Histopathology of periodontal disease

Question 1

JE and gingival epithelium. Which one has Rete’s pegs?

Answer 1

Gingival epithelium

Question 2

Normal sulcus depth in health

Answer 2

0.5-2mm

Question 3

Gingivitis stages

Answer 3

Initial changes occur in 1st week
Early lesion occurs in 2nd week
Chronic marginal gingivitis: established lesion
-occurs within 2-3 weeks
Destructive periodontitis: timescale unknown

Question 4

Inflammatory response to plaque (early gingivitis)

Answer 4

Crevicular fluid
> blood flow
Formation of oedema
Migration of neutrophils
Loss of perivascular collaged

Question 5

The early lesion (early gingivitis)

Answer 5

> in neutrophils & crevicular fluid
Macrophages
Lymphocytes
JE starts to proliferate but still attached to tooth & ends at ACJ
Fibroblasts show signs of damage & get collagen loss but fibres inserting into cementum still attached

Question 6

The established lesion (chronic marginal gingivitis)

Answer 6

> in vascularity & formation of crevicular fluid
lymphocytes & plasma cells
JE becomes detached from tooth but still remains attached at ACJ
JE may become ulcerated
Marked loss of collagen but fibres inserting into cementum still intact
Sulcus may appear deepened but no true pocket formation

Question 7

Destructive periodontitis

Answer 7

Loss of collagen fibres inserting into cementum
JE migrates onto cementum - formation of true periodontal pocket
Destruction of alveolar bone
Destruction not continuous, occurs in bursts

Question 8

Management of destructive periodontitis

Answer 8

RSD:
Removal of plaque, calculus, debris
Inflammation subsides
JE proliferates
Attaches to tooth - long epithelial attachment
Little/ no regeneration of bone or collagen fibres inserting into cementum