L1 Recognising health, gingivitis and periodontitis Flashcards
What percentage of the world’s population will experience gingvitis or periodontitis?
- 95% will experience gingivitis at some point in their life
- 60-65% of the adult population will have periodontitis
What percentage of the population are at a higher risk of periodontitis and what percentage of these will have aggressive disease forms?
- 10% of population are at a higher risk of periodontitis
- 1% of these will have aggressive disease forms
What does gingival phenotype/biotype refer to?
The thickness of the gingivae.
Can be assessed by placing a probe in the sulcus, if the probe can be seen then the gingiva is thin (<1mm).
Is gingival stippling healthy?
Yes, it indicates the attachment of collagen fibres in gingival tissues.
Is a knife edge gingival margin healthy? What is the opposite of this?
Knife edge margin is healthy, if the margin is inflammed and swollen it is described as a “rolled margin”.
What are the main signs of gingival health?
- Pale pink or brown in certain ethnic groups
- Gingival stippling
- Knife edge margin
- Scalloped margin
- Sulcus up to 3mm deep
- Interdental papillae is a triangular shape and fully fills the interproximal space
- No BoP
- No recession
- No mobility
What are the 3 classifications of gingival health according to the 2017 world workshop classification?
- Pristine
- Clinical gingival health on an intact periodontium
- Clinical gingival health on a reduced periodontium
Describe pristine gingival health.
- No attachment loss
- No BoP
- No sulcular probing >3mm
- No redness, swelling or pus
Describe clinical gingival health on an intact periodontium.
- Majority of tissues healthy
- 10% BoP or less
Describe clinical gingival health on a reduced periodontium.
- Periodontium reduced due to previous disease
- Recession
- 10% BoP or less
Define biofilm/dental plaque.
Microbial communities of microorganisms attached to a tooth surface encased within extracellular polymeric substances.
What extracellular polymeric substances are found in dental biofilm?
EPS are products of microbial cells (not from the host).
- Proteins
- Extracellular DNA (eDNA)
- Exopolysaccharides
- Lipids
- Surfactants
- Metals
- Inorganic salts
- Water
What are the 5 microbial complexes found in subgingival dental plaque?
- Yellow complex: found in health
- Purple complex: early colonisers
- Green complex: early colonisers
- Orange complex: gingivitis
- Red complex: periodontitis
What type of relationships do microorganisms in the same complex have with eachother?
Symbiotic relationships.
What microorganisms are found in subgingival dental plaque in health?
- Streptococcus
- S. grodonii
What microorganisms are found in subgingival dental plaque in gingivitis?
- P. intermedia
- F. nucleatum
- C. rectus
- F. periodonticum
What microorganisms are found in subgingival dental plaque in periodontitis?
- P. gingivalis
- T. forsythia (formerly B. forsythus)
- T. denticola
What microorganisms are found in the purple and green complexes (early colonisers)?
- V. parvula
- C. gingivalis
- C. sputigena
- E. corrodens
When do clinical signs of gingivitis present following plaque accumulation?
Within 4-5 days of undisturbed plaque accumulation.
What are the clinical features of gingivitis?
- Erythema
- Oedema
- Loss of stippling (shiny appearance)
- Soft tissues
- Bleeding on probing
- Sulcus depths increased (false pocketing)
- Increased GCF flow
- Painless
What is the difference between localised and generalised gingivitis?
Localised = 30% or less BoP
Generalised = 30% or more BoP
Why is bleeding on probing a significant feature to measure?
- Approx. 30% of sites that bleed from the base of the pocket (not gingival margin) will continue to deteriorate
- 98-99% of sites that don’t bleed remain healthy over time
What are the 4 stages of periodontal disease according to Page and Schroeder (1976)?
1) Initial gingival lesion
2) Early gingival lesion
3) Established gingival lesion
4) Advanced lesion
Describe the first stage of the disease process.
Initial gingival lesion
- Biofilm accumulates over 2-4 days
- Gingivitis not evident clinically
- Increased vascularity and capillary permeability = inflammatory cells able to reach tissues
- Increased GCF = oedema
- Increased polymorphonuclear neutrophils
- 5-10% loss of connective tissue
- Only evident histologically (loss of JE attachment, inflammatory cell infiltrate from fenestrated capillaries)
