Benign Oral and Dental Disease
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The gingivae and the periodontium may become inflamed secondary to a variety of pathological causes ranging from autoimmune to infectious causes (Figure 42.1). The generic terms gingivitis and periodontitis are usually applied to plaque-related inflammation of these tissues. The aetiology of chronic adult periodontal disease is multi-factorial, involving interaction between dental plaque, genetic and environmental risk factors. Dental plaque differing in microbial composition, forms above (supra-) and below (sub-) the gingival margin. Periodontitis develops when the plaque-related gingivitis results in an increase in depth of the gingival sulcus by mechanisms involving apical migration of the gingival attachment to the tooth root surface, loss of connective tissue attachment and alveolar bone loss. Examples of clinical parameters used by dental surgeons to assess periodontal disease include placing a periodontal probe in the gingival sulcus, measuring pocket depth which allows an indication of periodontal attachment loss. Bleeding on placement of the periodontal probe tip into the gingival sulcus or periodontal pocket reflects the presence of active gingival inflammation (Table 42.2). There has been significant research into the aetiology and association between periodontal disease and systemic diseases such as diabetes mellitus and atherosclerotic vascular disease.
The gastrointestinal system
C. Simon Herrington in Muir's Textbook of Pathology, 2020
Disease of the periodontal tissues presents as inflammation of the gingival tissues (gingivitis) or involves the gingivae, the periodontal ligament, and the related alveolar bone (periodontitis). Recent new classification of periodontal disease divides periodontal conditions into four categories: periodontal health, gingival disease and conditions, periodontitis, other conditions affecting the periodontium, and peri-implant diseases and conditions. The most common of these is gingivitis (Figure 10.3), which does not result in the loss of attachment of the periodontal tissues, is reversible and is usually caused by dental plaque but may also be influenced by other factors such as a genetic susceptibility. Periodontitis is measured in Stages (1–4) and Grades (A–C). The higher the stage the more advanced the disease. Grading reflects the rate of progression of disease and the risk of future progression A (slow progression), B (moderate rate of progression), or C (rapid progression). Local and systemic factors influence periodontitis, the most important of which is bacterial plaque within the pocket around the tooth. The inflammation in periodontitis results in the progressive loss of attachment of the periodontal ligament. The deepening of the gingival sulcus occurs with the formation of deep pockets. Prolonged inflammation results in osteoclastic resorption of the alveolar bone which leads to a lack of support and subsequent tooth loss if allowed to progress. Infrequently there may be an acute exacerbation of infection in such pockets and a periodontal abscess can develop.
The Dental Connection to Health
Aruna Bakhru in Nutrition and Integrative Medicine, 2018
Periodontal disease primarily results from a highly complex, anaerobic and dysbiotic biofilm that breeds in the gingival sulcus.19 The disease is exacerbated by a variety of issues: host immunity, genetic susceptibility, hormonal changes, and a vast array of systemic disease states, including obesity, diabetes, osteoporosis, nutritional deficiencies, and poor dietary and sleep habits.26 Emotional states of depression, stress, and distress are independent risk factors for periodontal disease.26 Lifestyle choices such as tobacco and alcohol use, poor oral hygiene and lack of professional care also contribute to the inflammatory response and eventual degradation of the periodontal tissues. Localized oral factors contributing to periodontal disease include decayed teeth, defective restorations, fractured teeth, occlusal imbalances, ill-fitting fixed and removable prostheses, habitual grinding and clenching, xerostomia, and infectious contact.26,27
Critical roles of adherens junctions in diseases of the oral mucosa
Published in Tissue Barriers, 2023
Christina Kingsley, Antonis Kourtidis
The gingival epithelium has been extensively studied due to its implication in periodontal disease. The gingival epithelium is composed of keratinizing stratified epithelium and covers the external surface of the gingiva, which surrounds the teeth (Figure 1).6 An important function of the gingival epithelium is to provide the first line of defense in the oral cavity against pathogens.7 There are several components of the gingiva. The attached gingiva is firmly bonded to the connective tissue over the alveolar bone and is separated from the oral mucosa by the mucogingival line (Figure 1). The attached gingiva is located apically to the gingival sulcus, which is the space surrounding each tooth and is lined by the oral sulcular epithelium (Box 1; Figure 1). This epithelium is stratified and non-keratinized.2 The junctional epithelium is a specialized epithelial component. This epithelium is derived from the enamel epithelium and mediates the attachment of the gingival epithelium to the enamel on the tooth surface (Figure 1).8 This is an important function of the junctional epithelium, because it forms a barrier against pathogens passing from the oral cavity into the tissue that supports the tooth.9 Due to its role, the junctional epithelium isan area of extensive study in periodontal disease,10 where tooth mobility and loss are found. In comparison to the gingival epithelium, the junctional epithelium shows no keratinization and exhibits much higher proliferation and turnover rate2,7,8 (Figure 1).
Proteomic analysis of human immunodeficiency virus and periodontitis
Published in Expert Review of Proteomics, 2020
Sachio Tsuchida, Tomohiro Nakayama
Gingival crevicular fluid (GCF) is the so-called proximal fluid that best reflects the condition of periodontal tissues and is close to the lesion site. GCF has been used widely as a sample. The gingival sulcus, a V-shaped space that surrounds the tooth, exudes the GCF. This fluid contains a large number of enzymes and proteins related to the metabolism of periodontal tissues, and these amounts are said to be very important indicators for understanding the progression of periodontitis and evaluating its pathological processes. However, the level of each enzyme and protein in GCFs is very small, and mass spectrometry can be used to analyze the trace amounts of proteins in periodontal tissues and GCF [18–20]. The gingival sulcus exudate contains various proteins involved in the progression of periodontal diseases and destruction of periodontal tissues; for example, proteins specific to each pathological condition of periodontal diseases are expressed or increased, and enzymes are produced by the destruction of cells. It is expected that some of these proteins are candidate markers for periodontal diseases.
Incorporation of zinc into cetylpyridinium chloride mouthwash affects the composition of multispecies biofilms
Published in Biofouling, 2023
Willy Bustillos Torrez, Luciene Cristina Figueiredo, Thalita Dias Silva Santos, Geisla Mary Soares, João Marcos Spessoto Pingueiro, Hélio Doyle Pereira da Silva, Zilson Malheiros, Bernal Stewart, Magda Feres, Bruno Bueno-Silva
Biofilm models may be considered as the starting point to study new antimicrobials. Taking this into account, the present multispecies in vitro biofilm model was proposed (Soares et al. 2015) and was shown to present a high complexity due to the number of microorganisms included (Coenye and Nelis 2010; Prado et al. 2022). To the best of our knowledge, this biofilm model includes the largest number of microorganisms as well as members of the supra and subgingival biofilm (Miranda et al. 2019; Pingueiro et al. 2019; Miranda et al. 2020). However, one of its limitations consists of the absence of crevicular fluid of the gingival sulcus (Arweiler et al. 2018). Additionally, it should be noted that while this study reports novel information about the in vitro antimicrobial effect of CPC + Zn, clinical studies are necessary in order to support the benefits of this formulation over those obtained with CHX or CPC alone.
Related Knowledge Centers
- Connective Tissue
- Potential Space
- Gums
- Sulcular Epithelium
- Glossary of Dentistry
- Gingival Fibers
- Gingival Margin
- Toothbrush
- Porphyromonas Gingivalis
- Periodontal Fiber