Nonplaque induced gingivitis

Question 1

Gingival diseases of specific bacterial origin

Answer 1

Streptococci sp (rare)
Treponema pallidum (Syphilis)
Neisseria gonorrhoea (Gonorrhea)

Question 2

**Gingival diseases of viral origin

Answer 2

1. Primary herpetic gingivostomatitis
   Caused by Herpes Simplex Virus type I (HSV 1)

Mostly seen in children younger then 6 years old

Incubation period is usually 1 week and healing of the lesion usually occurs without scaring

virus remains latent In ganglion cell = reactivation (20-40% of patients) = presents as herpes labialis but recurrent intraoral herpes infections are also seen

Patient experiences pyrexia, malaise, loss of appetite, lymphadenopathy

Question 3

Herpes Labialis

Answer 3

Caused by stress, sunlight, fever, trauma, immunosuppression

Begins as small cluster of vesicles that rapture (Seen on corner of lips but can present elsewhere on mouth extra-orally

When lesion heals, crust forms but heals without scaring

Question 4

Gingival diseases of fungal origin

Answer 4

Patients with:
prosthetic devices with poor OH, decreased salivary flow/secretion, smoking, treatment with corticosteroids, immunocompromised individuals, increased salivary glucose, patients on long-term broad spectrum antibiotics

1. Oral thrash (candidiasis)= Candida albicans
2. Linear gingival erythema

Question 5

Linear Gingival Erythema

Answer 5

Most common clinical characteristic of gingival candida infections is redness of the attached gingiva, often associated with granular surface
May be localized or generalized
Erythematous gingiva may be limited to marginal gingiva, may extend to attached gingiva, alveolar mucosa or maybe diffused

Question 6

Pseudomembranous candidiasis

Answer 6

Also described as “white cottage cheese” appearance

Lesions may appear on buccal mucosa, labial mucosa as well as gingiva (all sections)

Question 7

Gingival diseases of genetic origin

Hereditary gingival fibromatosis

Answer 7

Autosomal dominant mode of inheritance

Uncommon condition, diffuse gingival enlargement/generalized gingival hyperplasia

Has an autosomal dominant mode of inheritance
Characterized by a slow, progressive enlargement of gingiva
The lesions develop irrespective of effective plaque removal
May completely cover teeth, delaying eruption

Question 8

Gingival manifestations of systemic conditions

in the form of desquamative lesions or ulcerations of the gingiva

Answer 8

Lichen Planus :
Inflammatory mucocutaneous condition, bilateral white lesions in the oral cavity (mainly in buccal mucosa regions)
Caused by stresss, medications, hep-c infection etc

Pemphigus vulgaris :
Group of autoimmune diseases characterized by formation of intraepithelial bullae in the skin and mucous membrane

Question 9

Lichen planus

6 P’s
Purple, Polygonal, Pruritic, Planar, Papules, Plaque

Answer 9

4 types of lichen planus

• Erosive
• Plaque
• Reticular (Wickham striae)
• Papular
• Ulcerative
• Bullous

The popular, reticular and plaque forms of LP usually don’t present with symptoms, whereas erythematous and ulcerative are associated with moderate to severe pain (especially in relation to oral hygiene procedures and eating

Question 10

Pemphigus Vulgaris

Answer 10

• Bulla formation is located in the spinous cell layer, therefore bulla ruptures easily because it is not intact
• Antibodies are directed towards desmosomes
• Nikolskys sign is positive
• Acantholysis present
  Disease occurs at any age, but mostly seen in middle aged or elderly
  If left untreated, disease is life threatening
  Early lesions may resemble apthous ulcer

Question 11

Bullous pemphigoid

Answer 11

• Subepithelial bulla formation
• Nikolskys sign is negative
• Antibodies are against the hemidesmosomes

The blisters are firm
No acantholysis
Usually affects elderly people

Question 12

Gingival diseases due to allergic reactions

Clinical manifestation of Type IV allergy (Contact allergy)

Answer 12

(A) Dental restorative materials
(mercury, acrylic, nickel, gold, zinc, chromium, palladium and acrylics)

• Occurs 12-24 hours following contact with allergen
• Lesions look similar to that of Oral Lichen Planus

(B) Reactions to oral hygiene products, chewing gum, food :

• Flavour additives, for instance cinnamon or preservatives

Clinical manifestaions of allergy include a diffuse, fiery red edematous gingivitis, sometimes with ulcerations or whitening

Question 13

Traumatic lesions

Answer 13

1. Chemical = Usually due to Aspirin (Chemical burn), white lesion that at times can be peeled off, leaving a bleeding surface
2. Thermal = Usually due to hot foods, liquids such as coffee, soup etc
3. Physical = Malocclusion, removable dentures (complete or partial) retainers, oral piercings, improper flossing, tooth brush trauma

Question 14

Foreign body reactions

amalgam, abrasives during polishing procedures

Answer 14

Foreign body reactions lead to localized inflammatory conditions of the gingiva (or other areas in oral cavity) and are caused by the introduction of foreign material into the gingival connective tissues through breaks in the epithelium

Common examples are the introduction of amalgam into the gingiva during placement of restoration, extraction of a tooth leaving an amalgam tattoo, or introduction of abrasives during polishing procedures