Drug – Induced Enlargement

• Phenytoin: Fibrotic nature
• Cyclosporine: Vascular nature

Pregnancy Gingivitis

• Angiogranuloma: Appears after 3rd month
• Raspberry appearance: Characteristic finding
• Peak severity: 8th month, decreases in 9th month
• Cause: Increased progesterone levels

Children vs Adults

• Children: T – lymphocyte dominated response

Desquamative Gingivitis

• 75% have dermatological origin
• 50% localized to gingiva only

Desquamative Gingivitis

• Characteristics: Desquamative gingivitis is characterized by intense erythema, desquamation, and ulceration of both free and attached gingiva.
• Associated Diseases:
  • Lichen Planus
  • Pemphigus
  • Pemphigoid
  • Linear IgA Disease
  • Chronic Ulcerative Stomatitis
  • Epidermolysis Bullosa
  • Systemic Lupus Erythematosus (SLE)
  • Dermatitis Herpetiformis

• Biological Width: Composed of connective tissue (1.07 mm) and epithelial attachment (0.97 mm).
• Gingival Sulcus: Shallower in primary teeth; probing depth is 1 – 2 mm.
• Gingival Blood Supply: Includes supraperiosteal arterioles, periodontal ligament vessels, and interdental septa arterioles.
• GCF (Gingival Crevicular Fluid): Can be exudative or transudative; becomes exudative during inflammation.

Pediatric & Pregnancy Considerations

• Safest Dental Care Period: Early second trimester.
• Pregnancy Gingivitis: Characterized by pronounced bleeding.
• Puberty-Related Changes: Increase in P. intermedia and Capnocytophaga.

Finger Rests in Dental Instrumentation

Use of finger rests is essential for providing stability and control during procedures. A proper finger rest allows for more precise movements and reduces the risk of hand fatigue.

Importance of Finger Rests

• Stabilization: Finger rests serve to stabilize the hand and the instrument, providing a firm fulcrum that enhances control during procedures.
• Precision: A stable finger rest allows for more accurate instrumentation, which is crucial for effective treatment and patient safety.
• Reduced Fatigue: By providing support, finger rests help reduce hand and wrist fatigue, allowing the clinician to work more comfortably for extended periods.

Types of Finger Rests

1. Conventional Finger Rest:

   • Description: The finger rest is established on the tooth surfaces immediately adjacent to the working area.
   • Application: This is the most common type of finger rest, providing direct support for the hand while working on a specific tooth. It allows for precise movements and control during instrumentation.

2. Cross Arch Finger Rest:

   • Description: The finger rest is established on the tooth surfaces on the other side of the same arch.
   • Application: This technique is useful when working on teeth that are not directly adjacent to the finger rest. It provides stability while allowing access to the working area from a different angle.

3. Opposite Arch Finger Rest:

   • Description: The finger rest is established on the tooth surfaces of the opposite arch (e.g., using a mandibular arch finger rest for instrumentation on the maxillary arch).
   • Application: This type of finger rest is particularly beneficial when accessing the maxillary teeth from the mandibular arch, providing a stable fulcrum while maintaining visibility and access.

4. Finger on Finger Rest:

   • Description: The finger rest is established on the index finger or thumb of the non-operating hand.
   • Application: This technique is often used in areas where traditional finger rests are difficult to establish, such as in the posterior regions of the mouth. It allows for flexibility and adaptability in positioning.

• Budd-Chiari:
  • Cause: PNH or Polycythemia vera
  • Common site: Hepatic veins
• Wilson Disease:
  • Autosomal recessive < age 40
  • Excess copper in liver + brain

Hormonal Effects on Periodontal Tissues

Optimal Treatment Timing

• Safest Period: Early second trimester (weeks 14-20)
• Rationale: Organogenesis complete, uterine size manageable

Clinical Manifestations

• Most Striking Feature: Pronounced ease of bleeding (pregnancy gingivitis)
• Mechanism: Increased vascular permeability due to hormonal changes

Microbial Changes

• Bacterial Shift: Increased Prevotella intermedia
• Hormonal Influence: Estrogen and progesterone serve as growth factors for certain bacteria