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Perio II > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

What are the clinical parameters that define gingival clinical health?

A
  • Absence of bleeding on probing
  • Erythema
  • Edema
  • Symptoms by the patient
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2
Q

What is the best clinical parameter to differentiate health and gingival inflammation?
How is this parameter assessed?

A

• Bleeding at probing
Assessed as the proportion of bleeding sites, stimulated using a periodontal probe with controlled force (∼0.25N) to apical end of the sulcus at the six sites on all teeth present.

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3
Q

What are the 6 sulcular sites for periodontal probing?

A
  • Mesio-buccal
  • Buccal
  • Disto-buccal
  • Mesio-lingual
  • Lingual
  • Disto-lingual
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4
Q

What is generally associated with clinical gingival health?

A
  • Inflammatory infiltrate
  • Host response consistent with homeostasis
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5
Q

How do we classify clinical gingival health?

A

• Clinical gingival health on an intact periodontium (there is no insertion and bone loss)
• Clinical gingival health on a reduced periodontium.
—– Stable periodontitis patient
—– Non-periodontitis patient

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6
Q

The cause that caused the reduced periodontium in clinical gingival health can be differentiated between stable periodontitis and non-periodontitis patient. Explain what both are.

A
  • Stable periodontitis patient: the attachment and bone loss is to periodontitis, successful treatment and stable condition.
  • Non-periodontitis patient: Insertion and bone loss (eg. recession, crown lengthening)
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7
Q

What is the characteristics of clinical gingival health on an intact periodontium?

A
  • Absence of bleeding on probing
  • Erythema
  • Edema
  • Patient symptoms
  • Attachment and bone loss
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8
Q

What is the characteristics of clinical gingival health on an a reduced periodontium?

A
  • Absence of bleeding on probing
  • Erythema
  • Edema
  • Patient symptoms in the presence of reduced clinical attachment and bone levels.
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9
Q

Do successfully treated and stable periodontitis patients remain at increased risk of recurrent progression of periodontitis?
In non-periodontitis patients, is there increased risk of periodontitis?

A
  • yes
  • there is no current evidence for increased risk of periodontitis.
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10
Q

For an intact periodontium and reduced and stable periodontium, gingival health is defined as…

A

<10% bleeding sites with probing depths ≤3mm or less.

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11
Q

”<10% bleeding sites with probing depths ≤3mm or less” (gingival health) occurs for both in cases of intact and reduced periodontium. But, what is the distinction made in patients with reduced periodontium due to periodontitis?

A

Periodontal Stability:
Is introduced and defined, characterised by -
• success of treatment by controlling local and systemic factors
• obtaining <10% bleeding at probing
• no depth upon probing with bleeding of ≥4mm
• improvement in other clinical parameters
• break on progressive periodontal destruction

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12
Q

Fill table on:

Diagnostic look-up table for gingival health or dental plaque-induced gingivitis in clinical practice

A
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13
Q

What are the gingival phases?

A
  • Stage I Gingivitis - The initial lesion
  • Stage II Gingivitis - The early leasion
  • Stage III Gingivitis - The established lesion
  • Stage IV Gingivitis - The advanced leasion
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14
Q

Describe Stage I Gingivitis - The intial lesion

A
  • First manifestations:
    • Vascular changes - dilated capillaries; increased blood flow
    • Increase in migration + acculmulation of leukocytes in gingival sulcus
      • Coorelated w/ an increase in the flow of gingival fluid into the sulcus
  • Character + intensity of host response = rate of lesion resolution (normal state/chronic inflammatory lesion)
    • Chronic inflammatory lesion
      • Infiltrate of macrophages + lymphoid cells appear within a few days.
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15
Q

Describe Stage II Gingivitis - The early lesion

A
  • Erythema may appear (due proliferation of cappilaries)
  • Bleeding on probing may also be evident
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16
Q

Describe Stage III Gingivitis - The established lesion

A
  • Chronic gingivits
    • Occurs 2-3 weeks after beginning of plaque accumulation.
  • Blood vessels are engorged + congested
  • Venous return is impaired; blood flow is slow
    • Results in localised gingival anoxemia
      • Bluish hue
  • Extravasation of eruthrocytes into Connective Tissue
  • Breakdown of hemoglobin into components
    • Deepens color of chronically inflamed gingiva.
  • Predominance of plasma cells.
  • Time for development of classic “established lesion” may >6 months.
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17
Q

Describe Stage IV Gingivitis - The advanced lesion

A
  • Also called “phase of periodontal breakdown”
  • Extension of lesion into alveolar bone.
  • Gingivitis –> periodontitis
    • Only in ppl who are susceptible.
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18
Q

Dental plaque biofilm-induced gingivitis is defined as …

A

“an inflammatory lesion resulting from interactions between the dental plaque biofilm and the host’s immune-inflammatory response, which remains contained within the gingiva and does not extend to the periodontal attachment (cementum, PDL, alveolar bone). Such inflammation remains confined to the gingiva and does not extend beyond the mucogingival junction and is reversible by reducing levels of dental plaque at the apical to the gingival margin”

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19
Q

Oral health survey Spain 2010 stated that ….

A

85-94% of the spanish population >35years presents gum related problems.

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20
Q

What are the changes that characterise plaque-induced gingivitis are:

A
  • Signs + symptoms that are confined to the gingiva
  • Presence of dental plaque to initiate and/or exacerbate the severity of the lesion
  • Clinical signs of imflammation
    • Enlarged gingival contours due to edema/fibrosis
    • Color transition (red –> blue-red
    • Elevated sulcular temp
    • Bleeding upon stimulation
    • Increased gingival exudate
  • Clinical signs + symptoms associated with stable attachment levels on a periodontium with no loss of attachment or on a stable but reduced periodontium
  • Reversibility of the disease by removing the etiology(ies)
  • Possible rol as a precursor to attachment loss around teeth.
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21
Q

Gingivitis can be differentiated according to the affected anatomical area. What are they?

A
  • Marginal gingivits
  • Papillary gingivitis
  • Diffuse gingivitis
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22
Q

What is Marginal gingivitis?

A

It affects the free gingiva extending from the gingival margin to part of the inserted gingiva

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23
Q

What is Papillary gingivitis?

A

Affects the gingiva in the interporximal area (the papilla)

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24
Q

What is diffuse gingivitis?

A

It affects the inserted gingiva, which extends from the marginal area (free gingiva) to the mucogingival line

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25
Q

Gingivitis can be differentiated according to the extent of the inflamed area. What are they?

A
  • Localised gingivits
  • Generalised gingivits
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26
Q

What is localised gingivitis?

A

Gingivitis limited to one tooth or a group of teeth

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27
Q

What is generalised gingivitis?

A

Gingivitis affecting entire dentition

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28
Q

What is Localised papillary gingivitis?

A

It is attached to one or more interpoximal spaces in a limited area

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29
Q

What is Generalised papilarry gingivitis?

A

Affects most interpoximal spaces

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30
Q

What is localised marginal gingivitis?

A

It is limited to the free gum of a tooth or some

31
Q

What is generalised marginal gingivitis?

A

Affects the entire gum free of an arch or both

32
Q

What is localised diffuse gingivitis?

A

Inflammation extends form the gingival margin to the mucogingival line in a single tooth or in some teeth.

33
Q

What is generalised diffuse gingivitis?

A

It affects the entire gum. The alveolar mucosa and the inserted gum show inflammation, so the anatomical separation between them, the mucogingival line, is erased.

34
Q

Taking into account the temporary course of inflammation, gingivitis can be differentiated into:

A
  • Acute gingivitis
  • Recurrent gingivitis
  • Chronic gingivitis
35
Q

Clinical diagnosis of gingivitis requires a systematic method that explores and records the potential tissue changes that define this pathology. What kind of changes can we expect to find?

A

Changes in:

  • Shape
  • Size
  • Colour
  • Temp
  • Consistency
  • Position + Possibility of spontaneous bleeding or after exploration
36
Q

What are the clinical diagnosis of gingivitis that we expect to find?

A
  • Gingival bleeding on probing
  • Changes in gingiva colour
  • Changes in consistency
  • Changes in gingival contour
  • Changes in gingival texture
37
Q

What are the 2 most premature signs of gingivitis?

A
  • increase in crevicular fluid production
  • Bleeding to the soft probing of the gingival groove.
38
Q

Why does bleeding upon probing have an important early and therefore preventive diagnostic value?

A
  • Due to its ease of clinical detection
  • Appears early
  • More objective than orther clinical changes (colour, sign of inflammation…)
39
Q

How does smoking affect the gingiva?

A
  • Supressess the inflammatory gingival response
  • Exerts a strong suppressive effect on bleeding on probing that is dose-dependent.
  • An increase in bleeding on probing after elimination of smoking habit.
    • Warn patients to avoid alarm
40
Q

What is the normal colour of a healthy gingiva?

What is it produced by?

When is it pale?

What colour change occurs when inflammation intensifies?

A
  • Coral pink
  • The vascularisation of the underlying connective tissue and modified by the degree of keratinisation of the epithelium that convers it.
  • When vascularisation (fibrosis of the dermis) is reduced or epithelial keratinisation (nicotinic parakeratosis) increases.
  • Gingival redness increases until reaching the characteristic red/bluish-red colour of chronic inflammation
41
Q

What is the normal consistency of gingiva?

A
  • Firm
  • Resistant
42
Q

What is the texture of normal gingiva?

A
  • Has small depressions + elevations that give it that “orange peel” appearance.
  • The stippling is limited to the inserted gingiva
    • Located primarily in subpapillary area, extending variably to the papillary area.
  • Pattern + extent of this stippling varies in
    • different areas of the mouth
    • different individuals
    • @ different ages
43
Q

What is a common feature of plaque-induced gingival disease?

What is it also produced/conditioned by?

A
  • Gingiva enlargement
  • systemic conditioning; drugs or genetic characterisitics.
44
Q

Where does the inflammatory gingival enlargement originate as?

A
  • A mild swelling of the interdental papilla and marginal gum.
  • There is a buldge that covers part of the crown of the tooth and, if the cause is not resolved, it usually advances slowly and painlessly.
45
Q

How is the degree of gingival scored?

A
  • Grade 0 - There are no signs of gingival enlargement
  • Grade I - Enlargment limited to the interdental papilla
  • Grade II - Enlargement involves papilla and marginal gingiva
  • Grade III - Enlargement covers 3/4 or more of the crown.
46
Q

What does localised gingival enlargement mean?

A

Limited to the gingiva adjacent to a single tooth or group of teeth

47
Q

What does generalised gingival enlargement mean?

A

involving the gingiva throughout the mouth

48
Q

What does marginal gingival enlargement mean?

A

confined to the marginal gingiva

49
Q

What does papillary gingival enlargement mean?

A

Confined to the interdental papilla

50
Q

What does diffuse gingival enlargement mean?

A

Involving the marginal and attached gingiva and papilla

51
Q

What does discrete gingival enlargement mean?

A

An isolated sessile or pedunculated, tumorlike enlargement.

52
Q

Depending on its temporal evolution, Gingival enlargement can be defined as…

A
  • Chronic
  • Acute
53
Q

What causes chronic inflammatory gingival enlargement?

A

Prolonged exposure to dental plaque

54
Q

What are the factors that favor plaque accumulation and retention?

A
  • Poor oral hygiene
  • irritation by anatomic abnormalities
  • Improper restorative and orthodontic appliances.
  • Oral breathing (favours plaque accumulation)
55
Q

What is acute inflammatory gingival enlargement? What is it limited by (location)? How does it appear in its early stages/within 24-48 hours?

A
  • Localised
  • Painful
  • rapidly expanding lesion
  • Usually sudden onset
  • Limited to the marginal gingiva or interdental pailla.
  • Early stages - red swelling w/ smooth, shiny surface
  • 24-48h - lesion is fluctuant and pointed with a surface orifice where pus may be expressed.
56
Q

Depending on its location and possible tissues affection, abscesses can be classed as…

A
  • Gingival abscess
  • Periodontal Abscess
57
Q

Gingival enlargement is a well-known consequence of the administration of what? and may cause what problems?

A
  • some anticonvulsants
  • some immunosuppressants
  • some calcium channel blockers
  • speech
  • mastication
  • tooth eruption
  • aesthetic problems
58
Q

How does drug-induced gingival enlargement grow? and how does its growth progress? And when it is uncomplicated by inflammation?

A

Growth starts as painless, beadlike enlargement of the interdental papilla and extend to the facial and lingual gingival margins.

The marginal and papillary enlargements unite - they may develop into a massive tissue fold convering a considerable protion of the crowns, and they may interfere with occlusion.

The lesion is mulberry shaped, firm, pale pink, and resilient, with a small lobulated surface and no tendency to bleed.

59
Q

What anticonvulsant will lead to gingival enlargement?

Gingival enlargement occurs in about what % of patients receiving this anticonvulsant?

A

Phenytoin (Dilantin) - is a hydantoin fror the treatment of all forms of epilepsy

50% of patients receiving the drug.

60
Q

What immunosuppressants will lead to gingival enlargement?

A

Cyclosporine - is a potent immunosupressive agent used to prevent organ transplant rejection and to treat several diseases of autoimmune origin.

It affects children more frequently.

Occurence: 25-70%

61
Q

What calcium channel blockers is most frequently used? and for what?

A

Nifedipine - induces gingival enlargement in 20% pts.

Treatment of cardiovascular conditions such as hypertension, angina pectoris, coronary artery spasms, and cardiac arrhythmias.

62
Q

Idiopathic enlargement has been designated terms such as…

A
  • Gingivomatosis
  • Elephantiasis
  • Idiopathic fibromatosis
  • Hereditary gingival hyperplasia
  • Congenital familial fibromatosis
63
Q

What does the Idiopathic enlargement affect?

A
  • The attached gingiva
  • Gingival margin
  • interdental papillae
64
Q

Many systemic disease can develop oral manifestations that may include gingival enlargement. These diseases and conditions can affect the periodontium by 2 different mechanisms. What are they?

A
  • Magnification of an existing inflammation initiated by dental plaque.
  • Manifestation of the systemic disease independetly of the inflammatory status of the gingiva.
65
Q

Magnification of an existing inflammation initiated by dental plaque (enlargement related to systemic diseases) includes…

A
  • Hormonal conditions (enlargement in pregnancy/puberty)
  • nutritional diseases (enlargement in vit C deficiency)
  • Pyogenic Granuloma
  • Where systemic influence not identified (nonspecific conditioned enlargement)
  • Plasma cell gingivitis.
66
Q

What causes enlargement in pregnancy?

What happens to subgingival microbiota?

A

Increase in levels of both progesterone and estrogen.

Undegoes some changes, including an increase in Prevotella intermedia.

67
Q

What appearance does Enlargement have in puberty and how does it normally come about?

A

Its appearance is sporadic and related to the level of plaque control (in areas of plaque accumulation).

68
Q

What disease is the enlargement in vitamin C deficiency related to?

What does acute vitamin C deficiency cause/not cause?

How do these causes modify the response of the gingiva to plaque?

A

Scurvy

It does not cause gingival inflammation. But does cause bleeding, collagen degeneration, and edema of gingival connective tissue.

To the extent that the normal defensive delimiting reaction is inhibited, and the extent of the inflammation is exaggerated, resulting in the massive gingival enlargement seen in scurvy.

69
Q

What is pyogenic granuloma?

Treatment method?

A

Tumorlike gingival enlargement. The exact nature of the systemic conditioning factor has not been identified.

Treatment is surgical.

70
Q

What benign tumours (gingival tumors) cause neoplastic enlargements?

A
  • Fibromas
  • Papillomas
  • Peripheral Giant Cell Granuloma
  • Leukoplakia
  • Gingival Cysts
  • Malignant Tumours
  • Sqaumous cell carcinoma
  • Malignant melanoma
  • Sarcoma
  • Metastasis

(check their defintion in the lecture)

71
Q

What are false enlargements?

What are osseous lesions?

A

They are not true enlargements of the gingival tissues but may appear as such as a result of increases in size of the underlying osseous or dental tissue.

Enlargement of the bone subjacent to the gingival area occurs most often in tori and exostoses, but it can also occur in Paget’s disease, fibrous dysplasia, cherubism, central giant cell granuloma, ameloblastoma, osteoma, osteosarcoma.

72
Q

[On acute gingival infections - page 23 of lecture]

A
73
Q
A

Perio II (1 decks)

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