PowerPoint Presentation

Gingivitis

:- . :- .

Gingivitis

Is the most common form of gingival disease. Its refer to the inflammation of the gingival tissue usually caused by a bacterial infection. Gingivitis is reversible but if left untreated it can progress to periodontitis.

Characteristics of gingivitis

Color. The color of the attached and marginal gingiva is generally described as coral pink; it is produced by the vascular supply, the thickness and degree of keratinization of the epithelium,

Location normal gingiva covers the alveolar bone and tooth root to a level just coronal to the cementoenamel junction.

Consistency. The gingiva is firm and resilient and, with the exception of the movable free margin, tightly bound to the underlying bone.

Surface Texture. The gingiva presents a textured surface similar to that of an orange peel and is referred to as stippled .Stippling is best viewed by drying the gingiva. The attached gingiva is stippled; the marginal gingiva is not

Characteristics of gingivitis

the presence of clinical signs of inflammation that are confined to the gingiva.Redness (change in color) Swelling (edema) of the gingival tissue Bleeding upon provocationChange in the consistency (Sponginess of the gingiva)Increase gingival exudate & histological change No clinical attachment loss and no radiographic bone loss

Bad Breath

patient-initiated plaque-control techniques

Modified stillman technique

Classification of gingivitis

Dental-PlaqueInduced Gingival DiseasesNonPlaque-Induced Gingival Lesions

Dental-PlaqueInduced Gingival DiseasesGingivitis Associated with Dental Plaque Only. A. Without local contributing factors B. With local contributing factorsGingival Diseases Modified by Systemic Factors.Gingival Diseases Modified by MedicationsGingival Diseases Modified by Malnutrition.

NonPlaque-Induced Gingival Lesions

Gingival Diseases of Specific Bacterial Origin.Gingival Diseases of Viral Origin.Gingival Diseases of Fungal Origin.Gingival Diseases of Genetic Origin.Gingival Manifestations of Systemic Conditions.Traumatic Lesions.Foreign-Body Reactions.

Gingivitis Associated with Dental Plaque Only.

Plaque-induced gingival disease is the result of an interaction between the microorganisms found in the dental plaque biofilm and the tissues and inflammatory cells of the host.

Without local contributing factors.TreatmentPlaque removal by patient-initiated plaque-control techniques.

B. With local contributing factors Local factors may contribute to gingivitis by their ability to retain and inhibit their removal by patient-initiated plaque-control techniques. Like dental restoration (overhang) and appliances. Treatment removal of local factor and patient-initiated plaque-control techniques.

Gingival Diseases Modified by Systemic Factors.

Systemic factors that contribute to gingivitissuch as the endocrine changes associated with puberty the menstrual cycle, pregnancy and diabetesmay be exacerbated as a result of alterations in the gingival inflammatory response to plaque. This altered response appears to result from the effects of systemic conditions on the hosts cellular and immunologic functions. These changes are apparent even in the presence of low levels of plaque.

Blood dyscrasias (e.g., leukemia) may alter immune function by disturbing the normal balance of the immunologically competent white blood cells that supply the periodontium. Gingival enlargement and bleeding are common findings that may be associated with the swollen, spongy gingival tissues caused by the excessive infiltration of blood cells.

Gingival Diseases Modified by Medications.

Gingival diseases that are modified by medications are increasingly prevalent as a result of the increased use of drugs known to induce gingival enlargement. These include *anticonvulsant drugs such as phenytoin, immunosuppressive drugs such as cyclosporine ,and *calcium channel blockers such as nifedipine ,verapamil, diltiazem,. The development and severity of gingival enlargement in response to medications are patient specific and may be influenced by uncontrolled plaque accumulation as well as by elevated hormonal levels. The increased use of *oral contraceptives by premenopausal women has been associated with a higher incidence of gingival inflammation and the development of gingival enlargement, which may be reversed by discontinuation of the oral contraceptive.

Gingival Diseases Modified by Malnutrition.

Gingival diseases modified by malnutrition have received attention because of clinical descriptions of bright red, swollen, and bleeding gingiva associated with severe ascorbic acid (vitamin C) deficiency or scurvy. Nutritional deficiencies are known to affect immune function, and they may alter the hosts ability to protect himself or herself against some of the detrimental effects of cellular products such as oxygen radicals. Unfortunately, little scientific evidence is available to support a role for specific nutritional deficiencies in the development or severity of gingival inflammation or periodontitis in humans.

NonPlaque-Induced Gingival Lesions

Gingival diseases of specific bacterial originGingival diseases of viral originGingival diseases of fungal originGingival lesions of genetic originGingival manifestations of systemic conditionsTraumatic lesionsForeign-body reactions

Gingival diseases of specific bacterial origin

are increasing in prevalence, especially as a result of sexually transmitted diseases such as gonorrhea (Neisseria gonorrhoeae) and, to a lesser degree, syphilis (Treponema pallidum). Oral lesions may be a result of systemic infection, or they may occur through direct infection. Streptococcal gingivitis or gingivostomatitis is a rare entity that may present as an acute condition with fever, malaise, and pain associated with acutely inflamed, diffuse, red, and swollen gingiva with increased bleeding and occasional gingival abscess formation. The gingival infections are usually preceded by tonsillitis, and they have been associated with group A -hemolytic streptococcal infections.

Gingival Diseases of Viral Origin.

Gingival diseases of viral origin may be caused by a variety of deoxyribonucleic acid and ribonucleic acid viruses, with the most common being the herpesviruses .Lesions are frequently related to the reactivation of latent viruses, especially as a result of reduced immune function. The oral manifestations of viral infection have been comprehensively reviewed. Viral gingival diseases are treated with topical or systemic antiviral drugs.

Gingival Diseases of Fungal Origin.

Gingival diseases of fungal origin are relatively uncommon in immunocompetent individuals, but they occur more frequently in immunocompromised individuals and in those with normal oral flora that has been disturbed by the long-term use of broad-spectrum antibiotics. The most common oral fungal infection is candidiasis, which is caused by infection with Candida albicans; it can also be seen under prosthetic devices, in individuals using topical steroids, and in individuals with decreased salivary flow, increased salivary glucose, or decreased salivary pH. A generalized candidal infection may manifest as white patches on the gingiva, tongue, or oral mucous membrane that can be removed with gauze and that leave a red, bleeding surface. In individuals with human immunodeficiency virus (HIV), candidal infection may present as erythema of the attached gingiva; this has been referred to as linear gingival erythema or HIV-associated gingivitis. The diagnosis of candidal infection can be made by culture, smear, or biopsy. Less common fungal infections have also been described.

Gingival Diseases of Genetic Origin.

Gingival diseases of genetic origin may involve the tissues of the periodontium One of the most clinically evident conditions is hereditary gingival fibromatosis, which exhibits autosomal-dominant or (rarely) autosomal-recessive modes of inheritance. The gingival enlargement may completely cover the teeth, delay eruption, and present as an isolated finding; alternatively, it may be associated with several more generalized syndromes.

Gingival Manifestations of Systemic Conditions.Gingival manifestations of systemic conditions may appear as desquamative lesions, ulcerations of the gingiva, or both. Allergic reactions that manifest with gingival changes are uncommon but have been observed in association with several restorative materials, toothpastes, mouthwashes, chewing gums ,and foods). The diagnosis of these conditions may prove difficult and may require an extensive history and the selective elimination of potential causes. Histologic traits of biopsies from gingival allergic reactions include a dense infiltrate of eosinophilic cells.

Traumatic Lesions.

A. Chemical injuryB. Physical injuryC. Thermal injury

Traumatic lesions may be self-inflicted and factitious in origin, which means that they are produced by intentional or unintentional artificial means examples of traumatic lesions include toothbrush trauma that results in gingival ulceration, recession, or both. Iatrogenic trauma (i.e., induced by the dentist or health professional) to the gingiva can be caused by the induction of orthodontic cement or preventive or restorative materials. Peripheral ossifying fibroma may develop in response to the embedment of a foreign body. Alternatively, accidental damage to the gingiva may occur as a result of minor burns from hot foods and drinks.

Foreign-Body Reactions.

Foreign-body reactions lead to localized inflammatory conditions of the gingiva and are caused by the introduction of foreign material into the gingival connectivetissues through breaks in the epithelium. Common examples are the introduction of amalgam into the gingiva during the placement of a restoration, the extraction of a tooth, or an endodontic apicoectomy with retrofill leaving an amalgam tattoo, with resultant metal fragments observed during biopsies, abrasives may also be introduced during polishing procedures.