Lecture - Cogingival and periodontal diseases
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Transcript of Lecture - Cogingival and periodontal diseases
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GINGIVAL AND
PERIODONTAL DISEASES
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INTRODUCTION
Oral mucosa consists of 3 zones:
1.Gingiva & Hard Palate: Masticatory Mucosa.
2. Dorsum of Tongue: Specialized Mucosa.
3. Remaining oral Cavity: Oral Mucous membrane.
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INTRODUCTION
PERIODONTIUM:Investing & Supporting
tissues of the tooth.
GINGIVA: Protecting theunderlying tissues
PERIODONTAL
LIGAMENTS
CEMENTUM
ALVEOLAR BONE
ATTACHMENTAPPARATUS
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Gingiva is that part of
the oral mucosa that
covers the alveolar
processes of the jaws
and surrounds thenecks of the teeth
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Any inherited or acquired disorder of the tissues
surrounding and supporting the teeth(periodontium)
can be defined as a periodontal disease.
Periodontal disease usually refers to the
common inflammatory disorders of gingivitis
and periodontitis that are caused by pathogenicmicroflora in the biofilm or dental plaque that
forms adjacent to the teeth on a daily basis.
Developmental, traumatic, neoplastic,
genetic, or metabolic origin
PERIODONTAL DISEASES
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Gingivitis, the mildest form of
periodontal disease, is highlyprevalent and readily
reversible by simple, effective oral
hygiene.
Gingivitis affects 5090% of adultsworldwide, depending on its
precise definition
Inflammation that extends deep into
the tissues and causes loss of
supporting connective tissue andalveolar bone is known as
periodontitis .
Periodontitis results in the formationof soft tissue pockets or deepened
crevices between the gingiva and
tooth root.
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CLASSIFICATION (AAP
1999)
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GINGIVAL DISEASES
PLAQUE INDUCED GINGIVALDISEASES
most common form
is a result of interaction between plaquebacteria & defence cells of the host.
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CLINICAL FEATURES
GINGIVITIS
ACUTE/CHRONIC
LOCALIZED/GENERALIZED
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CLINICAL FEATURES
Marginal gingivitis: inflammation
involving the marginal gingiva
Papillary gingivitis: involving the
interdental papilla
Diffuse gingivitis: involving the marginal
gingiva, attached gingiva & interdental
papilla
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CLINICAL EXAMINATION
The aim of the clinical examination is to identify signs of possible
disease. The gingiva is assessed on the basis of the following
parameters:
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GINGIVAL DISEASES
NON-PLAQUE INDUCED GINGIVALDISEASES
Have different etiology & characteristic
clinical presentation. Include specific bacterial, viral or
fungal infections etc
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NECROTIZING ULCERATIVE
GINGIVITIS
Vincents infection/ trench mouth
Causes: fusiform bacillus &
Bactereoids intermedius, Prevotellaintermedia
Local predisposing factors:pre-existing gingivitis
injury to gingiva
smoking
ORAL SIGNS:
Punched out crater like depressions at the crest of
interdental papillae extending to marginal gingiva.
Covered with grey pseudomembranous slough / Red, shinyhemorrhagic
Demarcated from the reminder gingival mucosa by
pronounced linear erythema
Pronounced Bleeding after slight stimulation
Fetid odor
Increased salivationDoes not lead to pocket formation , cause recession
ORAL SYMPTOMS
Lesions: extremely sensitive to touch
Constant radiating gnawing pain ,
spicy and hot foodMetallic foul taste
EXTRA ORAL SIGNS AND
SYMPTOMSLocal lymphadenopathy, Slight
elevation in temperature,
Leukocytosis, loss of appetite
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ACUTE HERPETIC GINGIVOSTOMATITIS
Caused by: HSV
Most frequently in infants & childrenyounger than 6 yrs of age but can also
be seen in adults
ORAL SIGNS:
Diffuse erythematous shiny involvement of gingiva and
adjacent oral mucosa with varying degrees of edema and
gingival bleeding.
Initial stages: discrete spherical gray vesicles, on labial
mucosa, buccal mucosa, soft palate, pharynx, tounge.
Vesicles rupture, form small painful ulcers, with red elevated
halo margin and depressed yellowishgray central portion
ORAL SYMPTOMS
Generalized soreness of the oral
cavity
Interfering with eating and drinking.
Ruptured vesicles: painful, sensitiveto touch
EXTRA ORAL SIGNS AND
SYMPTOMS
Fever, Generalized malaise
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DESQUAMATIVE GINGIVITIS
Is not a disease entity but a clinical
term used to describe a unique
condition of gingiva characterized byintense redness & desquamation of
the surface epithelium.
The clinical presentation includes thegingival manifestations of a variety of
diseases like lichen planus,
pemphigus vulgaris, bullous
Intense erythema, desquamation, and ulceration of
free and attached gingiva
May be asymptomatic, if symptomatic: mild burning
sensation to intense pain.
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DRUG INDUCED GINGIVAL ENLARGEMENT
SIGNS & SYMPTOMS:
The growth starts as painless , beadlike enlargement of theinterdental papillae and extends to facial and lingual gingival
margin.
As condition progresses marginal and interdental papillae
unite into massive fold covering considerable portion of
crowns and interfere with occlusionAnticonvulsants(Phenytoin),
immunosuppressants(Cyclosporines)and calcium channel
blockers(Nifedipine)
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PLASMA CELL GINGIVITIS
Some of the compounds that cause
contact allergy to in the gingiva are,
mercurial compounds, like amalgam,
tartar control tooth pastes, like,pyrophosphates, can lead to intense
erythema of gingival tissue.
Elimination of the offending agentusually leads to resolution of the
lesion within a week.
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PERICORONITIS
SIGNS & SYMPTOMS:Gingival flap associated with incompletely erupted tooth :
chronically inflamed: red swollen suppurative, tender with
radiating pain to ear, throat floor of mouth.
Foul taste, extraoral swelling, trismusEXTRA ORAL SIGNS AND
SYMPTOMS
Local lymphadenopathy, Slight
elevation in temperature,Leukocytosis, malaise
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ENLARGEMENT IN PREGNANCY
MARGINAL: results from aggravation of previous
inflammation
Does not occour without the presence of plaque
Generalized
More prominent interproximally than on facial and lingual
surfaces
Enlarged gingiva is bright red or magenta, soft , friable,
smooth and shiny surface.
TUMOR LIKE: PREGNANCY TUMOR: Inflammatory
response to bacterial plaque, modified by patients condition.
Discrete mushroom like flattened spherical masses that
protrudes from gingival margin or more often from
interproximal areas, dusky red or magenta, smooth,
glistening surface, numerous red pinpoint markings.Superficial lesion and does not invade bone.
ESTROGEN / PROGESTERONE
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ENLARGEMENT IN PUBERTY
MALE / FEMALE ADOLESCENTS
Marginal and interdental : characterized by prominent
bulbous interproximal papillae.
Facial gingiva enlarged, lingual gingiva: unaltered
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PERIODONTITIS
Any inflammatory disease of the
supporting tissues of the tooth
caused by specificmicroorganisms, resulting in
progressive destruction of the
periodontal ligament and alveolarbone with pocket formation,
recession, or both.
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CLINICAL EXAMINATION
PERIODONTALPROBING
Periodontal pockets should be examined for
their presence, type and distribution in relation
to each tooth.
This can be done by systematic and careful
probing with Williams graduated probe.
The Williams periodontal probe is marked in
millimeters at the following distances from the
probe tip. 1, 2, 3, 5 then 7, 8, 9 and 10
millimeters
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Incorrect angle correct angle
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Periodontal probing is accomplished for allsurfaces of every tooth in the dentition.
During probing, a periodontal probe should beused with gentle pressure and it should be"walked" around the entire circumference ofeach tooth.
Probing depth is recorded for all teeth on eachof six locations (buccal, lingual, mesio-buccal,mesio-lingual, disto-lingual, disto-buccal).
The probe should be inserted parallel to thelong axis of the tooth and walked around eachsurface of each tooth to detect the depth ofpocket at each surface.
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CLINICAL EXAMINATION
CLINICAL ATTACHMENT LOSS
While probing, the level of cemento enamel
junction should also be noted.
This is the distance from the cemento-enamel
junction to the base of the pocket andrepresents the best measure of disease severity
in terms of loss of support for the teeth.
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CLINICAL EXAMINATION
CLINICAL ATTACHMENT LOSS
The Periodontal Probe is a suitable instrument forthe assessment of loss of attachment.
The evidence of loss of attachment can be in the form of: Recession (which results in part of the root being visible in
the mouth) or
Pockets or Recession + Pockets
Pockets are measured as the distance between theterminal end of the probe at the pocket base and the
gingival margin.
An increased probing depth as measured beyond the
CEJ is considered as attachment loss.
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CLINICAL EXAMINATION
CLINICAL ATTACHMENT LOSS
Recession is measured from the visible CEJ to
the gingival margin using the Periodontal Probe
as the measuring instrument.
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CLASSIFICATION OF GINGIVAL
RECESSION (P.D. MILLER)
Class I: marginal tissue recession that does notextend to the mucogingival junction. There is noloss of bone or soft tissue in the interdental area.
Class II: marginal gingival recession that extendsto or beyond the mucogingival junction. There isno loss of bone or soft tissue in the interdentalarea
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Class III: : marginal tissue recession thatextends to or beyond the mucogingival
junction. In addition, there is loss of boneand/or soft tissue in the interdental area orthere is malpositioning of teeth.
Class IV: marginal tissue recession thatextends to or beyond the mucogingivaljunction with severe bone loss and soft
tissue interdentally or severe malpositioningof teeth.
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If recession and a probing depth coexist at one site, the
amount of attachment from the CEJ is the sum of the
two figures.
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CLINICAL EXAMINATION
TOOTH MOBILITY
Tooth mobility is represented by the Romannumerals I, II or III. Mobility is detected by
using the end of the handle of two instruments(e.g. mirror and periodontal probe).
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CLINICAL EXAMINATION
FURCATION
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CLINICAL EXAMINATION
Furcation involvement can be readily detectedin good periapical or bitewing radiographs.Clinically it can be confirmed by using theperidontal or Nabers probe.
If the probe can go into the furcation thatindicates there is loss of attachment in thefurcation, an open arrow should be used.
If the probe can go through the furcation e.g.,buccal to lingual or mesial to distal, thatindicates no attachment remains around the
furcation, a closed arrow should be used.
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DISEASED CONDITIONS
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CHRONIC PERIODONTITIS
Periodontoclasia/ pyorrhea/ pyorrhoeaalveolaris
Most common form
Begins as marginal gingivitis, whichusually progresses, if untreated or
improperly treated, to chronic
periodontitis.
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PERIODONTAL ABSCESS
It is a destructive process occurring in theperiodontium, resulting in localized collections of pus,
communicating with the oral cavity through the
gingival sulcus or other periodontal sites and not
arising from the tooth pulp.
The important characteristics of the periodontal
abscess include:
localized accumulation of pus in the gingival wall of
the periodontal pockets; usually occurring on thelateral aspect of the tooth; the appearance of
oedematous red and shiny gingiva; may have a
dome like appearance or may come to a distinct
point.
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RADIOGRAPHIC ASSESSMENT
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Gingivitis and acuteperiodontitis do not have
any specific radiographic
features
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Calculus is
prominently visibleon the second
premolar, first
molar,
and second molar.
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Widening of the
periodontal
ligament
space
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Bone loss is
considered horizontal
when the crest of the
proximal bone remainsparallel to an imaginary
line drawn between the
cemento-enamel
junctions of adjacent
teeth.
Horizontal bone loss proximal to the
posterior teeth.
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Bone loss is
considered vertical
when the crest of the
proximal bone is not
parallel to an imaginaryline drawn between the
cemento-enamel
junctions of adjacent
teeth.
Vertical (angular) bone loss mesial to the
maxillary molar.
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Furcation involvement of molar teeth inAdvanced periodontal disease.
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Lateral periodontal abscess
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LOCALIZEDAGGRESSIVEPERIODONTITIS
A. Loss of bone support in the area of the firstmolars and incisors of both maxillary and mandibular right
quadrants
B. left quadrants of the same patient depicted
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RADIOGRAPHIC ASSESSMENT
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