W1: Intro Classifying Periodontitis Flashcards
Describe periodontal diseases classified by the 2017 American
Association of Periodontology (AAP) classification system
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Compare and contrast dental plaque biofilm-induced gingivitis
and non–dental plaque-induced gingival diseases
In clinic, you would identify what is wrong -> sus it out, what category could issue be?
Plaque Gingivitis: if you remove the plaque , issue will get better.
Non plaque Gingivitis: heaps of things could cause problems in the gum that is NOT plaque related. which means removing plaque won’t make gums better.
Recognise the variety of sources responsible for non-dental plaque-induced gingival diseases.
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What is required before Perio Tx?
- Examination
- Diagnosis
- Establish risk and consider prognosis
- Intervention
We will look at classification in detail this sem
How do we define gingivitis at a site level (biological & clinical)?
inflammation= condition, can have it anywhere in body… we focus on gums which is…
gingivitis= diagnosis (red, bleed on probe, bad breath)
how many categories of gingivitis is there?
there are 2 categories dental plaque and non dental plaque induced
Gingivitis - dental plaque biofilm-induced is
Defined at the site level as
inflammation in periodontium that is intact, or reduced gums in non perio pt (they had recession or crown lengthening.
What causes Gingivitis - dental plaque biofilm-induced?
few things
- biofilm
- cancer
- local RF covered last sem
- drug induced gum enlargement
Associated with biofilm alone looks like….
some cases lots of gingivitis and not lot of plaque vice versa.
consider anatomy, tooth not in alignment or ortho?
What hormone is considered to mediate gingivitis?
Is this plaque/ non plaque and systemic/ local?
What are the clinical presentation?
plaque related.
systemic.
Sex steroid hormones: puberty, menstrual cycle
-can sometimes get Pyogenic granuloma, pedunculated mushroom like, or wide, bleeds readily, big red lump on gums bleed profusely
What may occur in pregnancy?
Pregnancy tumors are large gum-like abscesses that are a result of elevated hormones during pregnancy which overreact to plaque. They’re often found near the gum line of teeth and they may be isolated to one tooth or multiple teeth. This condition is essentially gingivitis on steroids with every growth hormone that you can imagine.
They typically present with these symptoms:
Very red and poofy looking gums
Swollen
Easily bleeding gums
Severe inflammation
Sore and tender gums
According to studies, it is not uncommon for pregnant women to experience this condition. Approximately 11% or one in nine women will experience some sort of gum disorder during their pregnancy
What’s the difference between drug induced gingival enlargement and cancer?
Image: Hematological Leukemia.
unusual presentation of gingivitis with minimal plaque- gum enlarged, small heamoraghes in all areas of OC have to investigate.
- oral manifestations, such as gingival bleeding, gingival inflammation or overgrowth, and periodontitis, are the first symptoms of leukemia.
Leukemia=no plaque. Covers gums
Drug induced= asymptomatic except when bad oral hygiene and they get perio as well
Note:
Genetically induced gingival enlargement appears pink in color with minimal signs of inflammation, has a slow growth rate, and is firm in consistency. Soft, edematous, tender gingiva with ease to bleeding is a sign in blood disorders.[2] Gingival enlargement in leukemia occurs due to infiltration of premature leukocytes. This is a common symptom that aids in the diagnosis of leukemia and warrants dental consultation
What types of drugs may induce gingivitis?
Describe the clinical manifestation of it.
some drugs that can inflame gums…
anticonvulsants
immuno-regulating
high dose oral contraceptives
As OHT you could debride but must refer to periodontist and GP- these meds may be required (e..g dont want to stop anticonvulsants) will have to collaborate with team. Need to recognise this is not normal.
manifestation: Firm, painless, nodular enlargement of the interdental papilla, limited to the keratinized portions of the gingiva and extending to the facial and lingual gingival margins. In severe cases, a huge fold of hypertrophied gingival tissue is observed covering the crowns.
What are some Gingival diseases that are
A) hereditary: characterized by a benign, non-hemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome
B) infections
Are these considered to cause gingivitis because of plaque or non plaque?
- tissue unhealthy in absence of biofilm which means something else is sus, so examine more in pt hx.
- Genetic: rare to get HGF (can occur on its own or with other disease.
- Infections leading to gum inflammation: caused by B/F/V, some are rare/common. determine tissue is not normal and keep sussing out what it is
What 3 bacteria can cause gingivitis? what may it look like?
could be TB, gonorhea, strep
- diffuse gum enlargement (TB on left)
- right= strep bacterial infection
What are the causes of gingivitis in the following images?
Viral Infection.
A: Herpes Simplex
B: Varicella Zoster
inflamed gingiva covering crown of teeth (kid, left)
- oral lesions
- viral can spread like wildfire in kids childcare- spread of lesions in 1st week when signs and symptoms not present. may start with fever, tire, headaches.
- heals 3-4 days, week in severe cases
- make sure to hydrate
- don’t want to present in clinic bc highly contagious, we have PPE so its ok but once discovering, reappointment, ask them about contact, history of if older adult shingles
- advice: will take 10-14 days to resolve, ice blocks
RIGHT
- chickenpox
What is the cause of the following lesion?…
“Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of mouth, gums and tonsils. Slightly raised lesions with a cottage cheese-like appearance. Redness, burning or soreness that may be severe enough to cause difficulty eating or swallowing”
Candida (normal to have in mouth but if in imbalanced level, it can cause gingivitis)
Causes:
Oral thrush causes creamy white lesions, usually on your tongue or inner cheeks. Sometimes oral thrush may spread to the roof of your mouth, your gums or tonsils, or the back of your throat.
Who is susceptible to fungal induced gingivitis?
diabetics, denture wearers,
Inflammatory and immune conditions - what category?
In clinic:
- does gums look normal?
- If no, sus it out, it could be some of these - presentation may be difficult to remember:
- fungal is distinct though
- some conditions are rarer
- know in exam to list things
NOTE: non plaque tx: means we go beyond managing plaque
For Immune/AID non plaque consider 3 categories (AAA)
1. Allergy: contact allergy, Erythema multiforme
2. AID of mucosa: lupus, pemphigus vulgaris
3. Alot of cells (cluster of blood/tissue cells): Granulomatous Inflammation: Crohns, sarcodosis
What condition is this?
Erythema multiforme
self resolve, may need steroids, pain, itchy sometimes
- notice something is off
- refer GP for further tx
- skin disorder
- bull’s-eye-shaped lesions.
- cause of erythema multiforme isn’t well understood, but it may be triggered by an infection.
- Symptoms include skin or mouth lesions that have a pink-red centre surrounded by a pale ring border and an outer pink-red ring. The lesions can sometimes be painful or itchy.
The condition usually resolves itself. However, steroids can help relieve symptoms. Antivirals are occasionally used when erythema multiforme is triggered by a viral infection.
What is a rare autoimmune disease characterised by blisters/lesions?
desmosomes fail, med: systemic corticosteroids
what disease involves attack of one’s own tissue? What are it’s clinical presentation?
Lupus
pt will come knowing
affects all parts of bodies- joints, kidneys, lungs
- fatigue, pain
- butterfly rash on cheek= classic
- OC flareups
- no cure
What may be caused by this lesion?
Crohns disease- affects bowl, GIT causes
- abd pain, diarrhoea, fatigue
- severe chronic
- uncrable, only mx: steroids, immunosupp, sometimes surgery
- may see this type of lesion in OC
- refer to oral surgery to makesure it is not cancerous/ GP to makesure no undelrying systemic disease is happening
“unusual, granulomatous-appearing gingivitis, which was hyperplastic in the anterior labial or buccal mucosa with extension up to or above of the mucogingival margin”
a) What are ‘lumps’/ overgrowths on the gingiva termed?
b) What may they be caused by?
c) Is this lump classified as non plaque or plaque related?
d) how may these lumps be treated?
- Epilus (there’s heaps of diff types)
- cause= long term, related to local irritants like dentures, poor contoured fillings
- Non plaque gingivitis.
- The treatment of epulis is to remove the causative factors and surgical excision of the lesion.
What are some neoplasmic AND endocrinal/metabolic/ hormonal diseases that can induce gingivitis?
Is this non plaque or plaque induced?
Neoplasmic:
- precancerous: Leukplakia
- cancerous: lumphoma
Nutrition
- Scurvy (lack of Vit C)
What is this?
Neoplasm. hyperplasia associated with leukemia
- LARGE upper anterior ext. To alveolar mucosa
- posterior diffuse
generalized gingival enlargement that was more prominent in the maxilla and anterior regions. In the maxillary anterior area, there was a discrete, bulbous enlargement in the interproximal region. In the maxillary posterior area, there was diffuse enlargement, which extended to the alveolar mucosa (Fig. 1A). Gingival enlargement was most severe in the palatal area, extending beyond the cingulum of the maxillary anterior teeth
What disease is this?
- detected in children with neurodevelopmental disorders and with selective diet habit
- symptoms: bleeding sores, tooth loss, anemia, and a reduced rate of healing for injuries.
- Scurvey caused by Vit C def
- tx: take Vit C to see improvement in gums
- rare
- if you see in children, can consider diet if you see this
- Oral scurvy = intense red, painful swollen gingiva, bleeds spontaneously on slightest touch, resulting in hemorrhages/purpuras/bruising, general discoloration.
- Severe vitamin C deficiency = ulcerative gingivitis and rapid periodontal pocket development with tooth exfoliation. It is often associated with fetid odor and poor oral hygiene.
NOTE: scurvy = misdiagnosed as vasculitis, blood dyscrasias, ulcerative gingivitis. NEED thorough general physical examination, past medical/ diet history along with blood examination and histopathological examination can aid in formulating a proper diagnosis.
How else can gingiva be damaged mechanically? What types of gingival pigmentation are there?
Are these causes plaque or non plaque?
Non plaque
Mechanical: burns, chemical burns, trauma
Pigment: smokers, drug, amalgam tattoo
tooth paste allergy rare? what does it look like
shiny, sore gums, cracked lips, burning tongue, flavours
What 2 traumatic lesions may present as white lesions on the gingiva? Describe what shape these lesions may look like.
- bleaching= white lesion.
- Rinsing with warm saltwater swishes away any lingering bleaching product and soothes the irritation. - frictional keratosis=
- white line AKA linea alba, nicely aligns with occlusal plane, thickening of buccal mucosa, DW, probs grinder or clencher
- lesion are smooth or wrinkled, totally asymptomatic and surrounded by healthy and pink-coloured mucosa.
- Tx: remove the source of trauma. Monitor 2-3 wk
- If the lesion does not disappear, a biopsy and histo-pathological exam needed.
You spot a dark gray or blue, flat macule located adjacent to a restored tooth and pt confirms of filling previously done there. What is cause for this pigment og mycosa? (Most are located on the gingiva and alveolar mucosa followed by the buccal mucosa and the floor of the mouth)
amalgam enter soft tissue, can happen in placement or removal of amalgam.
e.g. sometimes in Apicectomy can occur
MCQ1
B
MCQ 2
B
MCQ 3
C
Name 3 viral infections that could occur in the gingiva. Describe clinical presentation:
Herpes simplex: sores and ulcers. These mouth ulcers are not the same as canker sores, which are not caused by a virus. Abnormally enlarged, bulging, protruding, or swollen gums are a possible indication of disease.
Varicella Zoster : Intra-oral vesicles of varicella, when present, are seen on the tongue, buccal mucosa, gingival, palate and oropharynx. They generally are not very painful.
Cocksackie virus: can cause gingiva stomitis like Herpes simplex.
