§3.Periodontal DiseasesIn the United

States , about 60% of young adults,

80% of middle-aged people,

90% of people older than 65 have some form of periodontal disease

ContentDefinition of periodontal diseasesAetiology and pathogenesis of periodontal

diseases Classification of periodontal diseasesManifestation of periodontal diseasesTreatment of periodontal diseases

Definition of periodontal diseasesPeriodontal diseases can be defined as any

pathological process affecting the periodontal tissues, but invariably refers to inflammatory disease, gingivitis and periodontitis

1.Initial factor-----Pathogenic microorganism

New laboratory techniques show that over 530 species and subspecies have been isolated and classified from subgingival and supragingival bacterial samples.

Aetiology -How does periodontal disease start?

530

These bacteria possess biochemical capacities for the pathogenesis of

inflammatory periodontal diseases .

• Dental plaque is a sticky, colorless deposit of bacteria that constantly forms on the teeth. Saliva, food and fluids combine to produce this plaque. If it is not removed by regular brushing and flossing, it hardens and calcifies to form a stone like crusty deposit, commonly referred to as tartar or calculus.

Calculus is a hardened substance that comes from a combination of minerals in the saliva and from the dead plaque bacterial cells. They precipitate a crusty deposit that, once mineralized, can grow rather quickly.

.

There are two types of calculus: Supragingival calculus is the hard deposit on top of the teeth, the kind we can see and feel. Subgingival calculus forms below the gums. It is just as hard and adherent as supragingival calculus, this allows the bacteria to congregate in greater numbers. Though it is difficult to remove plaque formed on top of/within subgingival calculus, it is necessary to do because these pathogens cause more periodontal tissue breakdown.

Dental plaque forms soon after it is removed.

Some studies report that it starts forming as soon as five minutes after it is removed.

Regardless of how quickly it begins reforming, effective plaque control will keep it to a minimum.

Supragingival dental plaque, early stage in formation.

Supragingival dental plaque, late stage in formation.

If plaque is allowed to build up on the teeth, toxin or enzymes produced by the bacteria can damage the attachment of the gums, periodontal ligament, and bone to the teeth.

Healthy gums should fit snugly around the teeth. But as periodontal bacteria make their way beneath the gums, they create periodontal pocket which are unwanted gaps around the teeth. Teeth with pockets around them may eventually loosen or fall out.

If the inflammation is allowed to continue, the bone will begin to demineralize and dissolve. This stage is known as periodontitis .

As the bone dissolves around the teeth, the teeth become unsupported and will fall out.

As more bone is destroyed, the tooth begins to loosen and, as the pockets get deeper, abscesses often occur. Sometimes the gum will shrink as bone underneath is destroyed so that part of the root will become visible in the mouth

Unfortunately, pain does not occur until the final stages of the disease and treatment at that time has very little chance of being successful.

2.Local contributing factors may increase the risk or severity of periodontal disease:

1.Oral hygiene:

2.Food impaction

3.Tauma from occlusion

3.Systemic factor: 1.Smoking: a major risk factor for

increasing the prevalence and severity of periodontal destruction.

2. Genetics: some factors can increase the sensibility that the host responds to periodontal disease.

3.Pregnancy: gingiva is a target organ for female sex hormones.

4. Stress: stress can increase the release of hormones and immune medium ,which can reduce defense function of the host.

5.Systemic disease:

Classification of gingival disease

Gingival disease

Chronic gingivitis

Gingival hyperplasia

System

Acute necrotizing ulcerative gingivitisAcute papilla gingivalistaAcute multiple abscesses of the gingiva

Margingnal gingvitis Hyperplastic gingvitis

Puberty gingivitis Pregnancy gingvitis

Drug-inducedHereditary gingival fibromatosisEpulis

Gingivitis associated systemic diseases

Classification of periodontitis

1. Acute necrotizing ulcerative gingivitis (also named Vincent gingivitis -----

ANUG)

Acute necrotizing inflammation occurring on marginal gingiva and papillae.

Acute necrotizing ulcerative gingivitisAcute papilla gingivalistaAcute multiple abscesses of the gingiva

EatiologyEatiology ANUG

Smear for fusospirochaetal bacteria Smear for fusospirochaetal bacteria

fusospirochaetal bacteria

Some reasons

Defense of host

Existing gingivitis and periodontitis

are important contributing factor

Deep pocket are suitable for bacteria growthDeep pocket are suitable for bacteria growthLocal or systemic factor make bacteria growLocal or systemic factor make bacteria grow

Clinical featuresAge :young and middle aged people

(18-30) smoking male

weaken child

Size: lower anterior teeth

ANUG

Severe soreness

Profuse gingival bleeding

Halitosis and a bad taste

Interdental papillae ulcerated with

necrotic slough

ANUG

2.Acute papilla gingivalista

Acute inflammation

localized in certain interdental papillae

Acute Acute papilla papilla gingivalistagingivalista

Acute necrotizing ulcerative gingivitisAcute papilla gingivalistaAcute multiple abscesses of the gingiva

Acute Acute papilla papilla gingivalistagingivalistaAetiology

Mechanical stimulationFood impaction

Adjacent caries

Bad restoration

Chemical irritants

AsO3 ---Arsenic trioxide

Clinical features

Spontaneous, lasting pain

Short onset

Single papilla--- bright, red, swelling,

soft texture

Severe bleeding and pain while

probing

Percussion （＋）， loose （—）

X-ray

Acute Acute papilla papilla gingivalistagingivalista

Acute necrotizing ulcerative gingivitisAcute papilla gingivalistaAcute multiple abscesses of the gingivae

Multiple papillaeAcute suppurative inflammation

3.Acute multiple abscesses of the gingivae

clinical features

Throbbing pain.

Red swelling

Small abscess

Subsequent rupture

Halitosis

1.Margingnal gingivitis

Almost universal in adults to some degree

Dental plaque(main cause)

Erythema, edema and painless swelling of

marginal gingivae with bleeding on brushing

or eating hard food

Chronic gingivitis

Margingnal gingvitis Hyperplastic gingvitis

Puberty gingvitis Pregnancy gingivitis

2. Hyperplastic gingivitis

May occur following prolonged accumulation of dental

plaque

Firm ,pink gingival enlargement, particularly at

interdental sites.

May cover the crowns of teeth, resulting in aesthetic

and cleaning difficulties.

3.Puberty gingivitis

Tooth arrangement is not good, fixed orthodontic

appliance, the eruption of teeth in teenagers, bad habit

of oral hygiene are all contributing factors

Less calculus, much dental plaque

Gingiva is the target tissue of sexual hormone, and the

change of sex hormone in teenagers is great ,which

can easily result in inflammation of gingivae.

Chronic gingivitis

Margingnal gingvitis Hyperplastic gingivitis

Puberty gingivitis Pregnancy gingvitis

4.Pregnancy gingivitis

Common

Exacerbation of chronic gingivitis mainly after 2nd

month of pregnancy

Erythema, swelling and liability to bleed

Gingival hyperplasia

Drug-induced gingival hyperplasiaHereditary gingival fibromatosisEpulis

1.Drug-induced hyperplasia

Usually aggravated by poor oral hygiene

It starts interdentally ,especially liabially

Papillae firm, pale and enlarge to form false

vertical clefts

2.Hereditary gingival fibromatosis

Gingival hyperplasia

Drug-induced gingiva hyperplasiaHereditary gingival fibromatosisEpulis

3.Epulis

Localized gingival swelling

Fibrous are most common

Local gingival irritation leading

to fibrous hyperplasia

Epulis

Typically form narrow,firm,pale swellings of

an anterior interdental papillae

May ulcerate

Leukemia

Most common in adults

Characterized by swelling

haemorrhage and ulceration

Gingivitis associated systemic diseases

Leukemia

Treatment of gingival diseases includes

Oral hygiene---Plaque control to a meticulous standard

Rinsing

Tooth brushing

Interdentally brushing

Scaling

The use of antibiotic treatment

Excision

The main topic

Definition : Dental plaque CalculusClassification of periodontal diseases