1.SMIJAL

2. INTRODUCTIONThe periodontium, defined asthose tissues supporting andinvesting the tooth,comprises ofCEMENTUMPDLALVEOLAR BONEDENTOGINGIVAL JUNCTION 3. EPIDEMIOLOGY The epidemology of periodontaldisease is one of the most importantchallengesThere are 3 main type of chronic destructive periodontaldisease.1.Inflammatory disease is the commonestform,usually called peridontitis or marginalperiodontitis.In this, destruction of alveolar boneby the formation of subgingival pockets at thesite of chronic inflammation. 4. 2.The second type of periodontal disease isapparently systemic in origin and is calledperiodontosis or juvenile periodontitis/diffusealveolar atrophy.Which is charecterized bybone loss usually generalized.3.The third type of periodontal disease isatrophy associated with such conditions asold age or disease. 5. In India,data from the National Oral HealthSurvey (2002-2003) states that in children aged12yrs, the prevelence of periodontal disease was57%. In 15yr age group,it was 67.7%. The prevalence was 89.6% and 79.9% in the 35-44year and the 65-74 year age group respectively. 6. ETOIOLOGY OF PERIODONTALDISEASE Gingivitis: is a disease charecterized by inflamation restricted to the gingival soft tissues with no loss of alveolar bone or apical migration of the PDL along the root surface. Periodontal disease: it is an inflammatory disease of the supporting tissues of the teeth caused by specific microorganism resulting in progressive destruction of the PDL and alveolar bone with pocket formation ,recession or both. 7. ETIOLOGYLOCAL FACTORS SYSTEMIC FACTORS Deposits on teeth Faulty nutrition Abnormal habits Debilitating disease Food impaction Blood dyscrasias Non-detergent diet Endocrine Other irritants dysfunctions Abnormal anatomy Radiation Factors of occlusal Psychogenic factors function Iatrogenic factors 8. LOCAL FACTORSDEPOSITS ON TEETH1. Supragingival Calculus It is found above the gingival margins consists of mineral salts from the saliva embedded ina bacterial and fungus matrix.2. Subgingival CalculusThe calcified deposits found on the root surface in the periodontal pocket.3. Materia Alba This white, soft deposits occur around the necks of the crown.Which consist of food debris,dead tissue etc. 9. ABNORMAL HABITS1.Unilateral mastication One side of the mouth is affected by periodontaldisease.Mouth in the non functional side with loss oftone,accumulation of food&calculus.2.Abnormal biting habits It includes pencil biting,nail biting,lip biting,cheekbiting etc.These traumatic injury affects bothperiodontium&tooth.3.Clenching and bruxism These excessive pressure may cause necrosis ofthe periodontal membrane. 10. FOOD IMPACTION It is the wedging of food b/w 2 teeth because offaulty contact creating a constant source ofirritation leads to the tissue inflammation.TYPES1.Vertical:wedging of food between the teeth byocclusal pressure.2.Horizontal: wedging of food by the action of thecheecks&tongue during the mastication. 11. OTHER IRRITANTS1.Mechanical irritants Bridges, clasp,overhanging margins of any restoration will irritate the gingiva.2.Chemical irritants Alcohol,cigarettes and others causes necrotizing ulcerative gingivitis .3.Atmospheric irritantsMouth breathing leads to the dehydration of the mucous membrane&lowered tissue resistance4.Improper orthodontic procedures also irritate the periodontium 12. ABNORMAL ANATOMY Underdeveloped cingulum,improper tooth position,improper contact area will cause the inflammation of gingiva.FACTORS OF OCCLUSAL FUNCTION1.Over function:a)Excessive stress on teeth b)Insufficient periodontal supportc)Powerful masticatorymusculature2.Under function:a)Premature wearb)Non-occlusionc)Indolent mastication 13. SYSTEMIC FACTORSA.FAULTY NUTRITIONDietary deficiency conditions such as scorbuticgingivitis,rachitic gingivitis and non detergent dietgingivitis are often responsible in part for thedevelopment of periodontal disease.Deficiency invit.c may be accompanied by gingival bleeding.B.DEBILITATING DISEASEGastrointestinal disorders,syphilis,nephritis,liver diseases,tuberculosis and other systemic diseases may show signs in the mouth. 14. c.BLOOD DYSCRASIAS In myelogenous leukemia,the gingival lesion may be described as a symptom of the blood disease or as myeloid infiltration of gingivae.D.ENDOCRINE DYSFUNCTIONMiller believed that even mild uniglandular or polyglandular aberrations my create a periodontal susceptibility which together with local etiologic factors could create a periodontal lesion.E.DIABETESThere is a tendency toward alveolar bone destruction in patients with uncontrolled diabetes, Periodontal abscesses with profuse exudative flow are common. 15. F.PITUITARY DISORDERS In hypopituitarism,crowding of teeth andenlargement of gingival tissues have been noted..Spacing of the lower teeth due to enlargement ofthe jaws may occur in hyperpituitarism.G.PUBERTY,PREGNANCY AND CLIMACTERIC Susceptibility to gingival disturbances is moreprevalent during puberty,pregnancy,andclimacteric, usually because of endocrineadjustments taking place during these periods. Gingival enlargements accompanied bydiscolouration,bleeding,and mulberry like swellingcan be seen. . 16. H.PSYCHOGENIC FACTORS Persons under stress and tension often develophabits antagonistic to the health of theperiodontium such as pencil bitingI.IATROGENIC FACTORS Iatrogenic dental and periodontal disease may occur from overhanging margins of fillings which irritate the gingiva and cause inflammation.J.ATOMIC RADIATIONRadiations of intense dose/higher dose disturbs thenormal alveolar bone pattern resulting in periodontaldestruction. 17. NO: AUTHORSYEAR POPULATIONFINDINGS1.Mehta and 19561640 school children of Prevalence of gingivitis wasSanjana Bombay city(11-17yrs) 93.7%&increased with age.2.Gupta 1962800 people in TVM(11-50yrs) Periodontal disease-100%after 30 yrs,90% in(11-30yrs)3 Ramachandr19736,647 rural & 1,536 urban Prevalence of periodontalan et alpopulation in Tamilnadu.disease(95.3%&95.5%)respectively.4.Nagaraj Rao 1980500 children in Udupi(5-28%-marginal gingivitiset al 10yrs)7.2%-chronic generalizedgingivitis5.Anil.S,Hari.S 19902756 subjects(15-44)in TVM. Calculus & bleeding(86%) inand 15-19yrs.shallowVijayakumar pocketing(80%)in 25-29yrs.deep pockets(33%)in35-44 yrs.6 Mathew19961513 subjects(15yrs) in Udupi 0.4%-healthyKurian et alperiodontium.Shallowpockets in(26.6%) & deeppockets in(24.1%). 18. CURRENT CONCEPTS OFPATHOGENESIS OF PERIODONTITIS Bacteria of dentalplaqueActivatiDirect on ofImmune bacterialimmunedysfunc tissuemechani tiondamagesmPeriodontaldisease 19. Prevalence of Periodontosis among Indians Marshall Day & Shourie {1949}, Belting& Massler reported{1953}, Miglani & Sharma {1965}, Tewari & S.S Raoconducted Studies & reported that 95-100% population hasbeen shown to be suffring from periodontal disease in variouspopulation groups only differing in severity from one toanother. In the younger age group i.e. till the age of 20 years it isgingivitis in its various severities; above that specially abovethe age of 30 years, 99-100% of the population has beenreported to be suffering from periodontal disease & as high as70% from periodontal pockets or bone resorption. Habits such as smoking & betel leaf chewing are associatedwith an above average severity of periodontal disease. Suchgroup have more plaque & calculus & are much lessconcerned about their dental health. 20. Distribution of Disease in differentareas of mouth Dividing each of areas into upper & lingualarches, revealed that gingivitis was more severe inupper arch than lower for interproximal areas. Most severly affected teeth by periodontal disease are upper molars & lower incisors. Least affected are lower premolars & upper canines. Higher tendency is right half than left, it may be due to difficulty of right handed person in brushing right half. 21. Other important studies done on descriptive epidemiology of gingival & periodontal disease:A. Prevelance of Gingivitis:.1. Macall 1933 {New York} 4,600 children Age group l-14years Percentage of persons affected with gingivitis - 98.0%2. Messner et al in 1938. {us} 1,438,318 children 6-14 years age group 3.5 - 8.6% with gingivitis 22. Surveys on prevalence of gingivitisconducted in India:.Marshall - Day and Tandon in 1940 {Lahore}756 childrenAge group approximately 13 years68.0% affected with gingivitis2. Marshall - Day in 1940 {fluoride endemic area in Northern India} 203 individuals Age group 5-18 years 59.6% gingivitis3. Marshall - Day in 1944 {Kangra district of India} 200 boys Approximately 13 years 81.0% of gingivitis 23. Other survey:. McHugh et al in 1964{ Boys and girls in Dundee, Scotland}1 2905 individuals 13 years age group 99.4% gingivitis2. King in 1940 {Isle of Lewis} 2280 individuals 6-15yr age group 90% gingivitis3. Stahl & Goldman 1953 {children in Massachusetts} 1300 children 13-17 age group 29% gingivitis4. Russel 1957 {urban area in US} Survey among white & black. 24. B. Prevelance of Periodontal Diseases: Periodontal diseases accounts for greatest loss of teeth inhumans. Lack of public concern & general unawareness ofconsequences of periodontal diseases have contributed to itsbroad prevalence. In India PDL disease caused loss of 11,960 teeth for allpatients of age & was responsible for loss of 79.2% of al teethin all patients over 30years of age. This was estimated in astudy conducted by Mehta et al 1958. Levels of PDL disease such as those found in US have alsobeen recorded in Scandinavian Countries according to Shei etal in 1959. 25. Reports of some important periodontal surveys conducted in India:. Marshall - Day & Shourie K.L in 1947 {Lahore} 1054 individuals 9-17 years age group 99.496 gingivitis2. Mehta FS & Sanjana in 1956 {Bombay City School children} 1640 children 11-16 years age group 96.9% gingivitis3. I.C. Greene in 1960 {Bombay} 1613 individuals 1 l-17years age group 96.9% gingivitis 26. Samples Age groupGingivitis PeriodontalDestruction155 11-20 years90.396 16.8%275 21 -30 years 96.796 55.6%153 31- 40 years 100% 87.6%7441 -50 years 100% 94.8%4351 -60 years 100% 0.0%3361 -70 years 100% 94.8%2571 -80 years 100% 100% 27. C. Prevalence of juvenile periodontitis Its difficult to arrive at statement of prevalence for juvenileperiondotitis because few studies have been specificallydesigned determine extend of this degenerative disease. An examination percentage distribution of PDL disease forperson in US shows that prevalence of destructive periodontaldisease is: 58% for adolesants 12-17 yr age 10% for young adults 18-24 yr age 17% for adults 30-34 yr age Assuming that approx.half of these individuals had juvenileperiodontitis, it would be reasonable to expect that trueprevalence of juvenile periodontitis would be some what lessthan 8%. 28. RISK FACTORS IN PERIODONTALDISEASE1.AGE Chronic destructive periodontal disease hasalways been associated with older age groups.2.SEX The males have a higher prevalence and severityof periodontal disease than females.But relatively highincidence of juvenile periodontitis has been found infemales.3.RACE The severity among Spanish-Americans appear tobe higher than that of whites&blacks. 29. 4.EDUCATION Occupation which is so closely tied toeducation,shows a relationship to periodontal diseasethat is similar to that of education.5.INCOME Periodontal disease is inversly related to increasinglevels of income.6.PLACE OF RESIDENCEPrevelance of periodontal disease are slightlyhigher in rural areas than in urban areas. 30. 7.DIETVegetarians tends to consume more CHO containgsticky foods.so prevalence is more evident amongvegetarians.8.NUTRITION Higher severity of periodontal disease in areaswhere protein calorie malnutrition and vitamin Adeficiency are common.9.SOCIO-ECNOMIC FACTORS Lower income group have a higher rate ofperiodontal disease than the higher income group. 31. PREVENTION OF PERIODONTALDISEASE Adequate plaque removal has been shown to preventgingivitis as well as subtantially limit the progressionof periodontitis. Regular and thorough removal of plaque by dentistand dental hygienist can successfully controlperiodontal disease. Oral hygiene practices involve the thorough dailyremoval of dental plaque and other debris by toothbrushing and flossing. 32. Levels ofPRIMARYSECONDARY TERTIARYprevention Health SpecificEarly diagnosis Disability Rehabilitation promotionprotection& promptlimitationtreatmentServices periodic visit to Avoidance of SelfUtilization of Utilization ofprovided bydental office knownexamination & dental dentalthe individual irritantsreferralservices servicesServices Dental healthAvoidance ofPeriodicProvision of Provision ofprovided byeducationknown screening & dental dentalthe dental programs irritants referralservices servicescommunityServices PatientRemoval ofCompleteChemotherapy -Plasticprovided byeducationknown examinationsurgerythe dentalirritants-speechprofessional therapy 33. ORAL HYGIENE PRACTICESMECHANICAL PLAQUE CHEMICAL PLAQUECONTROL CONTROL Tooth brushes and Chlorhexidinedentifrices gluconate(0.2%)Interdental aids Triclosan Dental floss Interdentalbrushes Delmopinol Wooden tips Metallic ions Aids for gingival Quaternary ammoniumstimulation compounds Gingival massage Enzymes Waterirrigationdevices Tongue scrapers Antibiotics 34. CONCLUSION Periodontal disease accounts for a majority ofmissing teeth in adults and result in tremendouseconomic and social burdens both to the individualand society. Periodontal disease is so prevalent that the onlypossible solution is the prevention