Chronic periodontitis is a slowly progressive infectious disease that results in inflammation of the gums and bone destruction around the teeth. It is caused by a subgingival biofilm of bacteria that spreads below the gumline. Common symptoms include bleeding gums, deepening pockets between teeth, and loose or mobile teeth. Treatment involves nonsurgical procedures like scaling and root planing to remove plaque and tartar, as well as surgery in some cases to regenerate lost bone and reduce pocket depths. Prognosis depends on factors like patient compliance, systemic health issues, disease severity, and tooth-specific characteristics such as attachment levels and furcation involvement.
explaining about Periodontal disease
The term periodontal disease is used in a general sense to encompass all diseases of the periodontium.
The most common disease is initiated by plaque accumulation in the gingivodental area and is basically inflammatory in character, termed marginal periodontitis or more accurately chronic destructive periodontitis.
The periodontal tissues can also be involved by other nosologic entities and many of these fall into degenerative or neoplastic categories. They are considered as periodontal manifestations of systemic diseases
CHRONIC DESTRUCTIVE PERIODONTITIS
Periodontitis
Marginal periodontitis
Slowly progressing
Rapidly progressing
Refractory
Juvenile form of periodontitis
Generalized form
Localized form
Necrotizing Ulcerative Periodontitis
Trauma from occlusion*
Periodontal atrophy*
Presenile atrophy
Disuse atrophy
MARGINAL PERIODONTITIS
Clinical features: chronic inflammation of the gingiva, pocket formation, and bone loss. Tooth mobility and pathologic migration appear in advanced cases.
Etiology: dental plaque
Types: slowly progressing periodontitis, rapidly progressing periodontitis, refractory periodontitis
Presenile atrophy
reduction in the height of periodontium that is uniform throughout the mouth and without apparent cause
Disuse atrophy
Results when the functional stimulation for the maintenance of the periodontal tissues is markedly diminished or absent.
characterized by thinning of periodontal ligament, thinning and reduction in the number of periodontal fibers and disruption of fiber bundle arrangement, thickened cementum, reduction in height of alveolar bone, and osteoporosis
A periodontal pocket is a pathologically deepened sulcus: it is one of the important clinical features of periodontal disease.
SYMPTOMS:
Localized pain or a sensation of pressure after eating, which gradually diminishes
A foul taste in localized areas.
A tendency to suck material from the interproximal spaces.
Radiating pain “deep in the bone”
A “gnawing” feeling or feeling of itchiness in the gums.
explaining about Periodontal disease
The term periodontal disease is used in a general sense to encompass all diseases of the periodontium.
The most common disease is initiated by plaque accumulation in the gingivodental area and is basically inflammatory in character, termed marginal periodontitis or more accurately chronic destructive periodontitis.
The periodontal tissues can also be involved by other nosologic entities and many of these fall into degenerative or neoplastic categories. They are considered as periodontal manifestations of systemic diseases
CHRONIC DESTRUCTIVE PERIODONTITIS
Periodontitis
Marginal periodontitis
Slowly progressing
Rapidly progressing
Refractory
Juvenile form of periodontitis
Generalized form
Localized form
Necrotizing Ulcerative Periodontitis
Trauma from occlusion*
Periodontal atrophy*
Presenile atrophy
Disuse atrophy
MARGINAL PERIODONTITIS
Clinical features: chronic inflammation of the gingiva, pocket formation, and bone loss. Tooth mobility and pathologic migration appear in advanced cases.
Etiology: dental plaque
Types: slowly progressing periodontitis, rapidly progressing periodontitis, refractory periodontitis
Presenile atrophy
reduction in the height of periodontium that is uniform throughout the mouth and without apparent cause
Disuse atrophy
Results when the functional stimulation for the maintenance of the periodontal tissues is markedly diminished or absent.
characterized by thinning of periodontal ligament, thinning and reduction in the number of periodontal fibers and disruption of fiber bundle arrangement, thickened cementum, reduction in height of alveolar bone, and osteoporosis
A periodontal pocket is a pathologically deepened sulcus: it is one of the important clinical features of periodontal disease.
SYMPTOMS:
Localized pain or a sensation of pressure after eating, which gradually diminishes
A foul taste in localized areas.
A tendency to suck material from the interproximal spaces.
Radiating pain “deep in the bone”
A “gnawing” feeling or feeling of itchiness in the gums.
All about gingivitis
*definition
*classification
*Signs and Symptoms: Increased GCF, Gingival Bleeding, Color change, Consistency, Surface texture (STIPPLING), Position of Gingiva, Gingival Contour, Size.
Treatment consisits of scaling and root planing. The more inflamed a gingival unit appears clinically, the better the chances of therapeutic measures resulting in a return to normal gingival health
Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. It is no more a separate entity, as earlier it had Aggressive periodontitis as a differential diagnosis. According to the New Classification from the 2017 World Workshop on Periodontal and Peri- Implant Disease and Conditions, it is now classified further into stages and grades under Periodontitis.
about pathophysiology behind endo perio lesion and various methods for it. it also explains various complications related to it, dental anomalies associated.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
All about gingivitis
*definition
*classification
*Signs and Symptoms: Increased GCF, Gingival Bleeding, Color change, Consistency, Surface texture (STIPPLING), Position of Gingiva, Gingival Contour, Size.
Treatment consisits of scaling and root planing. The more inflamed a gingival unit appears clinically, the better the chances of therapeutic measures resulting in a return to normal gingival health
Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. It is no more a separate entity, as earlier it had Aggressive periodontitis as a differential diagnosis. According to the New Classification from the 2017 World Workshop on Periodontal and Peri- Implant Disease and Conditions, it is now classified further into stages and grades under Periodontitis.
about pathophysiology behind endo perio lesion and various methods for it. it also explains various complications related to it, dental anomalies associated.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
TOP AND BEST GLUTE BUILDER A 606 | Fitking FitnessFitking Fitness
"Feature:
• Intelligent Ergonomically Design Glute Builder Is A Must Have For Those Looking To Target Their Gluteal Muscles And Hamstrings With Precision.
• The Ability To Adjust The Starting Position, This Machine Allows For A More Targeted Workout That Is Tailored To Your Specific Needs.
• Spacious And Supportive Cushioned Seat Provide Added Comfort And Stability During Your Workout."
Get more information visit on:- www.fitking.in
Our mail I.D:-care@fitking.in, fitking.in@gmail.com
Call us at :- 9958880790, 9870336406, 8800695917
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
2. Definition
Chronic Periodontitis can be defined as “an
infectious disease resulting in inflammation
within the supporting tissues of the teeth,
progressive attachment loss, and bone loss.”
- Previously known as adult periodontitis or
slowly progressive periodontitis.
- Occur as a result of extension of inflammation
from the gingiva into deeper periodontal tissue.
2
3. Common Characteristics
Onset - any age; most common in adults
Plaque initiates condition
Subgingival calculus common finding
Slow-mod progression; periods of rapid
progression possible
Modified by local factors/systemic
factors/stress/smoking
3
4. Extent & Severity
Extent:
Localized: <30% of sites affected
Generalized: > 30% of sites affected
Severity: entire dentition or individual
teeth/site
Slight = 1-2 mm CAL
Moderate = 3-4 mm CAL
Severe = 5 mm CAL
4
5. Clinical Characteristics
Gingiva moderately
swollen
Deep red to bluish-
red tissues
Blunted and rolled
gingival margin
Cratered papilla
Bleeding and/or
suppuration
5
7. CLASSIFICATION
7
A) Based on Disease Distribution:
Localized:
Periodontitis is considered localized when <30% of
the sites assessed in mouth demonstrate attachment
loss and bone loss.
Generalized:
Periodontitis is considered generalized when >30% of
the sites assessed demonstrate attachment loss and
bone loss.
The pattern of bone loss in chronic periodontitis can
be vertical or horizontal.
8. Sub classification of Chronic
Periodontitis
Severity Pocket
Depths
CAL Bone
Loss
Furcation
Early 4-5 mm 1-2 mm Slight
horizontal
Moderate 5-7 mm 3-4 mm Sl – mod
horizontal
Advanced > 7 mm 5 mm Mod-
severe
horizontal
vertical
8
9. DISEASE DISTRIBUTION : It is a site-specific disease
CLINICAL SIGNS -
- Inflammation ,pocket formation ,attacment loss ,bone loss
- All caused by site specific effects of a sub-gingival plaque
accumulation
-That is why the effect are on one side only –other surface
may maintain normal attachment level.
- Eg.-proximal surface with plaque may have C.A.L.
- And plaque free surface –FACIALsurface of same tooth
may be without disease.
10. SYMPTOMS
Patient notices--
1. gum bleed
2. space appear between teeth due to tooth movement
3. May be painless (sleeping disease )goes unnoticed
4. Some time pain due to caries , root hypersensitivity
5. To cold /hot or both
6. PAIN-may be-- dull—deep radiating in the jaw
7. Area of food impaction can cause more discomfort
8. May be gingival tenderness or itchiness found
11. Periodontal Pathogens
• Gram negative organism dominate
• P.g., P.i., A.a. may infiltrate:
• - Intercellular spaces of the epithelium
• - Between deeper epithelial cells
• - Basement lamina
11
13. Pathogenesis – Pocket
Formation
Bacterial challenge
initiates initial lesion
of gingivitis
With disease
progression &
change in
microorganisms
development of
periodontitis
13
14. Pocket Formation
Cellular & fluid inflammatory exudate
degenerates CT
Gingival fibers destroyed
Collagen fibers apical to JE destroyed
infiltration of inflammatory cells & edema
Apical migration of junctional epithelium
along root
Coronal portion of JE detaches
14
15. Pocket Formation
Continued extension
of JE requires
healthy epithelial
cells!
Necrotic JE slows
down pocket
formation
Pocket base
degeneration less
severe than lateral
15
16. Pocket Formation
Continue inflammation:
Coronal extension of gingival margin
JE migrates apically & separates from root
Lateral pocket wall proliferates & extends into CT
Leukocytes & edema
Infiltrate lining epithelium
Varying degrees of degeneration & necrosis
16
19. Classification of Pockets
Gingival:
Coronal migration of gingival margin
Periodontal:
Apical migration of epithelial attachment
Suprabony:
Base of pocket coronal to height of alveolar crest
Infrabony:
Base of pocket apical to height of alveolar crest
Characterized by angular bony defects
19
20. Histopathology
ConnectiveTissue:
Edematous
Dense infiltrate:
Plasma cells (80%)
Lymphocytes, PMNs
Blood vessels proliferate, dilate & are engorged.
Varying degrees of degeneration in addition to newly
formed capillaries, fibroblasts, collagen fibers in some
areas.
20
21. Histopathology
Periodontal pocket:
Lateral wall shows most severe degeneration
Epithelial proliferation & degeneration
Rete pegs protrude deep within CT
Dense infiltrate of leukocytes & fluid found in rete
pegs & epithelium
Degeneration & necrosis of epithelium leads to
ulceration of lateral wall, exposure of CT,
suppuration
21
27. Root Surface Wall Contn…
Necrotic areas of cementum form; clinically
soft
Act as reservoir for bacteria
Root planing may remove necrotic areas
firmer surface
27
28. Inflammatory Pathway
Stages I-III – inflammation degrades gingival
fibers
Spreads via blood vessels:
Interproximal:
Loose CT transseptal fibers marrow spaces
of cancellous bone periodontal ligament
suprabony pockets & horizontal bone loss
transseptal fibers transverse horizontally
28
29. Inflammatory Pathway
Interproximal:
Loose CT periodontal ligament bone
infrabony pockets & vertical bone loss
transseptal fibers transverse in oblique direction
29
30. Inflammatory Pathway
Facial & Lingual:
Loose CT along periosteum marrow spaces
of cancellous bone supporting bone destroyed
first alvoelar bone proper periodontal
ligament suprabony pocket & horizontal bone
loss
30
31. Inflammatory Pathway
Facial & Lingual:
Loose CT periodontal ligament destruction
of periodontal ligament fibers infrabony pockets
& vertical or angular bone loss
31
32. Periodontal Disease Activity
Bursts of activity followed by periods of
quiescence characterized by:
Reduced inflammatory response
Little to no bone loss & CT loss
Accumulation of Gram negative organisms leads
to:
Bone & attachment loss
Bleeding, exudates
May last days, weeks, months
32
33. Periodontal Disease Activity
Period of activity followed by period of
remission:
Accumulation of Gram positive bacteria
Condition somewhat stabilized
Periodontal destruction is site specific
PD affects few teeth at one time, or some
surfaces of given teeth
33
34. Prevalence:
Chronic Periodontitis increases in prevalence &
severity with age.
Affect both the sexes equally.
It is an age-associated, not age related
disease.
35. RISK FACTORS FOR DISEASE:
1) PRIOR HISTORY OF PERIODONTITIS—predictor-more risk for developing
damage to periodontium.
2) LOCAL FACTORS:
Plaque Accumulation
Oral Hygiene
Tooth Malposition
Restoration
Preserve & Quantity of certain bacteria
Host defences
Subgingival Restoration
Environment
Calculus, smoking
ConnectiveTissue destruction
Genetic influence
Inflammation
Periodontopathic bacteria
Smoking, Calculus
Loss of Attachment
M
O
D
I
F
Y
I
N
G
F
A
C
T
O
R
S
36. 3) SYSTEMIC FACTORS:
Type II or Non – Insulin dependent Diabetes Mellitus (NIIDDM)
4) ENVIRONMENTAL & BEHAVIORAL FACTORS:
Smoking
Emotional Stress
5) GENETIC FACTORS:
Frequent among family members and across different generations.
GENERAL CONCEPT FOR ETIOLOGY OF CHRONIC PERIODONTITIS
Plaque accumulation
Maturation of Plaque
Quality & Quantity of periodontopathic Plaque
accumulation
Maturation of Plaque
Quality & Quantity of periodontopathic bacteria
InflammationPlaque accumulation
Maturation of Plaque
Quality & Quantity of periodontopathic bacteria
Inflammation
Connective tissue destruction.
Connective tissue destruction.
bacteria
Inflammation
Connective tissue destruction.
Host
status and
defences
Plaque accumulation
Maturation of Plaque
Quality & Quantity of
periodontopathic bacteria
Inflammation
37. MANAGEMENT
The treatment consists of –
1. Non-surgical procedures
Scaling
Root planing
Curettage
2. Surgical procedure
Pocket reduction surgery
Resective
Regenerative
Correction of morphological / anatomic defects
38. Overall Prognosis
Dependent on:
Client compliance
Systemic involvement
Severity of condition
# of remaining teeth
38
39. Prognosis of Individual
Teeth
Dependent on:
Attachment levels, bone height
Status of adjacent teeth
Type of pockets: suprabony, infrabony
Furcation involvement
Root resorption
39