Electron microscope quantitation of inflammatory infiltrates in childhood gingivitis

Abstract

Quantitation of inflammatory cell infiltrates in gingival connective tissues was carried out on 12 gingival biopsies from the deciduous dentition of 11 children aged 4–8 years. The tissue was prepared for electron microscopy and from ultrathin sections mounted on 200 mesh grids, cells in one third of the grid squares enclosing infiltrated connective tissue were counted. The infiltrate displayed large numbers of small and medium lymphocytes and was moderately vascular. A distinct population of peripherally distributed plasma cells was present and pathologically altered fibroblasts together with marked collagen loss were notable features. Small numbers of macrophages, mast cells and polymorphonuclear neutrophils were recorded but T‐blasts (immunoblasts) were very rarely encountered. The childhood lesions have much in common with the early lesion of adult gingivitis which is considered to be a cell‐mediated immune phenomenon. However, the lack of T‐blasts and rather larger proportion of plasma cells suggest that the lesion of childhood gingivitis represents a position between the early and established phases of gingival disease described in older individuals. A more exact interpretation of these, the earliest stages of human gingival disease should be achieved when the lymphocytes contributing to the childhood infiltrates can be assigned to the T‐ and B‐ cell lines.

The composition of gingival inflammatory cell infiltrates in children studied by enzyme histochemistry

“…Using methyl green-pyronin stain on sections of inflamed gingiva from adults and children, they found that small and medium-sized lymphocytes predominated in the latter group. Our findings are, however, at some variance with the observations of Longhurst et al (1980). On the basis of electron microscopic observations which demonstrated a relative lack of transforming T lymphocytes Table 2.…”

“…The proportion of plasma cells appears to increase with increasing severity of inflammation (Lindhe et al 1980). Immunohistochemical studies indicate that there is a gradually increasing proportion of plasma cells producing IgG with increasing severity of the inflammatory changes (Brandtzaeg & Tolo 1977), Longhurst et al, (1977Longhurst et al, ( , 1980 and Seymour et al, (1981) have presented studies based on morphological methods which may indicate that in children, the gingival inflammatory infiltrate contains a higher proportion of lymphocytes than usually seen in CIPD in adults, , on the basis of histochemical and immunofluorescence studies, have presented evidence suggesting that the change from a stable to a destructive lesion may involve a shift from a T cell to a B cell (plasma cell) dominated lesion. However.…”

The role of histopathology in the diagnosis and prognosis of periodontal diseases

“…trated connective tissue, facilitating such a transformation. The time-scale of this change was once considered to be a matter of 2-4 weeks in man (Payne et al 1975, Page & Schroeder 1976, but this was based mainly on extrapolation from experimental studies in animals and it is now clear that such a transition may take much longer in man (Zachrisson 1968, Longhurst et al 1980, Seymour et al 1983a. The transition time probably varies considerably in the different forms of periodontal disease and at different tooth sites within and between patients.…”

“…The transition time probably varies considerably in the different forms of periodontal disease and at different tooth sites within and between patients. The rapid tissue destruction, marked and consistent plasma cell domination seen in Juvenile Periodontitis , Davenport et al 1982, Longhurst et al 1977, Gillett & Johnson 1982, Gillett et al 1986) perhaps reflects a rapid transition, whilst in childhood gingivitis progression of disease and the transformation of B-lymphocytes to active plasma cells appears to be indefinitely delayed (Longhurst et al 1977, Longhurst et al 1980, Gillett et al 1986, Walsh et al 1987. Brecx et al (1987b) have recently shown that even when 3 to 4 weeks of meticulous professionally administered oral hygiene has rendered the gingiva healthy as judged by clinical evaluation.…”

“…Thus as the gingival inOammatory infiltrate develops and increases in size, it becomes stratified with small lymphocytes and heutrophils coming to lie against the basal lamina, just under the junctional and pocket epithelium, while the growing numbers of plasma cells congregate deeper in the connective tissue at the border of the lesion. In the centre of the infiltrated area small lymphocytes, fibroblasts and macrophages can be found (Seymour & Greenspan 1979, Longhurst et al 1980, Okada et al, 1983, It is at this stage that the pocket advances beyond the cement-enamel junction, with a resultant loss of connective tissue attachment and with epithelium coming to lie against the surface of the cementum.…”