Gingivitis:

(1)  Definition

(2)  Etiology

(3)  Gender preference

(4)  When is it most prevalent?

(1)  Inflammation limited to soft tissues around teeth

(2)  Most due to poor oral hygiene

(3)  More common in males

(4)  Slow increase until about 100% in 6th decade

• Plaque-related
• Acute necrotizing ulcerative gingivitis
  (ANUG)
• Medication-influenced
  (Dylantin aka Phenytoin, Ca channel blockers, immunosuppresants - Cyclosporine)
• Allergic (cinnamon)
• Specific infection-related
• Dermatosis-related

ANUG:

(1)  predisposing factors

(2)  types of microbes associated

(3)  prevalence

(4)  location of first attack

(1)  stress related; smoking, poor nutrition, poor hygiene

(2)  Spirochetes (PROS) & fusiform bacteria association (fusobacterium nucleatum)

(3)  0.1% of general population; 7% of military recruits

(4)  Attacks the interdental papillae first

Plasma cell gingivitis:

(1)  initial causation

(2)  categories

(3)  clinical presentation

(4)  location of where plasma cell filled

(1)  cinnamon gum

(2)  allergic, neoplastic, idiopathic

(3)  generally entire attached and free gingiva shows redness and enlargement.

(4)  lamina propria

Granulomatous gingivitis

(1)  location

(2)  effectiveness of therapy

(3)  possible causes

(1)  interdental papillae and marginal gingiva

(2)  often persistent despite therapy

(3)

• infectious (TB, fungus)
• Orofacial granulomatosis
• Sarcoidosis
• Crohn's disease
• Wegener's granulomatosis
• Foreign materials

Desquamative gingivitis:

(1)  Important distinction

(2)  gender preference

(3)  clinical presentation

(4)  age

(1)  Descriptive term for a clinical presentation.  NOT A DIAGNOSIS!!!

(2)  Up to 80% female

(3)  Smooth erythematous gingiva to blister formation and erosion

(4)  Usually seen after 40 yo.

Desquamative gingivitis:

(1)  Most common causes

(2)  Less common causes

Most common causes

• Lichen planus
• Pemphigoid

Less common causes

• Pemphigus
• Linear IgA disease
• Epidermolysis bullosa acquisita
• Lupus erythematosis

Gingival Fibromatosis

(1)  Description

(2)  Most common association

(3)  age

(1)  Slowly progressive gingival overgrowth due to fibrous hyperplasia.

(2)  Hypertrichosis

(3)  Enlargement usually begins before age 20 and commences with eruptoin of teeth.

Periodontitis:

(1)  Description

(2)  Believed to be associated with change in....

(1)  Inflammatory process that involves the supporting structures of teeth:  PDL, bone, & cementum.

(2)  ....bacterial composition of plaque

-Chronic periodontitis

• Localized
• Generalized

-Aggressive periodontitis

• Localized
• Generalized

-Periodontitis associated with systemic disease

-Necrotizing ulcerative periodontitis

-Abscesses of the periodontium

-Periodontitis with endodontic lesions

Chronic Periodontitis

(1)  Important trivia

(2)  Factors that increase prevalence

(3)  Pericoronitis associated with ______

(1)  Primary cause of tooth loss after age 30

(2) 

• Advancing age
• increased quantity of plaque and calculus
• smoking
• diabetes mellitus
• lower SE level
• decreased professional dental care.

(3)  ....partially erupted tooth

Aggressive Periodontitis

(1)  Severity compared to chronic periodontitis

(2)  Usual population/locations for Localized AP

(3)  Usual population for Generalized AP

(1)  Destruction 3 to 5 times faster than chronic periodontitis

(2)  LAP

• Primarily children (Ages 11-13)
• Incisor & 1st molar areas

(3)  GAP

• Young adults (ages 20-35)
• Widespread and rapid; sometimes with periods of quiescence

Papillon-Lefevre Syndrome

(1)  Description

(2)  Relation to dentition

(3)  Dental disease appears to be caused by:

(1)  Palmer-plantar hyperkeratosis

(2)  Dramatically advanced periodontitis involving both deciduous and permanent dentition

(3)

• Impaired T- and B-lymphocyte reactivity
• A chemotactic defect
• Reduced intracellular killing of both bacterial and fungal organisms
• Actinobacillus actinomycetemcomitans
• 3rd molars usually not affected