23476208 Periodontal Diseases

8/11/2019 23476208 Periodontal Diseases

1/51

Periodontal Diseases

Chapter seven


2/51

Periodontal Tissues of the Teeth

1. alveolar process2. periodontal ligament

3. gums


3/51

definition

Periodontal diseases include gingivitisand periodontitis. Both are inflammatory

conditions of the gingival tissues (gumtissues around the teeth). In more

severe forms, periodontitis includes loss

of supporting bone tissue which canlead to tooth loss.


4/51

Etiological factors

Initial factor

Local accelerated factors systemic factors


5/51

Initial factor : dental plaque

A product of microbial colonizationand metabolism.

Plaque is an irritant and causesinflammation.

1 Bacteria produce byproducts (called

toxins or enzymes), along with mucus,constantly form a sticky, colorless

plaque on teeth.


6/51

2 Can damage the attachment ofgums, periodontal ligament, andbone to teeth.

3 Brushing and flossing can help getrid of plaque but when its not

removed can harden and formdental calculus.


7/51

4 Dental calculus forms around teeth.

5 Tissue that attaches the gums to theteeth can be destroyed by theirritants of plaque.


8/51

6 Gums pull away

from the teeth andsmall pockets formbetween the teethand gums.

7 Pockets becomefilled with moreplaque.


9/51

8 Pockets deepen, becomingimpossible to clean plaque out.

9 Bone structure supporting teethcan be destroyed.


10/51

Local accelerated factors:

dental calculus

teeth pigmentation

food impactiontrauma from occlusion/

(occlusal trauma)

Abnormal oral conditions or habitsothers


11/51

systemic factors:

heredity

immune disfigurementsex hormonesmokingstress

certain diseases (diabetes mellitus,AIDS, osteoporosis)


12/51

gingivitis

A reversible and mildest form ofperiodontal disease.


13/51

1 Pinkish color2 Firm, resilient tissues3 Shape around teeth

4 No redness, swelling, orinflammation

5 No bleeding6 No discomfort

Characteristics ofHealthy gums:

The gums reach up snugly onto the enamel of

the tooth, protecting the roots and bone structure.


14/51

symptom

Swelling

redness

changes in gum form or position

bleeding


15/51

category

Marginal gingivitis /simple gingivitis

Puberty gingivitis

Pregnancy gingivitis Acute necrotizing ulcerative gingivitis

Hyperplastic gingivitis

Drug-induced gingival hyperplasia Epulis

etc


16/51

Marginal gingivitis

the most common type of gingival disease.

affects both the gingival margins andpapillae.

usually starts at the tips of the papillae and

then extends to the gingival margins.


17/51

Swelling, loss of stippling (orange peel

texture of surface) of the attachedgingiva, 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 toone or two or a group of teeth.


18/51


19/51

Treatment

Eliminated by daily brushing,

flossing, and regular cleanings.


20/51

Periodontitis

Definition:

Inflammation of supporting tissues of

teeth. An extension of inflammation fromgingiva into the adjacent bone and ligament.Usually a progressively destructive changeleading to loss of bone and periodontal

ligament. Ligaments holding tooth in itssocket break down and gums pull away,resulting in a periodontal pocket betweenthe tooth and gum.


21/51

Chronic Periodontitis

Characteristics:

Most prevalent in adults, but can occur inchildren and adolescents.

Amount of destruction is consistent with thepresence of local factors.

Associated with variable microbial pattern. Slow to moderate rate of progression, but

may have period of rapid progression.


22/51

Can be further classified on the basis ofextent and severity.

Can be associated with localpredisposing factors .

May be modified by and /or associatedwith systemic diseases .

Can be modified by environmentalfactors such as cigarette smoking andemotional stress.


23/51

supra- & subgingival plaqueaccumulation that is frequentlyassociated with calculus formation.

gingival inflammation:

color:

range from pale-red to magenta.

consistency:

Slightly-moderate swollen (edematous)or

Thickened, fibrotic margin (as a resultof long-standing, low-grade

inflammation). contour:

loss of stippling,

rolled margins

flattened or cratered papilla.


24/51

General Clinical Features:

Periodontal pocket formation with

variable depth. Bleeding upon probing

Tooth mobility (often appears inadvanced 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)


25/51

Disease Distribution:

clinical signs of chronic periodontitis areconsidered to be due to the direct, sitespecific effect of subgingival plaqueaccumulation.

therefore, clinical signs of disease may

occur on one surface of a tooth whileother surfaces maintain normalattachment level.


26/51

Severity:

Slight (early): 1-2 mm

Moderate: 3-4 mmSevere (advanced): >5 mm


27/51


28/51


29/51


30/51


31/51

Periodontal pocketdeepens and fillswith more bacteria

Supportiveligaments and bonebegin to showdamage

Moderateperiodontal disease


32/51

Advanced stage

Gums severely recede

Pockets deepen and

may fill with pus Swelling around root

Sensitivity to cold/hotor brushing

Bone loss increasesneed to be removed


33/51

Aggressive Periodontitis

Definition:

A specific type of periodontitis withclearly identifiable

clinical and laboratory findings thatmake it sufficiently

different from Chronic Periodontitis.


34/51

features of Aggressive Periodontitis:

Except for the presence of periodontitis,patients are otherwise clinically healthy.

Rapid attachment loss and bonedestruction.

Familial aggregation.


35/51

Aggressive Periodontitis

Localized Aggressive Generalized AggressiveLocalized Aggressive


36/51

Case of Localized Aggressive Periodontitis

In 18-year-old female


37/51

Generalized Aggressive Periodontitis


38/51

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.


39/51

Necrotizing Ulcerative Periodontal Diseases

An infection characterized by necrosis of gingival

tissues, periodontal ligament, and alveolar bone.These lesions are most commonly seen inindividuals with systemic diseases including, but notlimited to HIV infection, malnutrition, andimmunosuppression

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.


40/51


41/51

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 orseparating

Changes in byte


42/51

Bad breath or a chronic bad taste inyour mouth

Teeth that are over sensitive to hot orcold

Itchy sensation


43/51

prevent

Daily good oral hygiene can help reduceyour risk of developing periodontal disease.

Brushing teeth at least twice a day (withfluoride toothpaste)

Careful cleaning between your teeth oncea day with dental floss or another

interdental cleaner to remove plaque


44/51

Use antimicrobial mouth rinse orother oral hygiene aids

Eat a balanced diet Visit the dentist routinely for a check-

up and professional cleaning

Dont use tobacco products


45/51

Treatment

The main goal of treatment is tocontrol the infection. The number and

types of treatment will vary,depending on the extend of the gumdisease. Keeping a good daily care at

home and modifying certain behaviorswill also improve treatment outcome.


46/51

Types of Treatment

Deep cleaning

Scaling-scraping offthe tartarabove and

below gum line


47/51

Root planing- gets rid

of rough spots on the

tooth root where thegerms gather, and

helps remove bacteria


48/51

Medications- may be used withtreatment that includes scaling androot planing, but cannot always take

the place of surgery. Surgical treatments


49/51

Surgical Treatments

Curettage removes the soft tissuelining the periodontal pocket. This

helps the gum tissue to heal Gingivectomy is surgical removal of

the periodontal pocket to allow easier

access for cleaning


50/51

Flap surgery allows to gain access tothe root of the tooth for removal ofcalculus, tartar, plaque, and diseased

tissue.1. Lifting back the gums and removing

tartar

2. Gums are sutured back in place


51/51

Bone and tissue grafts

Grafting is a way to replace or

encourage new growth of bone orgum tissue destroyed

Tissue generation

23476208 Periodontal Diseases

Documents

Transcript of 23476208 Periodontal Diseases