Periodontal Health and Gingivitis

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

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.