Lecture #10 Gingivitis Flashcards
What is gingivitis?
An inflammation of gingival tissues, due to plaque build-up.
What is gingivitis characterized by?
Redness, swelling, and bleeding of the gingival tissues.
What differentiates gingivitis from periodontitis?
There is no destruction of the periodontal ligament, no bone loss and no apical migration of the junctional epithelium.
Bacteria and their products in plaque induce what?
Inflammatory response in the underlying gingival tissues
This RESULTS in a vascular reaction that produces redness, swelling, edema, and perhaps bleeding in the gingiva = gingivitis
__________ are also chemotactically “called” out of the blood, through the junctional epithelium, and into direct contact with the plaque.
PMNs
If the plaque community shifts to containing more gram-negative the inflammatory response can be___?
What happens next?
-More pronounced
1) More PMNs enter the gingival sulcus, macrophages begin to accumulate in the gingival tissue the battel intensifies
2) Leads to lose periodontal ligament and bone= periodontitis
List the steps that occur in the progression from healthy gums to disease?
Step 1 to 2 : Increase Junctional epi
- Increase Capillary flow and Increase junctional fluid
- PMNs migrate + marginate
- perivascular infiltrate mainly lymphoctyes
Step 2 to 3: Acute to Chronic Gingivitis
(this progression is unknown)
Step 3: Chronic gingivitis–> Perio
- INCREASE ULCERATION
- DECREASE TIGHT JUNCTIONS = INCREASE BLEEDING
- Perivascular infilatrate= plasma cells (macrophages)
- INCREASE VASCULAR DENSITY
- WEAK vessel support (i.e basement membrane) = INCREASE BLEEDING
Gingivitis is a _____ host inflammatory response to plaque microbial products, with both degree of toxicity and concentration of _________ playing a major role.
- “REVERSIBLE”
- Toxins
Fluctuations in the host capabilities that contribute to disease outcome are brought on by what?
-Stress, drugs disease etc. contributing heavily to disease outcome
For all practical purposes gingival health demands an inflammatory response to insure _____________?
Plaque bacteria doesn’t invade the tissues
What can cause a the tip from chronic gingivits to periodontitis?
- Most of us develop chronic gingivits, which is generally stable w/ no lose of functional tissue.
- Temporary, long-term, or permanent immune dysfunction can cause this progression.
Periodontitis usually measurement of ____ loss?
PAST
All periodontis pockets display___________?
Climax community flora
The progression of the plaque community to one with more _______ , _______ bacteria appears to be key to the induction of exudate and bleeding in gingivits (as well as periodontitis)
- Anaerobic
- Gram (-)
initially supragingival plaque contains primarily __________ and ________ species
- Strep
- Actino
As plaque grows a more anaerobic environment begins to appear, this leads to the _________ in __________ _____________ ________________ and the emergence of ________ ______________ and ______________
- INCREASE
- MICROAEROPHILIC
- Gram (+) Actino
-Emergence of gram-negative anaerobic rods and Spirochetes
Bleeding induced by the inflammatory reaction provides RBC that are lysed by __________, and this provides the heme needed for _____________ organisms
- Gram (-) bacterial toxins
- Bacteroides-type organisms
Note: these organisms in turn PRODUCE LPS that is HIGHLY inflammatory
Chronic marginal gingivits is the _______ state of affairs for most of us.
-What inflammatory response is this to?
” Normal”
-A non-specific inflammatory response to supra-gingival plaque
As plaque builds up what microbes increase in numbers?
Relatively anerobic environemtns can develop and allow anaerobic Gram (+) and Gram (-) to increase in numbers
What causes the bleeding in the inflammatory response?
The LPS from the gram (-) bacteria causes a more pronounced inflammatory reaction that causes the bleeding.
Hormones, drugs, predisposing diseases, stress and some oral habits all contribute to what?
To INCREASED susceptibility to more severe sulcular disease
*Impacts gingivitis
Evidence shows that what can initiate gingival disease progression ?
Evidence is mounting that some interruption of the normal bacteria/host defense balance may initiate progression
What can improve the oral health of future generations?
- Understanding and using cytokines and other immune modulators.
- Improved methods of stress management and plaque removal techniques
The severity of gingivitis is a balance between the _______ and the __________ to it.
- Plaque bacteria
- Immune response
What are some hormonal factors that can cause chronic gingivitis?
1) Pregnancy
2) Puberty
3) Contraceptives
4) Estrogen and progesterone
What are some diseases that can cause chronic gingivitis?
1) Diabetes
2) Leukemia
3) HIV
What are some factors that can cause chronic gingivitis?
Stress
leading to elevated corticosteroid levels and suppresed immunity
What are some oral habits that can cause chronic gingivitis?
1) Smoking
2) Chewing
3) mouth breathing
4) braces
In chronic gingivits there is no obvious cause related to what?
related to plaque load
What is Narcotizing ulcerative gingivitis (NUG) ?
AKA Vincent’s
-A painful gingival lesion characterized by a gray pseudo-membrane on the gingiva that lead readily sliughs off revealing a bleeding, necrotic area.
The NUG lesion causes what?
- Onset ?
- What are the lesions limited to?
- This lesion has a rapid onset and causes considerable pain and bad breath
- The lesions are usually limited to the tips of the gingival papillae
NUG patients have shown to have decreased ________ numbers and __________ antibody to the suspected pathogens.
- PMN
- INCREASED Ab
What is the classic case of NUG is?
“Trench mouth”
-Stress is often exaggerated by poor sleep, poor eating habits, smoking (which constricts blood flow) and poor plaque control.
-In soldiers in combat (and college students taking finals)
Although bacteria invasion is uncommon in _______ , NUG is a _______________ infection.
- Gingivitis
- NUG is a TRUE TISSUE INFECTION (typically a superficial invasion)
Which microbes were found in oral sites, which produce noxious sulfur products that cuase the bad breath associated with NUG?
Invasive Gram (-) spirochetes (Treponema spp- 30%) and RODS (e.g Prevotella intermedia- 24%)
What is the age group this disease is associated with?
- 16-30 years
* Recurrence is common
What is the severe type of NUG, invasive bacterial disease, seen in poor malnourished children in sub Saharan Africa?
-NOMA
**If diagnosed early and treated w/ inexpensive antibiotics it can prevented.
How does NOMA affect patients?
- The disease spreads very rapidly thru the oral cavity and face, w/ huge permanent loose of vital tissue.
- Death and disfigurement is common
What orgnaisms cause NUG?
- 70% GRAM- ROD
- Porphyromonas gingivalis
- Prevotella intermedia
- Fusobacterium nucleatum
- Treponema vincentii (30%)
What are the symptoms of NOMA?
- Bad breath
- Pseudo necrotic membrane
- painful, bleeding
- Ulcerative papillae mainly anterior teeth
What are the predisposing factors for NOMA?
INCREASE in PATH. FLORA:
- poorl oral hygiene
- gingivitis
DECRASE in HOST DEFENSE:
- stress
- smoking
- malnutrition
- systemic disease–> measles, HIV, (NUG, NUP)
In NUG, with no systemic effects( NO FEVER) how do you treat it?
- debridement
- H2O2, etc
In NUG, with systemic effects( FEVER) how do you treat it?
-Antibiotics
What are the 3 main zones NUG lesions can be divided into?
1) A grayish psuedomembrane made up of bacteria & PMNs
2) A red, bleeding necrotic zone made up of DEAD and DYING epi cells, bacteria and PMNs.
3) Deeper tissues that have significant numbers of invasive Gram (-) bacteria
What kind of affect does steroids have on the immune system?
- Decrease PMNs
- Decrease chemotaxis
- Decrease phagocytosis
NUG is associated with a _____________ host immunity especially with regard to PMNs.
Why?
- DECREASE
- B/c INCREASED amount of corticosteroids produced during times of significant stress
How can a decreased immunity and poor oral hygiene are thought to work together to cause NUG?
More anaerobic conditions in plaque help gram (-) bacteria to flourish
