PERIODONTAL PATHOLOGY

Hayyu failasufa, drg

DEFENSE MECHANISM OF GINGIVA
 Gingival tissue constantly subjected to mechanical &
bacterial agregation

SALIVA,EPITHELIAL SURFACE,
INFLAMATORY RESPON ( INITIAL STAGE)
GINGIVAL CREVICULAR FLUID ( GCF)
 SULCULAR FLUID has been known  19 century 
Brill and Krasse 1950
 METHOD OF COLLECTION
 Absorbsing paper strips
 Twisted threads
 Micripipettes
 Intracrevicular Washing
How to collect GCF
PERMEABILITY OF JUNCTIONAL
EPITHELIUM
 ALBUMIN
 ENDOTOXIN Amount
 THYMIDINE Mean GCF  0.43-1.5mikrol in
 HISTAMIN human with GI less than 1
 PHENYTOIN
 HORSE RADISH PEROXIDE
 SUBTANCES up to 1000kD
Compotition of GCF

CELLULER NON CELLULER Organic

COMPONENTS COMPONENTS compound
• Desquamated • Immunoglobins • Glucosa
epithelial cell • Complement hexosamine
• Leukocytes • Serum protein, • Hexuronic acid
• Microorganism cytokine
• Antimicrobial
lysosomal
enzymes
• Elyctrolyte Ca,
PO4,Na
Metabolic product in GCF

Lactic acid Urea hydroxyproline

Cytotoxyn
Endotoxin Hydrogen sulphide
and antibacterial
factor
CELULAR & HUMORAL ACTIVITY
 IL-A and IL-B increase the binding of PMNs and
monocyte, macrophage endothelial cells  stimulate
the production of PGE-2 – release of lysosomal
enzymes and stimulate bone resoption
 Interferon-a present in GCF has protective role in
periodontal disease because of its ability to inhibit bone
resoption activity of IL-B
CLINICAL SIGNIFICANCE OF GCF
 Inflamatory exudate
 GCF production is increased by mastication of coarse
food, toothbrushing, gingival massage, ovulation,
hormonal contraceptives, smoking circardian periodicity,
& periodontal therapy
LEUKOCYTES IN DENTOGINGIVAL AREA
 Leukocyte are present in gingival sulcus even when
histologic section are free of inflamatory
 The most common leukocyte present in the gingival
sulcus  PMNs
 The first line of defense in the dentogingival area 
neutrophil
GINGIVAL INFLAMATION
STAGE I : Intitial lession

• GINGIVAL INFLAMATION  vascular changes consisting of

dillate capillary & increased blood flow
• Response to microbial activation endothelial cell

STAGE II : Early lession

STAGE III: Established lession

STAGE IV: Advanced lession

• Extension of the lession into alveolar bone characterizes

Clinical feature of gingivitis

Redness and sponginess of gingival tissue

Bleeding on provocation

Changes in contour

Presense of calculus or calculus with no radiograph

evidece of crestal bone loss
Course & Duration
 Gingivitis can occur with sudden onset and short
duration and can be painful  Acute gingivitis
 Gingivitis can reappears after having been eliminated by
treatment or dissapeared spontaneously  Reccurent
gingivitis
 Gingivitis can be slow in onset and of long duration
Chronic gingivitis
CLINICAL FINDING

• Bleeding on
probing
• Color
CLINICAL • Consistency
FINDING • Contour
• Position
• Surface texture
Bleeding on Probing
 Earliest signs of gingival inflamation
 BOP Iis widely used to measure :
 Disease prevalance
 Progression
 Outcome of treatment
 Motivate patient
Bleeding on Probing
Local factor
• Anatomic & developmental
tooth variation
• Caries
• Frenulum pull
• Iatrogenic factor
• Malpositioned teeth
• Mouth breathing
• Overhangs
• Partial denture
• Lack of attached gingiva
• Recession
• Orthodontic treatment and
fixed retainer
Systemic factor
• Vascular abnormalities
• Platelete disorder
• Hypophrotombipenia
• Coagolation effect
• Multiple myeloma & post rubela
purpura
• Androgenic hormone
• Estrogen/progesterom
• Diabetes
• Several medication
COLOR
 color changes in gingiva is determined by several factors:
 Number and size of blood vessel
 Ephitelial thickness
 Quantity of keratinization
 Pigment within the epithelium

RED, REDDISH
CORAL PINK BLUE, DEEP BLUE
CONSISTENSY
SURFACE TEXTURE
 Normal gingival  stippling ( orange –peel appearance)
 Chronic  smooth, shiny, or firm and nodular
POSITION OF GINGIVA
 ETIOLOGY OF GINGIVAL RESESION
 Toothbrush technique
 Toot malposition
 Friction from soft tissue
 gingival inflamation
 Abnormal frenulum attachment
CONTOUR
 Changes in gingival contour are primarily associated with
gngial enlargment, but such changes may also occur in
other condition

Stillman’s cleft McCall Feestoon

HISTOPATOLOGIC
PERIODONTITIS
THANKYOU