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Periodontal Diseases

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Community Dentistry …

Community Dentistry
Third Year

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  • 1. 08-May-09 Periodontal Diseases PDS 372 Dr. Aim Al-Ansari • • • • • Understanding periodontal Diseases Distribution of PD Demographic Risk Factors in Periodontitis Risk Factors in Periodontitis Periodontitis and Systemic Diseases Understanding Periodontal Diseases • Gingivitis and periodontitis – Gingivitis • Inflammation of the gingiva in which the junctional epithelium remains attached to the tooth at its original level – Periodontitis • Inflammation of the periodontium characterized by the clinical attachment loss (CAL) – Loss of periodontal ligament and the bony support 1
  • 2. 08-May-09 Understanding Periodontal Diseases • Gingivitis and periodontitis – Not every gingivitis turns into periodontitis – Teeth have supragingival plaque that serve as a reservoir (storage) – Strong infection overcomes the host defense – Pathogenic organisms migrate subgingivally creating a biofilm – The inflammatory process starts and mediators are realease Understanding Periodontal Diseases • Gingivitis and periodontitis – The way the disease progresses after this is a determined by the nature and extent of the host response to the infection – It is believed now that: • 25% of periodontal disease is attributed to bacteria • 50% to genetic variance • 25% to tobacco Understanding Periodontal Diseases • Gingivitis and periodontitis – Based on this periodontitis is believed to be of two major types based on cause: • Plaque and local factors type: – – – – The most common Pathogens dominate the host response It happens in bursts (burst theory) Usually site specific • Compromised host type – Less common – Aggressive – Less responsive to standard treatment 2
  • 3. 08-May-09 Distribution of Periodontal Diseases • Geographic Distribution – Over 70% of adults in different parts of the world have some degree of gingivitis or periodontitis – WHO: • Gingivitis and calculus is more in low-income countries • Periodontitis is not so much different between low- and high-income countries Distribution of Periodontal Diseases • Prevalence of Gingivitis – Gingivitis “may” be found in children but it is more prevalent and severe in adolescence – In U.S., 40% - 60% of school children have gingivitis Distribution of Periodontal Diseases • Prevalence of Periodontitis – Prevalence of “generalized severe periodontitis” is in the range of 5% - 15% in almost all populations, regardless of “economic status”, “oral hygiene”, or “availability of dental care.” 3
  • 4. 08-May-09 Distribution of Periodontal Diseases • Incidence of Periodontitis – Difficult and expensive – A study of measuring CAL • CAL in the first period of the study was positively related to CAL in the second period at the “individual level” rather than on the “site level” Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Men > women • No inherent differences in susceptibility to periodontitis 4
  • 5. 08-May-09 Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • According to WHO Global Oral Health Data Bank… Periodontal Disease is uniform around the world • Race and Ethnicity cannot in themselves be considered as demographic risk factors for Periodontitis Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Generally, CAL is greater among older than among younger persons • The prevalence and severity of CAL in older people is not due to susceptibility but due to cumulative progression of the disease Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • When PD starts in susceptible person, it starts early in life • Those who retain their teeth into old age are likely to be less susceptible individuals 5
  • 6. 08-May-09 Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Gingivitis and poor OH are clearly related to SES. • The relationship between periodontitis and SES is less direct Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • It is clear that periodontitis has a genetic component • Specific genotype of polymorphic interleukin-1 gene was associated with severe periodontitis • The strength of the association is not fully determined Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • The clear causal relationship between gingivitis and OH was established back in 60s • Periodontitis and OH are not the same because of the host response issue 6
  • 7. 08-May-09 Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Overhangs • Have minor role in the etiology of periodontitis Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Nutritional adequacy is important in the treatment of any disease • No nutritional or dietary factors have been shown to be directly related to the prevalence or intensity of periodontitis Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Smoking is a “clear” risk factor for periodontitis • Higher prevalence of periodontitis among smokers • Healing is slower • Smokers have higher prevalence of bacteria 7
  • 8. 08-May-09 Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Smoking reduces vascularity of the area • Smoking affects host response Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Psychosocial stress seems associated with periodontitis • More studies are needed to fully understand the mechanism Periodontitis and Systemic Conditions • Diabetes Mellitus (DM) – DM is a risk factor for periodontitis – Periodontitis is inversely related to “metabolic control” in diabetic patiens – Periodontitis is a risk factor for more severe DM patients because they have exaggerated host response to bacterial burden – Periodontitis more rapidly in patients with poorly controlled DM 8
  • 9. 08-May-09 Periodontitis and Systemic Conditions • Diabetes Mellitus (DM) – Patients with type 2 DM have greater CAL, loss of alveolar bone, and tooth loss – They also have a 2-3 times higher risk of developing destructive periodontitis – The relationship between periodontitis and DM is not a result of change in flora. Rather, it is due to vascular changes, abnormal collagen synthesis, and genetic predisposition Periodontitis and Systemic Conditions • Cardiovascular Disorders (CVD) – Chronic inflammation anywhere in the body is believed to have an effect on the heart function – An association between periodontitis and CVD is recognized but causality is yet to be established Periodontitis and Systemic Conditions • Osteoporosis – Bone fragility characterized by low bone mass and structural deterioration. – It is common in old age, especially postmenopausal women – Alveolar bone loss is often seen with generalized osteoporosis – How much of alveolar bone loss is due to osteoporosis rather than periodontitis? 9
  • 10. 08-May-09 Periodontitis and Systemic Conditions • Pregnancy – An association seems to exist between “maternal Periodontitis” and the “risk” of delivering a “preterm low-birth-weight” infant – The relationship cannot be established as “causal” – The association is strong enough to indicate that periodontal care and treatment are important during pregnancy Periodontitis and Systemic Conditions • HIV – The relationship between periodontal diseases and HIV is not yet fully understood. – The results of the studies are not uniform and are sometimes contradictory – A systematic review might be the solution to establishing the relationship • • • • • Understanding periodontal Diseases Distribution of PD Demographic Risk Factors in Periodontitis Risk Factors in Periodontitis Periodontitis and Systemic Diseases 10