Introduction to PeriodontologyDr. Feras Aalam

outline

• Periodontium

• Healthy

• Gingivitis

• Periodontitis

• Periodontal examinations

Gingival crest

Marginal gingiva

Attached gingiva

Alveolar bone

Enamel

Dentine

Gingival sulcus

Cementum

Periodontal ligament

Lamina dura

Epithelial attachment

Alveolar mucosa

Ginigval unit

Attachment unit

Clean tooth

pellicle

plaque

calculus

No Oral hygeine 6-8 H

No Oral hygeine >14 Days

Pellicle

• Glycoprotein pellicle• Initial phase of plaque

formation• Soft and hard surfaces

of O.C (teeth, prothesis,tissue)

Pellicle

• Contents

salivary components

crevicular fluid

bacterial products

tissue cellproducts

debris

Pellicle

• Functions

1. protective barrier (lubrication, prevent tissue desiccation)

2. provides a substrate on which bacteria accumulate to form dental plaque

Clean tooth

pellicle

plaque

calculus

No Oral hygeine 6-8 H

No Oral hygeine >14 Days

Plaque

• Soft deposits, within few hours

• Composition:– A mixed microbial biofilm

growing on dental pellicle

• The prime etiological agent of the two main oral diseases:

dental caries periodontal disease

Plaque formation

• 1-2 days• Initial colonization by pioneer

species on dental pellicle• Outgrowth, microcolonies.....spread

outwards and upwards• Secondary colonization and

multiplication• Species diversity increases

Major sites of plaque accumulation

• Fissures of molar teeth

• Supragingival: on the tooth surface above the gingiva

• Subgingival: in the area bounded by the margin of the gum and the tooth

• Interproximal: between adjacent teeth

Clean tooth

pellicle

plaque

calculus

No Oral hygeine 6-8 H

No Oral hygeine >14 Days

Calculus

Consists of miniralized bacterial plaque that forms on the surfaces

Supragingival or subgingival

Calculus

Composition

• 1. inorganic content 70-90% of calcium phosphate, calcium carbonate, magnesium phosphate

• 2.organic content protein-polysaccharide, desquamated epithelial cells, leukocytes, microorganisms

Calculus formation

• Calculus is dental plaque that has undergone miniralization

• Soft plaque.......precipitation of miniral salts between 1st and 14 days

• Saliva is the source of miniralization

• Gingival Cervicular Fluid (GCF)

Health

Gingivitis

Periodontitis

Periodontal Disease

How do we know there is a problem??

DIAGNOSIS

• Individual complaine

• Clinical examinations

• Radiographic examination

Individual complaine

• Bleeding gums• Red gums• Blood on my pilo• Bad taste • Bad smell (halitosis)• Smokers ....less bleeding

Clinical examinations

• Plaque index

• Gingival index

• Pocket measurment

• Furcation

• Tooth mobility

Plaque IndexSilness & Löe 1964

Score 1

Score 2Score 0

Score 3

Plaque Scoring System for Quigley and Hein

Score

no plaque 0

flecks of stain at the gingival margin 1

definite line of plaque at the gingival margin 2

gingival third of surface 3

two thirds of surface 4

greater than two thirds of surface 5  

Plaque Index

total score = = SUM(scores for all facial and lingual surfaces)

index = = (total score) / (number of surfaces examined)

Gingival Index Löe & Silness 1963

Score 0 Score 2

Score 3Score 1

Appearance Bleeding Inflammation Points

normal no bleeding none 0

slight change in color and mild edema with slight change in texture

no bleeding mild 1

redness, hypertrophy, edema and glazing

bleeding on probing/pressure

moderate 2

marked redness, hypertrophy, edema, ulceration

spontaneous bleeding

severe 3

Gingival Index Löe & Silness 1963

Gingival Index Löe & Silness 1963

Teeth examined:

• (1) maxillary right first molar

• (2) maxillary right lateral incisor

• (3) maxillary left first bicuspid

• (4) mandibular left first molar

• (5) mandibular left lateral incisor

• (6) mandibular right first bicuspid

Surfaces examined on each tooth:

• (1) buccal

• (2) lingual

• (3) mesial

• (4) distal

Gingival Index Löe & Silness 1963

Average Gingival Index Interpretation

2.1 - 3.0 severe inflammation

1.1 - 2.0 moderate inflammation

0.1 - 1.0 mild inflammation

< 0.1 no inflammation

 

Gingival Index Löe & Silness 1963

Gingival sulcus

Pocket

Furcation

Furcation

Furcation

• Bacterial plque

• Extent of inflammation

• Enamel projection

• Increase with age

• Increase in smokers

Radiographic examination

Horizontal bone resorption

Radiographic examination

Vertical bone resorption

Treatment plan

Hygeinic phase (Phase I therapy)• Oral hygeine instruction (OHI)• Gingivitis treatment

*maintain good OH (brushing, flossing)

*chlorohexidine mouth wash 2%• Supragingival scaling• Subgingival scaling and root planing• 3 weeks follow up

Summary

• Plaque

• Calculus

• Gingivitis

• periodontitis