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perio > lecture 4: periodontal health gingival ds/conditions > Flashcards

lecture 4: periodontal health gingival ds/conditions Flashcards

1
Q

microscopic features of periodontal health

A
  • gingival epithelium
  • gingival CT
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2
Q

parts of gingival epithelium

A
  • oral epithelium
  • sulcular epithelium
  • junctional epithelium
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3
Q

keratinized or non keratinized:
oral epithelium
sulcular epithelium
junctional epithelium

A

oral epithelium - keratinized

sulcular epithelium - non-keratinized, semi perm membrane, no rete pegs

junctional epithelium- non-keratinized attached to tooth with hemidesmosomes infiltrate by PMN.

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4
Q

supracrestal tissue attachment size

A

2.04
JE = 0.97
CTA = 1.07

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5
Q

color of healthy

A
  • coral pink on marginal/attached gingiva
  • red smooth shiny on alveolar mucosa
  • physiologic pigmentation
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6
Q

size of healthy

A
  • size should correspond with the sum total of the bulk of cellular and intercellular elements and vascular supply
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7
Q

consistency of healthy

A
  • firm and resilient (gingival fibers)
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8
Q

surface texture of healthy

A
  • stippled on the attached gingiva BUT not always a sign of health, only 40% of pts will have it on attached gingiva.
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9
Q

contour of healthy

A
  • scalloped and collar-like fashion
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10
Q

shape of healthy

A
  • pyramidal towards the anterior, flattened towards the posterior
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11
Q

position of healthy

A
  • the level at which the gingival margin is attached to the tooth
  • continuous tooth eruption - active and passive eruption - altered passive eruption
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12
Q

definition of gingival health

A

absence of clinically detectable inflammation

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13
Q

3 determinants to initiate ds

A
  • Microbiological determinants
  • host determinants
  • environmental determinants
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14
Q

microbiological determinants are

A
  • supragingival plaque
  • subgingival plaque
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15
Q

host determinants are

A
  • local predisposing factors
    (periodontal pockets, restorations, root anatomy, tooth position and crowding)
  • systemic modifying factors
    (host immune function, systemic health, genetics)
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16
Q

environmental determinants are

A
  • smoking
  • medication
  • stress
  • nutrition and lack of vitamins
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17
Q

indicators for perio/gingival ds

A
  • BOP
  • Peridontal probing
  • Radiographic features
  • Tooth mobility
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18
Q

which is a reliable sign of ds for indicators

A

BOP

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19
Q

indicators - radiographic features

A
  • if there is a well defined lamina dura = sign of healthy periodontium
  • but if do not have, and this is the only sign it could be an xray prob
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20
Q

clinical features of intact periodontium

A
  • no clinical attachment loss or bone loss
  • inflammation is minimum <10%
  • PD within 3mm
  • no erythema and edema
  • physiological bone levels range from 1-3mm (avg 2mm) apical to the CEJ
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21
Q

clinical feature of a reduced periodontium

A
  • BOP more than 10%
  • PD within 3mm
  • no edema, erythema and pt symptoms in the presence of reduced clinical attachment and bone levels
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22
Q

two types of gingivitis

A
  • dental plaque-induced gingival ds
  • non-plaque-induced gingivial ds
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23
Q

how does smoking play a role in clinical findings of gingivitis

A
  • smoking masks BOP by suppressing inflammatory response
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24
Q

clinical findings of gingival features pale color means what

A

reduced vascularization or increased keratinization

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25
Q

clinical findings of gingival features coral pink color means what

A

normal

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26
Q

clinical findings of gingival features red to blueish red color means what

A
  • inflammation intensity
  • red or blueish red: vascular proliferation or reduced keratinization
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27
Q

clinical findings of gingival features gray color means what

A

tissue necrosis

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28
Q

chronic forms of consistency change in clinical findings

A
  • soggy puffiness
  • softness and friability
  • firm, leathery consistency
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29
Q

acute forms of consistency change in clinical findings

A
  • sloughing with grayish, desquamative debris
  • vesicle formation
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30
Q

if the surface texture is smooth shiny, then what is the indication

A

epithelial atrophy in atrophic gingivitis

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31
Q

if the surface texture is peeling, then what is the indication

A

chronic desquamative gingivitis

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32
Q

if the surface texture is leathery, then what is the indication

A

hyperkeratosis

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33
Q

if the surface texture is nodular, then what is the indication

A

drug-induced gingival overgrowth (like with high bp meds and Ca2+ blockers)

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34
Q

two types of recession

A
  • visible and hidden
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35
Q

visible recession

A

is clinically observable and you have an exposed root

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36
Q

a hidden recession

A

is covered by gingiva, can be measured by probing to the level of epithelial attachment

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37
Q

two types of position of gingiva

A

apparent and actual

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38
Q

the severity of clinical findings of the gingiva is determined through

A

the actual position of gingiva

measured from the coronal end of the epithelial attachment of the tooth vs apparent position is measured up to the level of the crest of the gingival margin

39
Q

exposed roots are susceptible to

A

caries, hypersensitivity, pulp symptoms, plaque accumulation

40
Q

what is McCall festoons

A

rolled up margins

  • a rolled, thickened band of gingiva. Close to the mucogingival junction. Usually adjacent to the cuspid.
41
Q

what are stillman’s clefts

A
  • narrow triangular shaped gingival recession
  • cleft becomes broader when progressing apically
42
Q

gingival features - designation

A
  • localized (gingiva adjacent to one or a group of teeth) OR generalized (involving the gingiva throughout the mouth)
43
Q

types of localized designations

A

marginal and papillary

marginal is confined to marginal gingiva

papillary is confined to interdental papilla

44
Q

types of generalized designations

A
  • diffuse involves marginal, attached gingiva and papilla
  • discrete is an isolated sessile or pednucleate, tumor like enlargement
45
Q

the degree scoring system and each grade

A

it is grade 0 to III.

grade 0: no signs of gingival enlargement

grade I: confined to the interdental papilla

grade II: involves papillae and marginal gingiva

grade III: enlargement covers more than 3/4 of the crown.

46
Q

how would you describe this?

A
  • localized because is limited to the gingiva adjacent to the one tooth or a group
  • diffuse because it inovlves marginal, attached gingiva and papilla
  • grade II because it involves papillae and marginal gingiva
47
Q

characteristics of plaque induced inflammation

A
  • clincial signs and symptoms are confined in the gingival unit
  • systemic modifying factors
  • stable attachment may or may not experience further attachment loss
  • reversibility
48
Q

modifying factors of systemic conditions for plaque induced

A
  • steroid hormones (puberty, menstrual cycle, pregnancy, oral contraceptives)
  • smoking
  • hyperglycemia
  • leukemia
  • malnutrition
49
Q

local/predisposing factors for plaque induced

A
  • prominent subgingival restoration margins
  • hyposalivation
50
Q

drug-induced gingival enlargements

A
  • antiepileptic drugs/dilactin
  • Ca2+ channel blockers/ nifedipine, verapamil, diltiazem, amlodipine, felodipine
  • Immunoregulating drugs/ cyclosporine
  • High-dose oral contraceptives
51
Q
A
52
Q

non-plaque induced gingival ds genetic abnormalities

A

hereditary gingival fibromatosis

53
Q

non-plaque induced gingival ds- specific infection

A

bacteria (necrotizing peridontal ds), viral or fungal

54
Q

non-plaque induced gingival ds- inflammatory and immune conditions

A
  • contact allergy
  • pemphigus vulgaris
  • pemphigoid
  • lichen planus
55
Q

non-plaque induced gingival ds-neoplasms

A
  • leukoplakia
  • erythroplakia
  • SCC
  • leukemia
  • lymphoma
56
Q

non-plaque induced gingival ds- endocrine, nutritional, metabolic ds

A
  • scurvy
  • toothbrushing trauma
  • etching
  • burning
57
Q

non-plaque induced gingival ds- gingival pigmentation

A

a type of gingival ds potentially or if its abnormal

58
Q

how can clinical signs of inflammation manifested in gingivitis

A
  • swelling, with loss of knife edged gingiva
  • bleeding on gentle probing
  • redness
  • discomfort on gentle probing
59
Q

can you use xrays to dx gingivitis

A

no becaue you cannot tell inflammation of the SOFT tissues with an xray

60
Q

gingivitis case could be simply, objectively and accurately identified and graded using what

A

bleeding on probing score.

61
Q
A
62
Q

a case of dental plaque-induced gingivitis is defined as

A

more than or equal to 10% bleeding site with probing depths less than or equal to 3mm

63
Q

how much % bleeding sites for localized gingivitis

A

10 to 30 %

64
Q

generalized gingivitis % bleeding sites

A

more than 30%

65
Q

what is desquamative gingivitis

A

NOT A DX, BUT A FINDING/clinical term

  • it is ds clinically presenting as desquamative gingivitis
  • you need a series of laboratory results for final dx and corresponding tx.
66
Q

which ds clinically present as desquamative gingivitis

A
  • lichen planus
  • pemphigoid
  • pemphigus vulgaris
  • lupus erythematosus
  • erythema multiforme
  • necrotizing stomatitis
67
Q

desquamative gingivitis - lichen planus

A

= an immunologically-mediated mucocutaneous disorder

  • t-lymphocytes play a central role
  • prevalent in middle aged and older F
  • 5 subtypes: reticular, erosive, patch, atrophic, bullous. Oral lesions: more than gingiva is involved and gingival lesion: restricted in gingiva.
68
Q

what type of desquamative gingivitis is this

A

lichen planus

69
Q

what type of desquamative gingivitis is this

A

pemphigoid

70
Q

what type of desquamative gingivitis is this

A

pemphigus vulgaris

71
Q

what type of desquamative gingivitis is this

A

lupus erythematosus

72
Q

what type of desquamative gingivitis is this

A

erythema multiforme

73
Q

what type of desquamative gingivitis is this

A

necrotizing stomatitis

74
Q

what type of desquamative gingivitis is this

A

lichen planus

reticular lesion

75
Q

what type of desquamative gingivitis is this

A

lichen planus

keratotic lesion

76
Q

what type of desquamative gingivitis is this

A

lichen planus

bullous lesion

77
Q

what type of desquamative gingivitis is this

A

lichen planus

erosive/ulcerative lesion

78
Q

what type of desquamative gingivitis is this

A

lichen planus

erosive/ulcerative lesion

79
Q

desquamative gingivitis - pemphigoid

A
  • a cutaneous, immune-mediated, sub epithelial ds
  • separation of the basement membrane zone

- Has 3 conditions:

  1. pemphigoid gestiations
  2. bullous pemphigoid

3. mucous membrane pemphigoid

80
Q

what type of desquamative gingivitis is this

A

pemphigoid

bullous pemphigoid predom skin lesion

81
Q

what type of desquamative gingivitis is this

A

mucous membrane pemphigoid

characteristic of ocular lesion

82
Q

what type of desquamative gingivitis is this

A

mucous membrane pemphigoid

83
Q

what type of desquamative gingivitis is this

A

pemphigoid

mucous membrane pemphigoid

84
Q

for desquamative gingivitis pemphigoid what do you see in the mucous membrane pemphigoid oral lesions

A
  • nikolyskys signs
  • attached gingiva
  • bullae rupter in 2-3 days
  • healing takes up to 3 weeks
85
Q

desquamative gingivits - lupus erythematosus

A
  • an autoimmune ds with 3 clinical presentations

systemic, chronic cutaneous and subacute cutaneous

-it an oral lesion: ulcerative or lichen-planus like

86
Q

what type of desquamative gingivitis is this

A

gingival discoid lupus erythematosus lesion

ulcerative or lichen planus like

in the attached gingiva

87
Q

desquamative gingivitis - erythema multiforme

A
  • a reactive acute vesiculobullous ds
  • mucocutaneous inflammatory ds
  • broad spectrum from self-limiting to severe progression
  • predom in young individuals
88
Q

what type of desquamative gingivitis is this

A

erythema multiforme

oral lesion

swollen lip

crust formation

89
Q

what type of desquamative gingivitis is this

A
  • ruptured bullae
  • extensive ulcers
  • pseudomembranes
90
Q

what type of desquamative gingivitis is this

A

erythema multiforme

  • skin lesions
  • iris appearance these signs help you dx more accurately
91
Q

desquamaative gingivitis - necrotizing stomatitis

A
  • an inflammatory, destructive gingival condition
  • young adults (HIV) infected individuals
  • Characteristics of gingival lesion (punched out apperance and pseudomembrane)

- may develop fever and malaise

92
Q

what type of desquamative gingivitis is this

A

necrotizing stomatitis

punched out lesion

93
Q

what type of desquamative gingivitis is this

A

necrotizing stomatitis

extensive ulcers

94
Q

what is pseudomembrane for necrostizing stomatitis

A
  • leukocytes, fibrin, and necrotic tissue
  • masses of bacteria

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