periodontitis, its causes, diagnosis, treatment and prevention..!!!

1. THE UNIVERSITY OF PAPUA NEW GUINEA
SCHOOL OF MEDICINE & HEALTH SCIENCE
DIVISION OF DENTISTRY
Periodontology
Topic: Periodontitis - Describe its causes, signs and symptoms and its management..
Name: Willie Yanimo Francis
Id: 20110187
Program: BOH/BDS III
Lecturer: Dr. Beaga

2. Periodontitis
Describe its causes, signs and symptoms and its management..
Introduction
Periodontitis is a disease which categorized under periodontal diseases. It is a disease which affects
more than one or all the constituents of the periodontum. The constituents of the periodontum are
gingiva, periodontal ligaments, cementum and alveolar bone. Some people may take gingivitis as the
same as periodontitis but the main difference is that gingivitis usually refers to gingival inflammation
while periodontitis refers to gum disease and the destruction of tissue and/or bone. Gingivitis is the
precursor of periodontitis if left untreated or ignored for a long period of time. Marginal gingiva, the
part of the gingiva that seals to the tooth is weakened and become loose thus forming spaces between
the tooth and the gingiva. This space is known as periodontal pockets and bacteria can accumulate here
causing further inflammation (redness and swelling).
The following content of this write up describes periodontitis in the following manner:
1. Aetiology
2. Signs &Symptoms
3. Diagnosis and treatment (management)
4. prevention
Aetiology
Formation of dental plaque on the teeth–it is a biofilm that is pale-yellow in color and develops
naturally on tooth surfaces. Plaque is mainly caused by bacteria which adheres to the tooth’s smooth
surfaces
Tooth brushing gets rid of plaque but it soon builds up after an hour or a day after brushing.
If the plaque is not removed from tooth surfaces for two or three days it calcifies and hardens into
calculus(tartar). Calculus is much harder and can be very difficult to remove with a teeth brush.The
removal of calculus is much difficult and requires a dental professional.
This calculus can irritate the gingiva and progressively damage the surrounding tissues as well. The
patient may develop Gingivitis (inflammation of the gingiva around the marginal area of the teeth) at
first.
If gingivitis persists it can result in the development of pockets between the tooth and the gingiva.
These pockets are known as periodontal pockets and they can be filled up very easily by bacteria.
As the depth of the pocket increases downwards, infection also travels apically toward the root. As
infection spreads it damages the periodontal fibers. Sometimes the gingiva moves apically exposing
the dentinal part of the roots.
Bacterial toxins and our immune system's response to infection start destroying the alveolar bone and
connective tissue that hold teeth in place in the socket. Eventually if there is too much bone loss the
teeth start becoming loose, and can even fall out.

3. Signs & symptoms
A symptom is what the patients’ feels and complaints about it to the doctor, while on the other hand a
sign is what the doctor observes on the patient after doing an examination or checkup. For example, a
patient complains of pain is a symptom and a doctor observing redness and inflammation is a sign.
Periodontitis can show signs and symptoms and this includes:
Inflammation of the gingiva and also its persistence after brushing
Gingiva loses its natural color and turns bright red or even purple
Gingiva really hurt when touched
Gingival recession occurs, making teeth look longer
Extra periodontal pockets appear between the teeth
Appearance of pus between the soft tissues and teeth
Bleeding when brushing teeth
Bleeding when flossing
Metallic taste in the mouth
Halitosis (another term for bad breath)
Loose or mobile teeth
Malocclusion occurs. The patient's "bite" feels different because the teeth do not fit the same
Misaligned tooth
Diagnosis&Treatment
Dentists are qualified and should find it fairly straightforward to diagnose periodontitis. The dentist will
examine the patient's mouth using a periodontal probe. The probe is inserted next to the tooth, under
the gingival margin. If the tooth is healthy, the probe does not slide between the tooth and the marginal
gingiva. In cases of periodontitis, the probe will reach apically under the gingival margin.
The main aim of the dentist in treating periodontitis is to remove the plaque and calculus from pockets
around the teeth and prevent further destruction of bone and tissue.
Initial treatment
Inorder to restore periodontal health it is important that plaque and calculus must be removed. The
healthcare professional uses periodontal scalers to scrape out any plaque and calculus found below the
gingival margin. This procedure is known as scaling and debridement. Sometimes an ultrasonic device
may be used to remove plaque and calculus. In the past Root Planing was used (the cemental layer was
removed, as well as calculus) but not anymore.

4. Medications
The following are medications which can be prescribed by the dentist to a periodontitis patient:
Prescription antimicrobial mouth rinse - for example chlorhexidine. It controls bacteria when treating
gum disease, as well as after surgery. Patients use it like they would a regular mouthwash.
Antiseptic "chip" - this is a small piece of gelatin which is filled with chlorhexidine. It controls bacteria
and reduces periodontal pocket size. This medication is placed in the pockets after root planing. The
medication is slowly resealed over time.
Antibiotic gel - a gel that contains doxycycline, an antibiotic. This medication controls bacteria and
shrinks periodontal pockets. It is placed in the pockets after scaling and root planing. It is a slow-
release medication.
Antibiotic microspheres - miniscule particles containing minocycline, an antibiotic. Also used to
control bacteria and reduce periodontal pocket size. They are placed into pockets after scaling and
root planing. A slow-release medication.
Enzyme suppressant - keeps destructive enzymes in check with a low-dose of doxycycline. Some
enzymes can break down gum tissue, this medication holds back the body's enzyme response. Taken
orally as a pill, and is used with scaling and root planing.
Oral antibiotics - either in capsule or tablet form and are taken orally. They are used short-term for
the treatment of acute or locally persistent periodontal infection.
Advanced periodontitis
the following are surgical intervention which follows if good oral health and non-surgical procedures are
not effective enough:
Flap surgery - the dentist performs flap surgery to remove calculus in deep pockets, or to reduce the
pocket thus keeping it clean is easier. The gingival tissues are lifted back and calculus is removed,
when finished the gingival tissues are sutured back into place so that it fits closely to the tooth.The
gingival tissues heal up after the surgery and hold tightly around the tooth. In some cases the tooth
may eventually seem longer than it used to.
Bone and tissue grafts - this procedure helps regenerate bone or gingival tissue that has been
destroyed. With bone grafting, new natural or synthetic bone is placed where bone was lost,
promoting bone growth.
In a procedure called guided tissue regeneration, a small piece of mesh-like material is inserted
between the gingival tissue and bone. This stops the gingiva from growing into bone space, giving the
bone and connective tissue a chance to regrow. The dentist may also use special proteins (growth
factors) that help the body regrow bone naturally. The dentist may suggest a soft tissue graft - tissue
taken from another part of the mouth, or synthetic material is used to cover exposed tooth roots.
Experts say it is not possible to predict how successful these procedures are - each case is different.
Treatment results also depend on how advanced the disease is, how well the patient adheres to a good
oral hygiene program, as well as other factors, such as smoking status.

5. Prevention
Periodontitis is a disease which can be prevented. The best method used to prevent periodontitis is to
follow a program of good oral hygiene. A good oral hygiene program is one which you can begin early
and practice consistently throughout life. The following are some of the good oral hygiene which can be
used:
Brushing teeth at least twice a day; in the morning and before going to bed. Some dentists may
give advice to brush three times a day
Flossing between teeth at least once a day
Get treatment early if there is any slight marginal inflammation
Always visit dental clinics every six to twelve months for a regular check up
There are some risk factors which can increase the chances of having periodontitis; Smoking,
hormonal changes in females, diabetes, Aids, cancer, genetics. If a person has these risk factors, it is
advisable for him or her to visit the dental clinic for regular cleaning of teeth.
Conclusion
It can be concluded that periodontitis is a disease which occurs because of poor oral hygiene. Poor oral
hygiene can occur because of two major things; individuals are too lazy to practice oral health or they
don’t know how to take care of their oral health. Therefore it is up to us as dentists to carry out
awareness about the consequences associated with poor oral health, especially periodontitis. We have
to try our best to at least take the message across rather than just working in the clinic.
Periodontitis is a preventable disease. It won’t be a problem if the general public is practicing oral health
hygiene. As the saying goes “prevention is better than cure” we have to take preventative measures to
protect individuals from contracting periodontitis. By doing this there won’t be too many patients in the
clinic and also reduces stress from workload.

6. Reference
1. J.D Da Silva et al, Oxford American Handbook of Clinical Dentistry. 2008, Oxford
University Press, Oxford.
2. Lindhe J. Textbook of Clinical Periodontology. 1984, Munksgaard press Copenhagen
3. Livingstone. C, J.H.Scott&N.B.B.Symons. introduction to Dental Anatomy, 9th
ed. 1982,
Oxford University Press, Oxford.
4. R.C Sheid. WolfielsDental Anatomy: Its relevance to dentistry, 7th
ed. 2007, Liippincot
Williams and Wilkins Press, Pensylvania.
5. What are the causes of periodontitis? / eHow.com
http://www.ehow.com/about 5117742 causes-periodontitis.html#ixzz26yKZ1lhg