Disorders of the Periodontal Tissues

(1)

Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
 
Abstract
Disorders of the periodontal tissues can be divided in diseases of the marginal gingiva proper and those also involving the underlying bone of the alveolar socket. Gingival diseases may be either hyperplastic or inflammatory. Periodontal disease is characterised by inflammation and breakdown of bone. Osseous dysplasia may be considered as a hamartoma of the periodontal tissues being composed of connective tissue, bone and cementum. A lot of systemic disorders may have their impact on the periodontal tissues. Most of them do not result in histologic alterations that differ from the common inflammatory changes, a few excluded such as haematological malignancies, amyloidosis and Ehlers-Danlos syndrome.

Disorders of the periodontal tissues can be divided in diseases of the marginal gingiva proper and those also involving the underlying bone of the alveolar socket. Gingival diseases may be either hyperplastic or inflammatory. Periodontal disease is characterised by inflammation and breakdown of bone. Osseous dysplasia may be considered as a hamartoma of the periodontal tissues being composed of connective tissue, bone and cementum. A lot of systemic disorders may have their impact on the periodontal tissues [1]. Most of them do not result in histologic alterations that differ from the common inflammatory changes, a few excluded such as haematological malignancies, amyloidosis and Ehlers-Danlos syndrome [2].

Gingival Inflammation

Gingival inflammation usually is caused by accumulation of bacterial plaque at the adjacent tooth surface. This plaque may be seen in histologic sections as a deep blue mass lying at the surface of the tooth. Toxins of these bacteria as well as enzymes from the attracted neutrophils cause damage to the junctional epithelium that loses its fixation to the tooth. In this way, a niche is created between gingiva and tooth in which further plaque accumulation may occur. The thin layer of junctional epithelium becomes spongiotic and hyperplastic and may even disappear resulting in ulceration. Also, elongated rete ridges develop that penetrate into the underlying fibrous tissue forming the bulk of the free gingiva. In this connective tissue, an inflammatory infiltrate evolves that may be either acute, subacute or chronic (Fig. 9.1a, b). In due time, the inflammation involves the underlying periodontal bone that will be resorbed, thus causing loss of the fixation of the tooth in the jaw bone. At this stage, gingivitis has evolved into periodontitis that will be discussed in section “Periodontitis”.

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Fig. 9.1

Healthy gingival attachment (a) compared with gingival inflammation (b). In the normal situation, the junctional epithelium is only a thin cell layer with some rete ridges extending into the underlying gingival fibrous tissue. In case of gingivitis, the epithelium becomes spongiotic and hyperplastic, and the underlying stroma is densely infiltrated with lymphocytes and plasma cells

Gingival Hyperplasia

Gingival hyperplasia may be generalised in which case one speaks of gingival fibromatosis (Fig. 9.2). It may also occur confined to a limited area of the jaw, then it is called an epulis fibrosa (Fig. 9.3

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Oct 18, 2015 | Posted by in General Dentistry | Comments Off on Disorders of the Periodontal Tissues
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