Podcast
Questions and Answers
What is a characteristic of healthy normal gingiva?
What is a characteristic of healthy normal gingiva?
What occurs in the initial lesion of gingivitis?
What occurs in the initial lesion of gingivitis?
What is a feature of the established lesion of chronic gingivitis?
What is a feature of the established lesion of chronic gingivitis?
What is a consequence of the inflammatory response in periodontal disease?
What is a consequence of the inflammatory response in periodontal disease?
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What is a mechanism of tissue damage in periodontal disease?
What is a mechanism of tissue damage in periodontal disease?
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What is a feature of periodontal breakdown?
What is a feature of periodontal breakdown?
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What is a feature of homeostasis?
What is a feature of homeostasis?
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What is a consequence of periodontal disease?
What is a consequence of periodontal disease?
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What is the primary response to endotoxins-LPS in healthy normal gingiva?
What is the primary response to endotoxins-LPS in healthy normal gingiva?
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What is the effect of vasodilation and increased vascular permeability on the sulcus in the initial lesion of gingivitis?
What is the effect of vasodilation and increased vascular permeability on the sulcus in the initial lesion of gingivitis?
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What type of cells proliferate into collagen-depleted areas in the early lesion of gingivitis?
What type of cells proliferate into collagen-depleted areas in the early lesion of gingivitis?
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What is the main type of cell found in the pocket of an established lesion of chronic gingivitis?
What is the main type of cell found in the pocket of an established lesion of chronic gingivitis?
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What is the consequence of the apical migration of the junctional epithelium in periodontitis?
What is the consequence of the apical migration of the junctional epithelium in periodontitis?
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What is the effect of oxygen radicals on connective tissue and cells in periodontal disease?
What is the effect of oxygen radicals on connective tissue and cells in periodontal disease?
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What is the consequence of periodontal breakdown on the periodontal ligament?
What is the consequence of periodontal breakdown on the periodontal ligament?
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What is the significance of homeostasis in relation to periodontal disease?
What is the significance of homeostasis in relation to periodontal disease?
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Study Notes
Healthy Normal Gingiva
- Minimal inflammation occurs with some bacteria present sub-gingivally
- PMNs are always found in GCF/sulcus in response to endotoxins-LPS
Initial Lesion (2-4 days)
- Vasodilation and increased vascular permeability occur
- GCF flows out of sulcus, PMNs cross JE and enter sulcus
- Connective tissue expands, epithelium stretches, and appears red due to less fibrous content
- BOP (Bleeding on Probing) occurs
Early Lesion (5-7 days)
- Vasodilation and increased vascular permeability occur
- GCF flow increases, with many PMNs, lymphocytes, and macrophages present
- Fibroblasts degenerate, collagen is destroyed, and JE and sulcular epithelium proliferate into collagen-depleted areas
Established Lesion (2-3 weeks)
- Many inflammatory cells infiltrate and accumulate in connective tissues
- MMPs and lysosomal contents are released from neutrophils, leading to collagen loss
- Epithelium proliferates into a pocket, containing many PMNs
Advanced Lesion (Gingivitis -> Periodontitis)
- Mostly neutrophils are present in the pocket
- Mostly plasma cells are present in connective tissues
- Apical migration of JE occurs to preserve intact epithelial barrier
- Collagen breakdown and osteoclastic resorption of alveolar bone occur
Inflammatory Response and Immune Response
- Inflammatory response triggers immune response, leading to periodontal destruction
- Activated macrophages and PMNs contribute to periodontal destruction
- MMPs (collagenase, elastase…) damage connective tissue
- Oxygen radicals damage connective tissue, fibroblasts, and epithelial cells
Periodontal Breakdown
- Apical migration of epithelium occurs due to destruction of underlying CT and changes
- PDL breakdown occurs due to increased host and bacterial factors in the CT
- Bone resorption occurs due to osteoclastic resorption from both host-derived and bacterial factors
Homeostasis
- Balance and maintenance of a relatively constant internal environment in the body
- Everyone has a different homeostasis with unique levels of factors that help achieve equilibrium
- Immune system balances and triggers skeletal system
- Omega-3-fatty acids aid in the natural resolution of inflammation
Key Points
- Bacteria trigger inflammatory response from host, but inflammation is responsible for most tissue destruction in periodontal disease
- Homeostasis is essential for a balanced response
- Balance between microbiology and host response dictates the outcome of inflammatory response
- A susceptible host where bacterial challenge is not neutralized by immune response is crucial for developing periodontal disease
Healthy Normal Gingiva
- Minimal inflammation occurs with some bacteria present sub-gingivally
- PMNs are always found in GCF/sulcus in response to endotoxins-LPS
Initial Lesion (2-4 days)
- Vasodilation and increased vascular permeability occur
- GCF flows out of sulcus, PMNs cross JE and enter sulcus
- Connective tissue expands, epithelium stretches, and appears red due to less fibrous content
- BOP (Bleeding on Probing) occurs
Early Lesion (5-7 days)
- Vasodilation and increased vascular permeability occur
- GCF flow increases, with many PMNs, lymphocytes, and macrophages present
- Fibroblasts degenerate, collagen is destroyed, and JE and sulcular epithelium proliferate into collagen-depleted areas
Established Lesion (2-3 weeks)
- Many inflammatory cells infiltrate and accumulate in connective tissues
- MMPs and lysosomal contents are released from neutrophils, leading to collagen loss
- Epithelium proliferates into a pocket, containing many PMNs
Advanced Lesion (Gingivitis -> Periodontitis)
- Mostly neutrophils are present in the pocket
- Mostly plasma cells are present in connective tissues
- Apical migration of JE occurs to preserve intact epithelial barrier
- Collagen breakdown and osteoclastic resorption of alveolar bone occur
Inflammatory Response and Immune Response
- Inflammatory response triggers immune response, leading to periodontal destruction
- Activated macrophages and PMNs contribute to periodontal destruction
- MMPs (collagenase, elastase…) damage connective tissue
- Oxygen radicals damage connective tissue, fibroblasts, and epithelial cells
Periodontal Breakdown
- Apical migration of epithelium occurs due to destruction of underlying CT and changes
- PDL breakdown occurs due to increased host and bacterial factors in the CT
- Bone resorption occurs due to osteoclastic resorption from both host-derived and bacterial factors
Homeostasis
- Balance and maintenance of a relatively constant internal environment in the body
- Everyone has a different homeostasis with unique levels of factors that help achieve equilibrium
- Immune system balances and triggers skeletal system
- Omega-3-fatty acids aid in the natural resolution of inflammation
Key Points
- Bacteria trigger inflammatory response from host, but inflammation is responsible for most tissue destruction in periodontal disease
- Homeostasis is essential for a balanced response
- Balance between microbiology and host response dictates the outcome of inflammatory response
- A susceptible host where bacterial challenge is not neutralized by immune response is crucial for developing periodontal disease
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Description
Understand the stages of periodontal health and gingivitis, including minimal inflammation, initial lesion, and early lesion. Learn about the role of bacteria, PMNs, and GCF in periodontal health.
