Periodontal Diseases

Chapter seven
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 its 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.

1 Pinkish color
2 Firm, resilient tissues
3 Shape around teeth
4 No redness, swelling, or
inflammation
5 No bleeding
6 No discomfort
Characteristics of Healthy gums:
The gums reach up snugly onto the enamel of
the tooth, protecting the roots and bone structure.
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 Periodontitis
Localized Aggressive Generalized Aggressive Localized Aggressive
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 ordinarily
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
Dont 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


Scaling-
scraping 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
Flap surgery allows to gain access to
the root of the tooth for removal of
calculus, tartar, plaque, and diseased
tissue.
1. Lifting back the gums and removing
tartar
2. 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