Lecture Notes: Understanding Gingivitis

Introduction

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Overview of Gingivitis

• Definition: Gingivitis means inflammation of the gums, a form of gum disease caused by harmful bacteria.
• Oral Bacteria: Mouth harbors both beneficial and harmful bacteria.
• Plaque Formation:
  • Bacteria combine with sugars and proteins to form plaque.
  • Plaque accumulation can lead to bacterial attacks on gums causing gingivitis.

Contributing Factors to Gum Disease

• Poor oral hygiene.
• Dry mouth due to medication or breathing issues.
• Crowded or crooked teeth.
• Hormonal changes.
• Carbohydrate-rich, vitamin-poor diet.
• Smoking increases risk.

Stages of Gingivitis

1. Initial Stage:

   • Occurs 2-4 days post plaque accumulation.
   • Bacterial toxins initiate inflammation by stimulating immune cells.
   • Histamine, TNF alpha involved.
   • Increased vascular permeability and exudate formation.
   • Known as the "subclinical stage," asymptomatic.

2. Early Lesion Stage:

   • Develops 1 week post initial stage.
   • Exaggeration of initial stage events.
   • Inflammatory cells: Neutrophils, T lymphocytes, macrophages.
   • Destroys gingival fibers, leading to swelling and erythma.
   • Slight gum bleeding during probing.

3. Established Lesion Stage:

   • Occurs 14-21 days after early lesion.
   • Predominantly plasma cells and B lymphocytes.
   • Enzymes like matrix metalloproteins released, destructing collagen fibers.
   • Blood flow reduction causes bluish hue.
   • Formation of pocket epithelium, still reversible with proper care.

4. Advanced Lesion Stage:

   • Involves periodontal breakdown, to be discussed in future videos.

Gingival Anatomy Recap

• Gingiva Structure:
  • Central core of connective tissue covered by stratified squamous epithelium.
  • Three types of epithelium: Oral, Circular, Junctional.
• Junctional Epithelium:
  • Plays central role in gingivitis.
  • Allows movement of immune cells and bacteria/toxins.

Conclusion

• Reversibility:
  • The first three stages are reversible with good oral hygiene.
• Future Content: Advanced lesion will be covered later.
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