Types of Periodontal Disease
Periodontal disease (also known as periodontitis and gum disease) is a progressive disease
wh...
progression of the disease using scaling and root planing procedures in combination with
antimicrobial treatments. If nece...
G
ingivitisis is the mildest form of periodontal disease and causes the gums to become red,
swollen, and bleed easily. The...
Two types of gingival/periodontal disease associated with HIV infection have been widely
reported in the literature. In th...
NUP affects the osseous structures of the periodontium. Clinical features include pain,
interproximal gingival necrosis, a...
Oral health care providers report their most favorable treatment responses when HIV-associated
periodontal disease is addr...
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  1. 1. Types of Periodontal Disease Periodontal disease (also known as periodontitis and gum disease) is a progressive disease which affects the supporting and surrounding tissue of the gums, and also the underlying jawbone. If left untreated, periodontal disease can result in loose, unstable teeth, and even tooth loss. Periodontal disease is in fact the leading cause of tooth loss in adults in the developed world and should not be taken lightly. Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and, if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss. Types of Periodontal Disease There are many different varieties of periodontal disease, and many ways in which these variations manifest themselves. All require immediate treatment by a periodontist to halt the progression and save the gum tissue and bone. Here are some of the most common types of periodontal disease along with the treatments typically performed to correct them: Gingivitis Gingivitis is the mildest and most common form of periodontitis. It is caused by the toxins in plaque and leads to periodontal disease. People at increased risk of developing gingivitis include pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users and people who control seizures and blood pressure using medication. Treatment: Gingivitis is easily reversible using a solid combination of home care and professional cleaning. The dentist may perform root planing and deep scaling procedures to cleanse the pockets of debris. A combination of antibiotics and medicated mouthwashes may be used to kill any remaining bacteria and promote the good healing of the pockets. Chronic Periodontal Disease Chronic periodontal disease is the most common form of the disease, and occurs much more frequently in people over 45. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are gradually growing in length, but in actuality the gums are gradually recessing. Treatment: Unfortunately unlike gingivitis, chronic periodontal disease cannot be completely cured because the supportive tissue cannot be rebuilt. However, the dentist can halt the
  2. 2. progression of the disease using scaling and root planing procedures in combination with antimicrobial treatments. If necessary, the periodontist can perform surgical treatments such as pocket reduction surgery and also tissue grafts to strengthen the bone and improve the aesthetic appearance of the oral cavity. Aggressive Periodontal Disease Aggressive periodontal disease is characterized by the rapid loss of gum attachment, the rapid loss of bone tissue and familial aggregation. The disease itself is essentially the same as chronic periodontitis but the progression is much faster. Smokers and those with a family history of this disease are at an increased risk of developing aggressive periodontitis. Treatment: The treatments for aggressive periodontal disease are the same as those for chronic periodontal disease, but aggressive periodontal disease sufferers are far more likely to require a surgical intervention. This form of the disease is harder to halt and treat, but the dentist will perform scaling, root planing, antimicrobial, and in some cases laser procedures in an attempt to save valuable tissue and bone. Periodontal Disease Relating to Systemic Conditions Periodontal disease can be a symptom of a disease or condition affecting the rest of the body. Depending on the underlying condition, the disease can behave like aggressive periodontal disease, working quickly to destroy tissue. Heart disease, diabetes and respiratory disease are the most common cofactors, though there are many others. Even in cases where little plaque coats the teeth, many medical conditions intensify and accelerate the progression of periodontal disease. Treatment: Initially, the medical condition which caused the onset of periodontal disease must be controlled. The dentist will halt the progression of the disease using the same treatments used for controlling aggressive and chronic periodontal disease. Necrotizing Periodontal Disease This form of the disease rapidly worsens and is more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress or choose to smoke. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues and alveolar bone. Treatment: Necrotizing periodontal disease is extremely rare. Because it may be associated with HIV or another serious medical condition, it is likely the dentist will consult with a physician before commencing treatment. Scaling, root planing, antibiotic pills, medicated mouth wash and fungicidal medicines are generally used to treat this form of the disease. Types of Periodontal Diseases There are many types of periodontal diseases and they can affect individuals of all ages from children to seniors.
  3. 3. G ingivitisis is the mildest form of periodontal disease and causes the gums to become red, swollen, and bleed easily. There is little to no discomfort at this stage and it is reversible with professional treatment and good home oral care. C hronic periodontitis results in inflammation within the supporting tissues of the teeth and progressive loss of tissue attachment and bone. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur. It is prevalent in adults, but can occur at any age and is the most frequently occurring form of periodontitis. A ggressive periodontitis is a highly destructive form of periodontal disease that occurs in patients who are otherwise clinically healthy. This disease may occur in localized or generalized patterns and can include rapid loss of tissue attachment and destruction of bone. P eriodontitis as a manifestation of systemic diseases. This form of periodontitis is associated with one of several systemic diseases, such as diabetes. Patients who have rare but specified blood diseases or genetic disorders frequently show signs of periodontal diseases. N ecrotizing Periodontal Diseases are infections characterized by necrosis (death) of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly associated with pain, bleeding, and a foul odor. Contributing factors can include emotional stress, tobacco use, and HIV infection. I. INTRODUCTION Recommendation: The most important components in the management of HIV-associated gingival and periodontal disease should be the removal of local irritants from the root surfaces, débridement of necrotic tissues, and appropriate use of antibiotics.
  4. 4. Two types of gingival/periodontal disease associated with HIV infection have been widely reported in the literature. In the past, these have been called HIV-associated gingivitis (HIV-G) and HIV-associated periodontitis (HIV-P). There is now evidence that these diseases also occur in HIV-negative immunocompromised individuals and are not specific to HIV infection, thus making the original terms inappropriate. Therefore, HIV-associated gingivitis has been renamed linear gingival erythema (LGE) and HIV-associated periodontitis has been renamed necrotizing ulcerative periodontitis (NUP). The prevalence of these two diseases remains unclear,1-3 with estimates of occurrence among HIV-infected individuals ranging from 5% to 50%. It is not yet clear where in the spectrum of HIV disease these conditions occur or which patients are at greatest risk for developing them. There is some evidence that NUP is associated with a low CD4 count (<200 cells/mm3 ).4 back to top II. LINEAR GINGIVAL ERYTHEMA (LGE) A. Presentation LGE is limited to the soft tissue of the periodontium and characteristically appears as an erythematous linear band that extends approximately 2 mm to 3 mm from the free gingival margin. There also may be punctate erythema, which extends onto the alveolar mucosa. At times, these areas coalesce, creating broadly diffuse erythematous zones from the gingival margin into the vestibule. Unlike conventional gingivitis, LGE is not significantly associated with plaque. In most cases of LGE, bleeding is seen after gentle probing (see Appendix 3-A for photographic example). B. Diagnosis Recommendation: The diagnosis of LGE is made on the basis of distinctive clinical characteristics (see Section II. A. Presentation). C. Treatment There is no known treatment for LGE. III. NECROTIZING ULCERATIVE PERIODONTITIS (NUP) A. Presentation
  5. 5. NUP affects the osseous structures of the periodontium. Clinical features include pain, interproximal gingival necrosis, and cratered soft tissues (see Appendix 3-A for photographic example). Patients frequently complain of spontaneous bleeding and deep-seated pain in the jaws. Destruction of the periodontal attachment and bone can be extremely rapid and extensive and may result in as much as 90% bone loss around isolated teeth in as few as 12 weeks. If left untreated, NUP may extend into the contiguous tissues and expose the alveolar or palatal bone. When this occurs, the condition has been called necrotizing stomatitis. B. Diagnosis Recommendation: The diagnosis of NUP is made on the basis of distinct clinical characteristics (see Section III. A. Presentation). C. Treatment Recommendations: Systemic antibiotics, such as metronidazole, tetracycline, clindamycin, amoxicillin, and amoxicillin-clavulanate potassium, should be combined with débridement of necrotic tissues. As systemic antibiotics increase the patient’s risk of developing candidiasis, concurrent, empiric administration of an antifungal agent should be considered. Frequent appointments are appropriate and recommended in the acute and healing stages of NUP to perform the necessary periodontal therapies, to assess tissue response, and to monitor the patient’s oral hygiene performance. A thorough periodontal examination should be performed at each recall session for any patient with a history of NUP. Because the periodontal maintenance program for patients with HIV should be individualized, oral health care providers should consider plaque control, past severity of disease, and evidence of case stabilization when determining the frequency of recall visits. Published reports, supported by clinical experience, suggest that an antibiotic regimen of 250 mg metronidazole 3 times per day for 5 to 7 days, often combined with 250 mg amoxicillin- clavulanate potassium 3 times a day for 5 to 7 days, is effective for management of this disease. Chlorhexidine oral rinse 15 cc twice daily has been reported to be very useful in the management and control of NUP, and intrasulcular lavage with povidone-iodine has been shown to have a palliative effect for patients with NUP.
  6. 6. Oral health care providers report their most favorable treatment responses when HIV-associated periodontal disease is addressed in the earliest stages. Patients who have been treated for NUP may develop repeated episodes, especially when oral hygiene levels are unsatisfactory. NUP can be insidious, localized, and not necessarily related to plaque. Once clinical stabilization has occurred, recall visits are generally scheduled every 3 months to detect and prevent disease recurrence at an incipient stage. IV. NECROTIZING ULCERATIVE GINGIVITIS (NUG) Recommendation: Necrotizing ulcerative gingivitis should be treated similarly to NUP. Necrotizing ulcerative gingivitis (NUG) has been associated with HIV infection. NUG and NUP may represent different stages of the same pathologic process, with NUP being a later stage of NUG.5

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