Transcript Gingival Disease - Tri-State Business Institute Dental Hygiene

Gingival Disease
Nield-Gehrig CH 10
Perry CH 6
Gingival Description
6 Gingival Characteristics






Color
Size
Position of margin
Shape of margins and papillae
Texture and consistency
Bleeding and/or exudate
Healthy Gingiva




Tissue fits snugly around the tooth
Pointed papillae fill embrasure spaces
Firm and resilient
Little or no gingival crevicular fluid
(GCF)
Normal Variations of Color
Gingivitis
 The mildest and most
common form of
periodontal disese
 Gingivitis –
inflammation of the
gingiva causing tissue
to become edematous
and
erythematous…bleeds
easily on provocation.
Tissue Color In Gingivitis
 Acute inflammation = increased blood
flow = RED tissue
 Chronic inflammation = bluish-red or
purplish – red
Changes in Disease
Gingival Bleeding on Probing
 The two earliest signs of ginigval
inflammation preceding established
gingivitis are:
 1. Increased gingival crevicular fluid
production rate
 GCF = inflammatory exudate
 Recently – development of tests for the
detection or prediction of periodontal
disease using the components, origin, and
function of GCF
 Drugs in GCF – tetracycline and
Metronidazole
 2. Bleeding from the gingivl sulcus on
gentle probing
Gingival Bleeding
 In gingival inflammation, histopathologic alterations
that result in abnormal gingival bleeding include
dilation and engorgement of the capillaries and
thinning or laceration of the sulcular epithelium.
 Because the capillaries are engorged and closer to the
surface, and the thinned, degenerated epithelium is
less protective, stimuli that are normally innocuous
cause rupture of the capillaries and gingival bleeding.
 The severity of the bleeding and the ease of its
provocation depend on the intensity of the
inflammation.
 In cases of moderate or advanced periodontitis, the
presence of bleeding on probing is considered a sign
of active tissue destruction.
Gingival Bleeding Associated with
Systemc Changes
 In some systemic disorders, gingival
hemorrhage occurs spontaneously or after
irritation and is excessive and difficult to
control.
 Vascular abnormalities – Vit. C deficiency
or allergy
 Platelet disorders – thrombocytopenic
purpura
 Hypprothrombinemia – Vit. K deficiency
 Other coagulation defects – hemophilia,
leukemia,
 Deficient platlet thromboplastic factor
(PF3) resulting from uremia, multiple
myeloma and ostrubella purpura.
Gingival Bleeding Associated with
Systemc Changes






Hormonal replacement therapy
Oral contraceptives
Pregnancy
Menstral cycle
Diabetes
Medications:




Anticonvulsants
Antihypertensive calcium channel blockers
Immunosuppressant drugs
aspirin
Change in Size
in disease
Tissue Size in Gingivitis
 Increase in tissue fluid causes
enlargement of the marginal and
interproximal gingival tissues
(Edema)
 Change can be localized to a few
areas or affect the whole mouth
(generalized)
Change in Position in Margin
Change in Position of Margin
Change in Shape of Margin
Bulbous Papilla
Cratered Papilla
Missing and Blunted Papilla
Changes in the Consistency
In Gingival Disease
 Both chronic and acute inflammations
produce changes int the normal firm and
resilient consistency of the gingiva.
 Chronic gingivitis = edematous –
(destructive) and fibrotic –
(repairative) changes coexist
 The consistency of the gingiva is
determined by their relative pedominance.
Spongy Tissue
Surface Texture Changes in Disease
 The surface of normal gingiva usually
exhibits numerous small depressions
and elevations = stippling
 In chronic inflammation the surface is
either smooth and shiny or firm and
nodular
 This depends on whether the dominant
changes are exudative or fibrotic
Smooth, Shiny Tissue
 Can be:
 exudative
 Epithelial atrophy in atrophic gingivitis
 Chronic desquamative gingivitis can also
have peeling of the surface
Smooth, Shiny Tissue
Changes in surface texture
chronic gingivitis
 Hyperkeratosis results in a leathery
texture (example = chronic gingival
disease in a smoker)
 Fibrotic = firm nodular
 Drug induced gingival overgrowth
also produces a nodular surface
Nodular Tissue
Assess the Following
Color
Size
Position of gingival margin
Shape of margins and papillae
Use air and probe to determine
texture
 Consistency
 Check for bleeding





More on Size
 Gingival Enlargement or gingival
overgrowth are the current terms
used to describe an increase in the
size of the gingiva
 “hypertrophic gingivitis” or “gingival
hyperplasia” may have erroneous
pathologic connotations
 Gingival enlargement is a purely
clinical term
Gingival enlargement can be
classified according to etiologic
factors and pathologic changes
 I. Inflammatory enlargement
 A. Chronic
 B. Acute
 II. Drug-induced enlargement
 III. Enlagements associated with systemic
diseases or conditions
 IV. Neoplastic enlargement (gingival
tumors)
 V. False enlargement
Criteria of location
 Localized: limited to the gingiva adjacent
to a sengle tooth or group of teeth.
 Generalized: involving the gingiva
throughout the mouth
 Marginal: confined to the marginal gingiva
 Papillary: Confined to the interdental
papillae
 Diffuse: Involving the marginal and
attached gingivae and papillae.
 Discrete: An isolated sessile or
pedunculated, tumorlike enlargement.
Non-Plaque –Induced Gingival
diseases
 Bacterial origin –
 Neisseria gonorrhea – associated lesions
 Treponema pallidum – associated lesions
 Streptococcal species – associated
lesions
 RARE – Non-plaque is RARE
Non-Plaque-induced gingival
diseases of viral origins




RARE – Non-plaque is RARE
Acute herpetic gingivostomatitis
Recurrent oral herpes
Varicella-zoster infections
Primary Herpetic Gingivostomatitis
 Caused by herpes simplex virus type 1
(HSV-1)
 Most often occuring in infants and children
under 6 years
 In most people the primary infection is
asymptomatic
 As part of the primary infection, the virus
ascends through sensory and autonomic
nerves, where it persists as latent HSV in
neuronal ganglia that innervate the site
 In 1/3 of the world’s population secondary
manifestations result from various stimuli
NUG
 Punched-out, craterlike depressions
at the crest of the interdental papillae
 Gray, pseudomembranous slough
 Linear erythema
 Spontanious gingival hemorrhage
 Fetid odor
Gingival Diseases Modified by
Malnutrition
 Most clinical studies have not shown a
relationship between the
development of gingival diseases and
malnutrition with the possible
exception of severe vitamin C
deficiency.
Lichen Planus
 Inflammatory mucocutaneous
disorder that may involve mucosal
surfaces and the skin.
 Current evidence suggests that lichen
planus is an immunologically
mediated mucocutaneous disorder in
which host T lymphocytes play a
central role.