Non-Plaque Induced Gingival Diseases and Conditions 2024-2025 PDF

Dental Clinical Practice 2 N O N - D E N TA L B I O F I L M - I N D U C E D G I N G I VA L D I S EA S E S A N D CONDITIONS DR. ABIER ABDULSATTAR MOHAMMED Abier A. LEARNING OBJECTIVES 1. List the local etiological factors of dentalbiofilm-indu...

Dental Clinical Practice 2 N O N - D E N TA L B I O F I L M - I N D U C E D G I N G I VA L D I S EA S E S A N D CONDITIONS DR. ABIER ABDULSATTAR MOHAMMED Abier A. LEARNING OBJECTIVES 1. List the local etiological factors of dentalbiofilm-induced gingival diseases. 2. Interpret the classification non- dental biofilm- induced gingival conditions and diseases 3. List the outcomes for periodontal health for plaque- associated periodontal diseases 4. Describe the types of non-dentalbiofilm- induced gingival diseases 5. Summarize future research needs for classifying and diagnosing gingival diseases and conditions. Abier A. 2 LOCAL RISK FACTORS/PREDISPOSING FACTORS: Local risk factors are those that encourage plaque accumulation at a specific site by either inhibiting its removal during daily oral hygiene practice, and/or creating a biological niche that encourages increased plaque accumulation. These include: Abier A. 3 A. Prominent subgingival restoration margins: (including certain tooth anatomical factors) – facilitate plaque accumulation at and apical to the gingival margin, enabling biofilm adherence and maturation and increasing the difficulty of mechanical plaque removal. Abier A. 4 B. Oral dryness/ Hyposalivation: a clinical condition due to reduced salivary flow, availability, or changes in saliva quality. This condition leads to decreased cleansing of tooth surfaces, resulting in enhanced gingival inflammation and reduced dental plaque biofilm removal. Common causes of xerostomia include medications with antiparasympathetic action, Sjogren's syndrome, and mouth breathing. Abier A. 5  DRUG-INFLUENCED GINGIVAL ENLARGEMENTS An assortment of medications have been reported to a ect the size of the gingival tissues. The most associated with gingival tissue enlargement include antiepileptic drugs (phenytoin and sodium valproate), certain calcium channel–blocking drugs (e.g., nifedipine, felodipine), immunoregulating drugs (e.g., cyclosporine), and high-dose oral contraceptives. 1. For drug- plaque bacteria in conjunction with the drug are necessary to produce a gingival response. 2. Some individuals who take certain medications may develop enlargements of the gingival tissues, but not everyone is susceptible, suggesting that specific characteristics may play a role. 3. Furthermore, some sites/patients with drug- present little, if any, clinically evident gingivitis at a ected sites. Abier A. 6  THE COMMON CLINICAL CHARACTERISTICS OF DRUG-INflUENCED GINGIVAL ENLARGEMENTS 1. Enlargement patterns may vary between patients due to genetic predisposition.2. The enlargement tends to occur more frequently in the anterior gingiva.3. It is more prevalent in younger age groups.4. Onset typically occurs within three months of use , and is first observed at the papilla, and can occur with or without bone loss.5. There is no association with attachment loss or tooth mortality.6. The clinical and histologic characteristics induced by these drugs are indistinguishable from one another. Abier A. 7 To be considered a gingival enlargement resulting from medications, the size of the gingival unit must be greater than would normally be expected from purely an inflammatory reaction in the gingival tissues. Mild gingival enlargement involves enlargement of the gingival papilla; Moderate gingival enlargement involves enlargement of the gingival papilla and marginal gingiva, and Severe gingival enlargement involves enlargement of the gingival papilla, gingival margin, and attached gingiva Abier A. 8  Gingivitis in an Intact Periodontium Localized Gingivitis Generalized Gingivitis Probing attachment Loss No No Radiographic bone Loss No No > or equal 10%, Bop Score >30% or equal 10%, Bop Score >30% < or equal 30% OUTCOMES OF PERIODONTAL HEALTH FOR PLAQUE ASSOCIATED PERIODONTAL DISEASE  NON-DENTAL BIOFILM-INDUCED GINGIVAL DISEASES While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non–dental biofilm- induced gingival diseases are less common but often of major significance for patients. The non–dental biofilm-induced gingival lesions often manifest systemic conditions, but they may also represent pathologic changes limited to gingival tissues. Abier A. 12  3. GINGIVAL DISEASES: NON-DENTAL PLAQUE- INDUCED C. Inflammatory and Immune Conditions: B. Specific Infections: i. Hypersensitivity Reactions. i. Bacterial Origin. (a) Neisseria gonorrhoeaea (a) Contact allergya A.Genetic/Development (b) Treponema palliduma (b) Plasma cell gingivitisa al Disorders: (c) Mycobacterium tuberculosisa (c) Erythema multiformea Hereditary gingival (d) Streptococcal gingivitis ii. Autoimmune Diseases of skin and mucous Membranes. fibromatosis a (e) Necrotizing Periodontal (a) Pemphigus vulgarisa ii. Viral Origin. (b) Pemphigoida (a) Coxsackie virus (hand-foot-and-mouth disease)a (c) Lichen planusa (b) Herpes simplex I & II (primary or recurrent)a (d) Lupus erythematosusa (c) Varicella zoster (chicken pox & shingles – V nerve)a Systemic lupus erythematosis Discoid lupus Patient - centered care in PDM erythematosis (d) Molluscum contagiosuma (Precision Dental Medicine). (e) Human papilloma virus (squamous cell papilloma; condyloma iii. Granulomatous Inflammatory The conditions marked with an ‘a’ have associated systemic acuminatum; verruca vulgaris; focal epithelial hyperplasia) (a) Crohn's diseasea involvement or are oral iii. Fungal Origin: manifestations of systemic (b) Sarcoidosisa conditions other health care (a) Candidosis. providers may be involved in (b)Other Mycoses diagnosis and treatment.  GINGIVAL DISEASES: NON-DENTAL PLAQUE- INDUCED H. Gingival Pigmentationi. i. Melanoplakiaa D. Reactive processes: ii.Smoker's melanosis i. Epulides E. Neoplasms. F. Endocrine,nutritional & iii.Drug-induced pigmentation (a) Fibrous epulis i. Premalignancy metabolic diseases. (antimalarials, minocycline) (b) Calcifying fibroblastic (a) Leukoplakia Vitamin deficienciesa granuloma (a) Vitamin C deficiency (scurvy) iv.Amalgam tattoo (b) Erythroplakia. (c) Vascular epulis (pyogenic granuloma) ii. Malignancy: (d) Peripheral giant cell (a) Squamous cell carcinomaa granulomaa (b) Leukemic cell infiltrationa (c) Lymphomaa Hodgkin, Non-Hodgkin G. Traumatic lesions i. Physical/mechanical trauma (a) Frictional keratosis (b) Mechanically induced gingival ulceration (c) Factitious injury (self-harm) ii. Chemical (toxic) burn iii. Thermal insults (a) Burns to gingiva 1. Genetic/developmental disorders 1.1. Hereditary gingival fibromatosis Generalized fibrous gingival enlargement of tuberosities, anterior free/attached gingiva and retro-molar pads https://www.oralhealthgroup.com/features/the-new- 2. Specific infections global-classification-system-for-periodontal-and-peri- implant-diseases-an-executive-summary-for-the-busy- 2.1. Bacterial origin dental-professional/ Necrotizing periodontal diseases Ulceration with central necrosis of the papillae may result in considerable tissue destruction with formation of a crater. http://www.emdocs.net/em3am-acute-necrotizing-ulcerative-gingivitis/ Abier A. 15 2.2. Viral origin Hand-foot-and-mouth disease Small vesicles that after rupture leave fibrinous coated ulcers. Usually in children Thelancent.com 2.3. Fungal Candidosis Various types of clinical manifestations including: pseudomembranous (also known as thrush in neonates) erythematous plaque-like nodular Abier A. 16  3. Inflammatory and immune conditions and lesions 3.1. Hypersensitivity reactions Contact allergy Redness and sometimes lichenoid lesions mucous 3.2. Autoimmune diseases of skin and mucous membranes Pemphigus vulgaris Gingival manifestation is usually described as desquamative gingivitis and/or as vesiculo-bullous lesions of the free and attached gingiva characterized by intraepithelial bullae which, after rupture, leave erosions Abier A. 17 3.3 Granulomatous inflammatory conditions (orofacial granulomatosis) Crohn's disease Cobblestone appearance of the oral mucosa, linear ulceration and gingival overgrowth 4. Reactive processes 4.1 Epulides Fibrous epulis Exophytic smooth-surfaced pink masses of fibrous consistency attached to the gingiva Abier A. 18 5. Neoplasms 5.1 Premalignant Leukoplakia Not-removable white spot in the oral mucosa with smooth, corrugated or verrucous surface 5.2 Malignant Squamous cell carcinoma Gingival squamous cell carcinoma often presents as painless exophytic masses, red and white speckled patches or non-healing ulcerations involving the keratinized gingiva Abier A. 19 6. Endocrine, nutritional and metabolic diseases 6.1. Vitamin deficiencies Vitamin C deficiency (Scurvy) Enhanced gingival bleeding, ulceration, swelling 7. Traumatic lesions 7.1. Physical/mechanical insults Frictional keratosis White lesion sharply demarcated, leukoplakia-like asymptomatic, homogeneous whitish-plaques that are irremovable usually presenting on facial attached gingiva Abier A. 20  7.2. Chemical (toxic) insults Etching, chlorhexidine, acetylsalicylic acid, cocaine, hydrogen peroxide, dentifrice detergents, paraformaldehyde or calcium hydroxide Surface slough or ulceration 7.3. Thermal insults Burns of mucosa Erythematous lesions that may slough a coagulated surface. Vesicles and sometimes ulceration, petecchia or erosion. 8. Gingival pigmentation Gingival pigmentation/melanoplakia Brownish to black diffusely pigmented areas Abier A. 21  FUTURE RESEARCH NEEDS. Develop simple tests (like using saliva) to find early signs of gum problems.- Figure out what makes some people less likely to get gum disease than others.- Learn more about why some tests for gum disease might not always give accurate results. Understand the differences between different types of gum diseases. We recommend using an ISO periodontal probe for better and more consistent gum disease diagnosis. Standardizing how we use the probe can help ensure that our diagnosis is accurate and reliable. The current International Organization for Standardization (ISO) for periodontal probes is ISO 21672, but it requires updating to define the features of a global standard periodontal probe. These characteristics are: 1. Tip diameter 0.5 mm. 2. Cylindrical tine structure. 3. Constant force limiter of 0.25 N. 4. 15-mm scale with precise individual or banded millimeter markings. 5. A taper of 1.75◦ Abier A. 23  REFERENCES 1. ChappleILC,MealeyBL,etal.Periodonta lhealth and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1):S74– S84. 2. Caton et al. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification J Periodontol. 2018;89(Suppl 1):S1–S8 3. Holmstrup_et_al-2018-Journal_of_Periodontology.pdf 4. Murakami_et_al-2018-Journal_of_Periodontology 5. https://www.oralhealthgroup.com/features/the-new-global-classification- system-for-periodontal-and-peri-implant-diseases-an-executive-summary-for- the-busy-dental-professional/ Abier A. 24 Bacteria Associated with Gingival Diseases Porphyromonas gingivalis is a bacterium linked to bacterial origin gingival diseases. Viral Gingival Disease Herpes simplex virus (HSV) is associated with some gingival diseases. Autoimmune Disease Related to Gingival Inflammation Lupus erythematosus is an autoimmune disease linked to inflammatory conditions in the mouth. Hereditary Gingival Disorders Hereditary gingival fibromatosis is categorized as a hereditary gingival disorder. Crohn's Disease and Gingival Diseases Crohn's disease is an inflammatory condition that can affect the gingiva. Infections Not Affecting the Gingiva HIV is not classified as a specific infection affecting the gingiva. Viral Conditions of the Gingiva Herpes simplex virus (HSV) is associated with viral conditions of the gingiva. Hypersensitivity Reactions and Gingival Disease Contact hypersensitivity is a type of hypersensitivity reaction related to gingival disease. Drug-Induced Gingival Enlargement Location The maxillary anterior region is the most common location for drug-influenced gingival enlargement. Criteria for Drug-Related Gingival Enlargement Gingival enlargement must be reversible upon discontinuation of the medication to be considered drug-related. Onset of Drug-Induced Gingival Enlargement Drug-influenced gingival enlargement typically begins to appear within a few weeks after starting medication. Localized vs. Generalized Gingivitis Localized gingivitis is characterized by inflammation limited to a specific area, while generalized gingivitisaffects multiple areas of the gingiva. Pattern of Drug-Induced Gingival Enlargement Drug-induced gingival enlargement typically presents as diffuse, symmetrical overgrowth. Gingival Enlargement: Papilla and Attached Gingiva Generalized gingival enlargement involves the expansion of both the gingival papilla and the attached gingiva. Characteristics of Generalized Gingivitis Bleeding on probing without plaque is not a characteristic of generalized gingivitis. Non-Dental Biofilm-Induced Gingival Lesions Non-dental biofilm-induced gingival lesions may indicate underlying systemic conditions. Conditions not Associated with Gingival Diseases Herpes labialis is not associated with gingival diseases. Reactive Oral Lesions Fibrous epulis is classified as a reactive oral lesion. Drug-Induced Pigmentation Minocycline can cause drug-induced pigmentation. Scurvy Deficiency Scurvy indicates a vitamin C deficiency. Premalignant Oral Condition Leukoplakia could signify a premalignant state in the oral cavity. Traumatic Lesions of the Gingiva Traumatic lesions of the gingiva are characterized by localized inflammation and tissue damage due to trauma like biting. Granuloma Caused by Trauma Traumatic granuloma is caused by physical or mechanical trauma. Thermal Insults to Gingiva Burns can arise due to thermal insults to the gingiva. Pemphigus Vulgaris and Gingival Manifestations Pemphigus vulgaris manifests as bullae and erosions on the gingiva. Cobblestone Appearance in Oral Mucosa Oral lichen planus is associated with a cobblestone appearance of the oral mucosa. Necrotizing Periodontal Diseases and Ulceration Necrotizing ulcerative gingivitis (NUG) is commonly associated with crater-like ulcerations. Symptom of Hand-Foot-and-Mouth Disease Oral ulcers are a symptom of hand-foot-and-mouth disease. Leukoplakia Appearance Leukoplakia is described as white, thickened patches on the oral mucosa. Fibrous Epulis Tissue Development Fibrous epulis represents fibrous connective tissue development. Candidosis Variants Median rhomboid glossitis is not a form of candidosis. Tissue Destruction and Ulcers Necrotizing ulcerative gingivitis (NUG) can result in significant tissue destruction with the formation of papillae ulcers. Frictional Keratosis on Gingiva Frictional keratosis on gingiva is characterized by localized thickening of the gingiva due to friction. Chemicals Causing Oral Mucosa Damage Chemicals such as acids can cause surface slough or ulceration in the oral mucosa. Vitamin C Deficiency Symptom Bleeding gums are a symptom most associated with vitamin C deficiency. Global Standard Periodontal Probe A global standard periodontal probe according to ISO should not have a color-coded tip. Future Research Needs in Gum Disease The development of new diagnostic tools is not a proposed future research need concerning gum disease. Diffuse Pigmentation on Gingiva Melanosis is used to describe brownish to black diffusely pigmented areas on the gingiva. Sign of Thermal Insults to Oral Mucosa Burns are a sign of thermal insults to the oral mucosa. Outcome of Frictional Keratosis Frictional keratosis is likely to resolve with the removal of the irritant.