Lecture 10 - Gingivitis Flashcards
Gingivitis definition
Name 3 ways to characterize it
an inflammation of gingival tissues, due to plaque build-up.
- Characterized by redness, swelling, edema 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.
If the plaque community shifts to one containing more G- bacteria, what happens to the inflammatory response?
It will become more pronounced
4 things characterizing periodontitis
- Bone loss
- Attachment loss
- Fibrotic margins
- Loss of stipleing
Is Gingivitis reversible?
Yes, it is a reversible host inflammatory response to plaque microbial products
T or F, most chronic gingivitis sites do not go on to periodontitis, even when not treated
True
The progression of the plaque community to one with what appears to be key to the induction of exudate and bleeding in gingivitis ( as well as periodontitis)
One with more anaerobic, gram-negative bacteria
As plaque load grows in supragingival area, what type of environment begins to appear? What is the result of this?
A more anaerobic environment begins to appear
- This leads to the increase in microaerophilic, gram-positive Actino., and the emergence of gram-negative anaerobic rods and spirochetes
What occurs to the bacteria community when bleeding is induced by the inflammatory reaction of gingivitis
Bacteroides-type organisms begin to thrive because the red blood cells provided by the inflammatory reaction are lysed by G- bacterial toxins, thus providing the heme needed for the bacteroides organisms to survive. These organisms in turn produce LPS that is highly inflammatory.
T or F, The LPS from the G- bacteria causes a more pronounced inflammatory reaction that causes bleeding
True
Dr. H. Loe conducted an experiment that showed what?
Showed the relationship between plaque build-up and progression of gingivitis. Once a person stopped brushing, their plaque level increased, as did their gingivitis index. G- bacteria increased, but after the person started to brush again, their gingivitis subsided. It is reversible!!!
What 5 things contribute to increased susceptibility to more severe sulcular disease?
- Hormones
- Drugs
- Predisposing diseases
- Stress
- Some oral habits
T or F, There is no supporting evidence that some interruption of the normal bacteria/host defense ‘balance’ may initiate gingival disease progression.
False, There is mounting evidence that this does occur
What is NUG
Necrotizing ulcerative gingivitis (or Vicnent’s infection)
- A painful gingival lesion characterized by a gray pseudo-membrane on the gingiva that readily sloughs off revealing a bleeding, necrotic area. 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.
Where are NUG lesions usually limited to?
To the tips of the gingival papillae
T or F, NUG patients have been shown to have decreased PMN numbers as well as decreased antibody to the suspected pathogens
False, Antibodies are increased
What is the classic case of NUG?
trench mouth in soldiers in combat
Why might patients develop NUG?
The patients are usually debilitated by some other disease or very stressed - leading to elevated corticosteroid levels and suppressed immunity.
- This stress is often exaggerated by poor sleep, poor eating habits, smoking and poor plaque control
Is bacteria invasion uncommon in gingivitis?
Yes it is uncommon
Is NUG a true tissue infection
Yes, typically a superficial invasion.
In one study of NUG, what bacterial species were found in the tissue?
Gram-negative spirochetes (Treponema) and rods (Prevotella, which produce noxious sulfur products that cause bad breath associated with NUG)
What causes the bad breath associated with NUG
G- rods – Prevotella which produce noxious sulfur products that cause bad breath
NUG is a disease found in what group of people?
A disease of young adults 16-30 yrs.
A similar condition to NUG has been seen in what type of patients?
HIV patients
What is the much more severe type of NUG and where is it found?
Called NOMA, seen in poor malnourished children in sub-Saharan Africa.
NUG is found usually on what teeth?
Mainly anterior teeth
What 4 bacteria are associated with NUG?
70% G- Rods - P. gingivalis - P. intermedia - F. nucleatum 30% G- Spirochetes - T. vincentii
Is NUG transmissible? Are recurrences common?
Not transmissible
Recurrence common
The NUG lesion can be divided into what 3 main zones?
- Grayish psuedomembrane made up mainly of bacteria and PMNs
- A red, bleeding necrotic zone, made up of dead and dying epithelial cells, bacteria, and PMNs
- Deeper tissues that have significant numbers of invasive G- bacteria
One of the major causes of NUG being associated with decreased host immunity, especially with regard to PMNs
May ben an increased amount of corticosteroids produced during times of significant stress
