Week 6 Ch.6 Periodontal Health Diseases

Question 1

A state free from inflammatory periodontal disease that allows an individual to function normally and avoid consequences (mental or physical) due to current or past disease

Answer 1

Characteristics of Periodontal Health
• Absence of:
- Bleeding on probing
- Erythema
- Edema
- Patient symptoms
- Attachment loss
- Bone loss

Question 2

Normal vs. Reduced Periodontium
Periodontal Health can have:

Answer 2

• Intact periodontium:
- no loss of periodontal tissue (past or present)
• Reduced periodontium:
- pre-existing loss of periodontal tissue but no current activity of loss of connective tissue and/or alveolar bone.

Question 3

Categories of Periodontal Health

Answer 3

1. Periodontal health on an intact periodontium.
2. Periodontal health on a reduced periodontium in a nonperiodontal patient.
3. Periodontal health on a reduced periodontium in a successfully treated stable periodontitis patient.

Question 4

Periodontal health on a reduced periodontium in a nonperiodontal patient

Answer 4

Question 5

Periodontal health on a reduced periodontium in a successfully treated stable periodontitis patient

Answer 5

Question 6

Dental Plaque-Induced
Gingival Conditions
Gingival Diseases and Conditions:
two categories

Answer 6

Question 7

Characteristics Common to All Gingival
Diseases

Answer 7

• Signs of inflammation confined to the gingiva.
• No attachment loss associated with the inflammation.
• Initiated by plaque biofilm.
• Inflammation reversible with plaque removal.
• May progress to periodontitis if left untreated.

Question 8

Plaque-Induced
Gingival Diseases

Answer 8

• Diseases that involve inflammation of the gingiva in response to dental plague.
• Plaque biofilm triggers the body’s immune response.
• Bacteria remain in contact at or below gingival margin resulting in inflammation.
• Plaque-induced gingivitis is the MOST common type of periodontal disease.
• Clinical signs vary from one individual to the next.
• Does not directly cause tooth loss.
• Managing gingivitis is primary strategy for preventing periodontitis.

Question 9

Children vs. Adults

Answer 9

• Given the same quantity of oral bacteria:
- Inflammation is not as intense in children as in adults.
- Children have fewer pathogenic bacteria in plaque biofilm than adults.
- Children’s immune response is less developed and therefore do not have the same response to plaque biofilm.
- Adults have more dental restorations and conditions that act as retention for plaque.
- Adolescents have higher levels of certain bacteria
(Ex: Actinomyces).

Question 10

Plaque-Induced Gingivitis:
Clinical Signs

Answer 10

Clinical Signs
• Change in color from light pink to red:
- most evident at gingival margin where plaque accumulates.
- Erythema - redness
• Edema-swelling
• Bleeding evident upon gentle probing (BOP)
• Increased gingival crevicular fluid (GCF)
• Tenderness

Question 11

Let’s Review
Types of Gingivitis

Answer 11

Papillary gingivitis:
• involves interdental papillae
• earliest sign of gingivitis
Marginal gingivitis:
• includes interdental papillae plus gingival margin
Diffuse gingivitis:
• includes interdental papillae, gingival margin, and attached gingiva

Question 12

Plaque-Induced Gingivitis: Duration
Let’s Review

Answer 12

• Acute Gingivitis:
- Short duration
- Return to health after good patient self-care
• Chronic Gingivitis:
- Long-lasting
- May exist for years without progressing to periodontitis

Question 13

Plaque-Induced Gingivitis on a Reduced Periodontium in a Nonperiodontitis Patient

Answer 13

Question 14

Gingivitis on a Reduced Periodontium in a Successfully Treated Periodontitis Patient

Question 15

• A patient exhibits a bacterial infection of all parts of the periodontium. Which of the following is the state of her periodontium?
A. Health
B. Gingivitis
C. Periodontal disease
D. Periodontitis

Question 16

• A patient has a healthy periodontium. If the hygienist could see the microscopic structures of this patient’s periodontium, how would the interface of the JUNCTIONAL epithelium with the gingival connective tissue appear?
A. Smooth interface
B. Wavy interface

Question 17

• A patient’s gingiva is pink in color and there is no recession of the gingival margin. Plaque biofilm on the teeth is light. The hygienist decides after a visual inspection with a mouth mirror that this patient has a healthy periodontium. Is the hygienist correct?

Answer 17

A. Yes, because in gingivitis the tissue color is red and there may not be recession.
B. Yes, because in periodontitis the tissue color is purplish-red and this patient only has light biofilm plaque.
C. No, because the tissue can be pink in gingivitis
D. No, because it is impossible to tell the state of the periodontium with just a visual inspection.

Question 18

How do we differentiate between health and gingivitis?

Remember we are looking at three categories of periodontium:

Answer 18

1. intact periodontium
2. reduced periodontium in a nonperiodontitis patient
3. reduced periodontium in a successfully treated stable periodontitis patient

Question 19

Plaque-Induced Gingival Disease
With Modifying Factors

Answer 19

Systemic Conditions:
- Gender and steroid hormones such as puberty, menstrual cycle, pregnancy and oral contraceptives
- Hyperglycemia - Diabetes
- Leukemia
- Smoking
- Malnutrition

Question 20

Fluctuations in Sex Hormones

Answer 20

• Levels of sex hormones cause exaggerated response to presence of plaque.
•Gingival tissues are bright red, soft, thinly stretched, smooth and bleed easily:
- Puberty
- Menstrual cycle
- Oral contraceptives
- Pregnancy

Question 21

Puberty-Associated Gingivitis

Question 22

Pregnancy-Associated Gingivitis

Answer 22

Question 23

Pyogenic Granuloma: aka “Pregnancy Tumor”

Answer 23

• A mushroom-like growth.
• More common in the maxilla and in gingival papillae.
• Growths are not cancerous.
• Growths are usually not painful.
• There is an exaggerated response to an irritation.
• Growth bleeds easily if disturbed.
• Growth usually regresses after giving birth.

Question 24

Pregnancy-Associated Pyogenic Granuloma: “Pregnancy Tumor”

Answer 24

Question 25

Plaque-Induced Gingival Disease
With Modifying Factors (cont.)

Answer 25

• Hyperglycemia
- Poorly controlled diabetes
• Leukemia
- Plaque biofilm not a prerequisite
• Smoking
Gingival fibrosis is evident
• Malnutrition
- Lack of vitamin C

Question 26

Gingivitis Associated with
Diabetes

Answer 26

• Inflammatory response of the gingiva to plaque aggravated by poorly controlled blood glucose levels.
• Reduction in gingival inflammation in diabetic adults may result in reduction of insulin needed.
•Often seen in children with poorly controlled
Type I Diabetes.

Question 27

Diabetes-Associated Gingivitis

Question 28

• Diabetes associated gingivitis is an example of de plaque-induced gingival disease modified by a systemic factor.
• True or False

Question 29

Do you know where to find this on Consult Pro to check off the box?
• Yes, No

Question 30

• Can you name other plaque-induced gingival diseases with a modifying factor?

Question 31

Gingivitis Associated With Blood Dyscrasias—Leukemia

Answer 31

• Exaggerated response to plaque biofilm results in enlarged tissue and increased bleeding:
- tissues appear swollen, red-deep purple, spongy, shiny
- tissues tear easily
- tissues bleed with very little provocation tissue changes usually begins in papilla

Question 32

Leukemia-Associated Gingivitis

Answer 32

Question 33

Plaque-Induced Gingival Disease
Modified by Malnutrition

Answer 33

Groups most at risk:
• Infants
• Institutionalized elderly
• Alcoholics
Vitamin Deficiencies:
- Ascorbic acid deficiency gingivitis due to chronically low levels of vitamin C (Scurvy).
- Vitamin A helps to maintain healthy sulcular epithelium.
- B-Complex helps to maintain healthy mucosal tissues.

Question 34

Vitamin C (ascorbic acid) Deficiency:
Patient with Scurvy

Question 35

Plaque-Induced Gingival Disease
Modified by Medications (cont.)

Answer 35

52 / 101
100%
•
Modified by Medications (cont.)
• Clinical appearance of drug-influenced gingival enlargement:
- Onset usually within 3 months of taking medication
- Pattern is irregular: begins in papillae, proceeds to the margin
- Anterior affected more than posterior
- Severity related to ability to remove plaque
- Increase in crevicular fluid and bleeding
- No attachment loss

Question 36

Medications Most Commonly Associated With Gingival Enlargement

Answer 36

• Anticonvulsants:
- phenytoin (brand name: Dilantin)
- Celontin
- Depakote
• Calcium channel blockers:
- amlodipine
- nifedipine
- verapamil
• Immunosuppressants:
- cyclosporine (brand name:Gengraf )

Question 37

Classification of Non–Plaque-Induced
Gingival Diseases and Conditions

Answer 37

1. Genetic/developmental
2. Infection
3. Inflammatory and immune conditions and lesions
4. Reactive Processes
5. Neoplasms
6. Endocrine, Nutritional and Metabolic Diseases
7. Traumatic Lesions
8. Gingival Pigmentation

Question 38

Hereditary Gingival Fibromatosis

Answer 38

• Hereditary, rare
• Benign
• Slow and progressive enlargement of attached gingiva

Question 39

Necrotizing Periodontal Disease

Answer 39

• Includes necrotising gingivitis, necrotising periodontitis, and necrotizing stomatitis.
• Severe inflammatory disease caused by bacteria.
• Underlying conditions exist: poor oral hygiene, smoking, stress, poor nutrition, compromised immune status.
• In Necrotizing gingivitis - no loss of periodontal attachment.
• Ulcerated and necrotic papillae and gingival margins (punched-out or cratered).

Question 40

Viral Origin

Answer 40

• Coxsackie virus (hand-foot-and-mouth disease)
• Herpes Simplex
• Varicella-zoster (chicken pox, shingles)
• Molluscum contagiosum virus:
- produces red, raised lesions (Mollusca) on skin
• Human papilloma:
- squamous cell papilloma
- condyloma acuminatum
- verruca vulgaris
- focal epithelial hyperplasia

Question 41

Primary Heretic Gingivostomatitis

Answer 41

• Usually affects infants and young children but may affect young adults
• Primary heretic gingivostomatitis-the initial oral infection with the herpes simplex type-1 virus (HSV-1)
• Characterized by fiery red, multiple vesicles (tiny fluid-filled blisters) that easily rupture to form painful ulcers
• By the time individuals reach middle age, about 70% have been infected with HSV-1.
• In most cases, the virus never causes symptoms during this primary HSV-1 infection (subclinical infection).

Question 42

Primary Herpetic
Gingivostomatitis (cont.)

Answer 42

• Infection is contagious during the vesicular stage!
• Infection can be spread to eyes by touching the mouth and then eyes.
• Infection can be spread to others by kissing,

Question 43

Fungal Origin

Answer 43

• Candidosis
• Mycoses - diseases caused by fungus (histoplasmosis, aspergillosis

Question 44

Inflammatory and Immune Conditions

Answer 44

• Hypersensitivity reactions
- Contact allergy
- Plasma cell gingivitis
- Erythema multiforme (allergic reaction or infection which includes swollen lips and excessive crust formation)
• Autoimmune diseases
- Pemphigoid
- Lichen planus
- Lupus erythematosus
• Granulomatous inflammatory conditions
Crohn’s Disease
- Sarcoidosis

Question 45

Erythema Multiforme

Answer 45

Disorder of the skin and mucous membranes
• May be due to allergic reaction or infection
Large symmetrical red
D
blotches, resembling targets, appear all over the skin
Blisters and ulcers occur on the oral mucous membranes

Question 46

LIST SIGNS AND SYMPTOMS OF
PERIODONTITIS

Answer 46

Ging bleeding
Bone loss
Mobility
Swelling