Diagnosis Flashcards
(42 cards)
What is the definition of gingivitis
nonspecific gingival inflammation resulting from interactions between dental plaque and the hosts immune response without loss of periodontal attachment. It is reversable.
Describe the clinical and biologic signs of gingivitis
erythema, swelling, BOP, Edemarednes and/or bleeding gingiva, Halitosis, Pain or soreness
What are the histopathologic changes of gingivitis? Clinical signs?
histopathologic changes
- elongation of rete ridges into the gingival connective tissue
- vasculitis of blood vessels adjacent to the junctional epithelium,
- progressive destruction of the collagen fiber network (alterations in fibroblasts and collagen types)
- progressive inflammatory and immune cellular infiltrate
Clinical signs
- Erythema, bleeding, tenderness, edema, and enlargement
What is periodontitis?
Periodontitis is gingival inflammation at sites where there has been loss of collagen fibers from cementum and the junctional epithelium has migrated apically. IT is a complex disease involving interactions between subgingival bacteria, inflammatory responses, and host immune system, and the environmental modifying factors
Primary features
loss of periodontal tissue support
Radiographically assessed alveolar bone loss
Periodontal pocketing and gingival bleeding
How do you diagnose a patient as having periodontitis?
- Interdental clinical attachment loss is detectable at 2 or more nonadjacent teeth
- buccal or lingual/palatal CAL 3+mm with pocketing 3+mm is detectable at 2 or more teeth
- The observed CAL cannot be ascribed to non-periodontal causes
What is clinical attachment level
Clinical attachment level is the distance from the CEJ to the tip of the periodontal probe during normal probing.
What is probing depth?
the distance from the soft tissue margin to the tip of the periodontal probe
What can affect probing depth?
insertion force, size of the tip, inflammatory status of the tissues
In health the probe should stop within the junctional epithelium, in periodontitis it will stop within the connective tissue or bone
On a site level how is clinical gingival health classified?
Clinical health on an intact periodontium is BOP <10% without attachment loss, erythema, edema, and radiographic bone loss, no PD of 4mm or greater with BOP
Clinical health on a reduced periodontum is stable periodontitis patient (no BOP, erythema, and edema in the presence of reduced bone and clinical attachment levels, no PD of 4+mm with BOP), or a non-periodontitis patient with BOP <10%
Gingival diseases/conditions: Biofilm induced Gingivitis
localized - BOP 10-30%
Generalized - BOP 30+%
gingivitis on a reduced periodontum requires no history of periodontitis, possible radiographic bone loss, and all probing depths 3mm or less
Gingival diseases/conditions: gingivitis mediated by systemic or local risk factors
systemic risk factors
- Smoking
- Hyperglycemia
- Nutritional factors
- Pharmacologic agents
- Sex Hormones (puberty, Menstrual cycle, pregnancy, contraceptives)
- Hematologic conditions
Oral factors enhancing plaque accumulation
- Prominant subgingivl restoration margins
- Hyposalivation
Gingival diseases/conditions: drug induced
Causes gingival enlargement that can mechanically obstruct plaque control, and be painful
Gingival diseases/conditions: non-biofilm induced
Genetic disorders (hereditary gingival fibromatosis)
Specific infections (necrotizing, gonorrhea, syphilis, tuburculosis), Viral infection (Coxsackie, HSV, Varicella, PHV), Fungal infection (Candidosis)
Inflammatory and immune conditions. Hypersensitivity reactions (contcact allergy, plasma cell gingivitis, erythema multiforme), Autoimmune diseases (pemphigus vulgaris, pemphigoid, Lichen Planus, Lupus), Granulomatous inflammatory condition (Crohn disease, Sarcoidosis)
Reactive processes. Epulides,
Neoplasms (leukoplakia/erythroplakia, SSC, Leukemia, Lymphoma)
Endocrine/metabolic (Vitamin C)
Traumatic lesions (frictional keratosis, mechanical ulceration, chemical insult, thermal insult
Gingival pigmentation (melanoplakia, smokers melanosis, drug induced pigmentation, amalgam tattoo)
What determines clinical periodontal health
Microbial determinants (supragingival plaque and subgingival biofilm composition
Host determinants (local predisposing factors (PPD, restorations, crown anatomy, tooth position and crowding), and systemic modifying factors (host immune function, systemic health, genetics)
Environmental determinants (Smoking, Medications, Stress, Genetics)
From Lang and Bartold, Determinants of periodontal health
Describe the difference between health and gingivitis in an intact periodontium and reduced periodontium (non-periodontitis and successfully treated stable periodontitis patient)
Difference is BOP and <10% vs >10%
periodontal helath - no probing attachment loss, PPD 3mm or less, no radiographic bone loss
Reduced periodontium in a non-periodontitis patient - Probing attachment loss present, but PPD 3mm or less, might have radiographic bone loss.
Successfully treated stable periodontitis patient - probing attachment loss and radiographic attachment loss present. Gingivitis can not have 4mmPD, but health can have 4mmPD with no BOP
Describe the characteristics of drug indiced gingiva enlargement
occurs mostly in the anterior
higher prevalence in younger age groups
symptoms within 3 months of use
No tooth mortality or tooth loss
first observed in the papilla
What forms of periodontitis are recognised in the revised classification?
necrotizing periodontitis
Periodontitis as a manifestation of systemic disease
Periodontitis
Periodontitis Stage 1
Interdental CAL 1-2mm at site of greatest loss
Radiographic bone loss <15%
PD 3-4mm
Periodontitis Stage II
Interdental CAL 3-4mm at site of greatest loss
Radiographic bone loss 15-33%
PD 4-5mm
Periodontitis Stage III
Interdental CAL 5mm+
Radiographic bone loss into the middle third
vertical defects 3mm+
probing depths 6mm+
furcation involvement II or III
masticatory function is preserved
Moderate ridge defect
periodontal tooth loss 4 or less
Periodontitis Stage IV
Criteria for Stage III must be met, plus
Masticatory disfunction - need for complex rehabilitation
Secondary occlusal trauma, mobility 2+
bite collapse
less than 20 remaining teeth
Severe reidge defect
5+ teeth lost to periodontitis
Grading periodontitis
A - no bone loss over 5 years, or <0.25 bone loss/age, nonsmoker, no diabetes. Heavy biofilm with no destruction
B - <2mm bone loss over 5 years, 0.25-1 bone loss/age, <10 cigarettes/day, HBA1c <7% in patients with diabetes, Biofilm matches destruction
C - >2mm bone loss over 5 years, >1 bone loss/age, >10 cigarettes/day, HbA1c >7, Destruction exceeds destruction
Describe Papillon-Lefevre Syndrome
autosomal recessive syndrome characterized by hyperkeratosis of the soles of the feet, palms, knees, and elbows. Most patients have severe periodontitis that leads to early loss of primary and permanent teeth. Neutrophil dysfunction is believed to he the cause of disease.
What is the classification of necrotizing periodontal diseases?
Necrotizing gingivitis (necrosis/ulcer of the interdental papillae, gingival bleeding)
Necrotizing periodontitis (necrosis/ulcer of the interdental papilla, gingival bleeding, halitosis and rapid bone loss)
Necrotizing Stomatitis (severe inflammatory condition with soft tissue necrosis extending beyond the gingiva and bone denudation with bone sequestrum)
Noma (usually in severely immunocompromised patients, eg AIDS, malnutrition)
