periodontal health, gingival disease and conditions - periodontitis

Question 1

what are the periodontal treatment?

Answer 1

examination
diagnosis
establish risk and consider prognosis
intervention

Question 2

how do we define gingivitis at a site level (biological and clinical)?

Answer 2

defining inflammation at a site level is quite distinct from defining a case of gingivitis.
a universal case definition is essential to facilitate population surveillance for clinician setting therapeutic targets, and to enable assessment of the efficacy of prevention and or treatment regimes
there are broadly two categories of gingival disease;
- dental plaque biofilm induced gingivitis
- non dental plaque induced gingival disease

Question 3

compare and contrast dental plaque biofilm induced gingivitis and non dental plaque induced gingival disease

Answer 3

dental plaque biofilm induced;
- associated with biofilm alone
- mediated by systemic or local risk factors ; systemic (smoking, hyperglycaemia, nutritional factors and sex steroid hormones, haematological conditions). local risk factors (dental plaque biofilm retention factors and oral dryness)
- drug- influenced gingival enlargement

gingival disease non dental plaque induced;
- genetic/development disorder (hereditary gingival fibromatosis)
- specific infections; bacterial origins (neisserigonorrhoeae, treponemapatllidum, mycrobacteriumtuberculosis, and streptococcal gingivitis). viral origin (coxsackie virus, herpes simplex, vercella zoster, molluscum contagiousm, human papilloma virus). fungal origin (candidiasis and other mycoses)
- inflammatory and immune conditions; hypersensitivity reactions (contact allergy, plasma cells gingivitis, erythema multiform), autoimmune disease of skin and mucous membranes (pemphigus vulgarisms, pemphigoid, lichen planus and lupus eythematosus). granulomatous inflammatory lesions (Crohn’s disease and sarcoidosis)
- reactive process; epulides (fibrous epulis, calcifying fibroblastic granuloma, vascular epulis and peripheral giant cell granuloma)
- neoplasms; pre malignancy (leukoplakia, eythroplakia). malignancy (squamous cell carcinoma, leukemic cell infiltration, lymphoma)
- endocrine, nutritional and metabolic disease; vitamin deficiencies (vitamin C deficiency- scurvy)
- traumatic lesions; physical/mechanical trauma (frictional keratosis, mechanically induced gingival ulceration, factitious injury) chemical toxic burn, thermal insults (burns to gingiva)
- gingival pigmentation; melanoplakia, smokers melanosis, drug - induced pigmentation and amalgam tattoo

Question 4

gingivitis can be further classified as …

Answer 4

depending on whether occurs on intact or reduced periodontist, or in patient diagnoses with periodontitis, gingivitis can be further classified as
gingivitis on an intact peridontium
gingivitis on a reduced periodontist in a non - periodontitis patient e.g recession, crown lengthening
gingival inflammation on a reduced periodontist in successfully treated periodontist patient.

Question 5

gingivitis - dental plaque biofilm induced

Answer 5

an inflammatory lesion resulting from interaction between plaque biofilm and the host’s immune inflammatory response, which remains contain within gingiva and does not extend to the periodontal attachment