Periodontal Health, Gingival Disease:Conditions Flashcards
(107 cards)
1
Q
Periodontal Health
A
Absence of clinically
detectable inflammation A state free from inflammatory periodontal disease
2
Q
Periodontal Health
A
“A state free from inflammatory
periodontal disease that allows an
individual to function normally and
avoid consequences (mental and
physical) due to current or past
disease.”
3
Q
Impact
(5)
A
Cardiovascular diesases
Respiratory disease
Diabetes
Pregnancy complications
Others: Dementia, Cancers
4
Q
Importance
To find the common —
for assessing disease and determining
the meaningful treatment outcomes.
A
reference point
5
Q
Periodontium
(4)
A
- Gingiva
- PDL
- Cementum
- Alveolar process
6
Q
Macroscopic (clinical features)
(4)
A
- Marginal Gingiva
- Gingival Sulcus
- Attached Gingiva
- Interdental Gingiva
7
Q
Microscopic
(2)
A
- Gingival Epithelium
- Gingival Connective Tissue
8
Q
Oral epithelium
A
*Keratinized, turnover rate 30
days
9
Q
Sulcular epithelium
A
*Non-keratinized, no rete pegs,
semipermeable membrane
10
Q
Junctional epithelium
A
*Non-keratinized, attached via
hemidesmosomes, infiltrate by
PMN, turnover rate 7-10 days
11
Q
Microscopic
* Gingival Connective Tissue
(2)
A
Connective tissue presents a
diffuse, amorphous ground
substance and collagen fibers.
Blood vessels stand out clearly in
the papillary projections of the
connective tissue.
12
Q
Biologic width
A
2.04 mm
13
Q
Replaced “Biologic Width”
A
Supracrestal Tissue Attachment
14
Q
Color:
(3)
A
- Coral pink on marginal/attached gingiva
- Red smooth shiny on alveolar mucosa
- physiologic pigmentation
15
Q
Size:
A
Should corresponds
with the sum total of the bulk
of cellular and intercellular
elements and vascular
supply
16
Q
Consistency:
A
Firm and
resilient (gingival fibers)
17
Q
Surface texture:
A
Stippled on
the attached gingiva
18
Q
Contour:
A
Scalloped and collar-like fashion
19
Q
Shape:
A
Pyramidal towards the anterior,
flattened towards the posterior
20
Q
Position:
A
the level at which the gingival margin
is attached to the tooth
21
Q
Continuous tooth eruption-
A
active and passive
eruption- altered passive eruption
22
Q
Microbiological
Determinants
(2)
A
Supragingival plaque
Subgingival plaque
23
Q
Host
Determinants
Local predisposing factors
(4)
A
Periodontal pockets
Restorations
Root anatomy
Tooth position and crowding
24
Q
Environmental
Determinants
(4)
A
Smoking
Medication
Stress
Nutrition
25
Systemic modifying factors
(3)
Host immune function
Systemic health
Genetics
26
Indicators
Bleeding on Probing
(BOP):
Periodontal Probing:
Radiographic Features:
Tooth Mobility:
light pressure 0.25N
Inadequate for diagnosis when used alone
Lamina dura, The distance of 2mm from the most
coronal part of the alveolar crest to CEJ
Not recommended
27
Clinical Gingival
Health on an Intact Periodontium
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -
** Physiological bone levels range
from
<10%
≤3mm
No
No
1-3 mm (average 2mm) apical
to the CEJ
28
Clinical Gingival
Health on a Reduced
Periodontium: Stable Periodontitis Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -
<10%
≤4mm
(no site ≥4mm with BOP)
Yes
Yes
I.e., a patient with a history of periodontitis
who is currently periodontally stable
29
Clinical Gingival
Health on a Reduced
Periodontium:
Non-periodontitis
Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -
<10%
≤3mm
Yes
Possible
I.e., recession; crown lengthening.
30
Pristine periodontal health
Total absence of of clinical inflammation and physiological immune surveillance with no attachment or
bone loss
Not likely to be observed clinically
31
Clinical periodontal health
Absence or minimal levels of clinical inflammation in a periodontist with no attachment or bone loss
32
Periodontal disease stability
In a reduced periodontium
33
Periodontal disease remission/control
In a reduced periodontium
Control modifying factors and therapeutic response
34
Clinical gingival health can be restored following treatment. However,
the treated and stable periodontitis patient with
current gingival health remains at increased risk of
recurrent periodontitis, and must be closely monitored.
35
Gingivitis
“Gingivitis is the inflammation of the
gingival tissues without loss of
connective tissue attachment.”
36
Bleeding on Probing
(4)
* One of the early signs
* Prior to color change or other visual signs of inflammation
* Excellent negative predictor (absence of BOP) of future
attachment loss
* Smoking masks BOP by suppressing inflammatory response
37
Early sign: bleeding on probing Under microscope
* Dilation and engorgement of the
capillaries and thinning or ulceration
of the sulcular epithelium
* Vasculitis of blood vessels adjacent to
the junctional epithelium
* Progressive destruction of the
collagen fiber network (collagen-poor)
* Cytopathologic alterations of resident
fibroblasts (cell-rich)
* Progressive infiammatory immune
cellular infiltrate (predominantly
lymphocytic)
38
Change in Gingival Features
* Color:
* Patterns:
important clinical sign of gingival disease
marginal, diffuse or patchlike
39
Change in Gingival Features
Consistency:
Acute Forms
(2)
Chronic Forms
(3)
result from the predominance of the
destructive (edematous) and reparative (fibrotic)
changes
• Sloughing with grayish,
desquamative debris
• Vesicle formation
• Soggy puffiness
• Softness and friability
• Firm, leathery consistency
40
Change in Gingival Features
Surface texture:
loss of stippling is an early sign of
gingivitis ( 40% patients have stippling)
41
Surface texture Indication
Smooth, Shiny
Peeling
Leathery
Nodular
Epithelial atrophy in atrophic gingivitis
Chronic desquamative gingivitis
Hyperkeratosis
Drug-induced gingival overgrowth
42
Change in Gingival Features
* Position:
* Prevalence, extent and
severity increase with ---
* More prevalent in ---
* The gingival margin shifts
---, resulting in the
gingival recession is a common finding
age
male
apically, root surface exposure
43
Type of recession
Visible
Clinically observable
44
Type of recession
Hidden
Covered by gingiva,
can be measured by
probing to the level of
epithelial attachment
45
Position of gingiva
Apparent position
The level of the crest of the
gingival margin
46
Position of gingiva
Actual position
severity
The level of the coronal
end of the epithelial
attachment on the tooth
47
Change in Gingival Features
Clinical significance
Exposed roots are susceptible to (4)
caries,
hypersensitivity, pulp symptoms, plaque accumulation
48
Change in Gingival Features
* Contour:
(2)
* Primarily associated with gingival enlargement
* Stillman’s clefts, McCall festoons
49
Change in Gingival Features
* Size/Contour:
gingival enlargement/overgrowth
50
Localized
Limited to the
gingiva adjacent to
one tooth or a
group of teeth
51
Papillary
Confined to the
interdental papilla
51
Generalized
Involving the gingiva
throughout the
mouth
52
Diffuse
Involve marginal,
attached gingiva
and papilla
53
Discrete
An isolated sessile or
pedunculate, tumor
like enlargement
54
Marginal
Confined to the
marginal gingiva
55
Grade 0
No signs of gingival
enlargement
56
Grade I
Confined to the
interdental papilla
57
Grade II
Involves papillae
and marginal
gingiva
58
Grade III
Enlargement covers
>3/4 crown
59
Gingivitis
Dental plaque-induced
An inflammatory response of
gingiva resulting
from plaque biofilm accumulation located and
below the gingival margin
60
Characteristics
--- to initiate the inflammation
Clinical signs and symptoms are
confined in the ---
--- modifying factors
--- attachment may or may not
experience ---
Reversible?
Plaque
gingival unit
Systemic
Stable
further attachment loss
Reversibility
61
Systemic conditions
(5)
Steroid Hormones
-Puberty, menstrual cycle, pregnancy,
oral contraceptives
Smoking
Hyperglycemia
Leukemia
Malnutrition
62
Local/predisposing factors
(2)
Prominent subgingival
restoration margins
Hyposalivation
63
Drug-induced gingival enlargements
(4)
Antiepileptic drugs
Calcium channel-blocking drugs
Immunoregulating drugs
High-dose oral contraceptives
64
Calcium channel-blocking drugs
(5)
Nifedipine, verapamil, diltiazem, amlodipine, felodipine
65
Antiepileptic drugs (1)
Dilantin
66
Immunoregulating drugs (1)
Cyclosporine
67
The clinical signs of inflammation are (5)
erythema,
edema, pain (soreness), heat, and loss of function.
68
These may manifest clinically in gingivitis as:
(4)
a. Swelling, seen as loss of knife-edged gingival
margin and blunting of papillae
b. Bleeding on gentle probing
c. Redness
d. Discomfort on gentle probing
69
--- is not helpful in diagnosing gingivitis
Radiograph
70
Based on available methods to assess gingival
inflammation, gingivitis case could be simply,
objectively and accurately identified and graded using
Bleeding on Probing
Score (BOP%)
71
A case of dental plaque-induced gingivitis is defined
as
≥10% bleeding sites with probing depths ≤3 mm
72
Localized gingivitis:
Generalized gingivitis:
10%-30% bleeding sites
> 30% bleeding sites
73
For epidemiological purposes alone, a patient with a
history of periodontitis, with gingival inflammation is
still a
periodontitis case
74
Biofilm-induced Gingivitis
Intact Periodontium:
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -
≥10%
≤3mm
No
No
75
Biofilm-induced Gingivitis
Reduced
Periodontium:
Stable Periodontitis
Patient:
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -
≥10%
≤4mm*
(no site ≥4mm with BOP)
Yes
Yes
76
Biofilm-induced Gingivitis
Reduced
Periodontium:
Non-periodontitis
Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -
≥10%
≤3mm
Yes
Possible
77
Localized gingivitis is --- BOP
Generalized Gingivitis is --- BOP
>10% and <30%
>30%
78
Gingivitis
Non-plaque-induced
The oral conditions resulted from the
manifestations of systemic conditions which
may be further exacerbated by local factors
such as plaque or oral dryness. These conditions
may persist even after plaque removal.
79
skipped
Non-Biofilm-induced Gingivitis
Genetic abnormalities
Hereditary gingival fibromatosis
(Son of the Sevenless gene)
80
skipped
Specific infection
Bacteria (Necrotizing Periodontal Disease), Viral,
Fungal
81
skipped
Inflammatory and
immune conditions
Contact allergy, pemphigus vulgaris, pemphigoid,
lichen planus
82
skipped
Neoplasms
Leukoplakia, erythroplakia, squamous cell
carcinoma, leukemia, lymphoma
83
skipped
Endocrine, nutritional,
metabolic disease
Scurvy (Vit C deficiency), toothbrushing trauma,
etching, burning
84
skipped
Gingival pigmentation
Melanoplakia (smoker’s melanosis, drug-induced
pigmentation, amalgam tattoo)
85
Management
(2)
Interdisciplinary consultation: know when to refer
Remove etiology: plaque control (OHI, dental prophylaxis, scaling in the presence
of gingival inflammation with re-evaluation), routine recall/maintenance
86
Desquamative
Gingivitis
Gingival Disease/Conditions
A gingival response is a peculiar condition
associated with a variety of conditions, characterized
by
intense erythema, desquamation, and ulceration
of both the free and attached gingiva.
87
Desquamative gingivitis is
a clinical term
NOT a
DIAGNOSIS
88
Desquamative Gingivitis
Need a series of laboratory result for final
diagnosis and corresponding treatment
Clinical
history Clinical
examination Biopsy Microscopic
examination
Immuno-
fluorescence
89
Lichen Planus
(3)
* A immunologically-mediated mucocutaneous disorder
* T lymphocytes play a central role
* Prevalent in middle aged and older females
90
Lichen Planus
Five subtypes:
Reticular,
erosive,
patch,
atrophic,
bullous
91
Lichen Planus
* Oral lesion:
* Gingival lesion:
more than gingiva is involved
restricted in gingiva
92
Pemphigoid
(2)
* A cutaneous, immune-mediated subepithelial disease
* Separation of the basement membrane zone
93
Pemphigoid
Three conditions:
* Pemphigoid gestationis, bullous pemphigoid,
mucous membrane pemphigoid
94
Pemphigus
Vulgaris
(2)
* Pemphigus disease is a group of autoimmune disorders
* Produces cutaneous and mucous membrane blisters
95
Pemphigus vulgaris is the most common of all.
(2)
* Lethal chronic condition (10% mortality rate)
* Predilection in women (after 4th decade of life)
96
Pemphigus vulgaris
Soft palate (--%)
Lower labial mucosa (--%)
Buccal mucosa (--%)
Tongue (--%)
Gingival tissue
80
10
46
20
97
Lupus
Erythematosus
(2)
An autoimmune disease with three clinical presentations:
* Systemic/Chronic cutaneous/Subacute cutaneous
98
Lupus Erythematosus
* Cutaneous lesion
(3)
* Oral lesion:
* Butterfly pattern
* Discoid lesion
* Scar and atrophy production
ulcerative or lichen planus-like
99
Lupus Erythematosus
Clinical Presentation
Gingival discoid lupus erythematosus lesion
Ulcerative or lichen planus-like
100
Erythema Multiforme
* Reactive acute -- disease
* -- inflammatory disease
* Broad spectrum from --
* Predominant in --
vesiculobullous
Mucocutaneous
self-limiting to severe progression
young individuals
101
Erythema
Multiforme
Clinical Presentation
(3)
Oral lesion
Swollen lip
Crust formation
Ruptured Bullae
Extensive ulcers
Pseudomembranes
Skin lesions
Iris appearance
102
Necrotizing
Periodontal
Disease
(3)
* An inflammatory, destructive gingival condition
* Young adults, (HIV)‐infected individuals
* Mild to severe, may develop fever and malaise
103
Necrotizing
Periodontal
Disease
* Characteristics of gingival lesion
(2)
* Punched‐out appearance
* Pseudomembrane
104
Necrotizing
Periodontal
Disease
Clinical Presentation
Pseudomembrane
(2)
Leukocytes, fibrin and necrotic tissue
Masses of bacteria
105
Diagnosis criteria: health
Bleeding on probing
Probing depth
Intact periodontium
Reduced periodontium
<10%
≤3mm
No
Possible
106
Diagnosis criteria: gingivitis
Bleeding on probing
Probing depth
Intact periodontium
Reduced periodontium
≥10%
≤3mm
No
Possible
