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What are the two categories of gingival diseases
- Plaque induced gingival disease
- Non-plaque induces gingival disease
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What are the 3 stages of gingivitis
- Initial lesion
- Early lesion
- Established lesion
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Describe the initial lesion stage
develops within 4 days of biofilm accumulation with mostly gram + bacteria
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Describe the early lesion stage
inflammation clinically detected after 7 days with increase in gram – bacteria
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Describe the established lesion stage
bleeding on probing with increased numbers of gram – rods and spirochetes
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What percentage of demineralization occurs before bone loss appears radiographically
60%
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What are some indicators of GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY
- Most common form
- Plaque at gingival margin
- Redness, tenderness
- Swollen margins
- Bleeding upon probing
- Damage reversible with good patient self-care
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GINGIVITIS ON A REDUCED BUT STABLE PERIODONTIUM occurs in patients
who have been successfully treated for periodontitis (there is existing attachment loss, but no ongoing periodontal disease)
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What are some indicators of GINGIVITIS ON REDUCED BUT STABLE PERIODONTIUM
- Pre-existing bone loss from previous history of periodontitis
- Plaque at the gingival margin
- All other signs of plaque-induced gingivitis
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Three main categories of gingival diseases with modifying factors are
- –Gingival diseases modified by systemic factors
- –Gingival diseases modified by medications–Gingival diseases modified by malnutrition
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In GINGIVAL DISEASES MODIFIED BY SYSTEMIC FACTORS ______ initiates the disease and then _______ found in the host ___________. It is modified by the _______ system and __________
- plaque
- specific systemic factors
- exaggerate the disease process
- endocrine system and fluctuations in sex hormones
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What are some indications of Puberty-Associated Gingivitis
- –The signs of inflammation seem exaggerated in relation to the amount of plaque present
- –Occurs in males and females
- –Clinical features are inflamed gingiva with prominent bulbous papillae on the facial aspect
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What is Menstrual cycle-Associated Gingivitis
An exaggerated inflammatory response to plaque biofilm due to elevated estrogen and progesterone prior to ovulation
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What is Pregnancy-Associated Gingivitis
- An exaggerated inflammatory response to plaque biofilm
- Usually occurring during the 2nd and 3rd trimesters of pregnancy due to rise in estrogen and progesterone
- Decreases after child birth
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What is a Pregnancy associated pyogenic granuloma (pregnancy tumor)
- –A localized mass projecting from the gingival papilla during pregnancy.
- –There is an exaggerated response to an irritation.
- –Growth bleeds easily if disturbed.
- –Growth usually regresses after giving birth
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pyogenic granuloma (pregnancy tumor)
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What is Diabetes-Associated Gingivitis
- An exaggerated inflammatory response aggravated by poor glycemic control (poorly controlled blood glucose)
- Reduction in inflammation in adults may lead to reduction in amount of insulin needed to to control blood glucose levels
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What is Leukemia-Associated Gingivitis
- An exaggerated inflammatory response to plaque resulting in increased bleeding and tissue enlargement (plaque is not a prerequisite)
- May be first clinical sign of leukemia
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What is Drug-influenced gingivitis
an exaggerated inflammatory response to dental plaque and a systemic medication
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Medications Most Commonly Associated with Gingival Enlargement
- Calcium channel blockers
- Immunosuppressants
- Anticonvulsants
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What is an Anticonvulsants medication associated with gingival enlargement
phenytoin/dilantin
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What is an Immunosuppressant medication associated with gingival enlargement
cyclosporine
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What are some Calcium channel blockers associated with gingival enlargement
nifedipine, amlodipine, verapamil
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In GINGIVAL DISEASES MODIFIED BY MEDICATIONS plaque accumulation is _______ for initiation of gingival enlargement
not necessary
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Gingival enlargement medications stimulate
fibroblast proliferation
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What medication is this patient taking?
 - Cyclosporine
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What medication is this patient taking?
- Dilantin
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What are some factors of gingival enlargement
- Onset within 3 months of taking medication
- Exaggerated response to plaque biofilm
- Higher prevalence in children
- Gingiva on anterior sextants most commonly affected
- Enlargement first observed at the interdental papilla
- Good daily self-care control limits the severity of gingival overgrowth
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GINGIVAL DISEASES OF SPECIFIC BACTERIAL ORIGIN are characterized by a
bacterial infection of the gingiva by a specific bacterium that is not a common component of the bacterial plaque biofilm
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What are rare gingival diseases and what does it result in
- –Neisseria gonorrhea
- –Treponema pallidum
- –Streptococci
- Result in painful ulcerations, patches or atypical highly inflamed gingiva
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Primary Herpetic Gingivostomatitis
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What is Primary Herpetic Gingivostomatitis and what is it characterized by
- The initial oral infection with the herpes simplex type-1 virus (HSV-1) usually occurring by age 3
- Characterized by redness and multiple vesicles (tiny fluid-filled blisters) that easily rupture to form painful ulcers
- Fiery red marginal gingiva
- Swollen papillae that bleed easily
- PainfulYellowish ulcers surrounded by red halo
- Fever, lymphadenopathy
- Dehydration is a concern
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Primary Herpetic Gingivostomatitis resolves in ______ days
10-20
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Primary Herpetic Gingivostomatitis
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What are some indications of Linear Gingival Erythema
- Associated with HIV
- May be associated with Candida albicans fungus
- Gingival manifestation of immunosuppression
- Characterized by inflammation that is exaggerated for the amount of plaque present
- Does not respond well to improved oral self-care or professional therapy – chlorhexidine rinse has proven helpful
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Hereditary gingival fibromatosis
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What is Hereditary gingival fibromatosis
- Characterized by gingival hyperplasia beginning around puberty which may cover the teeth.
- Tissue appears paler than surrounding tissue because of marked collagenization of the fibrous connective tissue
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What are some characteristics of oral lichen planus
- Intense redness of the gingiva
- Sloughing (pealing)of the epithelium leaving painful red, raw surface
- Has nothing to do with bacterial plaque although plaque control is difficult during outbreaks
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What are some indications of MUCOUS MEMBRANE PEMPHIGOID AND PEMPHIGUS VULGARIS
- –Chronic autoimmune diseases
- –Blistering followed by sloughing of the gingiva leaving painful, red, raw surface
- –Nothing to do with bacterial plaque
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MUCOUS MEMBRANE PEMPHIGOID AND PEMPHIGUS VULGARIS
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