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Periodontics - Chapter 6 - Gingival Disease

Periodontics - Chapter 6 - Gingival Disease
This is possibly the MOST common human ailment?
inflammation of the gingival tissues
Gingivitis is known as ___?
Gingivitis is often ___ and not recognized
Initial or subclinic stage
Stage I gingivitis is also known as ___?
Stage 1 Gingivitis
This stage of gingivitis occurs in the first few days after plaque accumulation
T/F during Stage 1 gingivitis the lymphocyes in the connective tissue are present but do not cause tissue damage.
1. Acute inflammatory
2. Dilation of blood vessels and increased blood flow
3.PMN's attach to the vessel walls & into connective tissue & phagocytize bacteria etc.
4. Edema in tissues
5. Exudate is composed mostly of serum
6. Lymphocytes are present in the connective tissue but do not cause harm, just response to the bacterial infection
7. NO clinical signs
Describe Stage I - Gingivitis
subclinical infection
Another name for "no clinical signs" is ___?
1. Initial - Stage I (aka Subclinical)
2. Early - Stage II
3. Established - Stage III
4. Advanced - Stage IV
What are the stages of gingivitis?
1. Lesion begin 4-7 days after plaque has accumulated
2. T-cells increase & localize in the connective tissue
3. Exudate increases and may becomes yellow or white
4. Redness is observed in the tissue
5.Gingival stippling begins to disappear
6. Collagen fibers are destroyed that are attached to the connective tissue
7. Junctional Epithelium begins to lengthen
8. Bleeding upon probing is observed
9. Can last 21 days or more and is earliest clinical sign of gingivitis
Describe Stage II - Gingivitis
Stage II - Early Stage
Which stage is the earliest clinical sign of gingivitis?
1. Occurs after 15-21 days
2. T & B lymphocyte cells are present
3. Tissue destruction IS occurring
4. Connective tissue is destroyed
5. The junctional epithelium thickens & moves apically on the root surface towards the deeper connective tissue
6. Clinical probing depths increase
7. Edema moves the gingival margin coronally
8. Visable pus formation
9. Red, swollen & shiny tissue
10. Exudate is present
Describe Stage III - Gingivitis
T/F: Stage IV or Advanced gingivitis is reversible?
advanced or stage IV
This type of gingivitis is the beginning stage of periodontitis?
Stage IV
When the inflammatory stage has extended beyond the gingiva and now into other periodontal tissues it is known as which stage of gingivitis?
Whatever gets infected LAST will heal FIRST
What is the basic process for healing after gingival treatment?
1. Connective tissue
2. Inflammatory cells are reduced
3. Gingival color improves
4. Stippling reappears
5. No edema is present
What is the order of healing after gingival tx?
Periodontal disease
If not treatment is given then gingivitis will progress into ____?
T/F: Recession is a term of disease and NOT a term of location.
This refers to the location of the marginal gingiva and not the condition
T/F: Recession can be associated with healthy gingiva
What percentage of adults over 50% have some recession?
What percentage of children have recession?
Faulty tooth brushing, tooth malposition, gingival ablation, gingival inflammation, abnormal frenum attachment
What are some causes of tooth recession?
Soft tissue friction
What is ablation?
All levels
Gingival disease occurs most often in which levels of society?
all ethnicities
Which ethnicities are most effected by gingival disease/
bleeding gums
What is the most common symptom of gingival disease?
Most poeple think that bleeding gums are __?
People wrongly expect their gums to bleed when ___.
Gingiva becomes inflamed with the prescence of ___?
dental plaque
The most common form of gingivitis is gingivitis associated with ___?
accumulation of plaque
The level of severity of gingivitis is directly related with the ___?
Reddened gingival margin, swelling & edema, deepened periodontal pockets due to swelling, red shiny attached gingiva, bleeding upon probing, clear gingival fluid or exudate
Name some clinical signs of gingivitis?
plaque; time
Gingivitis appears to be directly related to the amount of ____, and the amount of __ it remains on the tooth.
location, degree of involvement
Gingivitis can be classified by severity(ex.Class I < Class IV) or also by ___ & ___?
localized or generalized
What are the 2 types of classifying categories for gingivitis ?
What percentage of the gingiva must be affected for gingivitis to be classified as Generalized?
This type of gingivitis may be found JUST in the gingivial margin, interdental papilla or in the attached gingiva & also other specific areas.
T/F Neither local or generalized gingivitis involves the periodontal attachement & there is no loss of supporting bone in either condition.
localized, generalized, marginal, papillary, slight, moderate, severe, color, shape, shininess
Name some descriptive words for the gingival condition.
Experimental gingivitis
With this condition, clinical signs appear in 10-21 days, patient must have excellent homecare, regular maintenance & recalls, this kind of gingivitis is also reversible.
Tooth-related factors, malposition or crowded teeth, orthodontic appliances, restorations.
What are some contributing factors that cause plaque induced gingivitis?
plaque traps
Plaque biofilm-induced gingivitis contributing factors act as ___?
systemic factors
These factors can modify the way a person's immune system responds to the accumulation of plaque?
Use of corticosteroids, hormones and changes due to pregnancy, menstruation, puberty, menopause
Name some systemic factors that affect gingival disease
T/F Gingival disease that is modified by systemic factors may not heal with oral hygiene improvement
Cellular proliferation, keratinization & vascular proliferation
What does estrogen regulate?
Endocrine influenced gingival disease
This type of gingival disease can be caused by an increase in femal hormones like birth control or hormone replacement therapy.
This is a type of subgingival bacteria that is caused by endocrine-influenced gingival disease & may cause an increase in gingival inflammation.
poor plaque control
The most likely way to aggravate symptoms associated with endocrine -influenced gingival disease is __?
pregnancy gingiva
This type of gingival condition effects preganant women in their 2nd trimester
dark red gingiva that is hyperplastic and has increased bleeding, usually resolved with good hygiene & removal of irritants
What are some signs of pregnancy gingiva?
increased hormones
If a women is not pregnant but shows the same signs pregnancy gingiva it is likely due to what?
pregnancy gingivitis
Porphyromomas gingivalis & actinomycetemcomitans are bacterial types commonly found with what condition?
prostaglandin E
The bacteria that increases during pregnancy gingiva may be due to an increase in ___?
Which trimester is a pregnancy tumor likely to occur?
How do you remove a pregnancy tumor or any other gingival overgrowth?
T/F often pregnancy tumors can be cancerous
This is an anti-seizure medicine that can gingival overgrowth and cause denser more fibrous connective tissue
anti-seizure, phenytoin
What type of medication causes changes in the epithelial cells and fibroblasts that causes a denser connective tissue and gingival overgrowth (hard like rubber)
high blood pressure
Nifedipine is used to treat ___ & can cause drug induced gingivitis
cyclosporine(transplant), Nifedipine(high blood pressure), calcium channel blockers, Phenytoin(anti-seizure)
Name some different types of meds that can cause gingivitis.
A, B1, B2, B12, & C
Which vitamin when removed from the diet can cause gingival conditions or even scurvy?
This infection mostly effects children and can can cause a gingival reaction WITHOUT plaque being present.
gonorrhea, syphillis, candida infection, herpes simplex
The following systemic infections can cause gingival changes without plaque.
antimicrobial or antiviral treatment
Gingival infections due to systemic conditions like gonorrhea and syphillis may require what kind of treatment?
Fusiform bacillus & spirochete
Name 2 types of Vincent bacteria that cause NUG.
This condition is centuries old, has a rapid onset of pain but no bone loss, bad breath is common and it is related to extreme stress & has has punched out interdental papilla & white necrotic pseudo membrane
This condition is commonly associated with stress and a Feter oris.
Feter oris
Another name for bad breath?
Vincent Organisms
NUG is associated with what kind of bacterial microorganisms?
antibiotics, & metronidazole (if fever & malaise are present), debride all plaque, good home care, Hydrogen peroxide & warm water home rinse
How do you treat NUG?
when the bone & perio tissues are effected
What is the difference between NUG & NUP
Name a type of gingival disease that is derived from a viral origin
gingival dx of a VIRAL origin
Primary Herpetic Gingivostomatitis or Primary Herpes Virus are both examples of this type of gingival disease origin.
Herpes virus infection can be similar to this is appearance.
highly contagious, elevated temp, ill patient w. malaise, vesicle formation,
Virally contracted gingival disease has the following symptoms.
This is a common disease of viral origin that affects the gingiva and occur in children.
candida albicans
The most common oral fungal infection is ___?
Candida Albicans is most commonly found in patients that are ___?
linear gingival erythema, severe redness with white patches that wipe off
Some additional clinical symptoms of candida albicans are?
T/F In candida albicans, the white patches do NOT wipe off
plaque biofilm, medications, and infections of systemic disease
Idiopathic gingival lesions of genetic origin may be due to ____?
T/F Idiopathic gingival lesions generally do NOT respond to plaque control methods
Acute leukemia
This type of cancer may initially be seen in the gingiva, manifesting itself and hemorrhagic & swollen gingival tissues
lichen planus
A common gingival dermatologic manifestation is ___?
middle aged; skin & mucous membranes
Lichen Planus affects what type of patients and where?
Lichen planus
Wickham's striae is associated with which gingival dx?
White lesions alternating with reddened raw areas and severity is related to stress, (uncommon but sometimes small, flat topped itchy papules,) erosive patches that may transform to squamous cell carcinoma
Some commonly seen attributes of lichen planus are ___.
topical steroids
Lichen planus is treated how?
Cicatrical pemphigoid
This is a vesticulobulbous disease that causes blistering & sloughing of the gingiva that is painful & causes difficulty eating
steroid therapy, chlorhexidine rinses
Cicatrical pemphigoid is treated with __?
peeling of the epithelium when rubbed, cicatrical pemphigoid
What is Nikolskys sign & what disease is it associated with?
Mucous Membrane Pemphigoid
Cicatrical Pemphigoid is also called ___?
desquamative gingivitis
This condition may be due to drugs or food allergies
Disquamative gingivitis is also known as __?
Desquamative gingivitis or ginvivosis
When mucous membrane pemphigoid is limited to the gingival tissues is is referred to as ___?
can be continuous or sporadic and can last for years
How long does desquamative gingivitis last?
burns from food or trauma
How do you get a tramatic lesion?
food impaction
How does a foreign body reaction occur?
remove the substance
How do you treat a foreign body reaction?