P2-PERIO CHAPTER 15 (2)

Coral pink

Color of healthy gingiva

Red

COlor of gingivitis

Knife edge and scalloped

COntour of healthy gingiva

Firm and resilient with stippling of attached gingiva

CoNSISTENCY OF HEALTH YGINGIVA

ROlled with bulbous papillae

COntour of gingivitis

edematous with loss of stippling

Consistency and texture of gingivits

Dental plaque biofilm-Indiced GIngivitis Site

it is defined as an inflammatory lesion taht arises from the interaction between the dental plaque biofilm and the host's immune inflammatory response

-GIngivitis site= specific location of gingivitis

- GIngivitis case = presence of inflammation (one or more gingival sites)

Difference between gingivitis site and gingivitis case

-Redness

-Swelling

-BOP (Bleeding On Probing)

GIngival site is typically identified by signs of?

GIngivitis site

Refers to specific location in the mouth where gingival inflammation is present

GIngival case

Refers to a whole patient who ahs been diagnosed with gingivities based on presence of inflammation at one or more gingival sites

-Intact periodontium

-Reduced periodontium

Name the 2 subclassification under gingivitis case

Intact periodontium

THis periodontium will present without clinical attachement loss or radiographic bone loss

Reduced periodontium

This periodontium is GC on a reduced perodontium can typically present as gingical recession or crown lengthening

-Localized severity

-Generalized severity

TWo category of severity

Localized severity

This type of gingival severity is where BOP % >10% and <30% noting that patients

Generlized severity

This type of gingival severity shows as BOP greater than 30%

Bleeding on Probing

Meaning of BOP

Localized gingivitis

This type of gingivitis is confined to the gingiva of a single tooth or group of teeth

Generalized gingivitis

This type of gingivitis involved the entire mouth

Marginal gingivitis

This type of gingivitis involves the gingival margin and it can include portion of contigous attached gingiva

Papillary gingivitis

THis type of gingivitis involves the interdental papillary and it often extends into the adjacent porption of the gingival margin

Diffuse gingivitis

THis type of gingivisitis affects gingival margin, attached gingiva and interdental papillae

-Initial lesion

-Early lesion

-Established lesion

-Advanced lesion

List the 4 stages of gingival inflammation

-DIlated capillaries

in initial lesion, what type of capillaries does it consist of?

Increased blood flow

In inital lesion, what happens to the blood flow?

2-4 DAYS

How many days does inital lesion last

TRue

TRue or false: the blood vessels in inital lesion is vasodialted/ vasodialtion (Vasculitis)

-Polymorphonuclear leukocytes

-Junction and sulcular epithelium

In the inital lesion, to defend the gums there would be infiltration of what cells and what epithelium are they heading

-Polymorphonuclear leukocytes

Predominant cells of initial lesions

Increase gingival fluid flow

Clinical findings of Initial lesion

Early lesion

What evolves from the initial lesion after the beginning of plaque accumulation

1 WEEK

How long does the evolution from stage 1 (initial lesion) to stage 2 (early lesion)

Leukocytes (specifically lymphocytes)

In early lesion (stage 2), what cells are revealed in the connective tissue

junctional epithelium

In stage 2( early lesion) Most of the leukocytes are beneath what type of epithelium?

False, it increases

True or false: in early lesion (stage 2), collagen destruction is decreased?

4-7 days

DUration of early lesion (stage 2)

vascular proliferation

In early lesions (stage 2), what is the stage of the blood vessels or what is present in blood vessels

Early lesion (stage 2)

In this stage, it shows erythema due to the proliferation of capillaries and increase formation of capillary loops between rete pegs or ridges

Lymphocytes

Predominant cell present in early lesion (stage 2)

Erythema and bleeding on probing (BOP)

Clincal findings in ealry lesion (stage 2)

Early lesion (Stage 2)

What stage is where BOP is present?

Small gingival pocket line

In Established lesion( stage 3), what is created in the pocket epithelium

blood vessels = engorged & congested

Venous return = impared

blood flow = sluggish

Deinf the sibgingival plaque phase

Locallized gingival anoxemia

What is present in estalbished lesion that is superimposed a somewhat bluish hue on the reddened gingiva?

True

True or false: increase number of plasma cells in established lesion

Plasma cells

Predominant cell in established lesion

14-21 DAYS

duration of stage 3 estalbished lesion

True

True or false: vascular state is the same in stage 2 with blood stasis in stage 3

CHanges in color, size, texture, and so on

CLinical findings of stage 3 established lesion

irreversible tissue destruction phase

What phase is present in stage 4 advanced lesion

Plasma cells

iN stage 4 advanced lesion, what cells are dominant in connective tissue

Neutrophils

In stage 4 advanced lesion, what cells are dominant in junctional epithelium

Stage 4 advanced lesion

This stage is where fibrosis of the gingiva is present and there is a widespread manifestation of inflammatory and immnopathologic tissue damage

Alveolar bone

The extension of the inflammation in stage 4 advanced lesion reaches to?

-Attachement loss

-destruction of alevolar bone

in stage 4 advanced lesion, lengthenign of tooth crown and gingival destruction is shown through

Chronic gingivits

Identify chronic or acute: soggy puffiness that pits on pressure

Chronic gingivitis

Identify chronic or acute: Marked siftness and friability with ready fragmentation on exploration with probe and pinpoint surface areas of redness and desquamation

CHronic gingivitis

Identify clinical differencechronic or acute: consistency is firm & leathery

Acute gingivitis

Identify clinical difference chronic or acute: diffuse puffiness and softening

Acute gingivitis

Identify clinical difference chronic and acute: sloughing with grayish, flakelike particles of debris adhering to eroded surface

Acute gingivitis

Identify clinical difference chronic and acute: vescile formation

-increease gingival crevical fluid

-Bleeding from the gingival sulcus on gentle probing

2 earliest signs of gingival inflammation

Chronic inflammation

Most common cause of abnormal gingival BOP is?

-toothbrush

-toothpick

-food impaction

example of mechanical trauma

-Endogenous

-Exogenous

What are the two systemic factors that are associated wtih color change

-Peutz-jeghers syndrome

-Addison's disease

-Von recklinghausen disease

-Albright syndrome

PAVA

In endogenous, list teh 4 types of conditions that increase melanin pigmentation

adrenal dysfunction

Addison's disease is caused by what?

Peutz-Jeghers syndrome

This condition produces intestinal polyposis and melanin pigmentation in the oral mucosa and lips

-Intestinal polyposis

-Melanin pigmentation

Peutz Jeghers sydnrome procudes 2 condtions in the oral mucosa and lips?

Isolated patches of discoloration (bluish-black to brown)

In addison's disease, what does it produce?

-Albright syndrome

-Von Recklinghausen

2 conditions produce ares of oral melanin pigmentation, waht are the 2 condtions

-coal

-metal dust

-coloring agents (food and lozengers)

examples of exogenous

Actual position

This is the level of the coronal end of the epithelium attachment on the tooth

Gingivitis in maxillary buccal area of oral cavity

IN mouth breather what is a common finding in patients?

Apparent position

This position is the level of the crest of the gingival margin

Red, shiny, edematous

Appearance of the affected gingiva caused by mouth breathing

Apparent positon of the gingiva

THe severity of recession is usually determind by what position?

Surface dehydration

reason for red, shiny and edematous appearance of gingiva from mouth breathing

Actual position

THis position determinds the clinical attachment loss

Stippling

THis surface feature is an external reflection of the underlyign connective tissue proejctions into the overlying epithelium

-Toothbrush abrasion

-Toothpicks

Causes of stillman's cleft

Stillman's cleft

This is the v shaped recession that does not follow the contour

-Fautly toothbrushing technique

-TOoth malposition

-FRiction from soft tissue

-GIngival inflammation

-Abnormal frenum attachement

-Iatrogenic dentsitry

6 Etiologic factors for gingiva recession

-Size of blood vessels

-Epithelial thickness

-Quantity of keratinization

-Pigments in the epihtelium

BEKP

COlor changes in gingiva is determined by?