4 gingivitis classification etiology pathogenesis

8/10/2019 4 Gingivitis Classification Etiology Pathogenesis

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PERIODONTAL P

Clinical Types oDisea



I) GINGIVAL DISEASE

A) Dental plaque induced

1) Gingivitis associated with dental plaque only | factors

Example: Bleeding on probing Associated with endocrine system

a) Without other local contributing factors Puberty

b) With local contributing factors 2) Menstrual cycle

Example: Restorations 3) Pregnancy

Mouth breathing Examples: a) Gingivitis

| b) Pyogenic gran



I) GINGIVAL DISEASE (continued)


2) Gingival diseases modified by systemic factors

a) Associated with endocrine system

4) Diabetes mellitus associated gingivitis

Examples: I Role of diabetes in periodontal dise

II Periodontal disease in diab

increased gingivadisease.

b) Associated with blood dyscrasias

1) Leukemia-associated gingivitis - Examples:

Gingival enlargements

2) Other




A) Dental plaque induced| B) Non plaque induced gingival lesions

3) Gingival diseases modified by medication | origin

a) Drug induced gingival disease Neisseria gonorrhea

1) Gingival enlargement Treponema pallidum

Examples: I Phenytoin Streptococcal

II Calcium channel blockers

III Immunosuppresant cyclosAphtous ulcers - Periadenitis

4) Gingival diseases modified by malnutrition |Mucosan Necroticans Recurrens

a) Ascorbic acid gingivitis disease of viral origin

b) Other

| a) Herpes virus




B) Non plaque induced gingival lesions

3) Gingival diseases of fungal origin conditions

a) Candida species infections

1) Generalized gingival candidiasis |

b) Linear gingival erythema

Example: HIV associated gingivitis |

AIDS related periodontitis multiforme

c) Histoplasmosis 5) Lupus erythematosus

d) Other 6) Drug induced

4) Gingival lesions of genetic origin

a Hereditar in ival fibromatosis




B) Non plaque induced gingival lesions

5) Gingival manifestations of systemic conditions

b) Allergic reactions

1) Dental restorative materials Traumatic lesions (factitious, iatrogenic,

a) Mercury| accidental)

b) Nickel| a) Chemical injury

c) Acrylic| Example: Hydrogen peroxide,

d) Other - Example: Nickel allergy

2) Reactions attributable to b) Physical injury - Example:

a) Tooth paste| toothbrush trauma, cotton roll burn

b) Mouth rinse| c) Thermal injury



II) CHRONIC PERIODONTITIS

A) Localized

Example: Molar furcation, premolar, intrabony defec

B) Generalized Example: Upper molars and prem

III) AGGRESSIVE PERIODONTITIS

A) Localized - Example: Juvenile onset periodontitis. Agingival inflamm

a) Actinibacillus

B) Generalized

IV) PERIODONTITIS AS MANIFESTATION OF SYSTEMIC DISE

A) Associated with hematologic disorders

1) Acquired neutropenia



IV) PERIODONTITIS AS MANIFESTATION OF SYSTEMIC DISEA

B) Associated with genetic disorders

1) Familial and cyclic neutropenia

Example: ANUG type lesions that do not respond t

2) Down syndrome

a) See high prevalence of advanced periodontitis.

Trisomy 21 (three chromosomes). More commo

3) Leukocyte Adhesion Deficiency Syndromesb) Leukocytes can’t adhere to blood vessels and m

4) Papillon Lefévre syndrome

Example: Aggressive periodontitis in children with

Autosomal recessive inheritance.

5) Chediak-Higashi syndrome

c) Functional neutrophil defects of chemotasis and



IV) PERIODONTITIS AS MANIFESTATION OF SYSTEMIC DISEA

B) Associated with genetic disorders

6) Histiocytosis syndrome

d) Cause unknown. Increase in monocytes and ma

7) Glycogen storage disease

e) Many types of genetics upsets,to enzymes with

8) Infantile genetic agranulocytosis

9) Cohen syndromef) Autosomal recessive, short head and upper lip e

10) Ehlers-Danlos syndrome

g) Group of inherited disorders of collagen, joint af

11) Hypophosphatasia

Example: Disturbance to bone metabolism, loss of

12) Other

C) Not otherwise specified

)



V) NECROTIZING PERIODONTAL DISEASES

A) Necrotizing ulcerative gingivitis

Example: Associated with large amounts of

Only affects children that have se

B) Necrotizing ulcerative periodontitis

Example: Can be associated with AIDS

VI) ABSCESSES OF THE PERIODONTIUM

A) Gingival abscessExample: Localized to gingival tissue

B) Periodontal abscess

Example: Spread to involve larger area

C) Pericoronal abscess

VII) PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESI

A) Combined periodontic endodontic lesions

Examples: Need to have radiologic evaluation

VIII) DEVELOPED OR ACQUIRED DEFORMITIES AND CONDIT




A) Localized tooth related factors that modify or predisp

1) Teeth anatomic factors

Example: Development at groove on palatal of u

2) Dental restorations

Example: Over contoured crowns. Poorly fitting m

3) Root fracture

Example: Longitudinal fractures have hopeless pB) Mucogingival deformities and conditions around teeth

1) Gingival soft tissue recession

a) Facial or lingual surfaces

Example: Inadequate band of keratinized gin

b) Interproximal papillary

Examples: Loss of anterior papilla




B) Mucogingival deformities and conditions around teet

2) Lack of keratinized gingiva

3) Decreased vestibular depth

4) Aberrant frenum

5) Gingival excess

a) Pseudopocket

b) Inconsistent gingival margin

c) Excessive gingival display

Example: Poor gingival esthetics

d) Gingival enlargement

i) See 1A3, 1A4

e) Abnormal color




C) Mucogingival deformities and conditions on edentulo

1) Vertical and/or horizontal ridge deformity

Example: Ridge deformities

2) Lack of gingiva keratinized tissue

3) Gingival/soft tissue enlargements4) Decreased vestibular depth

5) Abnormal color

D) Occlusal Trauma

1) Primary occlusal trauma

2) Secondary occlusal trauma



I) Gingival diseaseA) Dental plaque induced

1) Gingivitis associated with dental plaquExample: BLEEDING ON PROBING



I) Gingival Disease (Continue


1) Gingivitis associate

b) With local contrib

Example: RESTO

Inflammatiopocket derestricted

gingival tis

I) Gingival Disease (Continued)



I) Gingival Disease (Continued) A) Dental plaque induced

1) Gingivitis associated with dental plaqb) With local contributing factorsExample: MOUTH BREATHING

This type of gingaffects the ante

gingiva of chronic breathers or indiv

with incompleteclosure. Note terythematou

hypertrophic max

anterior gingiv



I. Gingival Disease (Continued) A) Dental plaque induced

2) Gingival diseases modified by systemia) Associated with endocrine system

1) Puberty2) Menstrual cycle3) Pregnancy

Examples: a) Gingivitisb) Pyogenic granulom

The gingival tissues may have a modifichanges in circulating estrogen and proresult in the inflammation having moregenerally not very obvious in puberty be quite pronounced in some pregnant

I) Gingival Disease (Continued)



I) Gingival Disease (Continued)A) Dental plaque induced

2) Gingival diseases modifiea) Associated with endocr

3) PREGNANCY GINGIV

These are twoexamples of

pregnancy gingivNote the intens

burgundy color athe marked ginghypertrophy. Th

lesions bleed

profusely.



I) Gingival Disease (Continued)A) Dental plaque induced

2) Gingival diseases modified by systemic factora) Associated with endocrine system

3) PYOGENIC GRANULOMA

Py

I) Gingival disease (Continued)



I) Gingival disease (Continued)A) Dental plaque induced

2) Gingival disease modified by systemic factorsa) Associated with endocrine system

4) DIABETES MELLITUS ASSOCIATED GIN



Periodontal disease in diabetic patient

1)increased incidence of periodontal a

2)increase gingival inflammatory reac

3)increase risk of periodontal disease

4)increase severity and rate of destru

Attachment and bone loss twice as compared with controls



Role of Diabetes in Periodontal diseas

1)Reduce vasculature efficiency

2)PMN defects

3)Macrophage increase cytokines withmore TNF 4 times increase in PGE

4)Increase collagenase

Increase in cross linked collagen by

Delayed healing and repair




2) Gingival disease modified by systemic factorsa) Associated with endocrine system

4) DIABETES MELLITUS PERIODONTAL AB

T



Poor diabetic contr

time increase riskbreakdown and incrpoor response





2) Gingival disease modified by b) Associated with blood dysc

1) LEUKEMIA ASSOCIATED

Note the generfacial pallor an

echymosis. Tgingiva is

hypertrophicshows a typ

intragingivhemorrhag

I) Gi i l di (C ti d)




3) Gingival diseases modified by medicationsa) Drug induced gingival disease

1) PHENYTOIN GINGIVAL HYPERTHROPHY

Phe

a

he



CALCIUM CHANNEL BLOCKERS OF

° TRADE NAME

VERAPAMIC CALAN DILTIAZEM

FECODIPINE PLENDIL ESRAPIDINE

NICARDIPIDINE CARDENE NIFEDIPIDIN

NISOLPIDINE SYSLOC NITRENDIPID

MIMODIPIDINE NIMOTOP





3) Gingival diseases modified by medicationsa) Drug induced gingival disease

1) CALCIUM CHANNEL BLOCKERS - NIFED

Nart

dud

hyp





3) Gingival diseases modified by medicaa) Drug induced gingival disease

1) IMMUNOSUPPRESANT CYCLOS

Cyclosporin A immunosuppre

used in orgtransplant anproduces gin

enlargement in 30% of patients

treatment





3) Gingival diseases modified by malnuta) ASCORBIC ACID GINGIVITIS

This gingivitis seethe late stages of

plaque associatedvitamin C deficiencabsence of intra

oxidation, abnormaformation, ginhypertrophy

hemorrhage and echymoses




I) Gingival disease (Continued)B) Non plaque induced

1) Gingival diseases of specific bacteriaExample: RECURRENT APHTOUS STO

Recurrent apstomatitis is div

aphthous minor,

major and herpulcers. Aphthou

rarely affects theThese ulcers a

painful and may

14 days.Etiounknow





2) Gingival diseases of viral origina) Herpes virus - PRIMARY HERPETIC GIN

To the left a 13 and to the right

man both with

herpetic gingivosNote gingival ble

ulcerations whpreceded by vesnote sero-purule

in the 23 y.ol





2) Gingival diseases of viral origina) Herpes virus - RECURRENT INTRAORA

The intraoral lRHS are charaby small linearthat rupture a

small areaulceration. Bfree and att

gingiva can beof these les




2) Gingival diseases of viral origina) Herpes virus - HERPES ZOSTER INFE

Skin and mulesions of herpe

are characterizlinear crops of vas seen here. Wintraoral vesicle

leave painful uPost zoster neu

a frequent seq




) g ( )B) Non plaque induced

2) Gingival diseases of viral origina) Herpes virus - HERPES ZOSTER IN

Herpes Zostefollow the af

nerve distribthis case Mandibular brthe TrigeminaTo the right h

weeks la





2) Gingival diseases of viral origina) Herpes virus - AIDS RELATED KAP

These are two exgingival Kaposi sTo the left gen

gingival involvemthe right a locsarcoma mimi

pyogenic granHerpes virus

considered the agent of AIDS

Kaposi sarco





3) Gingival diseases of fungal origina) Candida species infections

1) GENERALIZED GINGIVAL CAND

The left is an examacute pseudo

membranous cand(thrush),white lesio

can be lifted offgingiva.The other

the right showsexample of acute a

(eythematous) gi

candidiasis.



B) Non plaque induced3) Gingival diseases of fungal origin

b) Linear gingival erythema

AIDS RELATED PERIODONTITIS

The photo to the lareas of gingiv

periodontal necrgingival hypertrophoto to the rigmarked gingival rand bone exposulesions can destrrapidly Both patie

HIV positiv




B) Non plaque induced4) Gingival lesions of genetic origin

a) Hereditary gingival fibromatosisAUTOSOMAL DOMINANT GINGIVAL FIBRO

Ma

pagieadco




B) Non plaque induced gingival lesions5) Gingival manifestations of systemic con

a) Mucocutaneous disorders - LICHEN P

Nta

t





B) Non plaque induced gingival lesions5) Gingival manifestations of systemic con

a) Mucocutaneous disorders - LICHEN P

These asquamou

arisingerosive

observedpatients

an incneopla

Li h

I) Gi i l di (C i d)




B) Non plaque induced gingival lesions5) Gingival manifestations of systemic conditio

a) Mucocutaneous disorders - MUCOUS MEM

These photos gingival erythand desquamwith sympton

gingival pain ipatients with BMucous Memb

Pemphigoi



I) Gingival disease (Continued)B) N l i d d i i l l i



B) Non plaque induced gingival lesions5) Gingival manifestations of systemic condition

a) Mucocutaneous disorders - MUCOUS MEMB

Indis

anat ba

a




I) Gingival disease (Continued)B) Non plaque induced gingival lesions

5) Gingival manifestations of systemic conditiona) Mucocutaneous disorders - PEMPHIGUS V

These photosame patien

gingival desquulcers, erythe

vesicle formThese were thpainful manifeof Pemphigu

patien




B) Non plaque induced gingival lesions5) Gingival manifestations of systemic condi

a) Mucocutaneous disorders - PEMPHIGUS

The drawing amicrosco

demonstratintraepithelial formation typPemphigus VuAlso note Tzan

within the vlumen.




) g ( )B) Non plaque induced gingival lesions

5) Gingival manifestations of systemic conditiona) Mucocutaneous disorders - PEMPHIGUS VU

DirePemp

autoreagin

adhedesmo

The cellul





5) Gingival manifestations of systemic conditionsa) Mucocutaneous disorders - ERYTHEMA MU

The left showerythema an

manifestations oresemble Herpe

lesions. Also notethe upper right lito the right showlip crusting in ano

with E




) G g a d sease (Co t ued)B) Non plaque induced gingival lesions

5) Gingival manifestations of systemic conditionsa) Mucocutaneous disorders - LUPUS ERYTHEMA

The photo to the ltypical erythemat

systemic Lupus Eraffecting the butteface. The right phintraoral lesion of

erythematosus thato Lichen Planus

affect the g




These two patierare localized re

metal prosthesisnickel. Note

erythema of gibuccal mucosa, ahypertrophy on

Systemic allergy

B) Non plaque induced gingival lesions5) Gingival manifestations of systemic conditions

b) Allergic reactions1) Dental restorative materials - NICKEL ALLER





b) Allergic reactions2) Reactions attributable to: a) TOOTH PA

Somcon

sanggc

folesio





b) Allergic reactions2) Reactions attributable to: b) Chewing g

This patchew

wheryt

cinnain che

I) Gingival disease (Continued)B) Non plaque induced gingival lesions5) Gi i l if t ti f t i diti



5) Gingival manifestations of systemic conditionb) Allergic reactions

1) UNIDENTIFIED ALLERGEN




) p q g g5) Gingival manifestations of systemic conditions

b) Allergic reactions3) Traumatic lesions (factitious, iatrogenic, acci

a) Physical injury - Factitious





b) Allergic reactions3) Traumatic lesions (factitious, iatrogenic,

a) Chemical injury - HYDROGEN PEROX

Thigenerprodu

mouth peroxide

for





b) Allergic reactions3) Traumatic lesions (factitious, iatrogenic, ac

a) Chemical injury - ASPIRIN BURN

This pburn puse of

eaper




5) Gingival manifestations of systemic conditionsb) Allergic reactions

3) Traumatic lesions (factitious, iatrogenic, accia) Physical injury - TOOTHBRUSH TRAUMA




B) Non plaque induced gingival lesions5) Gingival manifestations of systemic conditions

b) Allergic reactions3) Traumatic lesions (factitious, iatrogenic, a

a) Physical injury - COTTON ROLL BURN

corode

re

I) Gingival disease (Continued)B) Non plaque induced gingival lesions5) Gingival manifestations of systemic conditions



5) Gingival manifestations of systemic conditionsb) Allergic reactions

5) Not otherwise specifiedExample: COCAINE INDUCED GINGIVAL N

This seve

in a coassociatusage super

necrosiconstric

II) Chronic Periodontitis1) Localized



These photodeep intrabo

at the levefurcation of tmaxillary mo

a ceramic

1) LocalizedExample: MOLAR FURCATION



II) Chronic Periodontitis (Continued)2) Generalized



2) GeneralizedExample: UPPER MOLARS AND PREMOLARS

insb

II) Chronic Periodontitis (Continued)2) Generalized

E l UPPER MOLARS AND PREMOLARS



Example: UPPER MOLARS AND PREMOLARS

Tp

surg

bd

III) Aggressive PeriodontitisA) Localized



A) LocalizedExample: JUVENILE ONSET PERIODONTITIS

The clinical pX-Ray of thisman show th

alveolar boneabsence of gingival infltypical of th

aggressive p

III) Aggressive Periodontitis (Continued)A) Localized




III) Aggressive Periodontitis(Continue)A) Localized




These X-rlocalized a

periodontitifirst m

III) Aggressive Periodontitis (Continued)B) Generalized



)

This patienadvanced gen

aggressperiodontitis wpockets throu

mouth




)




)

Posterior segthe patient sh

previous sli

upper left firstwas extracteextensive ge

aggressive pe

IV) Periodontitis as a Manifestation of Systemic DiseaseA) Associated with hematologic disorders

2) LEUKEMIAS ( l L k i i d i i



2) LEUKEMIAS (see also Leukemia associated gingiv

These two patients acute myelogenouleukemia. Note th

severe gingivo-periodontal

involvement as welthe lip hemorrhag

IV) Periodontitis as a Manifestation of Systemic DiseaB) Associated with genetic disorders

1) CYCLIC NEUTROPENIA



1) CYCLIC NEUTROPENIA

These photos sintraoral clini

radiologic appin a child wit

neutropenia. marked destruthe periodontthe acute necgingivitis type

IV) Periodontitis as a Manifestation of Systemic DiseaseB) Associated with genetic disorders



4) PAPILLON-LEFEVRE SYNDROME

These two patienPapillon Lèfe

Syndrome. The i

photo is of a 13 yboy and the panoray is of an 8 ye

boy. Note mainflammation witmobility and agg

periodontit

IV) Periodontitis as a Manifestation of Systemic DiseaseB) Associated with genetic disorders



4) PAPILLON-LEFEVRE SYNDROME

These photos shpalmo-plan

hyperkeratosis ppatients with theLèfevre Syndromlesions remain fo

improve when with retinoic



V) Necrotizing Periodontal DiseaseA) NECROTIZING ULCERATIVE GINGIVITIS



The photo to the left anshow necrotizing lesmarginal gingiva an

papillae. The right phpost-treatment with s

hygiene instru



VI) Abscesses of the PeriodontiumA) Gingival abscess

Example: LOCALIZED TO GINGIVAL TISSUE



Example: LOCALIZED TO GINGIVAL TISSUE

VI) Abscesses of the Periodontium (Continue)B) Periodontal abscess

Example: SPREAD TO INVOLVE LARGER A



Example: SPREAD TO INVOLVE LARGER A

VII) Periodontitis Associated with Endodontic LesioA) COMBINED PERIODONTIC ENDODONTIC L



This case shcombinatio

periodontit

endodoninflammation bone loss at t

and at the

VII) Periodontitis Associated with Endodontic Lesions A) COMBINED PERIODONTIC ENDODONTIC LESI



A) COMBINED PERIODONTIC ENDODONTIC LESI

VII) Periodontitis Associated with Endodontic Lesions A) COMBINED PERIODONTIC ENDODONTIC LESI



These photothe patient shprevious slide

incisor testethe absce

periodontal awas initiated w

starting in agroove of t

surfa

VIII) Developed or Acquired Deformities and ConditionsA) Localized tooth related factors that modify or predisp

gingival disease, periodontitis) f



1) Anatomic factors

Example: DEVELOPMENT AT GROOVE ON PALATAPERIODONTAL BONE LOSS.

VIII) Developed or Acquired Deformities and Conditions (CoA) Localized tooth related factors that modify or predigingival disease, periodontitis



2) Dental restorations

Example: OVER CONTOURED CROWNS. POORLY

These photos

gingivo-periodreactions assowith poorly fi

margins of thescontoured cro

VIII) Developed or Acquired Deformities and Condit

A) Localized tooth related factors that modify gingival disease, periodontitis3) Root fracture



)

Example: LONGITUDINAL FRACTURE

The left photo shperiodontal prob

into a palatal pocright photo shovertical root fracthe lateral incisotype of fracturehopeless progn

VIII) Developed or Acquired Deformities and ConditioB) Mucogingival deformities and conditions arou1) Gingival soft tissue recession



) ga) Facial or lingual surfaces

Example: INADEQUATE BAND OF KERAT

G

VIII) Developed or Acquired Deformities and ConditioB) Mucogingival deformities and conditions arou

1) Gingival soft tissue recessionb) I t i l ill



b) Interproximal papillary

Example: LOSS OF ANTERIOR PAPILLA

VIII) Developed or Acquired Deformities and ConditionB) Mucogingival deformities and conditions aroun

2) LACK OF KERATINIZED GINGIVA



2) LACK OF KERATINIZED GINGIVA

T

t

VIII) Developed or Acquired Deformities and ConditionB) Mucogingival deformities and conditions aroun

3) DECREASED VESTIBULAR DEPTH



3) DECREASED VESTIBULAR DEPTH

In

p

VIII) Developed or Acquired Deformities and ConditionsB) Mucogingival deformities and conditions around4) ABERRANT FRENUM



An aberrafrenum ca

excessive ton the gin

margin resulted

gingivrecessioninflamma

VIII) Developed or Acquired Deformities and ConditionB) Mucogingival deformities and conditions aroun5) Gingival excess



c) EXCESSIVE GINGIVAL DYSPLAY

VIII) Developed or Acquired Deformities and ConditionC) Mucogingival deformities and conditions on ed1) Vertical and/or horizontal ridge deformity

E l RIDGE DEFORMITIES



Example: RIDGE DEFORMITIES

T

VIII) Developed or Acquired Deformities and Conditions C) Mucogingival deformities and conditions on ede1) Vertical and/or horizontal ridge deformity

E l RIDGE DEFORMITIES



Example: RIDGE DEFORMITIES

VIII Developed or Acquired Deformities a

D. Occlusal trauma





When trauma from occlusion is the resu

occlusal forces, it is called primary occ

2) Secondary occlusal trauma

When it results from reduced ability oocclusal forces, it is known as seconda

This occurs when a tooth has lost bon

and there is normal occlusal force.

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