2- clinical forms of periodontal diseases

What is periodontal health?

Patient who has never had or suffered perio problems or patients who have had them but treated successfully- restored health

Clinical heath can occur in 3 distinct situations…

Intact periodontum- no loss of insertion or bone

Reduced periodontum- loss of insertion and bone

Depending on cause that caused loss- difference between…

Patient with stable periodontitis- loss due to periodontitis- successful treatment, stable

Non periodontal patient- loss due to other causes like recessions or coronary lengthening surgery

What is periodontal stability characterised by?

Treatment successful by controlling systemic and local risk factors

Less than 10% bleeding on probing and probing depth 3mm or less

What does gingival health present?

Less than 10% of locations bleed with PD of 3mm or less

Difference between localised vs generalised gingivitis?

10-30% bleeding

More than 30% BOP

How does periodontitis start from initial- early- established to advanced stages?(4)

The first manifestations of gingival inflammation are vascular changes

Time passes, erythema signs may appear, especially capillary proliferation

Blood vessels dilate and congest, venous return is disturbed, slow blood circulation

Periodontal destruction

What changes are seen in gingiva (diseased) induced by dental biofilm?

Plaque at gingival margin where disease begins- changes gingival colour (red/blueish in interdental papillae and gingival margin)

Changes in gingival contour and groove temp- increased exudate (crevicular fluid)- bleeding from provocation (hemorrhage from smooth probing), no bone or insertion loss

Histologic modifications due to inflammation- reversible when plaque removed

How does gingivitis change gum texture?

Usually has depressions and small elevations- orange peel appearance

Dotted limited to inserted gum and mainly on subpapilalry area

Localised vs generalised marginal gingivitis affects what?

Limited to free gum of a tooth or more

Affects entire free gum of one arch or both

Localised vs generalised papillary gingivitis affects what?

Limited to one or more interproximal spaces in limited area

Affects most interproximal spaces

Localised vs generalised diffuse gingivitis affects what?

Inflammation extends from gingival margin to mucogingival line (goes apically) in 1 or more teeth

Affects entire gum, alveolar mucosa and inserted gum are inflamed, mucogingival line erased

What is gum enlargement a common feature of?

Plaque induced gum disease or systemic conditions- drugs or genetics

Inflammatory enlargement

Drug-induced gingival enlargement

Idiopathic enlargement

Enlargement related to systemic diseases

Neoplasic enlargement

False enlargement- enlarged underlying tissues, bone injuries and dental tissues

Inflammatory enlargement characteristics?

Mild swelling of the papilla and marginal gum

Bulge covering part of the crown

Slow and painless

Localized/ generalized/ papillary/marginal/diffuse

Acute or Chronic

Drug induced enlargement characteristics

Small lobe in papilla and MGV vb + lingual

Pale pink color and resistance to touch

Inflammation secondary to drugs without or little plaque

Painless

Papillary

Drugs: Anticonvulsants/Immunosuppressants/Calcium channel blockers/hypertension

What drugs can cause gingival enlargement?

Phenytoin

Ethotoin

Mephenytoin

Valproic acid

Nifedipine

Diltiacem

Cyclosporine

Idiopathic enlargement characteristics

Rare lobed alteration in inserted gum---in papilla and MGV

Pale pink color, firm and completely covers the crown

Unknown cause

Painless

In primary or secondary dentition

Surgical treatment

What systemic diseases can cause enlargement?

Increased pre existing plaque inflammation + conditioned enlargement:

Pregnancy / Puberty / Vitamin C deficiency / Plasma cells / Pyogenic granuloma

Systemic diseases that cause gingival enlargement:

Leukemias, Granulomatous diseases, Wegener's granulomatosis/Sarcoidosis

What benign vs malignant tumours can cause neoplastic enlargement?

Benign tumors

- Fibromas

- Papilomas

- Peripheral or central giant cell granuloma

- Leukoplasia

- Gingival cysts

Malignant tumors

- Squamous cell carcinoma

- Malignant melanoma

- Sarcoma

- Metastasis

What is necrotising ulcerative gingivitis- etiology, location, signs, symptoms, treatment?

Microbial disease causing death and destruction of gingival tissue

Previous acute respiratory disease, lifestyle- stress, tobacco, nutrition, altered immune system

Marginal gum

Crater-like depressions on crest of interdental papilla

Halitosis, hyper salivation, pain, metallic taste, spontaneous bleeding

Scaling and root planing - Reversible- no loss of bone- papilla height given by bone so papilla can grow back

What is primary herpetic gingivostomatitis- who, signs, symptoms, presentations, place, treatment?

Infection of oral cavity by HSV 1

Under 6 yrs- sometimes adolescents and adults

Small spherical grey vesicles, after 24hrs painful ulcers with raised red margin, yellow central portion

Painful, avoid hot foods, lasts 7-10days

Oral mucosal soft palate, pharynx, floor of mouth, tongue, sublingual area

Antivirals- shorten duration and severity, antipyretics, systemic analgesics and analgesic mouthwashes

What is pericoronitis- presentations and treatments?

Inflammation of gum and/or alveolar mucosa of partially erupted tooth- mainly in L3M- operculum

Swollen, suppurating, painful red lesion- halitosis, sensitive to touch, may interfere with mouth closure, extraoral swelling in corner, lymohoadenopathy, fever sometimes

ATB therapy, systemic anyipyretics, antiseptic mouthwash- no antibiotics unless fever

What is desquamative gingivitis- injury, place, symptoms, cause?

Gingival erythema, desquamation, severe ulceration of free + inserted gum

Diffuse inflammation reaching mucogingival line

Range from burning sensation to severe pain

Usually dermatological origin