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Periodontics I > Wk 4 Periodontial Health Gingival Disease > Flashcards

Wk 4 Periodontial Health Gingival Disease Flashcards

1
Q

describe the marginal/free gingiva

A
  • the portion of the gingiva surrounding the neck of the tooth
  • not directly attached to tooth
  • forms the soft tissue wall of the gingival sulcus
  • extends from the gingival margin to the gingival (marginal) groove
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2
Q

describe the gingival sulcus

A
  • space bounded by the tooth and the free gingiva
  • has the junctional epithelium at its base
  • non-keratinized epithelium
  • no rete pegs
  • semi-permeable membrane
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3
Q

describe the attached gingivs

A
  • portion of the gingiva that extends apically from the area of the free gingival groove to the MGJ
  • normally covered by keratinized epithelium with rete ridges
  • no submucosa
  • bound to the underlying tooth and bone
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4
Q

describe the interdental gingiva

A

-portion of the gingiva that extends between the teeth
- includes the col area which is composed of a non- keratinized stratified squamous epithelium in the interproximal space

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5
Q

describe the oral epithelium and its rate of turnover

A
  • keratinized stratified squamous epithelium
  • rete pegs present
  • resistant to forces from mastication
  • turnover rate of 30 days
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6
Q

describe the sulcular epithelium

A
  • non-keratinized startified sqaumous epithelium
  • no rete pegs
  • semi-permeable membrane
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7
Q

describe the junctional epithelium

A
  • non-keratinized
  • attached to the tooth with hemidesmosomes and non-collagenous proteins attachment
    attachment on the tooth is normally at or near the CEJ
  • can be infiltrated by PMNs
  • high rate of turnover (7-10 days)
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8
Q

describe gingival connective tissue

A
  • diffuse amorphous ground substance
  • collagen fibers
  • blood vessels in the papillary projections of the connective tissue
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9
Q

what forms the connective tissue attachment

A

densely packed collagen fibers

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10
Q

the stability of the connective tissue attachment is a key factor in:

A

the limitation of the migration of the JE

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11
Q

what is the new term for biologic width

A

supracrestal tissue attachment

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12
Q

what is prone to invasion by bacteria and their byproducts due to the nature of the type of epithelium

A

the epithelium lining and the sulcus

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13
Q

what colors can the attached and marginal gingiva be and why

A

brown, orange, pink and is a result from the colors of the vascular supply, the thickness and degree of keratinization of the epithelium and the pigment containing cells

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14
Q

the color of gingiva correlates with

A

the cutaneous skin pigmentation

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15
Q

what color are healthy marginal and attached gingiva

A

coral pink

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16
Q

what color is the alveolar mucosa

A

red, smooth and shiny

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17
Q

what is the healthy contour of the gums

A

scalloped and collar like
- gingival level is higher interproximally

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18
Q

what is the shape of the interdental gingiva governed by

A

the contour of the proximal tooth surfaces and the location and shape of the gingival embrasures

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19
Q

the size of the gingiva should correspond with:

A

the sum total of the bulk of cellular and intercellular elements and vascular supply

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20
Q

what is the healthy consistency of gums

A

firm and resilient

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21
Q

what contributes to the firmness of the gingival margin

A

consistency

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22
Q

what is a healthy surface texture

A

attached gingiva is stipples, the marginal gingiva is not

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23
Q

when is stippling present

A
  • varies with age
  • absent during infancy
  • appears in some children at 5 years of age
  • increases until adulthood
  • begins to disappear during old age
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24
Q

where is stippling less prominent

A

on lingual surfaces

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25
Q

what is stippling produced by microscopically

A

by alternate rounded protuberances and depressions in the gingival surface

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26
Q

what does position of the gingiva describe

A

the level to which the gingival margin is attached to the tooth

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27
Q

what are the determinants of gingival health

A
  • microbiological determinants
  • host determinants
  • environmental determinants
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28
Q

what are the microbiological determinants of gingival health

A
  • supragingival plaque
  • subgingival plaque
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29
Q

what are the host determinants of gingival health

A
  • local predisposing factors: periodontial pockets, restorations, root anatomy, tooth position and crowding
  • systemic factors: host immune function, systemic health, genetics
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30
Q

what are the environmental determinants of gingival health

A

-smoking
- medication
- stress
- nutrition

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31
Q

what are the indicators of gingival health

A
  • bleeding on probing
  • periodontal probing
  • radiographic features
  • tooth mobility
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32
Q

what pressure should be done with probing

A

light pressure of 0.25 N

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33
Q

is periodontal probing adequate for dx when used alone

A

no

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34
Q

what is gingival health in radiographs

A

lamina dura is 2mm from the most coronal part of the alveolar crest to CEJ

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35
Q

is tooth mobility recommended as a singular means of dx

A

no

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36
Q

what are the clinical features of an intact periodontium

A
  • no CAL or bone loss
  • BOP less than 10%
  • probing depth within 3mm
  • absence of erythema, edema, and patient symptoms
  • physiological bone levels range from 1-3mm with an average of 2mm apical to the CEJ
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37
Q

what are the clinical features of a non-periodontitis patient on a reduced periodontium

A
  • gingival recession, crown lengthening, surgery
  • BOP more than 10%
  • probing depths within 3mm
  • absence of erythema, edema and patient symptoms in the presence of reduced CAL and bone levels
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38
Q

what are the clinical features of a patient on a reduced periodontium with stable periodontitis

A
  • a pt with a hx of perio
  • BOP more than 10%
  • probing depths within 3mm
  • absence of erythema, edema and patient symptoms in the presence of reduced CAL and bone levels
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39
Q

for stable periodontitis, probing depth is allowed to be:

A

within 4mm or more than 4mm without BOP sites

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40
Q

are treated and stable periodontitis patients with current gingival health at an increased risk for recurrent periodontitis

A

yes

41
Q

what is pristine periodontal health

A

total absence of clinical inflammation and physiological immune surveillance with no attachment or bone loss

42
Q

what is clinical periodontal health

A

absence or minimal levels of clinical inflammation with no attachment or bone loss

43
Q

what is peridontal disease stability

A

absence or minimal levels of clinical inflammation in a reduced periodontium

44
Q

describe periodontal disease remission/control

A

absence or minimal levels of clinical inflammation in a reduced periodontium with previous inflammation and disease

45
Q

what are the 2 types of gingivitis

A
  • dental plaque induced gingival disease
  • non-dental plaque induced gingival diseases
46
Q

what is the most common form of periodontal disease

A

gingivitis

47
Q

what are the signs and symptoms of gingivitis

A
  • bleeding when brushing
  • blood in saliva
  • gingival swelling and redness
  • halitosis
48
Q

what are the clinical findings at dental exam in gingivitis patients

A
  • bleeding upon gentle probing
  • change in gingival clinical features such as color, contour, shape, size, consistency, surface texture, and/or position
49
Q

what is an early sign prior to color change or signs of inflammation

A

BOP

50
Q

absence of BOP is a excellent negative predictor of:

A

future attachment loss

51
Q

what does smoking do to the gingiva

A

masks BOP by suppressing the inflammatory response

52
Q

what are the colors gingiva can be with gingivitis

A
  • can be marginal, patch-like, generalized or. localized
  • can be pale, coral, pink, red, bluish-red, or whitish gray
53
Q

what are the chronic forms of consistency of the gingiva in gingivitis

A
  • soggy puffiness
  • softness and friability
  • firm, leathery consistency
54
Q

what are the acute forms of consistency in gingiva in gingivitis

A
  • sloughing with grayish, desquamative debris
  • vesicle formation
55
Q

what are the changes seen in surface texture during gingivitis

A

loss of stippling

56
Q

what does smooth and shiny surface texture indicate in gingivitis

A

epithelial atrophy

57
Q

what does peeling indicate in gingivitis

A

chronic desquamative gingivitis

58
Q

what does leathery surface texture indicate in gingvitisi

A

hyperkeratosis

59
Q

what does a nodular surface texture indicate about gingivitis

A

drug- induced gingival overgrowth

60
Q

describe gingival recession in gingivitis

A
  • prevalence, extent and severity increase with age
  • more prevalent in males
  • exposed roots with recession are susceptible to caries, hypersensitivity, pulpal symptoms and plaque/calculus accumulation
61
Q

describe gingival overgrowth in gingivitis

A
  • gingival level is exaggerated higher than normal
  • can be due to medications, inflammation tooth position
62
Q

what are the changes in the contour of the gingiva in gingivitis

A
  • changes in contour can be related to gingival enlargement
  • examples of this are stillman’s clefts, McCall festoons
63
Q

what is the definition of dental plaque induced gingival diseases

A

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

64
Q

what is an early clinical sign of dental plaque induced gingivitis

A

BOP

65
Q

what is BOP microscopically

A
  • dilation and enlargement 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
  • cytopathologic alterations of resident fibroblasts
  • progressive inflammatory immune cellular infiltrate - mostly lymphocytic
66
Q

what systemic conditions are modifying factors for plaque induced gingivitis

A
  • steroid hormones: puberty, menstrual cycle, pregnancy, oral contraceptive
  • smoking
  • hyperglycemia
  • leukemia
  • malnutrition
67
Q

what are the local/predisposing factors in plaque induced gingivitis

A
  • prominent subgingival restoration margins
  • inadequate interproximal tooth contacts
  • hyposalivation
68
Q

what medications can cause drug induced gingival enlargement

A
  • anti epileptic drugs: dilantin
  • calcium channel blockers: nifedipine, verapamil, diltiazem, amlodipine, felodipine
  • immuno regulatory drugs: cyclosporin
  • endocrine dugs: high dose contraceptives
69
Q

what are the clinical signs of inflammation

A

erythema, edema, pain (soreness), heat and loss of function

70
Q

what might clinical signs of inflammation manifest as

A
  • swelling, seen as loss of knife-edged gingival margin and blunting of papillae
  • Bleeding on gentle probing
  • redness
  • discomfort on gentle probing
71
Q

what is a good diagnostic tool for gingival inflammation

A

bleeding on probing score

72
Q

what is a case of dental plaque induced gingivitis defined as

A

less than 10% bleeding sites with probing depths greater than 3mm

73
Q

what is localized gingivitis definition on an intact periodontium

A

10-30% bleeding sites
- no probing attachment loss
- no radiographic bone loss

74
Q

what is generalized gingivitis definition on an intact periodontium

A

more than 30% bleeding sites
- no probing attachment loss
- no radiographic bone loss

75
Q

what is localized gingivitis in a reduced periodontium without hx of perio disease

A
  • probing attachment loss
  • possible radiographic bone loss
  • probing depth in al sites less than 3mm
  • BOP 10-30%
76
Q

what is generalized gingivitis on a reduced periodontium without a hx of perio disease

A
  • probing attachment loss
  • possible radiographic bone loss
  • probing depth less than 3mm
  • BOP score greater than 30%
77
Q

what is desquamative gingivitis

A

a condition characterized by intense, erythema, desquamation and ulceration of the free and attached gingiva

78
Q

what are the diseases clinically presenting as desquamative gingivitis

A
  • lichen planus
  • pemphigoid
  • pemphigus vulgaris
  • lupus erythematous
  • erythema multiforme
  • necrotizing stomatitis
79
Q

what is lichen planus

A
  • an immunologially mediated mucocutaneous disroder
  • T-lymphocytes play a central role
  • prevalent in middle aged and older females
80
Q

what are the 5 subtypes of lichen planus

A
  • reticular
  • erosive
  • patch
  • atrophic
  • bullous
81
Q

describe the reticular lesion in lichen planus

A

striae of Wickham

82
Q

describe the keratotic lesion of lichen planus

A

plaque like lesion

83
Q

describe the bullous lesion and erosive/ulcerative lesion in lichen planus

A
  • can be reticular or not
84
Q

what is phemphigoid

A

a cutaneous, immune mediated subepithelial disease
- separation of the basement membrane zone

85
Q

what are the 3 conditions of phemphigoid

A
  • pemphigoid gestationis
  • bullous pemphigoid
  • mucous membrane pemphigoid
86
Q

where is the bullous pemphigoid found

A

skin

87
Q

describe mucous membrane pemphigoid

A
  • symblepharon scar formation of the eye
  • positive Nikolsky’s sign
  • bullae ruptures in 2-3 days
  • healing takes up to 3 weeks
88
Q

what is pemphigus vulgaris

A

a group of autoimmune disorders that produced cutaneous and mucous membrane blisters

89
Q

what is the most common phemphigoid

A

pemphigus vulgaris

90
Q

describe the prognosis and predeliction for pemphigus vulgaris

A
  • lethal chronic condition - 10% mortality rate
  • prediliction in women after 4th decade of life
91
Q

where can pemphigus vulgaris occur

A
  • soft palate
  • buccal mucosa
  • tongue
  • lower labial mucosa
92
Q

what are the three clinical presentations of lupus erythematous

A
  • systemic: can affect the kidneys, heart, skin and mucosa
  • cutaneous: butterfly pattern, discoid lesion, scar and atrophy production
  • oral- ulcerative or lichen planus like
93
Q

describe lupus erythematosus

A

gingival discoid lupus erythematosus lesion
- ulcerative or lichen planus like

94
Q

what is erythema multiforme

A
  • reactive acute vesiculobullous disease
  • mucucutaneous inflammatory disease
  • broad spectrum from self limiting to severe progression
  • predominant in young individuals
95
Q

what are the presentations of erythema multiforme

A
  • oral lesion: swollen lip and crust formatino
  • ruptured bullae
  • labial/buccal mucosa
  • skin lesions
96
Q

what is necrotizing stomatitis

A
  • an inflammatory destructive gingival condition
  • young adults HIV infected individuals
  • may develop fever and malaise
97
Q

what is the presentation of necrotizing stomatitis

A
  • punched out lesion
  • extensive ulcers
  • pseudomembrane: leukocytes, fibrin and necrotic tissue, masses of bacteria
98
Q

when is scaling done

A

when there is generalized moderate or severe gingival inflammation in the absence of attachment loss

99
Q

when is scaling and root planing done

A

bone loss and subsequent loss of attachment
instrumentation of the exposed root surface to remove deposits is an integral part of this procedure

Periodontics I (13 decks)

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