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Periodontal Diseases In Children & Young Adolescents

Periodontal Diseases In Children & Young Adolescents Short Essays

Question 1. Papillan – Lefevre Syndrome.
Answer:

Etiology: Mutation of chromosome

• Autosomal recessive disorder

Age: Before 4 years

Site: Skin of palms and soles, knees and elbows

• Primary and permanent dentition

Features:

Extraoral: Hyperkeratosis of a localized area

Intraoral: Inflammation

• Bone loss
• Severe periodontal destruction
• Premature loss of primary and permanent teeth

Question 2. Ehler-Danlos Syndrome.
Answer:

Etiology:

• Hereditary
• Defective collagen structure

Features:

General:

• Hyperextensibility of joints
• Hyperextensibility of skin
• Fragility of skin
• The fragility of blood vessels
• Scarring of wounds

Intra-Oral:

• Fragile mucosa
• Easy bruising
• Post-extraction bleeding
• Increased gingival bleeding
• Advanced periodontal destruction
• Teeth are easily fracture
• Frequent dislocation of TMJ.

Read And Learn More: Periodontics Question and Answers

Treatment:

• Prevention of the features
• Atraumatic periodontal procedures

Question 3. Physiologic gingival changes associated with tooth eruption.
Answer:

• Gingival changes associated with various stages of tooth eruption are

1. Pre-eruptive stage

• Before the eruption of the permanent tooth crown, the gingiva presents a bulge that is firm and pink
  It may be slightly blanched
• It conforms to the contour of the underlying crown

2. Eruptive stage:

• As the tooth erupts, the gingival margin and sulcus develop
• The margin is rounded, oedematous, and reddened
• Marginal gingiva surrounding partially erupted teeth appear prominent
• The prominence is caused by the height of the contour of the erupting tooth and mild inflammation from mastication

3. Post-eruptive stage

• The gingiva reduces in bulk
• It becomes thinner, firmly attached around the Retarded growth cervical portion of the tooth

Periodontal Diseases In Children & Young Adolescents Short Answers

Question 1. Chediak-Higashi syndrome.
Answer:

Etiology:

• Hereditary
• Neutrophil defect

Features:

• Recurrent bacterial infections
• Oral ulcerations
• Destructive periodontitis

Question 2. Periodontal Diseases associated with the syndrome.
Answer:

• Papillon-Lefevre syndrome
• Chediak Higashi syndrome
• Down’s syndrome
• Ehler Danlos syndrome
• Rickets-like deformities

Question 3. Hypophosphatasia.
Answer:

• Hypophosphatasia is a rare familial skeletal disease that appears clinically in infants, young children, and adults

Clinical Features:

• Cementum formation is affected
• Periodontal attachment loss
• Premature loss of teeth
• Deficiency of alkaline phosphatase
• Excretion of phosphoethanolamine in urine

Question 4. Eruption cyst.
Answer:

• When a primary tooth is lost or the first molar is erupting, behind the deciduous second molar an eruption cyst may form

Features:

• Bluish enlargement of gingiva over erupting tooth
• Cyst may be filled with blood
• Color- dark blue or deep red
• Site involved-permanent lower incisors and first molars
• It may be painful
• Interferes with occlusion

Treatment:

• Resolves on its own
• May require marsupialisation

 

Acute Gingival Infections

Acute Gingival Infections Important Notes

1. Acute Necrotizing Ulcerative Gingivitis (ANUG)

• Also known as vincents infection, vincents stomatitis, trench mouth, fetid stomatitis, putrid stomatitis
• Smears from the lesions of ANUG show spirochaetes and fusiform bacilli

Clinical Features:

• Punched out crater-like depressions at the crest of interdental papilla covered by pseudomembrane and extend- ing into marginal gingiva
• The pseudomembranous slough is demarcated from the remaining gingival mucosa by linear erythema
• Attached gingiva and alveolar mucosa are rarely involved

Zones:

• Listergarten described 4 zones in ANUG
• Bacterial zone
• Neutrophil rich zone
• Necrotic zone
• Zone of spirochaetal infiltration
• Mouthwash Used:
• 3% H2O2 with an equal dilution of water every 2 hours for 3 days gives the best results in patients with ANUG
• It creates an oxidative environment and prevents the growth of an anaerobic environment

2. Stages of ANUG

3. Predisposing factors of ANUG

• Local
  • Smoking
  • Pericoronal flaps – Injury to the gingiva
  • Pre-existing gingivitis
• Systemic
  • Nutritional deficiency
  • Debilitating diseases
• Psychosomatic

4. Factors causing the recurrence of ANUG

• Pericoronal flap
• Inadequate local therapy
• Anterior overbite

5. Pericoronitis

Clinical Features:

• Red, painful, swollen, and tender gingiva
• Radiating pain to ear, throat
• Foul taste
• Inability to close mouth

Read And Learn More: Periodontics Question and Answers

Treatment:

• Gentle flushing with warm water to remove debris and exudate
• Swabbing with antiseptic after elevating the flap gently from the tooth with a scaler
• Antibiotics in severe cases
• If the flap is swollen and fluctuant, an incision may be necessary to establish drainage
• After the inflammation subsides, the tooth should be extracted

6. Pseudomembrane formation

• It is seen in ANUG, diphtheria, erythema multiforme, leukemic ulcers, syphilis, and candidiasis
• It can be easily removed in ANUG
• Undetachable in syphilis
• Difficult to remove in diphtheria

7. Primary herpetic gingivostomatitis

• It is a primary infection of the oral cavity caused by the HSV type 1 virus

Clinical Features:

• High-grade fever
• Lymphadenopathy Soreness of mouth
• Vesicles that rupture to form ulcers
• Ulcers are typically present in masticatory mucosa
• Preschool children are affected mostly by it
• Secondary herpes may manifest as herpes labialis, herpes genitalis, and ocular herpes. It occurs due to stimulation of latent virus in neuronal ganglia

Treatment:

• Treatment is palliative
• Local anesthetic mouthwash
• Increased water intake
• Pain control
• Supportive antibiotics
• Lesions subside within 7-10 days

8. Staging of oral necrotizing disease by Horning and Cohen

Acute Gingival Infections Long Essays

Question 1. Describe the etiology, clinical features, and treatment of acute necrotizing ulcerative gingivitis.
Answer:

Acute Necrotizing Ulcerative Gingivitis (ANUG):

• It is an inflammatory destructive disease of the gingiva

Etiology:

• Bacteria- fusospirochaetal organisms and bacteroids intermedius
• Predisposing factors

1. Local predisposing factors:

• Pre-existing gingivitis
• Injury to gingiva
• Smoking

2. Systemic predisposing factors:

• Nutritional deficiency
• Debilitating diseases
• Psychosomatic factors

Clinical Features:

1. Intraoral signs:

• Punch out crater-like depression
• Covering of pseudomembranous slough
• Gingival hemorrhage
• Fetid odor
• Increased salivation- pasty saliva
• Sensitive to touch
• Radiating gnawing pain
• Increased pain on having spicy foods
• Metallic foul taste

2. Extraoral signs:

• Lymphadenopathy
• Fever
• Loss of appatite
• Lassitude
• Leucocytosis

Stages Of Progresson:

Treatment:

1. Antibiotic coverage.

• Penicillin 500 mg TDS
• Metronidazole- 200-400 mg BID

2.

Question 2. Enumerate acute gingival infections. Describe the clinical features and management of ANUG.
Answer:

Acute Gingival Infections:

1. Traumatic lesions:

• Physical injury
• Chemical injury

2. Viral infections:

• Acute herpetic gingivostomatitis
• Herpangina
• Measles
• Zoster virus infection

3. Bacterial infection:

• Aug
• Tuberculosis
• Syphilis

4. Fungal diseases:

• Candidiasis

5. Gingival abscess:

6. Aphthous ulceration:

• Erythema multiforme
• Drug allergy

Acute Necrotizing Ulcerative Gingivitis:

• It is an inflammatory destructive disease of the gingiva

Question 3. Describe etiology, clinical features, and differential. diagnosis of acute herpetic gingivostomatitis.
Answer:

Acute Herpetic Gingivostomatitis:

• It is an acute infection of the oral cavity

Etiology:

• It is caused by the herpes simplex type-I virus

Clinical Features:

• Age-occurs during childhood
• Headache
• Fever
• Nausea, anorexia
• Lack of tactile and sensory sensation
• Sore throat
• Drooling of saliva
• Bilateral cervical lymphadenopathy
• Irritability
• Myalgia
• Site involved
  • Gingiva
  • Hard palate
  • Dorsum of tongue
  • Lips
  • Vermillion border
  • Perioral skin
  • Nasopharynx
• Present as shiny erythematous gingival swelling
• Reddening of the oral mucosa
• Formation of numerous small, dome-shaped, or pin-head type vesicle
• Size-2-3 mm in diameter
• Vesicles contain clear fluid and rupture to form ulcers
• Ulcers are multiple, small, circular, punctuate, shallow and painful
• Have red margins and yellowish or greyish floor
• Small ulcers fuse to form diffuse, large, whitish ulcers
• Difficulty in swallowing
• Increased bleeding
• Soreness of the oral cavity
• Sensitive to touch
• Numerous vesicle formations over the tonsillar area and posterior pharynx

Differential Diagnosis:

• Aug
• Erythema multiforme
• Lichen planus
• Steven-Johnson syndrome
• Desquamative gingivitis

Question 4. Define gingival abscess. Write in detail about the etiology and treatment of it.
Answer:

Gingival Abscess:

• A gingival abscess is a localized, acute inflammatory lesion that may arise from a variety of sources including microbial plaque, trauma, and foreign body impaction

Etiology:

• When bacteria are carried deep into tissues due to force- fully embedding of foreign particles into gingiva like
  • Toothbrush bristles
  • Piece of apple core
  • Lobster shell fragment

Clinical Features:

• Involves marginal gingiva or interdental papilla
• It appears as red swelling with a smooth shiny surface
• Sudden in onset
• It is a rapidly expanding lesion
• Within 24-48 hours the lesion usually becomes fluctuate- ant and points with the surface orifice
• Lesion generally ruptures spontaneously
• The adjacent teeth are often sensitive to percussion

Treatment:

• Administration of topical or local anesthesia
• Scaling and root planning
• Drainage of abscess
• The fluctuant area is incised and the exudate is drained by gentle digital pressure
• Irrigation of area with water
• Cover the area with a gauge under light pressure
• Once bleeding is stopped, relieve the patient
• Instruct the patient to rinse with warm salt water every 2 hours
• After 24 hours the area is reassessed

Acute Gingival Infections Short Essays

Question 1. Aphthous ulcers.
Answer:

• It is a common disease characterized by the development of painful, recurrent, solitary ulceration of the oral mucosa

Etiology:

• Immunological abnormalities:
  • Due to T cell-mediated immunological abnormality
• Genetic predisposition
  • Increased susceptibility to RAS
• Microbial organism
  • Form L form of a hemolytic streptococci
• Systemic factors
  • Nutritional deficiency
  • Cyclic neutropenia

Classification:

• Minor aphthae: the ulcers are less than 1 cm in diameter
• Major aphthae: they are over 1 cm in diameter
• Herpetiform ulcers: they are small ulcers throughout the mucosa

Clinical Features:

• Age and sex: common in women in the second and third decade of life
• Site: it occurs most commonly on buccal and lingual mucosa, tongue, soft palate, pharynx, and gingiva
• Prodromal symptoms:
  • Next ulcer appears
  • The ulcer gradually enlarges over the next 48-72 hours
• Later symptoms
  • The lesion is typically painful
  • It interferes with eating for several days
  • It begins as a single or multiple superficial erosion covered by grey membrane it is surrounded by localized areas of erythema
  • Lesions are round, symmetrical and shallow
  • Multiple lesions are present

1. Minor aphthae:

• Size: 0.3-1 cm
• They heal without scar formation within 10-14 days

2. Major aphthae:

• Size: upto 5 cm in diameter
• They interfere with speech and eating
• The large portion may be covered with deep painful ulcers The lesions heal slowly and leave scars
• Due to it there is decreased mobility of the uvula and tongue

3. Herpetiform ulcers:

• Multiple small shallow ulcers often up to 100 in number
• It begins as small pinhead-size erosions that gradually enlarge in size
• Lesions are more painful
• It is present continuously for one to three years
• Patients get relief immediately with 2% tetracycline mouthwash

Question 2. Differentiate between ANUG and primary herpetic gingivostomatitis.
Answer:

Question 3. Pericoronitis.
Answer:

Definition:

• Inflammation of gingiva and surrounding soft tissues of an incompletely erupted tooth
• ITIS – Inflammation ‘PERI’ – Surrounding `CORO’ – Crown

Types:

1. Acute, Sub-acute, or chronic

Features:

• Red, erythematous lesion
• Tenderness
• Radiating pain
• Difficulty in closing jaws
• Foul taste
• Swelling of the cheek region

Sequel:

• Pericoronal abscess
• Cyst formation
• Spread of infection into adjacent areas
• Lymphadenitis
• Peritonsillar abscess
• Cellulitis
• Ludwig’s angina

Treatment:

Cleanse and Anesthetize the area

• Reflection of flap
• Debridement
• Post-operative instructions
  • Rinse with warm water along with salt
  • Copious fluid intake
  • Systemic antibiotics
• Recall
• Next visit decide
  • To retain tooth

• To extract
  • Impaction

Acute Gingival Infections Short Answers

Question 1. Differential diagnosis of acute herpetic gingivostomatitis.
Answer:

• AUG
• Erythema multiforme
• Lichen planus
• Steven-Johnson syndrome
• Desquamative gingivitis

Question 2. Management of acute herpetic gingivostomatitis.
Answer:

• Antiviral therapy 15 mg/kg of acyclovir suspension given 5 times daily for 7 days
• Scaling- to remove plaque and food debris
• Topical application of chlortetracycline
• Administration of NSAIDs
• Nutrient supplements
• Relief of pain by topical anesthetic mouthwash

Question 3. Diagnosis of acute herpetic gingivostomatitis.
Answer:

• Diagnosis is made by
  • History
  • Clinical examination
  • Virus culture
  • Immunologic tests

Question 4. Bacterial microflora of ANUG.
Answer:

• Treponema micodentium
• Intermediate spirochaetes
• Vibrios
• Fusiform bacilli
• Filamentous organisms
• Borrelia species

Question 5. Enumerate acute infections of the gingiva
Answer:

1. Traumatic lesions:

• Physical injury
• Chemical injury

2. Viral infections:

• Acute herpetic gingivostomatitis
• Herpangina
• Measles
• Zoster virus infection

3. Bacterial infection:

• Aug
• Tuberculosis
• Syphilis

4. Fungal diseses

• Candidiasis

5. Gingival abscess

6. Aphthous ulceration

• Erythema multiforme
• Drug allergy

Question 6. Define gingival abscess.
Answer:

• A gingival abscess is a localized, acute inflammatory lesion that may arise from a variety of sources including microbial plaque, trauma, and foreign body impaction

Etiology:

• When bacteria are carried deep into tissues due to the force-fully embedding of foreign particles into gingiva like
  • Toothbrush bristles
  • Piece of apple core
  • Lobster shell fragment

Acute Gingival Infections Viva Voce

1. ANUG and Vincent angina are fusospirochaetal infec- tions
2. 3% H2O2 diluted to one part peroxide and 2 parts water twice a day is recommended in patients with desquamative gingivitis
3. Spirochaetes are classified into 3 groups: small, in- intermediate, and large
4. Intermediate spirochaetes are present in great numbers in ANUG
5. Dark field microscopy is used to demonstrate spiro- chapters
6. Corticosteroids are contraindicated in ANUG
7. Extraction and periodontal surgery should be planned 4 weeks after the signs and symptoms of ANUG have subsided
8. Herpes is common in preschool children
9. ANUG is common in adolescents
10. Juvenile periodontitis is common in young adolescents
11. Viridians group of streptococci and anaerobes pre- dominate in samples collected in pericoronitis
12. Aphthous ulcers are predominately present in labial mucosa.
13. Color changes of Gingiva is diffuse in acute herpetic gingivostomatitis gingivostomatitis
14. Diffuse erythema of the Gingiva with no ulcers is seen in streptococcal gingivostomatitis
15. Necrotizing ulcerative gingivitis is caused by spiro- chapters and fusiform bacilli
16. Herpetic gingivostomatitis is a viral infection
17. Vesicles in herpetic gingivostomatitis rupture approximately after 24 hours
18. Tzanck cells are seen in herpetic
19. Healing of the lesions with scarring is seen in large aphthous ulcers
20. The pseudomembrane in ANUG should be removed at the first visit
21. Amoxicillin is the drug of choice in ANUG

 

Gingival Enlargements

Gingival Enlargements Definitions

1. Periodontal abscess

• The periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket

Gingival Enlargements Important Notes

1. Gingival enlargement

1. Based on etiology
   • Inflammation – Acute
   • Chronic
2. Drug-induced
   • Phenytoin
   • Cyclosporins
3. Systemic diseases
   • Conditioned enlargements
     • Puberty
     • Pregnancy
     • Non-specific
   • Systemic diseases
     • Leukemia
   • Neoplastic
     • Benign tumors
     • Malignant tumors
   • False enlargements
     • Idiopathic
4. According to location
   • Localized-limited to one/more teeth
   • Generalized- involves the entire mouth
   • Papillary-confined to interdental papilla – Marginal- confined to marginal gingiva – Diffuse-involves entire gingiva
   • Discrete-isolated lesions
5. According to the degree
   • Grade 0- Normal gingiva
   • Grade 1- Involves interdental gingiva
   • Grade 2- Involves marginal and interdental papilla
   • Grade 3- Covers 3/4th of the crown of teeth

2. Leukemic gingival enlargement

• Occurs only in the acute type and not in the chronic type
• Mostly occurs in acute monocytic leukemia
• The gingival connective tissue is infiltrated with immature leukocytes

3. Gingival enlargements and their locations

4. Cyclosporine

• It is a potent immunosuppressive drug used to prevent organ transplant rejection and treat several autoimmune diseases
• Gingival enlargement, nephrotoxicity, hypertension, etc are its side effects
• Another immunosuppressive tacrolimus exhibits less severe gingival inflammation
• It is used as a substitute for cyclosporine

5. Phenytoin

• It is used to treat all forms of epilepsy
• Gingival enlargements occur in 50% of patients on this drug
• It often occurs in young patients
• Phenytoin stimulates the fibroblasts and reduces collagen degradation
• Ethosuximide, valproic acid, and mephenytoin are other antiepileptic drugs causing gingival enlargements

6. Plasma cell gingivitis

• Gingiva appears red, friable, granular
• It bleeds easily
• It may be associated with cheilitis and glossitis
• It is allergic in origin possibly related to components of chewing gums, denitrifies, or diet.

7. Gingival abscess

• It is a localized, painful rapidly expanding lesion of sudden onset
• It is limited to marginal gingiva or interdental papilla
• It is due to foreign substances carried deep into the tissues such as toothbrush bristle, a piece of apple core, or a lobster shell

Gingival Enlargements Long Essays

Question 1. Classify gingival enlargements. Discuss the history- theology and clinical features of drug-induced gingivitis.
Answer:

Gingival Enlargements Classification:

1. Based on etiology:

Inflammation:

• Acute
• Chronic

Drug-Induced:

• Phenytoin
• Cyclosporins

Gingival Enlargements Systemic diseases:

• Conditioned enlargements:
  • Puberty
  • Pregnancy
  • Non-specific
• Systemic diseases:
  • Leukemia
• Neoplastic:
  • Benign tumors
  • Malignant tumors
  • False enlargements:
  • Idiopathic:

Read And Learn More: Periodontics Question and Answers

3. According to the degree:

• Grade 0- Normal gingiva
• Grade 1- Involves interdental gingiva
• Grade 2- Involves marginal and interdental papilla
• Grade 3- Covers 3/4th of the crown of teeth

Drug-Induced Gingivitis:

Drug-Induced Gingivitis Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• The site involved- marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Drug-Induced Gingivitis Histopathology:

1. Epithelium:

• Shows varying degrees of acanthosis
• Elongated, thin rete pegs are present
• Increased epithelial pearls
• Presence of PMNs

2. Lamina propria:

• The proliferation of fibroblasts present
• There is an increase in collagen production

Question 2. Classify different gingival enlargements. Describe in detail acute inflammatory enlargement.
Answer:

Gingival enlargement Classification:

1. According to the etiology:

Inflammation:

• Acute
• Chronic

Drug-Induced:

• Phenytoin
• Cyclosporins
• CCB’s

Systemic diseases:

• Conditioned Vitamin C deficiency
• Puberty
• Pregnancy
• Non-specific
• Systemic diseases – Leukemia

Neoplastic:

• Benign
• Malignant
• False enlargements

2. According to Location:

Localized: limited to one/more teeth

• Generalized: Involves entire mouth
• Papillary: Confined to interdental papilla
• Marginal: Confined to the marginal gingiva
• Diffuse: involves the entire gingiva
• Discrete: Isolated lesions

3. According to the degree:

• Grade 0: Normal gingiva
• Grade 1: Involves interdental papilla
• Grade 2: Involves marginal and interdental papilla
• Grade 3: Covers 3/4th of the crown of teeth

Acute Inflammatory Enlargement:

• Sudden localized painful expanding lesion occurring on biting of hard objects like apple or fish thorns

Etio-Pathogenesis:

Gingival enlargement Features:

• Site – Localized to the marginal gingiva
• Color – Reddish
• Surface – Smooth and shiny
• Symptoms – Painful, expanding lesion
• Sign – Bleeding on probing
• Tender on percussion
• Exudation of purulent material
• Size – Swollen gums

Gingival enlargement Treatment:

• Removal of etiological factors
• Incision and drainage of abscess
• In persistent cases, prescribe antibiotics

Gingival Enlargements Short Essays

Question 1. Pericoronal Abscess.
Answer:

• It is a localized accumulation of pus covering the crown of unerupted/partially erupted teeth

Pericoronal Abscess Etiology:

• Plaque accumulation around the impacted teeth

Pericoronal Abscess Features:

• Red, swollen, erythematous gingiva around impacted teeth
• Interferes with occlusion

Pericoronal Abscess Radiographic Features:

• Radiograph shows impacted teeth

Pericoronal Abscess Treatment:

• Flap removal
• Impaction

Question 3. Dilantin sodium-induced hyperplasia.
Answer:

Dilantin Sodium-Induced Hyperplasia Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• Site involved-marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Dilantin Sodium-Induced Hyperplasia Histopathology:

1. Epithelium:

• Shows varying degrees of acanthosis
• Elongated, thin rete pegs are present
• Increased epithelial pearls
• Presence of PMNs

2. Lamina propria:

• The proliferation of fibroblasts present
• There is an increase in collagen production

Question 4. Differentiate Acute and Chronic Inflammatory Enlargement.
Answer:

Question 5. Differentiate periapical, periodontal, and gingival abscesses.
Answer:

Question 6. Drug-induced Gingival Enlargement.
Answer:

Drugs Causing Enlargement:

Drugs Causing Enlargement Features:

1. Duration – 3 months after initiation of drug therapy
2. Location – Generalized
   • Severe in maxilla
3. The site involved – Marginal gingiva and interdental papilla
4. Appearance – Painless, bead-like enlargement
5. Complication – Interferes with occlusion
   • Absence of inflammation
     • Mulberry shaped enlargement
     • Color-pale pink
   • Presence of inflammation
     • Color-red/bluish-red
     • Presence of increased bleeding
6. Consistency – Firm and resilient
7. Surface:
   • Lobulated
8. Bleeding:
   • Absent

Drugs Causing Enlargement Pathogenesis:

• The similarity in the structure of phenytoin and sub-population of fibroblasts
• Thus, fibroblasts become sensitive to phenytoin
• Results in increased collagen production

Drugs Causing Enlargement Treatment:

Step 1:

• Oral prophylaxis
• Substitute drug
• Recall

Step 2:

• Mild case – Gingivectomy
• Severe destruction – flap surgery

Question 7. Leukemic Gingival Enlargement.
Answer:

Leukemic Gingival Enlargement Distribution:

• Diffuse/marginal
• Localized/Generalized

Leukemic Gingival Enlargement Appearance:

• It increases in size gradually and covers the tooth crown
• Tumor like enlargement
• Color-bluish red
• Surface-shiny
• Consistency-moderately firm
• Bleeding on probing – positive
• Increased susceptibility to infections Associated symptoms: ANUG

Leukemic Gingival Enlargement Treatment:

• Consult physician
• Monitor hematological values
• Antibiotic prophylaxis
• Incision and drainage
• Cleanse the area with cotton pellets soaked in hydrogen peroxide
• Application of pressure with gauze

Question 8. Classify gingival enlargement. Add a note on idiopathic gingival enlargement.
Answer:

Gingival Enlargement:

• It is an increase in the size of the gingiva

Classification:

1. Based on etiology:

1. Inflammation
   • Acute
   • Chronic
2. Drug-induced
   • Phenytoin
   • Cyclosporins
3. Systemic diseases
   • Conditioned enlargements
     • Puberty
     • Pregnancy
     • Non-specific
4. Systemic diseases
   • Leukemia
5. Neoplastic
   • Benign tumors
   • Malignant tumors
6. False enlargements
7. Idiopathic

2. According to the location:

1. Localized-limited to one/more teeth
2. Generalized- involves the entire mouth
   • Papillary-confined to interdental papilla
   • Marginal- confined to the marginal gingiva
   • Diffuse- involves the entire gingiva
   • Discrete- Isolated lesions

Idiopathic Gingival Enlargement:

• It is a rare condition of unknown etiology

Clinical Features:

• It has diffuse involvement
• Involves attached gingiva, marginal gingiva, and inter-dental papilla
• The affected gingiva is firm, pink, and leathery in consistency and has a pebbled surface
• Facial and lingual surfaces of the mandible and maxilla are generally affected
• Teeth are almost completely covered by the gingival enlargement
• The enlargement projects into the oral vestibule
• Jaws appear distorted
• Secondary inflammatory changes occur

Question 9. How will you differentiate between scorbutic gingival enlargement and leukemic gingival enlargement?
Answer:

Question 10. Compare drug-induced gingival enlargement and leukemic gingival enlargement.
Answer:

Question 11. Compare drug Induced and Idiopathic gingival enlargement.
Answer:

Question 12. Benign tumors of the gingiva.
Answer:

Benign Tumours Of Gingiva:

1. Focal fibrous hyperplasia:

• It is present often in adults
• It is a nodular lesion
• Has dome-like growth with a smooth surface of normal color
• Surface keratosis occurs
• It is slow progressing lesion
• It may remain the same size for many years
• It is also known as peripheral fibroma

2. Peripheral ossifying fibroma:

• It is a gingival nodule consisting of reactive hyperplasia of connective tissue containing focal areas of bone

Peripheral ossifying fibroma Clinical Features:

• It represents a well-demarcated, encapsulated, ex-pantile, central jaw lesion
• It is localized, painless, non tendered bony hard swelling.
• It is a slow-growing lesion
• It leads to the expansion and distortion of cortical plates
• There may be displacement of regional teeth

3. Peripheral giant cell granuloma:

• It is the hyperplastic reaction of gingival connective tissue in which the histiocytic and endothelial cellular components predominate

Peripheral giant cell granuloma Clinical Features:

• Age- during the mixed dentition period
• Sex- common in females
• Site- interdental papilla
• Appears as a small, exophytic, well-circumscribed, pedunculated lesion on the gingival surface
• It is painless, firm, and lobulated
• Surface- smooth or granular
• Size-less than 2 cm in diameter
• Color-purplish-red to dark-red in color
• The overlying epithelium is ulcerated
• Consistency-firm
• Bleeding occurs spontaneously
• Some lesions may develop with hour-glass shapes located between teeth and lobulated extremities projecting both buccally and lingually

4. Gingival cyst:

• It is derived from the rest of the dental lamina

Gingival Cyst Clinical Features:

• It occurs as firm, compressible, fluid-filled swelling on the facial gingiva usually in the anterior or premolar region
• It usually develops as a solitary lesion
• Color remains normal
• Occurs on attached gingiva or interdental papilla

Question 13. Clinical features of drug-induced gingival enlargement.
Answer:

Drug-Induced Gingival Enlargement :

• Phenytoin
• Cyclosporins
• CCB’s
  • It occurs 3 months after initiation of phenytoin therapy
  • Common in younger individuals
  • Generalized distribution but severe in the maxilla
  • The site involved- marginal gingiva and interdental papilla
  • Appears as a painless, bead-like enlargement
  • Interferes with occlusion
  • Has lobulated surface
  • Firm to resilient in consistency
  • No tendency to bleed

Gingival Enlargements Short Answers

Question 1. Periodontal abscess.
Answer:

• The periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket

Periodontal abscess Etiology:

• Presence of plaque and calculus

Periodontal abscess Clinical Features:

• Involves deep periodontal structures
• Localized pain
• Deep pockets
• Vital tooth
• Tender on lateral percussion
• Tooth mobility
• Associated fistula

Periodontal abscess Treatment:

• Drainage
• Flap surgery

Question 2. Conditioned Gingival Enlargements.
Answer:

• Conditioned enlargements are caused by systemic conditions of the patient which exaggerates the usual ginger- val response to dental plaque

Conditioned Gingival Enlargements Types:

• Hormonal
• Nutritional
• Allergic

Question 3. Angiogranuloma.
Answer:

• Gingival enlargement in pregnancy is also known as angiogranuloma
• It is an inflammatory response to local irritation
• It is modified by the patient’s condition
• It usually appears after the first trimester

Question 4. Drug-induced gingival enlargements.
Answer:

Drug-Induced Gingival Enlargements Clinical Features:

• It occurs 3 months after initiation of phenytoin therapy
• Common in younger individuals
• Generalized distribution but severe in the maxilla
• The site involved- marginal gingiva and interdental papilla
• Appears as a painless, bead-like enlargement
• Interferes with occlusion
• Has lobulated surface
• Firm to resilient in consistency
• No tendency to bleed

Question 5. Write the difference between gingival and periodontal abscess.
Answer:

Question 6. Wegener’s Granulomatosis.
Answer:

• It is a disease of unknown etiology
• It basically involves the vascular, renal, and respiratory systems

Wegener’s Granulomatosis Clinical Features:

• Occurs at any age
• Common in males
• Initially, there is the development of rhinitis, sinusitis, and otitis
• The patient later develops cough and hemoptysis, fever, joint pain
• Hemorrhagic or vesicular skin lesions are common

Wegener’s Granulomatosis Oral Manifestations

• Affected gingiva is termed strawberry gingiva Gingival lesions may be ulcerations, friable granular lesions
• It starts in the interdental papilla and spreads rapidly
• This leads to bone loss and tooth mobility

Question 7. Developmental gingival enlargements.
Answer:

• These enlargements are physiologic
• During various stages of the eruption, the labial gingiva may show a bulbous marginal distortion caused by the superimposition of the bulk of the gingiva on normal enamel
• This enlargement is known as developmental enlargement

Question 8. Differential diagnosis of epulis.
Answer:

• Epulis refers to all discrete tumors and tumor-like masses of the gingiva
• Differential diagnosis of it includes oral fibroma

Question 9. Leukemic gingival enlargement.
Answer:

Leukemic Gingival Enlargement Clinical Features:

Distribution:

1. Diffuse or marginal
2. Localized or generalized

• • It increases in size and gradually covers the tooth crown
  • It appears as a tumor-like enlargement
  • Color-bluish red in color
  • Surface-shiny surface
  • Consistency-spongy-like and friable
  • Gingiva bleeds spontaneously
  • Increased susceptibility to infections

Gingival Enlargements Viva Voce

1. Three types of conditioned gingival enlargements are: hormonal, nutritional, and allergic
2. Fibrotic gingival enlargement is a side effect of some anticonvulsants, calcium channel blockers, and immunosuppressant drugs
3. Leukemic enlargement is generally bluish-red and has a shiny surface
4. Administration of phenytoin may precipitate mega-holoblastic anemia and folic acid deficiency.
5. Drug-induced gingival enlargement starts at the interdental papilla
6. Cyclosporine causes highly vascularized gingival enlargement
7. Systemic administration of phenytoin accelerates the healing of a gingival wound
8. Tacrolimus can replace Cyclosporine
9. Bacterial plaque is not necessary for the initiation of gingival enlargement in Wegener’s granulomatosis

 

Smoking And Periodontal Diseases Short Essays

Question 1. Smoking and Periodontal diseases.
Answer:

Effects On Micro-Organisms:

• No effect on plaque accumulation
• Increased colonization in shallow pockets
• Increased pathogens in deep pockets
• Increased levels of B-forsythias, A.a. contains and P.gingivalis

Cytological Effects:

• Altered neutrophil mechanism
• Increased TNF-a and PGE2
• Reduced IgG2

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• Altered fibroblastic activity
• Suppresses osteoblastic activity
• Altered repair and regeneration

Effects On Gingiva:

• Decreased gingivitis
• Decreased bleeding on probing
• Decreased GCF flow
• Decreased sub-gingival temperature

Effects On Periodontitis:

• Increased disease severity
• Increased pocket depth
• Attachment loss
• Bone loss
• Tooth loss

Effect On Treatment:

• Increased time to recover from anesthesia
• Reduced post-operative gain of attachment pocket depth
• Reduced post-treatment response
• Requires frequent re-treatment
• Increased refractory disease

Periodontal Structures in Aging Humans

Periodontal Structures In Aging Humans Important Notes

1. Aging in the gingiva

• Thinning and reduced keratinization
• Increase in epithelial permeability
• Flattening of recipes
• Increase in width of attached gingiva
• Migration of junctional epithelium apically

2. Aging in the periodontal ligament

• Decreased cellularity
• Decreased vascularity
• Decreased mitotic activity
• Decrease in the number of collagen fibers
• Increase in arteriosclerotic changes
• Decrease in the number of epithelial rests of Malassez
• Increase in diameter of a collagen fiber bundle
• Increase in cementless

3. Aging in cementum

• The smooth surface becomes irregular
• Hypercementosis
• The permeability of cementum decreases with age
• Increase in cemental width
• Accumulation of resorption bays

4. Aging in alveolar bone

• The irregular periodontal surface of a bone

Periodontal Structures In Aging Humans Short Essays

Question 1. Aging and Periodontium.
Answer:

Age Changes In Gingiva:

1. Epithelium:

• Thinning of epithelium
• Decreased Keratinization
  • Passage of bacteria into connective tissue
  • The greater amount of intracellular substance

2. Connective Tissue:

• ↓ connective tissue cellularity
• ↓oxygen consumption
• ↑ mast cell
• Atrophy of CT

3. Macroscopic:

• Gingival recession
• Passive eruption of the tooth
• ↑ denaturing temperature

Age Changes in Periodontal Ligament:

↓ Vasucalarity

Elastic fibers

↓ organic matrix

↑ width with less number of teeth present

↓ mitotic activity

↓ collagen fibers

↓ width with ↓ masticatory muscle strength

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Age changes in alveolar bone

Osteoporosis

↓ Vascularity

↓metabolic rate

↓ healing capacity

↓bone formation ↑ bone resorption

Age changes in cementum:

↑ cemental width, more apically and lingually

 

 

 

Classification And Epidemiology Of Periodontal Diseases Short Essays

Question 1. Classification of Periodontal diseases. (or) AAP Classification.
Answer:

• By AAP 1999 (International Workshop for Classification of Periodontal Disease)

Gingival Disease:

Dental Plaque – Induced gingival disease:

• These diseases may occur on a periodontium with no attachment loss or on one attachment loss that is stable and not progressing.

1. Gingivitis associated with dental plaque only

• Without local contributing factors
• With local contributing factors

2. Gingival diseases modified by systemic factors

• Associated with the endocrine system
  1. Puberty associated gingivitis
  2. Menstrual cycle – associated gingivitis
  3. Pregnancy-associated
     • Gingivitis
     • Pyogenic granuloma
  4. Diabetes mellitus-associated gingivitis
• Associated with blood dysplasias
  1. Leukemia-associated gingivitis
  2. Others

3. Gingival diseases modified by medication

• Drug-influenced gingival diseases
  1. Drug-induced gingival enlargement
  2. Drug-induced gingivitis
     • Oral contraceptive-associated gingivitis
     • Others

4. Gingival diseases modified by malnutrition

• Ascorbic acid deficiency gingivitis
• Others

Non-plaque-induced gingival lesion:

1. Gingival diseases of specific bacterial origin

• Neisseria gonorrhea
• Treponema palladium
• Streptococcal species
• Others

2. Gingival diseases of viral origin

• Herpes virus infection
  • Primary herpetic gingivostomatitis
  • Recurrent oral herpes
  • Varicella zoster
• Others

3. Gingival diseases of fungal origin

• Candida species infections, generalized gingival candidiasis
• Linear gingival erythema
• Histoplasmosis
• Others

4. Gingival lesions of genetic origin

• Hereditary gingival fibromatosis
• Others

5. Gingival manifestations of systemic conditions

• Subcutaneous lesions
  • Lichen Planus
  • Pemphigoid
  • Pemphigus Vulgaris
  • Erythema multiforme
  • Lupus erythematosus
  • Drug-induced
  • Others
• Allergic reactions

6. Traumatic lesions (factitious, iatrogenic, or accidental)

• Chemical injury
• Physical injury
• Thermal injury

7. Foreign body reactions

8. NOT otherwise specified (MOS)

Chronic Periodontitis:

• Localized – Less than 30% of sites involved
• Generalized – More than 30% of sites involve
• Slight – 1 to 2 mm clinical attachment loss
• Moderate – 3 to 4 mm clinical attachment loss
• Severe – More than 5 mm clinical attachment loss

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Aggressive Periodontitis:

• Localized – Slight, moderate, or severe
• Generalized -Periodontitis as a manifestation of systemic diseases.

1. Associated with hematological disease

• Acquired neutropenia
• Leukaemia
• Others

2. Associated with genetic disorders

• Familiar and cyclic neutropenia
• Down’s syndrome
• Cohen syndrome
• Hypophosphatasia

3. Necrotizing periodontal diseases:

• Necrotizing ulcerative gingivitis
• Necrotizing ulcerative periodontitis

4. Abscesses of the Periodontium:

• Gingival abscess
• Periodontal abscess
• Periocoronal abscess

Periodontitis associated with endodontic – Lesion End-period lesion:

Developmental/Acquired Deformities:

• Localized
• Mucogingival around teeth
• Mucogingival around edentulous ridges
• Occlusive trauma

Question 2. Plaque-induced gingival Inflammation.
Answer:

These diseases may occur on a periodontium with no attachment loss or on one attachment loss that is stable and not progressing.

1. Gingivitis associated with dental plaque only

• Without local contributing factors
• With local contributing factors

2. Gingival diseases modified by systemic factors

• Associated with the endocrine system
  • Puberty associated gingivitis
  • Menstrual cycle-associated gingivitis
  • Pregnancy-associated
    • Gingivitis
    • Pyogenic granuloma
  • Diabetes mellitus-associated gingivitis
• Associated with blood dysplasias
  • Leukemia associated gingivitis
  • Others

3. Gingival diseases modified by medication

• Drug-influenced gingival diseases
• Drug-induced gingival enlargement
• Drug-induced gingivitis
  • Oral contraceptive-associated gingivitis
  • Others

4. Gingival diseases modified by malnutrition

• Ascorbic acid deficiency gingivitis
• Others

Changes In Epithelium:

Presence of plaque bacteria → Destruction of intercell lar junctions → Loss of epithelium barrier → Entry of bacteria into connective tissue → Results in ulceration in the epithelium

Changes In Connective Tissue:

Periodontics Normal Periodontium Definitions

1. Gingiva
   • It is a part of oral mucosa that covers the alveolar process of the jaws and surrounds the neck of the teeth
2. Gingival sulcus
   • The gingival sulcus is defined as the shallow crevice or space around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other side.
3. Stippling
   • It is a form of adaptive specialization or reinforcement for function
4. Periodontal ligament
   • It is a connective tissue that surrounds the root and connects it with the bone
5. Alveolar bone
   • It is that portion of the maxilla and mandible that forms and supports the tooth socket
6. Cementum
   • It is a calcified avascular mesenchymal tissue that forms the outer covering of the anatomic root
7. Fenestration
   • These are isolated areas in which the root surface is covered only by the periosteum and gingiva
8. Dehiscence
   • It is a defect involving the denudation of bone.

Periodontics Normal Periodontium Important Notes

1. Parts of the Gingiva

• Marginal Gingiva
  • Border of the gingiva surrounding the teeth in the collar-like fashion
  • Demarcated apically by a shallow depression called “free gingival groove”
• Attached Gingiva
  • Part of the gingiva that is firm, resilient, and tightly bound to the underlying periosteum of the alveolar bone
• Interdental Gingiva
  • Occupies gingival embrasure

2. Layers of Gingival Epithelium

• Basal layer – Cells are cylindrical/cuboidal Attach to the basement membrane
• Cells have the ability to divide
• Stratum Spinosum
• Large cells with short processes called spines
• Cells have a prickled appearance
• Cells are attached to one another with the help of desmosomes
• Stratum Granulosum – Keratohyalin granules are seen
• Stratum Corneum
• The cytoplasm of cells in this layer is filled with keratin
• It can be
• Orthokeratinized
• Parakeratinized

3. Interdental col is an area with more susceptibility to infection because

• It is non keratinized
• Nonaccessible area
• Area with food lodgement

4. Blood Supply of Gingiva

• Supraperiosteal arteries
  • Arises from above alveolar bone
  • Branches and supplies facial and lingual surfaces
• Vessels of the periodontal ligament
  • Anastomoses with the capillaries
• Arterioles emerging from the crest of the interdental septa

5. Gingival Fibers

• Dentogingival – From cervical cementum to lamina propria
• Alveologingival – From bone to lamina propria
• Circular – Around the neck of a tooth
• Dentoperiosteal – From cementum to alveolar process
• Transeptal – Runs interdentally

6. Blood supply to a periodontal ligament is through

• Apical vessels
• Transalveolar vessels
• Gingival vessels

7. Types of the cementoenamel junction

• 60-65%-Cementum overlaps enamel
• 30% End to end relationship
• 5-10%-Cementum and enamel fail to meet

8. Principal fibers of periodontal ligament

• Trans-septal group
  • Connects cementum of one tooth with that of other
• Alveolar crest
  • Extends from cementum to alveolar crest
• Function – Retains tooth in the socket, Retains lateral tooth movement
• Horizontal group – Extends from cementum to alveolar bone
• Oblique group
  • Extends coronally from the cementum to the bone
• Function – Resist axially directed forces
• Apical group
  • From the cementum to the bone of the alveolar fundus
• Function – Prevents tipping movement, Resists luxation
• Inter-radicular fibers
  • Presents between the cementum of a multi-rooted tooth.
• Function – Resists luxation, Resists tipping and torquing

9. Difference between acellular and cellular cementum.

Periodontics Normal Periodontium Short Answers

Question 1. Junctional Epithelium.
Answer:

• It is the tissue that joins the tooth on one side and the oral. sulcular epithelium and connective tissue to the other
• It forms the base of the sulcus

Junctional Epithelium Attachment:

• Attach to the tooth surface
• By internal basal lamina
• Reinforced by the gingival fibers
• Consists of lamina dens and lamina lucida
• Attach to gingival connective tissue By external basal lamina

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Junctional Epithelium Features:

• Consists of non-keratinizing epithelium
• Thickness
• Early life- 3-4 layers
• Later Increases
• Length- 0.25-1.35 mm

Question 2. Lamina dura.
Answer:

• This is the wall of the tooth socket that surrounds the tooth
• It is made up of dense cortical bone
• A thin radiopaque line surrounds the root of the tooth
• It is continuous with the shadow of the cortical bone at the alveolar crest
• It is slightly thicker than the trabeculae of the cancellous bone in the area
• The thickness and density of the lamina dura will vary. with the number of occlusal stresses
• It is wider and more dense around the roots of teeth. By alternate protruberances and depression heavy occlusion
• It is thinner and less dense around teeth not subjected to occlusion function
• The presence of intact lamina dura around the tooth indicates a vital pulp.

Question 3. Gingival Sulcus.
Answer:

• The gingival sulcus is defined as the shallow crevice or space around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other side.

Gingival Sulcus Boundaries:

• Tooth side- bounded by tooth surface
• Tissue side- Bounded by marginal gingiva
• Lateral wall- Formed by sulcular epithelium
• Bottom of sulcus- Formed by junctional epithelium

Gingival Sulcus Depth:

• It is a V-shaped crevice
• The depth of the gingival sulcus is determined by estimating the depth of penetration of the periodontal probe
• In normal or ideal conditions, the depth of the gingival sulcus is 0 mm
• The probing depth of clinically normal gingival sulcus is 2 to 3 mm.
• The histological depth of the sulcus is 1.8 mm with variations of 0 to 6 mm.

Pathological variations:

• A sulcus depth of about 3 mm leads to the appearance of pocket epithelium with irregular ridges and ulcerations
• Sulcus depth of more than 3 to 5 mm results in the period- dentists
• It is characterized by active bone resorption

Gingival Sulcus Significance:

• The soft tissue wall of the gingival sulcus is prone to infections.
• As the sulcus depth deepens it leads to the periodontal pocket
• which acts as a reservoir for the gingival crevicular fluid

Question 4. Stippling.
Answer:

• It is a form of adaptive specialization or reinforcement for function

Stippling Significance:

• Sign of healthy gingiva
• Loss or reduction – Denotes diseased condition

Stippling Formation:

• By alternate protruberances and depression
• A papillary layer of connective tissue projects into the epithelium

Stippling Diagnosis:

• By drying the gingiva

Question 5. Attached gingiva.
Answer:

Attached Gingiva Definition:

Attached gingiva is defined as that part of the gingiva that is firm, resilient & tightly bound to the underlying periosteum of the alveolar bone

Attached are Gingiva Features:

The surface of the attached gingiva is stippled like an orange peel

• This appearance is most prominent in the facial aspect
• On the facial aspect, the attached gingiva extends upto al- alveolar mucosa
• It is demarcated here by the mucogingival junction
• On the Lingual aspect of the mandible, the attached gingiva terminates at the junction of the lingual alveolar mucosa
• The palatal surface of the attached gingiva in the maxilla blends with the palatal mucosa

Question 6. How to measure attached gingiva?
Answer:

1. Histological test:

• Schiller’s potassium iodide solution stain
• In this test, Schiller’s potassium iodide solution is applied over gingiva
• This stains the total gingiva.
• Total gingiva is thus measured
• Next measure the pocket depth
• The attached gingiva is calculated by subtracting pocket depth from the total width of the gingiva

2. Anatomical test:

• It includes a measurement approach
• It first, the pocket depth is measured by probing
• Next, the total width of the gingiva is measured
• The attached gingiva is calculated by
• Total width-pocket depth

3. Functional tests:

Tension test:

• Initially, the lip/cheek is stretched
• Observe for the movement of marginal or free gin- give
• Movement of free gingiva indicates inadequate at-attached gingiva

Roll test:

• In this test, adjacent mucosa is pushed coronally
• If the gingiva moves along with it, it donates inadequate attached gingiva

Question 7. Roll test.
Answer:

• In this test, adjacent mucosa is pushed coronally
• If the gingiva moves along with it, it donates inadequate attached gingiva

Question 8. Periosteum.
Answer:

• It is the tissue covering the outer surface of the bone
• It consists of
  • Inner layers- cells differentiating into osteoblasts
  • Outer layer- Blood vessels, nerves, fibers
  • Collagen fibers- penetrate the bone

Question 9. Functions of the gingiva.
Answer:

1. Attached gingival:

• It braces marginal gingiva
• It allows for proper deflection of food
• It provides room for proper placement of toothbrush
• It is important for the overall maintenance of gingival health

2. Gingival crevicular fluid:

• It cleanses material from the sulcus
• It improves the adhesion of the epithelium to the tooth by plasma proteins
• It possesses antimicrobial properties
• It exerts antibody activity to defend gingiva
• It transports a variety of molecules

3. Gingival fibers:

• Provides support to the gingiva and attaches it to the bone
• It anchors the tooth to the bone
• Maintains relationship of adjacent teeth
• Secures alignment of teeth in the arch

Question 10. Functions of Gingival Fibers.
Answer:

• Adapts marginal gingiva to tooth
• Withstands forces of mastication
• Unites marginal gingiva to cementum

Question 11. Trans-septal fibers.
Answer:

Trans-septal fibers Location:

• Connects the cementum of one tooth to the cementum of the adjacent tooth

Trans-septal fibers Functions:

• Protect interproximal bone
• Maintain tooth to tooth contact

Trans-septal fibers Significance:

• These are the last to get destroyed due to disease condition
• They are the first to degenerate

Question 12. Blood supply to the gingiva.
Answer:

1. Supraperiosteal arteries:

• Arises from above alveolar bone
• Branches and supplies facial and lingual surfaces

2. Vessels of the periodontal ligament:

• Anastomoses with the capillaries

3. Arterioles emerging from the crest of the interdental septa:

Question 13. Fibroblasts.
Answer:

• They are spindle-shaped cells
• Synthesizes chondroitin sulfate, heparin sulfate, and hyaluronic sulfate
• Synthesizes connective tissue matrix
• It produces
  • Collagen fibers
  • Reticulin fibers
  • Oxytalalan fibers
  • Elastin fibers

Question 14. Epithelial cell rests on molasses.
Answer:

• It is a remnant of Hertwig’s epithelial root sheath
• Present near and parallel to root surfaces
• Attached to one another by desmosomes
• During disease conditions they undergo proliferation
• Persists as a network strand, island, or tubule
• Exhibits tonofilaments

Question 15. Gingival col.
Answer:

• Col is the depressed central concave area, which fits below the contact point

Gingival col Features:

• It lies directly below the contact points of the teeth
• It connects the facial and Lingual papilla
• It is derived from reduced enamel epithelium

Gingival col Histology:

• The epithelium of the col is non keratinized
• This epithelium is continuous with junctional epithe- lium on each side
• The connective tissue contains xylan fibers
• Its potential as a stagnant site makes it highly susceptible to inflammatory diseases

Question 16. Osteoclast.
Answer:

• They are multinucleated giant cells
• Precursor- Blood-borne monocytes

Osteoclast Functions:

• Resorption of bone
• Secretes hydrolytic enzymes

Question 17. Mechanism of tooth Support.
Answer:

1. Tensional theory:

Application of forces
↓
Straightening of principal fiber
↓
Transmission of forces to alveolar bone
↓
Causes elastic deformation of socket

2. Viscoelastic theory:

Transmission of forces to tooth
↓
Transportation of extracellular fluid into marrow spaces
↓
Bundle fibers absorb shock and tighten

Question 18. Difference between acellular and cellular cementum.
Answer:

Question 19. Sharpey’s fibers.
Answer:

• Sharpey’s fibers are contained in bundle bone
• Arranged parallel to the root
• Some fibers are completely calcified while most contain an uncalcified central core within a calcified outer layer

Question 20. Bundle Bone.
Answer:

• It is a bone adjacent to the periodontal ligament con- training a great number of Sharpey’s fibers
• Thin lamellae are arranged in layers parallel to the root
• Bundle bone occurs throughout the skeletal system wherever ligaments and muscles are attached

Question 21. Interdental Septum.
Answer:

Interdental Septum Consists of:

• Socket walls
• Facial and lingual plates

Interdental Septum Significance:

• Factors Affecting Its Dimensions:
• Size of adjacent teeth
• Convexity of crowns of adjacent teeth
• Position of teeth in the jaw
• Degree of the eruption of teeth

Question 22. Hypercementosis.
Answer:

• Prominent thickening of cementum

Hypercementosis Types:

1. Localized
2. Generalized

Hypercementosis Types Etiology:

Hypercementosis Types Localized:

• Excessive tension
• Excessive occlusal forces

Hypercementosis Types Generalized:

• Periapical infections
• Paget’s disease

Question 23. Cemento enamel junction.
Answer:

• It is a junction of the enamel of the crown and the cementum of the root

Cemento enamel junction Types:

• 60-65%-Cementum overlaps enamel
• 30%-End to end a relationship
• 5-10%-Cementum and enamel fail to meet

Question 24. Acellular cementum.
Answer:

• Acellular cementum is first formed cementum
• It is formed during root formation
• Covers approximately the cervical third or half of the root
• It does not contain cells
• If interdental space is narrow, the septum may consist
• It is formed before the tooth reaches the occlusal plane
• Its thickness ranges from 30-230 micrometers

Acellular cementum contains:

1. Sharpey’s fibers:

• It supports the tooth
• Inserted at an approximately right angle into root surfaces
• They are completely calcified

2. Intrinsic collagen fibrils:

1. Calcified fibers
2. Irregularly arranged or parallel to the surface

Question 25. Mast cells.
Answer:

• They are small, round, or oval cell
• Contains cytoplasmic granules
• These granules contain heparin and histamine
• During an inflammatory response, these cells release their- time causing the antigen-antibody formation

Question 26. Differences between attached gingiva and al-volar mucosa.
Answer:

Question 27. Palatogingival groove.
Answer:

• Palatogingival groove is found primarily on maxillary incisors
• It is associated with increased plaque accumulation, clinical attachment, and bone loss
• These are developmental grooves that sometimes appear in maxillary lateral incisors
• It leads to accessibility problems

Question 28. Define and classify embrasures.
Answer:

Embrasures:

• When two teeth in the same arch are in contact, their curvature adjacent to the contact areas forms spillway spaces called embrasures

Embrasures Functions:

• Provides spillway for food during mastication
• Prevents food from being forced through the contact area
• Make the teeth more self-cleansing

Embrasures Types

• Interproximal embrasure
• Embrasure with no gingival recession
• Larger spaces with exposed root surfaces

Question 29. Functions of cementum.
Answer:

1. Anchorage:

• Provides anchorage to the tooth in its alveolus

2. Occlusal maintenance:

• Continuous deposition helps in achieving the crown length lost due to attrition

3. Reparative:

• It serves as major reparative tissue for root surfaces
• It maintains the integrity of root surfaces

Question 30. Define periodontal ligament. What does it? There are small collagen fibers associated with the lar- comprise of?
Answer:

Periodontal Ligament:

• It is the specialized connective tissue that forms the inter. face between the tooth and the alveolar bone

1. Cellular components:

• Synthesizing cells:
  • Fibroblasts
  • Cementoblasts
  • Osteoblasts
• Resorptive cells:
  • Fibroblasts
  • Cementoclasts
  • Osteoclasts
• Epithelial cells:
  • Cell rests of Malassez
• Progenitor cells:
  • Undifferentiated mesenchymal cells
• Defense cells:
  • Mast cells
  • Macrophages

2. Extracellular components:

• Fibers:
  • Collagen fibers
  • Elastic fibers
  • Oxytalan fibers
  • Elaunin fibers
• Ground substances:
  • Protein polysaccharides
  • Glycosaminoglycans
  • Proteoglycan
  • Glycoprotein
  • Fibronectin

3. Connective tissue component:

• Blood vessels
• Nerves
• Lymphatics

Question 31. Define intermediate plexus.
Answer:

• There are small collagen fibers associated with the larger principal collagen fibers
• These fiber run in all directions forming a plexus called the intermediate plexus
• They are reticulate fibers which are fine, immature collagen fibers with the lattice-like arrangement

Question 32. Parts of the alveolar bone
Answer:

The alveolar bone contains two parts

1. Alveolar bone proper

• It is 0.1-0.4 mm thick
• It surrounds the root of the teeth
• Gives attachment to principal fibers of PDL
• Parts
• Lamellated bone
  • Contains osteon which contains blood vessel
  • Bundle bone
  • The bone directly lining the socket is referred to as bundle bone

2. Supporting alveolar bone

• The bone that surrounds the alveolar bone proper and gives support to the socket is called the supporting alveolar bone
• It consists of:
• Cortical plate
  • It forms the outer and inner plates of the alveolar processes
• Spongy bone
  • It is bone occupying the central part of the al-alveolar process

Question 33. Factors affecting the color of gingiva

• The color of the gingiva normally appears coral pink.
• It depends on
  • Degree of keratinization
  • Thickness of epithelium
  • Degree of pigmentation
  • Amount of circulation

Periodontics Normal Periodontium Viva Voce

1. The gradual increase occurs in GCF amount from 6:00 am to 10:00 pm and decreases afterward.
2. Non-keratinocytes present in the gingival epithelium are: melanocytes, Langerhans cells, Merkel cells
3. The junctional epithelium is collar like a band of non-keratinizing epithelium
4. Values:
   
5. Stippling is seen in the attached gingiva and central core of the interdental papilla.
6. It is absent in marginal gingiva
7. Sulcular epithelium is non-keratinized and without recipes
8. The junctional epithelium is widest in the coronal portion and thin towards the center
9. The turnover rate of junctional epithelium is about 5 days
10. The attachment apparatus of the tooth includes the periodontal ligament, cementum, and alveolar bone
11. Progenitor cells are undifferentiated mesenchymal cells.