P2-PERIO CHAPTER 15

What is the normal color of healthy gingiva?

Coral pink

What is the contour of healthy gingiva?

Knife edge and scalloped

What is the consistency and texture of healthy gingiva?

Stippling of attached gingiva

What is the color of gingivitis?

Red

What is the contour of gingivitis?

Rolled with bulbous papillae

What is the consistency and texture of gingivitis?

Edematous and loss of stippling

What is a gingivitis site?

Location with redness, swelling, and bleeding on probing

What defines a gingivitis case?

Patient with inflammation at one or more gingival sites

What is an intact periodontium?

Gingiva without attachment or bone loss

What is a reduced periodontium?

Gingival recession or crown lengthening

When is gingivitis considered localized?

BOP >10% and <30%

When is gingivitis considered generalized?

BOP >30%

What does localized gingivitis involve?

Single tooth or group of teeth

What does generalized gingivitis involve?

Entire mouth

What is marginal gingivitis?

Involves gingival margin and attached gingiva

What is papillary gingivitis?

Involves interdental papillae and adjacent gingiva

What is diffuse gingivitis?

Involves margin, attached gingiva, and papillae

What is Stage I of gingival inflammation?

Initial lesion (subclinical)

Is Stage I visible clinically?

No

What vascular changes occur in Stage I?

Dilated capillaries and increased blood flow

What histological changes occur in Stage I?

Increased leukocytes and gingival crevicular fluid

When does Stage II begin?

Around 1 week after plaque

What is a clinical feature of Stage II?

Bleeding on probing

What is the dominant immune cell in Stage II?

T lymphocytes (75%)

How much collagen is destroyed in Stage II?

70%

When does Stage III occur?

2–3 weeks of plaque accumulation

What cells dominate Stage III?

Plasma cells and B lymphocytes

What Ig subclasses are found in Stage III?

IgG1 and IgG3

What vascular condition appears in Stage III?

Localized gingival anoxemia

What enzymes increase in Stage III?

Collagenase, acid phosphatase, alkaline phosphatase, beta

What happens to junctional epithelium in Stage III?

Widened spaces with granular debris

What is Stage IV of gingival inflammation?

Irreversible tissue destruction

What occurs to alveolar bone in Stage IV?

Extension of lesion into alveolar bone

What is the dominant immune cell in Stage IV connective tissue?

Plasma cells

What causes red gingiva in acute inflammation?

Increased blood flow

What causes bluish

red gingiva in chronic inflammation?

What is melanin pigmentation in gingiva?

Normal physiologic process in pigmented groups

Which syndromes increase melanin pigmentation?

Addison's, Peutz

What blood disorders affect gingiva color?

Anemia, polycythemia, leukemia

What endocrine conditions affect gingiva?

Diabetes, pregnancy

What are exogenous pigment causes?

Tobacco, coal dust, food dyes, amalgam

What are McCall’s festoons?

Rolled, thickened bands near canines

What is the normal gingival texture?

Stippled

What causes smooth, shiny gingiva?

Exudative changes

What causes firm, nodular gingiva?

Fibrotic changes

What drugs cause nodular gingival overgrowth?

Anticonvulsants, CCBs, immunosuppressants

What causes gingival recession?

Brushing, inflammation, frenum, occlusion, iatrogenic factors

What does recession lead to?

Root caries, cementum erosion, hypersensitivity

What is a key sign of gingivitis?

Bleeding on probing

What increases early in gingivitis?

Gingival crevicular fluid

What local factors cause gingival bleeding?

Malposition, caries, overhangs, mouth breathing

What mechanical trauma causes bleeding?

Brushing, toothpicks, food impaction

What causes spontaneous bleeding?

ANUG (Acute Necrotizing Ulcerative Gingivitis)

What systemic conditions cause gingival bleeding?

Vitamin C deficiency, thrombocytopenia, hemophilia

What drugs cause bleeding or overgrowth?

Anticonvulsants, CCBs, immunosuppressants

What is acute gingivitis?

Sudden, painful, short duration

What is chronic gingivitis?

Slow onset, painless, long duration

What is recurrent gingivitis?

Reappears after treatment or spontaneous remission

What is marginal gingivitis?

Involves gingival margin

What is papillary gingivitis?

Involves interdental papilla

What is diffuse gingivitis?

Involves margin, papilla, and attached gingiva

What is localized marginal gingivitis?

Limited to one or more marginal gingival areas

What is generalized marginal gingivitis?

Affects margins of all teeth

What are the 2 earliest signs of gingival inflammation?

GCF increase and bleeding on probing

What is gingival depigmentation?

Aesthetic procedure to remove melanin pigmentation

What methods are used for gingival depigmentation?

Scalpels, chemicals, electrocautery, lasers

What causes clefts in gingiva?

Traumatic occlusion

What is the treatment for gingival clefts due to trauma?

Occlusal adjustments

How do clefts progress in recession?

Cleft broadens and exposes root cementum

What is the surface of healthy gingiva?

Stippled, like orange peel

Where is stippling seen?

Interdental and attached gingiva

What causes smooth shiny surface in gingiva?

Exudative disease changes

What causes firm nodular gingival surface?

Fibrotic changes

What texture change is seen in drug

induced gingival overgrowth?

What are causes of gingival recession?

Brushing, malposition, inflammation, frenum, trauma

What is a clinical effect of recession?

Root caries and dentin hypersensitivity

What is the visible position of gingiva?

Coronal end of epithelium

What is the apparent position of gingiva?

Crest of gingival margin

What determines severity of gingival recession?

Apparent gingival position

What is clinical attachment loss?

Actual position of gingiva on the tooth

What is the key sign of gingival inflammation?

Bleeding on probing

What does bleeding on probing indicate?

Active inflammation

What is the earliest objective sign of gingivitis?

Increased gingival crevicular fluid (GCF)

What is the significance of no bleeding on probing?

Negative predictor for attachment loss

What are chronic causes of gingival bleeding?

Inflammation and mechanical trauma

What mechanical actions cause bleeding?

Brushing, toothpicks, food impaction

What happens after vessel rupture?

Contraction, platelet adhesion, fibrous clot

What injuries can cause bleeding?

Laceration, hot foods, chemical burns

What is spontaneous gingival bleeding seen in?

Acute Necrotizing Ulcerative Gingivitis (ANUG)

What systemic issue causes spontaneous oral bleeding?

Hemostatic failure

What hemorrhagic disorders cause gingival bleeding?

Vitamin C deficiency, thrombocytopenia, hemophilia

What hormonal factors affect gingivitis?

Pregnancy, menstrual cycle, oral contraceptives

What medications cause gingival bleeding or enlargement?

Anticonvulsants, CCBs, immunosuppressants

What happens to sulcus lining in diseased gingiva?

Ulcerated and bleeds easily

What determines severity of bleeding?

Intensity of inflammation

What does widespread color and texture change suggest?

Chronic gingivitis