COMMON PERIODONTAL

DISEASESBY

THE DENTAL TEAMCENTRAL HOSPITAL AGBOR

23/06/15

INTRODUCTION DISEASES OF THE PERIODONTIUM COMMON PERIODONTAL DISEASE AETIOLOGY PATHOGENESIS CLINICAL PRESENTATION/EFFECTS OF

PERIODONTAL DISEASES MANAGEMENT CONCLUSION

OUTLINE

Periodontal tissues otherwise referred to as

the periodontium are the surrounding soft and hard tissues that support the tooth. They are specialized tissues that both surround and support the teeth, maintaining them in their anatomical positions in the mandible (lower jaw)and maxilla (upper jaw).

It comes from the Greek words peri- meaning “around” and –odons meaning tooth.

INTRODUCTION

The periodontal tissues are four namely: -gingiva(gum) -cementum -alveolar bone -periodontal ligament The disease conditions that affect these

tissues are therefore referred to as periodontal diseases.

INTRODUCTION cont’d

Longitudinal section of a molar tooth

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Healthy periodontal tissuesNote the snug fit of the periodontal tissues around the teeth.

Longitudinal section showing periodontal-tooth relations.

International Workshop for a Classification of Periodontal Diseases and Conditions in 1999 classified these diseases as follows: Gingival diseases (non-plaque induced and plaque

induced) Chronic periodontitis. Aggressive periodontitis. Periodontitis as a manifestation of a systemic

disease, physiological changes, infection, drug reactions, DM, AIDS, dietary and nutritional factors

DISEASES OF THE PERIODONTIUM

Necrotizing periodontal diseases. Abscesses of the periodontium. Periodontitis associated with endodontic

lesions. Developmental or aquired deformities and

conditions e.g. genetic conditions like Downs syndrome, Ehlers-Danlos syndrome, hereditary gingival fibromatosis etc; hematological conditions such as anaemia, leukaemia etc

INFLAMMATORY PERIODONTAL DX-GINGIVITIS1. Acute gingivitis-Acute ulcerative gingivitis -Acute non-specific gngivitis2. Chronic gingivitis-PERIODONTITIS2. Acute periodontitis3. Chronic periodontitis4. Juvenile periodontitis

MISCELLANEOUS PERIODONTAL DISORDERS -GINGIVAL HYPERPLASIA -PERIODONTAL ATROPHY

COMMON PERIODONTAL DISEASES

-PRIMARY CAUSE-plaque (bacterial

aggregates, complex polysaccharide matrix) irritation.

-SECONDARY CAUSES-local and systemic factors which predispose towards plaque accumulation or alter the gingival response to plaque.

AETIOLOGY

LOCAL FACTORS: Calculus Faulty restorations Carious cavities Tooth impaction/pericoronitis Oral habits (tooth-picking, bottle-opening, etc) Tooth brushing trauma Badly designed dentures Orthodontic appliances Malalignment of teeth Lack of lip-seal or mouth-breathing Tobacco smoking Developmental grooves on cervical enamel or root surface

Dental caries Misaligned teeth

Tobacco-staining Dental caries with advancing periodontitis

Jaw fractures

Orthodontic brackets Dentures

SYSTEMIC FACTORS Physiological changes- puberty, menstruation,

pregnancy, oral contraceptives. Systemic diseases eg endocrine like Diabetes mellitus;

genetic conditions{Downs syndrome, Ehler-Danlos syndrome, etc}

Hematological{anaemias,neutropenias,lukaemias} Immunosuppressive therapy, Infections{ANUG,abscesses,viral,fungal} Drug reactions{phenytoin, nifedipine} Dietary and nutritional factors

Cervical abrasionApical periodontitis

Healthy gingivae are firm , pink, knife-edged and do not bleed on probing.

Periodontal disease primarily begins usually from plaque accumulation leading to gingivitis which when sustained can progress to chronic periodontitis

This disease process is mostly painless and can go unnoticed for years.

Note that periodontal destruction when established is not continuous but progresses in an episodic manner with bursts of destructive activity alternating with periods of quiescence and possibly repair.

PATHOGENESIS

Foot note: plaque= bacterial aggregation + complex polysaccharide matrix calculus= calcified plaque

Plaque-induced periodontal lesions can be divided into four stages:1. Initial lesion2. Early lesion3. Established lesion4. Advanced lesion

5. Initial lesion: here host-response mechanisms are raised in response to causative micro-organisms {major offenders being porphyromonas gingivalis & Aggregatibacter actinomycetemcomitans} in accumulating dental plaque within 2-4 days.

False pockets are formed as marginal gingiva and interdental papilla become bulbous and bright red as connective tissue and collagen surrounding bloodvessels in the area dissolve, leaking out fluid into the tissues.

2. Early lesion: occurs about 6-12 days later; here features of the initial lesion are accelerated. Up to 60-70 percent of collagen is lost. Formation of micro-abcesses at the junctional epithelium.

3. Established lesion: begins about 2-3 weeks post-plaque accumulation.Plasma cell accumulation in gingival sulci (no bone loss yet); presence of complement and antigen-antibody complexes is marked.Apical migration of junction epithelium (gum recession makes teeth appear longer)This stage can remain indefinitely or progress to an advanced lesion.

4. Advanced lesion: here the features are better described clinically than histologically. Typically there is Periodontal pocket formation. Gingival ulceration and suppuration. Destruction of alveolar bone and periodontal ligament Tooth mobility, drifting and eventual tooth lossBecause the bone loss appears here, it is equated as periodontitis.The earlier lesions can be classified as gingivitis of increasing severity.The advanced lesion spreads apically, laterally around the tooth and deep into the gum tissue papilla.Bone resorption produces scarring and fibrous change.

Swelling and hyperemia of interdental papilla and gingival margins Plaque and calculus deposits Halitosis Bleeding Pocketing Tooth mobility Sensitivity Pain Pulpal disease(perio-endodontic lesions, pulpitis, apical abscesses) Tooth fractures Tooth loss

CLINICAL PRESENTATION/EFFECTS OF

PERIODONTAL DISEASE

Establish a diagnosis. Aim to create a healthy mouth which the patient

is capable of, and willing to maintain.These principles can be divided as follows:Initial (cause-related) phaseCorrective phaseMaintenance (supportive phase)

MANAGEMENT

1) Initial (cause-related) phase : here we aim to control or eliminate gingivitis and stop any further progression of periodontal disease by removing plaque and other contributory factors. This is key and can cause a failure of more complex treatments.

MANAGEMENT

2) The corrective phase designed to restore function and sometimes, aesthetics. This includes procedures like - scaling and polishing - root debridement - periodontal access surgery - regenerative surgery - muco-gingival surgery -selected use of local and systemic antibiotics -furcation lesion treatments -restorative procedures(overhanging fillings, fitting of crowns, bridges etc) - endodontic treatment - occlusal adjustment

All the aforementioned procedures are aimed

at: Elimination of pathological pockets and the

creation of tight epithelial attachments. To arrest bone loss and in some cases improve

alveolar bone support(bone augmentation procedures).

Create an oral environment that the patient can easily keep plaque-free.

3) The maintenance (supportive) phase that aims at reinforcing patient motivation so their oral hygiene is kept at a level that prevents a reoccurrence of disease.Patient should be instructed on proper dental hygiene practices: toothbrush and tooth brushing techniques, flossing.Proper balanced diet for overall health.Regular dental checkups ( every 3 or 6 months).

Oral hygiene practices (brushing, flossing habits), dental and medical history

Examine the teeth for: -plaque control, -calculus, - staining; -gingival colour change, -swelling, -recession, -pocketing; -furcation involvement, -tooth mobility, -bleeding on probing.

Dental check ups

Radiographs - Full mouth periapicals, horizontal bitewings: to show

degree bone loss(vertical, horizontal), root surface deposits, furcation involvement, perio-endo lesions.

- Sequential radiographs can be used to monitor the disease.

Dental check ups

Periodontal diseases are largely preventable hence the dental team prescribes the following:

Effective tooth brushing technique with medium bristled toothbrush and fluoridated toothpaste twice daily.

The proper use of floss, plastic toothpicks and other interdental aids.

The use of mouthwashes as prescribed by dentist. Proper nutrition. Visit your dentist for consultation at least every 6 months for routine oral examination. There, scaling and polishing amongst other lines of management can be instituted.

CONCLUSION

Dental flossing(with handle)

Ultrasonic scaling and polishing

Manual scaling and polishing

Toothbrush and toothpaste

Dental flossing

Good nutrition

Laura mitchell & David A. Mitchell Oxford

Handbook of Clinical Dentistry 5th Edition. Pg 173-214

Cawsons Essentials of Oral Pathology and Oral Medicine 7th edition. Pg 68-89

Outline of Periodontics by J.D Manson and B.M Eley

www.dentallecnotes.blogspot.com www.en.m.wikipedia.org/wiki/Periodontium www.shutterstock.com

REFERENCES

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