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Chronic gingivitis


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Preventive Periodontics

Preventive Periodontics

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  • 1. Clinical Features of Gingivitis (Plaque-induced gingivitis) Khalid S. Hassan BDS,MSc,PhD ,Assist. Prof. Department of PDS, Periodontics
  • 2. Clinical Criteria of Healthy Gingiva coral pink (alveolar mucosa is red )Color:-1 -Variation in color [degree of keratinization, vascularity, pigmentation and thickness of epi). -Contour:-2 -Free gingiva thin and end in a knife like edge -Attach gingiva scalloped elevations related to roots and depression in the interradicular areas interradicular groove. -Interdental papillae pointed and fill the inter proximal space under contact area. -papillae (OrangeinterdentalStippling in attach. gingiva and base of-:textureSuface-3 peel appearance) (Firmly attached to the teeth and underling alveolarresillentFirm and-:Consistency-4 bone except free gingiva). mm-3mm not exceed2-5.0-Depth of gingival sulcus:-5 .transudate:Type of gingival fluid-6
  • 3. •Course and Duration: Acute gingivitis: painful condition, sudden onset, and short duration. Sub-acute gingivitis: less severe than acute gingivitis. Recurrent gingivitis: reappear after treatment. Chronic gingivitis: comes in slowly, is of long duration, and painless.
  • 4. Chronic Gingivitis Def. It is a simple and long-standing inflammation of the gingiva (gingivitis may exist for years without change to periodontitis) Types. 1- Localized 2- Generalized Distribution of inflammation:- 1- Papillary (localized or generalized) 2- Marginal (localized or generalized) 3- Diffuse (localized or generalized)
  • 5. Chronic localized marginal gingivitis
  • 6. Chronic generalized marginal gingivitis
  • 7. Generalized diffuse gingivitis
  • 8. Etiology:- 1-Local initiating factor (Dental Plaque). 2- Local predisposing factors. 3- Systemic factors * Puberty * Pregnancy * Diabetes * Vit. C deficiency
  • 9. Etiology of Periodontal Diseases Bacterial plaque Host response Reparative tissue capacity Factors upset the balance By Increasing aggression of bacterial plaque Decreasing defense mechanisms Local Predisposing Factors Systemic Factors 1- Calculus 2- Material alba 3- Food debris 4- Food impaction 5- Food retention 6- Faulty dentistry 7- Malocclusion 8- Mouth breathing 9- Trauma from occlusion * Overhanging filling * Over and under contoured crowns * Occlusal disharmony * Orthodontic wires * Rough fillings * Open contact 1- Hormonal imbalance 2- Nutritional deficiency 3- Blood diseases 4- Genetics 5- Immunologic 6- Metallic intoxication 7- Debilitating diseases 8- Psychologic
  • 10. Bacteria associated with Gingivitis Gr+ve species S. Sangus S. Mitis S. Intermedius S. Oralis A . Viscosus A . Naeslundii Peptostrepococcus Gr-ve species F. Nucleatum P.intermedia Haemophilus Capnocytophaga
  • 11. Clinical Features 1- Color: - Red V.D. of capillary bed, keratinization - Bluish-red b1. stasis - Cyanotic 02 tension N.B:- in healing by fibrosis pale pink. -In acute gingivitis the color change may be marginal as in NUG ,diffuse as in acute herpetic gingivostomatitis or patch-like due to chemical irritation. -In severe acute gingivitis, the red color change to a shiny gray then to whitish gray due to necrosis.
  • 12. Factors affecting the color • Endogenous Factors ( systemic factors): - melanin , bilirubin or iron. - examples : Addison disease bluish black to brown. - Peutz-jeghers syndrome melanin pigmentation. - Albright’s syndrome melanin pigmentation. • Exogenous Factors: - Metal dust. - Coloring agents in food. - Lozenges. - Tobacco. - Amalgam tattoo.
  • 13. Metallic Pigmentation Bismuth Lead Mercury Others Bluish-black pigmentation of gingival margin(liner) -Liner pig. of gingival margin. (Burtonian line) -Steel gray -Liner to diffuse grayish gingival pigmentation -Ulceration of gingiva -e.g.: phosphorous, arsenic & chromium -Bluish gray line. -Necrosis of alveolar bone loosening of teeth -Inflammation and ulceration of gingiva.
  • 14. Bismuth gingivitis ( bluish black line on margin)
  • 15. Due to edema and inflam. infiltrate •2-Contour: -Free gingiva thick and rounded -Att. gingiva loss of interradicular grooves -Interdental papilla blunt ,bulbous, convex labiolingually & bulging out inbetween the embrasure. NB.- Interdental papilla in NUG Crater like depression. - In the interproximal space appear as flat papilla.
  • 16. Plaque-induced gingivitis
  • 17. Fibrotic gingival inflammation
  • 18. Crater-licke depression papilla (NUG)
  • 19. 3-Consistency:- Soft( Spongy) and edematous (in fibrosis firm) Chronic gingivitis: Clinical changes Histopathology Pits on pressure infiltration by fluid and cells of inflammatory exudates. Softness and friability degeneration of CT and epi. Firm fibrosis and epi. Proliferation with long-standing chronic inflammation.
  • 20. 4- Surface texture:- Loss of stippling due to -Stagnation of circulation -Accumulation of inflammatory exudates -Degeneration of gingival fibers 5- Position of gingiva:- gingival margin change to coronal position deeping of gingival sulcus without apical migration of epi. attachment gingival pocket (pseudo-pocket- relative pocket). -Actual position: is the level of the epi. attachment on the tooth. -Apparent position: is the level of the crest of the gingival margin. -The position of gingiva is determined by the actual position, not the apparent position.
  • 21. •6- Gingival Bleeding on Probing:- - indicates an inflammatory lesion in the epith. and CT. - due to - Ulceration of sulcular epithelium. - Thinning and degeneration of epi. - Increase vascularity. - Dilatation of the capillaries.
  • 22. Acute gingival bleeding • Caused by injury or occur spontaneously in acute gingival disease. • Laceration of the gingiva by aggressive tooth brushing or sharp pieces of hard food causes bleeding even in the absence of gingival diseases. • Spontaneous bleeding or on minor trauma occurs in NUG.
  • 23. Gingival Bleeding Associated with Systemic Factors • Occurs spontaneously or after irritation. • Excessive and difficult to control. • Occurs in other organs e.g. skin , internal organs. • Examples : Vit. C deficiency. - Thrombocytopenic purura. - Vit K deficiency. - Hemophilia . - Leukemia. - Some medications.
  • 24. How do to determine bleeding on probing
  • 25. Insertion of a probe in gingival sulcus
  • 26. Bleeding appears 30 second after probing
  • 27. Generalized gingival bleeding on probing
  • 28. •7-Pain: - Chronic gingivitis is usually painless unless complicated by acute exacerbation. - Chronically inflamed gingiva may be painful on instrumentation (scaling and root planning).
  • 29. •Stillman’s Cleft: -Described by Stillman. -Is apostrophe-shaped indentation on gingival margin. - Is a specific type of gingival recession. -Generally occur on the facial surface. -Considered to be the result of occlusal trauma. -The margins of the clefts are rolled. - Clinical significant: difficult to maintain plaque control.
  • 30. •McCall’s Festoons: Enlargement of the gingival margin in the canine and premolar area on the facial surface. In the early stages, the color and consistency are normal. Clinical significance: accumulation of food debris leads to secondary inflammatory changes.
  • 31. Histopathology:- 1- Inflammatory cell infiltration 2- Ulceration of sulcular epi. 3-Inter and intra-cellular edema. 4- Fibrosis in longstanding inflammation Treatment:- 1- Thorough scaling. 2- Removal of local factors. 3- Plaque control and oral hygiene instruction. Prognosis:- Excellent