2.
INTRODUCTION
DISEASES OF THE PERIODONTIUM
COMMON PERIODONTAL DISEASE
AETIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION/EFFECTS OF
PERIODONTAL DISEASES
MANAGEMENT
CONCLUSION
OUTLINE
3.
Periodontal tissues otherwise referred to as the
periodontium are the surrounding soft and hard
tissues that support the tooth. They are specialized
tissues that both surround and support the teeth,
maintaining them in their anatomical positions in the
mandible (lower jaw)and maxilla (upper jaw).
It comes from the Greek words peri- meaning
“around” and –odons meaning tooth.
INTRODUCTION
4.
The periodontal tissues are four namely:
-gingiva(gum)
-cementum
-alveolar bone
-periodontal ligament
The disease conditions that affect these tissues are
therefore referred to as periodontal diseases.
INTRODUCTION cont’d
6.
‘’
Healthy periodontal tissues
Note the snug fit of the periodontal tiss
around the teeth.
Longitudinal section showing
periodontal-tooth relations.
7. International Workshop for a Classification of Periodontal
Diseases and Conditions in 1999 classified these diseases as
follows:
Gingival diseases (non-plaque induced and plaque
induced)
Chronic periodontitis.
Aggressive periodontitis.
Periodontitis as a manifestation of a systemic disease,
physiological changes, infection, drug reactions, DM,
AIDS, dietary and nutritional factors
DISEASES OF THE PERIODONTIUM
8.
Necrotizing periodontal diseases.
Abscesses of the periodontium.
Periodontitis associated with endodontic lesions.
Developmental or aquired deformities and
conditions e.g. genetic conditions like Downs
syndrome, Ehlers-Danlos syndrome, hereditary
gingival fibromatosis etc; hematological conditions
such as anaemia, leukaemia etc
11.
-PRIMARY CAUSE-plaque (bacterial aggregates,
complex polysaccharide matrix) irritation.
-SECONDARY CAUSES-local and systemic factors
which predispose towards plaque accumulation or
alter the gingival response to plaque.
AETIOLOGY
12.
LOCAL FACTORS:
Calculus
Faulty restorations
Carious cavities
Tooth impaction/pericoronitis
Oral habits (tooth-picking, bottle-opening, etc)
Tooth brushing trauma
Badly designed dentures
Orthodontic appliances
Malalignment of teeth
Lack of lip-seal or mouth-breathing
Tobacco smoking
Developmental grooves on cervical enamel or root surface
18. Healthy gingivae are firm , pink, knife-edged and do not
bleed on probing.
Periodontal disease primarily begins usually from plaque
accumulation leading to gingivitis which when sustained
can progress to chronic periodontitis
This disease process is mostly painless and can go
unnoticed for years.
Note that periodontal destruction when established is not
continuous but progresses in an episodic manner with
bursts of destructive activity alternating with periods of
quiescence and possibly repair.
PATHOGENESIS
Foot note: plaque= bacterial aggregation + complex polysaccharide matrix
calculus= calcified plaque
19.
Plaque-induced periodontal lesions can be divided into four stages:
1. Initial lesion
2. Early lesion
3. Established lesion
4. Advanced lesion
1. Initial lesion: here host-response mechanisms are raised in
response to causative micro-organisms {major offenders being
porphyromonas gingivalis & Aggregatibacter
actinomycetemcomitans} in accumulating dental plaque within 2-
4 days.
False pockets are formed as marginal gingiva and interdental
papilla become bulbous and bright red as connective tissue and
collagen surrounding blood
vessels in the area dissolve,
leaking out fluid into the tissues.
20.
2. Early lesion: occurs about 6-12 days later; here features
of the initial lesion are accelerated.
Up to 60-70 percent of collagen is lost.
Formation of micro-abcesses at the junctional epithelium.
3. Established lesion: begins about 2-3 weeks post-plaque
accumulation.
Plasma cell accumulation in gingival sulci (no bone loss
yet); presence of complement and antigen-antibody
complexes is marked.
Apical migration of junction epithelium (gum recession
makes teeth appear longer)
This stage can remain indefinitely or progress to an
advanced lesion.
21.
4. Advanced lesion: here the features are better described
clinically than histologically. Typically there is
Periodontal pocket formation.
Gingival ulceration and suppuration.
Destruction of alveolar bone and periodontal ligament
Tooth mobility, drifting and eventual tooth loss
Because the bone loss appears here, it is equated as
periodontitis.
The earlier lesions can be classified as gingivitis of
increasing severity.
The advanced lesion spreads apically, laterally around
the tooth and deep into the gum tissue papilla.
Bone resorption produces scarring and fibrous change.
23.
Swelling and hyperemia of interdental papilla and gingival
margins
Plaque and calculus deposits
Halitosis
Bleeding
Pocketing
Tooth mobility
Sensitivity
Pain
Pulpal disease(perio-endodontic lesions, pulpitis, apical
abscesses)
Tooth fractures
Tooth loss
CLINICAL
PRESENTATION/EFFECTS OF
PERIODONTAL DISEASE
24.
Establish a diagnosis.
Aim to create a healthy mouth which the patient is
capable of, and willing to maintain.
These principles can be divided as follows:
Initial (cause-related) phase
Corrective phase
Maintenance (supportive phase)
MANAGEMENT
25.
1) Initial (cause-related) phase : here we aim to control or
eliminate gingivitis and stop any further progression of
periodontal disease by removing plaque and other
contributory factors. This is key and can cause a failure of
more complex treatments.
MANAGEMENT
26.
2) The corrective phase designed to restore function and
sometimes, aesthetics. This includes procedures like
- scaling and polishing
- root debridement
- periodontal access surgery
- regenerative surgery
- muco-gingival surgery
-selected use of local and systemic antibiotics
-furcation lesion treatments
-restorative procedures(overhanging fillings, fitting
of crowns, bridges etc)
- endodontic treatment
- occlusal adjustment
27.
All the aforementioned procedures are aimed at:
- Elimination of pathological pockets and the creation
of tight epithelial attachments.
- To arrest bone loss and in some cases improve
alveolar bone support(bone augmentation
procedures).
- Create an oral environment that the patient can
easily keep plaque-free.
28.
3) The maintenance (supportive) phase that aims at
reinforcing patient motivation so their oral hygiene is
kept at a level that prevents a reoccurrence of disease.
Patient should be instructed on proper dental hygiene
practices: toothbrush and tooth brushing techniques,
flossing.
Proper balanced diet for overall health.
Regular dental checkups ( every 3 or 6 months).
29. Oral hygiene practices (brushing, flossing habits), dental and
medical history
Examine the teeth for:
-plaque control,
-calculus,
- staining;
-gingival colour change,
-swelling,
-recession,
-pocketing;
-furcation involvement,
-tooth mobility,
-bleeding on probing.
Dental check ups
30. Radiographs
- Full mouth periapicals, horizontal bitewings: to show degree
bone loss(vertical, horizontal), root surface deposits, furcation
involvement, perio-endo lesions.
- Sequential radiographs can be used to monitor the disease.
Dental check ups
31. Periodontal diseases are largely preventable hence the
dental team prescribes the following:
Effective tooth brushing technique with medium
bristled toothbrush and fluoridated toothpaste twice
daily.
The proper use of floss, plastic toothpicks and other
interdental aids.
The use of mouthwashes as prescribed by dentist.
Proper nutrition.
Visit your dentist for consultation at least every 6
months for routine oral examination. There, scaling and
polishing amongst other lines of management can be
instituted.
CONCLUSION
34.
Laura mitchell & David A. Mitchell Oxford
Handbook of Clinical Dentistry 5th Edition. Pg 173-
214
Cawsons Essentials of Oral Pathology and Oral
Medicine 7th edition. Pg 68-89
Outline of Periodontics by J.D Manson and B.M Eley
www.dentallecnotes.blogspot.com
www.en.m.wikipedia.org/wiki/Periodontium
www.shutterstock.com
REFERENCES
