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PA CH8 Periodontal diseases (Granulomatous gingivitis (Clinical features,…
PA CH8 Periodontal diseases
Drug related gingival hyperplasia
Concept
abnormal growth of the gingival tissues secondary to use 繼發於of a systemic medication.
neither the epithelium nor the cells within the connective tissue exhibit either hyperplasia or hypertrophy
increased gingival size is due to
production of an increased amount of extracellular matrix
predominantly collagen膠原蛋白
associated with gingival hyperplasia
anticonvulsants抗驚厥藥
Phenobarbital
phenitoin
calcium channel blockers鈣通道阻滯劑
Nifedipine
cyclosporine
erythromicyn紅黴素
oral contraceptives口服避孕藥
histopathologic features
Increased amount of collagen per unit volume
with secondary inflammation
increased vascularity and a chronic infiltrate that most frequently consists of lymphocytes and plasma cells漿細胞
Granulomatous gingivitis
unexplained granulomatous inflammation in a gingival biopsy specimen is termed granulomatous gingivitis
Types
histologically distinctive granulomatous disease
chronic disease
sarcoidosis 結節病
chronic granulomatous disease
specific granulomatous infectious process
foreign material – silicon
aluminium
iron
deep fugal infection
Clinical features
may occur at any age
frequently in adulthood
solitary 孤束
multifocal多灶性
affected areas have red or red and white macules
found at
along the marginal gingiva
into the attached gingiva
pain and sensibility
can be seen adjacent to clinically normal teeth or next to teeth with restorations.
Histopathologic features
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.
Diagnosis
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 )
Concepts
Acute gingivitis can become necrotizing
identified a fusiform bacterium (Bacillus fusiforms) and a spirochete (fusobacterium nucleatum)
Related with
psychologic stress
stress inmune-supression
local trauma
poor nutrient status
smoking
poor oral hygiene
inadequate sleep
recent illness
Clinical features
affect papillae
blunts 鈍化
areas of crater-like necrosis are covered by a gray psudomenmbrane偽膜
fetid odor
Loss of attachment
Interdental papillae are highly
inflamed
edematous
hemorrhagic
occur in any age(young and middle age adults)
associated periodontitis牙周炎
Treatment and prognosis
quick resolution after removal of the bacterial challenge.
Gingivitis
Types
Plaque-related gingivitis
Clinical feature
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
Age
begin in chilhood and increase with age
Inflammatory changes are greater in adults
increased sensibility in puberty.
Sex
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
Factors
stress
poor nutrition
smoking
diabetes
trauma
tooth crowding
mouth breathing
Concept
progress
progression--> light red, redder and edematous,
entrench根深蒂固的--> brighter red or magenta洋紅
chronic inflammation -->significant enlargement becouse of edema or fibrosis(chronicles hyper plastic gingivitis)
Healthy gingiva is coral pink
diffuse or confined to the free gingival margins or the interdental papillae
may be localized or generalized
Histopathologic features
Incipient初期-->light inflammatory infiltrate consisting of polymorphonuclear leukocytes.多形核白細胞組成
progression
infiltrate becomes more intense
mixture of
lymphocytes
plasma cells
acute inflammatory cells
Necrotizing ulcerative gingivitis
Medication ulcerative gingivitis
Allergic gingivitis
Specific infection related gingivitis
Dermatosis related gingivitis皮膚病相關的牙齦炎
Periodontitis牙周炎
Concept
Periodontitis occurs
not from the mere presence of dental plaqu不僅源於牙菌斑的存在
a result of shifts in the proportion of bacterial species in the plaque
possible related to changes in the dento-gingival environmenT
EX:a soft diet or a highly fermentable發酵 carbohydrate content diet
few have been related to periodontitis
Porphyromonas gingivalis 牙齦卟啉單胞菌
Prevotella intermedia中間普氏菌
Bacteriodes forsythus連翹桿菌
Actinobacillus actinomycetemcomitans放線桿菌放線桿菌
Apical migration of the crevicular epithelium along the root surface-->formation of periodontal pockets-->Loosening and eventual loss of teeth
presence of pathogenic bacteria is essential but insufficient to produce periodontitis.
inflammation of gingival tissues in association with some loss of both the attachment of the periodontal ligament and bony support
prevalence in males
chronic periodontitis has become the primary cause of tooth loss in patients older than 35 years of age
increased prevalence related
diabetes mellitus
lower socioeconomic leve降低社會經濟水平
Smoking
hereditary predisposition遺傳
Advancing age
Clasiification of periodontitis
Periodontitis associated as a manifestation of systemic diseases
Genetic disorders
hematologic disorders
Necrotizing periodontal diseases
Necrotizing ulcerative gingivitis
Necrotizing ulcerative periodontitis
Aggressive periodontitis
generated
localized
Abscesses of the periodontium
Gingival abscess 牙齦膿腫
Periodontal abcess 牙周膿腫
Pericoronal abcess 牙冠膿腫
Chronic periodontitis
localized
Generalized
Periodontitis associated with endodontic lesions牙髓病變
Clinical features
With advanced bone loss, tooth mobility is present.
High-quality dental radiographs
decreased vertical height of the bone surrounding the affected teeth
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
Periodontal disease is present when a loss of attachment can be demonstrated through the use of a periodontal probe.
Gingivitis precedes the development of significant periodontal lesions and blunting and apical positioning of the gingival margins are typically present.
Histopathologic features
The crevicular epithelium lining the pocket is hyperplasic, with extensive exocytosis胞吐 of acute inflammatory cells.
adjacent connective tissue exhibit
increased vascularity
and contains an inflammatory cellular infiltrate consisting predominantly of lymphocytes and plasma cells
with a variable number of polymorphonuclear leukocytes多形核白細胞
Gingivitis is present.