10

Distribution of periodontal diseases

Geographic Distribution (there could be some differences from one region to another, although as you will
see, when it comes to severe periodontitis or progressive periodontitis, geographic distribution is not a
strong factor. It may be a good factor for mild to moderate gingivitis & periodontitis. You can find that
proportion of people with severe periodontitis in a country like Jordan may be similar to that in a very wealthy
developed country like Sweden. The difference will be in mild to moderate form)
 Over 70% of adults in all parts of the world have some degree of gingivitis or periodontitis
 This makes periodontal disease in general as the most common disease
 Gingivitis ‘NOT periodontitis’ and calculus deposits are more prevalent and severe in low-income
nations
 So low income or high income is a factor for distribution of gingivitis. For example, proportion of
people with gingivitis in Jordan is higher than in U.K
 There are fewer global differences in the prevalence of severe periodontitis
 It’s not related to GDP of nations.
, ‫ نفسه او لرٌب جدًا‬prevalence ‫ ممكن ٌكون الـ‬severe periodontitis ‫ ٌعنً لو اخدنا دوله فمٌره جدًا ودوله غنٌه جدًا لو نتطلع عالـ‬
factor that play roles have nothing to do with SES, income, ‫ فٌه اله‬severe periodontitis ‫هاد معناه انه الـ‬
Genetic factor ‫ زي مثال‬education
 Severe periodontitis is not clearly dependent on the presence of plaque and calculus
‫ ما‬oral environment ‫ بتطلع عالـ‬,severe periodontitis ‫ تاللً عنده‬,‫ تبعه منٌح‬income ‫ الـ‬,‫ ٌعنً ممكن تفحص مرٌض متعلم‬
Genetic & ‫ فهون بناللً انه الـ‬,floss ‫ وبستخدم‬good oral hygiene ‫ وبتاللً المرٌض عنده‬plaque & calculus ‫بتاللً كتٌر‬
severe form of periodontitis ‫ بتلعب دور فً الـ‬familial factors
‫ لكن عادي جدا تاللً الـ‬gingivitis & periodontitis ‫ بالممابل ممكن تشوف بٌشنت بحٌاته ما فرشى أسنانه وطبعا اكٌد حتاللً عنده‬
genetic factor ‫ عنده نوعا ما منٌح فبرضو السبب‬bone level
 It is consistent with the compromised host model of periodontitis
Prevalence of Gingivitis
 At the population level, gingivitis is found in early childhood, is more prevalent and severe in
adolescence, and tends to level off after that
ً‫ وبنشوفها اكتر ش‬ )‫ (اعتمدو حكً السالٌد او اسألوه عنها‬late childhood ‫ باألطفال على عمر معٌن تمرٌبا بالـ‬gingivitis ‫ بنشوف‬
‫ سنه‬45 ‫ وبعد عمر الـ‬males ‫ سنه عشان ما بكونو كتٌر مهتمٌن ٌفرشو اسنانهم خاصه الـ‬44-41 ‫ ٌلً اعمارهم بٌن‬adolescence ‫بالـ‬
‫بخف الموضوع عشان بزٌد االهتمام وبصٌر ٌنظف اسنانه‬
 Relationship or Association of gingivitis with oral hygiene is linear (the more you clean your teeth &
use auxiliary measures, the less gingivitis you will have and vice versa). But in periodontitis; especially
in rapidly progressing or severe form of periodontitis, it’s not always linear.
 The prevalence of gingivitis among schoolchildren in the United States has been around 40%-60% in
various national surveys
 In a national survey of employed adults in 1985-86, 47% of males and 39% of females ages 18-64 had at
least one site that have bleeding on probing (female is better than males)
 There has been an improvement in gingival health between 60’s and 80’s
 No increase in prevalence and severity of gingivitis between the late teen years and age 40 (Norway- Sri
Lanka ) - No age-related increase in gingivitis
gingivitis ‫ بمعنى اخر مش ضروري كل ما نكبر ٌزٌد الـ‬
 Gingivitis is likely to have declined over recent years in the United States because of greater attention to
oral hygiene as a part of personal cleaning
‫ جزء من النظافه الشخصٌه زي ما بتتعطر وبتمشط وبتكشخ الزم تفرشً اسنانن خاصه‬oral hygiene ‫ الناس صارت تهتم اكتر وتعتبر الـ‬
female ‫بالـ‬
 The main research interest in gingivitis today is why some lesions progress to periodontitis and some do
not, and what factors may predict these outcomes
‫ فٌه عوامل بتلعب دور وهاد‬, ‫؟ مش بالضروره‬periodontitis ‫ مع التمدم بالعمر او لو اعطٌناه ولت ممكن ٌتحول لـ‬gingivitis ‫ هل كل‬
‫ شو ح‬gingivitis ‫ وانه هل احنا ممكن نتنبأ مثال لو شفنا مرٌض بالعشرٌنات عنده‬,researchers ‫هو الموضوع ٌلً شاغل معظم الـ‬
‫ ممكن‬age ‫ الـ‬,‫ او ال؟ الموضوع مش سهل والعوامل ٌلً بتعل دور مش واضحه‬periodontitis ‫ سنه؟ ولو ح ٌصٌر عنده‬02 ‫ٌصٌرله بعد‬
gingivitis ‫ ٌعنً مش هو ٌلً بسبب انه الـ‬associated factor rather than a causative factor ‫ لكن هو غالبا‬factor ‫ٌكون‬
‫ لكن الحظو انه االنتمال بصٌر مع التمدم بالعمر‬periodontitis ‫ٌتحول لـ‬
 ً‫ بنسوف على علبة الدخان مكتوب "التدخٌن ٌسبب الوفاة" او "ٌسبب سرطان الرئة" لكن ه‬: associated ‫ و‬causative ‫ عشان نمٌز بٌن‬
smoking is one of risk factors of lung disease which finally ً‫ األصح انه نحك‬,)>_< ‫فعلٌا عباره غلط (المدخنٌن انبسطو‬
‫ فٌه ناس بتدخن وبكمٌات كبٌره مع هٌن ما‬,‫ لما نحكً انه التدخٌن ٌسبب الوفاه ٌعنً اي حد بدخن الزم ٌموت‬, could lead to death
‫بصٌر عندها سرطان رئه وبتعٌش عمر طوٌل‬
their ً‫ ٌعن‬risk factor of leukoplakia ‫ ٌعتبروا‬smoking & alcohol ‫ الـ‬:)‫ كمان مثال (ما اله دخل بالمحاضره بس الدكتور حكاه‬
‫ عشان هاد معناه انه خلص مجرد ما‬cause ‫ (مش صح نحكً انهم‬presence increase the chance of developing oral cancer
)leukoplakia ‫البٌشنت دخن ح ٌصٌر عنده‬
herpes ً‫ هون خلص وجود الفاٌروس رح ٌعمل‬,herpes labialis ‫ بسبب‬herpes simplex ‫ لما احكً انه الـ‬:causative ‫ مثال عالـ‬
‫ وفٌه بٌنهم عالله مباشرة‬labialis
Prevalence of Periodontitis
 Interpretation of epidemiologic data from before 1980 is difficult because the indexes used to measure
the conditions before that time are no longer considered valid
‫ غٌر واضحه او خاطئه‬indices ‫ كانوا ٌعتمدو على‬4652 ‫ لبل‬
 CAL is considered to be the most valid measure of periodontitis, even though it measures past disease
rather than present activity
CAL ‫ وبنحسب الـ‬pocket depth ‫ و‬recession ‫ البٌرٌو عادي) بنمٌس‬chart ‫ لكل سن (زي‬6 different sites ‫ بنمٌس‬
valid ‫ ألنهم ممكن ٌكونو مش‬wisdoms ‫ بنستثنً الـ‬
periodontitis ‫ تبعً بالدٌاغنوسٌز للـ‬guide ‫ وبتكون هً الـ‬CAL ‫ وبنشوف أكتر منطمه فٌها‬sextants ‫ لـ‬teeth ‫ بنمسم الـ‬
 Data from many parts of the world have now shown that the prevalence of generalized, severe
periodontitis is in the range of 5%-15% in almost all populations regardless of their state of economic
development, conditions of oral hygiene, or availability of dental care
‫ وانه فٌه عوامل اخرى‬oral hygiene ‫ وال الـ‬,economic development ‫ مش متعلك بالـ‬severe periodontitis ‫ زي ما حكٌنا الـ‬
genetic ‫بتلعب دور ممكن تكون‬
 The prevalence of periodontitis depends mainly on the definition of periodontal disease
CAL ‫ احنا بنعتمد عالـ‬
 If we considered any CAL (1mm+) is a disease then the prevalence is high
CAL of 1 mm is enough to say that we have ‫؟ بشكل عام‬disease ‫ ٌلً بناء علٌه بحكً انه فٌه‬CAL level ‫ اٌش الـ‬
periodontitis
to what ‫ لكن‬periodontitis ‫ هو اكٌد عنده‬,‫؟ غالبا ال‬functional problem ‫ عنده‬CAL of 1 mm ‫ السؤال هون هل ٌلً عنده‬
‫ مم وتكون األسنان بشكل عام‬1 ‫ ٌوصل‬CAL ‫ وحتى ممكن الـ‬,extent this periodontitis is causing a problem or morbidity
dentist ‫ والمرٌض بهتم فٌها وبروح عند الـ‬functional
‫ للـ‬risk ‫ ممكن ٌكون عنده‬,well controlled ‫ بس مثال عاٌش حٌاه طبٌعٌه ألنه‬hyperlipidemia ‫ مرٌض عنده‬,‫ عشان نمرب الفكره‬
functional problem ‫ لكن بالولت الحالً ما عنده اي‬cardiovascular disease
 Proportion of U.S. adults with at least one site showing clinical attachment loss of 2 mm or more by age
and gender, 1985-86.
‫ ووزعوهم‬CAL 2 mm or more ‫ شافوا الناس ٌلً عندهم‬,‫دراسه انعملت بالوالٌات المتحده لدٌمه شوي‬ 
CAL ‫ للناس ٌلً عندهم‬percentage ‫ وجدوا انه كل ما تمدم العمر زادت الـ‬,age & gender ‫حسب الـ‬
‫ وضعهم افضل‬females ‫ لكن الـ‬males & females ‫ وبنالحظ انه فٌه فرق بسٌط بٌن الـ‬,≥ 2mm
periodontal disease ‫ وضعهم افضل بالـ‬females ‫وخدوها لاعده بشكل عام الـ‬ 
age ‫ ومش بالضروره الـ‬associated factor ‫ حكٌنا انه هو‬,age is a factor ‫ممكن حد ٌحكً انه الـ‬ 
severe ‫ ولو كان مسبب فهاد الحكً معناه انه كل واحد فٌنا بس ٌكبر رح ٌصٌر عنده‬,‫هو المسبب‬
periodontitis
‫ لكن‬+75 ‫ والناس ٌلً اعمارهم‬45 ‫ او ما فٌه فرق كبٌر بٌن الناس ٌلً اعمارهم‬level off ‫الحظوا انه فٌه‬ 
‫ انه الـ‬indication ‫ وهاد بعطٌنا‬middle aged adult ‫ و‬young adults ‫فٌه فٌه فرق بٌن‬
periodontitis starts in the middle age & progresses slowly as we advance in age

 Acceptable definition of periodontal disease:

 Mild disease = 2+ mm CAL (less than 4 mm)
 Moderate disease = 4-5mm CAL (at the worst site)
 Serious disease= 6+ mm CAL
‫ اذا حد مهتم‬,ً‫ ومش موضوعنا ما حطٌته عشان التفرٌغ ما ٌصٌر طوٌل عالفاض‬grading & staging system ‫ الدكتور رجع ٌشرح عن‬
‫ بس اعتمدو السالٌد لالمتحان‬new classification ‫ وحكا انه هاد هو الـ‬03-02 ‫ٌرجع للرٌكورد دلٌمه‬
  Proportion of U.S. adults with at least one site showing clinical attachment loss of 2 mm or more, 4 mm or
more, and 6 mm or more, by age, 1988-94

‫ تبعه حسب الـ‬prevalence ‫ والـ‬mild, moderate, severe periodontitis ‫ درسوا الـ‬

age group
‫ تمرٌبا‬+75 ‫) بكون أكتر وبالـ‬mild( ‫ مم‬3-2 ‫ للناس ٌلً عندهم‬prevalence ‫ بنالحظ انه الـ‬
%100 ‫بوصل‬
severe periodontitis ‫ مم بكون الل والل شً نسبة الـ‬5-4 ‫بٌنما‬
‫ كمان بنالحظ انه الفرق بٌن عمر األربعٌنات والخمسٌنات وحتى للسبعٌنات ما بكون كتٌر‬
young age ‫ والـ‬middle age ‫ بٌنما فٌه فرق بٌن الـ‬,‫واضح‬

 Cumulative proportion of U.S. adults ages 18-44, 45-64, and 65 or older showing varying degrees of
clinical attachment loss at most severely affected site, 1988-94 (Skipped by the doctor)

Incidence of Periodontitis
 Only a few longitudinal studies have been conducted
follow up a group of people for ‫ بعمل فٌها‬longitudinal cohort ‫ ألنه بده دراسات اسمها‬incidence ‫ ما فٌه كتٌر دراسات عالـ‬
‫ ٌعنً بنفحص البٌشنت مره‬cross-sectional ‫ واغلب الدراسات عالبٌرٌو بتكون‬it’s not easy to conduct ‫ فـ‬a period of time
‫وحده‬
 Sri Lanka study for 15 years:
 It was concluded that some 8% demonstrated rapid progression, 81% moderate progression, and 11%
no progression beyond gingivitis.
%54 ,rapid progression ‫ صار عندهم‬%5 ‫ سنه الحظو انه‬42 ‫ لـ‬group of people ‫ دراسه طولٌة انعملت بسٌرٌالنكا تابعو فٌها‬
periodontitis ‫ ما صار عندهم‬gingivitis ‫ ضلو بالـ‬%44 ‫ و‬moderate progression ‫صار عندهم‬
‫ بتكون‬longitudinal studies ‫ ونتذكر انها الـ‬,risk factor ‫ اذا بتتذكروا الدراسات الطولٌه بتساعدنً اعرف دور او تأثٌر الـ‬
‫ وبكون فٌه غالبا‬risk factor ‫ وبصنع‬clinical trial ‫ اذا بدي اتدخل بتصٌر‬,‫ ٌعنً انا ما بتدخل بس بالحظ شو بصٌر‬observational
ethical problems
Distribution of periodontal diseases summary
 Only a small proportion of persons (5%-15%) exhibit severe periodontitis, where “severe” means that
tooth loss occurs or is threatened.
‫ او واصله لمرحلة حركه شدٌده ورح ٌنخلع‬periodontitis ‫ بتكون األسنان انفمدت بسبب‬severe ً‫ ٌعنً لما بحك‬
 Mild gingivitis is common, as is mild to moderate periodontitis. Most adults exhibit some loss of bony
support and loss of probing attachment while still maintaining a functioning dentition.
functioning ‫ لكن لسا عندهم‬CAL ‫ الناس بكون عندهم‬Mild to moderate form of periodontal disease ‫ زي ما حكٌنا بالـ‬
‫ واضحه‬mobility ‫ وغالبا مابكون فٌه‬dentition
 Gingivitis and periodontitis are associated with bacterial flora that have some similarities but also some
differences between the two conditions.
gingivitis ‫ ممكن تكون بتختلف عن الـ‬periodontitis ‫ البكتٌرٌا ٌلً بتسبب الـ‬
 Gingivitis precedes periodontitis, but only a percentage of sites with gingivitis later develop periodontitis.
periodontitis ‫ رح ٌصٌر فٌها‬gingivitis ‫ ٌلً فٌها‬sites ‫ ومش كل الـ‬periodontitis ‫ ٌسبك الـ‬gingivitis ‫ ٌعنً داٌما الـ‬
 Although periodontitis is usually related to age in cross-sectional surveys, it is not a natural consequence
of aging.
ً‫ هو متعلك بالعمر لكنه لٌس سبب رئٌس‬.‫ أبدًا لٌس نتٌجه حتمٌه للتمدم فً العمر‬periodontitis ‫ الـ‬
 Periodontitis is not the major cause of tooth loss in adults, except in the oldest age-groups in some
populations.
young adults ‫ اسباب شائعه أكتر بالـ‬caries ‫ والـ‬trauma ‫ الـ‬
  Periodontitis is usually a site-specific condition and is only occasionally seen in generalized forms. (it’s
rare to find the periodontitis as extremely generalized affecting all the areas in the same rete)
‫ لكن فعلٌا مش كل الـ‬generalized ‫ بنحكً انه‬periodontitis ‫ فٌها‬sites ‫ او اكتر من الـ‬%02 ً‫ هأل احنا لما نفحص المرٌض ونالل‬
the same degree of CAL ‫ فٌها‬sites ‫ ومش كل الـ‬periodontitis ‫ فٌها‬sites
 Generalized periodontitis is usually severe and of the early-onset type.
all the sites are ‫ بهاد العمر بناللً انه‬,‫ على عمر صغٌر بالعشرٌنات مثال‬periodontitis ‫ همه ٌلً ببدا عندهم الـ‬early-onset ‫ الـ‬
affected at the same level
 Periodontitis is usually thought to proceed in bursts of destructive activity with inactive periods between
the bursts.
‫ ٌعنً ما بكون اله‬degree ‫ بنفس الـ‬progressing ‫ ما بكون‬periodontitis ‫ الـ‬,‫ وفترات هدوء‬destructive activity ‫ فٌه فترات من الـ‬
linear progression
Demographic risk factors in periodontitis
Gender and Race or Ethnicity
 Men have poorer periodontal health than women
 Women usually exhibit better oral hygiene than do men
 Current Evidence: there are no inherent differences between men and women in susceptibility to
periodontitis.
oral hygiene ‫ هً غالبا اسباب متعلمه أكتر بالـ‬,male or female ‫ ٌعنً السبب مش ألنه‬

There is a significant difference in prevalence of periodontitis

between males & females according to this graph

 No differences in disease prevalence that could be attributed to race or Ethnicity

Age
 The interpretation of old cross-sectional survey data demonstrated that the severity of the disease
increased with advancing age (not causative factor)
 This is come from the cumulative progression of lesions over time
 Those who retain their teeth into old age are likely to be the less susceptible individuals.
 Those susceptible to serious disease exhibit CAL and bone loss when young, often in the teenage years
‫ ٌعنً ٌلً بفمدو اسنانهم‬,‫ اصال بلش عندهم على عمر مبكر‬disease ‫ بكون الـ‬disease ‫ بالـ‬serious ‫ ٌعنً الناس ٌلً بوصلو لمراحل‬
early ‫ بلش عنده‬periodontitis ‫ بعرف انه الـ‬periodontitis ‫نتٌجة الـ‬
Socioeconomic Status
 Generally, those who are better educated, wealthier, and live in better circumstances enjoy better health
status than the less educated and poorer sections of society.
 Gingivitis and poorer oral hygiene are clearly related to lower SES
 The relationship between periodontitis and SES is less direct (specifically severe periodontitis)
 Proportion of U.S. adults with at least one site showing clinical attachment loss of 6 mm or more by age
and socioeconomic status (SES), 1988-94

‫ بنالحظ‬,SES ‫ وعاللتهم بالـ‬severe form of periodontitis ‫ درسوا الـ‬

‫ والـ‬middle ‫ لكن ما فٌه فرق واضح بٌن الـ‬low SES ‫انه النسبه اعلى بالـ‬
high
‫ انه مش‬indication ‫ فهاد بعطٌنا‬low ‫ والـ‬middle ‫ فٌه فرق بٌن الـ‬
good oral health ‫ حتى ٌكون عنده‬wealthy ‫ضروري الواحد ٌكون‬
Genetics
 Interleukin-1 (IL-1) gene cluster was associated with more severe periodontitis.
 IL-1 has been identified as a contributory cause of periodontitis among some patient groups by
regulating host response to infection.
Risk factors for periodontitis
Oral Hygiene, Plaque, and Microorganisms
 There is a clear causal relationship between poor oral hygiene and gingivitis (clear causal relationship)
 The relationship between oral hygiene status and periodontitis is less straightforward (not very linear or
direct causal specially in severe form)
 Oral hygiene practices seem unrelated to periodontitis (specifically severe form of periodontitis)
 On the other hand, the presence of specific microorganisms could not predict the development or
progression of periodontitis in clinical longitudinal studies of up to 3 years.
progression of ‫ او انه اله عالله بالـ‬periodontitis ‫ رح ٌتحول لـ‬gingivitis ‫ معٌن مش بالضروره ٌخلٌنا نتنبأ انه هاد الـ‬MO ‫ وجود‬
periodontitis
Local Factors
 Gingival overhangs have been found not to be associated with serious periodontitis
mild to ‫ ممكن بتلعب دور بالـ‬,serious periodontitis ‫ لـ‬local factor ‫ مش بالضروره تكون‬overhang restoration ‫ ٌعنً الـ‬
moderate forms
 Local factors are generally considered to be of minor importance in the etiology of periodontitis
Nutrition
 No nutritional or dietary factors have been shown to be directly related to the prevalence or intensity
except Scurvy
indirect ‫ ممكن نعتبرها‬perio ‫ وعاللته بالـ‬,caries ‫ بلعب دور اكبر بالـ‬diet ‫ الـ‬
 Scurvy is a disease resulting from a lack of vitamin C ( Ascorbic acid)
 Ascorbic acid is probably the nutrient that has been shown to be associated with periodontitis
‫ حتى بالعائالت ٌلً وضعهم المادي مش بزٌاده‬food ‫ واهتمام أكتر بالـ‬access ‫ وما بنشوفه كتٌر ألنه صار فٌه‬rare ‫ ٌعتبر‬scurvy ‫ هأل الـ‬
Tobacco Use
 Smoking is clearly a risk factor for periodontitis, with relative risk on the order of 2.5-6.0 (not causative)
 The causal chain of how smoking acts on periodontal tissues is still a subject of research
vasoconstrictor ‫ ٌعتبرو‬tobacco ‫ لكن بشكل عام التدخٌن والنٌكوتٌن والـ‬periodontitis ‫ لساته تحت الدراسه كٌف التدخٌن بسبب‬
inflammatory ‫ وبملل الـ‬WBC’s ‫ ألنه بأخر وصول الـ‬healing ‫ وبأخر الـ‬periodontium ‫ ٌلً بوصل الـ‬blood supply ‫بمللو الـ‬
‫ وبملل المناعه‬neutrophils ‫ وبأثر عالـ‬chemotactic factors of WBC’s ‫ وممكن ٌكو اله عالله بالـ‬mediators
 It has been stated that 90% of persons with stubborn chronic periodontitis are smokers
 Stubborn means refractory which does not respond to treatment
Psychosocial Stresses
 Psychosocial stress seems to be associated with progressive periodontitis
periodontal disease ‫ بلعب دور خاصه بالـ‬stress ‫ عشان الـ‬social history ‫ الزم بالعٌاده نسأل المرٌض عن الـ‬
‫ دردشه عادٌه مع المرٌض بتعطٌن‬, ‫ مبسوط او مرتاح ولو عنده توتر او ال‬,‫ كٌف حٌاته بشكل عام‬,‫ اسأل المرٌض عن مثال لو بلعب رٌاضه‬
ً‫فكره عن وضع المرٌض النفس‬
Periodontitis and systemic conditions
Diabetes
 Both type 1 diabetes and type 2 DM (especially type 2) are risk factors for periodontitis.
 Generally, the poorer the metabolic control, the more severe the periodontitis
an increased risk to ‫ فانت عندن‬DM ‫ شو ٌعنً؟ اذا كان عندن‬,bidirectional ‫ تعتبر‬DM & periodontitis ‫ العالله بٌن‬
‫ والعكس صحٌح‬.develop periodontitis or an increased risk to progress your periodontitis to more severe form
you have a risk to develop DM & you have a risk to have your DM more uncontrolled ‫ فـ‬periodontitis ‫لو عندن‬
 Periodontitis also progresses more rapidly in individuals with poorly controlled diabetes 3

HIV Infection
Cardiovascular Disorders
 An association between periodontitis and cardiovascular disorders has been shown fairly consistently
 The odds ratios have been in the range of 1.5-3.0
‫ والعكس صحٌح‬cardiovascular disease ‫ مرات اذا كان عندن‬0-4.2 ‫ بممدار‬periodontitis ‫ ٌعنً بزٌد احتمال ٌصٌر عندن‬
 The presence of C-reactive protein is a risk factor for cardiovascular disease, and the protein has been
found at higher levels in persons with periodontitis
periodontitis ‫ والـ‬cardiovascular disorder ‫ بٌن الـ‬molecular level ‫ ٌعنً فٌه عالله على الـ‬
‫ لكن الـ‬Cardiovascular disease ‫ ٌسبب‬perio ‫ ٌعنً مش بالضروره الـ‬DM ‫ زي الـ‬bidirectional ‫ ممكن ما تكون‬
‫ الموجوده عندن‬periodontal disease ‫ او ٌزٌد سوء الـ‬periodontal disease ‫ فٌه احتمال ٌصٌر عندن‬cardiovascular disease
Osteoporosis
 Osteoporosis is a condition of bone fragility characterized by low bone mass and structural deterioration
(affect bone quality)
 One study from Denmark for 20 young people with severe periodontitis over a 5- to 10-year period found
that periodontitis is a local condition (the doctor said that he’s not sure what’s the meaning of this point
so don’t worry about it)
 Cross-sectional studies, give conflicting results.
longitudinal studies ‫ بدنا‬osteoporosis ‫ فحتى نمدر نشوف تأثٌر الـ‬
Adverse Pregnancy Outcomes
Prediction of Periodontitis
 The aim is to identify the presence of some easily measured entity, one that clinicians can readily test for
in a patient that will predict with high reliability the risk of future disease.
 Plaque deposits, sub-gingival calculus deposits, tobacco use, diabetes, SES, specific cytokines in gingival,
cervicular fluid, psychic stress) are measured in participants at baseline
poor dental ,with poor oral hygiene ‫ مثال واحد‬,stage of gingivitis ‫ حتى لو كان لسا بالـ‬periodontitis ‫ ممكن نتنبأ بالـ‬
,periodontitis ‫ حٌصٌرعنده‬at some stage ‫ فبتنبأ انه‬,DM ‫ عنده‬,tobacco use ,calculus deposits ,low SES ,attitude
‫ بصٌر التنبؤ اصعب عشان بتصٌر األمور غالبا‬absence of risk factors ‫ او‬risk factors ‫ وكل ما للت الـ‬,‫لكن مش بالضروره دائ ًما‬
based on genetics
 The presence of visible plaque and calculus, as one example of a hypothesized marker, was long assumed
to predict future CAL or bone loss
main factor that can predict ‫ هً الـ‬visible plaque & calculus ‫ بتحكً انه الـ‬hypothesized ‫ معٌنه طبعا كلها‬markers ‫ فٌه‬
future CAL & bone loss ‫انه الواحد ٌصٌر عنده‬