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PERIO I > Periodontal Health, Gingival Disease:Conditions > Flashcards

Periodontal Health, Gingival Disease:Conditions Flashcards

1
Q

Periodontal Health

A

Absence of clinically detectable inflammation A state free from inflammatory periodontal disease

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2
Q

potential impacts of gingival dx

A
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3
Q

Importance of determining gingival health

A

To find the common reference point for assessing disease and determining the meaningful treatment outcomes.

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4
Q

Gingival Epitheliums

A

Oral epithelium
Sulcular epithelium
Junctional epithelium

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5
Q

Oral epithelium

A

*Keratinized, turnover rate 30
days

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6
Q

Sulcular epithelium

A

*Non-keratinized, no rete pegs,
semipermeable membrane

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7
Q

Junctional epithelium

A

*Non-keratinized, attached via hemidesmosomes infiltrate by PMN, turnover rate 7-10 days

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8
Q
  • Gingival Connective Tissue contents
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.

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9
Q

Correlation of Clinical and
Microscopic Features

A
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10
Q

Correlation of Clinical and
Microscopic Features: color (wnl)

A
  • Coral pink on marginal/attached gingiva
  • Red smooth shiny on alveolar mucosa
  • physiologic pigmentation
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11
Q

Correlation of Clinical and Microscopic Features:
size corresponds to what?

A

: Should corresponds with the total of the bulk of cellular and intercellular elements and vascular supply

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12
Q
  • Consistency wnl
A
  • Consistency: Firm and
    resilient (gingival fibers)
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13
Q

Surface texture wnl

A

Surface texture: Stippled on
the attached gingiva

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14
Q

contour wnl

A

scalloped and collar-like fashion

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15
Q

gingival shape wnl

A

Shape: Pyramidal towards the anterior, flattened towards the posterior

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16
Q

Position of gingiva wnl
how can this be different?

A

The level at which the gingival margin is attached to the tooth
can be different due to eruption patterns (continuous eruption-active and passive-altered passive eruption)

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17
Q

Etiologic Factors

A

host determinants
microbe determinants
environmental determinants

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18
Q

host determinants of gingival health

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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19
Q

microbial determinants of gingival health

A

Supragingival plaque
Subgingival plaque

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20
Q

environmental determinants of gingival health

A

Smoking
Medication
Stress
Nutrition

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21
Q

Indicators for gingival dx

A

BOP
probing
radio features
tooth mobility

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22
Q

BOP

A

light pressure 0.25N

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23
Q

can probing be used for diagnosis alone?

A

no

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24
Q

radio features of dx

A

Lamina dura
The distance of 2mm from the most coronal part of the alveolar crest to CEJ (max distance for WNL)

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25
Q

tooth mobility as a diagnosis

A

Not recommended

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26
Q

Clinical Gingival Health on an Intact Periodontium
Bleeding on Probing level
Pocket Probing depths
Probing Attachment Loss
Radiological Bone Loss

A

Bleeding on Probing <10%
Pocket Probing depths ≤3mm
Probing Attachment Loss - No
Radiological Bone Loss - No

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27
Q

Clinical Gingival Health on a Reduced
Periodontium:Stable Periodontitis
Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

Bleeding on Probing <10%
Pocket Probing depths ≤4mm
(no site ≥4mm with BOP)
Probing Attachment Loss - Yes
Radiological Bone Loss - Yes

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28
Q

Clinical Gingival Health on a Reduced
Periodontium: Non-periodontitis Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

Bleeding on Probing <10%
Pocket Probing depths ≤3mm
Probing Attachment Loss - Yes
Radiological Bone Loss - Possible

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29
Q

Pristine periodontal health

A

Total absence of of clinical inflammation and physiological immune surveillance with no attachment or bone loss
Not likely to be observed clinically

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30
Q

Clinical periodontal health

A

Absence or minimal levels of clinical inflammation in a periodontist with no attachment or bone loss

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31
Q

Periodontal disease stability present with what periodontium?

A

In a reduced periodontium

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32
Q

Periodontal disease remission/control

A

In a reduced periodontium
Control modifying factors and therapeutic response

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33
Q

Treatment Goals

A

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.

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34
Q

which gingival epthelium are non-keratinized?

A

junctional epithelium and sulcular

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35
Q

induced forms of gingivitis

A

plaque and non-plaque induced

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36
Q

supracrestal tissue attatchment diagram

A
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37
Q

common pt complaints regarding gingiva

A

*Bleeding when brushing
*Blood in saliva
*Gingival swelling and redness
*Halitosis

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38
Q

common clincal observations

A

*Bleeding on gentle probing
*Increased gingival crevicular fluid production rate
*Change in gingival clinical features

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39
Q

Bleeding on Probing
when can this be seen?
predictor of?
smoking?

A
  • 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
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40
Q

BOP under the microscope

A
  • 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=chronic stage)
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41
Q

changes in gingival color
scale?
patterns?

A
  • Color: important clinical sign of gingival disease
  • Patterns: marginal, diffuse or patchlike
42
Q

changes to gingival consistency
acute vs chronic forms?

A

result from the predominance of the destructive (edematous) and reparative (fibrotic) changes

Acute Forms:
* Sloughing with grayish, desquamative debris
* Vesicle formation

Chronic Forms:
* Soggy puffiness
* Softness and friability
* Firm, leathery consistency

43
Q

changes to gingival surface texture

A

loss of stippling is an early sign of gingivitis ( 40% patients have stippling)

44
Q

Smooth Shiny surface texture can indicate:

A

Epithelial atrophy in atrophic gingivitis

45
Q

peeling gingiva can indicate?

A

Chronic desquamative gingivitis

46
Q

leathery gingiva can indicate

A

hyperkeratosis

47
Q

nodular ginigva can indicate

A

Drug-induced gingival overgrowth

48
Q

gingival recession
prevalence?
demo?
result?

A

gingival recession is a common finding
* Prevalence, extent and severity increase with age
* More prevalent in male
* The gingival margin shifts apically, resulting in the
root surface exposure

49
Q

types of recession

A

Visible: Clinically observable
Hidden: Covered by gingiva, can be measured by probing to the level of epithelial attachment

50
Q

apparent and actual postion of gingiva

A

Apparent position: The level of the crest of the gingival margin
Actual position: The level of the coronal end of the epithelial attachment on the tooth

51
Q

clincal significance of gingival recession and resulting root exposure

A

Exposed roots are susceptible to caries, hypersensitivity, pulp symptoms, plaque accumulation

52
Q

changes to gingival contour

A
  • Primarily associated with gingival enlargement
  • Stillman’s clefts, McCall festoons
53
Q

Stillman’s clefts

A

Narrow triangular-shaped gingival recession Cleft becomes broader when progressing apically

54
Q

McCall festoons

A

A rolled, thickened band of gingiva Close to the mucogingival junction Usually adjacent to the cuspid

55
Q

terms to describe distribution and location

56
Q

Degree Scoring system of gingival enlargement

57
Q

key indicator of gingival health (regardless of pt Hx)

A

BOP less than or equal to 10%

58
Q

GingivitisDental plaque-induced

A

An inflammatory response of gingiva resulting
from plaque biofilm accumulation located and
below the gingival margin

59
Q

Characteristics of plaque induced gingivits

A
  • Plaque to initiate the inflammation
  • Clinical signs and symptoms are confined in the gingival unit
  • Systemic modifying factors
  • Stable attachment may or may not experience further attachment loss
  • Reversibility
60
Q

Modifying Factors of plaque induced gingivitis
systemic vs local

61
Q

med factors of gingival enlargment

A
  • Antiepileptic drugs Dilantin
  • Calcium channel-blocking drugs (Nifedipine, verapamil, diltiazem, amlodipine, felodipine)
  • Immunoregulating drugs (Cyclosporine)
  • High-dose oral contraceptives
62
Q

Diagnostic Criteria of plaque induced gingivitis

A
  • The clinical signs of inflammation present
  • These may manifest clinically in gingivitis as:
    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 (dalore)
    radiographs are not helpful
63
Q

Based on available methods to assess gingival
inflammation, gingivitis case could be simply,
objectively and accurately identified and graded using:

A

Bleeding on Probing
Score (BOP%)

64
Q

A case of dental plaque-induced gingivitis is defined as:

A

≥10% bleeding sites with probing depths ≤3 mm*

65
Q

Localized gingivitis:

A

Localized gingivitis: 10%-30% bleeding sites

66
Q

Generalized gingivitis:

A

Generalized gingivitis: > 30% bleeding sites

67
Q

For epidemiological purposes alone, a patient with a
history of periodontitis, with gingival inflammation is
still a:

A

periodontitis case

68
Q

Biofilm-induced Gingivitis categories

69
Q

Biofilm-induced Gingivitis with Intact Periodontium
Bleeding on Probing
Pocket Probing depth
Probing Attachment Loss -
Radiological Bone Loss -

A

Bleeding on Probing ≥10%
Pocket Probing depths ≤3mm
Probing Attachment Loss - No
Radiological Bone Loss - No

70
Q

Biofilm-induced Gingivitis with Reduced
Periodontium:Stable Periodontitis Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

Bleeding on Probing ≥10%
Pocket Probing depths ≤4mm*
(no site ≥4mm with BOP)
Probing Attachment Loss - Yes
Radiological Bone Loss - Yes

71
Q

Biofilm-induced Gingivitis with Reduced
Periodontium:Non-periodontitis Patient
Bleeding on Probing
Pocket Probing depths
Probing Attachment Loss -
Radiological Bone Loss -

A

Bleeding on Probing ≥10%
Pocket Probing depths ≤3mm
Probing Attachment Loss - Yes
Radiological Bone Loss - Possible

72
Q

non-plaque induced gingivitis

A

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.

73
Q

Non-Biofilm-induced Gingivitis factors/potential etiologies

74
Q

Genetic abnormalities of non-plaque gingivitis

A

Hereditary gingival fibromatosis
(Son of the Sevenless gene)

75
Q

Specific infection of non-plaque induced gingivitis

A

Bacteria (Necrotizing Periodontal Disease), Viral, Fungal

76
Q

Inflammatory and immune conditions of non-plaque induced gingivitis

A

Contact allergy,
pemphigus vulgaris,
pemphigoid,
lichen planus

77
Q

Neoplasms of non-plaque induced gingivitis

A

Leukoplakia,
erythroplakia,
squamous cell carcinoma,
leukemia,
lymphoma

78
Q

vitamin def, physical and chemical factors associated with non-plaque induced gingivitis

A

Scurvy (Vit C deficiency), toothbrushing trauma,
etching, burning

79
Q

Gingival pigmentations associated with non-plaque induced gingivitis

A

Melanoplakia (smoker’s melanosis, drug-induced
pigmentation, amalgam tattoo)

80
Q

Management of non-plaque induced gingivitis

A

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

81
Q

Desquamative Gingivitis

A

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.

82
Q

Desquamative gingivitis as a diagnosis?

A

Desquamative gingivitis is
a clinical term
NOT a DIAGNOSIS

83
Q

Desquamative Gingivitis conditions req what for diagnosis and tx?

A

Need a series of laboratory result for final diagnosis and corresponding treatment

84
Q

Diseases clinically presenting as desquamative gingivitis

85
Q

Lichen Planus
* mediated by?
* cells with central role
* Prevalent in?
* subtypes?
* Oral lesion form?
* Gingival lesion form?

A
  • A immunologically-mediated mucocutaneous disorder
  • T lymphocytes play a central role
  • Prevalent in middle aged and older females
  • Five subtypes: Reticular, erosive, patch, atrophic, bullous
  • Oral lesion form: more than gingiva is involved
  • Gingival lesion form: restricted in gingiva
86
Q

lichen planus clinical presentation

87
Q

Histology/IF of lichen planus

A
  • Hyperkeratosis and Hypergranulosis
  • A band-like T lymphocyte infiltrate against undersurface connective tissue
  • Saw tooth appearance of rite pegs
  • DIF shaggy deposits of fibrinogen at DEJ
88
Q

Pemphigoid
mediated by?
Result?
Subtypes?

A
  • A cutaneous, immune-mediated subepithelial disease: Separation of the basement membrane zone
  • Three conditions: Pemphigoid gestationis, bullous pemphigoid, mucous membrane pemphigoid
89
Q

Clinical Presentation of pemphigoid
oral?
skin?
occular?

A

oral: nikolsky sign, bullae rupture 2-3 days, heal in 3 weeks
occular: symblepharon scar
skin: bullous pemphigoid lesions

90
Q

Histology/IF of pemphigoid

A
  • Separated epithelium with Intact basal cell layer
  • DIF linear deposits of **IgG and C3 ** at oral mucosal basement membrane zone
91
Q

Pemphigus Vulgaris
group of?
produces?
most common?
lethality?
fav demo?

A
  • group of autoimmune disorders : Produces cutaneous and mucous membrane blisters
  • Pemphigus vulgaris is the most common of all.
    -Lethal chronic condition (10% mortality rate)
    -Predilection in women (after 4th decade of life)
92
Q

Clinical Presentation of Pemphigus
Vulgaris (locations)

A

Soft palate (80%)
Lower labial mucosa (10%)
Buccal mucosa (46%)
Tongue (20%)
Gingival tissue

93
Q

Histology of pemphigus vulgaris

A

* Tombstone appearance **Basal cells remain attached to subjacent basement membrane **and connective tissue
* Tzanck cells
* DIF intercellular deposits of IgG in epithelium
*

94
Q

Lupus
Erythematosus

A
  • An autoimmune disease with three clinical presentations:
  • Systemic/Chronic cutaneous/Subacute cutaneous
  • Cutaneous lesion:
    1. * Butterfly pattern
    1. * Discoid lesion
    1. * Scar and atrophy production
  • Oral lesion: ulcerative or lichen planus-like
95
Q

Clinical Presentation SLE orally

A

Gingival discoid lupus erythematosus lesion
Ulcerative or lichen planus-like

96
Q

Erythema Multiforme

A
  • Reactive acute vesiculobullous disease
  • Mucocutaneous inflammatory disease
  • Broad spectrum from self-limiting to severe progression
  • Predominant in young individuals
97
Q

Clinical Presentation of erythema multiforme

98
Q

Necrotizing Periodontal Disease
demo?
Characteristics?
Severity?

A
  • An inflammatory, destructive gingival condition
  • Young adults, (HIV)‐infected individuals
  • Characteristics of gingival lesion:
    1. Punched‐out appearance
    1. Pseudomembrane
  • Mild to severe, may develop fever and malaise
99
Q

Clinical Presentation of necrotizing perio dx

A

Punched-out lesions, Extensive ulcers
Pseudomembrane: Leukocytes, fibrin and necrotic tissue and Masses of bacteria

100
Q

non-plaque. induced gingivits tx

A

must determine underlying cause, possibly work with PCP

PERIO I (13 decks)

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