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Diagnosis and Treatment of 
Periodontal Disease 
dr shabeel pn 1
STAGES OF GINGIVITIS AND 
PERIODONTAL DISEASE 
dr shabeel pn 2
Did you know? 
Gum disease is a common dental 
problem that may result in tooth 
loss. Gingivitis and Periodontitis 
are t...
HEALTHY GUMS 
dr shabeel pn 4
Healthy teeth and gums are 
maintained by daily plaque 
removal from all surfaces of 
the tooth (through tooth 
brushing a...
Healthy gums are characterized 
by the following features: 
• pink or coral pink color, 
(normal variations in 
color depe...
dr shabeel pn 7
WHAT IS GINGIVITIS ? 
dr shabeel pn 8
WHAT IS GINGIVITIS ? 
• Gingivitis is inflammation of the gum tissue. 
• The gums are irritated and swollen due to a plaqu...
WHAT IS GINGIVITIS ? 
• No bone structure is lost around the teeth at this 
stage of gum disease. 
• Blood on the toothbru...
Gingivitis: Notice the gums are 
red and swollen 
dr shabeel pn 11
WHAT IS PERIODONTAL 
DISEASE? 
• Periodontal disease is destruction of 
bone and the structures supporting the 
teeth. Unf...
Eight Warning Signs of 
Periodontal Disease: 
• gums that bleed when 
you brush or floss your 
teeth 
• gums that are red,...
EARLY AND MODERATE 
PERIODONTITIS: 
dr shabeel pn 14
EARLY AND MODERATE 
PERIODONTITIS: 
• Periodontitis occurs when the 
inflammation of the gums progresses 
into the deeper ...
EARLY AND MODERATE 
PERIODONTITIS: 
• The ligaments holding the tooth in its 
socket break down and the gums pull 
away fr...
EARLY AND MODERATE 
PERIODONTITIS: 
dr shabeel pn 17
dr shabeel pn 18
ADVANCED PERIODONTITIS: 
dr shabeel pn 19
ADVANCED PERIODONTITIS: 
• When periodontitis progresses to the 
advanced stage, the gums severely 
recede (pull away from...
Advanced Periodontitis 
• There may be swelling around the root 
and you may experience sensitivity to 
hot or cold or fee...
Advanced Periodontitis 
• As bone loss increases, your teeth may 
lose so much support that they need to 
be removed to pr...
Advanced Periodontal Disease 
dr shabeel pn 23
dr shabeel pn 24
Treatment of Periodontal Disease 
• Prevention 
• Detection 
• Assessment 
• Scaling, debridement, root surface planing 
•...
Prevention 
• Regular homecare 
– Brush 
– Floss 
– Rinse 
– Aids to oral hygiene 
• Regular dental visits 
• Dietary cons...
dr shabeel pn 27
dr shabeel pn 28
Detection 
• Signs and Symptoms 
– Bleeding, inflamed gums 
– Halitosis 
– Discoloration/Stain 
– Long in the tooth 
– Mob...
Detection 
dr shabeel pn 30
dr shabeel pn 31
dr shabeel pn 32
dr shabeel pn 33
dr shabeel pn 34
Assessment 
• Radiographs 
• Periodontal Charting 
• Diagnosis 
– I 
– II 
– III 
– IV 
• Prognosis 
dr shabeel pn 35
Scaling, debridement, root surface 
planing 
dr shabeel pn 36
dr shabeel pn 37
Periodontal surgery 
dr shabeel pn 38
Deep pocket with calculus 
dr shabeel pn 39
Flap Reflected to Visualize 
Calculus 
dr shabeel pn 40
Gum sutured back to normal 
height, leaving a deepened space 
dr shabeel pn 41
Gum sutured down to bone to 
reduce residual space 
dr shabeel pn 42
Bone grafting 
dr shabeel pn 43
Flap reflected to allow 
bone implant 
dr shabeel pn 44
Flap resutured over 
bone implant 
dr shabeel pn 45
Flap reflected to 
insert membrane 
dr shabeel pn 46
Flap resutured 
over membrane 
dr shabeel pn 47
Mucogingival Surgery 
dr shabeel pn 48
Oral Irrigation 
dr shabeel pn 49
Pharmacological Intervention 
• Topical Antibiotics 
– Tetracycline 
– Doxycycline 
– Minocycline 
dr shabeel pn 50
Pharmacological Intervention 
• Periochip (cholorhexidine, and 
bacteriocidal drug) 
• Atridox (doxycycline antibiotic, a ...
dr shabeel pn 52
Post Treatment Care 
• Regular periodontal maintainance 
– 3 month recare 
– Monitor probing depths 
– Follow up radiograp...
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  1. 1. Diagnosis and Treatment of Periodontal Disease dr shabeel pn 1
  2. 2. STAGES OF GINGIVITIS AND PERIODONTAL DISEASE dr shabeel pn 2
  3. 3. Did you know? Gum disease is a common dental problem that may result in tooth loss. Gingivitis and Periodontitis are the most common types of adult gum disease. dr shabeel pn 3
  4. 4. HEALTHY GUMS dr shabeel pn 4
  5. 5. Healthy teeth and gums are maintained by daily plaque removal from all surfaces of the tooth (through tooth brushing and interdental cleaning) dr shabeel pn 5
  6. 6. Healthy gums are characterized by the following features: • pink or coral pink color, (normal variations in color depend on race and complexion) • firm, resilient tissues • 'orange-peel' texture (known as stippling) • shape that follows the contour of the teeth and forms a scalloped edge • no areas of redness, swelling or inflammation • no bleeding during daily plaque removal • no discomfort dr shabeel pn 6
  7. 7. dr shabeel pn 7
  8. 8. WHAT IS GINGIVITIS ? dr shabeel pn 8
  9. 9. WHAT IS GINGIVITIS ? • Gingivitis is inflammation of the gum tissue. • The gums are irritated and swollen due to a plaque or calculus (tartar) buildup along the gum line. • The gums may be sore, bleed easily and appear puffy, soft and swollen. dr shabeel pn 9
  10. 10. WHAT IS GINGIVITIS ? • No bone structure is lost around the teeth at this stage of gum disease. • Blood on the toothbrush or dental floss is one of the earliest and most common signs of gingivitis. • Your gums should never bleed while brushing or flossing. • The good news about gingivitis is that it is preventable and reversible through good brushing and flossing techniques (or other interdental tooth cleansing). • On the other hand, if oral hygiene habits are poor, gingivitis may progress to periodontitis. dr shabeel pn 10
  11. 11. Gingivitis: Notice the gums are red and swollen dr shabeel pn 11
  12. 12. WHAT IS PERIODONTAL DISEASE? • Periodontal disease is destruction of bone and the structures supporting the teeth. Unfortunately periodontitis is irreversible, but you can stop its progression through good oral hygiene and visiting your dental professional. dr shabeel pn 12
  13. 13. Eight Warning Signs of Periodontal Disease: • gums that bleed when you brush or floss your teeth • gums that are red, swollen or tender • gums that have pulled away from teeth • infection including purulence (pus) between the teeth and gums when the gums are pressed • permanent teeth that are loose or separating • any changes in the way your teeth fit together when you bite • any changes in the fit of your partial denture • bad breath • itchy sensation dr shabeel pn 13
  14. 14. EARLY AND MODERATE PERIODONTITIS: dr shabeel pn 14
  15. 15. EARLY AND MODERATE PERIODONTITIS: • Periodontitis occurs when the inflammation of the gums progresses into the deeper underlying structures and bone. • In the most common form of periodontitis, plaque (and sometimes calculus) is found below the gum line. • The gums may feel irritated, appear bright red, and bleed easily. dr shabeel pn 15
  16. 16. EARLY AND MODERATE PERIODONTITIS: • The ligaments holding the tooth in its socket break down and the gums pull away from the teeth, resulting in a periodontal pocket or space between the tooth and gum. • The periodontal pocket deepens and fills with more bacteria. Supportive ligaments and bone start to show damage. dr shabeel pn 16
  17. 17. EARLY AND MODERATE PERIODONTITIS: dr shabeel pn 17
  18. 18. dr shabeel pn 18
  19. 19. ADVANCED PERIODONTITIS: dr shabeel pn 19
  20. 20. ADVANCED PERIODONTITIS: • When periodontitis progresses to the advanced stage, the gums severely recede (pull away from the tooth ); pockets deepen and may be filled with pus. dr shabeel pn 20
  21. 21. Advanced Periodontitis • There may be swelling around the root and you may experience sensitivity to hot or cold or feel pain when brushing your teeth. This is due to the severely receding gums exposing the root surface. dr shabeel pn 21
  22. 22. Advanced Periodontitis • As bone loss increases, your teeth may lose so much support that they need to be removed to preserve the overall health of your mouth. dr shabeel pn 22
  23. 23. Advanced Periodontal Disease dr shabeel pn 23
  24. 24. dr shabeel pn 24
  25. 25. Treatment of Periodontal Disease • Prevention • Detection • Assessment • Scaling, debridement, root surface planing • Periodontal surgery • Bone grafting dr shabeel pn 25
  26. 26. Prevention • Regular homecare – Brush – Floss – Rinse – Aids to oral hygiene • Regular dental visits • Dietary consideration dr shabeel pn 26
  27. 27. dr shabeel pn 27
  28. 28. dr shabeel pn 28
  29. 29. Detection • Signs and Symptoms – Bleeding, inflamed gums – Halitosis – Discoloration/Stain – Long in the tooth – Mobility • Radiographic findings • Periodontal probing depths dr shabeel pn 29
  30. 30. Detection dr shabeel pn 30
  31. 31. dr shabeel pn 31
  32. 32. dr shabeel pn 32
  33. 33. dr shabeel pn 33
  34. 34. dr shabeel pn 34
  35. 35. Assessment • Radiographs • Periodontal Charting • Diagnosis – I – II – III – IV • Prognosis dr shabeel pn 35
  36. 36. Scaling, debridement, root surface planing dr shabeel pn 36
  37. 37. dr shabeel pn 37
  38. 38. Periodontal surgery dr shabeel pn 38
  39. 39. Deep pocket with calculus dr shabeel pn 39
  40. 40. Flap Reflected to Visualize Calculus dr shabeel pn 40
  41. 41. Gum sutured back to normal height, leaving a deepened space dr shabeel pn 41
  42. 42. Gum sutured down to bone to reduce residual space dr shabeel pn 42
  43. 43. Bone grafting dr shabeel pn 43
  44. 44. Flap reflected to allow bone implant dr shabeel pn 44
  45. 45. Flap resutured over bone implant dr shabeel pn 45
  46. 46. Flap reflected to insert membrane dr shabeel pn 46
  47. 47. Flap resutured over membrane dr shabeel pn 47
  48. 48. Mucogingival Surgery dr shabeel pn 48
  49. 49. Oral Irrigation dr shabeel pn 49
  50. 50. Pharmacological Intervention • Topical Antibiotics – Tetracycline – Doxycycline – Minocycline dr shabeel pn 50
  51. 51. Pharmacological Intervention • Periochip (cholorhexidine, and bacteriocidal drug) • Atridox (doxycycline antibiotic, a form of tetracycline) • Arestin (minocycline antibiotic, a form of tetracycline) dr shabeel pn 51
  52. 52. dr shabeel pn 52
  53. 53. Post Treatment Care • Regular periodontal maintainance – 3 month recare – Monitor probing depths – Follow up radiographs • Empahasis on Homecare dr shabeel pn 53

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