L10--GINGIVITIS!!!

Question 1

Gingivitis is an inflammation of gingival tissues, due to ______ build-up.

Answer 1

plaque

Question 2

What are the three conditions that separate gingivitis from periodontitis?

Answer 2

1. no distruction of PDL 2. No Bone loss 3. No apical migration of the junctional epitlelium

Question 3

What is the catalyst to change from reversible, chronic gingivitis to irreversible periodontitis?

Answer 3

no one knows!!

Question 4

During periodontitis, what is the perivascular infiltrate composed of?

Answer 4

Plasma cells, especially macrophages (the hallmark of chronic inflammation!)

Question 5

Has osteoclast activity been changed since making the plunge to periodontitis?

Answer 5

yes, osteoclast activity has been stimulated

Question 6

What causes loss of collagen during periodontitis?

Answer 6

PMN’s spewing their end products

Question 7

When is the pseudo-pocket formed?

Answer 7

During acute gingivitis

Question 8

Do MOST chronic gingivitis sites go on to periodontitis?

Answer 8

Most chronic gingivitis sites DO NOT go on to periodontitis, even when not treated!

Question 9

What percent of Americans have gingivitis?

Answer 9

Over 50%

Question 10

What is the estimated underlying cause to pregnancy gingivitis?

Answer 10

hormonal

Question 11

What is NUG!? What is ANUG? (even though he just wanted us to know NUG…)

Answer 11

Necrotizing Ulcerating Gingivitis…Acute Necrotizing Ulcerating Gingivitis

Question 12

How do you typically measure periodontitis?

Answer 12

Usually its a measurement of PAST loss

Question 13

What are the three types of periodontitis we discussed? What is the most common? General or local?

Answer 13

1.Chronic (adult) (general) (most common) 2. Aggressive Juvenile (mostly juvenile) (both local and general) 3.Systemic disease (no se)

Question 14

“All” periodontitis pockets display “_________”.

Answer 14

“Climax Community Flora”

Question 15

What is the key to the induction of exudate and bleeding in gingivitis (as well as periodontitis)?

Answer 15

more anaerobic, gram- negative bacteria show up!

Question 16

Initially supragingival plaque contains primarily _______ and _______ species.

Answer 16

streptococcus and actinomyoces

Question 17

As the plaque load grows a more anaerobic environment begins to appear. This leads to the increase in microaerophilic, gram-positive ________, and the emergence of gram negative anaerobic rods and _______.

Answer 17

actinomyces…..Spirochetes

Question 18

Which organisms use haemin for fuel? How do they access it?

Answer 18

Black-Pigmented-Bacteriodes…gram negative bacterial toxins

Question 19

What’s an example of a gram + rod found in supra gingival plaque?

Answer 19

Actinomyces Israelli

Question 20

What is the pathway that ends in more sulcular fluid after Black Pigmented Bacteriods have shed lots of LPS?

Answer 20

T-helper cells call on Macrophages which release cytokines.. These cytokines cause capillary dilation and increased blood flow…Hence more sulcular fluid

Question 21

Following Loe’s experiments: what is one hallmark bacterium in the beginning? What are 3 that come on strong in gingivitis?

Answer 21

Start: S. Mutans Gingivitis: Veillonella Al-Cal-Es-Cens, Treponema Denticola, Fusobacterium Nucleatum

Question 22

What are 5 common things that increase susceptibility to gingivitis?

Answer 22

1.Hormonal (prego, pubery) 2.Drugs (xerostomia) 3.Dieseases (hiv, diabetes) 4.STRESS 5. “oral habits”(braces, smoking, mouth breathing)

Question 23

_________ is a painful gingival lesion characterized by a gray pseudo-membrane on the gingiva that readily sloughs off revealing a bleeding, necrotic area.

Answer 23

Necrotizing Ulcerative Gingivitis

Question 24

Review: which oral lesion involves a gray pseudo membrane? which one involves a white pseudo-membrane?

Answer 24

gray: NUG……. white: candidiasis

Question 25

NUG: This lesion has a rapid onset and causes considerable _____ and ________. The lesions are usually limited to _________.

Answer 25

pain and bad breath….. the TIPS of the gingival papillae

Question 26

What is the classic case of NUG?

Answer 26

Trench mouth

Question 27

Although bacteria invasion is uncommon in gingivitis, _________ is a true tissue infection.

Answer 27

NUG (FOUND IN THE TISSUE)

Question 28

What is the Spirochete and the Rod that produce noxious sulfur products causing bad breath in NUG? (and are found IN the tissue!)

Answer 28

Spirochete: TREP-o-Nema Vincentii…….Rod: Pre-Vo-Tell-a Intermedia

Question 29

Which age group is most affected by NUG?

Answer 29

16-30 years of age

Question 30

What is the similar condition to NUG that is found in poor, malnourished children in sub-Saharan Africa?

Answer 30

NOMA (no, its not an acronym)

Question 31

What are the three bugs associated with NUG? What is their stain and shape? What % of total bug population do they make?

Answer 31

Gram - rods……POR-PHY-ROMONAS Gingivalis…..Pre-VO-Tella Intermedia (PI)…Fuso-Bacterium Nucleatum…70% of bug population (trep-o-nema=30%)

Question 32

Which region of the mouth does NUG usually affect more?

Answer 32

Anterior teeth

Question 33

Is NUG transmissible?

Answer 33

NOT TRANSMISSIBLE

Question 34

How do you treat NUG?

Answer 34

IT DEPENDS!….No systemic effects-debridement, peroxide…..Systemic effects (fever): antibiotics

Question 35

What would I find in the gray pseudo membrane of NUG?

Answer 35

PMNs and Bacteria (P.G., P.I., Spirochetes)

Question 36

What are the three zones of NUG?

Answer 36

1.gray pseudo membrane 2.Necrotic Zone 3.Deeper tissues (G - )

Question 37

What are the 3 main causes of NUG?

Answer 37

NUMERO UNO: STRESS (glucocortocoids) 2.decreased immunity 3.poor oral hygiene.