6 Perio Gingival Diseases & Conditions

Periodontal health can have:

intact periodontium & reduced periodontium

During Periodontal Health

No loss of periodontal tissues, past or present:

intact periodontium during periodontal health

During Periodontal Health

Pre-existing loss of periodotnal tissue but no current activity or loss of connective tissue and/or alveolar bone

reduced periodontium during periodontal health

3 different categories of periodontal health

• periodontal health on an intact periodontium

• periodontal health on a reduced periodontium in a nonperiodontal patient

• periodontal health on a reduced periodontium in a successfully treated stable periodontitis patient

What are the 3 categories of plaque-induced gingivitis?

Gingivitis on an intact periodontium

Gingivitis on a reduced periodontium on a non-periodontitis patient

Gingivitis on a reduced peirodontium in a successfully treated stable periodontitis patient.

a reduced periotontium on a nonperiodontitis patient can be due to what?

orthodontics or clenching

Gingivitis on a reduced periodontium after a successul periotontal treatment is at higher risk for

periodontitis

What are the two different causes of gingivitis?

• plaque induced

• non plaque induced

Is attachment loss associated with gingival inflammation?

No

In plaque induced gingivitis, is gingival inflammation reversible by removing plaque?

Yes

May plaque induced gingivitis tuprogress into periodontitis if left untreated?

Yes

Starred on Slides:

What is the most common type of periodontal disesase?

plaque induced gingivitis

In plaque biofilm induced gingivitis, plaque biofilm triggers ________ to dental plaque

the body’s immune response

In plaque induced gingivitis, _________ can remain in contact at or below gingival margin resulting in inflammation

bacteria

Inflammation is ________ intense in children when compared to adults

less

Children have _______ pathogenic bacteria in plaque biofilm than adults

less

Children’s _______ is less developed, and therefor does not have the same response to plaque biofilm.

immune system

Adults have more dental restorations and conditions that act as retention for ________

plaque

________ have higher levels of certain bacteria

adolescents

Plaqye induced gingivitis clinical signs:

• color changes from light pink to red

• edema-swelling

• bleeding evident upon gentle probing

• increased gingival crevicular fluid (GCF)

• tenderness

What are different extents of gingivitis?

papillary, marginal, diffuse

What are different severities of gingivitis?

mild, moderate, severe

What are different distributions of gingivitis?

localized, generalized

What are different causes of gingivitis?

plaque induced, non plaque induced

Gingivitis that has a short duration

acute gingivitis

Gingivitis that is long-lasting

chronic gingivitis

Systemic conditions affect _______ of disease

severity

What are different systemic conditions that can affect severity of disease?

• hormones related to puberty (menstrual cycle, pregnancy, oral contraceptives)

• hyperglycemia

• leukemia

• smoking

• malnutrition

Do current oral contraceptives induce changes in gingiva?

No

Levels of hormones cause _________ response to presence of plaque

exaggerated

In pregnancy associated gingivitis, it usually occurs during what trimester(s)?

2nd & 3rd

Mushroom-liked growth that is noncancerous, not painful, bleeds easily and is associated with pregnancy.

pyogenic granuloma

A pyogenic granuloma is considered to be a(n)

epulide

Other modifying factors for plaque induced gingivitis:

• hyperglycemia (poorly controlled diabetes)

• leukemia

• smoking

• malnutrition

T or F: in leukemia, plaque biofilm is not a prerequisite for plaque induced gingivitis

True

For smoking, ________ is evident

gingival fibrosis

In malnutrition, lack of vitamins __________ are modifying factors for plaque-induced gingivitis

A, C, B complex

In diabetes, response to plaque is aggravated by what?

poorly controlled blood glucose levels

Reduction in gingival inflammation in diabetic adults may result in:

reduction of amount of insulin needed

Gingivitis associated with diabetes is often seen in _____ with poorly controlled type I diabetes

children

Oral changes are often the ________ clinical sign of leukemia

first

What is blood dyscrasias?

abnormal blood condition

In gingivitis associated with blood dyscrasias, the exaggerated response to plaque results in __________ and ___________

enlarged tissue & increased bleeding

In gingivitis associated with blood dyscrasias, tissue often:

• appears swollen, red/deep purple, spongy, shiny

• tear easily

• bleed with little provocation

• changes usually begin in papilla

An exaggerated inflammatory response to dental plaque and systemic medication

Drug-influenced gingivitis

An increase in size of the gingiva resulting from systemic medications

Drug-influenced gingival enlargement

Is plaque accumulation necessary for initiation of gingival enlargement?

No

Can plaque accumulation exacerbate gingival enlargement and gingivitis?

Yes

Can plaque control reduce (not eliminate) gingival overgrowth?

yes

What are key aspects of drug-influenced gingival enlargement?

• onset uaually within 3 months of taking medication

• anterior affected more than posterior

• increase in GCF & bleeding

• No attachment loss

What type of medications are most commonly associated with gingival enlargement?

• Anticonvulsants (phenytoin)

• Calcium channel blockers (nifedipine)

• Immunosuppressants (cyclospirine)

What major groups are at risk for plaque-induced gingivitis modified by nutrition?

infants, institutionalized elderly, alcoholics

What vitamin deficiencies can increase severity of gingivitis?

C, A, & B complex

Ascorbic acid is also known as:

Vitamin C

Ascorbic acid deficiency gingivitis can appear:

• bright red

• swollen

• ulcerated

• bleeds easily

A ________ percentage of gingival diseases are not caused by plaque biofilm

small

Are non-plaque induced gingival disease resolved after plaque removal?

no

Can presence of plaque increase severity in non-plaque induced gingivitis?

yes

T or F: no-plaque induced gingival disease is not often painful

False

Rare, benign, slow progressive enlargement of attached gingiva

hereditary gingival fibromatosis

Severe inflammatory disease caused by bacteria. Ulcerated & necrotic papilla attached & gingival margins

necrotizing periodontal disease

uncommon, the specific bacteria isn’t found in plaque, overwhelms host resistance, gingival lesions are painful

bacterial infections of gingiva

Coxsacki virus, herpes simplex, varicella zoster, molluscum contagiosum virus & human papilloma are all _____ in origin

viral

What is primary herpetic gingivostomatitis?

The initial HSV-1 infection in a young child

Primary herpetic gingivostomatitis is characterized by:

redness, multiple vesicles that easily rupture to form painful ulcers

who does primary herpetic gingivostomatitis usually affect?

children, but it can still affect adults

By the time individuals reach middle age, about _____ % have been infected with HSV-1

70%

In some individuals, HSV-1 can remain _______ and be responsible for recurrent oral herpetic lesions (cold sores)

latent

HSV-1 infection is contagious during the ______ stage

vesicular

HSV-1 infection can be spread to the _____

eyes

HSV-1 infection can be spread to others by _________

kissing

primary herpetic gingivostomatitis (HSV-1) can be described as:

• fiery red marginal gingiva

• swollen papilla that bleed easily

• painful

Candidosis is ______ in origin

fungal

Pemphigoid is _______

fluid filled blisters

Lichen planus is _______

lacey white patches

Lupus erythematosis is ________

tissue attacking itself

Crohn’s disease is ____________

affected digestive tract lining

Sarcoidosis is _________

inflamed cells

Oral allergic reactions can occur from:

ingredients in toothpastes, mouthwashes, and chewing gum

________ is a disorder of the skin and mucous membranes that may be due to allergic reaction or infection

• large symmetrical red blotches

• blisters & ulcers occur on oral mucous membranes

• crust formation on lower lip

erythema multiforme

Oral lichen planus:

lacy white patches that can last for many years

How do you diagnose lichen planus?

Biopsy is needed

What is an epulide?

any tumor-like enlargement situated on the gingival or alveolar mucosa

What are examples of epulides?

• fibrous epulis

• calcifying fibroblastic granuloma

• pyogenic granuloma

• peripheral giant cell granuloma

What is a neoplasm?

an abnormal mass of tissue that can be benign or malignant

What are examples of premalignant neoplasms?

leukoplakia erythroplakia

What are examples of malignant neoplasms?

squamous cell carcinoma, Leukemia & Lymphoma

What are examples of chemical insults?

etching, chlorhexidine, acetylsalicylic acid, cocaine, hydrogen peroxide

What are examples of physical/mechanical insults?

frictional keratosis, toothbrushing-induced gingival ulceration, & factitious injury (self harm)

What are examples of thermal insults?

burns of mucosa

What are different examples of gingival pigmentation?

• melanoplakia

• smokers melanosis

• drug-induced pigmentation

• amalgam tattoo