Sunday, June 11, 2023

Periodontal pocket differ most significantly from gingival pocket with respect to.. The location of the bone of the pocket. Chronic gingivitis



Periodontal pocket differ most significantly from gingival pocket with respect to:


  • a- Depth.
  • b- Tendency to bleed on gentle probing.
  • c- The location of the bone of the pocket.***
  • d- All of the above.

Chronic gingivitis is, as the name suggests, inflammation of the gingival tissues. It is not associated with alveolar bone resorption or apical migration of the junctional epithelium. Pockets > 2 mm can occur in chronic gingivitis due to an increase in gingival size because of oedema or hyperplasia (false pockets).

Chronic gingivitis.Gingivitis is the most common cause of so-called periodontal diseases, those that affect the tissues that surround and hold the teeth and constitute an inflammatory response, characterized by redness, edema, bleeding, change in the gingival tissue contour , loss of adaptive tooth tissue and increased gingival fluid.

Classification:

It is classified according to its location, extent and anatomoclinic appearance:

- Location:

It can be classified as Localized if it covers a tooth or group of teeth or Generalized if it affects all the teeth in the oral cavity.

- Extension:

it can only affect the marginal or papillary gum or extend from the free gum to the adherent gum. According to these criteria, it is classified as: Papillary, Marginal or Diffuse, respectively.

- Anatomoclinic aspect:

It is classified as: Edematous, Fibrous and Fibroedematous. For this classification, knowledge of the normal characteristics of the gum in terms of color, consistency, contour, size and surface texture is required.
Gum bleeding is not a normal feature, but its presence is a very valuable clinical sign of Chronic Gingivitis that acquires a special connotation for differential diagnosis. When the gingival epithelium is reduced and degenerates, it does not offer the same protective degree, and in the face of simple stimuli such as the simple rubbing of the mucosa of the carrillo, the rupture of the capillaries and the subsequent hemorrhage that patients refer to as spontaneous are caused.

The anatomoclinic aspect of Chronic Gingivitis is representative of the events that occur since the gingival tissue is attacked, undertakes its defense and achieves its recovery or not. In the gum the destruction of its structures occurs when it is attacked by the harmful effect produced by the microbial metabolism of the dentobacterial plaque and the microbiota of the gingival groove, but simultaneously there is an organic response to repair the damage caused, which immediately begins at the aggression happen and extends in the course of its evolution. The extremes of this process of aggression and defense are represented by the destruction of tissue on one side and on the other its repair. The edematous clinical picture identifies the destruction and the fibrous repair.

Actually finding these two extremes in isolation is not the most frequent in the clinic, because a pathogenically appears a balance between destructive and reparative changes that define the manifestations of the clinical picture of Chronic Fibroedematous Gingivitis. The following table shows the variations of the normal characteristics of the gum as the destructive or reparative effects to condition Chronic Edematous or Fibrous Gingivitis are predominant, respectively. Fibroedematous is not included because its clinical manifestations are a combination of both.

Epidemiology:

Chronic Gingivitis affects a considerable part of the child population, mainly in school age, with a pandemic nature. The literature reports high prevalence in different parts of the world, the incidence is increasing with age, associated with deficiencies in Oral Hygiene and hormonal changes of puberty.

Different epidemiological investigations have linked the prevalence of chronic gingivitis with a variety of factors such as: age, sex, educational and socioeconomic status, geographic distribution and place of residence among others; and it has been shown that such factors condition the influence of Oral Hygiene. To determine the Prevalence and Severity of Chronic Gingivitis, various measuring instruments called Indices have been used, some of which allow us to know the status of the disease and other risk factors such as Oral Hygiene.

Risk Factors and Pathogenicity:

Several chronic risk factors have been recognized in chronic gingivitis. Today the greatest risk is attributed to the microbial metabolism of the dentobacterial plaque and the microbiota of the groove, to Smoking and Diabetes mellitus. Other risks have been implicated in the pathogenicity of chronic gingivitis.

  • The dentobacterial plaque and the microbiota of the gingival groove constitute the risk factor most strongly associated with the origin and subsequent evolution of chronic gingivitis perpetuating it as long as the contact of the gum with the plaque accumulations is maintained and in turn condition is the result of an incorrect oral hygiene habit. It is to be considered that in children when effective methods of plaque control are established, chronic gingivitis remits rapidly. It is also necessary to consider that the microbial metabolism and the microbiota of the groove release metabolites that act as antigens that lead to immunopathological abnormalities. The susceptibility of the gum to this disease health process occurs frequently by living with plaque and other risk factors that lead to its accumulation.

  • Smoking constitutes a risk factor strongly associated with chronic gingivitis in the first place because the stains that combustion products generate on the dental surface eliminate the smoothness of the enamel and that rough surface increases the possibility of plaque formation. In smokers there is also a tendency to decrease salivary flow that exerts a similar action. Among other alterations attributed to smoking is the decrease in serum antibody titres and the response of T lymphocytes.

  • Diabetes mellitus is another risk factor closely associated with chronic gingivitis, with a 2 or 3-fold increase in susceptibility, since it reduces polymorphonuclear chemotaxis and collagen synthesis, which results in an inhibition of the response to treatment. In diabetics there is a lower capacity to resist infections.

  • There are also a number of factors that favor the formation of plaque and the microbiota of the groove such as tartar, dental crowding, poor restorations, mouth breathing, presence of decay and poor dental contacts, among others.

  • There are different systemic conditions such as hemopathies, endocrinopathies, psychosomatic disorders, HIV infection and functional states in women, which establish biological conditions in the host favorable to the worsening of pre-established chronic gingivitis symptoms.

Diagnosis:

The diagnosis is established by a correct history and a thorough physical examination, based on the clinical characteristics of the gum, using the probing and ruling out the possibility of bone loss by X-rays.

Forecast:

The prognosis of chronic gingivitis is favorable to the extent that efficient oral hygiene is achieved that prevents the formation of dentobacterial plaque.

Treatment:

  • The promotion and prevention are priorities in the epidemiological control of chronic gingivitis, so it is necessary to resort to individual Health Education, in social groups and massively throughout the community.
  • Elimination of risk factors by specific health educational guidelines of each of them and control of treatments as appropriate for example: Tartrectomy, correction of malocclusions, therapeutic medical control of systemic conditions.
  • Phytotherapy: Mouthwashes with Calendula, Llantén mayor, Manzanilla or Romerillo 3 times a day. Llantén mayor cream or Chamomile cream 3 times a day. In the post-operative of surgical treatments, indicate mouthwash with Calendula, Llantén mayor, Camomile or Romerillo after brushing.
  • Acupuncture: E-2, E-44, Id-18, Vg-26, Pc-6, Ig-4.
  • Propolis: Remove tartar and dentobacterial plaque and apply 5% propolis tincture. It can also be after brushing, for 7 days. For Dentobacterial Plaque Control, apply 10% alcoholic tincture of propolis on the surface of the teeth.
  • Homeopathy: Prior repertorization of the patient will be indicated.