Periodontal diseases affect the tissues around the teeth and range from gingivitis to periodontitis. About 60-90% of people have some form of periodontal disease depending on age. Periodontal diseases are caused by bacterial dental plaque which leads to inflammation if not removed regularly. The bacteria can damage gum tissue, bone, and ligaments supporting the teeth. Periodontal diseases are classified based on severity from gingivitis to chronic periodontitis with bone loss. Treatment focuses on improving oral hygiene through regular cleaning to control the bacterial plaque.

1. §3.Periodontal Diseases In the United States , about 60% of young adults, 80% of middle-aged people, 90% of people older than 65 have some form of periodontal disease

2. Content Definition of periodontal diseases Aetiology and pathogenesis of periodontal diseases Classification of periodontal diseases Manifestation of periodontal diseases Treatment of periodontal diseases

3. Definition of periodontal diseases Periodontal diseases can be defined as any pathological process affecting the periodontal tissues, but invariably refers to inflammatory disease, gingivitis and periodontitis

4. 1.Initial factor-----Pathogenic microorganism New laboratory techniques show that over 530 species and subspecies have been isolated and classified from subgingival and supragingival bacterial samples. Aetiology - How does periodontal disease start?

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6. These bacteria possess biochemical capacities for the pathogenesis of inflammatory periodontal diseases .

7. Dental plaque is a sticky, colorless deposit of bacteria that constantly forms on the teeth. Saliva, food and fluids combine to produce this plaque. If it is not removed by regular brushing and flossing, it hardens and calcifies to form a stone like crusty deposit, commonly referred to as tartar or calculus .

8. Calculus is a hardened substance that comes from a combination of minerals in the saliva and from the dead plaque bacterial cells. They precipitate a crusty deposit that, once mineralized, can grow rather quickly. .

9. There are two types of calculus: Supragingival calculus is the hard deposit on top of the teeth, the kind we can see and feel. Subgingival calculus forms below the gums. It is just as hard and adherent as supragingival calculus, this allows the bacteria to congregate in greater numbers. Though it is difficult to remove plaque formed on top of/within subgingival calculus, it is necessary to do because these pathogens cause more periodontal tissue breakdown.

10. Dental plaque forms soon after it is removed. Some studies report that it starts forming as soon as five minutes after it is removed. Regardless of how quickly it begins reforming, effective plaque control will keep it to a minimum.

11. Supragingival dental plaque, early stage in formation. Supragingival dental plaque, late stage in formation.

12. If plaque is allowed to build up on the teeth, toxin or enzymes produced by the bacteria can damage the attachment of the gums, periodontal ligament, and bone to the teeth.

13. Healthy gums should fit snugly around the teeth. But as periodontal bacteria make their way beneath the gums, they create periodontal pocket which are unwanted gaps around the teeth. Teeth with pockets around them may eventually loosen or fall out.

14. If the inflammation is allowed to continue, the bone will begin to demineralize and dissolve. This stage is known as periodontitis . As the bone dissolves around the teeth, the teeth become unsupported and will fall out.

15. As more bone is destroyed, the tooth begins to loosen and, as the pockets get deeper, abscesses often occur. Sometimes the gum will shrink as bone underneath is destroyed so that part of the root will become visible in the mouth

16. Unfortunately, pain does not occur until the final stages of the disease and treatment at that time has very little chance of being successful .

17. 2.Local contributing factors may increase the risk or severity of periodontal disease: 1.Oral hygiene: 2.Food impaction 3.Tauma from occlusion

18. 3.Systemic factor: 1. Smoking : a major risk factor for increasing the prevalence and severity of periodontal destruction. 2. Genetics : some factors can increase the sensibility that the host responds to periodontal disease. 3.Pregnancy : gingiva is a target organ for female sex hormones. 4. Stress : stress can increase the release of hormones and immune medium ,which can reduce defense function of the host. 5.Systemic disease:

20. Classification of gingival disease Gingival disease Chronic gingivitis Gingival hyperplasia System Acute necrotizing ulcerative gingivitis Acute papilla gingivalista Acute multiple abscesses of the gingiva Margingnal gingvitis Hyperplastic gingvitis Puberty gingivitis Pregnancy gingvitis Drug-induced Hereditary gingival fibromatosis Epulis Gingivitis associated systemic diseases

21. Classification of periodontitis

22. 1. Acute necrotizing ulcerative gingivitis (also named Vincent gingivitis ----- ANUG ) Acute necrotizing inflammation occurring on marginal gingiva and papillae. Acute necrotizing ulcerative gingivitis Acute papilla gingivalista Acute multiple abscesses of the gingiva

23. Eatiology Smear for fusospirochaetal bacteria fusospirochaetal bacteria Some reasons Defense of host ANUG

24. Existing gingivitis and periodontitis are important contributing factor Deep pocket are suitable for bacteria growth Local or systemic factor make bacteria grow

25. Clinical features Age :young and middle aged people (18-30) smoking male weaken child Size: lower anterior teeth ANUG

26. Severe soreness Profuse gingival bleeding Halitosis and a bad taste Interdental papillae ulcerated with necrotic slough ANUG

27. 2.Acute papilla gingivalista Acute inflammation localized in certain interdental papillae Acute papilla gingivalista Acute necrotizing ulcerative gingivitis Acute papilla gingivalista Acute multiple abscesses of the gingiva

28. Acute papilla gingivalista Aetiology Mechanical stimulation Food impaction Adjacent caries Bad restoration Chemical irritants AsO3 ---Arsenic trioxide

29. Clinical features Spontaneous, lasting pain Short onset Single papilla--- bright, red, swelling, soft texture Severe bleeding and pain while probing Percussion （＋）， loose （—） X-ray Acute papilla gingivalista

30. Multiple papillae Acute suppurative inflammation 3.Acute multiple abscesses of the gingivae Acute necrotizing ulcerative gingivitis Acute papilla gingivalista Acute multiple abscesses of the gingivae

31. clinical features Throbbing pain. Red swelling Small abscess Subsequent rupture Halitosis

32. 1.Margingnal gingivitis Almost universal in adults to some degree Dental plaque(main cause) Erythema, edema and painless swelling of marginal gingivae with bleeding on brushing or eating hard food Chronic gingivitis Margingnal gingvitis Hyperplastic gingvitis Puberty gingvitis Pregnancy gingivitis

33. 2. Hyperplastic gingivitis May occur following prolonged accumulation of dental plaque Firm ,pink gingival enlargement, particularly at interdental sites. May cover the crowns of teeth, resulting in aesthetic and cleaning difficulties.

34. 3.Puberty gingivitis Tooth arrangement is not good, fixed orthodontic appliance, the eruption of teeth in teenagers, bad habit of oral hygiene are all contributing factors Less calculus, much dental plaque Gingiva is the target tissue of sexual hormone, and the change of sex hormone in teenagers is great ,which can easily result in inflammation of gingivae.

35. 4.Pregnancy gingivitis Common Exacerbation of chronic gingivitis mainly after 2 nd month of pregnancy Erythema, swelling and liability to bleed Chronic gingivitis Margingnal gingvitis Hyperplastic gingivitis Puberty gingivitis Pregnancy gingvitis

36. 1.Drug-induced hyperplasia Usually aggravated by poor oral hygiene It starts interdentally ,especially liabially Papillae firm, pale and enlarge to form false vertical clefts Gingival hyperplasia Drug-induced gingival hyperplasia Hereditary gingival fibromatosis Epulis

37. 2.Hereditary gingival fibromatosis

38. 3.Epulis Localized gingival swelling Fibrous are most common Local gingival irritation leading to fibrous hyperplasia Gingival hyperplasia Drug-induced gingiva hyperplasia Hereditary gingival fibromatosis Epulis

39. Epulis Typically form narrow,firm,pale swellings of an anterior interdental papillae May ulcerate

40. Leukemia Most common in adults Characterized by swelling haemorrhage and ulceration Leukemia Gingivitis associated systemic diseases

41. Treatment of gingival diseases includes Oral hygiene---Plaque control to a meticulous standard R insing Tooth brushing Interdentally brushing Scaling The use of antibiotic treatment Excision

43. The main topic Definition : Dental plaque Calculus Classification of periodontal diseases