histopathology of perio disease Flashcards
(14 cards)
Why is enamel not in histopathology?
Decalcification of teeth for process
Enamel is highly mineralised so is lost
What is the junctional epithelium?
In health- connected to enamel and attached to ACJ
V thin membrane- couple of cells think
Specialised and wide intercellular spaces (porous)- susceptible to attack
What is the normal sulcus depth?
0.5-2.0 mm
What is the periodontal ligament?
Fibres attach at cementum of tooth and bone to give a tight integral complex
What are stages of gingivitis and perio disease?
Early gingivitis
~ initial changes- 1st week
~ early lesion- 2nd week
Chronic marginal gingivitis- established lesion- 2-3 weeks (loss of stippling, accumulation of plaque, BOP, inderdental papilla is rounded/swollen)
Destructive periodontitis- advanced lesion- unknown timescale
What happens in early gingivitis- the initial response?
- Increased blood flow (vasodilation)
- Crevicular fluid tries to flush it away- cytokines/chemokines released to promote healing
- Oedema development
- Migration of neutrophils
- Loss of perivascular collagen
What happens in early gingivitis-the early lesion?
- Increase in neutrophils and crevicular fluid
- Junctional epithelium starts to proliferate (rete ridges)- however still attached
- Fibroblasts in c. tissue show signs of damage and collagen loss, however fibres into cementum still attached
- Macrophages and lymphocytes recruited
What happens in chronic marginal gingivitis?
- Increase in vascularity and formation of crevicular fluid
- Increase in lymphocytes and plasma cells
- Junctional epithelium (thickened and hypoplastic- basement membrane not flat) becomes detached from tooth but attached at ACJ
- J. epithelium may become ulcerated
- Marked loss of collagen but fibres inserting into tooth still intact
FALSE POCKETING- allows apical migration and maturation of plaque
What do the inflam cells look like?
Lymphocytes- small, single dark spots
Plasma cells- fried egg
Neutrophils- Mickey Mouse
What happens in destructive periodontitis?
- Loss of collagen fibres into cementum
- J. epithelium migrates into cementum (true pockets) (possibly ulceration)
- Destruction of alveolar bone (resorption)
- Destruction occurs in bursts
Irreversible
How do you manage destructive periodontitis?
Root surface debridement
~remove plaque, calculus, debris
- Inflam subsides
- J.epithelium proliferates
- Attaches to tooth, long epithelium attachment (not as tight to ACJ)
- Little/no regeneration of bone/collagen fibres inserting into cementum
What are the rests of Malassez?
Remnants of hertwigs root sheath- normal component of PDL
Disease- may proliferate and form radical at cyst
What is the difference between primary and secondary cementum?
Primary- acellular, present on entire root surface
Secondary- found near apex of root, contains cells
What is the lamina dura?
Thin layer of dense cortical bone which lines the roots of sound teeth
