The periodontium in health and disease
Gingival apparatus -where PDL is attached; cementum, pdl and alveolar bone
The periodontal tissues exists in three basic stages:
1. Health
A. Clinical Picture of Healthy Gingiva
1. Gingival tissue is pink, maybe pigmented, and if is firm in consistency
2. Gingival margin has scalloped outline
3. There is no bleeding, no sign of inflammation
4. The interdental papilla are firm and occupy the embrasure spaces apical to the contact areas
B. The healthy gingival sulcus
1. The junctional epithelium is firmly attached by hemidesmosomes to the enamel or CEJ
2. The junction epithelium has no epithelial ridges
3. Intact supragingival fiber bundles support the junction epithelium
4. The crest of the alveolar bone is intact and located 2-3mm apical(below) to the base of the junctional epithelium
Histology
State: Health
Junctional Epithelium: at Cemento-enamel junction ; Tight intercellular junction
Connective tissue: Intact ; Supragingival fibers bundles provide support to gingiva and junctional epithelium
Periodontal ligament fibers:Intact ; Attaches root to the bone of the tooth sockets
Alveolar Bone: Intact ; Bone support and protect root of the tooth
2. Gingivitis
-reversible damage
Clinical : Red, Swollen, Bleeding likely
Pseudopocket: Junctional epithelium at Cemento-enamel junction ; Supragingival fiber damage ; Alveolar bone intact ;
Periodontal ligament intact.
Histology
State: Gingivitis
Junctional Epithelium: Junctional epithelium at cementoenamel junction ; Widened intercellular junctions ; epithelial extensions
to connective tissues
Connective Tissue: Damage
Periodontal ligament fibers: Intact
Alveolar Bone: Intact
3. Periodontitis
Clinical: Pink or purplish, Swollen or Fibrotic, Bleeding + halitosis, pus or abscess
Periodontal Pocket: Junctional Epithelium on cementum ; Supragingival fiber destruction ; Alveolar Bone destruction ;
Periodontal ligament destruction
-Vertical Bone Resorption - hard to treat
-Horizontal Bone Resorption - common
Histology
State: Periodontitis
Junctional Epithelium: Junctional Epithelium apical to Cemento-enamel Junction ; Widened intercellular junctions ; Epithelial
extension into connective tissue
Connective Tissue: Destruction of supragingival Fiber
Periodontal Ligament Fibers: Destruction of PDL fibers ; Exposure of cementum to pocket environment
Alveolar Bone: Destruction of bone ; eventual tooth loss
INFLAMMATORY RESPONSE IN PERIODONTAL DISEASE
Inflammation is the body’s reaction to injury or invasion by disease-producing organism. The inflammatory is a proactive body
response that focuses host defense components at the site of infection to eliminate microorganism and heal damaged tissues.
Gingival apparatus -where PDL is attached; cementum, pdl and alveolar bone
The periodontal tissues exists in three basic stages:
1. Health
A. Clinical Picture of Healthy Gingiva
1. Gingival tissue is pink, maybe pigmented, and if is firm in consistency
2. Gingival margin has scalloped outline
3. There is no bleeding, no sign of inflammation
4. The interdental papilla are firm and occupy the embrasure spaces apical to the contact areas
B. The healthy gingival sulcus
1. The junctional epithelium is firmly attached by hemidesmosomes to the enamel or CEJ
2. The junction epithelium has no epithelial ridges
3. Intact supragingival fiber bundles support the junction epithelium
4. The crest of the alveolar bone is intact and located 2-3mm apical(below) to the base of the junctional epithelium
Histology
State: Health
Junctional Epithelium: at Cemento-enamel junction ; Tight intercellular junction
Connective tissue: Intact ; Supragingival fibers bundles provide support to gingiva and junctional epithelium
Periodontal ligament fibers:Intact ; Attaches root to the bone of the tooth sockets
Alveolar Bone: Intact ; Bone support and protect root of the tooth
2. Gingivitis
-reversible damage
Clinical : Red, Swollen, Bleeding likely
Pseudopocket: Junctional epithelium at Cemento-enamel junction ; Supragingival fiber damage ; Alveolar bone intact ;
Periodontal ligament intact.
Histology
State: Gingivitis
Junctional Epithelium: Junctional epithelium at cementoenamel junction ; Widened intercellular junctions ; epithelial extensions
to connective tissues
Connective Tissue: Damage
Periodontal ligament fibers: Intact
Alveolar Bone: Intact
3. Periodontitis
Clinical: Pink or purplish, Swollen or Fibrotic, Bleeding + halitosis, pus or abscess
Periodontal Pocket: Junctional Epithelium on cementum ; Supragingival fiber destruction ; Alveolar Bone destruction ;
Periodontal ligament destruction
-Vertical Bone Resorption - hard to treat
-Horizontal Bone Resorption - common
Histology
State: Periodontitis
Junctional Epithelium: Junctional Epithelium apical to Cemento-enamel Junction ; Widened intercellular junctions ; Epithelial
extension into connective tissue
Connective Tissue: Destruction of supragingival Fiber
Periodontal Ligament Fibers: Destruction of PDL fibers ; Exposure of cementum to pocket environment
Alveolar Bone: Destruction of bone ; eventual tooth loss
INFLAMMATORY RESPONSE IN PERIODONTAL DISEASE
Inflammation is the body’s reaction to injury or invasion by disease-producing organism. The inflammatory is a proactive body
response that focuses host defense components at the site of infection to eliminate microorganism and heal damaged tissues.
