NON PLAQUE INDUCED

GINGIVAL DISEASES
GINGIVAL DISEASES
Gingival disease of specific bacterial origin

This group of gingival diseases is caused by specific bacteria not considered

periodontal pathogenes

Usually not associated with plaque (biofilm). but plaque may increase severity of
disease

Rare disease ,when immunity is weak

.
 Neisseria Gonorrhea &Treponema Pallidum
Associated Lesions

This bacterium causes syphilis. In a primary syphilis infection, the lips,

gingiva, tongue, tonsils and palate

Streptococcal Species Associated Lesions

Streptococcal gingivitis
These bacteria cause an upper
respiratory infection (tonsillitis, pharyngitis )
with Diffuse gingivitis

Acutely inflamed, diffuse, red, and swollen gingiva

with increased bleeding and occasional gingival abscess formation
Lesions limited to oral cavity

Fever, malaise, and pain

.and ulcers of the oral mucosa may be present
Gingival diseases of viral origin

Herpes Virus Infections

Primary herpetic gingivostomatitis

Recurrent oral herpes

Varicella-Zoster
 Primery herpetic gingivostomatitis

Herpes simplex type 1

of case subclinical 90-95%
Most common in infants <10
rare in adults (short duration and not severe)(
Uncommon before 6 months (maternal antibodies (IgG)

More severe forms in malnutrition and imunnocompromised

infants
 :Symptoms
Fever , malaise, may occur 1 - 2 days before blisters and ulcers appear
Lymphoadenopathy
Excessive salivation

Acute marginal gingivitis

Small and multiple vesicles on both keratinized and nonkeratinized mucosa
These vesicles soon rupture into ulcers

Vesicles on vermellion border and skin of the lip

Recurent herpetic stomatitis
Clusters of small vesicles break into ulcers ( 1-2 mm – On keratinized mucosa
e.g. gingiva, hard palate
 Herpes Zoster(shingles(

Primary Varicella Zoster infection is chicken pox

Herpes Zoster(shingles)
)reactivation of virus – adults(

Reactivation of the latent virus

Virus involve the sensory branch of

trigeminal area
: Unilateral painful Vesicles
Vesicles rupture to form ulcers

:Lesions are
Unilateral
Clusters
Gingival Diseases of Fungal Origin

Generalized Gingival Candidosis

Linear Gingival Erythema

Histoplasmosis
Candidiasis
,Psuedomembranous
Erythematous and
Hyperplastic
 Linear gingival erythema

HIV ass gingivitis

Persistent linear, easily bleeding, erythematous gingiva
Not related to amount of plaque
No ulcerations , no pockets
No response to plaque control
Localised / generalised
Candida
Periodontal pathogens seen in periodontitis
 Gingival Diseases of Genetic Origin
Hereditary gingival fibromatosis

Rare condition characterized by progressive enlargement of the gingiva

Family history
Most cases are seen from birth, but the condition may not be noticed until later
.childhood at the time of eruption of the deciduous or permanent teeth

: Clinical features
Enlarged gingiva presents with normal color, firm consistency, and an abundance
.of stippling of the attached gingiva
Buccal/labial and lingual/palatal tissues may be involved
.in both the maxilla and the mandible
 Desquamative gingivitis
Condition characterized by intense erythema, desquamation and ulceration of the
free and attached gingiva

Desquamative gingivitis is not a specific disease entity, but a gingival

response associated with a variety of conditions

Disorders associated with desquamative gingivitis

Lichen planus

Mucous membrane Pemphigoid

Pemphigus vulgaris

Erythema multiforme
 Desquamative gingivitis

Clinical Features

.Females are more frequently affected

•.Buccal aspect of anterior gingiva on maxilla most commonly affected

The gingiva is fiery red, friable and desquamates easily

,Patients complain of soreness, especially when eating spicy or acidic food

.and of bleeding and discomfort with toothbrushing

.Lesions get aggravated by local plaque accumulation

A positive Nikolsky’s sign may indicate vesiculobullous

disorders
The presence of white plaques or white striae indicate lichen planus
Gingival Manifestations of Systemic Conditions

Mucocutaneous Disorders

Lichen planus

Inflammatory autoimmune mucocutaneous disorder 

Lichen planus is an inflmmatory mucocutaneous disorder

mucosal surfaces (e.g., oral cavity, genital tract, and skin (including the scalp
occurs bilateral

appears as radiating white or gray

’Wickham’s striae‘
Gingival lesions 
Keratotic lesions

Erosive or ulcerative lesions

Vesicular or bullous lesions

Atrophic lesions

HISTOPATHOLOGY
.hyperkeratosis
.saw toothed rete pegs
.colloid bodies present
lamina propria exhibit infiltration of T-
lymphocytes

Treatment
Corticosteroids : Topical application (triamcinolone acetonide)
 Pemphigus Vulgaris

Autoimmune mucocutaneuos disease (vesicles and bullae on skin

and mucous membrane
Skin lesions appear after oral lesions in a period of 1 year
Ulcers preceded by bullae
of cases the first appearance in the oral cavity 60%
More common in the 4th and 5th decade
Often seen in Ashkenazic Jews

Nikolsky sign is positive

Death due to dehydration and secondary infection

 pemphigus Vulgaris

Oral lesions
The first signs of disease occur in the oral cavity in more than 60 % of
.cases

Bullae fragile and quickly rupture to form painful shallow irregular

big ulcers

Desquamative gingivitis

Positive Nikolsky’s sign

.Rubbing with a finger can produce a bullae
 Histopathologically

intraepithelial blister formation resulting from acantholysis, a breakdown of

cellular adhesion between epithelial cells

Basal layer remains attached to the basement membrane

Bulla or vesicle are filled with fluid, Tzanck cells and neutrophils
Tzanck cells (acantholytic cells
The loss of attachment between epithelial cells leads to cells that
appear rounded
 Benign mucous membrane pemphigoid
Autoimmune chronic lesions with benign
course appear as vesiculo-bullous
eruptions mainly involve oral mucosa,
which heal with scaring
May affect also conjunctiva, genital mucosa

Old age more common in female

Oral lesions Desquamative gingivitis
Most common on marginal and attached
gingiva (desquamative gingivitis
vesicles that rupture leaving erosions that
spread peripherally more slowly than
.pemphigus

Skin lesions are uncommon

Nikolsky’s sign is +ve
Histopathology
.intra epithelial clefting above the basal layer
.basal cell layer is intact
acantholysis present
Diagnosis of Mucous Membrane
Pemphigoid
Made by biopsy and histologic examination

subepithelial blisters
separation at the basement membrane
No evidence of acantholysis

Treatment
Topical corticosteroid for mild cases
Systemic corticosteroids may be required for more severe
.cases
Eye lesions can lead to eye damage
Pemphigoid
Chronic autoimmune subepithelial disease primarily affecting the mucous
membranes of patients over the age of 50

.Multiple painful ulcers preceded by bullae

Oral cavity, conjunctiva, mucosa of the nose, vagina, rectum, 

esophagus, urethra
Gingival lesions 
Erosion or desquamation of attached gingival tissues or large areas of
vesiculobullous eruptions
Histopathology
Sub epithelial clefting with epithelial separation from lamina propria leaving an
basal layer intact
Linear IgA disease

:manifested as
.vesicles
painful ulcers
.erosive gingivitis

:Histopathology

.Separation of the basement membrane

Erythema Multiforme

Types 

Erythema multiforme minor

Erythema multiforme major/ Stevens-Johnson syndrome

Etiology 

Herpes simplex
infection
Mycoplasma
infection Drug reactions
Erythema multiforme

Gingival lesions
of patients with skin involvement 70%
Multiple, large, painful ulcers with an erythematous border

Hemorrhagic crusting of vermilion border of lips

Allergic Reactions

Dental Restorative Materials

Reactions Attributable To Toothpastes, Mouth Rinses, Chewing Gum

Additives and Food Additives
Traumatic Lesions

Chemical Injury

Physical Injury

Thermal Injury

Foreign Body Reactions