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ODDR- e lecs > Periodontal tissue damage and disease progression > Flashcards

Periodontal tissue damage and disease progression Flashcards

1
Q

Describe physical features of healthy gingivae

A

Pinkish gums
Knife like edges
Good contour

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2
Q

Describe how a section of the gums would look in healthy gingivae

A

Intact junctional epithelium
Connective tissue is located ash the CEJ
Intact alveolar bone
Periodontal ligament attaches alveolar bone to cementum of root surface

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3
Q

Name the 3 histopathological stages of gingivitis

A
  1. Initial lesion
  2. Early lesion
  3. Established lesion
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4
Q

What happens if plaque is allowed to build up on a clean tooth?

A

Experimental gingivitis is induced

Then the 3 histopathological stages of gingivitis occur

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5
Q

How can we differentiate between the 3 histopathological stages of gingivitis ?

A

It is difficult to distinguish these stages clinical as the patient should be brushing their teeth regularly

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6
Q

What can happen when gingivitis is established?

A

It can either remain stale or may progress to destructive periodontitis

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7
Q

Describe a section of the gums when the initial lesion forms?

A
  1. Initial accumulation of dental plaque
  2. Neutrophils present in the junctional epithelium
  3. Neutrophils and monocytes in junctional epithelium
  4. Increased vascularity of connective tissues
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8
Q

What are the key features of the initial lesion?

A
  1. Inflammation begins 24-48 hours after plaque accumulation begins
  2. Vasodilation and increased GCF
  3. Inflammatory infiltrates increase in size
  4. Poly morphic neutrophils migrate into the gingival sulcus
  5. Can see few lymphocytes and macrophages
  6. Clinically gingiva dont look very different
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9
Q

How can we detect the increase in GCF in the initial lesion?

A

By using specialised equipment like the periotron and filter paper strips

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10
Q

Describe a section of the gums when the early lesion forms?

A

1, Dental plaque accumulation more extensive

  1. Continues neutrophil migration
  2. Rete-peg proliferation in most coronal portion of the junctional epithelium
  3. Lymphocytes appear in the inflammatory infiltrate
  4. Fibroblasts begin to exhibit signs of cell damage
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11
Q

What are the key features of the early lesion?

A
  1. After one week of plaque accumulation there’s an increased in the inflammatory infiltrate
  2. Increased lymphocytes, macrophages and polymorphic neutrophils migrate
  3. Fibroblasts start to show signs of cell damage
  4. Early loss of gingival collagen
  5. Coronal junctional epithelium will begin to look hyperplasitic and gingiva will be swollen leading to deepening of gingival crevice
  6. Rete peg proliferation
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12
Q

Describe a section of the gums when the established lesion forms?

A
  1. Heavy neutrophil emigration into enlarged gingival crevice
  2. Extensive gingival plaque
  3. Plasma cells make up 10-30% of the inflammatory infiltrate
  4. No loss of connective tissue attachment
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13
Q

What are the key features of the early lesion?

A
  1. Increased inflammatory infiltrate and clinical signs may be seen
  2. PMNS are predominant
  3. Plasma cells make up 10-30% of the inflammatory infiltrate
  4. Fibroblasts start to show signs of cell destruction
  5. Early loss of gingival collagen
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14
Q

What happens to the gingivitis aft the established lesion has formed?

A

It may remain stable or progress to periodontitis

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15
Q

Describe a section of the gums suffering from periodontitis

A
  1. Gingival recession with fibrosis in connective tisue
  2. Continued extension of sub gingival plaque
  3. Extension of inflammation infiltrate
  4. Apical migration and ulceration of the junctional epithelium
  5. Alveolar bone resorption and periodontal ligament loss
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16
Q

What are the key features of periodontitis ?

A
  1. Inflammatory infiltrate extends apically laterally
  2. Plasma cells make up 50% of the infiltrate e
  3. Loss of periodontal connective tissue attachment
  4. Apical migration of junctional epithelium
  5. Alveolar bone loss
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17
Q

What effect do bacterial toxins have on tissues in the epithelium?

A

They have a cytotoxic effects to the keratinocytes

This leads to the distruption of the normal epithelial turnover and differentiation

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18
Q

What effect do bacterial enzymes have on tissues in the epithelium?

A

Damage the keratinocytes

19
Q

What effect does the release of enzymes from neutrophils have on tissues in the epithelium?

A

Damage the keratinocytes

20
Q

What effect does complement activation have on tissues in the epithelium?

A

Cell damage

21
Q

What effect does the production of TNF and interferon gamma by activates T lymphocytes have on tissues in the epithelium?

A

Decreased keratinocyte proliferation

22
Q

What effect does the production of Il-1 by macrophages have on tissues in the epithelium?

A

Increased keratinocyte proliferation rate per hyperplasia

23
Q

What effect do bacterial toxins have on tissues in the connective tissue?

A

Endotoxins are toxic to fibroblasts which as a result decreases collagen function

24
Q

What effect do bacterial enzymes have on tissues in the connective tissue?

A

Collagenase and hyaluronidase degrade the extra cellular matrix components

25
Q

What effect does the release of enzymes from neutrophils have on tissues in the connective tissue?

A

Degradation the extra cellular matrix components

26
Q

What effect does complement activation have on tissues in the connective tissue?

A

Damage to fibroblasts which as a result decreases collagen function

27
Q

What effect does the production of IL1 and TNF have on tissues in the connective tissue?

A

Increased secretion of collagenase and proliferation by fibroblasts

28
Q

What effect does the production of TGF beta and PDGF have on tissues in the connective tissue?

A

Stimulation of fibroblast chemotaxis, proliferation and matrix synthesis attempt,s at repair

29
Q

Name some bacteria derived bone resorbing agents

A 
Capsular material from A. actinomycetemocomita
Lipopolysaccharides
Capsular material from other bacteria 
Lipoteichoic acids 
Actinomyces resorbinf facto 
Petidoglycan 
Muramyl dipeptide
Bacterial lipoprotein
30
Q

Name some host derived bone resorbing agents

A 
Interleukin 1 
Tumor necrosis factor 
Transforming growth factor beta
Platelt derived growth factor 
Interleukin 6
Prostaglandins 
Leukotrienes
31
Q

Give the 3 features of periodontal breakdown

A
  1. Apical migration of epithelium
  2. Breakdown of periodontal ligament
  3. Bone resorption
32
Q

How is Apical migration of epithelium achieved?

A
  1. Destruction of underlying connective tissue
  2. Alterations in normal inhibitory mechanisms of epithelial migration
  3. Rete-peg hyperplasia Lang the root
33
Q

How is the Breakdown of the periodontal ligament achieved?

A
  1. Increased host factors causing connective tissue damage of the ligament
  2. Increased penetration of bacterial factors into the ligament causing connective tissue damage
34
Q

How is Bone resorption achieved?

A

Stimulation of osteoclastic resorption by host derived and bacterial factors

35
Q

If there is plaque present around the gingival margin what does that lead to?

A

Acute inflammation

36
Q

If the plaque around the gingival margin is removed what will happen?

A

Healing will occur with minimal tissue damage

37
Q

If the plaque around the gingival margin is NOT removed what will happen?

A

Can lead to chronic inflammation with irreversible tissue damage

38
Q

Describe the condition of a patients gingiva before periodontal therapy has started

A
  1. Gingival recession with fibrosis in connective tissues
  2. Continued extension of sub gingival plaque
  3. Extension of inflammatory infiltrate
  4. Apical migration and ulceration of junctional epithelium
  5. Alveolar bone reposition and periodontal ligament loss
39
Q

Name some examples of periodontal therapy

A
  1. Scaling
  2. Root surface debridement
  3. Root plaining
    All in conjunction with plaque control
40
Q

Describe the condition of a patients gingiva 1 week after periodontal therapy has started

A
  1. Reductio in number of neutrophils in gingival crevice
  2. Connective tissue begins to diminish
  3. Reduction in gingival swelling
  4. Ulcers in pocket linings begin to heal
  5. Fibroblast proliferation
41
Q

Describe the condition of a patients gingiva 1 month after periodontal therapy has started

A
  1. Gingival recession is evident associated with shrinkage of tissues
  2. New fibrous tissued formed and inflammatory infiltrate diminished
  3. Long epithelial attachment beings to reform
  4. Alveolar bone remodels but no regeneration occurs coronally
42
Q

Describe the condition of a patients gingiva 3-6 months after periodontal therapy has started

A
  1. Gingival crevice contains only a small number of neutrophils
  2. Junctional epithelium re establishes with formation of long epithelial attachment
  3. Gingival connective tissue is mature with minimal inflammatory infiltrate
43
Q

What are some clinical signs of periodontal healing

A
  1. Reduced probing picket depths
  2. Reduced bleeding on probing
  3. Gain in clinical attachment
  4. Reduced mobility
  5. May be some recession
  6. Possible infill in angular defects
44
Q

After clinical therapy what should we start doing?

A

Calling the patient In for a few appointments to keep check on their periodontal health.
Periodontal monitoring

ODDR- e lecs (5 decks)

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