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Gingivitis Flashcards

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1
Q

OVERVIEW

review
describe
diagnose
correlate

A

REVIEW: anatomy of periodontium

DESCRIBE: biofilm induced or non-biofilm-induced gingivitis

DIAGNOSE: type and severity of gingivitis

CORRELATE: histological and clinical signs of biofilm induced gingivitis

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2
Q

PERIODONTIUM

the _______ system of tissues that ________ the teeth and attaches them to the _____

what are the four components

A

the FUNCTIONAL system of tissues that SURROUND the teeth and attaches them to the BONE

Gingiva, cementum, PDL, and alveolar bone

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3
Q

GINGIVA

provides a ________ around the cervical portion of the tooth and covers the __________

holds tissues against the tooth during __________

composed of thin outer layer of _________ and an underlying core of ___________

A

provides a TISSUE SEAL around the cervical portion of the tooth and covers the ALVEOLAR PROCESSES

holds tissues against the tooth during MASTICATION

composed of thin outer layer of EPITHELIUM and an underlying core of CONNECTIVE TISSUE

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4
Q

FREE GINGIVA

  • non __________ gingiva: fits snuggly around the _____ but it is not ________
  • free gingival tissue: meets the tooth in a ____, rounded edge called the _______, should be coronal to the ____
  • gingival margin follows the contours of the _____ (wavy outline)
  • the FGM can be pulled away from the tooth with a ____ > forms a soft tissue wall: the ____________
A
  • non ATTACHED gingiva: fits snuggly around the TOOTH but it is not ATTACHED
  • free gingival tissue: meets the tooth in a THIN, rounded edge called the GINGIVAL MARGIN, should be coronal to the CEJ
  • gingival margin follows the contours of the TOOTH (wavy outline)
  • the FGM can be pulled away from the tooth with a PROBE > forms a soft tissue wall: the GINGIVAL SULCUS
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5
Q

GINGIVAL SULCUS

__ shaped, shallow space around the tooth

normal sulcus =

base of the sulcus is formed by the __________

A

U-shaped, SHALLOW space around the tooth

normal sulcus = 1-3mm

the base of the sulcus is formed by the JUNCTIONAL EPITHELIUM

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5
Q

GINGIVAL BOUNDARIES

coronal edge

apical edge

which mucosa is darker

what demarcates the attached gingiva from the alveolar mucosa

A

coronal edge - gingival margin

apical edge - alveolar mucosa

which mucosa is darker - alveolar (BVs)

what demarcates the attached gingiva from the alveolar mucosa - mucogingival junction

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6
Q

ATTACHED GINGIVA

prevents _______ from being pulled away

located between ______ and ______

widest in _______; narrowest in _____

width is not measured in the ______ because it’s difficult to distinguish between ________ mucosa

the color is ____ or _______, may be _________

A

prevents FREE GINGIVA from being pulled away

located between FREE GINGIVA and ALVEOLAR MUCOSA

widest in INCISOR & MOLAR REGIONS; narrowest in PREMOLAR REGIONS

width is not measured in the PALATE because it’s difficult to distinguish between PALATAL mucosa

the color is PALE or CORAL PINK, may be PIGMENTED

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7
Q

What would be “inadequate attached gingiva”

why is it bad?

A

2 mm with bleeding or 1 mm with or without bleeding

makes teeth more mobile, indicates bone loss

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8
Q

equation for amount of attached gingiva

A

(FGM-MGJ) - PD = amount of attached gingiva

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9
Q

INTERDENTAL PAPILLA/GINGIVA

part of gingiva that fills the area between two _________ teeth

________ to the ________

prevents _________

how many papillae does each tooth have

what is the COL; when is it absent

A

part of the gingiva that fills the area between two ADJACENT teeth

APICAL to the CONTACT AREA

prevents FOOD IMPACTION

teeth consist of TWO interdental papillae: FACIAL AND LINGUAL

col: valley-like depression in the interdental gingiva that lies directly apical to the contact area; absent if teeth are missing or recession is present

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10
Q

PERIODONTAL LIGAMENT (PDL)

____ connective tissue that covers the _____ and attaches it to the _____ of tooth socket

Composed of _____ bundles

Fibers attach to the _______ on one side and the ________ of the tooth socket on the other side

A

SOFT connective tissue that covers the ROOT and attaches it to the BONE of the tooth socket

Composed of FIBER bundles

Fibers attach to the ROOT CEMENTUM on one side and the ALVEOLAR BONE of the tooth socket on the other side

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11
Q

what are the 5 functions of the PDL

A
  1. suspends and maintains the tooth in the socket
  2. provides pressure/pain/sensory to the tooth
  3. provides nutrients to the cementum and bone
  4. builds and maintains cementum and alveolar bone
  5. remodels alveolar bone in response to pressure
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12
Q

CEMENTUM

thin layer of ______, ________ tissue that covers the surface of the ____

what color is it

overlies and protects _____

“bone-like” but more resistant to _________ than bone

does it have a blood/nutrient supply?

A

THIN layer of HARD, MINERALIZED tissue that covers the surface of the ROOT

LIGHT YELLOW

overlies and protects DENTIN

“bone-like” but more resistant to RESORPTION than bone

DOES NOT HAVE ITS OWN BLOOD/NUTRIENT SUPPLY

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13
Q

ALVEOLAR BONE

surrounds and supports ______ in the upper and lower jaws

AKA alveolar bone ______

existence of alveolar bone is dependent on ________

extractions lead to ________

A

surrounds and supports ROOTS in the upper and lower jaws

AKA alveolar bone PROPER

existence of alveolar bone is dependent on the PRESENCE OF TEETH

extractions lead to RESORPTION

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14
Q

what are the 4 functions of alveolar bone

A
  1. protection - sockets for teeth
  2. attachment - PDL fiber
  3. support - tooth roots
  4. shock absorption - forces placed on the tooth
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15
Q

CLINICAL GINGIVAL HEALTH ON AN INTACT PERIODONTIUM

BOP
PD
probing attachment loss
RBL

A

BOP - less than 10%

PD - 1-3 mm

probing/clinical attachment loss - none

RBL - none

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16
Q

CLINICAL GINGIVAL HEALTH ON A REDUCED PERIODONTIUM (stable periodontitis patient)

BOP
PD
probing attachment loss
RBL

A

BOP - less than 10%

PD - 4mm or less (no site over 4 mm with bleeding)

probing attachment loss - yes

RBL - yes

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16
Q

CLINICAL GINGIVAL HEALTH ON A REDUCED PERIODONTIUM (non-periodontitis patient/recession/bad brushing habit/crown lengthening)

BOP
PD
probing attachment loss
RBL

A

BOP - less than 10% bleeding

PD - 1-3mm

probing attachment loss - yes

RBL - possible

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17
Q

COLOR IN HEALTH

  • uniformly _____ (lighter hair/skin = usually lighter gingiva)(darker hair/complexion = darker shade)
  • pink gingiva is easily distinguished from ________
  • tissue may be _______
A
  • uniformly PINK (lighter hair/skin = usually lighter gingiva)(darker hair/complexion = darker shade)
  • pink gingiva is easily distinguished from DARKER ALVEOLAR MUCOSA
  • tissue may be PIGMENTED
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18
Q

3 basic states of periodontal tissues

A
  1. health (fills embrasures, no inflammation, coral pink)
  2. gingivitis (reversible, inflammation, BOP, rolled, edema)
  3. periodontitis (mobility, inflammation, loss of attachment, irreversible damage, working toward stability)
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19
Q

t/f: periodontal disease and periodontitis are the same thing

A

FALSE periodontitis is a TYPE of periodontal disease

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20
Q

periodontal disease is a _________ of the periodontium

what are the 2 types of periodontal disease

A

periodontal disease is a BACTERIAL INFECTION of the periodontium

gingivitis and periodontitis

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21
Q

CLINICAL(3) vs HISTOLOGICAL(4) HEALTH

A

CLINICAL
- pink
- firm
- less than 10% bleeding

HISTOLOGICAL
- Junctional epithelium coronal to CEJ
- supragingival fibers intact
- alveolar bone intact
- periodontal ligament intact

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22
Q

Pristine gingival health VS clinically health VS incipient gingivitis

A

PRISTINE GINGIVAL HEALTH
- no BOP or attachment loss
- 1-3mm PD
- no clinical signs of inflammation

CLINICALLY HEALTHY
- absence/low levels of inflammation

INCIPIENT GINGIVITIS
- less than 10% BOP
- variant of gingival health
- if left untreated, can rapidly progress to gingivitis

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23
clinical (3) VS histological (4) dental biofilm-induced gingivitis
CLINICAL - red - swollen - bleeding likely (more than 10% BOP) HISTOLOGICAL - JE is at the CEJ - supragingival fiber destruction - alveolar bone intact - periodontal ligament
24
prevalence of gingivitis ____ in the population ____ in ages 65+ ____ in men _____ in women
47.2% of the population 70.1% in ages 65+ 56.4% in men 38.4% in women
25
INFLAMMATORY PROCESS OF PATHOGENESIS (7 steps)
1. invasion of pathogens, injury or irritant to tissues produces transient vasoconstriction of BVs 2. biochemical mediators released causing vascular wall changes which increases BV permeability and flow 3. delivers defense supplies 4. fluid leakage - inflammatory exudate 5. defense cells migrate 6. plasma cells and leukocytes leak from capillaries into the tissues 7. disease signs followed by tissue destruction and healing
26
VASOCONSTRICTION, VASODILATION, AND EXUDATION ________ and ______ chain of events Injured or dying cell releases ______ breakdown products such as _______ Cause release of enzymes found along ______ cells Enzymes are activated and cause break in mast cell wall and release of _______ Histamine granules escape into tissue and cause ________
INTERDEPENDANT and INTERRELATED chain of events Injured or dying cell releases CHRONIC breakdown products such as POLYPEPTIDES Cause release of enzymes found along MAST cells Enzymes are activated and cause break in mast cell wall and release of HISTAMINE Histamine granules escape into tissue and cause DAMAGE
27
AS THE INFLAMMATORY PROCESS CONTINUES _______ in vessel permeability and _______ carry ______ supplies _______ of BV with ________ or pooling of blood in the capillaries _______ ________ causes a break in endothelial cells lining BV's
INCREASE in vessel permeability and BLOOD FLOW carry DEFENSE supplies VASODILATION of BV with HYPERMIA or pooling of blood in the capillaries ENGORGED HISTAMINE causes a break in endothelial cells lining BV's
28
What’s really happening? ________ form Blood enters the ____ carrying: ____, _____ cells, ______ Inflammatory _____ enters the tissue
MICROULCERATIONS form Blood enters the SULCUS carrying: PMNs, PLASMA cells, AND MACROPHAGES Inflammatory EXUDATE enters the tissue
29
WHAT ARE PMNS ___ line of _____ engulf and destroy ______ type of ______ Most _______ circulating immune cell Plays a key role in _______
FIRST line of DEFENSE engulf and destroy PATHOGENS type of LEUKOCYTE Most ABUNDANT circulating immune cell Plays a key role in INFLAMMATION
30
gingival inflammation ___, ______, and ______ repaired by _______
redness, swelling, bleeding repaired by firbroblasts
31
tissue invasion by bacteria results in _____ to the body inflammatory response: increased blood flow delivers defense cells: - _____ and _______ leak from blood vessel into the tissue - _______ fight invading bacteria - some tissue destruction occurs surrounding the infection site, this is a ________ of the inflammatory repsone
tissue invasion by bacteria results in INJURY to the body inflammatory response: increased blood flow delivers defense cells: - LEUKOCYTES and PLASMA PROTEINS leak from blood vessel into the tissue - LEUKOCYTES fight invading bacteria - some tissue destruction occurs surrounding the infection site, this is a SIDE EFFECT of the inflammatory repsone
32
ACUTE INFLAMMATION - bacterial infection of ____ or less - ____, heat, ______, swelling, loss of ______ CHRONIC INFLMMATION - no ______ - ______ onslaught of bacteria chronic inflammation causes an ______ host inflammatory repsonse
ACUTE INFLAMMATION - bacterial infection of 2 WEEKS or less - REDNESS, heat, PAIN, swelling, loss of FUNCTION CHRONIC INFLMMATION - no SYMPTOMS - PERSISTANT onslaught of bacteria (longer than 2 weeks) chronic inflammation causes an EXAGGERATED host inflammatory repsonse
33
GINGIVAL INFLAMMATION Biofilm stimulates _______ Inflammatory response results in _________ Changes involve ____ and ____ gingiva _______ papilla also impacted Patients are generally _____ as there is no _____ associated
Biofilm stimulates IMMUNE REPOSNE Inflammatory response results in CLINICAL CHANGES Changes involve FREE and ATTACHED gingiva INTERDENAL papilla also impacted Patients are generally UNAWARE as there is no PAIN associated
34
what is considered the key risk factor for the onset of periodontitis
gingival inflammation in reponse to bacterial plaque accumulation we must remove the irritant, control of gingival inflammation is essential for the primary prevention of periodontitis
35
what part of the periodontium does gingivitis affect first? what is the number one risk factor of PD
gingivitis affect the interdental papilla and the margins first (bulbous) individual host reposne to biofilm
36
slight gingivitis can be described as: moderate can be described as severe can be described as
- less than 30% BOP, confined to the margins/ acute range, bulbous papilla - more than 30% BOP, diffuse redness, bulbous, rolled margins - can't see the MGJ, red/bulbous
37
if inflammation AND recession is present on one tooth, how do we record this if bulbous and blunted what do we do
- record recession on the perio chart (+1) - describe the papilla as bulbous on the gingival descriptors we would mark the blunted because that is attachment loss
38
does color variation always mean disease
NO, color change can occur for reasons other than inflammation. injury such as brushing too hard can cause a color change. Intraoral tattoos.
39
CONTOURS OF HELATHY GINGIVA smooth, even _____ margin at or slightly _____ to the ___ _____ margin slightly coronal to the CEJ pointed papilla that fills the _____ FGM is ____
smooth, even SCALLOPED margin at or slightly CORONAL to the CEJ TAPERED margin slightly coronal to the CEJ pointed papilla that fills the SPACE FGM is 000
40
tissue size in gingivitis Increased tissue ____ enlarges _______ and _______ gingival tissue Enlargement can be _____ or involve the ____ mouth
Increased tissue FLUID enlarges MARGINAL and INTERPROXIMAL gingival tissue Enlargement can be LOCALIZED or involve the WHOLE mouth
41
stippling ____ of health Disappears with ______, giving tissue a more ____/____ appearance (Stretched plastic wrap) ____ Gingiva is still ____ Tissue is not ________ with air
SIGN of health Disappears with INFLAMMATION, giving tissue a more SMOOTH/SHINY appearance (Stretched plastic wrap) ATTACHED Gingiva is still BOUND Tissue is not RETRACTABLE with air (FLACCID)
42
healthy vs gingivitis texture
healthy: - firm - maybe stippled (varys) gingivitis - spongy - stipping disappears (varies)
43
what is each papilla assciated with
bulbous: gingivitis blunted and cratered: periodontitis or trauma
44
does bleeding = disease
not always, less than 10% is healthy, but still talk with the patient
45
BLEEDING - sulcus lining becomes ______ - BVs ______ - direct relation between the ________ and _______ - absence of bleeding indicates _____ - ______ means active disease - _______ technique can bleeding - no ________ despite bleeding (gingivitis)
- sulcus lining becomes ULCERATED - BVs ENGORGE - direct relation between the DEGREE OF INFLAMMATION and AMOUNT OF BLOOD - absence of bleeding indicates HEALTH - TYPICALLY means active disease - PROBING technique can bleeding - no ATTACHMENT LOSS despite bleeding (gingivitis)
46
PSUEDOPOCKETS - no _______ of the ___, remains _____ to the CEJ - no permanent destruction of the ____ or _____
- no APICAL MIGRATION of the JE, remains CORONAL to the CEJ - no permanent destruction of the PDL FIBERS or ALVEOLAR BONE
47
PERIODONTAL POCKET a _______ deepening of the gingival sulcus as a result of: -__________ of the JE -Destruction of ___ fibers and _____ The presence of a periodontal pocket does ___ indicate necessarily that there is ____ disease at the site. The majority of periodontal pockets in most adult patients with periodontitis are ______ sites. The pocket is an indicator of ____ destruction from periodontitis.
a PATHOLOGIC deepening of the gingival sulcus as a result of: - APICAL MIGRATION of the JE - Destruction of PDL fibers and ALVEOLAR BONE The presence of a periodontal pocket does NOT indicate necessarily that there is ACTIVE disease at the site. The majority of periodontal pockets in most adult patients with periodontitis are INACTIVE sites. The pocket is an indicator of PAST destruction from periodontitis.
48
in gingivitis the JE stays ______ while the ________ moves coronally
in gingivitis the JE stays STILL while the GINGIVAL MARGIN moves coronally
49
CHRONIC GINGIVITIS: GINGIVAL FLUID Inflammatory product secreted from ____ that exhibits pathologically-induced increased _______ ____ sign of inflammation Appears prior to ________ Provides _____ for the growth of subgingival plaque biofilm causing disease to increase Chronic: continues to feed and could progress to ________
Inflammatory product secreted from the SULCUS that exhibits pathologically-induced increased PERMEABILITY FIRST sign of inflammation Appears prior to BLEEDING Provides NUTRIENTS for the growth of subgingival plaque biofilm causing disease to increase Chronic: continues to feed and could progress to PERIODONTITIS
50
BIOFILM INDUCED GINGIVITIS - Gingival diseases with ______ factors - Most ______ disease - ____ relationship between inflammation and _____ NONBIOFILM INDUCED GINGIVITIS - ____, ____, ___, induced gingival diseases (different bacteria from gingivitis, not ____ bacteria) - ____ causes - _____ - Patient _____
BIOFILM INDUCED GINGIVITIS - Gingival diseases with MODIFYING factors - Most COMMON disease - LINEAR relationship between inflammation and BIOFILM NONBIOFILM INDUCED GINGIVITIS - BACTERIAL, VIRAL, FUNGAL, induced gingival diseases (different bacteria from gingivitis, not ORAL bacteria) - SYSTEMIC causes - MALNUTRITION - Patient SYMPTOMS
51
COMMON CHARACTERISTICS OF BOTH GINGIVITIS TYPES (4)
- Signs of inflammation confined to the gingiva - No attachment loss bone loss associated with the inflammation - Inflammation is REVERSIBLE with biofilm removal - May progress to PERIODONTITIS if left untreated
52
SUBTYPE: BIOFILM-INDUCED GINGIVITIS ON A REDUCED PERIODONTIUM (stable perio patient with over 10% bleeding) - BOP must be on _____ sites - when the gingivitis occurs, active ______ sites are NOT present - Preexisting _______ from a previous history of periodontitis - ______ at the gingival margin - very ____
- BOP must be on NON PERIO sites - when the gingivitis occurs, active PERIODONTITIS sites are NOT present - Preexisting BONE AND ATTACHMENT LOSS from a previous history of periodontitis - PLAQUE at the gingival margin - very RARE
53
LOCAL COMPLICATING FACTORS - factors that ____ or ______ localized areas of gingivitis - the most common local complicating factor for gingivitis would be ______ - list 4 examples
- factors that MODIFY or PREDISPOSE localized areas of gingivitis - the most common local complicating factor for gingivitis would be BIOFILM TRAPS: - malposition of teeth - overhanging restorations - orthodontics/braces - calculus
54
MODIFIED BY SYSTEMIC FACTORS _____ initiates the disease- _________ will modify/intensify the disease ________ system and fluctuations in ______ hormones cause more ______ species of microbes such as __________ Example causes: (3)
PLAQUE/BIOFILM initiates the disease- HOST SYSTEMIC FACTORS will modify/intensify the disease ENDOCRINE system and fluctuations in FEMALE hormones cause more BACTEROIDES species of microbes such as PREVETELLA INTERMEDIA Example causes: - PREGNANCY - PUBERTY - MENOPAUSE
55
MODIFIED BY MEDICATIONS ________ inflammation of the gingiva related to plaque biofilm and systemic _____ The cause is likely overstimulation of _____ Biofilm _______ the disease and is _____ by medications Xerostomia- over ___ meds ___________: an increase in the size of the gingiva resulting from systemic medications (e.g. ______)
EXAGGERATED inflammation of the gingiva related to plaque biofilm and systemic MEDICATIONS The cause is likely overstimulation of FIBROBLASTS Biofilm INITIATES the disease and is MODIFIED by medications Xerostomia- over 400 meds DRUG INFLUENCED GINGIVAL ENLARGMENT: an increase in the size of the gingiva resulting from systemic medications (e.g. DILANTIN)
56
is plaque accumulation necessary for the initiation of gingival enlargement? what can reduce (but not eliminate) gingival overgrowth, why doesn't it eliminate it which teeth are typically affected most, give 3 terms to describe the gingiva
Plaque accumulation is NOT necessary for initiation of gingival enlargement, but it will exacerbate the gingival disease. METICULOUS PLAQUE CONTROL can reduce but will not eliminate gingival overgrowth (fibrotic tissue remains forever, and needs to be removed via surgery) MAXILLARY TEETH are most affected; fibrotic, lobular, pink
57
what drugs are associated with gingival overgrowth (3)
- calcium channel blockers (nifedipine) - anti-convulsive (dilantin) - immunosuppressive (cyclosporine)
58
does medication impact someone plaque level?
no, it alters the hosts immune response which sends more fibroblasts to the area making the tissue firmer and overgrown. The best thing we can do is remove the plaque and put the pt. on 3 month recare
59
MODIFIED BY MALNUTRITION (3rd world countries typically) -Dental biofilm aggravated by nutritional ________ - although rare, vitamin __ def. predominates - ______ acid; spontaneous _____ -Vitamins __, __, __ -At risk for vitamin deficiencies: (3)
-Dental biofilm aggravated by nutritional DEFICIENCEIES - although rare, vitamin C def. predominates - ASCORBIC acid; spontaneous BLEEDING -Vitamins A, B, C -At risk for vitamin deficiencies: INFANTS, INSTITUTIONALIZED ELDERLY, ALCOHOLICS
60
NON BIOFILM INDUCED Viral, fungal or non-periodontal associated bacterial origin, ______ process Viral - ______ Fungal- _______ Fungal- _______ Reactive- _________
Viral, fungal or non-periodontal associated bacterial origin, FUNGAL process Viral - PRIMARY HERPES Fungal- CANDIDIASIS/THRUSH Fungal- HISTOPLASMOSIS Reactive- ALLERGIES (ex- toothpaste allergy would have no bleeding but inflammation)
61
description of the mouth during PRIMARY HERPETIC GINGIVOSTOMATITIS (PHG) (6) this occurs when you are first exposed to the herpes virus
- fiery red marginal gingiva - swollen papilla that bleed - painful - yellowish ulcers with red halo - fever - dehydration
62
non biofilm induced gingivitis: example of a viral origin PHG - usually affect _______ - HSV1: severe reaction to _______ - gingiva: rapidly ____, burst and form painful _____ - ____ manisfestations - _______! use caution with touching - after being infected you develop _______ - ______
- usually affects YOUNG CHILDREN - HSV1: severe reaction to INITIAL EXPOSURE - gingiva: rapidly ERUPT, burst and form painful ULCERS - SYSTEMIC manisfestations - TRANSMISSIBLE! use caution with touching - after being infected you develop IMMUNITY - RECURRENT
63
Dermatologic oral lichen planus - intense _____ of gingiva - u_______ - interlacing _______ may be present - raised _____ may be present - disease of ________ - characterized by ______, swollen ____ on skin and/or _____ - cause:
- intense REDNESS of gingiva - ULCERCATIONS - interlacing WHITE LINES may be present - raised WHITE LESIONS may be present - disease of SKIN AND MUCOUS MEMBRANES - characterized by ITCHY, swollen RASH on skin and/or MOUTH - cause: unknown, maybe allergic or immune reactoin
64
ALLERGIC REACTION TO TOOTHPASTE Reaction to _____ in toothpaste what ingredient is most commonly seen with allergic reactions Most common in those with _________ Fiery red ___ Tissue ______ of mucosa is there bleeding? what should the patient do?
Reaction to ADDITIVE in toothpaste SODIUM LAURYL SULPHATE Most common in those with OTHER ALLERGIES Fiery red GINGIVA Tissue SLOUGHING of mucosa no change brands
65
IAG can only be determined on the _____ how to calculate IAG
facial MGJ-GM - PD = IAG
66
what are the 2 codes for planning gingivitis treatment
D1110: adult prophylaxis (slight) D4346: scaling in the presence of mod/severe gingivitis

therapies/practices (7 decks)

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