Lecture 7 - Periodontal Disease Flashcards
Gingivitis
Inflammation limited to the soft tissues that surround teeth
Gingivitis Clinical Features
Accumulation of dental plaque and calculus
Inflammation can be local or generalized
Diffuse, marginal gingivitis, or papillary gingivitis
Gingivitis Signs
Loss of stippling and bleeding on gentle probing
Erythematous gingiva
Severe cases may have pyogenic granulomas
Gingivitis Epidemiology
Increased susceptibility during puberty
Progesterone (pregnancy) increases permeability of gingival blood vessels
Risk factors: smoking, stress, poor diet
Gingivitis Histology
Inflammatory infiltrate with PMN, then lymphocytes
Gingivitis Treatment
Reduce know risk factors
Improve oral hygiene
Remove plaque
Necrotizing Ulcerative Gingivitis
Vincent Infection, Trench Mouth
Infection caused byspirochetes and bacillus fusiformis in the presence of psychological stress.
NUG Clinical Features
Interdental papillae are highly inflamed, edematous, and hemorrhagic.
Papillae are blunted with crater-like necrosis covered by grey pseudomembrane.
Can lead to loss of attachment
NUG Epidemiology
Mostly seen in young and middle-aged adults and military
Can occur in all ages
NUG Histology
Non-specific
Inflammation, ulceration, necrotic material
NUG Treatment
Debride and rinses to remove bacteria
Resolves quickly
Granulomatous Gingivitis
Unexplained granulomatous inflammation on gingival biopsy
Rule out all other possible causes
May be caused by foreign body in gingival tissue
Granulomatous Gingivitis Clinical Features
Red and white macules at interdental papillae
Pain, sensitivity
Granulomatous Gingivitis Epidemiology
Most frequently in adults
Granulomatous Gingivitis Histology
Granulomas with multinucleated giant cells
Granulomatous Gingivitis Treatment
Surgically excise foreign body
If no foreign body, evaluate for other diseases
Desquamative Gingivitis
Gingival epithelium that sloughs spontaneously or with minor manipulation
Desquamative Gingivitis Epidemiology
Female
> 40 yo
Desquamative Gingivitis Clinical Features
Gradual involvement More facial than lingual Smooth erythema Loss of stippling Painful Can have blisters
Desquamative Gingivitis Histology
Lichen planus or pemphigoid
Desquamative Gingivitis Treatment
Clean area
Doxycycline
Immunosupressants
Drug Related Gingival Hyperplasia
Abnormal growth of gingival tissues secondary to systemic medication due to an increased production of ECM (collagen)
Most common with cyclosporine and phenytoin
Associated with poor dental hygiene???
DRGH Epidemiology
25 and younger
DRGH Clinical Features
Enlargements start in interdental papillae and spread
Dark red, bleeds easily, can ulcerate
Can interfere with speech and mastication
DRGH Histology
Elongated rete ridges
Increased collagen
DRGH Treatment
Discontinue medication
If med can’t be stopped - professional evaluations and home plaque control
Folic Acid
Gingival Fibromatosis
Hyperplasia of gingiva
Gingival Fibromatosis Epidemiology
Familial or idiopathic
Begins < 20 yo
May be associated with hypertrichosis, epilepsy, and mental retardation
Gingival Fibromatosis Clinical Features
Enlarged gingiva
Normal color
Smooth surface
Gingival Fibromatosis Histopathology
Dense hypocellular
Hypovascular tissue
Absent inflammation
Gingival Fibromatosis Treatment
Gingivectomy
Oral hygiene
Sometimes tooth extraction
Periodontitis
Inflammation of gingival tissue with associated loss of bony attchment and support
Risk factors: smoking, diabetes, genetics
Periodontitis Bacteria
Healthy gingiva: facultative gram postitive
Periodontisis: gram negative
-A.a.
-Bacteroides
-Prevotella intermadia
Form biofilm
Release lipopolysaccharides, stimulate inflammation
Chronic Periodontitis
Primary cause of tooth loss in pts >35 yo
No inflammation
Blunting and apical positioning of the gingival margins
Loss of attachment (shown with probe)
Necrotizing Ulcerative Periodontitis
Similar to NUG, with loss of attachment and alveolar bone
May occur in preexisting areas of NUG or periodontitis
Pts are younger
Periodontal Abcess
Occurs in pre-existing periodontal lesion
Can result from super infection
Appears as lateral enlargement of gingiva
May be red with edema or bleeding
Pain, sensitivity on palpation, foul taste, fever
Pericoronitis
Develops around impacted or partially erupted teeth with debris between the gingival flap and the crown
Inflammation
Foul taste
Can’t close jaws, pain may radiate to throat, floor of mouth, or ear
Periodontitis Histology
Hyperplasia of epithelium
Increased vascularity
Inflammation
