Inflammation of the gingiva characterized clinically by changes in color, gingival form, position, surface appearance, and presence of bleeding and/or exudate
Periodontal case type I
gingival disease
progression of the gingival inflammation into the deeper periodontal structures and alveolar bone crest, with slight bone loss. There is usually a slight loss of connective tissue attachment and alveolar bone
Periodontal case type II
Early periodontitis
A more advanced stage of the preceding condition, with increased destruction of the periodontal structures and noticeable loss of bone support, possibly accompanied by an increase in tooth mobility. There may be furcation involvement in multirooted teeth
periodontal case type III
moderate periodontitis
Further progression of periodontitis with major loss of alveolar bone support usually accompanied by increased tooth mobility. Furcation involvement in multirooted teeth
Periodontal case type IV
advanced periodontitis
The stages of development of gingivities and periodontitis are divided into what 4 lesions?
initial
early
established
advanced
Which lesion type is known as the inflammatory response to dental biofilm?
initial lesion
Which lesion do the following characteristics describe?
occurs within 2-4 days of irritation from bacteria
migration and infiltration of white blood cells in into the junctional epithelium and gingival sulcus result from the natural body response to infectious agents
increased flow of gingival sulcus fluid
early breakdown of collagen of the supporting gingival fiber groups
fluid fills the spaces in the connective tissue
Initial lesion
Describe the clinical appearance of the initial lesion
no clinical evidence of change appears in the earliest phase
there may be slight marginal redness with enlargement due to the fluid collection
Which lesion type is known as the increased inflammatory response?
early lesion
Which lesion do the following characteristics describe?
7-14 days of irritation from bacteria dental biofilm becomes older and thicker
infiltration of fluid, lymphocytes, and neutrophils with a few plasma cells in the connective tissue
breakdown of collagen fiber support to the gingival margin
Epithelial extenesions and rete ridges are formed
early lesion
Describe the clinical appearance of the early lesion
slight gingival enlargement
True or false. Early gingivitis is reversible when biofilm is controlled and inflammation is reduced
true
true or false. Susceptibility of individuals and time before lesion becomes established does NOT vary.
FALSE! They DO vary
Which lesion type is known as progression from early lesion?
the established lesion
Which lesion do the following characteristics describe?
fluid and leukocyte migration into tissues and sulcus increases; plasma cells are realted to areas of chronic inflammation
formation of pocket epithelium
collagen destruction continues; connective tissue fiber support is lost
progression to early periodontal lesion may occur
established lesion
Proliferation of the junctional and sulcular epithelium continue in an attempt to wall out the inflammation occurs during what?
formation of pocket epithelium in the established lesion
Is pocket epithelium more permeable than regular epithelium?
yes!
describe the clinical appearance of the established lesion
clear evidence of inflammation
marginal redness
bleeding on probing
spongy marginal gingiva
later chronic fobrosis develops
Which lesion type is known as extension of inflammation?
advanced lesion
Which lesion do the following characteristics describe?
subgingival biofilm forms as a reslult of supragingival biofilm entering sulcus
biofilm microorganisms produce irritants
alveolar bone destruction
advanced lesion - extension of inflammation
What occurs when inflammation spreads through the loose connective tissue along the blood vessels to the alveolar bone?
alveolar bone destruction in the advanced lesion
Where does the inflammation of the advanced lesion most commonly enters the bone?
through small vessel channels in the alveolar crest
Where does inflammation from the advanced lesion spread?
through the bone marrow and out into the periodontal ligament, destroying the alveolar bone
Which lesion type also includes progressive destruction of connective tissue?
advanced lesion
Which lesion do the following characteristics describe?
connective tissue fibers below the JE are destroyed, and the epithelium migrates along the root surface
coronal portion of JE becomes detached
exposed cementum where sharpey's fibers were attached become altered by inflammatory products of bacteria and the sulcus fluid
diseased cementum contains a thin layer of endotoxins from bacterial breakdown
the pocket continues to deepen
advanced lesion - progressive destruction of connective tissue
The following characteristics describe what lesion?
pocket formation, mobility, bone loss, all signs of periodontitis
persistence of the chronic inflammatory process; plasma cells predominate
JE continues to migrate; lesion extends through connective tissue
Periods of inactivitiy alternating with periods of activity can be expected (furcation involvement)
advanced lesion.
Which cells predominate in the advanced lesion?
plasma cells
diseased sulcus
pocket
What is the treatment area where calculus collects and instrumentation for nonsurgical periodontal therapy is applied?
sulcus and pocket
What distinguishes a pocket from a sulcus?
the presence or absence of infection
What distinguishes a gingival pocket from a periodontal pocket?
the level of attachment on the tooth
What is the innter wall of a pocket?
What is the outer wall of a pocket?
tooth surface
sulcular epithelium or pocket epithelium
Where is the base of the pocket?
where the inner and outer walls meet
Where is the coronal margin of the attached periodontal tissue?
