histopathology of periodontal disease Flashcards
Why is enamel not shown in histology
high mineralisation
Junctional epithelium and use in diagnosis
attached to the enamel and ACJ
- important in gingival health identification
normal sulcus depth helathy
0.5 to 2mm
what does the acquired pellicle allow
plaque can colonise on the tooth surface
most normal gingiva are.. due to
middle inflamed due to thin layer of plaque on teeth
PDL fibre function
attach into cementum and alveolar bone
helps maintain integrity of periodontium
in health what attaches to what
junctional epithelium attaches at the aDJ
stages in gingivitis and peridontonal disease
early gingivitis
chronic marginal gingivitis
destructive periodontitis
early gingivitis
initial changes occur in 1st week as plaque accumulates
early lesion occur in the 2nd week
chronic marginal gingivitis
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
destructive periodontis
the advanced lesion
timescale is unknown
where is plaque found and acts as..
accumulates at gingival margin
acts as an irritant and noxious stimulant
what does plaque accumulation lead to
vasodilation (increased blood flow)
oedema development
formation of crevicular fluid, flows out through gingival margin
neutrophulcs migrate to fight stimulus
what is the aim of formation of crevicular fluid
attempts to flush the noxious stimuli out
What happens at the junctional epithelium
susceptible to bacterial infection
very wide intracellular spaces
cells can be rapidly turned over
clinical signs of early gingivitis
gingiva is redder (erythematous) - due to increased vasculature dilation
gingiva still attached to tooth and ACJ
what is the cellular reponce t early gingivitis
epithelium proliferates (to protect)
rete pegs
fibroblasts show signs of damage
recruitment of macrophages and lympocytes
clinical signs of chronic gingivitis
loss of stippled gingiva due to inflamed tisue
gums erythematic
rounding of interdental papilla
BOProbing
small parts of plaque found on tooth surface
cellular reponce to chronic gingivitus
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)
why does the junctional epithelium detach from teeth during chronic gingivitus
expansion of the tissue due to oedema and looseness of the tissue
what can happen to and at the junctional epithelium
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)
rete ridges in chronic gingivitus
elongated rete ridges into underlying connective tissue
what does chronic gingititus lead to
destructive periodontitis
cellular response to destructive periodontitis
loss of collagen fibres insetting into cementum
junctional apitheliummigrates to cementum below ACJ - true pocket formation
destruction of alveolar bone, loss of PDL fibres
what does the true pocket formation allow
biofilm can develop apically
damage tissue on its way down via bacterial biproducts
clinical signs of destructive periodontis
recessing of gingival margin from aCJ apically
probe of true pockets
mobility of teeth due to loss of attachments and loss of alveolar bone
what is seen on a radiograph of destructive perioontits
significant bone loss
management of destructive peridontisis
root surface debridement
OH measures
- aim to remove plaque, calculus and debris
what happens when. a patient complies with management of periodontis
inflammation subsides
attaches to tooth (long epithelial attachment)
little or no regeneration of bone or collagen fibres inserting in cementum
summary of gingivitus
response to plaque accumulation acute then chronic inflammation response no bone destruction junctional epithelium at ACJ reversivle
summary of destructive periodontal diseas
unknown what causes progression loss of collagen fibres into cememntum true pocket JE apical onto cementum destrcuction of alveolar bone irreversible
when JE attaches directly onto cementum after destructive peritonitis it is called
long epithelial attachment
