Lecture 7 - Periodontal Disease

Question 1

Gingivitis

Answer 1

Inflammation limited to the soft tissues that surround teeth

Question 2

Gingivitis Clinical Features

Answer 2

Accumulation of dental plaque and calculus
Inflammation can be local or generalized
Diffuse, marginal gingivitis, or papillary gingivitis

Question 3

Gingivitis Signs

Answer 3

Loss of stippling and bleeding on gentle probing
Erythematous gingiva
Severe cases may have pyogenic granulomas

Question 4

Gingivitis Epidemiology

Answer 4

Increased susceptibility during puberty
Progesterone (pregnancy) increases permeability of gingival blood vessels
Risk factors: smoking, stress, poor diet

Question 5

Gingivitis Histology

Answer 5

Inflammatory infiltrate with PMN, then lymphocytes

Question 6

Gingivitis Treatment

Answer 6

Reduce know risk factors
Improve oral hygiene
Remove plaque

Question 7

Necrotizing Ulcerative Gingivitis

Answer 7

Vincent Infection, Trench Mouth

Infection caused byspirochetes and bacillus fusiformis in the presence of psychological stress.

Question 8

NUG Clinical Features

Answer 8

Interdental papillae are highly inflamed, edematous, and hemorrhagic.
Papillae are blunted with crater-like necrosis covered by grey pseudomembrane.
Can lead to loss of attachment

Question 9

NUG Epidemiology

Answer 9

Mostly seen in young and middle-aged adults and military

Can occur in all ages

Question 10

NUG Histology

Answer 10

Non-specific

Inflammation, ulceration, necrotic material

Question 11

NUG Treatment

Answer 11

Debride and rinses to remove bacteria

Resolves quickly

Question 12

Granulomatous Gingivitis

Answer 12

Unexplained granulomatous inflammation on gingival biopsy
Rule out all other possible causes
May be caused by foreign body in gingival tissue

Question 13

Granulomatous Gingivitis Clinical Features

Answer 13

Red and white macules at interdental papillae

Pain, sensitivity

Question 14

Granulomatous Gingivitis Epidemiology

Answer 14

Most frequently in adults

Question 15

Granulomatous Gingivitis Histology

Answer 15

Granulomas with multinucleated giant cells

Question 16

Granulomatous Gingivitis Treatment

Answer 16

Surgically excise foreign body

If no foreign body, evaluate for other diseases

Question 17

Desquamative Gingivitis

Answer 17

Gingival epithelium that sloughs spontaneously or with minor manipulation

Question 18

Desquamative Gingivitis Epidemiology

Answer 18

Female

> 40 yo

Question 19

Desquamative Gingivitis Clinical Features

Answer 19

Gradual involvement
More facial than lingual
Smooth erythema
Loss of stippling
Painful
Can have blisters

Question 20

Desquamative Gingivitis Histology

Answer 20

Lichen planus or pemphigoid

Question 21

Desquamative Gingivitis Treatment

Answer 21

Clean area
Doxycycline
Immunosupressants

Question 22

Drug Related Gingival Hyperplasia

Answer 22

Abnormal growth of gingival tissues secondary to systemic medication due to an increased production of ECM (collagen)
Most common with cyclosporine and phenytoin
Associated with poor dental hygiene???

Question 23

DRGH Epidemiology

Answer 23

25 and younger

Question 24

DRGH Clinical Features

Answer 24

Enlargements start in interdental papillae and spread
Dark red, bleeds easily, can ulcerate
Can interfere with speech and mastication

Question 25

DRGH Histology

Answer 25

Elongated rete ridges | Increased collagen

Question 26

DRGH Treatment

Answer 26

Discontinue medication If med can't be stopped - professional evaluations and home plaque control Folic Acid

Question 27

Gingival Fibromatosis

Answer 27

Hyperplasia of gingiva

Question 28

Gingival Fibromatosis Epidemiology

Answer 28

Familial or idiopathic Begins < 20 yo May be associated with hypertrichosis, epilepsy, and mental retardation

Question 29

Gingival Fibromatosis Clinical Features

Answer 29

Enlarged gingiva Normal color Smooth surface

Question 30

Gingival Fibromatosis Histopathology

Answer 30

Dense hypocellular Hypovascular tissue Absent inflammation

Question 31

Gingival Fibromatosis Treatment

Answer 31

Gingivectomy Oral hygiene Sometimes tooth extraction

Question 32

Periodontitis

Answer 32

Inflammation of gingival tissue with associated loss of bony attchment and support Risk factors: smoking, diabetes, genetics

Question 33

Periodontitis Bacteria

Answer 33

Healthy gingiva: facultative gram postitive Periodontisis: gram negative -A.a. -Bacteroides -Prevotella intermadia Form biofilm Release lipopolysaccharides, stimulate inflammation

Question 34

Chronic Periodontitis

Answer 34

Primary cause of tooth loss in pts >35 yo No inflammation Blunting and apical positioning of the gingival margins Loss of attachment (shown with probe)

Question 35

Necrotizing Ulcerative Periodontitis

Answer 35

Similar to NUG, with loss of attachment and alveolar bone May occur in preexisting areas of NUG or periodontitis Pts are younger

Question 36

Periodontal Abcess

Answer 36

Occurs in pre-existing periodontal lesion Can result from super infection Appears as lateral enlargement of gingiva May be red with edema or bleeding Pain, sensitivity on palpation, foul taste, fever

Question 37

Pericoronitis

Answer 37

Develops around impacted or partially erupted teeth with debris between the gingival flap and the crown Inflammation Foul taste Can't close jaws, pain may radiate to throat, floor of mouth, or ear

Question 38

Periodontitis Histology

Answer 38

Hyperplasia of epithelium Increased vascularity Inflammation