histopathology of periodontal disease

Question 1

Why is enamel not shown in histology

Answer 1

high mineralisation

Question 2

Junctional epithelium and use in diagnosis

Answer 2

attached to the enamel and ACJ

- important in gingival health identification

Question 3

normal sulcus depth helathy

Answer 3

0.5 to 2mm

Question 4

what does the acquired pellicle allow

Answer 4

plaque can colonise on the tooth surface

Question 5

most normal gingiva are.. due to

Answer 5

middle inflamed due to thin layer of plaque on teeth

Question 6

PDL fibre function

Answer 6

attach into cementum and alveolar bone

helps maintain integrity of periodontium

Question 7

in health what attaches to what

Answer 7

junctional epithelium attaches at the aDJ

Question 8

stages in gingivitis and peridontonal disease

Answer 8

early gingivitis
chronic marginal gingivitis
destructive periodontitis

Question 9

early gingivitis

Answer 9

initial changes occur in 1st week as plaque accumulates

early lesion occur in the 2nd week

Question 10

chronic marginal gingivitis

Answer 10

established lesion
occurs within 2-3 weeks if there is no change to OH
can either remain stable for a long period or develop rapidly

Question 11

destructive periodontis

Answer 11

the advanced lesion

timescale is unknown

Question 12

where is plaque found and acts as..

Answer 12

accumulates at gingival margin

acts as an irritant and noxious stimulant

Question 13

what does plaque accumulation lead to

Answer 13

vasodilation (increased blood flow)
oedema development
formation of crevicular fluid, flows out through gingival margin
neutrophulcs migrate to fight stimulus

Question 14

what is the aim of formation of crevicular fluid

Answer 14

attempts to flush the noxious stimuli out

Question 15

What happens at the junctional epithelium

Answer 15

susceptible to bacterial infection
very wide intracellular spaces
cells can be rapidly turned over

Question 16

clinical signs of early gingivitis

Answer 16

gingiva is redder (erythematous) - due to increased vasculature dilation
gingiva still attached to tooth and ACJ

Question 17

what is the cellular reponce t early gingivitis

Answer 17

epithelium proliferates (to protect)
rete pegs
fibroblasts show signs of damage
recruitment of macrophages and lympocytes

Question 18

clinical signs of chronic gingivitis

Answer 18

loss of stippled gingiva due to inflamed tisue
gums erythematic
rounding of interdental papilla
BOProbing
small parts of plaque found on tooth surface

Question 19

cellular reponce to chronic gingivitus

Answer 19

increase in vascularity (no. blood vessels) and formation of crevicular fluid
increase in lymphocytes and plasma cells
junctional epithelium becomes detached from teeth (still remains at ACJ)

Question 20

why does the junctional epithelium detach from teeth during chronic gingivitus

Answer 20

expansion of the tissue due to oedema and looseness of the tissue

Question 21

what can happen to and at the junctional epithelium

Answer 21

may become ulcerated
- loss of collagen but fibres inserting into cementum still intact
sulcus may appear depended but no true pocket formation
plaque and bacteria can fill the small pocket (psudopocket as it it still attached at ACJ)
projections rather than flat(rete pegs)

Question 22

rete ridges in chronic gingivitus

Answer 22

elongated rete ridges into underlying connective tissue

Question 23

what does chronic gingititus lead to

Answer 23

destructive periodontitis

Question 24

cellular response to destructive periodontitis

Answer 24

loss of collagen fibres insetting into cementum
junctional apitheliummigrates to cementum below ACJ - true pocket formation
destruction of alveolar bone, loss of PDL fibres

Question 25

what does the true pocket formation allow

Answer 25

biofilm can develop apically

damage tissue on its way down via bacterial biproducts

Question 26

clinical signs of destructive periodontis

Answer 26

recessing of gingival margin from aCJ apically
probe of true pockets
mobility of teeth due to loss of attachments and loss of alveolar bone

Question 27

what is seen on a radiograph of destructive perioontits

Answer 27

significant bone loss

Question 28

management of destructive peridontisis

Answer 28

root surface debridement
OH measures
- aim to remove plaque, calculus and debris

Question 29

what happens when. a patient complies with management of periodontis

Answer 29

inflammation subsides
attaches to tooth (long epithelial attachment)
little or no regeneration of bone or collagen fibres inserting in cementum

Question 30

summary of gingivitus

Answer 30

response to plaque accumulation
acute then chronic inflammation response
no bone destruction
junctional epithelium at ACJ
reversivle

Question 31

summary of destructive periodontal diseas

Answer 31

unknown what causes progression
loss of collagen fibres into cememntum
true pocket
JE apical onto cementum
destrcuction of alveolar bone
irreversible

Question 32

when JE attaches directly onto cementum after destructive peritonitis it is called

Answer 32

long epithelial attachment