Periodontics: Gingivitis – Dental Biofilm-Induced

Flashcards covering the characteristics, stages, and composition of dental biofilm-induced gingivitis as well as key periodontal terminologies.

What is the common form of gingivitis the result of?

An interaction between plaque bacteria, the tissues and the inflammatory cells of the host.

What two categories of factors can alter the severity and duration of the gingival response?

Local and systemic factors that affect plaque formation/retention and the host response.

What characterizes periodontal health and gingival health?

The absence of bleeding on probing, erythema and edema, patient symptoms, and attachment and bone loss.

What is the range for physiological bone levels in a healthy patient?

$1.0 - 3.0\,\text{mm}$ apical to the cemento-enamel junction.

What physiological bone level range is associated with Gingivitis / Periodontitis?

Beyond $3.0\,\text{mm}$ apical to the cemento-enamel junction.

Which clinical features are shared by both Gingivitis and Periodontitis?

Erythema, edema, bleeding, tenderness, and enlargement.

What features distinguish Periodontitis from Gingivitis?

Clinical attachment loss and bone loss and the presence of pathologic pockets.

Where are the clinical signs and symptoms of Dental Biofilm-Induced Gingivitis confined?

Confined to the gingiva.

How is inflammation in Dental Biofilm-Induced Gingivitis reversed?

By removing or disrupting the biofilm.

What is required to initiate inflammation in dental biofilm-induced gingivitis?

The presence of a high bacterial plaque burden.

What role do systemic modifying factors play in gingivitis?

They can alter the severity of the plaque-induced inflammation.

Describe attachment levels in gingivitis.

Stable (i.e., non-changing) attachment levels on a periodontium.

What is present within gingival tissues as part of physiologic immune surveillance even when plaque levels are minimized?

An inflammatory infiltrate.

When does the initiation of gingivitis occur during plaque accumulation?

If dental plaque accumulates over days or weeks without disruption or removal.

What phenomenon occurs due to a loss of symbiosis between the biofilm and the host's immune-inflammatory response?

Development of an incipient dysbiosis.

What are the common symptoms a patient may notice with gingivitis?

Bleeding with tooth brushing, blood in saliva, gingival swelling and redness, and halitosis.

Define Biofilm.

A thin, slimy film of bacteria that adheres to a surface; a collective of one or more types of microorganisms.

How is dental plaque considered the initiator of the periodontal disease process?

Through its ability to promote an inflammatory response in the periodontal tissues, which may lead to destruction of those same tissues.

What bacteria compose tooth-associated supragingival plaque?

Gram positive cocci and short rods.

What bacteria compose the mature outer surface of supragingival plaque?

Gram negative rods and filaments and spirochete.

What is the main source of inorganic components in supragingival plaque?

Saliva.

What is Calculus?

Mineralized bacterial plaque that forms on natural teeth and prosthetic devices.

When does the precipitation of mineral salts into soft plaque usually begin?

Within $1 \text{ to } 14\,\text{days}$ of plaque formation.

What are the tooth-associated bacteria in the cervical region of subgingival plaque?

Gram positive rods and cocci.

What are the tissue-associated bacteria in the cervical region of subgingival plaque?

Gram negative rods and cocci, filaments, flagellated rods and spirochetes.

What bacteria are tooth-associated deeper in the sulcus or pocket?

Gram negative rods.

What bacteria are tissue-associated deeper in the sulcus or pocket?

Gram negative rods and cocci, filaments, flagellated rods and spirochetes.

From where are the inorganic components of subgingival plaque primarily derived?

Gingival crevicular fluid.

What are the major organic constituents of the plaque biofilm?

Polysaccharides, proteins and glycoproteins, and lipids.

What are the major inorganic constituents of the plaque biofilm?

Calcium and phosphorus.

Which trace inorganic elements are found in plaque biofilm?

Sodium, potassium, and fluoride.

Changes in color, contour, and consistency in gingivitis are due to what primary physiological change?

Increase in blood flow.

Gingival contour changes are due to an increase in what?

Inflammatory exudates/edema within the gingival tissues.

What causes consistency changes in long-standing and chronic gingivitis?

Levels of inflammation and/or fibrosis.

How is gingivitis usually characterized regarding clinical attachment loss?

Gingival inflammation in the absence of clinical attachment loss.

Can gingivitis occur in successfully treated periodontitis patients?

Yes, if they develop inflammation with no additional attachment loss due to poor home care.

List three factors that influence dental plaque biofilm formation.

Smoking, diet chewing fibrous food, and salivary flow conditions.

What are the three phases of dental plaque formation?

1. Formation of the pellicle. 2. Initial adhesion and attachment of bacteria. 3. Colonization and plaque maturation.

What does the pellicle consist of?

Glycoproteins (mucins), proline-rich proteins, phosphoproteins, histidine-rich proteins, enzymes (amylase), and other molecules.

What serves as attachment sites for bacteria during pellicle formation?

Molecules within the pellicle, such as glycoproteins and enzymes.

Phase 2 initial adhesion is mediated by which forces?

Van der Waals and electrostatic forces.

Firm attachment in Phase 2 depends on which interactions?

Specific adhesions-receptor interactions.

What occurs during Phase 3 of dental plaque formation?

Firmly attached bacteria start growing, resulting in the formation of microcolonies.

The increased inflammatory response in gingivitis destroys cells and matrices but does not destroy what?

Periodontal ligament and bone.

What can influence the extent and severity of the inflammatory response in gingivitis?

Failure to remove plaque and environmental or genetic factors that enhance the host response.

What is the timeframe for Stage 1 (Initial lesion) of gingivitis?

$2 \text{ to } 4\,\text{days}$.

What are the histological features of the Stage 1 Initial lesion?

Vascular dilation, infiltration of PMNs, perivascular collagen loss, and increased gingival crevicular fluid flow.

What is the timeframe for Stage 2 (Early lesion) of gingivitis?

$4 \text{ to } 7\,\text{days}$.

What characterizes the Stage 2 Early lesion?

Increase in vasculature, lymphocyte infiltration, increased collagen loss, and redness and bleeding on probing.

What is the timeframe for Stage 3 (Established lesion) of gingivitis?

$14 \text{ to } 21\,\text{days}$.

What histological cell type is characteristic of the Stage 3 Established lesion?

Mature plasma cells in the tissues.

What happens in Stage 4 (Advanced stage)?

Characteristics of Stage 3 move into the periodontal ligament and bone to create periodontitis.

Define Periodontal pocket.

The spaces or opening surrounding the teeth under the gum line.

What is Periodic Pocket Depth (PD)?

The measured distance from the base of the pocket to the most apical point on the gingival margin.

What is Bleeding on Probing (BOP) an indicator of?

Tissue inflammatory response to bacterial pathogens.

When is Radiographic Bone Loss (RBL) defined as present?

When the distance between the cemento-enamel junction and the alveolar bone crest is greater than $2\,\text{mm}$.

Define Clinical attachment level.

The measurement of the position of the soft tissue in relation to the cemento-enamel junction (CEJ).

Why is the CEJ used as a reference point for clinical attachment level?

It is a fixed point that does not change throughout life.

What does Clinical attachment loss (CAL) precede?

Radiographic evidence of crestal alveolar bone loss.

Define Furcation Involvement.

A furcation defect referring to bone loss at the branching point of the roots.