Session 7:Gingivitis and Periodontitis

Question 1

Gingivitis versus Periodontitis

Answer 1

Gingivitis – Reversible inflammation confined to the gingiva

Periodontitis – Irreversible infection associated with all parts of the periodontium

Question 2

Describe the clinical and histological characteristics of gingivitis

Answer 2

Clinical Characteristics
– Pink or Pigmented
– Firm 
– No bleeding
Histological Characteristics
– JE coronal to cemento-enamel junction (CEJ)
– Supragingival fibres intact
– Alveolar bone intact
– Periodontal ligament intact

Question 3

Describe the stages of gingival inflammation

Answer 3

1) Healthy / Pristine Gingiva - Pink, firm, no bleeding. JE coronal to CEJ. SF, AB, PL intact
2) Initial lesion - PMNS passing from bloodstream into gingival C.T. & release cytokines that destroy the tissue - causing PMNs to move through faster
3) Early lesion - More bacteria penetrate into C.T. causing destruction. JE show development of rete pegs/ridges
4) Established lesion - Disrupts attachment of the JE. Macrophages and lumps are numerous. PMNs fight bacteria. Host cell produces more chemicals

Question 4

Describe the clinical and histological characteristics of periodontitis

Answer 4

Clinical Characteristics
– Colour varies from red and purplish-blue (may be pale pink, if fibrotic)
– Bleeding on probing (often). Increased pocket depths > 3mm
– Inflamed or fibrotic gingiva
– Recession (often) and Bone resorption (radiographic finding)
– Drifting of teeth (possibly). Tooth mobility
– Suppuration on probing (sometimes)
Histological Characteristics
– Coronal portion of JE detaches from root surface
– Apical portion of JE moves apically along surface of root creating a periodontal pocket
– Collagen fibres are destroyed
– Permanent destruction of alveolar bone
– Permanent destruction of periodontal fibres
– Cementum is exposed to oral environment

Question 5

Explain the process of the periodontal pocket formation

Answer 5

– Starts as an inflammatory change in CT wall of gingival sulcus. Degeneration of surrounding CT
– Collagen fibres just apical to JE destroyed and replaced by inflammatory cells and oedema
– Apical cells of JE proliferate along the root. Coronal portion detaches as apical portion migrates
– Increased PMNs in coronal JE
– With continued inflammation, JE continues to migrate along the root and separate from it. Increasing pocket depth

Question 6

Describe the clinical and histological patterns of the pocket formation

Answer 6

Clinical Appearance
- Gingival wall - red to bluish-red
- Smooth, shiny surface
- Pitting on pressure
- Flaccidity (soft and limp; lack of firmness)
- Bleeding present. Pocket wall is painful on probe
Histological Appearance
- Colour change caused by circulatory stagnation
- Destruction of gingival fibres and tissues
- Oedema and degeneration

Question 7

Explain the pathways to inflammation involved in periodontal disease

Answer 7

Periodontal disease (PD) that is initiated by specific bacteria also triggers production of inflammatory mediators. These processes lead to loss of tissue structure and function.

Question 8

Discuss the differences between Suprabony and Infrabony periodontal pockets and the pattern of bone loss associated with each type

Answer 8

Suprabony Pocket
– Inflammation spreads within the connective tissue into alveolar bone then into the periodontal space.
– Results in an even pattern of bone loss – horizontal bone loss
Infrabony Pocket
– Pathway directly to periodontal ligament (PDL) space. Inflammation spread from gingiva to periodontal space then alveolar bone
– Resulting in vertical bone loss

Question 9

Explain the radiographic differences between horizontal and vertical bone loss

Answer 9

Horizontal bone loss
– Most common pattern
– Even overall reduction in height of alveolar bone
Vertical bone loss
– Less common pattern
– Uneven overall reduction in height of alveolar bone
– Progression is rapid

Question 10

Explain the difference between an active and an inactive periodontal pocket

Answer 10

– Presence of a periodontal pocket does not indicate active disease
– Active site - Continued apical migration of the JE over time; bleeding on probing
– Inactive site - Stabilized periodontal pocket over time
– Regular periodontal analysis is necessary to monitor progression of disease