Wk 4 Periodontial Health Gingival Disease Flashcards
describe the marginal/free gingiva
- 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
describe the gingival sulcus
- 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
describe the attached gingivs
- 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
describe the interdental gingiva
-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
describe the oral epithelium and its rate of turnover
- keratinized stratified squamous epithelium
- rete pegs present
- resistant to forces from mastication
- turnover rate of 30 days
describe the sulcular epithelium
- non-keratinized startified sqaumous epithelium
- no rete pegs
- semi-permeable membrane
describe the junctional epithelium
- 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)
describe gingival connective tissue
- diffuse amorphous ground substance
- collagen fibers
- blood vessels in the papillary projections of the connective tissue
what forms the connective tissue attachment
densely packed collagen fibers
the stability of the connective tissue attachment is a key factor in:
the limitation of the migration of the JE
what is the new term for biologic width
supracrestal tissue attachment
what is prone to invasion by bacteria and their byproducts due to the nature of the type of epithelium
the epithelium lining and the sulcus
what colors can the attached and marginal gingiva be and why
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
the color of gingiva correlates with
the cutaneous skin pigmentation
what color are healthy marginal and attached gingiva
coral pink
what color is the alveolar mucosa
red, smooth and shiny
what is the healthy contour of the gums
scalloped and collar like
- gingival level is higher interproximally
what is the shape of the interdental gingiva governed by
the contour of the proximal tooth surfaces and the location and shape of the gingival embrasures
the size of the gingiva should correspond with:
the sum total of the bulk of cellular and intercellular elements and vascular supply
what is the healthy consistency of gums
firm and resilient
what contributes to the firmness of the gingival margin
consistency
what is a healthy surface texture
attached gingiva is stipples, the marginal gingiva is not
when is stippling present
- varies with age
- absent during infancy
- appears in some children at 5 years of age
- increases until adulthood
- begins to disappear during old age
where is stippling less prominent
on lingual surfaces
what is stippling produced by microscopically
by alternate rounded protuberances and depressions in the gingival surface
what does position of the gingiva describe
the level to which the gingival margin is attached to the tooth
what are the determinants of gingival health
- microbiological determinants
- host determinants
- environmental determinants
what are the microbiological determinants of gingival health
- supragingival plaque
- subgingival plaque
what are the host determinants of gingival health
- local predisposing factors: periodontial pockets, restorations, root anatomy, tooth position and crowding
- systemic factors: host immune function, systemic health, genetics
what are the environmental determinants of gingival health
-smoking
- medication
- stress
- nutrition
what are the indicators of gingival health
- bleeding on probing
- periodontal probing
- radiographic features
- tooth mobility
what pressure should be done with probing
light pressure of 0.25 N
is periodontal probing adequate for dx when used alone
no
what is gingival health in radiographs
lamina dura is 2mm from the most coronal part of the alveolar crest to CEJ
is tooth mobility recommended as a singular means of dx
no
what are the clinical features of an intact periodontium
- 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
what are the clinical features of a non-periodontitis patient on a reduced periodontium
- 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
what are the clinical features of a patient on a reduced periodontium with stable periodontitis
- 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
for stable periodontitis, probing depth is allowed to be:
within 4mm or more than 4mm without BOP sites
are treated and stable periodontitis patients with current gingival health at an increased risk for recurrent periodontitis
yes
what is pristine periodontal health
total absence of clinical inflammation and physiological immune surveillance with no attachment or bone loss
what is clinical periodontal health
absence or minimal levels of clinical inflammation with no attachment or bone loss
what is peridontal disease stability
absence or minimal levels of clinical inflammation in a reduced periodontium
describe periodontal disease remission/control
absence or minimal levels of clinical inflammation in a reduced periodontium with previous inflammation and disease
what are the 2 types of gingivitis
- dental plaque induced gingival disease
- non-dental plaque induced gingival diseases
what is the most common form of periodontal disease
gingivitis
what are the signs and symptoms of gingivitis
- bleeding when brushing
- blood in saliva
- gingival swelling and redness
- halitosis
what are the clinical findings at dental exam in gingivitis patients
- bleeding upon gentle probing
- change in gingival clinical features such as color, contour, shape, size, consistency, surface texture, and/or position
what is an early sign prior to color change or signs of inflammation
BOP
absence of BOP is a excellent negative predictor of:
future attachment loss
what does smoking do to the gingiva
masks BOP by suppressing the inflammatory response
what are the colors gingiva can be with gingivitis
- can be marginal, patch-like, generalized or. localized
- can be pale, coral, pink, red, bluish-red, or whitish gray
what are the chronic forms of consistency of the gingiva in gingivitis
- soggy puffiness
- softness and friability
- firm, leathery consistency
what are the acute forms of consistency in gingiva in gingivitis
- sloughing with grayish, desquamative debris
- vesicle formation
what are the changes seen in surface texture during gingivitis
loss of stippling
what does smooth and shiny surface texture indicate in gingivitis
epithelial atrophy
what does peeling indicate in gingivitis
chronic desquamative gingivitis
what does leathery surface texture indicate in gingvitisi
hyperkeratosis
what does a nodular surface texture indicate about gingivitis
drug- induced gingival overgrowth
describe gingival recession in gingivitis
- 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
describe gingival overgrowth in gingivitis
- gingival level is exaggerated higher than normal
- can be due to medications, inflammation tooth position
what are the changes in the contour of the gingiva in gingivitis
- changes in contour can be related to gingival enlargement
- examples of this are stillman’s clefts, McCall festoons
what is the definition of dental plaque induced gingival diseases
an inflammatory response of the gingiva resulting from plaque biofilm accumulation located at and below the gingival margin
what is an early clinical sign of dental plaque induced gingivitis
BOP
what is BOP microscopically
- 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
what systemic conditions are modifying factors for plaque induced gingivitis
- steroid hormones: puberty, menstrual cycle, pregnancy, oral contraceptive
- smoking
- hyperglycemia
- leukemia
- malnutrition
what are the local/predisposing factors in plaque induced gingivitis
- prominent subgingival restoration margins
- inadequate interproximal tooth contacts
- hyposalivation
what medications can cause drug induced gingival enlargement
- anti epileptic drugs: dilantin
- calcium channel blockers: nifedipine, verapamil, diltiazem, amlodipine, felodipine
- immuno regulatory drugs: cyclosporin
- endocrine dugs: high dose contraceptives
what are the clinical signs of inflammation
erythema, edema, pain (soreness), heat and loss of function
what might clinical signs of inflammation manifest as
- swelling, seen as loss of knife-edged gingival margin and blunting of papillae
- Bleeding on gentle probing
- redness
- discomfort on gentle probing
what is a good diagnostic tool for gingival inflammation
bleeding on probing score
what is a case of dental plaque induced gingivitis defined as
less than 10% bleeding sites with probing depths greater than 3mm
what is localized gingivitis definition on an intact periodontium
10-30% bleeding sites
- no probing attachment loss
- no radiographic bone loss
what is generalized gingivitis definition on an intact periodontium
more than 30% bleeding sites
- no probing attachment loss
- no radiographic bone loss
what is localized gingivitis in a reduced periodontium without hx of perio disease
- probing attachment loss
- possible radiographic bone loss
- probing depth in al sites less than 3mm
- BOP 10-30%
what is generalized gingivitis on a reduced periodontium without a hx of perio disease
- probing attachment loss
- possible radiographic bone loss
- probing depth less than 3mm
- BOP score greater than 30%
what is desquamative gingivitis
a condition characterized by intense, erythema, desquamation and ulceration of the free and attached gingiva
what are the diseases clinically presenting as desquamative gingivitis
- lichen planus
- pemphigoid
- pemphigus vulgaris
- lupus erythematous
- erythema multiforme
- necrotizing stomatitis
what is lichen planus
- an immunologially mediated mucocutaneous disroder
- T-lymphocytes play a central role
- prevalent in middle aged and older females
what are the 5 subtypes of lichen planus
- reticular
- erosive
- patch
- atrophic
- bullous
describe the reticular lesion in lichen planus
striae of Wickham
describe the keratotic lesion of lichen planus
plaque like lesion
describe the bullous lesion and erosive/ulcerative lesion in lichen planus
- can be reticular or not
what is phemphigoid
a cutaneous, immune mediated subepithelial disease
- separation of the basement membrane zone
what are the 3 conditions of phemphigoid
- pemphigoid gestationis
- bullous pemphigoid
- mucous membrane pemphigoid
where is the bullous pemphigoid found
skin
describe mucous membrane pemphigoid
- symblepharon scar formation of the eye
- positive Nikolsky’s sign
- bullae ruptures in 2-3 days
- healing takes up to 3 weeks
what is pemphigus vulgaris
a group of autoimmune disorders that produced cutaneous and mucous membrane blisters
what is the most common phemphigoid
pemphigus vulgaris
describe the prognosis and predeliction for pemphigus vulgaris
- lethal chronic condition - 10% mortality rate
- prediliction in women after 4th decade of life
where can pemphigus vulgaris occur
- soft palate
- buccal mucosa
- tongue
- lower labial mucosa
what are the three clinical presentations of lupus erythematous
- systemic: can affect the kidneys, heart, skin and mucosa
- cutaneous: butterfly pattern, discoid lesion, scar and atrophy production
- oral- ulcerative or lichen planus like
describe lupus erythematosus
gingival discoid lupus erythematosus lesion
- ulcerative or lichen planus like
what is erythema multiforme
- reactive acute vesiculobullous disease
- mucucutaneous inflammatory disease
- broad spectrum from self limiting to severe progression
- predominant in young individuals
what are the presentations of erythema multiforme
- oral lesion: swollen lip and crust formatino
- ruptured bullae
- labial/buccal mucosa
- skin lesions
what is necrotizing stomatitis
- an inflammatory destructive gingival condition
- young adults HIV infected individuals
- may develop fever and malaise
what is the presentation of necrotizing stomatitis
- punched out lesion
- extensive ulcers
- pseudomembrane: leukocytes, fibrin and necrotic tissue, masses of bacteria
when is scaling done
when there is generalized moderate or severe gingival inflammation in the absence of attachment loss
when is scaling and root planing done
bone loss and subsequent loss of attachment
instrumentation of the exposed root surface to remove deposits is an integral part of this procedure
