Periodontal Health and Gingival Diseases/Conditions PDF

CHAPTER 5 Periodontal Health and Gingival Diseases/Condition s Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com. Periodontal Health  2017 World Workshop definition:  State free from inflammatory periodontal disease that allows individual to function norm...

CHAPTER 5 Periodontal Health and Gingival Diseases/Condition s Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com. Periodontal Health  2017 World Workshop definition:  State free from inflammatory periodontal disease that allows individual to function normally and avoid consequences (mental or physical) due to current or past disease Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Characteristics of Periodontal Health  Absence of:  Bleeding on probing  Erythema  Edema Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Attachment loss  Bone loss Characteristics of Periodontal Health (cont.)  Gingival tissue has uniform, pink color  Gingival margin tightly encircles tooth’s cervical region  Smoothly scalloped contour conforming to CEJ outline Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Gingival margin meets cervix of tooth with tapered, flat, or slightly rounded edge  Gingival papilla has pyramidal appearance Characteristics of Periodontal Health (cont.)  Attached gingiva keratinized and firmly bound to underlying cementum and bone  Tissue firm and resilient on probing Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Stippling possibly present  Gingival margin coincides with level of CEJ or is slightly coronal to CEJ  No tissue bleeding when stimulated 2017 AAP/EFP Subcategories of Periodontal Health/Gingival Health  Intact periodontium  No loss of periodontal tissue  Reduced periodontium  Preexisting loss of periodontal tissue but not currently Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com undergoing loss of connective tissue/alveolar bone Three Subcategories of Periodontal Health  Periodontal health on intact periodontium Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Three Subcategories of Periodontal Health (cont.)  Periodontal health on reduced periodontium in nonperiodontitis patient Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Three Subcategories of Periodontal Health (cont.)  Periodontal health on reduced periodontium in successfully treated stable periodontitis patient Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Classifications of Gingival Diseases and Conditions Two broad classifications of gingival diseases and conditions Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer Features of Dental Biofilm-Induced Gingivitis  Most common form of periodontal disease  Does not directly cause tooth loss, but must be managed as active disease process  Inflammatory response of gingival tissues by periodontal Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com pathogens  Prevalent in all age groups within population Tissue Color in Gingivitis Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Tissue Contour in Gingivitis  Edema causes enlargement of gingival tissues  Example: Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Bulbous papilla Courtesy of Dr. Ralph Arnold, San Antonio, TX. Tissue Contour in Gingivitis (cont.)  Additional examples:  Blunted papilla  Cratered papilla Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Courtesy of Dr. Don Rolfs, Periodontal Foundations, Wenatchee, WA. Courtesy of Dr. Don Rolfs, Periodontal Foundations, Wenatchee, WA. Tissue Consistency in Gingivitis  Inflamed free gingiva loses firm consistency  Tissue spongy with light pressure Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Compressed air readily deflects gingival margin and papillae away from neck of tooth Courtesy of Dr. Ralph Arnold, San Antonio, TX. Tissue Texture in Gingivitis  Can appear smooth and very shiny  Almost has “stretched” appearance Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  May lose gingival stippling Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Position of Margin in Gingivitis  May appear more coronally compared to position in periodontal health due to tissue Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com swelling and enlargement Presence of Bleeding in Gingivitis  Occurs with gentle probing before color changes detectible  Epithelial lining of sulcus Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com becomes ulcerated and blood vessels engorge  Heavier bleeding as inflammation increases © Wolters Kluwer Extent of Dental Biofilm-Induced Gingivitis  Degree to which inflammation has spread  Primary parameter percentage score based on number of bleeding sites divided by total number of six sites on tooth Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Gingival health: less than 10%  Localized gingivitis: 10% to 30%  Generalized gingivitis: over 30% Distribution of Inflammation  How spread out inflammation is within gingival unit  Distribution may affect:  Only interdental papilla (papillary gingivitis)  Gingival margin and papilla (marginal gingivitis) Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Gingival margin, papilla, and attached gingiva (diffuse gingivitis) Localized Marginal Inflammation and Localized Diffuse Inflammation Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Courtesy of Dr. Ralph Arnold, San Antonio, TX. Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Generalized Diffuse Inflammation and Localized Marginal Inflammation Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Courtesy of Dr. Ralph Arnold, San Antonio, TX. Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Localized Diffuse Inflammation Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Subcategories of Dental Biofilm-Induced Gingivitis  Dental biofilm-induced gingivitis on intact periodontium Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Subcategories of Dental Biofilm-Induced Gingivitis (cont.) Page 103  Dental biofilm-induced gingivitis on reduced periodontium in nonperiodontitis patient Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Subcategories of Dental Biofilm-Induced Gingivitis (cont.)  Treatment objectives for dental biofilm-induced gingivitis on reduced periodontium in nonperiodontitis patient:  Remove etiologic factors Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Reinforce oral hygiene  Avoid further loss of periodontal tissues  Minimize risk of gingivitis converting into periodontitis Subcategories of Dental Biofilm-Induced Gingivitis (cont.)  Gingival inflammation on reduced periodontium in a successfully treated stable periodontitis patient Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Dental Biofilm-Induced Gingivitis on a Reduced Periodontium After Treatment  Characterized by return of bacteria-induced inflammation in successfully treated periodontitis case  Common clinical findings same as dental biofilm- induced gingivitis except for presence of preexisting Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com attachment loss (higher risk of periodontitis relapse) Dental Biofilm-Induced Gingivitis on a Reduced Periodontium After Treatment (cont.)  Patient cannot revert to being classified as “dental biofilm-induced gingivitis on intact periodontium”  Periodontitis is irreversible condition  Results in permanent loss of attachment and alveolar bone Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Patient remains periodontitis patient for life Systemic Conditions as Modifying Factors  Sex and steroid hormones  Conditions that may modify biofilm-induced gingivitis but are not considered diagnoses themselves:  Puberty Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Menstrual cycle  Pregnancy  Oral contraceptives Gingivitis Associated with Puberty  Temporary increase in gingival inflammation associated with increased steroid Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com hormone levels  Exaggerated response to relatively little plaque biofilm Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Gingivitis Associated with Menstrual Cycle  Only modest observable inflammatory changes during ovulation  Few women extremely sensitive to hormonal changes in gingiva Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  No clinically evident inflammatory changes in gingiva in most women Gingivitis Associated with Pregnancy  Increased hormones trigger gingival crevicular fluid flow  Can precipitate gingival Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com inflammation  High inflammation in response to even minimal plaque biofilm Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Gingivitis Associated with Pregnancy (cont.)  May spontaneously resolve postpartum  Pregnancy-associated pyogenic granuloma may Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com form  Painless  Usually resolves after pregnacy © Wolters Kluwer Oral Contraceptives  Older oral contraceptives contained higher doses of hormone concentrations that were associated with gingival inflammation.  Newer concentrations are much lower, and we don’t Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com see as many clinical gingival changes. Gingivitis Associated with Hyperglycemia  Hyperglycemia  Presence of abnormally high concentration of glucose in circulating blood  Occurs especially in individuals with diabetes mellitus Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Inflammatory response of gingiva to plaque biofilm exacerbated by high blood glucose levels Gingivitis Associated with Leukemia  Leukemia  Cancer of body’s blood-forming tissues  Exaggerated inflammatory response of gingiva to plaque biofilm Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Causes bleeding and tissue enlargement  Gingival tissues appear swollen, spongy, shiny, and red Gingivitis Associated with Leukemia (cont.)  Tissues very friable  Bleed with slight provocation  Presence of biofilm not a Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com prerequisite for gingivitis in patients with leukemia Courtesy of Dr. Ralph Arnold, San Antonio, TX. Gingivitis Associated with Smoking  Smoking major lifestyle risk factor for periodontal disease  Gingival fibrosis common  Formation of abnormal amount of fibrous tissue Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Smokers have fewer clinical signs, symptoms of gingival inflammation than nonsmokers Gingivitis Associated with Malnutrition  Precise relationship not fully understood  Vitamin C essential for:  Collagen and fibrous tissue for normal intercellular matrices in teeth, bone, cartilage, connective tissue, and skin Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Structural integrity of capillary walls  Vitamin C deficiency can cause scurvy, delay healing Gingivitis Associated with Malnutrition (cont.)  Characteristics usually similar to biofilm-induced gingivitis  Example: gingivitis in Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com patient with scurvy © Mediscan/Alamy Stock Photo Oral Factors that Enhance Plaque Biofilm Accumulation  Prominent subgingival restoration margins  Increase local accumulation of bacterial plaque biofilms  Hyposalivation may:  Cause progressive caries, taste disorders, halitosis, and Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com inflammation of oral mucosa, tongue, and gingiva  Make patient self-care more difficult  Worsen gingival inflammation Drug-Influenced Gingival Enlargements  Associated with certain systemic medications, such as:  Anticonvulsants  Calcium channel blocking agents  Immunosuppressants Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Does not occur in all patients taking these medications  Enlargement occurs within 3 months of medication use Drug-Influenced Gingival Enlargements (cont.)  Page 109  Higher prevalence in younger age groups  Tissues in anterior sextants most commonly affected Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Irregular pattern of enlargement  Characterized by:  Increased flow of crevicular fluid from sulcus  Bleeding upon probing with no attachment loss Nondental Biofilm-Induced Gingival Diseases and Conditions  Types:  Genetic/developmental disorders  Specific infections  Inflammatory and immune conditions and lesions Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Reactive processes  Neoplasms  Endocrine, nutritional, and metabolic diseases  Traumatic lesions  Gingival pigmentation Genetic/Developmental Abnormalities  Hereditary gingival fibromatosis Page 111  Rare benign oral condition involving slow, progressive enlargement of maxillary and mandibular attached gingiva  Infections of bacterial origin Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Caused by a specific bacterium not commonly found in the typical bacterial plaque biofilm  Manifest as ulcerations, chancres, or mucous patches  Neisseria gonorrhea, Treponema pallidum STD’s Hypersensitivity Reactions: Intraoral Allergic Reactions  Often caused by flavoring agents  Most common in patients with history of allergic Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com conditions  Manifests as diffuse fiery red gingivitis, sometimes with ulcerations © Wolters Kluwer Recognition and Treatment of Allergic Reaction  May suspect if patient has good self-care and history of healthy gingiva  Advise patient to change brands or flavors of gum, toothpaste, or mouthwash Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Can confirm with biopsy if necessary Erythema Multiforme  Uncommon acute immune, inflammatory disorder  Causes large, symmetrical Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com erythematous papules resembling a target in a circular pattern  Cause unknown Courtesy of Dr. Ralph Arnold, San Antonio, TX. Oral Lichen Planus  Characterized by:  Purplish, itchy, flat-topped bumps on skin  Lacy white patches (Wickham’s striae), sometimes with painful sores, in mouth and other areas Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Used with permission from Langlais RP, Color Atlas of Common Courtesy of Dr. Ralph Arnold, San Antonio, TX. Oral Diseases. Wolters Kluwer; 2016. © Wolters Kluwer; Oral Lichen Planus (cont.)  Etiology unknown, thought to be autoimmune  Affects skin, hair, nails and mucous membranes  Oral form usually chronic condition Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Can manage symptoms, but requires regular monitoring and good self-care  Increases risk for oral cancer Oral Lichen Planus (cont.)  Six types of clinical manifestations:  Papular, reticular, plaque-type, erythematous, ulcerative, and bulbous lesions Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com