Periodontology Quiz: Gingivitis vs Periodontitis

Introduction to Gingivitis & Periodontitis

• The presentation covers gingivitis and periodontitis, oral diseases affecting the gums and supporting structures of the teeth.
• Learning outcomes include describing clinical features of healthy/diseased gums, understanding basic histology, defining key terms (e.g., false/true pocketing, attachment loss), explaining patient symptoms, and differentiating between gingivitis and periodontitis.
• A safe practitioner framework outlines assessment and management of periodontal and soft tissue health, considering risk factors, lifestyle and compliance.
• Monitoring and recording periodontal health using appropriate methods is also important.

Revision of Inflammation

• The slideshow introduces a revision of inflammation, asking fundamental questions such as the definition of 'itis' and the classical signs of acute inflammation, including differences between acute and chronic inflammation, and four patterns of inflammation.

Revision of Gingival Histology

• The presentation displays a diagram of gingival histology, showing the structural elements: sulcular epithelium, enamel space, junctional epithelium, dentin, and cementum. This helps visualize the gum's intricate arrangement.

Consideration of Health vs Disease

• This section highlights the interconnectedness between a patient's clinical appearance, histological understanding, and reported symptoms.

Three basic states of the periodontium

• Different appearances of gums are shown, categorized into health, gingivitis, and periodontitis.
• The images show the progression, going from healthy gums, to gums that show signs of gingivitis, to further inflamed and diseased gums that show periodontitis.

Gingivitis versus Periodontitis Definition

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

Clinical Appearance

• Key aspects of clinical appearance include color, margin, bleeding, texture, and contour.

Bleeding – is it okay?

• Societal norms around bleeding gums are questioned during the presentation.
• Bleeding is not cured by Corsodyl, but is removed mechanically.
• A stable mouth, as defined by a BSP (<10%) score, makes achievable progress more easily.

Contour

• The presentation discusses variations in contour, including bulbous, blunted, and cratered gum margins in different disease stages.

Clinical Picture of Healthy Gingiva

• Healthy gums display uniform pink coloring, possibly with pigmentation.
• The marginal gingiva meets the tooth at a slightly rounded or tapered edge.
• Interdental papillae pointed and filled, positioned between the teeth.
• Tissue is firm, smooth or stippled, and there's no bleeding on probing.
• Gum margins are situated slightly coronal to the cementoenamel junction (CEJ).

Gingiva in Health

• Gingival thickness varies racially, and gingival biotypes should be considered.
• The presentation describes how gingival colour and shape are linked to racial differences, demonstrating that gums are not the same in all ethnicities.
• Probing depths for healthy gums range from 1 to 3 mm.

Microscopic Picture of Healthy Gingiva

• Histological examination shows a firm junctional epithelium firmly attached to the enamel, coronal to the CEJ.
• Intact gingival fibres, alveolar bone, and periodontal ligaments are noted in a sound healthy mouth.
• Alveolar bone is intact, situated 2-3 mm apical to the base of the junctional epithelium.
• The periodontal ligament fibres are intact.

What will the patient notice?

• This slide raises questions about what signs patients might notice, without specifically answering them.

Clinical Picture of Gingivitis

• Gingival color varies, showing shades of redness.
• Marginal gingiva might appear rolled, thickened.
• The interdental papilla may be rounded, blunted, or bulbous.
• The consistency of the tissues are spongy, loose, and boggy.
• Tissue texture is shiny and stretched.
• Bleeding often occurs upon probing, located above the CEJ, due to swelling.

Acute Versus Chronic Gingivitis

• Slides show the visual differences between acute and chronic gingivitis.

What signs of inflammation can you see? Can you recall the vascular & cellular events?

• This slide raises questions about observable signs of inflammation and related vascular/cellular processes.

Microscopic Picture of Gingivitis

• The microscopic examination reveals a swollen gingival tissue.
• Junctional epithelium may be present or may not be firmly attached to enamel.
• Supragingival fibres may or may not be intact in inflammation.
• Alveolar bone is intact, measuring 2-3mm apical to the base of the junctional epithelium.

Comparison of Gingival fibres and Epithelial Ridges

• Structures of healthy gums are compared to gums exhibiting gingivitis.

Pocketing In Gingivitis

• Pockets may develop due to gingival enlargement, characterized as false or pseudopockets, not true pockets.
• Depth of these pockets is increased, but no bone is lost.

What will the patient report?

• This slide is about what symptoms the patients will report to the dentist.

Clinical Picture of Periodontitis

• Healthy gums are compared to periodontitis.
• Oedematous gingival tissue is described as bluish/purplish coloured.
• Fibrotic or nodular gum appearance is observed.
• Loss of knife-edge margins is often seen.
• Interdental papillae may be lost, cratered, or blunted.
• Tissues are spongy, fibrotic, shiny or nodular.
• Bleeding and suppuration are common.

Highly visible changes to the gingiva Minimal visible changes to the gingiva

• The slides depict obvious gum changes in different stages of periodontal disease.

Microscopic Picture of Periodontitis

• The histological examination reveals epithelial ridges and swollen tissues in advanced periodontitis.
• Gingival fibrils and alveolar bone are significantly affected.
• Periodontal ligaments are damaged.
• Permanent bone destruction, and ligament fibres may be lost.

Pocketing In Periodontitis

• Pocketing in periodontitis is categorized as true pockets.
• True pocketing is an irreversible, deepened periodontal pocket, associated with apical migration of the junctional epithelium (JE).
• Pocket probing depths are increased (e.g., 4 mm).

What will the patient report?

• This slide shows what the patient will likely report to the dentist in periodontal diseases.

Variations of Appearance and Progression

• This slide shows how the progression of the gum disease can vary significantly.

Factors to Further Consider

• The presentation emphasizes the importance of understanding terminology, indices, risk factors, classification, pathogenesis of the disease, measurement and history taking.

Image References

• References for images used in the presentation are collected at the end.

Test your knowledge on the clinical features of gingivitis and periodontitis with this comprehensive quiz. Assess your understanding of inflammation patterns and the key differences between false and true pocketing. Perfect for students and professionals in dental health fields.