Gingivitis
Plaque-induced gingivitis is an inflammatory response of the gingival tissues resulting from bacterial plaque accumulation located at and below the gingival margin. It does not directly cause tooth loss, however, managing gingivitis is a primary preventive strategy for periodontitis.
Gingivitis is considered the most common form of periodontal disease, and may not be detected clinically. However, as plaque-induced gingivitis progresses to more established forms of this disease, the clinical symptoms become obvious and may include bleeding with tooth brushing, gingival swelling and redness, tenderness, and halitosis in the case of established forms.
Modifying Factors of Plaque-Induced Gingivitis
- Change in sex steroid hormones
- Puberty
- Pregnancy
- Oral Contraceptives
- Systemic Conditions
- Hyperglycemia
- Leukemia
- Smoking
- Malnutrition
- Dry-mouth (xerostomia)
- Restoration margins below the gumline
- Drugs
- Calcium channel blockers
- Anti-seizure medications
- Immunoregulating drugs
- Periodontitis
- Localized or Generalized
- Molar-incisor pattern (formerly known as Aggressive Periodontitis)
Necrotizing Periodontal Disease
Necrotizing Gingivitis
Necrotizing gingivitis lesions are characterized by the presence of ulcers within gingival connective tissue, surrounded by a non-specific acute inflammatory infiltrate.
Necrotizing gingivitis is an acute inflammatory process of the gingival tissues characterized by presence of necrosis/ulcer of the interdental papillae, gingival bleeding, and pain. Other signs/symptoms associated with this condition may include halitosis, pseudomembranes, regional lymphadenopathy, fever, and sialorrhea (in children).
Necrotizing Periodontitis
Necrotizing Periodontitis is an inflammatory process of the periodontium characterized by presence of necrosis/ulcer of the interdental papillae, gingival bleeding, halitosis, pain, and rapid bone loss. Other signs/symptoms associated with this condition may include pseudomembrane formation, lymphadenopathy, and fever.
Necrotizing periodontal diseases are strongly associated with impairment of the host immune system, as follows: (1) in chronically, severely compromised patients (e.g., AIDS patients, children suffering from severe malnourishment, extreme living conditions, or severe infections) and may constitute a severe or even life-threating condition; and (2) in temporarily and/or moderately compromised patients (e.g., in smokers or psycho-socially stressed adult patients).
Necrotizing Stomatitis
Necrotizing stomatitis is a severe inflammatory condition of the periodontium and the oral cavity in which soft tis- sue necrosis extends beyond the gingiva and bone denudation may occur through the alveolar mucosa, with larger areas of osteitis and formation of bone sequestrum. It typically occurs in severely systemically compromised patients. Atypical cases have also been reported, in which necrotizing stomatitis may develop without prior appearance of necrotizing gingivitis/periodontitis lesions.
Periodontitis as a manifestation of systemic disease
The pathogenesis of periodontal diseases is influenced by various host factors, including immune response, anatomical factors, and tissue structural factors. Most of these factors are determined by the genetic profile of the host and may be modified by environmental and host behavioral factors. Periodontal diseases and certain systemic disorders share similar genetic and/or environmental etiological factors and, therefore, affected individuals may show manifestations of both diseases. Hence, loss of periodontal tissue is a common manifestation of certain systemic disorders, which could have important diagnostic value and therapeutic implications
