GINGIVAL DISEASES – THEIR AETIOLOGY, PREVENTION AND TREATMENT Edited by Fotinos S. Panagakos and Robin M. Davies Gingival Diseases – Their Aetiology, Prevention and Treatment Edited by Fotinos S. Panagakos and Robin M. Davies Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Alenka Urbancic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Colgate-Palmolive, Co. 2011. Used under license from Shutterstock.com First published September, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Gingival Diseases – Their Aetiology, Prevention and Treatment, Edited by Fotinos S. Panagakos and Robin M. Davies p. cm. ISBN 978-953-307-376-7 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Gingival Tissues and Plaque-Associated Gingival Disease 1 Chapter 1 The Anatomy and Physiology of the Healthy Periodontium 3 Anthony Palumbo Chapter 2 Plaque Biofilm 23 Prapulla Devi Venkataramaiah and Baswaraj Biradar Chapter 3 Gingival Indices: State of Art 41 Maria Augusta Bessa Rebelo and Adriana Corrêa de Queiroz Chapter 4 Etiology of Gingivitis 55 Antonio Bascones-Martínez, Elena Criado-Cámara, Cristina Bascones-Ilundáin, Santiago Arias Herrera and Jaime Bascones-Ilundáin Chapter 5 Components of Host Response to Pathogenic Bacteria in Gingivitis 67 Jorge Gamonal, Nora Silva, Marcela Hernández, Nicolás Dutzan, Jocelyn Garcia-Sesnich, Loreto Abusleme, Andrea Dezerega and Rolando Vernal Chapter 6 Innate Immunite and Inflammation 81 Patrícia Abrahão and Dagmar Ruth Stach-Machado Chapter 7 Gingival Tissue and Pregnancy 95 Gloria Inés Lafaurie Chapter 8 Diagnosis and Monitoring of Gingivitis in vivo Using Non-Invasive Technology - Infrared Spectroscopy 115 Kan-Zhi Liu, Xiaoming Xiang, Anastasia Cholakis and Michael G. Sowa VI Contents Chapter 9 Gingivitis Control 133 Kirsten J Wade and Alison M Meldrum Chapter 10 Periodontal Inflammation: From Gingivitis to Systemic Disease? 149 Fotinos Panagakos and Frank Scannapieco Part 2 Non-Plaque Associated Gingival Disease 163 Chapter 11 Diagnosis and Management of Desquamative Gingivitis 165 Hiroyasu Endo and Terry D. Rees Chapter 12 Genetic Disorders Associated with Gingival Enlargement 183 Mostafa Ibrahim, Maha Abouzaid, Mennat Mehrez, Heba Gamal El Din and Ghada El Kamah Chapter 13 Gene Polymorphisms in Gingivitis 203 Lydie Izakovicova Holla, Kristina Musilova, Jan Vokurka, Pavla Pantuckova, Lubomir Kukla, Martina Kukletova and Zdenek Broukal Preface Gingival diseases are a family of distinct pathological entities that involve the gingival tissues. The signs and symptoms of these diseases are so prevalent in populations around the world that they are often considered to be “normal” features. Many attempts have been made to classify gingival diseases, the most recent being that by Mariotti (1999). The diseases are now classified into two main groups namely: Plaque- Induced and Non-Plaque Induced Gingival Diseases. The Plaque-Induced lesions are influenced by a range of factors such as systemic diseases, medications and malnutrition and non-Plaque Induced lesions may be the result of specific bacterial, viral and fungal infections, trauma and dermatological diseases. All these factors have been considered in developing the new classification. Although gingival lesions may occasionally be painful in most instances the signs and symptoms are not perceived by the individual as other than an inconvenience. Gingival lesions do not pose an immediate threat to the dentition and usually respond to relatively simple measures performed by the dental professional and improved levels of oral hygiene performed by the individual at home. Whilst gingival lesions are essentially reversible if left untreated they can progress to irreversible loss of the periodontal tissues (periodontitis) and threaten the life of the natural dentition. Recent studies have implicated gingival lesions as playing a role in various systemic conditions such as heart disease and have consequently received more attention than before. This book provides dentists, dental hygienists, dental therapists and students with a comprehensive review of gingival diseases, their aetiology and treatment. We hope that the reader finds this book and its contents a worthy addition to his or her medical and dental library. Dr. Fotinos S. Panagakos and Robin M. Davies Colgate-Palmolive, Research and Development division, Piscataway, USA [...]... groove appears at the border of the free and attached gingiva and usually represents the base of the gingival sulcus The gingival sulcus is the invagination around a tooth bounded by the free gingival margin Fig 4 Stippling of gingival tissue 6 Gingival Diseases – Their Aetiology, Prevention and Treatment Fig 5 Width of attached gingiva in specific areas The Anatomy and Physiology of the Healthy Periodontium... ligament and alveolar bone proper respectively Fig 17 Initial Stages of tooth development (Garant 2003) Fig 18 Detail of the bell stage (Garant 2003) 20 Gingival Diseases – Their Aetiology, Prevention and Treatment As the development of the future crown progresses, the development of the periodontal structures and root takes place The inner and outer enamel epithelium proliferate and fuse and become... metabolism and aerotolerance, with the number of gram-negative cocci, rods and filaments increasing as more anaerobic bacteria appear (Sbordone and Bortolaia,.2003) As the biofilm thickens and becomes more mature, anaerobic bacteria live deeper within the biofilm which protects them from the aerobic environment within the oral cavity 26 Gingival Diseases – Their Aetiology, Prevention and Treatment. .. as histamine and proteolytic enzymes Once 12 Gingival Diseases – Their Aetiology, Prevention and Treatment activated by stimuli, the cells can degranulate and induce changes in blood flow to the area and increase tissue permeability The immunologic cells present are macrophages, neutrophils, lymphocytes, and plasma cells These cells are present to initiate and maintain a response to a foreign substance... A)osteon B)vascular configuration 18 Gingival Diseases – Their Aetiology, Prevention and Treatment Osteoclasts are derived from monocytes and resorb bone by a specialized feature called a ruffled border This structure seals off an area and then vesicles stored within the osteoclast are released to cause the breakdown These enzymes include acid phosphatase, cathepsins, and matrix metalloproteinases The... follows a path that parallels the positions of the cementoenamel junctions of teeth (Ritchey and Orban 1953) In health the interdental bone is 1.0mm from the cementoenamel junction and increases with age to 2.8mm (Gargiulo 1961) 8 Gingival Diseases – Their Aetiology, Prevention and Treatment Fig 7 Appearance and location of periodontal components on a periapical radiograph 3 Microscopic appearance of... 3:504 Ritchey, B and Orban, B (1953) The crests of interdental alveolar septa J Periodontol, 24:7587 Rose, Louis F (2004) Periodontics: Medicine, Surgery and Implants Mosby ISBN 0801679788 St Louis Schroeder, H.E & Listgarten, M.A (1997) The gingival tissues: the architecture of periodontal protection Periodontology 2000 13, 91–120 22 Gingival Diseases – Their Aetiology, Prevention and Treatment Sodek... attachment (Costerton and Lappin-Scott, 1995) More recently a biofilm was defined as a microbially derived sessile community characterized by cells that are irreversibly attached to a substratum or interface or to each 24 Gingival Diseases – Their Aetiology, Prevention and Treatment other, are embedded in a matrix of extracellular polymeric substances that they have produced, and exhibit an altered... chondroblasts, osteoblasts and other cells in a manner described previously The fibers are 14 Gingival Diseases – Their Aetiology, Prevention and Treatment typically Type I collagen The fibers can also be arranged by their position and orientation The six groups are the transseptal, horizontal, alveolar, oblique, apical, and radicular groups (Fig 13) The transseptal group extends from the cementum of one tooth... margin is situated about 2mm coronal to the cementoenamel junction of the tooth and the attached gingiva extends from the base of the free gingiva to the mucogingival 4 Gingival Diseases – Their Aetiology, Prevention and Treatment junction (Ainamo and Loe 1966) The gingiva is typically coral pink in color, but may vary due to physiologic pigmentation among some races, whereas the alveolar mucosa is deep . GINGIVAL DISEASES – THEIR AETIOLOGY, PREVENTION AND TREATMENT Edited by Fotinos S. Panagakos and Robin M. Davies Gingival Diseases – Their Aetiology, Prevention. Gingival Diseases – Their Aetiology, Prevention and Treatment, Edited by Fotinos S. Panagakos and Robin M. Davies p. cm. ISBN 97 8-9 5 3-3 0 7-3 7 6-7 free online editions of InTech Books and. Garcia-Sesnich, Loreto Abusleme, Andrea Dezerega and Rolando Vernal Chapter 6 Innate Immunite and Inflammation 81 Patrícia Abrahão and Dagmar Ruth Stach-Machado Chapter 7 Gingival Tissue and