Periodontal Health and Inflammation Overview

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Questions and Answers

What characterizes periodontitis in comparison to gingivitis?

Bacterial infection confined to the gingiva

Irreversible destruction of all parts of the periodontium (correct)

Reversible destruction of the gingiva

Presence of bleeding only during brushing

Which of the following is NOT a classical sign of acute inflammation?

Heat

Redness

Hypotension (correct)

Swelling

What is the term used to describe the irreversible loss of attachment in periodontitis?

True pocketing

False pocketing

Inflammatory detachment

Clinical attachment loss (correct)

Which histological feature is characteristic of healthy gingiva?

Normal keratinization Signup and view all the answers

Which symptom is commonly associated with gingivitis?

Bleeding on probing Signup and view all the answers

What does the term 'false pocketing' refer to?

Pockets formed by gum recession without attachment loss Signup and view all the answers

What role do lifestyle factors play in periodontal health?

They can influence plaque control and self-care. Signup and view all the answers

Which clinical feature is typically assessed in patients with gingivitis?

Bleeding on brushing or probing Signup and view all the answers

What differentiates chronic inflammation from acute inflammation?

Duration and type of immune response Signup and view all the answers

What is the primary bacterial infection associated with gingivitis?

Bacterial infection confined to the gingiva Signup and view all the answers

What is the characteristic color of healthy gingiva?

Uniform pink Signup and view all the answers

Which clinical feature indicates the presence of gingivitis?

Thickened, rolled margins Signup and view all the answers

What is a significant distinction between false pocketing and true pocketing?

False pocketing occurs without apical migration of the junctional epithelium. Signup and view all the answers

What happens to the alveolar bone in periodontitis?

It experiences permanent loss. Signup and view all the answers

What change occurs to the junctional epithelium in periodontitis?

It migrates apically below the cementoenamel junction. Signup and view all the answers

Which statement correctly describes the appearance of gingival papilla in healthy gingiva?

Pointed and filling interproximal spaces Signup and view all the answers

What histological change occurs in gingivitis compared to healthy gingiva?

Epithelial ridges extend into connective tissue. Signup and view all the answers

What texture is commonly associated with gingivitis?

Shiny and stretched Signup and view all the answers

What kind of consistency is expected in periodontitis?

Loose and spongy or fibrotic Signup and view all the answers

What probing depth is indicative of true pocketing in periodontitis?

4 mm or more Signup and view all the answers

What is a common symptom of periodontitis?

Tooth mobility Signup and view all the answers

What is the primary role of collagen in healthy gingiva?

Providing structural support Signup and view all the answers

Which best describes the impact of inflammation on collagen in gingivitis?

Collagen degradation by enzymes Signup and view all the answers

What defines a stable periodontal status according to the British Society of Periodontology?

Less than 10% bleeding sites Signup and view all the answers

What symptom indicates that gingivitis has progressed to periodontitis?

Gum recession and tooth sensitivity Signup and view all the answers

What is a necessary step to treat gingivitis effectively?

Mechanical removal of plaque Signup and view all the answers

What type of damage occurs to collagen in periodontitis?

Permanent destruction Signup and view all the answers

Which of the following is a consequence of collagen breakdown in periodontitis?

Formation of periodontal pockets Signup and view all the answers

What type of therapy might be used to promote tissue repair in periodontitis?

Guided tissue regeneration Signup and view all the answers

What symptom of gingivitis is often mistaken for normal conditions?

Bleeding gums Signup and view all the answers

Study Notes

Learning Outcomes

Students should be able to describe the clinical features of healthy gingiva, gingivitis, and periodontitis
Students should be able to explain the basic histological presentation of healthy gingiva, gingivitis, and periodontitis
Students should be able to explain the terms ‘false pocketing’, ‘true pocketing’, and ‘clinical attachment loss’
Students should be able to explain symptoms that the patient may experience with gingivitis and periodontitis
Students should be able to explain the differences between gingivitis and periodontitis

Safe Practitioner Framework - LO

Clinical Knowledge and Skills - Assess and manage the health of periodontal and soft tissues taking into account risk, lifestyle factors, plaque control/self-care and compliance/response to advice
Clinical Knowledge and Skills - Monitor and record changes in periodontal health using appropriate methods

### Revision of Inflammation

"itis" means inflammation
Classical signs of acute inflammation include redness, swelling, heat, pain, and loss of function
Acute inflammation is a short-term response to injury or infection, while chronic inflammation is a long-term response that can persist for weeks, months, or even years
Four patterns of inflammation include serous, fibrinous, purulent, and hemorrhagic

Consideration of Health vs Disease

Clinical appearance, histological understanding, and patient symptoms can be used to assess the health of the periodontium

Three Basic States of the Periodontium

Health, Gingivitis, and Periodontitis are the three basic states of the periodontium
Periodontal Diseases are a category of diseases that affect the periodontium

Gingivitis Versus Periodontitis Definition

Gingivitis is a bacterial infection confined to the gingiva, and is reversible
Periodontitis is a bacterial infection of all parts of the periodontium, and is irreversible

Clinical Appearance

Color, Margin, Contour, Bleeding, Consistency, and Texture are all key clinical appearances to consider when diagnosing gingivitis and periodontitis
Bleeding in the gums is not always a sign of disease, but should be investigated.

Clinical Features of Gingival Health, Gingivitis, and Periodontitis

Healthy Gingiva:
- Uniform pink color with possible pigmentation variations
- Knife-edge margins at the gingival margin (GM) and pointed interdental papilla (IDP)
- Firm consistency, smooth or stippled texture
- No bleeding upon probing
- Margin slightly coronal to the cementoenamel junction (CEJ), with probing depths of 1-3mm
Gingivitis:
- Red color due to inflammation
- Rolled, thickened gingival margins, rounded or blunted IDP
- Spongy, loose, or boggy consistency
- Shiny, stretched texture
- Bleeding present upon probing
- Margin coronal to CEJ (due to swelling), increased probing depth (>3mm) but no apical migration of the JE
Periodontitis:
- Oedematous (bluish/purple) or fibrotic (pink, nodular) color
- Loss of knife-edge margins, IDP may be lost or cratered
- Spongy or fibrotic consistency
- Shiny or nodular texture
- Bleeding and suppuration present
- Margin apical to CEJ with deeper probing depths (4mm+), indicating a true pocket caused by the apical migration of the JE.

Histological Presentation

Healthy Gingiva:
- Junctional Epithelium (JE) firmly attached to enamel, located coronal to the CEJ.
- Intact supragingival fibre bundles support the JE.
- Intact alveolar bone located 2-3mm apical to the JE.
- Intact Periodontal Ligament (PDL) connects the tooth root to the alveolar bone.
Gingivitis:
- JE still attached to enamel, but extends epithelial ridges into connective tissue.
- Reversible damage to supragingival fibre bundles.
- No alveolar bone destruction.
- No progression into the PDL.
Periodontitis:
- Apical migration of the JE below the CEJ, attaching to cementum.
- Permanent destruction of gingival fibers with epithelial growth preventing reinsertion.
- Permanent alveolar bone loss.
- Permanent destruction of some or all PDL fibers.

Key Definitions

False Pocketing: Enlarged gingiva without apical migration of the JE, resulting in increased probing depth without true periodontal destruction.
True Pocketing: Apical migration of the JE, leading to deeper pockets and attachment loss, typically seen in periodontitis.
Clinical Attachment Loss: Loss of connective tissue attachment to the tooth characterized by the apical shift of the JE and destruction of periodontal support.

Patient Symptoms

Gingivitis:
- Red, swollen, and bleeding gums, especially when brushing or flossing.
- No pain, as gingivitis is usually painless.
Periodontitis:
- Gum recession leading to visible roots and tooth sensitivity.
- Persistent bad breath (halitosis).
- Tooth mobility or teeth appearing longer due to bone loss.
- Pain, especially when chewing, and possible abscesses.

Additional Considerations

Bleeding gums are not normal and cannot be treated solely with products like Corsodyl.
Plaque must be mechanically removed to resolve gingivitis.
The British Society of Periodontology (BSP) defines a stable periodontal status as less than 10% bleeding sites, a realistic target for patients to aim for.

Collagen in Gingival Health and Disease

Role of Collagen in Healthy Gingiva:
- Collagen (mainly Type I) provides strength and maintains the integrity of gingival tissue.
- Collagen fibers anchor the gum to the tooth and protect the JE from bacterial invasion.
Collagen in Gingivitis:
- Inflammation causes the release of enzymes like collagenase, leading to the degradation of collagen fibers.
- Damage to collagen in gingivitis is typically reversible with proper plaque removal and oral hygiene, allowing tissue regeneration.
Collagen in Periodontitis:
- Collagen breakdown extends to the PDL, leading to the loss of tissue attachment and bone support.
- Collagen destruction in periodontitis cannot be reversed, resulting in periodontal pockets and bone loss.
Collagen in Treatment:
- Regenerative therapies like guided tissue regeneration (GTR) use collagen membranes to promote tissue repair in periodontitis.

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Description

This quiz covers the clinical features, histological presentations, and patient symptoms related to healthy gingiva, gingivitis, and periodontitis. Additionally, it explores important terminology and differentiates between various periodontal conditions. Enhance your understanding of periodontal health assessment and management.