Dr Jamal Naim PhD 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 % 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 2 nd to 3 rd month Increased severity in the 8 th and decrease in the 9 th month

pyogenic granuloma/epulis It is not a neoplasm Occurs after the 3rd month of pregnancy Incidence is % 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.

Diabetes mellitus associated gingivitis 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.

Diabetes mellitus associated gingivitis 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.

Gingival diseases modified by malnutrition Scurvy - severe Vitamin C deficiency

Gingival diseases modified by malnutrition 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. Non-plaque induced gingival lesions

I. Gingival diseases of specific bacterial origin: Are preceded by tonsillitis Fever Pain Swollen gingiva Bleeding Occasionally abscesses Non-plaque induced gingival lesions

II. Gingival diseases of viral origin: A.Herpes virus infections Primary herpetic Gingivostomatitis (most common) Recurrent oral herpes Varicella-zoster infections B.HIV Non-plaque induced gingival lesions

II. Gingival diseases of viral origin: Non-plaque induced gingival lesions herpetic Gingivostomatitis

II. Gingival diseases of viral origin: Non-plaque induced gingival lesions 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 Non-plaque induced gingival lesions

III. Gingival diseases of fungal origin: Non-plaque induced gingival lesions generalised gingival candidiasis

III. Gingival diseases of fungal origin: A.Linear gingival erythema (by HIV) B.Histoplasmosis C.other Non-plaque induced gingival lesions Linear gingival erythema

IV. Gingival diseases of genetic origin: A.Heredity gingival fibromatosis  Me be isolated or associated with generalized syndrms B.other Non-plaque induced gingival lesions

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

IV. Gingival manifestations of systemic conditions: B.Allergic reactions 1.Dental restorative materials Mercury Nickel Acrylic (most cold acrylic resin) other Non-plaque induced gingival lesions

IV. Gingival manifestations of systemic conditions: B.Allergic reactions 2.Reactions attributable to: Toothpastes/dentifrices Mouthrinses/mouthwashes Chewing gum additives Foods and additives other Non-plaque induced gingival lesions

VI. Traumatic lesions (factitious, iatrogenic, accidental) a) Chemical injury b) Physical injury c) Thermal injury Non-plaque induced gingival lesions

Tongue jewelry

VII. Foreign body reactions Amalgam Abrasives during prof. polishing VIII. Not otherwise specified (NOS) Non-plaque induced gingival lesions