PA CH8 Periodontal diseases (Granulomatous gingivitis (Clinical features …
PA CH8 Periodontal diseases
Drug related gingival hyperplasia
with secondary inflammation
increased vascularity and a chronic infiltrate that most frequently consists of lymphocytes and plasma cells漿細胞
Increased amount of collagen per unit volume
associated with gingival hyperplasia
calcium channel blockers鈣通道阻滯劑
increased gingival size is due to
production of an increased amount of extracellular matrix
neither the epithelium nor the cells within the connective tissue exhibit either hyperplasia or hypertrophy
abnormal growth of the gingival tissues secondary to use 繼發於of a systemic medication.
focal collections of histiocytes intermixed with an intense lymphocytic infiltrate組織細胞的集合收集與強烈的淋巴細胞浸潤混合
well-formed histiocytic granulomas with multinucleated giant cells形成良好的組織細胞肉芽腫與多核鉅細胞
Special stains for organisms should be negative.
can be seen adjacent to clinically normal teeth or next to teeth with restorations.
pain and sensibility
along the marginal gingiva
into the attached gingiva
affected areas have red or red and white macules
frequently in adulthood
may occur at any age
specific granulomatous infectious process
deep fugal infection
foreign material – silicon
histologically distinctive granulomatous disease
chronic granulomatous disease
unexplained granulomatous inflammation in a gingival biopsy specimen is termed granulomatous gingivitis
foreign material is detected-->diagnosis of foreign-body reaction
Lichen planus reaction has been noted related with generalized granulomatous disease.
Necrotizing ulcerative gingivitis(Vincent infection,Trench mouth )
Treatment and prognosis
quick resolution after removal of the bacterial challenge.
occur in any age(young and middle age adults)
Interdental papillae are highly
Loss of attachment
areas of crater-like necrosis are covered by a gray psudomenmbrane偽膜
poor oral hygiene
poor nutrient status
identified a fusiform bacterium (Bacillus fusiforms) and a spirochete (fusobacterium nucleatum)
Acute gingivitis can become necrotizing
acute inflammatory cells
infiltrate becomes more intense
Incipient初期-->light inflammatory infiltrate consisting of polymorphonuclear leukocytes.多形核白細胞組成
Frequency is high in all age groups.
other factors can also affect the oral flora
lack of proper oral hygiene --> accumulation of dental plaque and calculus牙菌斑和牙結石的積累
begin in chilhood and increase with age
Inflammatory changes are greater in adults
increased sensibility in puberty.
more frequent in man
susceptibility in women when they are exposed to high levels of progesterone黃體酮
increase the permeability of gingival blood vessel
more sensitive to bacterial, physical and chemical irritants
may be localized or generalized
diffuse or confined to the free gingival margins or the interdental papillae
Healthy gingiva is coral pink
chronic inflammation -->significant enlargement becouse of edema or fibrosis(chronicles hyper plastic gingivitis)
entrench根深蒂固的--> brighter red or magenta洋紅
progression--> light red, redder and edematous,
Necrotizing ulcerative gingivitis
Medication ulcerative gingivitis
Specific infection related gingivitis
Dermatosis related gingivitis皮膚病相關的牙齦炎
Gingivitis is present.
adjacent connective tissue exhibit
with a variable number of polymorphonuclear leukocytes多形核白細胞
and contains an inflammatory cellular infiltrate consisting predominantly of lymphocytes and plasma cells
The crevicular epithelium lining the pocket is hyperplasic, with extensive exocytosis胞吐 of acute inflammatory cells.
Gingivitis precedes the development of significant periodontal lesions and blunting and apical positioning of the gingival margins are typically present.
Periodontal disease is present when a loss of attachment can be demonstrated through the use of a periodontal probe.
absence of significant hyperplasia, a measurement of pockets greater than 3 to 4 mm. indicates destruction of the periodontal ligament and resortion of adjacent alveolar bone鄰近牙槽骨萎縮
High-quality dental radiographs
decreased vertical height of the bone surrounding the affected teeth
With advanced bone loss, tooth mobility is present.
Clasiification of periodontitis
Periodontitis associated with endodontic lesions牙髓病變
Abscesses of the periodontium
Pericoronal abcess 牙冠膿腫
Periodontal abcess 牙周膿腫
Gingival abscess 牙齦膿腫
Necrotizing periodontal diseases
Necrotizing ulcerative periodontitis
Necrotizing ulcerative gingivitis
Periodontitis associated as a manifestation of systemic diseases
increased prevalence related
lower socioeconomic leve降低社會經濟水平
chronic periodontitis has become the primary cause of tooth loss in patients older than 35 years of age
prevalence in males
inflammation of gingival tissues in association with some loss of both the attachment of the periodontal ligament and bony support
presence of pathogenic bacteria is essential but insufficient to produce periodontitis.
Apical migration of the crevicular epithelium along the root surface-->formation of periodontal pockets-->Loosening and eventual loss of teeth
few have been related to periodontitis
Porphyromonas gingivalis 牙齦卟啉單胞菌
possible related to changes in the dento-gingival environmenT
EX:a soft diet or a highly fermentable發酵 carbohydrate content diet
a result of shifts in the proportion of bacterial species in the plaque
not from the mere presence of dental plaqu不僅源於牙菌斑的存在