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Chapter 8 - Gingival Diseases (Other causes of gingival diseases…
Chapter 8 - Gingival Diseases
Gingivitis
: An inflammatory lesion, mediated by host/microorganism interactions, which remains limited to the gingival tissues and does not involve the underlying periodontal ligament, cemetum, or alveolar and supporting bone
No attachment loss
Plaque induced or caused by systemic factors
Histopathogenesis
: the events that occur in the periodontal tissues that lead to the development of gingivitis and periodontitis
The development of the disease can be described as the progression of inflammation through four stages:
Initial (2-4 days): Acute inflammation; increased flow of GCF
Early (4-7 days): T cell lesion; redness, BOP, edema
Established (2-3) weeks: B cell lesion; bluish-red with increased probing depths
Advanced: Alveolar bone loss; Periodontitis
Many factors are involved and is difficult to pinpoint a clear delineation between the different stages
Pathogenesis of Gingivitis
Host Response:
Gingiva reacts to the presence of microorganisms by alterations in the gingival vascular supply. Vasodilation of vessels in the lamina propria
This leads to edema in the gingival tissues
Gingival Pocket
: formed by gingival enlargement and coronal migration fo the gingival margin( no loss of connective tissue)
Not true pockets (pseudo-pockets)
Often seen in drug induced gingivitis (phenytoin, cyclosporine, calcium channel blockers)
Classification of the Periodontal Diseases
Plaque-associated gingivitis
: most common
begins at the gingival margin and spreads
Will not develop unless bacteria is present
Reversible if plaque is removed
develops in 1-3 weeks
Gingival diseases by systemic factors
Puberty gingivitis
: distinguishing feature is inllammation in the presence of a small amount of plaque
Caused by rise in hormones;
Meticulous oral hygiene is recommended
Menstrual Cycle gingivitis
: increased levels of estrogen and progesterone
Pregnancy gingivitis:
30-100 %
Degree of inflammation is related to the state of oral hygiene of the patient
Plaque at the margin results in the exaggerated inflammatory response
Elevation in hormones cause an increased permeability of the blood vessels, resulting in the gingival redness, edema, and increased flow of the GCF
Subgingival growth of
Prevotella intermedia
Not associated with pregnancy tumor; will resolve postpartum
Treatment includes debridement and oral home care instruction
Other causes of gingival diseases
Leukemia associated gingivitis
Gingival bleeding and enlargement
Medications: commonly referred to as "gingival enlargement" or "overgrowth"
occurs 1-3 months after the start of the medication
Oral contraceptives
Bacteria origin: infections with Neisseria gonorrhea, Treponema pallidum, Streptococci or other microorganisms
Viral origin: Herpes viruses
Fungal Origin: coccidioidomycosis, crytococcosis, histoplasmosis
Genetic origin: fibrotic gingival enlargement
Mucocutaneous diseases
Lichen planus, benign mucous membrane pemphigoid, ulbous pemphigoid, pemphigus vulgaris
Traumatic lesions: thermal, chemical burns