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Oral Microbiology > Lecture #10 Gingivitis > Flashcards

Lecture #10 Gingivitis Flashcards

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1
Q

What is gingivitis?

A

An inflammation of gingival tissues, due to plaque build-up.

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2
Q

What is gingivitis characterized by?

A

Redness, swelling, and bleeding of the gingival tissues.

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3
Q

What differentiates gingivitis from periodontitis?

A

There is no destruction of the periodontal ligament, no bone loss and no apical migration of the junctional epithelium.

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4
Q

Bacteria and their products in plaque induce what?

A

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

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5
Q

__________ are also chemotactically “called” out of the blood, through the junctional epithelium, and into direct contact with the plaque.

A

PMNs

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6
Q

If the plaque community shifts to containing more gram-negative the inflammatory response can be___?
What happens next?

A

-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

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7
Q

List the steps that occur in the progression from healthy gums to disease?

A

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
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8
Q

Gingivitis is a _____ host inflammatory response to plaque microbial products, with both degree of toxicity and concentration of _________ playing a major role.

A
  • “REVERSIBLE”

- Toxins

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9
Q

Fluctuations in the host capabilities that contribute to disease outcome are brought on by what?

A

-Stress, drugs disease etc. contributing heavily to disease outcome

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10
Q

For all practical purposes gingival health demands an inflammatory response to insure _____________?

A

Plaque bacteria doesn’t invade the tissues

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11
Q

What can cause a the tip from chronic gingivits to periodontitis?

A
  • 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.
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12
Q

Periodontitis usually measurement of ____ loss?

A

PAST

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13
Q

All periodontis pockets display___________?

A

Climax community flora

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14
Q

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)

A
  • Anaerobic

- Gram (-)

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15
Q

initially supragingival plaque contains primarily __________ and ________ species

A
  • Strep

- Actino

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16
Q

As plaque grows a more anaerobic environment begins to appear, this leads to the _________ in __________ _____________ ________________ and the emergence of ________ ______________ and ______________

A
  • INCREASE
  • MICROAEROPHILIC
  • Gram (+) Actino

-Emergence of gram-negative anaerobic rods and Spirochetes

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17
Q

Bleeding induced by the inflammatory reaction provides RBC that are lysed by __________, and this provides the heme needed for _____________ organisms

A
  • Gram (-) bacterial toxins
  • Bacteroides-type organisms

Note: these organisms in turn PRODUCE LPS that is HIGHLY inflammatory

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18
Q

Chronic marginal gingivits is the _______ state of affairs for most of us.
-What inflammatory response is this to?

A

” Normal”

-A non-specific inflammatory response to supra-gingival plaque

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19
Q

As plaque builds up what microbes increase in numbers?

A

Relatively anerobic environemtns can develop and allow anaerobic Gram (+) and Gram (-) to increase in numbers

20
Q

What causes the bleeding in the inflammatory response?

A

The LPS from the gram (-) bacteria causes a more pronounced inflammatory reaction that causes the bleeding.

21
Q

Hormones, drugs, predisposing diseases, stress and some oral habits all contribute to what?

A

To INCREASED susceptibility to more severe sulcular disease

*Impacts gingivitis

22
Q

Evidence shows that what can initiate gingival disease progression ?

A

Evidence is mounting that some interruption of the normal bacteria/host defense balance may initiate progression

23
Q

What can improve the oral health of future generations?

A
  • Understanding and using cytokines and other immune modulators.
  • Improved methods of stress management and plaque removal techniques
24
Q

The severity of gingivitis is a balance between the _______ and the __________ to it.

A
  • Plaque bacteria

- Immune response

25
Q

What are some hormonal factors that can cause chronic gingivitis?

A

1) Pregnancy
2) Puberty
3) Contraceptives
4) Estrogen and progesterone

26
Q

What are some diseases that can cause chronic gingivitis?

A

1) Diabetes
2) Leukemia
3) HIV

27
Q

What are some factors that can cause chronic gingivitis?

A

Stress

leading to elevated corticosteroid levels and suppresed immunity

28
Q

What are some oral habits that can cause chronic gingivitis?

A

1) Smoking
2) Chewing
3) mouth breathing
4) braces

29
Q

In chronic gingivits there is no obvious cause related to what?

A

related to plaque load

30
Q

What is Narcotizing ulcerative gingivitis (NUG) ?

AKA Vincent’s

A

-A painful gingival lesion characterized by a gray pseudo-membrane on the gingiva that lead readily sliughs off revealing a bleeding, necrotic area.

31
Q

The NUG lesion causes what?

  • Onset ?
  • What are the lesions limited to?
A
  • 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
32
Q

NUG patients have shown to have decreased ________ numbers and __________ antibody to the suspected pathogens.

A
  • PMN

- INCREASED Ab

33
Q

What is the classic case of NUG is?

A

“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)

34
Q

Although bacteria invasion is uncommon in _______ , NUG is a _______________ infection.

A
  • Gingivitis

- NUG is a TRUE TISSUE INFECTION (typically a superficial invasion)

35
Q

Which microbes were found in oral sites, which produce noxious sulfur products that cuase the bad breath associated with NUG?

A

Invasive Gram (-) spirochetes (Treponema spp- 30%) and RODS (e.g Prevotella intermedia- 24%)

36
Q

What is the age group this disease is associated with?

A
  • 16-30 years

* Recurrence is common

37
Q

What is the severe type of NUG, invasive bacterial disease, seen in poor malnourished children in sub Saharan Africa?

A

-NOMA

**If diagnosed early and treated w/ inexpensive antibiotics it can prevented.

38
Q

How does NOMA affect patients?

A
  • The disease spreads very rapidly thru the oral cavity and face, w/ huge permanent loose of vital tissue.
  • Death and disfigurement is common
39
Q

What orgnaisms cause NUG?

A
  • 70% GRAM- ROD
  • Porphyromonas gingivalis
  • Prevotella intermedia
  • Fusobacterium nucleatum
  • Treponema vincentii (30%)
40
Q

What are the symptoms of NOMA?

A
  • Bad breath
  • Pseudo necrotic membrane
  • painful, bleeding
  • Ulcerative papillae mainly anterior teeth
41
Q

What are the predisposing factors for NOMA?

A

INCREASE in PATH. FLORA:

  • poorl oral hygiene
  • gingivitis

DECRASE in HOST DEFENSE:

  • stress
  • smoking
  • malnutrition
  • systemic disease–> measles, HIV, (NUG, NUP)
42
Q

In NUG, with no systemic effects( NO FEVER) how do you treat it?

A
  • debridement

- H2O2, etc

43
Q

In NUG, with systemic effects( FEVER) how do you treat it?

A

-Antibiotics

44
Q

What are the 3 main zones NUG lesions can be divided into?

A

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

45
Q

What kind of affect does steroids have on the immune system?

A
  • Decrease PMNs
  • Decrease chemotaxis
  • Decrease phagocytosis
46
Q

NUG is associated with a _____________ host immunity especially with regard to PMNs.

Why?

A
  • DECREASE

- B/c INCREASED amount of corticosteroids produced during times of significant stress

47
Q

How can a decreased immunity and poor oral hygiene are thought to work together to cause NUG?

A

More anaerobic conditions in plaque help gram (-) bacteria to flourish

Oral Microbiology (11 decks)

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