudates are caused by disturbances of hydrostatic or colloid osmotic pressure.
How does the GCF protect the mouth?
PROTECTIVE ROLE:
Cleansing action: flushes out unattached MO.
Anti bacterial Properties:
contains viable leucocytes and IgA’s. (not a rich source IgA though)
Adhesive properties: presence of sticky plasma proteins improves adhesion of JE (junctional epithelium).
What is the usefulness of collecting GCF and what is used to collect it?
(A ‘periotron’ is used to collect GCF)
Distinguish between passive and active sites.
Eval. healing after perio therapy such as Scaling or surgery.
Eval. healing after providing PCI (plaque control instructions).
Eval. effect of restorative or prosthetic appliances/implants.
Test for Infl. mediators.
Biomarkers are found in th GCF
Interleukin (IL) 1beta/ IL6/ 8/10.
TNF-alpha.
Pentraxin 3 (PTX3).
These biomarkers have been reported to correlate with active gingival inflammation
If one could analyze the contents for the presence of these markers, we may be able to say if the lesion is active or not as these biomarkers have been reported to correlate with active gingival inflammation.
What is saliva’s influence on plaque biofilm?
Mechanical cleansing action.
Controls bacterial activity.
Buffering acids produced by bacteria.
What does saliva have in it that can control bacteria?
LYSOZYMES – hydrolytic enzymes that cleave bact.cell wall
Lactoperoxidase-Thiocyanate system:-
Prevents accumulation of lysin, glutamic acids – essential for growth of certain bact such as Lacto and Strept.
Antibodies:- Mainly salivary Ig A. Reacts with bact proliferating on the surface of epithelial cells and impairs their ability to attach. Once the bact is dislodged and tries to re-attach it will find it difficult to be able to do so.
Lactoferrin:- Antibacterial agent effective against Actinobacillus sp.
What is the most important buffer system in the mouth?
Most impt. buffer is the
HCO3-H2CO3 System.
When media becomes too acidic (pH drops), a loss of CO2 occurs and the pH increases.
What is the early stages of inflammation?
Mostly neutrophils and macrophages
Engulf – digest bacteria.
A major protection mechanism!
What should you look for in healthy gingiva?
Look for: - COLOR (should be pink/reddish pink) - CONSISTENCY - SURFACE APPEARANCE CONTOUR - the gingiva should be 2mm from the height of the bone. - BLEEDING ON GENTLE PROBING THE SULCUS - PROBING DEPTHS.
What is the color of the gingiva determined by?
Thickness of epithelium. - more thick epithelium will appear more pale.
Keratinization. - more high keratinization will appear less pink
Vascularity.
Pigmentation. - melanin, besides functioning as a broadband UV absorbent, has antioxidant and radical scavenging properties. Tabacco smoke can stimulate melanocytes.
Subgingival deposits - sub G. calculus. and amalgam tatoo (for example if you take out amalgam, it can stain the gingiva)
What should you look for in consistency and surface texture in healthy gingiva?
CONSISTENCY:
FIRM,
RESILIENT,
FIRMLY BOUND.
Surface texture:
STIPPLED APPEARANCE, - appears to be moreso in the anterior teeth than the posterior
MARGINS ARE KNIFE EDGED.
What is the contour of the tooth determined by?
Shape of roots. Alignment of teeth. Location and size of contact areas. Size of embrasure. Inflammation. Medication.
In health, the papillae are pointed and form a triangle, filling the interproximal area.
The Gingival margins are Knife-edged, flat and follow a curved line around the tooth.
Gummy smile seen in altered passive eruption.
It is estimated that this occurs in about 12% of the population.
This is because the bone and gingiva didn’t recede as the crowns erupted.
In some medications you can get the overgrowth of the gingiva.
What does BOP stand for?
BLEEDING-on gently probing the sulcus. [Bleeding On Probing] You will not elicit BOP in healthy gingival tissue!
