histopathology of perio disease Flashcards
Why is enamel not in histopathology?
Decalcification of teeth for process
Enamel is highly mineralised so is lost
What is the junctional epithelium?
In health- connected to enamel and attached to ACJ
V thin membrane- couple of cells think
Specialised and wide intercellular spaces (porous)- susceptible to attack
What is the normal sulcus depth?
0.5-2.0 mm
What is the periodontal ligament?
Fibres attach at cementum of tooth and bone to give a tight integral complex
What are stages of gingivitis and perio disease?
Early gingivitis
~ initial changes- 1st week
~ early lesion- 2nd week
Chronic marginal gingivitis- established lesion- 2-3 weeks (loss of stippling, accumulation of plaque, BOP, inderdental papilla is rounded/swollen)
Destructive periodontitis- advanced lesion- unknown timescale
What happens in early gingivitis- the initial response?
- Increased blood flow (vasodilation)
- Crevicular fluid tries to flush it away- cytokines/chemokines released to promote healing
- Oedema development
- Migration of neutrophils
- Loss of perivascular collagen
What happens in early gingivitis-the early lesion?
- Increase in neutrophils and crevicular fluid
- Junctional epithelium starts to proliferate (rete ridges)- however still attached
- Fibroblasts in c. tissue show signs of damage and collagen loss, however fibres into cementum still attached
- Macrophages and lymphocytes recruited
What happens in chronic marginal gingivitis?
- Increase in vascularity and formation of crevicular fluid
- Increase in lymphocytes and plasma cells
- Junctional epithelium (thickened and hypoplastic- basement membrane not flat) becomes detached from tooth but attached at ACJ
- J. epithelium may become ulcerated
- Marked loss of collagen but fibres inserting into tooth still intact
FALSE POCKETING- allows apical migration and maturation of plaque
What do the inflam cells look like?
Lymphocytes- small, single dark spots
Plasma cells- fried egg
Neutrophils- Mickey Mouse
What happens in destructive periodontitis?
- Loss of collagen fibres into cementum
- J. epithelium migrates into cementum (true pockets) (possibly ulceration)
- Destruction of alveolar bone (resorption)
- Destruction occurs in bursts
Irreversible
How do you manage destructive periodontitis?
Root surface debridement
~remove plaque, calculus, debris
- Inflam subsides
- J.epithelium proliferates
- Attaches to tooth, long epithelium attachment (not as tight to ACJ)
- Little/no regeneration of bone/collagen fibres inserting into cementum
What are the rests of Malassez?
Remnants of hertwigs root sheath- normal component of PDL
Disease- may proliferate and form radical at cyst
What is the difference between primary and secondary cementum?
Primary- acellular, present on entire root surface
Secondary- found near apex of root, contains cells
What is the lamina dura?
Thin layer of dense cortical bone which lines the roots of sound teeth
