Lecture 10 - Gingivitis

Question 1

Gingivitis definition

Name 3 ways to characterize it

Answer 1

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

- Characterized by redness, swelling, edema and bleeding of the gingival tissues

Question 2

What differentiates gingivitis from periodontitis?

Answer 2

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

Question 3

If the plaque community shifts to one containing more G- bacteria, what happens to the inflammatory response?

Answer 3

It will become more pronounced

Question 4

4 things characterizing periodontitis

Answer 4

1. Bone loss
2. Attachment loss
3. Fibrotic margins
4. Loss of stipleing

Question 5

Is Gingivitis reversible?

Answer 5

Yes, it is a reversible host inflammatory response to plaque microbial products

Question 6

T or F, most chronic gingivitis sites do not go on to periodontitis, even when not treated

Answer 6

True

Question 7

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)

Answer 7

One with more anaerobic, gram-negative bacteria

Question 8

As plaque load grows in supragingival area, what type of environment begins to appear? What is the result of this?

Answer 8

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

Question 9

What occurs to the bacteria community when bleeding is induced by the inflammatory reaction of gingivitis

Answer 9

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.

Question 10

T or F, The LPS from the G- bacteria causes a more pronounced inflammatory reaction that causes bleeding

Answer 10

True

Question 11

Dr. H. Loe conducted an experiment that showed what?

Answer 11

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!!!

Question 12

What 5 things contribute to increased susceptibility to more severe sulcular disease?

Answer 12

1. Hormones
2. Drugs
3. Predisposing diseases
4. Stress
5. Some oral habits

Question 13

T or F, There is no supporting evidence that some interruption of the normal bacteria/host defense ‘balance’ may initiate gingival disease progression.

Answer 13

False, There is mounting evidence that this does occur

Question 14

What is NUG

Answer 14

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.

Question 15

Where are NUG lesions usually limited to?

Answer 15

To the tips of the gingival papillae

Question 16

T or F, NUG patients have been shown to have decreased PMN numbers as well as decreased antibody to the suspected pathogens

Answer 16

False, Antibodies are increased

Question 17

What is the classic case of NUG?

Answer 17

trench mouth in soldiers in combat

Question 18

Why might patients develop NUG?

Answer 18

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

Question 19

Is bacteria invasion uncommon in gingivitis?

Answer 19

Yes it is uncommon

Question 20

Is NUG a true tissue infection

Answer 20

Yes, typically a superficial invasion.

Question 21

In one study of NUG, what bacterial species were found in the tissue?

Answer 21

Gram-negative spirochetes (Treponema) and rods (Prevotella, which produce noxious sulfur products that cause bad breath associated with NUG)

Question 22

What causes the bad breath associated with NUG

Answer 22

G- rods – Prevotella which produce noxious sulfur products that cause bad breath

Question 23

NUG is a disease found in what group of people?

Answer 23

A disease of young adults 16-30 yrs.

Question 24

A similar condition to NUG has been seen in what type of patients?

Answer 24

HIV patients

Question 25

What is the much more severe type of NUG and where is it found?

Answer 25

Called NOMA, seen in poor malnourished children in sub-Saharan Africa.

Question 26

NUG is found usually on what teeth?

Answer 26

Mainly anterior teeth

Question 27

What 4 bacteria are associated with NUG?

Answer 27

70% G- Rods
- P. gingivalis
- P. intermedia
- F. nucleatum
30% G- Spirochetes
- T. vincentii

Question 28

Is NUG transmissible? Are recurrences common?

Answer 28

Not transmissible

Recurrence common

Question 29

The NUG lesion can be divided into what 3 main zones?

Answer 29

1. Grayish psuedomembrane made up mainly of bacteria and PMNs
2. A red, bleeding necrotic zone, made up of dead and dying epithelial cells, bacteria, and PMNs
3. Deeper tissues that have significant numbers of invasive G- bacteria

Question 30

One of the major causes of NUG being associated with decreased host immunity, especially with regard to PMNs

Answer 30

May ben an increased amount of corticosteroids produced during times of significant stress