DHE119 Chapter6 Gingival disease

  1. Characteristics Common to ALL Gingival Diseases?
    • Signs of inflammation confined to the gingiva
    • No attachment loss associated with the inflammation
    • Initiated by plaque biofilm
    • Inflammation reversible with plaque removal
    • May progress to periodontitis if left untreated
  2. Bacteria associated with health?
    Image Upload 1
  3. Gram + Rods in health =
    • Actinmyces israelii
    • Actinmyces naeslundii
    • Actinmyces odontolyticus
    • Rothia dentocariosa
    • Actinmyces gerencseriae
  4. Gram + Cocci in health=
    • Streptococcus mitis
    • Streptococcus oralis
    • Streptococcus sanguis
    • Streptococcus gordonii
    • Peptostreptococcus micros
  5. Gram - Rods in health=
    • Selenomanas sputigena
    • Capnocytophaga gingivalis
    • Prevotella intermedia
    • Fusobacterium nucleatum
  6. Gram – Diplococci in health=
  7. Spirochete in health=
  8. Bacteria associated with gingivitis?
    Image Upload 2
  9. Bacteria associated with gingivitis Gram + Rods =
    Acetinomyces naeslundii III
  10. Bacteria associated with gingivitis Gram + Cocci =
    • Sreptococcus anginosus
    • Sreptococcus sanguis
  11. Bacteria associated with gingivitis Gram - Rods =
    • Campylobacter concisus
    • Prophyromonas gingivalis
  12. Bacteria associated with gingivitis Gram – Diplococci =
    Neisseria gonorrhoeae
  13. Bacteria associated with gingivitis Spirochete =
    Treponema pallidum
  14. Gingival disease? 2
    Image Upload 3
  15. Dental Plaque-Induced Gingival Diseases:
    in 4 days?
    7 days?
    more than 7 days?
    • 4 Days:
    • INITIAL Lesion
    • biofilm in pocket / sulcus is heavily populated with Gram + cocci

    • 7 Days:
    • EARLY Lesion
    • Gram – begin to flourish

    • +7 DAYS:
    • ESTABLISHED Lesion:
    • BOP / spirochetes / Gram - rods
  16. what is Dental plaque-induced gingival disease?
    • periodontal diseases involving inflammation of the gingiva in response to dental plaque.
    • Gingivitis Associated with Dental Plaque Only
    • Plaque at gingival margin
    • Redness, tenderness
    • Swollen margins
    • Bleeding upon probing
    • Damage reversible with good patient self-care
    • The younger the child the ____ the pathogenic bacteria
  17. What gingival disease is the most common?
    Dental plaque-induced gingival diseases
  18. radiographically Dental plaque-induced gingival disease?
    • No attachment loss in the gingivitis
    • Radiographs reveal no changes in the height of bone or character of the bone.
    • Image Upload 4
  19. what is Plaque-Induced Gingivitis on a Reduced but Stable Periodontium?
    • This type occurs in patients who have been successfully treated for periodontits.
    • At a later date, after successful treatment of the periodontitis, the patient develops gingivitis.
    • At this later date when the gingivitis occurs, periodontitis is NOT present.
    • Pre‐existing bone loss from previous history of periodontitis
    • Plaque at the gingival margin
    • All other signs of plaque-induced gingivitis
  20. Three main categories of gingival diseases with modifying factors are
    • Systemic factors
    • Medications
    • Malnutrition
  21. Gingival Diseases Modified by Systemic Factors (endocrine)
    • In this form of gingival disease, plaque initiates the disease and then specific systemic factors found in the host modify the disease process. Make it worst (plaque + endocrine).
    • Example—Puberty-Associated Gingivitis
    • The signs of inflammation seem exaggerated in relation to the amount of plaque present in this 12-year-old female patient.
  22. Pregnancy-Associated Gingivitis
    An exaggerated inflammatory response; usually occurring during the 2nd and 3rd trimesters of pregnancy.

    • Recent studies show there is NO association between the use of oral
    • Contraceptives and increased gingival inflammation.
  23. Pregnancy-Associated Pyogenic Granuloma (“Pregnancy Tumor”)?
    • A localized mushroom-shaped gingival mass projecting from the gingival margin or gingival papilla during pregnancy.
    • It is a mushroom-like growth.
    • It is more common in the maxilla and in gingival papillae.
    • Growths are not cancerous.
    • Growths are usually not painful.
    • There is an exaggerated response to an irritation.
    • Growth bleeds easily if disturbed.
    • Growth usually regresses after giving birth.
    • Image Upload 5
  24. Diabetes-Associated Gingivitis?
    • An inflammatory response of the gingiva to plaque aggravated by poorly controlled blood glucose levels
    • Reduction in gingival inflammation in diabetic adults may result in reduction of insulin needed
    • Image Upload 6
  25. Blood dyscrasias Leukemia-Associated Gingivitis?
    • An exaggerated inflammatory response to plaque resulting in increased bleeding and tissue enlargement
    • Image Upload 7
  26. Drug-influenced gingivitis?
    an exaggerated inflammatory response to dental plaque and a systemic medication
  27. Drug-influenced gingival enlargement?
    an increase in size of the gingiva resulting from systemic medications
  28. Medications Most Commonly Associated With Gingival Enlargement?
    • Anticonvulsants (Phenytoin Induced)
    • Calcium channel blockers
    • Immunosuppressants (Cyclosporine Induced)
    • Oral contraceptives
  29. Is Plaque accumulation is necessary for initiation of gingival enlargement?
    • NO
    • but it will exacerbate the gingival disease.
    • Meticulous plaque control can reduce but will not eliminate gingival overgrowth.
  30. T/F
    women with pre-existing gingival conditions or susceptibility to periodontal disease may experience an exacerbated response to bacterial plaque

  31. Gingival Enlargement due to Cyclosporine?
    • Onset within 3 months of taking medication
    • Exaggerated response to plaque
    • 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
  32. Gingival Disease Modified by Malnutrition
    who is at risk for vitamin deficiencies?
    • Infants
    • Institutionalized elderly
    • Alcoholics
  33. Ascorbic Acid–Deficiency Gingivitis?
    • An inflammatory response to dental plaque aggravated by chronically low ascorbic acid (vitamin C) levels.
    • Bright red
    • Swollen
    • Ulcerated
    • Bleeds easily
    • Pseudo-pocket
    • Image Upload 8
  34. Categories of Non–Plaque‐Induced Gingival Lesions?
    Image Upload 9
  35. 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
    • Infection by a bacterium that is not usually considered to be a periodontal pathogen
    • If plaque biofilm should be introduced to any of the following there could be a major increase in the severity
  36. Gingival diseases of specific bacterial origin (STD)? 2
    • Neisseria gonorrhoea
    • Treponema pallidum
  37. Gingival diseases of specific bacterial origin (STD):
    Neisseria gonorrhoea
    • a species of gram-negative diplococci bacteria
    • establishes itself in the pharynx
    • white spots or whitish/yellow discharge
  38. Gingival diseases of specific bacterial origin (STD):
    Treponema pallidum
    • Syphilis
    • chronic systemic venereal disease
    • ulceration of the tongue dorsum, accompanied by hyperplasic foliate papillae, may be the only clinical signs of the disease
  39. Atypical Mycobacterial viral Infection?
    • Primary Herpetic Gingivostomatitis
    • Image Upload 10
  40. Viral (PHG) Primary Herpetic Gingivostomatitis?
    • Primary herpetic gingivostomatitis—the initial oral infection with the herpes simplex type-1 virus (HSV-1)
    • Characterized by redness and multiple vesicles (tiny fluid-filled blisters) that easily rupture to form painful ulcers
    • Usually affects infants and young children but may affect young adults.
    • *Initial HSV-1 infection in a young child
    • Image Upload 11
    • In some individuals, the initial infection presents with intensely painful gingivitis and vesicles that rupture to form painful ulcers.
    • Once infected, most people develop immunity to the virus.
    • In some individuals, the HSV-1 can remain latent and be responsible to recurrent oral herpetic lesions (cold sores).
    • Fiery red marginal gingiva
    • Swollen papillae that bleed easily
    • Painful
    • Yellowish ulcers surrounded by red halo
    • Fever
    • Dehydration is a concern

    • Infection is contagious during the vesicular stage!
    • Infection can be spread to eyes by touching the mouth and then eyes.
    • Infection can be spread to others by kissing
    • Reschedule this patient!!
  41. FUNGAL origin  Linear Gingival Erythema?
    • Erythema = superficial reddening of the skin due to capillary dilation
    • A 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
    • Characterized by a distinct red band that is limited to the free gingiva
    • Often associated with HIV infection
    • Image Upload 12
  42. Gingival Diseases of FUNGAL origin?
    • Histoplasmosis
    • Candidal infections
  43. Histoplasmosis
    • granulomatous disease
    • Oral findings include painful granulomatous lesions
    • caused by Histoplasma fungi.
    • Image Upload 13
  44. Candidal infections?
    • Generalized Gingival Candidiasis
    • gingival tissue and oral mucosa is erythematous with a removable white coating and appears fragile
    • Image Upload 14
  45. Gingival lesions of genetic origin:
    Hereditary Gingival Fibromatosis?
    • AKA: idiopathic gingival hyperplasia,
    • rare condition of gingival overgrowth
    • Characteristics:
    • benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva.
    • Image Upload 15
    Lichen Planus
    • Disease of the skin and mucous membranes
    • Characterized by an itchy, swollen rash on the skin or in the mouth
    • Etiology unknown
    • May be an allergic or immune reaction
    • Intense redness of the gingiva
    • Ulcerations
    • Interlacing white lines may be present
    • Raised white lesions may be present
    • Image Upload 16
    Pemphigus Vulgaris
    • autoimmune blistering diseases
    • Pemphigus vulgaris (PV) and bullous pemphigoid (BP)
    Lupus Erythematosus
    • autoimmune disease
    • immune system attacks its own tissues
    • External Butterfly rash
    • Rosacea
    *Erythema Multiforme
    • Disorder of the skin and mucous membranes
    • May be due to allergic reaction or infection
    • Large red blotches, resembling targets, appear all over the skin
    • Blisters and ulcers occur on the oral mucous membranes
    • affecting mostly children and young adult
    • Ulcerations of the gingiva
    • Crust formation on the lower lip
    • Image Upload 17
  50. what can cause Allergic Reactions of the Gingiva?
    • Dental Restorative Materials
    • Can occur to ingredients in toothpastes, mouthwashes, or chewing gum
    • Usually a result of a flavor additive or a preservative in the product
    • Cinnamon and carvone, two flavor additives known to cause allergic reactions of the gingiva
  51. Allergic Reaction to Toothpaste?
    • Reaction to additive in toothpaste
    • Most common in those with history of other allergies
    • Tissue sloughing of mucosa
  52. Allergic Reactions of the Gingiva due to trauma?
    • Chemical
    • Physical
    • Thermal
  53. Allergic Reactions of the Gingiva causes?
    • Iatrogenic
    • Accidental
    • Foreign body
    • Unknown
  54. Hyperdontia?
    Image Upload 18
Card Set
DHE119 Chapter6 Gingival disease
DHE119 Chapter6 Gingival disease