Notion about periodontal

diseases. Classification.
Trifan Diana
University Assistant

Dental Propedeutics Department

State University of Medicine and Pharmacy

“Nicolae Testemițanu”
Notion about periodontal disease.

 Periodontal disease, is a set of inflammatory conditions

affecting the tissues surrounding the teeth.[5]
 It is a chronic inflammatory disease that is triggered by
bacterial microorganisms
 It causes the destruction of the tooth-supporting apparatus
and can lead to tooth loss.
 It can also lead to other health problems.
Notion about periodontal disease.

 In its early stage, called gingivitis, the gums

become swollen and red and may bleed.
 In its more serious form, called periodontitis, the
gums pull away from the tooth, bone can be lost,
and the teeth have mobility or fall out.[5]
 Notion about periodontal disease.
 If it's left untreated, the disease will continue and the underlying bone around the teeth
will dissolve and will no longer be able to hold the teeth in place.
 Generally, periodontal disease isn't painful, so it is possible to have it and not be aware of
it.
 Notion about gingivitis.
 Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of
gingivitis, is in response to bacterial biofilms (also called plaque) that is attached to tooth surfaces,
termed plaque-induced gingivitis.
 Most forms of gingivitis are plaque-induced.
 Gingivitis is reversible with good oral hygiene; however, without treatment, gingivitis can progress to
periodontitis
Signs and symptoms
 The symptoms of gingivitis are somewhat
non-specific and manifest in the gum
tissue as the classic signs of inflammation
:
 Swollen gums
 Bright red gums
 Gums that are tender or painful to the
touch
 Bleeding gums or bleeding after brushing
and/or flossing
 Bad breath (halitosis)
 Notion about periodontitis.
 It is a chronic inflammatory disease of the deep
peiodontium, that is triggered by bacterial microorganisms
and involves a severe chronic inflammation that causes the
destruction of the tooth-supporting apparatus and can lead
to tooth loss.
 It can also lead to other health problems.
 Periodontitis is always preceded by gingivitis.
 Signs and symptoms
In the early stages, periodontitis has very few symptoms, and in many individuals the disease has
progressed significantly before they seek treatment. SILENT KILLER
Symptoms may include:
 Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food,
(though this may also occur in gingivitis, where there is no attachment loss gum disease)
 Gum swelling that recurs
 Spitting out blood after brushing teeth
 Halitosis, or bad breath, and a persistent metallic taste in the mouth
 Gingival recession, resulting in apparent lengthening of teeth
 Deep pockets between the teeth and the gums (pockets are sites where the attachment has been
gradually destroyed by collagen-destroying enzymes, known as collagenases)
 Tooth mobility (Loose teeth, in the later stages)
 Stages of periodontitis (severity)

 1. Stage I (initial)
 1–2 mm clinical attachment loss (CAL),
 less than 15% bone loss (BL) around
root,
 probing depth (PD) 4 mm or less
 no tooth loss due to periodontal disease,
Stages of periodontitis (severity)

 Stage II (moderate)
 3–4 mm clinical attachment
loss
 15%–33% bone loss (BL)
around root,
 probing depth 5 mm or less
 tooth loss,
 Stages of periodontitis (severity)

3. Stage III (severe, with tooth loss)

 5 mm or more clinical attachment loss ,
 tooth loss of four teeth or less,
 with complex issues, such as probing depth 6
mm or more,
 vertical bone loss 3 mm or more,
 Class II–III furcations, and/or moderate ridge
defects
 Stages of periodontitis (severity)
 4. Stage IV (severe with potential for loss of the whole
dentition)
Encompasses all of Stage III with additional features that will
require the need for complex rehabilitation due to
 masticatory dysfunction,
 secondary occlusal trauma,
 severe ridge defects, bite
 collapse,
 pathologic migration of teeth
 less than 20 remaining teeth (10 opposing pairs)
 What is the difference between gingivitis and periodontitis?

 Gingivitis is an inflammation that is limited to the gum line, while

in periodontitis there is loss of the jawbone, periodontal ligament, and root
cementum.
 In gingivitis, there is not yet any loss of the structures that hold teeth in place.
This means that good oral hygiene at home can stop the gingivitis and restore
healthy gums.
 But with periodontitis, it is different. Once the inflammation has caused bone
loss, this damage cannot be repaired.
 Treating periodontitis requires more than good oral hygiene at home. It needs
professional care from a dentist or periodontist.
Classification of periodontal diseases.
1999
 Classification of periodontal diseases.
1999
 As defined by the 1999 World Workshop in Clinical Periodontics, there are two primary
categories of gingival diseases, each with numerous subgroups:
 Dental plaque-induced gingival diseases.
 Gingivitis associated with plaque only
 Gingival diseases modified by systemic factors
 Gingival diseases modified by medications
 Gingival diseases modified by malnutrition
 Classification of periodontal diseases.
1999
 Non-plaque-induced gingival lesions
 Gingival diseases of specific bacterial origin
 Gingival diseases of viral origin
 Gingival diseases of fungal origin
 Gingival diseases of genetic origin
 Gingival manifestations of systemic conditions
 Traumatic lesions
 Foreign body reactions
 Not otherwise specified
 Classification of periodontal diseases 2017

 As defined by the 2017 World Workshop, periodontal health, gingival diseases/ conditions have
been categorised into the following:[12]
 Periodontal health and gingival health
 Clinical gingival health on an intact periodontium
 Clinical gingival health on a reduced periodontium
 Stable periodontitis patient
 Non-periodontitis patient

 Gingivitis – dental biofilm-induced

 Associated with dental biofilm alone
 Mediated by systemic or local risk factors
 Drug-influenced gingival enlargement
 Classification of periodontal diseases 2017

 Gingival diseases – non-dental biofilm induced

 Genetic/ developmental disorders
 Specific infections
 Inflammatory and immune conditions
 Reactive processes
 Neoplasms
 Endocrine, nutritional & metabolic diseases
 Traumatic lesions
 Gingival pigmentation
 Classification of periodontal diseases World
Health Organization (WHO)
 K.05 Gingivitis and periodontal diseases including lesions of the edentulous crest.
 K.05.0 Acute gingivitis
WHO Periodontal Lesions Classification

 K.05.1 Chronic gingivitis

• K.05.10 Simple Marginal
• K.05.11 Hyperplastic.
• K.05.12 Ulcerative.
• K.05.13 Descuamative.
• K.05.18 Other chronic gingivitis.
WHO Periodontal Lesions Classification

 K.05.2. Acute periodontitis.

 K.05.20 Periodontal abscess of gingival origin without fistula.
 K.05.21 Periodontal abscess of gingival origin with fistula.
 K.05.22 Acute pericoronitis.
 K.05.28 Another acute specified periodontitis.
 K.05.3 Chronic periodontitis:
 K.05.30 Simple.
 K.05.31 Complex.
 K.05.32 Chronic pericoronitis.
 K.05.33 Chronic hyperplastic folliculitis.
 K.05.38 Another chronic specified periodontitis.
 K.05.4 Chronic periodontal lesions:
 Juvenile parodontosis
 K 06 Other disorders of gingiva and edentulous alveolar ridge
 K.06.0 Gingival Recession (including postinfectious,
postoperative):
 K.06.00 Localized.
 K.06.01 Generalized.
 K.06.09 Gingival recession without specification
 K.06.1 Gingival hyperplasia.
 K.06.10 Gingival fibromatosis.
 K.06.18 Other gingival specified hyperplasias.
 K.06.2 Gingival lesions and of edentulous
alveolar crest associated with trauma.
 K.06.23 Irritation hyperplasia (by prosthesis).
K06.8Other specified disorders of gingiva and edentulous alveolar ridge
 Fibrous epulis
 Flabby ridge
 Giant cell epulis
 Peripheral giant cell granuloma
 Pyogenic granuloma of gingiva
K06.9Disorder of gingiva and
edentulous alveolar ridge,
unspecified
Classification of gingivitis ( by Gafar and Andreescu- 1990)

1. According to location and extension of the lesions:

 Chronic gingivitis
 Chronic superficial periodontitis
 Chronic deep periodontitis.
2. According to evolution:
 Pre-clinical pre-inflammatory phase;
 Clinical inflammatory phase;
 Post-clinical, post-infflamatory phase of tissue exhaustion with degenerative dystrophic
lesions.
Classification of gingivitis ( by Gafar and
Andreescu- 1990)
3. New dystrophic forms:
 Pure form of parodontosis;
 Juvenile parodontosis;
 Early onset form of involution;
 Physiological form of involution.

4. Mixt form of periodontitis characterized by association of infflamation to the dystrophic form.

5. Proliferative form.
Periodontal disease and conditions can be
broken down into three major categories
1. Periodontal health and gingival diseases
 a. Periodontal and gingival health
 b. Gingivitis caused by biofilm (bacteria)
 c. Gingivitis not caused by biofilm

2. Periodontitis
 a. Necrotizing diseases
 b. Periodontitis as a manifestation of systemic disease
 c. Periodontitis (more detailed explanation below)

3. Other conditions affecting the periodontium

Periodontal disease and conditions can be
broken down into three major categories
 3. Other conditions affecting the periodontium
 a. Systemic diseases affecting the periodontium
 b. Periodontal abscess or periodontal/endodontic lesions
 c. Mucogingival deformities and conditions
 d. Traumatic occlusal forces
 e. Tooth- and prosthesis-related factors

Etiology of periodontitits
Local factors in etiology of periodontal
diseases
 LOCAL FACTORS

 Deposits on teeth (Supragingival Subgingival calculus, dental plaque)

 Abnormal habits (Unilateral mastication, Abnormal biting habits,

Clenching and bruxism )
 Food impaction (Wedging of food between two teeth because of faulty
contact creating a constant source of irritation leads to the tissue
inflammation.)
 Non-detergent diet (not chewing hard food)
 Other irritants Mechanical, Chemical irritants, Improper orthodontic
procedures
Dental factors

 Abnormal Anatomy
 Underdeveloped cingulum
 Improper tooth position
 Improper contact area will cause the inflammation of gingiva.
 Functional factors (oclusal)
1. Over function:
a) Excessive stress on teeth (bruxism, overcontacts-)
b) Insufficient periodontal support
 Traumatic occlusal force is the force that exceeds the adaptive capacity of the
periodontium and/or the teeth.
Functional factors (oclusal)

2. Under function:
a) Premature wear
b) Non-occlusion
Chronic occlusal trauma
Traumatic lesions- Chronic or Acute
SYSTEMIC FACTORS in the etiology of periodontal disease

SYSTEMIC FACTORS
 Faulty nutrition (scorbut=Vit. C deficiency)
 Debilitating disease
 Blood disorders (leukemia etc.)
 Endocrine dysfunctions (diabetes etc. )
 Radiation (after radiotherapy)
 Osteoporosis
 Psychogenic factors
 Hormonal changes: Changes in the hormones that occur during
puberty, pregnancy, menstruation, and menopause can make your
gums more sensitive, increasing the chances of gingivitis.
 Illnesses: Diseases, such as cancer and HIV, weaken the body’s
immune system, which can make the gums more vulnerable to
gingivitis-causing bacteria.
 Medications: Some drugs can reduce the flow of saliva, which protects
the teeth and gums. Some drugs, such as the anticonvulsant Dilantin
and the anti-aging Procardia, can cause the gum tissue to grow
abnormally.(hyperplasia)
Risk Factors of Periodontal Disease
 The role of hygiene of oral cavity.

 The importance of oral hygiene for the health of your teeth and your overall health can’t be
overstated. Neglecting to brush and flush your teeth results in a cascade of diseases, including
gingivitis (gum inflammation, gum disease (periodontitis), tooth decay (cavity), etc.
 Proper cleaning of the teeth and the oral cavity can significantly reduce the occurrence of
cavities, tooth decay, and gum disease by removing dental plaque from the surfaces of the
teeth and reducing overall bacteria in the oral cavity.
 By thorough daily brushing and flossing you can remove these germs and help prevent
periodontal disease.