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Chapter 7: Gingival Diseases (Classification of the Periodontal Diseases…
Chapter 7: Gingival Diseases
Histopathogenesis of Gingivitis
: pathologic (disease) changes within the periodontal structures at a microscopic level and lead to development of gingivitis
Stages: Are intermingled!
Initial lesion (PMN Dominated)
2 to 4 Days
Plaque formation
Signs:
Acute inflammation; PMNs, Macrophages; vasculitis
Features
: Subclinical; no signs of gingivitis; increased flow of GCF
Early Lesion (T-Cell Dominated)
4 to 7 Days
Signs:
T Cell Lesion
Features:
Clinical signs of gingivitis first seen (redness, bleeding on probing, edema)
60-70% of collagen lost
Gingival Sulcus Deepens
Established Lesion (Few B-Cells/Plasma Cells)
2 to 3 weeks
Can last for months without progressing
Features:
Chronic gingivitis (gingiva may appear bluish-red with increased probing depths
Gingival Margin Swollen & Enlarged. Easily separated from tooth surface. Pseudopocket with
no bone loss
Signs:
B cell lesion; plasma cells
Advanced:
PERIODONTITIS
Alveolar bone loss, periodontal pocket formation; B cell lesion
Pathogenesis of Gingivitis
Gingival Pocket
Formed by gingival enlargement and coronal migration
Gingival fibers remain attached to root surface
Not true Pockets! Pseudo
Allows bacteria to migrate apically
Host response to Gingival Inflammation
alterations in gingival vascular (blood) supply
Vasodilation: allows exchange of fluid and cells
Edema: fluid filled. It "LEAKS" out of the blood vessels
Classification of the Periodontal Diseases
Dental Plaque-Induced Gingival Diseases
Bacteria and lack of oral hygiene
Develop 1-3 week
Gingival Diseases Modified by Systemic Factors
Puberty
Menstrual Cycle
Pregnancy
Diabetes Mellitus
Gingivitis Associated with Blood Dyscrasias
Leukemia-white blood cell disease
gingival bleeding & enlargements at the interdental papilla and spreads to attached gingiva
Gingival Diseases Modified by Medications
Gingival Enlargements/overgrowth,
excessive production of collagen or reduction of collagenase(break down of collagen)
happens 1-3 months after starting medications
calcium channel blocker: nifedipine, diltiazem, verampamil, & amlodipine
Drug-Influenced Gingivitis
Oral Contraceptive-associated gingivitis
similar to pregnancy, due to estrogen and progesterone
Non-Plaque-Induced Gingival Diseases
Specific Bacteria Origin
Neisseria gonorrhea, Treponema pallidum, Streptococci
Gingival lesions appear as erythematous(red), edematous (fluid-filled) ulcers, or inflamed, nonulcerated gingiva.
Viral Origin
Herpes virus 1 & 2, herpetic gingivostomatisis, varicella-zoster, herpes labialis
Genetic Origin
hereditary fibromatosis
Manifestations of systemic conditions
erosive lichen planus, benign mucous membrane pemphigoid, bullous pemphigoid, and pemphigus vulgaris
Allergic Reactons
Traumatic Lesions
thermal, chemical, or physical
Fungal Origin
Candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis
Gingival Disease
Gingivitis is an inflammatory lesion, mediated by host/microorganism interactions, which remains limited to the gingival tissues
JE and the coronal gingival connective tissue attachment stay at the CEJ
Defined by:
Clinical Manifestations
Duration of disease
Association with dental plaque/systemic factors such as medical conditions/medications