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PERIO I > Periodontal Health, Gingival Disease:Conditions > Flashcards

Periodontal Health, Gingival Disease:Conditions Flashcards

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1
Q

Periodontal Health

A

Absence of clinically detectable inflammation A state free from inflammatory periodontal disease

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2
Q

potential impacts of gingival dx

A
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3
Q

Importance of determining gingival health

A

To find the common reference point for assessing disease and determining the meaningful treatment outcomes.

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4
Q

Gingival Epitheliums

A

Oral epithelium
Sulcular epithelium
Junctional epithelium

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5
Q

Oral epithelium

A

*Keratinized, turnover rate 30
days

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6
Q

Sulcular epithelium

A

*Non-keratinized, no rete pegs,
semipermeable membrane

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7
Q

Junctional epithelium

A

*Non-keratinized, attached via hemidesmosomes infiltrate by PMN, turnover rate 7-10 days

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8
Q
  • Gingival Connective Tissue contents
A

Connective tissue presents a diffuse, amorphous ground substance and collagen fibers.
Blood vessels stand out clearly in the papillary projections of the connective tissue.

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9
Q

Correlation of Clinical and
Microscopic Features

A
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10
Q

Correlation of Clinical and
Microscopic Features: color (wnl)

A
  • Coral pink on marginal/attached gingiva
  • Red smooth shiny on alveolar mucosa
  • physiologic pigmentation
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11
Q

Correlation of Clinical and Microscopic Features:
size corresponds to what?

A

: Should corresponds with the total of the bulk of cellular and intercellular elements and vascular supply

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12
Q
  • Consistency wnl
A
  • Consistency: Firm and
    resilient (gingival fibers)
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13
Q

Surface texture wnl

A

Surface texture: Stippled on
the attached gingiva

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14
Q

contour wnl

A

scalloped and collar-like fashion

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15
Q

gingival shape wnl

A

Shape: Pyramidal towards the anterior, flattened towards the posterior

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16
Q

Position of gingiva wnl
how can this be different?

A

The level at which the gingival margin is attached to the tooth
can be different due to eruption patterns (continuous eruption-active and passive-altered passive eruption)

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17
Q

Etiologic Factors

A

host determinants
microbe determinants
environmental determinants

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18
Q

host determinants of gingival health

A

Local predisposing factors:
Periodontal pockets
Restorations
Root anatomy
Tooth position and crowding

Systemic modifying factors:
* Host immune function
* Systemic health
* Genetics

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19
Q

microbial determinants of gingival health

A

Supragingival plaque
Subgingival plaque

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20
Q

environmental determinants of gingival health

A

Smoking
Medication
Stress
Nutrition

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21
Q

Indicators for gingival dx

A

BOP
probing
radio features
tooth mobility

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22
Q

BOP

A

light pressure 0.25N

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23
Q

can probing be used for diagnosis alone?

A

no

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24
Q

radio features of dx

A

Lamina dura
The distance of 2mm from the most coronal part of the alveolar crest to CEJ (max distance for WNL)

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25
tooth mobility as a diagnosis
Not recommended
26
Clinical Gingival Health on an Intact Periodontium Bleeding on Probing level Pocket Probing depths Probing Attachment Loss Radiological Bone Loss
Bleeding on Probing <10% Pocket Probing depths ≤3mm Probing Attachment Loss - No Radiological Bone Loss - No
27
Clinical Gingival Health on a Reduced Periodontium:Stable Periodontitis Patient Bleeding on Probing Pocket Probing depths Probing Attachment Loss - Radiological Bone Loss -
Bleeding on Probing <10% Pocket Probing depths ≤4mm (no site ≥4mm with BOP) Probing Attachment Loss - Yes Radiological Bone Loss - Yes
28
Clinical Gingival Health on a Reduced Periodontium: Non-periodontitis Patient Bleeding on Probing Pocket Probing depths Probing Attachment Loss - Radiological Bone Loss -
Bleeding on Probing <10% Pocket Probing depths ≤3mm Probing Attachment Loss - Yes Radiological Bone Loss - Possible
29
Pristine periodontal health
Total absence of of clinical inflammation and physiological immune surveillance with no attachment or bone loss Not likely to be observed clinically
30
Clinical periodontal health
Absence or minimal levels of clinical inflammation in a periodontist with no attachment or bone loss
31
Periodontal disease stability present with what periodontium?
In a reduced periodontium
32
Periodontal disease remission/control
In a reduced periodontium Control modifying factors and therapeutic response
33
Treatment Goals
Clinical gingival health can be restored following treatment. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and must be closely monitored.
34
which gingival epthelium are non-keratinized?
junctional epithelium and sulcular
35
induced forms of gingivitis
plaque and non-plaque induced
36
supracrestal tissue attatchment diagram
37
common pt complaints regarding gingiva
*Bleeding when brushing *Blood in saliva *Gingival swelling and redness *Halitosis
38
common clincal observations
*Bleeding on gentle probing *Increased gingival crevicular fluid production rate *Change in gingival clinical features
39
Bleeding on Probing when can this be seen? predictor of? smoking?
* One of the early signs * Prior to color change or other visual signs of inflammation * Excellent negative predictor (absence of BOP) of future attachment loss * Smoking masks BOP by suppressing inflammatory response
40
BOP under the microscope
* Dilation and engorgement of the capillaries and thinning or ulceration of the sulcular epithelium * Vasculitis of blood vessels adjacent to the junctional epithelium * Progressive destruction of the collagen fiber network (collagen-poor) * Cytopathologic alterations of resident fibroblasts (cell-rich) * Progressive infiammatory immune cellular infiltrate (predominantly lymphocytic=chronic stage)
41
changes in gingival color scale? patterns?
* Color: important clinical sign of gingival disease * Patterns: marginal, diffuse or patchlike
42
changes to gingival consistency acute vs chronic forms?
result from the predominance of the destructive (edematous) and reparative (fibrotic) changes Acute Forms: * Sloughing with grayish, desquamative debris * Vesicle formation Chronic Forms: * Soggy puffiness * Softness and friability * Firm, leathery consistency
43
changes to gingival surface texture
loss of stippling is an early sign of gingivitis ( 40% patients have stippling)
44
Smooth Shiny surface texture can indicate:
Epithelial atrophy in atrophic gingivitis
45
peeling gingiva can indicate?
Chronic desquamative gingivitis
46
leathery gingiva can indicate
hyperkeratosis
47
nodular ginigva can indicate
Drug-induced gingival overgrowth
48
gingival recession prevalence? demo? result?
gingival recession is a common finding * Prevalence, extent and severity increase with age * More prevalent in male * The gingival margin shifts apically, resulting in the root surface exposure
49
types of recession
Visible: Clinically observable Hidden: Covered by gingiva, can be measured by probing to the level of epithelial attachment
50
apparent and actual postion of gingiva
Apparent position: The level of the crest of the gingival margin Actual position: The level of the coronal end of the epithelial attachment on the tooth
51
clincal significance of gingival recession and resulting root exposure
Exposed roots are susceptible to caries, hypersensitivity, pulp symptoms, plaque accumulation
52
changes to gingival contour
* Primarily associated with gingival enlargement * Stillman’s clefts, McCall festoons
53
Stillman’s clefts
Narrow triangular-shaped gingival recession Cleft becomes broader when progressing apically
54
McCall festoons
A rolled, thickened band of gingiva Close to the mucogingival junction Usually adjacent to the cuspid
55
terms to describe distribution and location
56
Degree Scoring system of gingival enlargement
w
57
key indicator of gingival health (regardless of pt Hx)
BOP less than or equal to 10%
58
GingivitisDental plaque-induced
An inflammatory response of gingiva resulting from plaque biofilm accumulation located and below the gingival margin
59
Characteristics of plaque induced gingivits
* Plaque to initiate the inflammation * Clinical signs and symptoms are confined in the gingival unit * Systemic modifying factors * Stable attachment may or may not experience further attachment loss * Reversibility
60
Modifying Factors of plaque induced gingivitis systemic vs local
table
61
med factors of gingival enlargment
* Antiepileptic drugs Dilantin * Calcium channel-blocking drugs (Nifedipine, verapamil, diltiazem, amlodipine, felodipine) * Immunoregulating drugs (Cyclosporine) * High-dose oral contraceptives
62
Diagnostic Criteria of plaque induced gingivitis
* The clinical signs of inflammation present * These may manifest clinically in gingivitis as: a. Swelling, seen as loss of knife-edged gingival margin and blunting of papillae b. Bleeding on gentle probing c. Redness d. Discomfort on gentle probing (dalore) radiographs are not helpful
63
Based on available methods to assess gingival inflammation, gingivitis case could be simply, objectively and accurately identified and graded using:
Bleeding on Probing Score (BOP%)
64
A case of dental plaque-induced gingivitis is defined as:
≥10% bleeding sites with probing depths ≤3 mm*
65
Localized gingivitis:
Localized gingivitis: 10%-30% bleeding sites
66
Generalized gingivitis:
Generalized gingivitis: > 30% bleeding sites
67
For epidemiological purposes alone, a patient with a history of periodontitis, with gingival inflammation is still a:
periodontitis case
68
Biofilm-induced Gingivitis categories
69
Biofilm-induced Gingivitis with Intact Periodontium Bleeding on Probing Pocket Probing depth Probing Attachment Loss - Radiological Bone Loss -
Bleeding on Probing ≥10% Pocket Probing depths ≤3mm Probing Attachment Loss - No Radiological Bone Loss - No
70
Biofilm-induced Gingivitis with Reduced Periodontium:Stable Periodontitis Patient Bleeding on Probing Pocket Probing depths Probing Attachment Loss - Radiological Bone Loss -
Bleeding on Probing ≥10% Pocket Probing depths ≤4mm* (no site ≥4mm with BOP) Probing Attachment Loss - Yes Radiological Bone Loss - Yes
71
Biofilm-induced Gingivitis with Reduced Periodontium:Non-periodontitis Patient Bleeding on Probing Pocket Probing depths Probing Attachment Loss - Radiological Bone Loss -
Bleeding on Probing ≥10% Pocket Probing depths ≤3mm Probing Attachment Loss - Yes Radiological Bone Loss - Possible
72
non-plaque induced gingivitis
The oral conditions resulted from the manifestations of systemic conditions which may be further exacerbated by local factors such as plaque or oral dryness. These conditions may persist even after plaque removal.
73
Non-Biofilm-induced Gingivitis factors/potential etiologies
74
Genetic abnormalities of non-plaque gingivitis
Hereditary gingival fibromatosis (Son of the Sevenless gene)
75
Specific infection of non-plaque induced gingivitis
Bacteria (Necrotizing Periodontal Disease), Viral, Fungal
76
Inflammatory and immune conditions of non-plaque induced gingivitis
Contact allergy, pemphigus vulgaris, pemphigoid, lichen planus
77
Neoplasms of non-plaque induced gingivitis
Leukoplakia, erythroplakia, squamous cell carcinoma, leukemia, lymphoma
78
vitamin def, physical and chemical factors associated with non-plaque induced gingivitis
Scurvy (Vit C deficiency), toothbrushing trauma, etching, burning
79
Gingival pigmentations associated with non-plaque induced gingivitis
Melanoplakia (smoker’s melanosis, drug-induced pigmentation, amalgam tattoo)
80
Management of non-plaque induced gingivitis
Interdisciplinary consultation: know when to refer Remove etiology: plaque control (OHI, dental prophylaxis, scaling in the presence of gingival inflammation with re-evaluation), routine recall/maintenance
81
Desquamative Gingivitis
A gingival response is a peculiar condition associated with a variety of conditions, characterized by intense erythema, desquamation, and ulceration of both the free and attached gingiva.
82
Desquamative gingivitis as a diagnosis?
Desquamative gingivitis is a clinical term NOT a DIAGNOSIS
83
Desquamative Gingivitis conditions req what for diagnosis and tx?
Need a series of laboratory result for final diagnosis and corresponding treatment
84
Diseases clinically presenting as desquamative gingivitis
85
Lichen Planus * mediated by? * cells with central role * Prevalent in? * subtypes? * Oral lesion form? * Gingival lesion form?
* A immunologically-mediated mucocutaneous disorder * T lymphocytes play a central role * Prevalent in middle aged and older females * Five subtypes: Reticular, erosive, patch, atrophic, bullous * Oral lesion form: more than gingiva is involved * Gingival lesion form: restricted in gingiva
86
lichen planus clinical presentation
87
Histology/IF of lichen planus
* Hyperkeratosis and Hypergranulosis * A band-like T lymphocyte infiltrate against undersurface connective tissue * Saw tooth appearance of rite pegs * DIF shaggy deposits of fibrinogen at DEJ
88
Pemphigoid mediated by? Result? Subtypes?
* A cutaneous, immune-mediated subepithelial disease: Separation of the basement membrane zone * Three conditions: Pemphigoid gestationis, bullous pemphigoid, mucous membrane pemphigoid
89
Clinical Presentation of pemphigoid oral? skin? occular?
oral: nikolsky sign, bullae rupture 2-3 days, heal in 3 weeks occular: symblepharon scar skin: bullous pemphigoid lesions
90
Histology/IF of pemphigoid
* Separated epithelium with Intact basal cell layer * DIF linear deposits of **IgG and C3 ** at oral mucosal basement membrane zone
91
Pemphigus Vulgaris group of? produces? most common? lethality? fav demo?
* group of autoimmune disorders : Produces cutaneous and mucous membrane blisters * Pemphigus vulgaris is the most common of all. -Lethal chronic condition (10% mortality rate) -Predilection in women (after 4th decade of life)
92
Clinical Presentation of Pemphigus Vulgaris (locations)
Soft palate (80%) Lower labial mucosa (10%) Buccal mucosa (46%) Tongue (20%) Gingival tissue
93
Histology of pemphigus vulgaris
*** Tombstone** appearance **Basal cells remain attached to subjacent basement membrane **and connective tissue * **Tzanck cells** * DIF intercellular deposits of **IgG in epithelium** *
94
Lupus Erythematosus
* An autoimmune disease with three clinical presentations: * Systemic/Chronic cutaneous/Subacute cutaneous * Cutaneous lesion: 1. * Butterfly pattern 1. * Discoid lesion 1. * Scar and atrophy production * Oral lesion: ulcerative or lichen planus-like
95
Clinical Presentation SLE orally
Gingival discoid lupus erythematosus lesion Ulcerative or lichen planus-like
96
Erythema Multiforme
* Reactive acute vesiculobullous disease * Mucocutaneous inflammatory disease * Broad spectrum from self-limiting to severe progression * Predominant in young individuals
97
Clinical Presentation of erythema multiforme
98
Necrotizing Periodontal Disease demo? Characteristics? Severity?
* An inflammatory, destructive gingival condition * Young adults, (HIV)‐infected individuals * Characteristics of gingival lesion: 1. Punched‐out appearance 1. Pseudomembrane * Mild to severe, may develop fever and malaise
99
Clinical Presentation of necrotizing perio dx
Punched-out lesions, Extensive ulcers Pseudomembrane: Leukocytes, fibrin and necrotic tissue and Masses of bacteria
100
non-plaque. induced gingivits tx
must determine underlying cause, possibly work with PCP

PERIO I (13 decks)

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