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Ging Vitus

The document provides an overview of gingivitis, an inflammatory condition of the gingiva, detailing its classification, types, and associated systemic factors. It discusses the etiology, clinical characteristics, histopathology, and treatment options for chronic gingivitis and its variations, including those linked to vitamin C deficiency, leukemia, puberty, and pregnancy. Emphasis is placed on the importance of patient education and preventive measures to manage and treat gingivitis effectively.

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Maaz Khan
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5 views33 pages

Ging Vitus

The document provides an overview of gingivitis, an inflammatory condition of the gingiva, detailing its classification, types, and associated systemic factors. It discusses the etiology, clinical characteristics, histopathology, and treatment options for chronic gingivitis and its variations, including those linked to vitamin C deficiency, leukemia, puberty, and pregnancy. Emphasis is placed on the importance of patient education and preventive measures to manage and treat gingivitis effectively.

Uploaded by

Maaz Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Gingivitis

BY S Y E DA FA RYA L
D E M O N S T RAT O R D E N TA L T E C H N O LO GY
IPMS-KMU
Outline
Introduction
Hypersensitivity and its types
Classification of gingivitis
 Chronic gingivitis
 Chronic Gingivitis modified by systemic factors
Vitamin C deficiency
Leukemia
Puberty
Pregnancy
Introduction
 Gingivitis is the inflammatory condition of gingiva.

 Majority of periodontal diseases are inflammatory in nature

 Inflammation is the normal response of living tissues to injury and is the primary response of
the periodontal tissues to irritation.

 Inflammation is the defense mechanism against injury.


Conti…
• The injury results primarily from the invasion of microorganisms and their microbial products in
to the gingival tissues.

• The body seeks to neutralize or destroy the microbial irritants as well as to prepare for tissue
repair and healing
Hypersensitivity and its types
Due to immune reactions tissue destruction are occur due to certain type of overreaction called
hypersensitivity.
4 types of hypersensitivity reactions are occur in periodontal disease
Anaphylactic
Cytotoxic
Immune complex
Delayed or cell mediated hypersensitivity reactions
Anaphylactic hypersensitivity
 It involves an antigen reacting with an antibody fixed to a mast cell
 Release of substance from mast cell which cause destruction of periodontal tissue
 Histamine are released causes vascular change in inflammation
Cytotoxic reaction
 Involves antibodies reacting directly with antigens tightly bound to cells
 Cell lysis and increase synthesis of lysosomal enzymes by polymorph nuclear leukocytes are
occur due to this hypersensitivity
 Lysosomal enzymes causing tissue damage
Immune complex type reaction
• Occurs when high level of antigens are present
• Antigen-antibody complexes precipitate with in and surround small blood vessels causing tissue
damages
• Tissue damages includes inflammation, hemorrhage and tissue necrosis etc.
• All these changes are due to lysosomal enzymes from polymorph nuclear leukocytes
Cell mediated immunity
• Occurs due to interaction of antigens with the surface of lymphocytes
• Accumulation of lymphocytes and macrophages
• Formation of lymph Okines
• Affect the fibroblast, osteoclast cells etc.
Classification of gingivitis
Chronic gingivitis
Chronic gingivitis modified by systemic factors
Gingivitis associated by mouth breathing
Allergic gingivitis
Desquamative gingivitis
Acute necrotizing ulcerative gingivitis
Acute primary herpetic gingivostomatitis
Gingivitis in children
Chronic gingivitis
 It is a disease in which the gingiva is affected by a chronic inflammatory process.

 Common type of gingivitis


Clinical characteristics
• Gingival color: bluish red and deep blue
• Gingival contour: Slightly enlargement of interdental, marginal gingival or both
Marginal gingiva appears round with blunted interdental gingiva
• Gingival texture: reduction in slipping
• Gingival consistency: fibrotic
Conti…
• Gingival size: varying degrees of gingival enlargement depend on the amount of tissue
proliferation and vascular stagnation
• Increased tendency to bleed on instrumentation
• Usually painless but it may be painful on instrumentation
• Disease duration is long
• Pocket depth: gingival pocket
• Exudate: no exudate
•Radiographic signs: No radiographic sign
Histopathology and
Pathogenesis
Bacterial plaque adjacent or with in the gingival sulcus

Disruption of junction and intercellular substance

provide longer pathway for microorganism down into connective tissue of gingiva

In chronic gingivitis the sulcular and col epithelium characterized micro ulceration, the lamina
propria change with influx of cells
Contii
 Products of cells along with noxious substances from the plaque microorganism cause
vasodilation, vascular stagnation, collagen fibers destruction
 Persistence of inflammation for long period of time, tissue attempt to repair the damage by
forming new collagen fibers
Etiology
• Dental plaque
Predisposing factors
• Calculus
• Overhanging gingival margins of restoration
• Food impaction and retention
• Frequent exposure to sugar and sweets
Nutritional implication &
Prognosis
• Soft retentive food provide oral bacteria the substrate needed for the production of bacterial
irritants and plaque
• Prognosis depend on patient and dental team to control or eliminate local etiological factors.
• If the causative factors are controlled the gingival tissue will heal and repair because the
gingivitis is reversible lesion
Treatment
 Diagnosis and assessment of etiological factors
 Removal of calculus through scaling
 Removal and replacement of dental restoration and prosthetic appliances contributing to
gingival disease
 Treatment of carious lesion contributing to plaque accumulation
 Evaluation of patient’s diet and reevaluation of gingival health
 Recall the patient
Patient education and
preventive measure
 Educate the patient about the nature and causes of disease.
 Maintenance of plaque control
 Removal of supragingival and subgingival calculus
 Placement of dental and prosthetic restoration by avoiding overhanging gingival margins and
bulky contours
 Diet with reduced amount of sugar
Chronic gingivitis modified by
systemic factors
Gingivitis associated with vitamin C deficiency

Gingivitis associated with leukemia

Gingivitis associated with puberty

Gingivitis associated with pregnancy


Gingivitis associated with
vitamin C deficiency
 Scurvy disease in human that result from severe vitamin c deficiency
 Vitamin c deficiency itself cannot cause gingivitis that only exaggerate the gingival inflammatory
response
 Local irritants cause the gingivitis in patient having vitamin c deficiency
 A severe vitamin c deficiency creates increased tendency for internal gingival hemorrhage
degeneration of collagen fibers
Clinical characteristics &
Treatment
Gingiva appears bluish red
Enlargement of marginal gingiva
 gingiva is soft
Bleed on instrumentation
Gingival pocket if the sulcular depth is increased
Treatment :
 complete removal of local irritants
Gingivitis associated with
leukemia
• Leukemia is disease of blood forming tissue by production of excessive number on immature
WBC
• Local irritants plaque and calculus, leukemia just aggravate it
Clinical characteristic:
• Purplish blue Bcz of stagnation of blood
• Enlargement of marginal or interdental gingiva, Necrosis and psudomembrane formation
• Tendency to bleed
• gingival pocket
Treatment
 Scaling and polishing
 Rigid oral hygiene and plaque control procedures
 Recall visits
Gingivitis associated with
puberty
Clinical characteristics:
 Red to bluish red
 Enlargement of marginal and interdental gingiva
 Interdental gingiva appears bulbous smooth and shiny
 Tendency to bleed is increased
 Affect both male and female
 No radiographic signs
 Histopathology is same as described chronic gingivitis
Conti…
Etiology : Local irritating factors must be present the hormonal changes just exaggerate it
Nutritional implication : no
Treatment:
 Scaling, polishing
 Gingivectomy for severe gingival enlargement
 Correct predisposing factors such as food impaction, mouth breathing
 Recall visits
Gingivitis associated with
pregnancy
Inflammation of gingiva during pregnancy
Clinical characteristics:
 Bright red to bluish red
 Enlargement of interdental gingiva
 Interdental and marginal gingiva are edematous, smooth and shiny
 Tendency to bleed on instrumentation
 Most severe in 2nd and 3rd trimester
 Pregnancy tumor
Conti…
 No radiographic sign
Histopathology and pathogenesis:
 Histological findings includes infiltration of inflammatory cells ,edema and hyperplastic
epithelium with enlarges rete peg formation.
 Number of engorged capillaries is increased
Etiology
 Local irritating factors : bacterial plaque
 Progesterone and estrogen hormone increase exaggerate it
Conti…
• Microorganism such as Bacterioides melaninogenicus, subspecies intermedius increases during
pregnancy

• No nutritional implication

Prognosis:
• The gingival inflammation will not disappear automatically at the termination of pregnancy if
the local irritants are still present
Treatment
 Scaling and curettage
 Treatment of tumor like growth consists of surgical excision
 Plaque control procedure are required for the elimination and control of all local irritants
 Recall visit
Patient Education:
 Educate the patient to control local irritants , tooth brushing, flossing
Reference book
• Essential of Periodontics by ELIZABETH A. PAWLAK 7th edition
• Chapter # 4 (Gingivitis)
Thank you

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