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Chapter 7 (Gingival Disease (Stages of Periodontal disease (1st stage…
Chapter 7 (Gingival Disease
Periodontal disease is a group of lesions affecting the tissue so it is not a single disease
Periodontal disease is
they are microbial infections in which work with the hosts reduced capacity to resist disease
Periodontitis
Gingivitis
Gingivitis is an inflammatory lesion mediated with a host and microorganism interaction which is in the gingival tissue ONLY and does not involve the periodontal ligament , cementum, aveolar bone, supporting bone
there is not attachment loss
it affects everyone kids -adults
gingivitis can be plaque induced or systemic factors (hormones, medical contion)
*
plaque-induced gingivitis will not develop unless bacteria is present
gingival margins become swollen and enlarged and it can be easily seperated from the tooth surface forming a gingival pocket
Gingival Pocket
they are not true pockets they are "pseuso" packets meaning fake pockets because when there is inflammation during gingivitis the packet increases in height because it is inflamed so it creates a fake pocket depth but because there is not attachment loss it is not a true pocket
what can cause a pseudo pocket?
drug induced gingivitis such as phenytoin cyclosporine and certain calcium channel blockers
or it can be hormone induced like during pregnancy or puberty
Bleeding occurs
Gingivitis becomes clinically more severe when t cells decrease and B-cells and Plasma cell increase with the Lamina Propria
Stages of Periodontal disease
1st stage (Initial ) 2 to 4 days onset after plaque accumulation, histopathological signs is acute inflammation: PMNS macrophages; Vasculitis, Features: Subclinical;no signs of gingivitis increased flow of GCF
2nd Stage (Early) 4 to 7 days onset after plaque accumulation
histopathological signs: T cells, Features: Clinical signs of gingivitis first seen (redness, bleeding on probing edema)
3rd Stage (Established) 2 to 3 weeks, Histopathological Signs B cells lesion; plasma cells Features: Chronic gingivitis (gingiva may appear bluish -red with increased probing depths
4th Stage (Advanced) undetermined onset after plaque accumulation, alveolar bone loss, periodontal pockets formation; b cell lesion, Feature: periodontitis
Because there are so many factors to consider when looking at periodontal disease it is hard to pinpoint the initial progression of periodontal disease
Initial Stage Steps: Plaque accumulates at the gingival margin
Then the leukocyte wall aka Protection wall of PMNS becomes comprmised
bacterial antigens cross the permeable junctional epithelium and enter the gingival connective tissue
the tissue response to the bacteria by created acute inflammation
there is an increase flow of crevicular fluid (gcf) into the crevice and migration of PMNS from the connective tissue into the junctional epithelium
there is loss of come collagen in the lamina propria because collagenase is replaced with PMNS with the inflammatory response
End result the lesion and can be reversible with regular oral hygiene visits
Early Lesion
After day 4 continuing to day 4-7 and up to day 14 plaque continues to accumulate
1 more item...
in the initial response from the gingival tissue to the bacteria there is vasodilation of the blood vessels in the lamina propria near the junctional epithelium (increased opening mean the vessels are allowed to exchange fluid and cells between the blood and lamina propria which allow increased levels of neutrophils
Plaque induced Gingivitis - Starts in the interdental papilla and is seens as redness, bleeding, swellng, gingival sensativity, and tenderness
Hormone Gingivitis
Found in...
Puberty: due to high hormone levels it can cause an gingival response. # of factors are plaque levels, dental caries, mouth breathing, tooth crowding, and tooth eruption. **Gingival inflammation is present in small amounts of dental plaque and meticulous oral hygiene is the recommended treatment
Menstrual Cycle Gingivitis: This types of hormone change can cause gingival inflammation that is enlarged, red, interdental papilla. all gingival changes can be revered after cycle and the change is seen in the gingiva with plaque present. not every female with have this response
Pregnancy Gingivitis: Incidence of gingivitis ranged between 30%- 100% . it can be seen as early as 2 months into pregnancy or 8th month of pregnancy at its worse usually. healthy gingiva during pregnancy does not develop pregnancy gingivitis but during pregnancy, it is it is aggressive. treatment can be periodontal debridement and oral home care instructions and the gingival condition should resolve after the baby is born.