Perio
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what host defences prevent gingivitis/perio
gingival crevicular fluid antibodies, monocytes, lymphocytes, neutrophils saliva cells proliferating and shedding
what causes gingivitis
more bacterial colonisation - plaque build up
what changes happen to the host defences in gingivitis
increased plasma infiltrate - more monocytes, neutrophils, lymphocytes. increased flow of GCF, proliferation and ulceration of epithelium. increased inflammation due to more colonisation of bacteria. response upregulated
what does the gingiva look like in health and how does this change in gingivitis
health - knife edge margins, scalloped margins, pink in gingivitis - knife egde is lost, more red, bleeding on probing
what is the difference between perio and gingivitis
apical migration of junctional epithelium, pocket formation and bone loss
what is the difference between true and false pockets
true - apical migration of junctional epi false - no migration of junctional epi, but pocket due to enlarged gingiva, inflamed but but junction the same
what are the properties of the biofilm
communication between bacteria, preventing invasion of other species, taking up nutrients or expelling waste products, development of appropriate environment
what are the changes in the biofilm resulting in perio
changes in the colonisers of the biofilm, accumulation, virulence factors
give an example of a late coloniser in perio disease
porformona gingivalis
why do some people develop perio and some stay with gingivitis
dependant on the bodies host response to the bacteria, determines how it will progress
describe the mechanisms of destruction in perio
change in biofilm, t cells are normally first at site. they release cytokines and attract b cells. b cells release antibodies. results in activation of complement - inflammatory mediators interleukins and prostaglandins. these do well to attack the bacteria. but also activate collagenase, which activates MMP’s. these destruct connective tissue, attack the gingiva. also activate osteoclasts which results in bone resorption
what is the difference between horizontal and vertical bone loss
horizontal - all bone on one plane lost vertical - 2mm radius of bone loss around site of inflammation, one side of bone is intact but one side is lost
what should normal bone levels be
1-2mm from amelocemental junction
what are some risk factors for perio disease
smoking, diabetes, socioeconomic status, genetics, stress, drugs
how does smoking affect periodontal disease
vasoconstriction - may be unaware, increased gingival keratinisation, impaired antibody function, increased pro-inflammatory cytokine production
what are the clinical signs of gingivitis
bleeding on probing, red and swollen gingiva, high plaque and bleeding scores, probing depths less than 3mm, no attachment loss or bone loss radiographically
what are the clinical signs of periodontitis
clinical attachment loss, pocket depths more than 4mm, radiographic bone loss, gingival recession
what is the relationship between diabetes and perio disease
if diabetes is uncontrolled, it can make gum disease worse. if gum disease is uncontrolled, it can make diabetes worse
how can you risk assess a patient for perio disease
asking about their dental history, their oral hygiene regime, can assess their motivation
what is a bpe useful for
screening tool for perio disease. can be used to assess what further investigations or treatment is required
what does a score of 0 mean on a bpe
no bleeding on probing, no plaque retentive factors, no probing depth >3.5mm
what does a score of 1 mean on a bpe
bleeding on probing, but no plaque retentive factors or probing depth >3.5mm
what does a score of 2 mean on a bpe
plaque retentive factors present e.g. over hang restoration or defective crown margins, probing depth >3.5mm
what does a score of 3 mean on a bpe
probing depth of 3.5-5.5mm