dr jamal naim phd in orthodontics pre-clinical periodontics gingivitis cont

Dr Jamal NaimPhD in Orthodontics

Pre-clinical Periodontics

Gingivitis cont.

Appears in both females and males.

PD tissue has exaggerated response to local factors

Increase in estrogen & progesterone.

Facial gingiva is enlarged, lingual surface are relatively

unaltered. (mechanical action of the tongue & food

prevent a heavy accumulation

of local irritants on the lingual

surface)

Puberty associated gingivitis

Inflamed tissues become erythematous, lobulated &

retractable

Easily bleeding with debridement.

Tendency for recurrence during puberty

After puberty the enlargement undergoes spontaneous

reduction but does not

disappear until local

irritations are removed.

Puberty associated gingivitis

Hormonal imbalances

Increase prevalence of G.

Bleeding and tense feeling in the gingiva

Increased salivary bacterial account

Increase of GCF amount

Menstrual cycle associated gingivitis

Pregnancy Gingivitis Reported in 50-100% of pregnant women.

The same bacterial environment in healthy gingiva pre-

pregnancy causes gingivitis during gingivitis

Local irritation starts the condition but the altered tissue

metabolism aggravates the response.

Generalized, more prominent interproximal than facial

and lingual.

Gingiva is red, soft and friable with spontaneous

bleeding

Increases GCF, pocket depth and tooth mobility

Pregnancy Gingivitis Beginning in the 2nd to 3rd month

Increased severity in the 8th and decrease in the 9th

month

pyogenic granuloma/epulis It is not a neoplasm

Occurs after the 3rd month of pregnancy

Incidence is 1.8 - 5%

Mushroom –like flattened, sessile or pedunculated

Painless unless complicated by inflammation

Very good oral hygiene may prevent enlargement,

usually regresses after delivery.

Complete removal requires incision

epulis/ pyogenic granuloma

Diabetes mellitus associated gingivitis

Diabetes may be first picked up by the oral health

practitioner because of the unusual response of the

gingival tissues to plaque.


Enlarged red, velvety gingival tissues that bleed easily,

Rapid bone loss / loose teeth,

Multiple periodontal abscesses,

Proliferative granulation tissue at the gingival margin,

Slow resolution of gingivitis after conventional treatment.


Vascular changes in diabetes:

thickening of the basement membrane of vessel walls leading to reduced: PMN migration

Oxygen diffusion

Removal of metabolic wastes.

Gingival diseases associated with blood dyscrasias

Leukemia associated gingivitis: Reduced production of RBC, WBC and

platelets bu leukemia True leukemia enlargement occurs with acute

rather than chronic leukemia. Gingiva is shiny, bluish red, firm or friable,

may be accompanied by painful necrotizing

ulcerative inflammatory involvement. Areas of Connective tissue infiltrated with

dense mass of immature and proliferating

leukocytes

Gingival diseases associated with leukemia

Cyclic neutropenia is a disorder in which the number of the neutrophils drops dramatically in a cyclical pattern, usually about every 21 days.

Very low neutrophil count in Cyclic neutropenia

Gingival diseases associated with Cyclic neutropenia

Gingival diseases modified by malnutrition

Nutritional deficiencies affect the host response to

bacterial by-products such as oxygen radicals.Vitamin C-deficiency (ascorbic acid) –scurvy- is the

most known plaque induced gingival disease

modified by this malnutrition.Acute vitamin C deficiency results in edema and

hemorrhage in the periodontal ligament and in the

gingiva. Degeneration of collagen fibers Osteoporosis of the alveolar bone, and tooth

mobility.Impaired gingival healing.


Scurvy - severe Vitamin C deficiency


Scurvy - severe Vitamin C deficiency / 14 year old girl

Non-plaque induced gingival lesions

I. Gingival diseases of specific bacterial origin:

Neisseria gonorrheae (gonorrhea) - associated

lesions are most common.

Treponema pallidum (syphilis) - associated

lesions are lesser common

Streptococcal species (streptococcal gingivitis) -

associated lesions are rare.


I. Gingival diseases of specific bacterial origin:

Are preceded by tonsillitis

Fever

Pain

Swollen gingiva

Bleeding

Occasionally abscesses


II. Gingival diseases of viral origin:

A. Herpes virus infections

Primary herpetic Gingivostomatitis (most common)

Recurrent oral herpes

Varicella-zoster infections

B. HIV


II. Gingival diseases of

viral origin:


herpetic Gingivostomatitis

II. Gingival diseases of

viral origin:


Herpes virus-induced acute gingivitis

III. Gingival diseases of fungal origin:

Relatively uncommon

By immuno-compromised patients

By long use of broad spectrum antibiotics

A. Candida-species infections: generalised gingival candidiasis

by:

• Prosthesis

• decreased salivary flow

• decreased salivary pH

• Increased salivary glucose




generalised gingival candidiasis


A. Linear gingival erythema (by HIV)

B. Histoplasmosis

C. other


Linear gingival erythema

IV. Gingival diseases of genetic origin:

A. Heredity gingival fibromatosis Me be isolated or associated with generalized syndrms

B. other


IV. Gingival manifestations of systemic conditions:A. Mucocutaneous disorders Lichen planus Pemphigoid Pemphigus vulgaris Erythema multiforme Lupus erythematosus Drug-induced other


Lichen planus

IV. Gingival manifestations of systemic conditions:B. Allergic reactions1. Dental restorative materials

Mercury Nickel Acrylic (most cold acrylic resin) other


IV. Gingival manifestations of systemic conditions:B. Allergic reactions2. Reactions attributable to:

Toothpastes/dentifrices Mouthrinses/mouthwashes Chewing gum additives Foods and additives other


VI. Traumatic lesions(factitious, iatrogenic, accidental)a) Chemical injuryb) Physical injuryc) Thermal injury



Tongue jewelry

VII. Foreign body reactions• Amalgam• Abrasives during prof. polishing

VIII. Not otherwise specified (NOS)


dr jamal naim phd in orthodontics pre-clinical periodontics gingivitis cont

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