8. INTRODUCTION-FROM A PUBLIC HEALTH POINT OF VIEW..
Periodontitis COMMONLY TERMED AS GUM DISEASE.
IT IS A GUM INFECTION THAT DAMAGES THE SOFT
TISSUES AS WELL AS THE BONE THAT SUPPORTS THE
TEETH AND CAN CLINICALLY CAUSE LOOSENING OF THE
TEETH AND EVENTUALLY TOOTH LOSS
PERIODONTITIS IS PREVENTABLE
IT RESULTS FROM POOR ORAL HYGIENE
EDUCATION AND HEALTH PROMOTION CAN REDUCE
CHANCES OF HAVING PERIODONTITIS
IT IS GENERALLY TREATABLE.
9. IN 2018, THE INITIAL RESULTS OF
THE PHILIPPINE NATIONAL SURVEY
ON ORAL HEALTH SHOWED 72% OF
FILIPINOS HAVING DENTAL CARRIES
WHILE 43% WITH GUM DISEASES.
10. PREVALENCE
10
• The Centers for Disease Control and Prevention
(CDC) recently did a study to regarding those
who suffer from gum disease. The study
confirmed that almost 50 percent of adults in the
U.S., who are over the age of 30, have the
advanced form of periodontal disease, or gum
disease.
11. DEPARTMENT OF HEALTH,
PHILIPPINES
11
• The two most common oral health diseases
affecting the Filipinos are Dental Caries
(tooth decay) and Periodontal Diseases
(gum diseases).
12. 12
Oral health problems in older adults include
the following:
Untreated tooth decay. Nearly all adults
(96%) aged 65 years or older have had a
cavity; 1 in 5 have untreated tooth decay. ...
Gum disease. A high percentage of older
adults have gum disease. ...
Tooth loss. ...
Oral cancer. ...
Chronic disease.
Source: Department of health Philippines
13. WI
TH A DENTI
STATEVERY RURALHEAL
TH
UNI
T
, THE RATI
O OFDENTI
STTO THE
POPULATI
ON -WI
LLAPPROACH THE
ST
ANDARD RATI
O OF1 :20,000
POPULATI
ON, SI
MI
LAR TO THATOF
PHYSI
CI
AN.
DOH PHILIPPINES
13
18. YEAR PREVALENCE
DENTAL CARIES PERIODONTAL
DISEASE
1987 93.9% 65.5%
1992 96.3% 48.1%
1998 92.4% 78.3%
DEPARTMENT OF HEALTH
18
19. 19
The prevalence of periodontal
disease is reduced
Annual Targets : 5% reduction
of the prevalence rate every year
DOH GOALS
20. 20
TYPES OF SERVICE
Mother(Pregnant Women)
**
Oral Examination
Oral Prophylaxis (scaling)
Permanent fillings
Gum treatment
Health instruction
21. Neonatal and Infants
under 1 year old**
Dental check-up as soon
as the first tooth erupts
Health instructions on
infant oral health care
and advise on exclusive
breastfeeding
21
22. Children 12-71 months old **
Dental check-up as soon as the first tooth appears and every
6 months thereafter
Supervised tooth brushing drills
Oral Urgent Treatment (OUT)
- removal of unsavable teeth
- referral of complicated cases
- treatment of post extraction complications
- drainage of localized oral abscess
Application of Atraumatic Restorative Treatment (ART)
22
23. School Children (6-12 years old)
Oral Examination
Supervising tooth brushing drills
Topical fluoride therapy
Pits and Fissure Sealant Application
Oral Prophylaxis
Permanent Fillings
Adolescent and Youth (10-24 years old)**
Oral Examination
Health promotion and education on oral hygiene, and adverse effect on
consumption of sweets and sugary beverages, tobacco and alcohol
24. Other Adults (25-59 years
old)
Oral Examination
Emergency dental treatment
Health instruction and advice
Referrals
Older Person (60 years old
and above)**
Oral Examination
Extraction of unsavable tooth
Gum treatment
Relief of Pain
Health instruction and advice
25. studies showed that
periodontal disease influences
the progression of certain
systemic diseases: diabetes
mellitus, cardiovascular
diseases, ischemic
cardiomyopathy, myocardial
infarction, stroke,
neurodegenerative diseases,
chronic kidney diseases,
cancer,
31. CLASSIFICATION OF PERIODONTITIS
2.AGGRESSIVE PERIODONTITIS
A.LOCALIZED
B.GENERALIZED
3.PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE
A.ASSOCIATED WITH HEMATOLOGICAL DISORDERS
1.AQUIRED NEUTROPENIA
2.LEUKEMIAS
3.OTHERS
Presentation title 31
36. HISTOPATHOLOGY OF PERIODONTAL DISEASES IS DESCRIBED IN 4
STAGES
STAGE 1.
‘INITIALLY, THE GINGIVAL CREVICULAR FLUID (GCF) AMOUNT IS
INCREASED DUE TO VASCULAR CHANGES IN RESPONSE TO THE INITIAL
INSULT. AT THIS BENIGN STAGE, POLYMORPHONUCLEAR NEUTROPHILS
ARE ATTRACTED TO THE LESION SITE, AND T LYMPHOCYTES ARE
RESPONSIBLE FOR FIBROBLASTS IN THE AREA.’
37. HISTOPATHOLOGY OF PERIODONTAL DISEASE
STAGE 2.
‘THE EARLY LESION IS CHARACTERIZED BY REDNESS OF THE LESION. AT
THIS STAGE, PMNS CLEAR AND BREAKDOWN THE COLLAGEN FIBERS,
WHICH LEADS TO AN INCREASE IN THE PREVIOUSLY MADE SPACE FOR
INFILTRATES. ‘
37
38. HISTOPATHOLOGY OF PERIODONTITIS
STAGE 3.
‘THE ESTABLISHED LESION IS DOMINATED BY B CELLS AND LEUKOCYTE
AGGREGATION. THIS WILL INITIATE THE LESION SIDE TRANSFORMATION
BY CHANGING BOTH JUNCTIONAL AND SULCULAR EPITHELIUM INTO AN
EXTREMELY VULNERABLE EPITHELIUM CALLED THE POCKET
EPITHELIUM. THIS IS APPARENT AS BLEEDING UPON GENTLE GINGIVAL
MANIPULATION.’
38
39. HISTOPATHOLOGY OF PERIODONTITIS
STAGE 4.
AN ADVANCED LESION CHARACTERIZED AS LOSS OF GINGIVAL FIBERS
AND ALVEOLAR BONE IS CAUSED BY MIGRATION OF BIOFILM INTO THE
POCKET AND CREATING AN ENVIRONMENT FOR ANAEROBIC BACTERIA
PROLIFERATION.
39
41. HISTOPATHOLOGY OF PERIODONTITIS
BY BALINT ORBAN,MD,DDS.
THE FOLLOWING CONDITIONS MAY BE FOUND IN PERIODONTITIS
INFLAMMATION
CIRCULATORY DISTURBANCES
DEGENERATIVE PROCESS
ATROPHY
HYPERPLASIA AND ATROPHY
41
42. ‘THE DEVELOPMENT OF GINGIVITIS AND PERIODONTITIS CAN BE DIVIDED INTO A SERIES OF STAGES:
INITIAL, EARLY, ESTABLISHED, AND ADVANCED LESIONS THE INITIAL LESION BEGINS 2–4 DAYS AFTER
THE ACCUMULATION OF THE MICROBIAL PLAQUE. DURING THE INITIAL LESION, AN ACUTE
EXUDATIVE VASCULITIS IN THE PLEXUS OF THE VENULES LATERAL TO THE JUNCTIONAL
EPITHELIUM, MIGRATION OF POLYMORPHONUCLEAR (PMN) CELLS THROUGH THE JUNCTIONAL
EPITHELIUM INTO THE GINGIVAL SULCUS, CO-EXUDATION OF FLUID FROM THE SULCUS, AND THE
LOSS OF PERIVASCULAR COLLAGEN WERE OBSERVED. THE EARLY INJURY DEVELOPS WITHIN 4–10
DAYS. THIS LESION IS CHARACTERIZED BY A DENSE INFILTRATE OF T LYMPHOCYTES AND OTHER
MONONUCLEAR CELLS, AS WELL AS BY THE PATHOLOGICAL ALTERATION OF THE FIBROBLASTS’
Pathogenesis of Periodontal Disease
José Luis Muñoz-Carrillo
42
43. HISTOPATHOLOGICAL LESIONS OF PERIODONTAL PATHOGENESIS. INITIAL, EARLY, ESTABLISHED, AND ADVANCED LESIONS OF THE
DEVELOPMENT OF GINGIVITIS AND PERIODONTITIS
43
47. GINGIVAL INFLAMMATION SPREADS
THROUGH :
LOOSE CONNECTIVE
TISSUE AROUND BLOOD
VESSELS
THROUGH GINGIVAL AND
TRANSEPTAL FIBERS
THROUGH THE VESSEL
CHANNELS INTO CREST
ATINTERDENTAL SEPTUM
OR THROUGH OUTER
PERIOSTIUN INTO
MARROW SPACES
47
50. HISTOPATHOLOGY
ONCE THE
INFLAMMATION REACHES
THE ALVEOLAR BONE,IT
REPLACES MARROW
SPACES WITH LEUKOCYTIC
AND INFLAMMATORY
FLUID EXUDATE
BONE SURFACES ARE
LINED BY
MULTINUCLEATED
OSTEOCLASTS
50
51. HISTOPATHOLOGY
IN MARROW SPACES,
RESORPTION PROCEEDS
FROM WITHIN AND LEAD
TO THINNING OF
TRABECULAE AND
ENLARGEMENT OF
MARROW SPACES
THIS LEADS TO THE
DESTRUCTION OF BONE
AND REDUCTION IN BONE
HEIGHT
54. PERIODONTAL DISEASE BY NERMIN MOHAMMED AHMED YUSSIF 54
The primary features of periodontitis
include:
-The loss of periodontal tissue support,
manifested through clinical attachment
loss and radiographically assessed
alveolar bone loss
-presence of periodontal pocketing
-Gingival bleeding
55. PERIODONTAL DISEASE BY Nermin
Mohammed Ahmed Yussif
55
development of gingivitis and periodontitis.
lesion is dominated by activated B cells (plasma cells)
and
accompanied by further loss of the marginal gingival
connective tissue matrix
Several PMN continue to migrate through the
junctional epithelium, and the gingival pocket.
Ithe advanced lesion, plasma cells continue to
predominate as the architecture of the gingival tissue is
disturbed, together with the destruction of the alveolar
bone and periodontal ligament.
formation of denser inflammatory infiltrate composed
of plasma cells and macrophages, loss of collagen
attachment to the root surface, and resorption of the
alveolar bone
57. JOURNAL
REVIEW
Histopathological and
immunohistochemical study
of periodontal changes in
chronic smokers
Gabriel Valeriu Popa,1,2 Adrian
Costache,3 Oana Badea,4 Melania
Olimpia Cojocaru,5 George Mitroi,6
Adela Cristina Lazăr,7 Daniel-Alin
Olimid,8 and Laurenţiu Mogoantă9
57
58. INTENSE CHRONIC INFLAMMATORY INFILTRATE IN A CASE OF
PERIODONTITIS, MAINLY FORMED OF LYMPHOCYTES, PLASMA CELLS
AND MACROPHAGES
58
62. IMAGE OF GINGIVITIS WITH A CHRONIC INFLAMMATORY INFILTRATE IN
THE CHORION, RICH IN CD3+ T-LYMPHOCYTES.
62
63. AREA OF CHRONIC PERIODONTITIS WITH A MODERATE INFLAMMATORY
INFILTRATE, CONNECTIVE FIBROSIS, VASCULAR CONGESTION AND
MICROHEMORRHAGES.
63
64. IMAGE OF CHRONIC PERIODONTITIS WITH A CHRONIC INFLAMMATORY
INFILTRATE AND MODERATE CELLULAR NECROSIS IN THE PERIODONTAL
CONNECTIVE TISSUE
64
65. IMAGE OF CHRONIC PERIODONTITIS WITH EXTENDED EPITHELIAL
EROSIONS, PARTIAL THICKNESS OF THE GINGIVAL EPITHELIUM,
MODERATE INFLAMMATORY INFILTRATE AND FIBROSIS
65
66. IMAGE OF GINGIVITIS WITH AREAS OF PAPILLARY NECROSIS AND
INTRAEPITHELIAL EDEMA CHARACTERIZED BY THE ENLARGEMENT OF
INTERCELLULAR SPACES AND PARTIAL RUPTURES OF THE
INTERCELLULAR SPIKES
66
67. AREA OF GINGIVAL EPITHELIUM WITH A REDUCED THICKNESS AND A
MODERATE INFLAMMATORY INFILTRATE IN THE PAPILLARY CHORION OF
THE GUM
67
69. WITH THESE FINDINGS : HISTOPATHOLOGICALLY :
69
Inflammatory infiltrates
Presence of Lymphocytes, plasma cells and
macrophages
Inflammatory reaction
Reaction of mast cells
High number of CD68+ macrophages.
Rich in CD3+ T-lymphocytes
Chronic inflammatory infiltrates
Cellular necrosis
Extended epithelial erosions
Fibrosis
Hypertrophic gingival epithelium
Hyperkeratosis
