periodontal diseases assemble in a file!

1. Periodontal disease
Presented by:Maryam Jahangiri

2. Periodotal disease
Gingival disease
Dental
plaque
induced
Non-plaque
induced
periodontitis
Chronic
periodontitis
Aggressive
periodontitis
Less
common
type of
periodontitis
Abscesses of the periodontium
Gingival
abscess
Pericoronal
abscess
Periodontal
abscess
Develop
mental or
acquired
deformiti
es and
condition
s

4. Gingivitis
• Gingivitis is a common and mild form of gum disease
(periodontal disease) that causes irritation, redness and
swelling (inflammation) of your gingiva, the part of your gum
around the base of your teeth. It's important to take gingivitis
seriously and treat it promptly. Gingivitis can lead to much
more serious gum disease called periodontitis and tooth loss.

5. Gingival disease
Non_plaque induced
Gingival disease of
special bacterial origin
Gingival disease of viral
origin
Traumatic lesions
Foreign body reactions
Not otherwise specified
Gingival disease of fungal
origin
Gingival disease of genetic
origin
Gingival manifestations of
systemic conditions
Allergic reaction
Plaque induced
plaque_induced gingivitis
Gingival diseases modified
by systemic factors
Gingival diseases modified
by medications
Gingival diseases modified
by malnutrition

6. Gingivitis associated with dental
plaque
Herpetic gingivostomatitis
Plaque induced modified by
systemic factors
Chemical burn

10. periodontitis
Chronic
periodontitis
localized generalized
Aggressive
periodontitis
localized generalized
Less common types
of periodontitis
Periodontitis
as a
manifestation
of a systemic
disease
Necrotizing
periodontal
disease
Periodontitis
associated
with
endodontic
lesions

11. Chronic periodontitis
• It is inflammatory disease of supporting tissues
of teeth caused by specific micro-organism
resulting in progressive destruction of
periodontal ligament and alveolar bone with
pocket formation,recession or both.
• Chronic periodontitis,formerly known as adult
periodontitis or chronic adult periodontitis is the
most prevalent form of periodontitis.
• Most commonly seen in adults.
• Age associated but not age related.
• Chronic periodontitis is considered a site-specific
disease.

12. Clinical features
• Supra and subgingival plaque accumulation
• Gingival inflammation
• Pocket formation
• Loss of periodontal attachment
• Occasional suppuration
• Poor oral hygience-gingiva is typically may be slightly to moderately
swollen
• Color-pale red
• Consistency-soft or firm
• Surface topography-loss of stippling
• Flattened or cratered papillae
• Furcation
• Tooth mobility
• BOP

13. symptoms
• Bleeding gums during brushing or eating
• Increasing spacing between their teeth
• Loose teeth
• Usually painless
• Sensitivity due to exposed root
• Halitosis
• Gingival tendernss or itching

14. Chronic periodontitis
Localized:
Less than 30%
sites are
involved
Generalized:
30% or more
sites shows CAL
& bone loss

15. -
age
Rate of proggression
Microbial etiology
immunological
Chronic
periodontitis
More prevalent in adults but may be
presented in children and
adolescents
Slow rate of progression
Consist of both aerobic & anaerobic
gram positive &gram negative
microorganism
No abnormalities detected
Aggressive
periodontitis
Circumpubertal onset in LAP & under
30 years of age in GAP
Rapid rate of progression with
pronounced episodic events of
attachment and bone loss
Aggreagatibacter
Actinomyctemcomitans
Prevotella intermedia
Hyper responsive macrophage
phenotype & phocyte abnormalities

17. early
•CAL= 1-2mm
•Pocket
depths=4-
5mm
•Bone loss=
slight
horizontal
moderate
•CAL=3-4mm
•Pocket
depths=5-
7mm
•Bone
loss=slight to
moderate
horizontal
advanced
•CAL=>5mm
•Pocket
depths=>7mm
•Bone
loss=moderate
to severe
horizontal and
vertical

18. Chronic periodontitis progression
1. The continuous model
2. The random model or episodic burst
model
3. The Asynchronous, multiple-Burst model

19. Risk factors for disease
• Local factors
• Systemic factors
• Genetic factors
• Environmental and behavioral factors
• Prior history of periodontitis

21. Aggressive periodontitis
• Aggressive periodontitis refers to the
multifactorial,severe and rapidly
progressive form of
periodontitis,which primarily but not
exclusively affects younger patients.

22. Diagnostic criteria
• 1-age
• 2-A distinctive radiography pattern depiciting vertical
alveolar bone loss at the first permanent molars and at one
or more incisor teeth.(classical case=an arc-shaped loss of
alveolar bone,extending from the distal surface of 5 to the
mesial surface of the 7)
• 3-Rapid progression
• 4-The disease affects only the permanent dentition.
• 5-The amount of local etiologic factors is not
commensurated with the severity of periodontal
destruction.
• 6-Black male>black female>white female>white male
• 7-In general female to male ratio is 3:1
• 8-Familial pattern

23. Aggressive periodontitis
Generalized)
-generalized juvenile periodontitis or
rapidly progressive periodontitis
- Usually <30 yrs
-at least three permanent teeth other
than first molars and incisors
Localized)
-localized juvenile periodontitis(LJP)
-11-13 yrs
-Attachment loss on at least 2
permanent(one of which is a first molar)

25. Necrotizing periodontal disease
Necrotizing
Ulcerative
Gingivitis
Necrotizing
Ulcerative
Periodontitis

26. Necrotizing ulcerative gingivitis
• Necrotizing ulcerative gingivitis(NUG),necrotizing ulcerative
periodontitis(NUP),necrotizing stomatitis(NS) are the most
severe inflammatory periodontal disorders caused by plaque
bacteria.
• nomenclature=trench mouth,vincent’s gingivostomatitis
• NUG often occurs in groups in an epidemic form
• NUG occurs at all ages,with the highest incidence reported
between ages 20-30 yrs & ages 15-20 yrs.
• The disease seems to occur slightly more among HIV infected
individuals.

27. Clinical features
• Ulcerated and necrotic papilla and gingival margin.
• Punch out crater
• Gray pseudomembranous slough
• Liner erythema
• In some cases the lesions are denuded of the surface
pseudomembrane , exposing the gingival margin
which is red,shiny,hemorrhagic.
• Spontaneous gingival hemorrhage

28. Necrotizing ulcerative periodontitis
• Progression of the interproximal lesion often results
in destruction of the interdental alveolar bone.
• Sequestrum formation:necrosis of a small or large
part of the alveolar bone,which is denoted as
sequestrum.the bone fragement is initially
immovable, later on it becomes loose.sequestrum
involves interproximal as well as facial or palatal
cortical bone.

29. Clinical features
• Sensetive to touch
• Gnawing pain that is often intensified by eating spicy or hot foods & chewing.
• Metallic foul taste & an excessive amount of pasty saliva.
• In mild & moderate stages of disease=local lymphadenopathy and slight elevation
in temperature
• In severe cases=high fever,increased pulse rate,leukocytosis,loss of appetite and
general lassitude.
• insomnia,constipation,gastro-intestinal disorders,headache,mental depression
• In vary rare cases, severe squeal such as gangrenous stomatitis & noma have been
described.

30. Stages of oral necrotizing disease-
by Horning & Cohen
• Stage 1-necrosis of the tip of the interdental papilla
• Stage 2-necrosis of entire papilla
• Stage 3-necrosis extending to the gingival margin.
• Stage 4-necrosis extending to the attached gingiva.
• Stage 5-necrosis extending to labial & buccal mucosa.
• Stage 6-necrosis exposing alveolar bone.
• Stage 7-necrosis perforating skin of cheek.

31. Stage 1)erosion of only tip of
interdental papilla
Stage 2)marginal gingiva affected and
complete loss of interdental papilla
Stage 3)involving attached gingiva
Stage 4)exposure of bone

32. Etiology
• Role of microorganism
• Role of host response
• Predisposing factors includes:local predisposing
factor,systemic predisposing factor

33. periodontitis as a manifestation of
a systemic disease
• At least 16 systemic diseases have been linked to
periodontitis. These systemic diseases are associated
with periodontal disease because they generally
contribute to either a decreased host resistance to
infections or dysfunction in the connective tissue of
the gums, increasing patient susceptibility to
inflammation-induced destruction

34. Conditions associated with
periodontitis
• Diabetes mellitus
• hematologic disorders:neutropenia, Leukemia
• Familial and cyclic neutropenia
• Down syndrome
• Leukocyte adhesion deficiency disorder
• Papillon–Lefèvre syndrome
• Chédiak–Higashi syndrome
• Langerhans cell disease (histiocytosis syndromes)
• Glycogen storage disease
• Chronic granulomatous disease
• Infantile genetic agranulocytosis
• Cohen syndrome
• Ehlers–Danlos syndrome (Types IV and VIII)
• Hypophosphatasia
• Crohn's disease (inflammatory bowel disease)
• Marfan syndrome
• Klinefelter syndrome

36. Periodontitis associated with
endodontic lesions
Combined lesions
Periodontic
lesions
Endodontic
lesions

38. True combined lesion

39. Abscesses of the periodontium
• Gingival abscess—a localized, purulent infection
involves only the soft gum tissue near the marginal
gingiva or the interdental papilla.[3]
• Periodontal abscess—a localized, purulent infection
involving a greater dimension of the gum tissue,
extending apically and adjacent to a periodontal
pocket.[3]
• Pericoronal abscess—a localized, purulent infection
within the gum tissue surrounding the crown of a
partially or fully erupted tooth.[3] Usually associated
with an acute episode of pericoronitis around a
partially erupted and impacted mandibular third
molar (lower wisdom tooth).

41. Developmental or acquired
deformities and conditions
developmental/acquiredcondition
Localized tooth-realated factors that increase
the risk of developing plaque-induced
gingivitis and periodontitis
Mucogingival deformities and conditions
around teeth
recession
Lack of attached gingiva
Frenal position
Gingival excess
Occlusal trauma
Accelerated and increases attachment loss in
areas already periodontally involved and may
widen PDL resulting in increasing mobility in
otherwise healthy teeth