THE UNIVERSITY OF PAPUA NEW GUINEASCHOOL OF MEDICINE & HEALTH SCIENCEDIVISION OF DENTISTRYPeriodontologyTopic: Periodontitis - Describe its causes, signs and symptoms and its management..Name: Willie Yanimo FrancisId: 20110187Program: BOH/BDS IIILecturer: Dr. Beaga
PeriodontitisDescribe its causes, signs and symptoms and its management..IntroductionPeriodontitis is a disease which categorized under periodontal diseases. It is a disease which affectsmore than one or all the constituents of the periodontum. The constituents of the periodontum aregingiva, periodontal ligaments, cementum and alveolar bone. Some people may take gingivitis as thesame as periodontitis but the main difference is that gingivitis usually refers to gingival inflammationwhile periodontitis refers to gum disease and the destruction of tissue and/or bone. Gingivitis is theprecursor of periodontitis if left untreated or ignored for a long period of time. Marginal gingiva, thepart of the gingiva that seals to the tooth is weakened and become loose thus forming spaces betweenthe tooth and the gingiva. This space is known as periodontal pockets and bacteria can accumulate herecausing further inflammation (redness and swelling).The following content of this write up describes periodontitis in the following manner:1. Aetiology2. Signs &Symptoms3. Diagnosis and treatment (management)4. preventionAetiologyFormation of dental plaque on the teeth–it is a biofilm that is pale-yellow in color and developsnaturally on tooth surfaces. Plaque is mainly caused by bacteria which adheres to the tooth’s smoothsurfacesTooth 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 intocalculus(tartar). Calculus is much harder and can be very difficult to remove with a teeth brush.Theremoval of calculus is much difficult and requires a dental professional.This calculus can irritate the gingiva and progressively damage the surrounding tissues as well. Thepatient may develop Gingivitis (inflammation of the gingiva around the marginal area of the teeth) atfirst.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. Asinfection spreads it damages the periodontal fibers. Sometimes the gingiva moves apically exposingthe dentinal part of the roots.Bacterial toxins and our immune systems response to infection start destroying the alveolar bone andconnective tissue that hold teeth in place in the socket. Eventually if there is too much bone loss theteeth start becoming loose, and can even fall out.
Signs & symptomsA symptom is what the patients’ feels and complaints about it to the doctor, while on the other hand asign is what the doctor observes on the patient after doing an examination or checkup. For example, apatient 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 brushingGingiva loses its natural color and turns bright red or even purpleGingiva really hurt when touchedGingival recession occurs, making teeth look longerExtra periodontal pockets appear between the teethAppearance of pus between the soft tissues and teethBleeding when brushing teethBleeding when flossingMetallic taste in the mouthHalitosis (another term for bad breath)Loose or mobile teethMalocclusion occurs. The patients "bite" feels different because the teeth do not fit the sameMisaligned toothDiagnosis&TreatmentDentists are qualified and should find it fairly straightforward to diagnose periodontitis. The dentist willexamine the patients mouth using a periodontal probe. The probe is inserted next to the tooth, underthe gingival margin. If the tooth is healthy, the probe does not slide between the tooth and the marginalgingiva. 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 pocketsaround the teeth and prevent further destruction of bone and tissue.Initial treatmentInorder to restore periodontal health it is important that plaque and calculus must be removed. Thehealthcare professional uses periodontal scalers to scrape out any plaque and calculus found below thegingival margin. This procedure is known as scaling and debridement. Sometimes an ultrasonic devicemay be used to remove plaque and calculus. In the past Root Planing was used (the cemental layer wasremoved, as well as calculus) but not anymore.
MedicationsThe 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 treatinggum 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 bacteriaand reduces periodontal pocket size. This medication is placed in the pockets after root planing. Themedication is slowly resealed over time.Antibiotic gel - a gel that contains doxycycline, an antibiotic. This medication controls bacteria andshrinks 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 tocontrol bacteria and reduce periodontal pocket size. They are placed into pockets after scaling androot planing. A slow-release medication.Enzyme suppressant - keeps destructive enzymes in check with a low-dose of doxycycline. Someenzymes can break down gum tissue, this medication holds back the bodys enzyme response. Takenorally 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 forthe treatment of acute or locally persistent periodontal infection.Advanced periodontitisthe following are surgical intervention which follows if good oral health and non-surgical procedures arenot effective enough:Flap surgery - the dentist performs flap surgery to remove calculus in deep pockets, or to reduce thepocket 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.Thegingival tissues heal up after the surgery and hold tightly around the tooth. In some cases the toothmay eventually seem longer than it used to.Bone and tissue grafts - this procedure helps regenerate bone or gingival tissue that has beendestroyed. 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 insertedbetween the gingival tissue and bone. This stops the gingiva from growing into bone space, giving thebone and connective tissue a chance to regrow. The dentist may also use special proteins (growthfactors) that help the body regrow bone naturally. The dentist may suggest a soft tissue graft - tissuetaken 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 goodoral hygiene program, as well as other factors, such as smoking status.
PreventionPeriodontitis is a disease which can be prevented. The best method used to prevent periodontitis is tofollow a program of good oral hygiene. A good oral hygiene program is one which you can begin earlyand practice consistently throughout life. The following are some of the good oral hygiene which can beused:Brushing teeth at least twice a day; in the morning and before going to bed. Some dentists maygive advice to brush three times a dayFlossing between teeth at least once a dayGet treatment early if there is any slight marginal inflammationAlways visit dental clinics every six to twelve months for a regular check upThere 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 isadvisable for him or her to visit the dental clinic for regular cleaning of teeth.ConclusionIt can be concluded that periodontitis is a disease which occurs because of poor oral hygiene. Poor oralhygiene can occur because of two major things; individuals are too lazy to practice oral health or theydon’t know how to take care of their oral health. Therefore it is up to us as dentists to carry outawareness about the consequences associated with poor oral health, especially periodontitis. We haveto 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 healthhygiene. As the saying goes “prevention is better than cure” we have to take preventative measures toprotect individuals from contracting periodontitis. By doing this there won’t be too many patients in theclinic and also reduces stress from workload.
Reference1. J.D Da Silva et al, Oxford American Handbook of Clinical Dentistry. 2008, OxfordUniversity Press, Oxford.2. Lindhe J. Textbook of Clinical Periodontology. 1984, Munksgaard press Copenhagen3. Livingstone. C, J.H.Scott&N.B.B.Symons. introduction to Dental Anatomy, 9thed. 1982,Oxford University Press, Oxford.4. R.C Sheid. WolfielsDental Anatomy: Its relevance to dentistry, 7thed. 2007, LiippincotWilliams and Wilkins Press, Pensylvania.5. What are the causes of periodontitis? / eHow.comhttp://www.ehow.com/about 5117742 causes-periodontitis.html#ixzz26yKZ1lhg