Periodontal Diseases
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Chapter seven Periodontal Diseases
Periodontal Tissues of the Teeth
1. alveolar process 2. periodontal ligament 3. gums
definition Periodontal diseases include gingivitis and periodontitis. Both are inflammatory conditions of the gingival tissues (gum tissues around the teeth). In more severe forms, periodontitis includes loss of supporting bone tissue which can lead to tooth loss.
Etiological factors Initial factor Local accelerated factors systemic factors
Initial
factor : dental plaque
A product of microbial colonization and metabolism. Plaque is an irritant and causes inflammation. 1 Bacteria produce byproducts (called toxins or enzymes), along with mucus, constantly form a sticky, colorless “plaque” on teeth.
2 Can damage the attachment of gums, periodontal ligament, and bone to teeth. 3 Brushing and flossing can help
get rid of plaque but when it’s not removed can harden and form dental calculus.
4 Dental calculus forms around teeth. 5 Tissue that attaches the gums to the teeth can be destroyed by the irritants of plaque.
6 Gums pull away from the teeth and small pockets form between the teeth and gums. 7 Pockets become filled with more plaque.
8 Pockets deepen, becoming impossible to clean plaque out. 9 Bone structure supporting teeth can be destroyed.
Local accelerated factors: dental calculus teeth pigmentation food impaction trauma from occlusion/ (occlusal trauma) Abnormal oral conditions or habits others
systemic factors: heredity immune disfigurement sex hormone smoking stress certain diseases (diabetes mellitus, AIDS, osteoporosis)
gingivitis
A reversible and mildest form of periodontal disease.
Characteristics of Healthy gums:
The gums reach up snugly onto the enamel of the tooth, protecting the roots and bone structur 1 Pinkish color 2 Firm, resilient tissues 3 Shape around teeth 4 No redness, swelling, or inflammation
symptom • Swelling • redness • changes in gum form or position • bleeding
category
Marginal gingivitis /simple gingivitis Puberty gingivitis Pregnancy gingivitis Acute necrotizing ulcerative gingivitis Hyperplastic gingivitis Drug-induced gingival hyperplasia Epulis etc
Marginal gingivitis the most common type of gingival disease. affects both the gingival margins and papillae. usually starts at the tips of the papillae and then extends to the gingival margins.
Swelling, loss of stippling (orange peel texture of surface) of the attached gingiva, redness, easily retractable sulcus, and foremost, a tendency to bleed easily, are the main characteristics. this condition may be generalized (exist around all teeth), or it may be localized to one or two or a group of teeth.
Treatment Eliminated by daily brushing, flossing, and regular cleanings.
Periodontitis
Definition:
Inflammation of supporting tissues of teeth. An extension of inflammation from gingiva into the adjacent bone and ligament. Usually a progressively destructive change leading to loss of bone and periodontal ligament. Ligaments holding tooth in its socket break down and gums pull away, resulting in a periodontal pocket between the tooth and gum.
Chronic Periodontitis Characteristics:
Most prevalent in adults, but can occur in children and adolescents. Amount of destruction is consistent with the presence of local factors. Associated with variable microbial pattern. Slow to moderate rate of progression, but may have period of rapid progression.
Can be further classified on the basis of extent and severity. Can be associated with local predisposing factors . May be modified by and /or associated with systemic diseases . Can be modified by environmental factors such as cigarette smoking and emotional stress.
supra- & sub- gingival plaque accumulation that is frequently associated with calculus formation. gingival inflammation: – color:
range from pale-red to magenta.
– consistency:
Slightly-moderate swollen (edematous) or Thickened, fibrotic margin (as a result of long-standing, low-grade inflammation).
– contour:
loss of stippling, rolled margins flattened or cratered papilla.
General Clinical Features: Periodontal pocket formation with variable depth. Bleeding upon probing Tooth mobility (often appears in advanced cases when bone loss has been considerable). Horizontal and/or vertical bone loss. Usually Painless. Occasionally, pain my be present: – Dull pain – Pain Radiating deep into the jaw – Gingival tenderness or “itchiness” (associated with food impaction)
Disease Distribution: – clinical signs of chronic periodontitis are considered to be due to the direct, site specific effect of subgingival plaque accumulation. – therefore, clinical signs of disease may occur on one surface of a tooth while other surfaces maintain normal attachment level.
Severity: Slight
(early): 1-2 mm Moderate: 3-4 mm Severe (advanced): >5 mm
Periodontal pocket deepens and fills with more bacteria Supportive ligaments and bone begin to show damage Moderate periodontal disease
Advanced stage Gums severely recede Pockets deepen and may fill with pus Swelling around root Sensitivity to cold/hot or brushing Bone loss increases need to be removed
Aggressive Periodontitis Definition: A specific type of periodontitis with clearly identifiable clinical and laboratory findings that make it sufficiently different from Chronic Periodontitis.
features of Aggressive Periodontitis: – Except for the presence of periodontitis, patients are otherwise clinically healthy. – Rapid attachment loss and bone destruction. – Familial aggregation.
Aggressive Aggressive Periodontitis Periodontitis
LocalizedAggressive Aggressive Localized
GeneralizedAggressive Aggressive Generalized
Case of Localized Aggressive Periodontitis In 18-year-old female
Generalized Aggressive Periodontitis
Refractory Periodontitis
Definition: A condition where one or more forms of periodontitis are unresponsive to treatment despite excellent patient compliance and delivery of periodontal therapy that ordinari is successful in arresting the progression of periodontitis.
Necrotizing Ulcerative Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament, and alveolar bone. These lesions are most commonly seen in individuals with systemic diseases including, but not limited to HIV infection, malnutrition, and immunosuppression
Signs and symptoms :
– Necrosis an ulceration of coronal part of interdental papilla and /or gingival margins – Deep. Crater-like osseous lesions most often located interdentally – Pain. – Mouth malodor (halitosis). – Systemic manifestations;
Fever, malaise, and lymphadenopathy.
Warning Signs
Gums bleed easily Red, swollen, or tender gums Gums pulled away from teeth Infection including purulence between the teeth and gums when pressed Permanent teeth that are loose or separating Changes in byte
Bad breath or a chronic bad taste in your mouth Teeth that are over sensitive to hot or cold Itchy sensation
prevent
Daily good oral hygiene can help reduce your risk of developing periodontal disease. Brushing teeth at least twice a day (with fluoride toothpaste) Careful cleaning between your teeth once a day with dental floss or another interdental cleaner to remove plaque
Use antimicrobial mouth rinse or other oral hygiene aids Eat a balanced diet Visit the dentist routinely for a check-up and professional cleaning Don’t use tobacco products
Treatment
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extend of the gum disease. Keeping a good daily care at home and modifying certain behaviors will also improve treatment outcome.
Types of Treatment Deep cleaning
Scalingscraping off the tartar above and below gum line
Root planing- gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria
Medications- may be used with treatment that includes scaling and root planing, but cannot always take the place of surgery. Surgical treatments
Surgical Treatments
Curettage removes the soft tissue lining the periodontal pocket. This helps the gum tissue to heal Gingivectomy is surgical removal of the periodontal pocket to allow easier access for cleaning
1.
2.
Flap surgery allows to gain access to the root of the tooth for removal of calculus, tartar, plaque, and diseased tissue. Lifting back the gums and removing tartar Gums are sutured back in place
Bone and tissue grafts Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed Tissue generation
Periodontal Tissues of the Teeth
1. alveolar process 2. periodontal ligament 3. gums
definition Periodontal diseases include gingivitis and periodontitis. Both are inflammatory conditions of the gingival tissues (gum tissues around the teeth). In more severe forms, periodontitis includes loss of supporting bone tissue which can lead to tooth loss.
Etiological factors Initial factor Local accelerated factors systemic factors
Initial
factor : dental plaque
A product of microbial colonization and metabolism. Plaque is an irritant and causes inflammation. 1 Bacteria produce byproducts (called toxins or enzymes), along with mucus, constantly form a sticky, colorless “plaque” on teeth.
2 Can damage the attachment of gums, periodontal ligament, and bone to teeth. 3 Brushing and flossing can help
get rid of plaque but when it’s not removed can harden and form dental calculus.
4 Dental calculus forms around teeth. 5 Tissue that attaches the gums to the teeth can be destroyed by the irritants of plaque.
6 Gums pull away from the teeth and small pockets form between the teeth and gums. 7 Pockets become filled with more plaque.
8 Pockets deepen, becoming impossible to clean plaque out. 9 Bone structure supporting teeth can be destroyed.
Local accelerated factors: dental calculus teeth pigmentation food impaction trauma from occlusion/ (occlusal trauma) Abnormal oral conditions or habits others
systemic factors: heredity immune disfigurement sex hormone smoking stress certain diseases (diabetes mellitus, AIDS, osteoporosis)
gingivitis
A reversible and mildest form of periodontal disease.
Characteristics of Healthy gums:
The gums reach up snugly onto the enamel of the tooth, protecting the roots and bone structur 1 Pinkish color 2 Firm, resilient tissues 3 Shape around teeth 4 No redness, swelling, or inflammation
symptom • Swelling • redness • changes in gum form or position • bleeding
category
Marginal gingivitis /simple gingivitis Puberty gingivitis Pregnancy gingivitis Acute necrotizing ulcerative gingivitis Hyperplastic gingivitis Drug-induced gingival hyperplasia Epulis etc
Marginal gingivitis the most common type of gingival disease. affects both the gingival margins and papillae. usually starts at the tips of the papillae and then extends to the gingival margins.
Swelling, loss of stippling (orange peel texture of surface) of the attached gingiva, redness, easily retractable sulcus, and foremost, a tendency to bleed easily, are the main characteristics. this condition may be generalized (exist around all teeth), or it may be localized to one or two or a group of teeth.
Treatment Eliminated by daily brushing, flossing, and regular cleanings.
Periodontitis
Definition:
Inflammation of supporting tissues of teeth. An extension of inflammation from gingiva into the adjacent bone and ligament. Usually a progressively destructive change leading to loss of bone and periodontal ligament. Ligaments holding tooth in its socket break down and gums pull away, resulting in a periodontal pocket between the tooth and gum.
Chronic Periodontitis Characteristics:
Most prevalent in adults, but can occur in children and adolescents. Amount of destruction is consistent with the presence of local factors. Associated with variable microbial pattern. Slow to moderate rate of progression, but may have period of rapid progression.
Can be further classified on the basis of extent and severity. Can be associated with local predisposing factors . May be modified by and /or associated with systemic diseases . Can be modified by environmental factors such as cigarette smoking and emotional stress.
supra- & sub- gingival plaque accumulation that is frequently associated with calculus formation. gingival inflammation: – color:
range from pale-red to magenta.
– consistency:
Slightly-moderate swollen (edematous) or Thickened, fibrotic margin (as a result of long-standing, low-grade inflammation).
– contour:
loss of stippling, rolled margins flattened or cratered papilla.
General Clinical Features: Periodontal pocket formation with variable depth. Bleeding upon probing Tooth mobility (often appears in advanced cases when bone loss has been considerable). Horizontal and/or vertical bone loss. Usually Painless. Occasionally, pain my be present: – Dull pain – Pain Radiating deep into the jaw – Gingival tenderness or “itchiness” (associated with food impaction)
Disease Distribution: – clinical signs of chronic periodontitis are considered to be due to the direct, site specific effect of subgingival plaque accumulation. – therefore, clinical signs of disease may occur on one surface of a tooth while other surfaces maintain normal attachment level.
Severity: Slight
(early): 1-2 mm Moderate: 3-4 mm Severe (advanced): >5 mm
Periodontal pocket deepens and fills with more bacteria Supportive ligaments and bone begin to show damage Moderate periodontal disease
Advanced stage Gums severely recede Pockets deepen and may fill with pus Swelling around root Sensitivity to cold/hot or brushing Bone loss increases need to be removed
Aggressive Periodontitis Definition: A specific type of periodontitis with clearly identifiable clinical and laboratory findings that make it sufficiently different from Chronic Periodontitis.
features of Aggressive Periodontitis: – Except for the presence of periodontitis, patients are otherwise clinically healthy. – Rapid attachment loss and bone destruction. – Familial aggregation.
Aggressive Aggressive Periodontitis Periodontitis
LocalizedAggressive Aggressive Localized
GeneralizedAggressive Aggressive Generalized
Case of Localized Aggressive Periodontitis In 18-year-old female
Generalized Aggressive Periodontitis
Refractory Periodontitis
Definition: A condition where one or more forms of periodontitis are unresponsive to treatment despite excellent patient compliance and delivery of periodontal therapy that ordinari is successful in arresting the progression of periodontitis.
Necrotizing Ulcerative Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament, and alveolar bone. These lesions are most commonly seen in individuals with systemic diseases including, but not limited to HIV infection, malnutrition, and immunosuppression
Signs and symptoms :
– Necrosis an ulceration of coronal part of interdental papilla and /or gingival margins – Deep. Crater-like osseous lesions most often located interdentally – Pain. – Mouth malodor (halitosis). – Systemic manifestations;
Fever, malaise, and lymphadenopathy.
Warning Signs
Gums bleed easily Red, swollen, or tender gums Gums pulled away from teeth Infection including purulence between the teeth and gums when pressed Permanent teeth that are loose or separating Changes in byte
Bad breath or a chronic bad taste in your mouth Teeth that are over sensitive to hot or cold Itchy sensation
prevent
Daily good oral hygiene can help reduce your risk of developing periodontal disease. Brushing teeth at least twice a day (with fluoride toothpaste) Careful cleaning between your teeth once a day with dental floss or another interdental cleaner to remove plaque
Use antimicrobial mouth rinse or other oral hygiene aids Eat a balanced diet Visit the dentist routinely for a check-up and professional cleaning Don’t use tobacco products
Treatment
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extend of the gum disease. Keeping a good daily care at home and modifying certain behaviors will also improve treatment outcome.
Types of Treatment Deep cleaning
Scalingscraping off the tartar above and below gum line
Root planing- gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria
Medications- may be used with treatment that includes scaling and root planing, but cannot always take the place of surgery. Surgical treatments
Surgical Treatments
Curettage removes the soft tissue lining the periodontal pocket. This helps the gum tissue to heal Gingivectomy is surgical removal of the periodontal pocket to allow easier access for cleaning
1.
2.
Flap surgery allows to gain access to the root of the tooth for removal of calculus, tartar, plaque, and diseased tissue. Lifting back the gums and removing tartar Gums are sutured back in place
Bone and tissue grafts Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed Tissue generation
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