Periodontal Disease Notes And Short Essays

Oral Medicine Periodontal Disease Important Notes

1. Widening of PDL space is seen in

  • Osteosarcoma
  • Chondrosarcoma
  • Scleroderma
  • Trauma from occlusion

2. Obliteration of PDL space is seen in

  • Hypercementosis
  • Ankylosis
  • Hypofunction of teeth
  • Paget’s disease

3. Papillon Lefevre syndrome

  • Juvenile periodontitis
  • Palmar plantar keratosis
  • Calcification of falx cerebri

4. Desquamative gingivitis represents oral manifestations of

  • Lichen planus
  • Cicatricial pemphigoid
  • Pemphigus

Oral Medicine Periodontal Disease Long Essays

Question 1. Describe clinical features, differential diagnosis, and treatment of acute necrotizing ulcerative gingivitis.


Acute Necrotising Ulcerative Gingivitis

  • It is a relatively rare condition and is characterized clinically by necrosis of the free gingival margin the crest of the gingiva and the interdental papillae

Acute Necrotising Ulcerative Gingivitis Clinical Features:

  • Age – 15-35 years
  • Sex – Common in males
  • Initially, the gingiva becomes red and painful
  • Further, punched-out erosion of the interdental papillae occurs
  • Gingiva is covered by a “pseudo-membrane”
  • Bleeding occurs spontaneously or on slight provocation
  • It produces an extremely unpleasant odor
  • The gingival lesion may extend to the mucosal surfaces of the soft palate and tonsils
  • It leads to difficulty in deglutition, mastication
  • Increased salivation and a metallic taste in the mouth

Read And Learn More: Oral Medicine Question and Answers

Acute Necrotising Ulcerative Gingivitis Generalized Symptoms:

  • Headache
  • Fever, malaise
  • Lymphadenopathy
  • Leukocytosis
  • Tachycardia
  • Gastrointestinal disturbances

Acute Necrotising Ulcerative Gingivitis Differential Diagnosis:

  • Primary acute herpetic gingivostomatitis
    • Occurs more frequently in children
    • Characterized by vesicular eruption
      • Erosive lichen planus
      • Drug allergy

Acute Necrotising Ulcerative Gingivitis Treatments:

  1. Removal of pseudomembrane by gently swabbing the area with a cotton pellet
  2. Rinsing the mouth with a glassful of an equal mixture of warm water and 3% hydrogen peroxide
  • Twice daily rinse with 0.12% chlorhexidine
    • Antibiotics:
      • Penicillin V – 250-500 mg or erythromycin 250-500 mg 6 hourly for 7 days
      • Metronidazole 400 mg 8 hourly for 7 days
    • Gingival curettage: After the active phase of the disease
    • Supportive treatment:
      • Fluid consumption
      • Administration of nutritional supplements

Oral Medicine Periodontal Disease Short Essays

Question 1. Pericoronitis.



  • It refers to inflammation of the gingiva about the crown of an incompletely erupted tooth

  Pericoronitis Types:

  • Acute
  • Sub-acute
  • Chronic

Pericoronitis Clinical Features:

  • It occurs most often in the mandibular third molar area
  • The space between the crown of the tooth and the overlying gingival flap leads to the accumulation of food debris and bacteria
  • Thus it is chronically inflamed and infected
  • Various degrees of ulceration occurs
  • The lesion is red, swollen, and suppurating
  • It is tender on palpation
  • The pain radiates to the ear, throat, and floor of the mouth
  • Presence of foul taste
  • Inability to close the jaws
  • Swelling of the cheek in the region of the angle of the jaw
  • Lymphadenitis
  • Fever, leukocytosis, and malaise occur

Pericoronitis Treatment:

  • Antibiotics
  • Phenoxymethyl penicillin 250 mg 4 times daily
  • Metronidazole 200 mg 3 times daily for 7 days
  • Drainage
  • To allow evacuation of pus
  • Extraction – during the sub-acute phase
  • Operculectomy – If retention of 3rd molar is preferred
  • Extraction of maxillary 3rd molar – when mandibular 3rd molar fully erupts

Question 2. Gingival Enlargement.


Gingival Enlargement

  • An increase in the size of the gingiva is termed gingival enlargement

Gingival Enlargement Types:

1. Inflammatory enlargement:

  •  Chronic:
    • It originates as a slight ballooning of the interdental papilla and marginal gingiva
    • In early stages, it produces a life-preserver-shaped bulge around the involved teeth
    • This bulge can increase in size until it covers part of the crown
    • It can be localized or generalized
  • Acute Inflammatory enlargement:
    • Gingival abscess:
      • It is a localized, painful, rapidly expanding lesion that is usually of sudden onset
      • It is generally limited to the marginal gingiva or interdental papilla
      • Initially, it appears as a red swelling with a smooth, shiny surface
      • Within 24-48 hours the lesion usually becomes fluctuant and pointed with a surface orifice from which purulent exudates may be expressed
    • Periodontal abscess: It produces enlargement of the gingiva along with the supporting periodontal tissues

Oral Medicine Periodontal Disease Vertical section through a 4 day human plaque sample.

Oral Medicine Periodontal Disease Vertical section through a 4 day human plaque sample.

Oral Medicine Periodontal Disease Diagram depicting the plaque bacteria association with tooth surface and periodontal tissues.

2. Drug-induced enlargement: Characterized by bead-like enlargement of the interdental papilla and extends to the facial and lingual gingival margins
Oral Medicine Periodontal Disease Scanning electron photomicrograph of cross section of cementum

3. Enlargements associated with systemic diseases:

  • Conditioned enlargement:
    • Types:
      • Hormonal (Pregnancy, Puberty)
      • Nutritional (Vit. C deficiency)
      • Allergy
    • Features:
      • Gingival edema
      • Increased inflammatory response to dental plaque
      • Gingiva is bright red/magenta in color
      • It is soft and friable
      • It has a smooth, shiny surface
      • Bleeding occurs spontaneously or on slight provocation
      • The lesion appears as a discrete, mushroom-like, flattened spherical mass that protrudes from the gingival margin
  •  Enlargement associated with the systemic disease: An existing inflammation initiated by dental plaque

Oral Medicine Periodontal Disease Scsnning electron micrograph of cocci and filaments associated with surface of pocket epithelium in a case of marginal gingivitis

4. Neoplastic enlargement:

  • Benign Tumor of Gingiva:
    • Fibroma
    • Papilloma
    • Leukoplakia
  • Malignant tumor of Gingiva:
    • Carcinoma
    • Malignant melanoma

Oral Medicine Periodontal Disease Histologic section of sub gingival plaque

5. False enlargement: They may appear as a result of an increase in the size of the underlying osseous or dental tissues

Question 3. Halitosis.



  • It is an unpleasant odor exhaled in breathing

Halitosis Classification:

  • Physiologic halitosis
  • Pathologic halitosis
  • Pseudo halitosis

Halitosis Causes:

  • Physiologic
    • Mouth breathing
    • Medications
    • Aging
    • Fasting, starvation
    • Tobacco
    • Food
  • Pathology:
  • Periodontal infection
  • Tongue coating
  • Stomatitis
  • Faulty restoration
  • Unclean dentures
  • Pathologic lesions
  • Abscess

Halitosis Diagnosis:

  • Subjective organoleptic method: It is used as a benchmark
  • Gas chromatography: Measure molecular levels of volatile sulfur compounds
  • Halimeters: Measure the level of sulfide gas
  • BANAtest:

Halitosis Treatment:

  • Improvement of oral hygiene and periodontal health
  • Tongue brushing should be advised
  • Rinsing or gargling with an effective mouthwash
  • Halita – It reduces volatile sulfur compound levels

Question 4. Investigation and management of Primary Herpetic Gingivostomatitis.


Primary Herpetic Gingivostomatitis Investigations:

  • Patient history
  • Clinical findings
  • Direct smear
    • The material is obtained from the base of the lesion and smeared and stained
    • The finding of multinucleated cells with swelling, ballooning, and degeneration is adequate for the diagnosis
    •  Inoculation of the virus from a suspected site to tissue culture
  • Serological studies

Primary Herpetic Gingivostomatitis Management:

  • Local applications:
    • Using 8% zinc chloride, Talbot’s iodine, phenol, riboflavin, thiamine, etc.
    • Chlortetracycline is used as a mouthwash.
  • Palliative treatment:
    • Plaque, food debris, and superficial calculus are removed
    • Relief in pain is obtained with diclonine hydrochloride
  • Supportive treatment: Copious fluid intake and systemic antibiotic therapy i.e. aspirin is administered

Oral Medicine Periodontal Disease Short Answers

Question 1. Name drugs causing gingival enlargement.


Drugs causing gingival enlargement

  • Nifedipine
  • Cyclosporine
  • Dilantin sodium

Question 2. Epulis.



  • It refers to solid swelling situated on the gum

Epulis Types:

1. Granulomatous Epulis:

  • Precipitating factors
    • Caries tooth
    • Denture
  • Poor oral hygiene
  • It manifests as a mass of granulation tissue around the teeth on the gums
  • It is soft to firm fleshy mass and bleeds on touch

2. Fibrous Epulis:

  • It is the commonest form
  • It arises from the periodontal membrane
  • It is present on the gum
  • It may undergo a sarcomatous change
  • It is a firm polypoidal mass, slow-growing, and non-tender

3. Giant cell Epulis:

  • It is an osteoclastoma arising in the jaw
  • It presents as hyperemic vascular oedematous, soft to firm gums with indurated underlying mass due to expansion of the bone
  • It may ulcerate and result in hemorrhage
  • X-ray shows bone destruction with ridging of walls

4. Carcinomatous Epulis:

  • This is an epithelioma arising from the mucous membrane of the alveolar margin
  • Typically, it presents as a non-healing, painful ulcer
  • It slowly infiltrates the bone

Question 4. Drug-induced gingival enlargement


drugs causing gingival enlargement:

Gingival Enlargement 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

Oral Medicine Periodontal Disease Viva Voce

  1. Drug-inducing gingivitis – phenytoin, cyclosporine, and nifedipine
  2. Phenytoin-induced gingivitis starts in interdental papillae
  3. Herpetic gingivostomatitis usually occurs in children and young adults
  4. Pseudomembrane formation occurs in ANUG

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