Gingival Health and Plaque Induced Gingivitis Flashcards
(32 cards)
What are the 4 levels of periodontal health?
1) pristine periodontal health with a structurally sound and uninflammed periodontium
2) well-maintained clinical periodontal health with a structurally and clinically sound (intact) periodontium
3) periodontal stability, with a reduced periodontium
4) periodontal disease remission/control, with a reduced periodontium
3/4 have the ability to control modifying factors and therapeutic response
Periodontal health ( __ of clinical signs and symptoms of inflammation) can exist ____ disease commences BUT can be restored to an anatomically ____ periodontium as well.
absence
before
reduced
what are the microbiological determinants of clinical periodontal health?
- supra gingival plaque composition
- sub gingival biofilm composition
What are the host determinants of clinical periodontal health?
Local predisposing factors: - periodontal pockets - dental restorations - root anatomy - tooth position and crowding Systemic modifying factors: - host immune function - systemic health - genetics
What are predisposing factors?
any agent or condition that contributes to the accumulation of dental plaque
what’s modifying factors?
any agent or condition that alters the way in which an individual responds to subgingival plaque accumulation
What’s plaque induced gingivitis?
- an inflammatory response of the gingival tissues resulting from bacterial plaque accumulation located at and below the gingival margin
- a loss of symbiosis between the biofilm and the host’s immune-inflammatory response, and development of incipient dysbiosis
- various systemic factors, including endocrinopathies, hematologic conditions, diet, and drugs can modify the immune-inflammatory response
What are some common clinical changes from health to gingivitis?
- color
- texture/edema
- bleeding
- exudate
- plaque
What are the color changes in the gingiva?
- normal gingival color: coral pink+ pigmentation
(tissue’s vascularity and overlying epithelial layers) - inflamed gingiva: red
(increased vascularization and decreased epithelial keratinization) - severely inflamed gingiva: red and cyanotic) vascular proliferation and reduction in keratinization + venous stasis)
- changes start at interdental papilla and gingival margin and spread to the attached gingiva
When does gingival bleeding occur?
- with increasing inflammation:
- dilation and engorgement of the capillaries
- thinning or ulceration of the sulcular epithelium
- chronic or recurrent bleeding, provoked by trauma
- spontaneous bleeding occurs in acute/severe gingival disease and may be related to systemic health problems
What are the changes in the consistency of the gingiva that can occur?
- health gingiva is firm and resilient
- with inflammation:
- increase in extracellular fluid and exudate
- degeneration of connective tissue and epithelium
- engorged connective tissue and thinning of epithelium
- soft, swollen (edema), friable
- in severe gingival disease:
- sloughing with grayish flake-like debris (necrosis)
- chronic inflammation can induce fibrosis and epithelial proliferation
- firm, leathery gingival tissue consistency
what are the changes in surface texture of the gingiva that can occur?
- healthy gingiva - dull surface texture with stippling present in some cases
- with inflammation:
- loss of stippling
- smooth and shiny (if exudate changes occur)
- firm and nodule (if fibrotic changes occur)
What is the shape of the gingival margin?
- in health gingiva
- scalloped with gingiva filling interdental scallops (presence of papilla)
- with inflammation
- knife edge gingival adaptation or loose gingival margins
- in some cases, clefts (stillman’s) or festoons (McCall’s) may develop
What’s gingival enlargement?
- enlargement: increase in size
- chronic inflammatory response characteristic with exudative and proliferative features
- clinically deep red lesions with soft, friable, smooth, shiny surface and bleeding tendency
- also, relatively firm, resilient and pink lesions with greater fibrotic component, abundant fibroblasts and collagen fibers
what are the characteristics common to all dental plaque induced inflammatory gingival conditions?
1) signs and symptoms limited to gingiva
2) reversibility of the disease by removing the etiology
3) the presence of high dental plaque
4) systemic modifying factors which can alter the severity of inflammation
5) stable (non-changing) attachment levels on a periodontium which may or may not experience a loss of attachment or alveolar bone
what are some characteristics of plaque-induced gingivitis?
1) plaque present at gingival margin
2) disease begins at the gingival margin (inflammation confined to the free and attached gingiva and doesn’t extend beyond MGJ)
3) reversible with plaque removal
4) change in color
5) change in gingival contour
6) sulcular temperature change
7) increased gingival exudate
8) bleeding upon provocation
9) absence of attachment loss
10) absence of bone loss
11) histological changes
4/8 varies among individuals
9-11 - stable (unchanging) attachment levels on a periodontium, which may or may not have experienced a loss of attachment or alveolar bone
What’s the classification of plaque-induced gingivitis?
A. associated with dental biofilm only
B. potential modifying factors for plaque-induced gingivitis
1) systemic conditions
- sex steroids
* puberty
* menstrual cycle
* pregnancy
* oral contraceptives
- hyperglycemia
- leukemia
- smoking
- malnutrition
2) oral factors enhancing plaque accumulation
- prominent sub gingival restoration margins
- hypo salivation
C. drug-influenced gingival enlargementsWhat can cause gingival diseases caused by non-dental biofilm-induced?
- genetic/development disorders
- specific infections
- inflammatory and immune conditions
- reactive processes
- neoplasms
- endocrine, nutritional and metabolic diseases
- traumatic lesions
- gingival pigmentation
what’s peri-mucositis?
gingivitis around implants (inflammation limited to mucosa)
What can be the severity and extent of inflammation?
- mild inflammation: minor change in color and little change in the texture of the tissue
- moderate inflammation: glazing, redness, edema, enlargement and bleeding upon probing
- severe inflammation: overt redness and edema with a tendency toward bleeding when touched rather than probed.
- generalized: >_30% of the sites with clinical signs of gingival inflammation
- incipient gingivitis: only a few sites are affected with mild signs of gingival inflammation can be considered “gingival health” having high risk of developing “gingivitis”
what can be the severity and extent of enlargement?
- mild gingival enlargement: gingival papilla
- moderate gingival enlargement: gingival papilla and marginal gingiva
- severe gingival enlargement: gingival papilla, gingival margin and attached gingiva
- generalized gingival enlargement: >_30% of the sites with clinical signs of gingival inflammation
- localized gingival enlargement: limited to the gingiva in relation to a single tooth or group of teeth, while generalized enlargement involves the gingiva throughout the mouth
What is plaque-induced gingivitis on a reduced periodontium characterized by?
its characterized by the return of bacterially induced inflammation to the gingival margin on a reduced periodontium with no evidence of progressive attachment loss (no indication of active diseases). The common clinical and microbial findings are the same as plaque-induced gingivitis on a full periodontium except for the presence of pre-existing attachment loss and therefore a higher risk of periodontitis, unless professional, tailored supportive care regimes are in place.
what’s plaque-induced gingivitis on a reduced periodontium?
- reduced periodontium following active periodontal treatment and the resolution of inflammation from periodontitis is a common finding
what’s the cause of gingivitis?
- primary etiologic factor = bacterial plaque (not enough data to support specific bacterial phenotypes associated with gingivitis)
- secondary etiological factors = local factors
- calculus
- marginal deficiencies in restoration and rough surfaces
- malocclusion
- tooth/root anomalies
