Plaque Induced Gingivitis

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Plaque Induced Gingivitis:

Plaque Induced Gingivitis Prevalence: It is evident world wide 82% of US adolescents More than 50% of adult have bleeding from gingiva

Gingival Inflammation:

Gingival Inflammation

Gingivitis Histopathologic Stages:

Gingivitis Histopathologic Stages Stage I (Initial Stage) Vascular changes, dilation of capillaries and increase blood flow Occur in 1 week Mainly PMNs predominate. Increase in gingival fluid

Neutrophiles Chemotaxis:

Neutrophiles Chemotaxis



Stage II gingivitis (Early Lesion):

Stage II gingivitis (Early Lesion) Erythema due to increase in capillary loops between rete pegs. Bleeding on probing Lymphocytes predominate Rete pegs in JE Collagen destruction around inflam. cells

Marginal inflammation and edema:

Marginal inflammation and edema

Host Bacterial Interaction:

Host Bacterial Interaction

Junctional Epithelium in stage III:

Junctional Epithelium in stage III Wide intercellular spaces filled with lysosomes Prominent rete pegs and destroyed basal lamina Collagenase enzyme produced by bacteria and PMNs destroy collagen

Clinical Features:

Clinical Features

Plasma Cell Domination:

Plasma Cell Domination

Plasma Cell Degeneration:

Plasma Cell Degeneration

Advanced Lesion:

Advanced Lesion


Distribution Localized gingivitis Generalized Marginal Papillary Diffuse

Generalized defuse gingivitis:

Generalized defuse gingivitis

Localized defuse:

Localized defuse

Generalized papillary gingivitis:

Generalized papillary gingivitis

Generalized marginal with localized defuse:

Generalized marginal with localized defuse

Course and Duration:

Course and Duration Acute: sudden onset, short duration and can be painful Recurrent: reappear after treatment Chronic: Slow onset, long duration, painless, fluctuating (inflammation appear and disappear)

Course and Duration:

Course and Duration Acute gingivitis (ANUG) Recurrent gingivitis Chronic gingivitis Comes slowly and of long duration

Clinical Features:

Clinical Features 1- Redness 2- Sponginess (softness) 3-Bleeding on provocation 4- Presence of plaque and calculus 5- No evidence of bone loss

Clinical Findings in Gingivitis :

Clinical Findings in Gingivitis Bleeding on probing Color changes Changes in consistency Surface texture

Signs and Symptoms of Gingivitis:

Signs and Symptoms of Gingivitis

Gingival bleeding:

Gingival bleeding

Change in Gingival Position:

Change in Gingival Position

Gingival Recession:

Gingival Recession

Gingival Recession:

Gingival Recession

Change in consistency:

Change in consistency

Fibrosis of the gingiva:

Fibrosis of the gingiva

Color change in gingiva Bithmus line:

Color change in gingiva Bithmus line

Embedded Metal :

Embedded Metal

PowerPoint Presentation:

Required Reading: Carranza’ Clinical Periodontology 10 th edition, Chapter 21 and 22

Chronic periodontitis:

Chronic periodontitis

Chronic Periodontitis:

Chronic Periodontitis Inflammation of the supporting periodontal tissues as a result of transition of inflammation from the gingiva.

Pathways of Gingival inflammation from the gingiva into supporting periodontal tissues:

Pathways of Gingival inflammation from the gingiva into supporting periodontal tissues

Clinical Features of Periodontitis:

Clinical Features of Periodontitis Signs and symptoms of gingivitis Periodontal pocket formation Tooth mobility Furcation involvement Alveolar bone loss

Radiographic Images:

Radiographic Images

Periodontal Pocket:

Periodontal Pocket Pathologically deepened gingival sulcus Careful probing is the reliable method for its detection

Clinical Signs:

Clinical Signs Enlarged bluish gingiva Red blue vertical zone Break in continuity of interdental papilla Gingival bleeding Exudate from gingival margin Mobility and extrusion of teeth Development of diastema


Symptoms Localized pain or sensation of pressure after eating A foul taste Tendency to suck material from interproximal spaces Itchiness in the gum Sensitivity to heat and cold

Classification of Periodontal Pockets Simple, Compound, Complex:

Classification of Periodontal Pockets Simple, Compound, Complex

True or false pockets Suprabony Or Infrabony:

True or false pockets Suprabony Or Infrabony

Bone Destruction Pattern in Periodontal Disease:

Bone Destruction Pattern in Periodontal Disease Horizontal Bone loss Vertical or angular defects

Tooth Mobility:

Tooth Mobility

Histopathologic Features Soft Tissue Wall of Periodontal Pocket:

Histopathologic Features Soft Tissue Wall of Periodontal Pocket

Ulceration of surface epithelium:

Ulceration of surface epithelium

Root Surface Changes:

Root Surface Changes

Furcation Involvement Definition:

Furcation Involvement Definition It refers to the denuded furcation area of multirooted teeth affected by periodontal disease

Examination and Detection:

Examination and Detection

When to suspect furcation:

When to suspect furcation Deep pockets more than 5 mm in multirooted teeth Rdiolucency in the furcation Teeth with B and Li pockets In all molars and maxillary first premolars

Classification Class I – Incipient Furcation:

Classification Class I – Incipient Furcation

Class II – Patent Furcation:

Class II – Patent Furcation

Class III – Communicating Furcation:

Class III – Communicating Furcation


Subclassification Subclass A: 0-3 mm probable depth from the roof Subclass B: 4-6 mm Subclass C: 7 mm or more from the roof of furcation

Examination and Detection of Upper molars:

Examination and Detection of Upper molars


Etiology Same etiology of periodontal disease Furcation is a plaque retentive area Role of T F O Enamel projections (E Pearls) Proximity of furcation to CE junction Accessory canals in the furcation area

Clinical Features:

Clinical Features Sensitivity to thermal changes Throbbing pain caused by pulp changes Sensitivity to percussion caused by inflammation in the periodontium

Clinical Feature:

Clinical Feature

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