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Periodontics > Gingival Disease > Flashcards

Gingival Disease Flashcards

1
Q

What are the three main periodontal health determiants?

A
  • Host
  • Microbiological
  • Environmental
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2
Q

What does the host determinant consist of ?

A
  • Local predisposing factors like: Periodontal pockets, dental restorations, root anatomy and tooth position and crowding
  • Systemic Modifying factors: Host immune function, systemic health, genetics
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3
Q

What does the Microbiological determinant consist of ?

A

Supragingival and subgingival biofilm

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4
Q

What does the Environmental determinant consist of ?

A
  • Smoking
  • Medications
  • Stress
  • Nutrition
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5
Q

What are the periodontal health four levels?

A

Pristine periodontal health
Clinical periodontal health
Periodontal disease stability
Periodontal disease remission/control

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6
Q

What does the pristine periodontal health consist of ?

A
  • Total absence of clinical inflammation (not observable)
  • normal support (bone level 1.0 - 3.0 mm apical to CEJ)
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7
Q

What does the Clinical periodontal health consist of ?

A
  • Absense or minimal inflammation (<10 BOP; PDs <=3mm)
  • Normal support (bone level 1.0 - 3.0 mm apical to CEJ)
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8
Q

What does the Periodontal disease stability consist of ?

A
  • minimal inflammation
  • control of modifiable risk factors
  • Reduced periodontium
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9
Q

What does the periodontal disease remission/control consist of ?

A
  • significant inflammation decrease
  • some clinical improvements
  • disease progession stability
  • reduced periodontium
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10
Q

What is the AAP 2018 Two catergories?

A
  • Clinical gingival Health on an intact periodontium- no history of destruction
  • Clinical gingival health on a reduced periodontium- previous history of destruction
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11
Q

What are the subcategories ?

A

Clinical gingival health on a reduced periodontium
- Stable periodontitis (increased risk for recurrence)
- Non periodontitis ( no evidence of increased risk)

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12
Q

What are Gingivitis and gingival disease ?

A
  • Plaque induced and non plaque induced
  • Certain characterisitics must be present to be classifed as gingival disease
  • Clinical diagnosis
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13
Q

What are the common characteristics ?

A
  • Signs and symp of inflammation= gingiva
  • Presence of plaque biofilm = aggravates inflammation
  • Inflammation is reversible with plaque removal
  • Untreated gingivitis = periodontitis
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14
Q

What are the clinical symptoms?

A
  • Edema
  • Erythema
  • Pain
  • Heat
  • Loss of function
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15
Q

What are gingivitis manifestation ?

A
  • enlarged contours
  • red and or bluish tisue color
  • bleeding on prob
  • discomfort on prob
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16
Q

Patient reports?

A
  • Bleeding gums
  • Pain
  • halitosis
  • Difficulty eating
  • Appearance
  • Reduced oral health= quality of life
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17
Q

What is the description of extent of inflammation?

A
  • Localized:10-30% bleeding sites
  • Generalized: greater then 30%
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18
Q

Description of distribution of inflammation

A
  • Papillary: interdental papilla
  • Marginal: Gingival margin and papilla
  • Diffused: Gingival margin, papilla and attached gingiva
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19
Q

Description of combination of descriptive terminology

A

Localized papillary inflammation
Generalized marginal inflammation
Generalized diffused inflammation

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20
Q

What are non dental plaque induced gingival diseases?

A

Genetic/developmental
Specific infections
Inflammatory and immune conditions
Reactive processes
Neoplasms
Endocrine nutritional metabolic disease
Traumatic leasons
Gingival pigmentation

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21
Q

Gingivitis with dental biofilm is?

A

The most common of the periodontal diseases induced by presence of plaque at gingival margin

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22
Q

What does gingivitis presents with?

A
  • Plaque present at gingival margin
  • Redness and tenderness
  • Swollen Rolled margins
  • Bleeding
  • Reversible with plaque removal
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23
Q

Gingivitis must be associated with?

A

Stable Attachement levels

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24
Q

What are the classifications for Gingivitis with biofilm?

A
  • intact periodontium- no histoyr of destruction
  • Reduced Periodontium in non-periodontisits
  • Reduced periodontium in successfully treated periodontitis: previous history
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25
Q

What is reduced periodontium in a successfully treated periodontistis?

A
  • Patients sucessfully treated for periodontitis
  • History of attachment loss which is not progressing
  • Periodontitis is controlled no addition bone or attachment loss.
  • Redeveloped gingivitis
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26
Q

What are the divisions of Gingivitis with biofilm?

A
  • Associated with biofilm alone
  • Modifying factors: Systemic factors, Oral (local) Factors.
  • Drug: Influenced gingival enlargement
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27
Q

Gingivitis with biofilm systemic factors are?

A
  • biofilm initate disease
  • Systemic factors: Sex steroid hormones, hyperglycermia, hematological conditions, smoking, nutritional factors
28
Q

What is the Sex Steroid Hormone systemic factor?

A
  • It exaggerates inflammatory response to biofilm and hormones
  • puberty
  • menstrual cycle
  • oral contraceptives= hormone replacement
  • Pregnancy= 2nd and 3rd trimester= Pyogenic granuloma/preg tumor
29
Q

What is the pyogenic granuloma/pregnancy tumor?

A
  • Localized protuberantss gingival mass of granulation tissue
  • Inflammatory reaction to irritation
  • Margina or papilla
  • Maxilla most common
  • Bleed easiy
  • Most resolve
  • Some require surgery
30
Q

What is Hypergycemia?

A
  • Diabetes
  • hormonal imbalances= exaggerates resposne to dental plaque
  • Poorly controlled plasma glucose levels aggravated the inflammatory response
31
Q

What is Hematological conditions?

A
  • Gingivitis associated with abnormal functiomn or number of blood cells
  • Cyclic neutripenia
  • Leukemia
32
Q

What is Cyclic neutropenia?

A
  • Gingivaostomatitis
  • Ulcerative gingivitis
  • Crater like Ulcers
33
Q

What is Leukemia within the oral cavity?

A
  • Broad group of disorders characterized by overproduction of atypical WBC
  • Move into circulating blood and tissues
  • Diffuse gingival enlargement
  • Persisten Bleeding
  • Exaggerated response to plaque
34
Q

Results of Smoking within the oral cavity?

A
  • Major liefstyle risk for periodontitis
  • Microvascular vasoconstriction and fibrosis
35
Q

What masks the clinical signs of gingivitis?

A

Smoking

36
Q

What does nutrition have to do with oral health?

A

Malnutrition leads to compromised host response and defense mechanisms
- increase susceptibility to infection
- Exacerbate gingival response to plaque

Who is affected/ population:
* Infants from low income families
* institutionalized elderly
* Alcoholics

37
Q

What are the oral factors of gingivitis dental biofilm-induced

A
  • Subgingival restoration margins: restorations placed marginally, increased biofilm retention
  • Oral dryness: increase risk to gingivitis, inflammatory resposne to biofilm, hyposalivation=decrease sailvary flow.
38
Q

What causes hyposalivation/decrease salivary flow?

A
  • Sjogrens syndrome
  • Anxiety
  • Poorly controlled diabetes
  • Medications: antihistamines, decongestants, antidepressants, antihypertensive
39
Q

Drug influcended gingival enlargement

A
  • Gingival enlargment from Systemic medications with no attachment loss
  • Exaggerated inflammatory response to plaque and a systemic medication
40
Q

What medications are most commonly associated with gingival enlargement?

A

Anticonvulsant
Clacium Channel BLockers
Cyclosporine

-Begins 1-3 months

41
Q

What are the mechansims for action for gingival enlargment?

A
  • Individual susceptibility
  • Immunological and genetic factors
  • Fibroblast sensitivity
42
Q

Does plaque accumulation necessary for initiation of drug induced enlargement?

A

No, its not

43
Q

Can the control of plaque reduce overgrowth?

A

Yes but will not eliminate it, gingivectomy often required.

44
Q

Where does drug induced gingival enlargement normaly takes place?

A
  • Starts in the interdental papilla
  • Gradually involves marginal and attached gingiva
45
Q

What does the degree of drug induced enlargement depend on?

A

Dose or serum concentration
Duration of therapy
State of oral hygiene

46
Q

What is the description of drug induced gingival enlargement?

A
  • Firm and lobulated
  • Inflammation
  • Anterior more affected
  • Higher prevalence in children
47
Q

What is gingivitis with nondental biofilm-induced?

A

Not cause by bacterial plaque
Does not disappear after plaque removal
Presence of plaque could increase inflammation

48
Q

What causes gingivitis with nondental biofilm-induced?

A
  • Genetic/developmental disorders
  • Specific infections
  • Inflammatory and immunce conditions
  • Reactive processses
  • Neoplasms
  • Endocrine nutritional and metabolic disease
  • Traumatic lesions
  • Gingival pigmentation
49
Q

What are gingivitis with nondental biofilm-induced Genteic/developmental disorders?

A
  • Hereditary Gingival Fibromatosis
  • Isolated or component of seral inherited syndromes
  • develops early in life
  • Firm, paler than normal gingiva
  • Does not respond to plaque control
50
Q

What are nondental biofilm specifici infections that are bacterial origin?

A

STDS: Nesseria Gonorrhea- Gonorrhea
Treponema Pallidum: Syphilis
Streptococci: Pharyngitis

Rare

51
Q

Nondental biofilm induced

Specific Infections: Viral origin

A
  • resembles plaque induced gingivitis
  • Primary forms of HSV- I: contagious treatment deferred
  • Secondary forms contagious but do not resemble gingivitis
52
Q

What is Primary Herpectic Gingivostomatitis ?

A
  • Initial Infection w/HSV
  • Resembles NG
  • Most common in Children and Young adults
  • Low grade fever, headache, sore throat and malaise
  • Lymphadenopathy
  • Painful and firey red
  • Swolen interdental papilla
  • Diffuse vesicle formation on gingiva or mucosa
  • Self-limiting 10-20 days
  • no scarring
53
Q

What is the treatment for Primary Herpic gingivostomatitis?

A

Fluid intake prevents dehydration
Dietary supplements
Antibiotics only if sepsis
Bacteria enter through sores

54
Q

What are the specific infections: fungal origin when it comes to nondental biofim?

A
  • Candidiasis- candida albicans (MOST COMMON)
  • Coccidioidomycosis-coccidiodies immitits
  • Histoplasmosis-Histoplasma capsulatum
55
Q

What is the description for fungal orgins?

A

-Erythematous and fragile tissue
-Thrive in prosthesis
-Range from linear gingiva redness to sever redness and white patches.

56
Q

What is candidiasis?

A
  • Frequent Immunocompromised patients
  • One of most commons lesions in HIV PT
  • Early signs of developing immunodeficiency
  • Also a predictor for developing AIDS
57
Q

What are the different factors of inflammatory and immune hypersensitivity for non dental biofilm?

A
  • Contact allergy: causation- dental restorative amterials, toothpastes and mouth rinses (causes cheilitis) , chewing gum and candies, food and additives.
  • Good plaque control
  • Stop products to resolve gingivitis
58
Q

What are the oral manifestations for autoimmune disease of skin and mucosus membrane?

A
  • Erythema multiforme
  • Lichen planus
  • Pemohigus vulgaris
  • Benign mucous membrane pemohigoid
  • can invole gingiva
59
Q

What is lichen planus?

A
  • Common benign, chronic disease
  • Affects skin and mucosa
  • middle age
60
Q

What are the oral lesions of lichen planus?

A
  • Lacelike network of white lines and circles- wickham straie
  • Reticular, Erosive, Bullous
61
Q

What is erosive lichen planus?

A
  • Symptomatic
  • Atrophic erythematous areas with central ulceration
  • Periphery bordered by fine white radiatin striae
  • Desquamativ gingivitits : role out pemohigus vulgaris and cicatricial pemphigoid.
62
Q

Cicatrical pemphigoid

A
  • chronic vesiculo-bullous disease
  • Affects oral mucosa and other tissues
  • Older
  • Female predilection
  • Erythema to painful ulcerations (nikolosky sign) peeling
63
Q

What is the most common site fro cicatrical pemphigoid?

A

Gingiva (Desquamative gingivitis)

64
Q

Endocrine

A

Vitamin C: Role int he function of fibro,osteo and odontoblasts.

65
Q

What is Scurby?

A

Defective Collagen formation
Caused by: deficiency of ascorbic acid
Impaired would healing
Progression to periodontitis

66
Q

What does Vitamin A and B do ?

A

A- maintains healthy sulcular epithelium
B- Maintains healhy mucosal tissue

67
Q

What are traumatic lesions?

A
  • Temp interferance with plaque control and contributes to periodontal inflammation
  • Physical mechanical
  • Chemical- asprin, alcohol
  • Thermal

Periodontics (9 decks)

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