- Explain how gingival recession occurs and what are some of the causes of recession? Why would patients with thin gingival biotypes be more prone to gingival recession than those with thicker gingival biotypes?
2. Explain the meaning of probing depth.
a. What is considered to be a healthy probing depth?
b. What is a periodontal pocket?
c. Can you determine the depth of a periodontal pocket from a radiograph? Justify your answer.
3. What is a pseudopocket? How is this formed?
4. What is attachment loss? Why is this considered to be a more critical determinant of periodontitis than pocket depths alone?
1. Gingival recession is when the gingival margin moves away from the crown of the tooth, exposing the root. There are many reasons why recession occurs:
ReplyDelete- aggressive or excessive toothbrushing
- trauma to gums (can be through habits such as chewing on wood sticks)
- oral piercings
- tooth position (crowding of teeth may cause inadequate jaw bone covering tooth)
- post orthodontics
- periodontal disease (as alveolar bone is lost around tooth, gingiva follows contour of bone and sits around 3mm above it)
- dehiscence of alveolar bone
People with thinner gingival biotypes are more susceptible to recession as the gingiva is much more delicate and won't be able to withstand the same forces as someone with a thick biotype. Thicker biotypes are thick as there is more buccal plate in the arch and therefore more collagen fibers are needed to attach and this results in the thick, robust gingiva. Therefore, thick biotype have more chance of resisting trauma and bacteria invasions and will take more for the gingiva to receed.
Well done Beth. I am liking the fact that you picked up on the dehiscence. What about the fenestrations?
DeleteWell done Beth. I am liking the fact that you picked up on the dehiscence. What about the fenestrations?
Delete2. Probing depth is the measurement from the gingival margin to the bottom of the gingival sulcus
ReplyDeletea) a Healthy probing depth is less than 3mm
b) a probing depth only becomes a pocket once it is 3mm or more. The periodontal pocket is caused by bone loss around the tooth caused by the cells (WBC?) within the crevicular fluid? and junctional epithelium fighting the bacteria. As it is fighting the bacteria, the WBC role is to protect the body and therefore will do all it can to remove the bacteria, even if it means destroying the oral tissues (alveolar bone)
c) bone loss can be detected on a radiograph, however radiographs are only 2 dimensional. You can't see the extent of bone loss from all surfaces of the tooth and therefore a clinical examination will have to be performed to confirm. The radiograph also doesn't show the gingiva (it isn't dense enough and therefore appears radiolucent) therefore it would be impossible to determine the depth from the gingival margin to the bottom on of the sulcus
Ok Beth.. you are definitely on the right track. You are jumping to second year perio lectures! let's just take a step back. A periodontal pocket is caused by the apical migration of the junctional epithelium in response to the loss of alveolar bone height due to periodontal disease. Periodontal disease is caused by the invading toxins from the bacteria which instigates an inflammatory response. The inflammatory response is indiscriminate so will also attack the body's own cells. The WBCs we find in crevicular fluid provide a first line of defense but this can be overcome by increasing bacterial growth. Hope this makes sense?
DeleteThanks Sophie! So concentrate more on the inflammatory response? And highlight the apical migration of the junctional epithelium is a result of alveolar bone height loss? In an scam question would you go into details of perio (toxins, bacteria WBC etc?) or would it depend on the question and how many marks it's worth? I could only imagine how frustrating it would be to mark exams which rant on a little bit! (which I am guilty of!!)
DeleteBeth
Hi Beth
DeleteYou don't need to go into details of the inflammatory response yet, only know that alveolar bone height is lost due to periodontal disease. When this happens the junctional epithelium migrates apically to maintain the 2mm biological width between the JE and the height of alveolar bone. I never fine students frustrating Beth! Keep up your enthusiasm for learning, it's fantastic to see such engaged students.
Hi Beth
DeleteYou don't need to go into details of the inflammatory response yet, only know that alveolar bone height is lost due to periodontal disease. When this happens the junctional epithelium migrates apically to maintain the 2mm biological width between the JE and the height of alveolar bone. I never fine students frustrating Beth! Keep up your enthusiasm for learning, it's fantastic to see such engaged students.
Hi Sophie,
DeleteThe part where I added about gingiv biotypes, would that answer not be sufficient? U mentioned veronica added in what I missed. Her answer was really good and included an example, would u suggest using examples in questions like that?
Thanks!
Yes that would be sufficient with an example like Veronica's.
DeleteWell done girls.
and my pleasure!
3. A pseudo pocket is a 'false' or relative gingival pocket - deepening of the sulcus caused by gingival hyperplasia (gingiva migrating coronally). The pocket is caused by an increase in gingival height instead of attahment loss.
ReplyDeleteTo determine the difference between a pseudo pocket and periodontal pocket, it is important to know in healthy gingiva the gingival margin should be around the CEJ (or 1mm above).
This is still a concern as it is an area which harbours plaque and bacteria and can lead to periodontal diseae
1. Gingival recession is the migration of gingival tissues towards the tooth apex. There can be various causes of recession, such as:
ReplyDelete- Abrasion from tooth brushing (very common)
- Abrasion from external objects within the mouth
- Alveolar Bone loss
- Orthodontic treatment
The most common area to experience recession is the premolar and canine area, as the alveolar bone in thinner and in regards to abrasion, it is a difficult area for people to clean correctly and effectively.
Patients that have thin biotypes are more prone to gingival recession as their gingiva is thinner. Due to having thinner gingival, these individuals would required weaker forces (than those with thicker biotypes) to cause trauma and damage to the tissues. For example, if an individual has a thin biotype and uses great finger pressure while brushing, abrasion is more likely to occur.
2. Probing depth is the depth of the gingival sulcus.
a. A healthy probing depth is up to 3mm
b. A periodontal pocket is a probing depth greater than 3mm, in which the junctional epithelium has migrated apically.
c. The depth of a periodontal pocket cannot be determined from a radiograph, as the tissue cannot be seen on a radiograph. This is due to the tissue being unmineralised, therefore appearing radiolucent. Although it is radiolucent, the surrounding soft tissues appear the same radiolucent colour, therefore making it impossible to differentiate between them. The radiograph does show the periodontal ligament space, however the epithelial tissues (junctional, sulcular and oral) cannot be differentiated.
3. A pseudopocket is a ‘fake’ pocket. During a periodontal probing examination, the junctional epithelium is probed, causing it to become inflamed, due to the influx of inflammatory cells. If the pocket is probed within a few days of the initial exam, a pseudopocket will be recorded, as the tissues are inflamed, possibly causing the pocket size to appear to have increased. Therefore, due to the cell turn over rate, 10 days is recommended before performing another periodontal examination, in order for the cells to recover and reform the junctional epithelium.
4. Attachment loss is simply the loss of attachment between the junctional epithelium and CEJ. Pocket depth can be naturally deeper in various individuals, therefore, making it an unreliable feature. Loss of attachment is a more critical determinant of periodontitis as involves the junctional epithelium migrating apically, therefore, causing some of the Sharpey’s fibres that connect to the Cementum to be broken. This characteristic is therefore a better determinant as this aspect is the main feature of periodontal disease.
whoops, for question 3. I mean migrating coronally, therefore, increasing the crest height, and thus causing the pocket depth to seem to have increased
ReplyDeleteGood stuff Veronica. You picked up on the biotype issues to add on to Beth's response and as well as that provided a very good explanation of radiographic understanding.
DeleteHowever, pseudopockets can also be caused by gingival inflammation in response to biofilm. In this case as there has been no bone loss the junctional epithelial cells migrate laterally (not apically) due to the inflammation. THis is also reversible similar to the situation you highlighted above once you remove the causative factors.
Good work girls.