Clinical & Histological Responses to Treatment of Gingivitis

• What are the 2 possible responses to treatment of gingivitis?

  Resolution of inflammation (favourable response to treatment by healing/treatment success)

  Persistence of inflammation
• How is plaque-induced gingivitis managed?

  Aims: Reduce gingival inflammation, restore gingival health-Supragingival scaling to remove plaque and calculus.-Eliminate/modify local plaque retentive factors-Improve oral hygiene-Smoking cessation advice
• What does resolution of inflammation look like?

  • Changes in colour-pink
  • Changes in gingival contour
  • Presence of stippling
  • Changes in texture - gingiva is more firm
  • Reduction in plaque score
  • Reduction in bleeding on probing score
• How does the histopathogenesis change from healthy gingivae, to gingivitis, to periodontitis?

  
• Describe the histopathogenisis in established gingivitis:


  
• What happens when you carry out supragingival scaling?

  Microbiological changes:-Major disruption to biofilm-Converts a predominantly anaerobic flora to predominantly aerobic floraCellular events during healing:-Initial acute inflammatory response-Initiation of resolution of inflammation
• Describe the microbiological changes that occur during supragingival scaling in more detail.

  -Reduction in total number of organisms-Proportion of Gram -ve anaerobic is reduced-Residual flora is predominately Gram +ve and aerobic

  
• Describe the cellular events that occur during supragingival scaling in more detail.


  First 24-48hrs = acute inflammatory responseWeek 1-4 = reduction in inflammation, reduction in GCF, reduction in inflammatory cells.Fibroblasts migrate into the area, proliferate, lay down ground substance and produce collagen fibres. New gingival connective tissues form with time.

  
• What is the resolution of inflammation consistent with?

  -Reduction in redness-Colour goes to a more healthy pink-Reduction in bleeding on probing-Reduction in swelling-Gingival contour becomes more knife edged-Gingiva is more firm-Presence of stippling
• What are some possible reasons for the persistence of inflammation following gingivitis treatment?

  Clinician factors:-Wrong diagnosis-Inadequate removal of calculus and other plaque retentive factors-Other- failure to remove local plaque retentive factorsPatient factors:-Inadequate plaque control-Lack of compliance/ motivation-Lack of dexterity-Poor/ incorrect technique