This document summarizes various gingival and periodontal diseases. It describes diseases caused by dental plaque, such as gingivitis, and modified by factors like medications, malnutrition, and systemic diseases. It also discusses periodontitis and other conditions like necrotizing gingivitis/periodontitis, endo-perio lesions, and developmental deformities that can affect the gingiva and periodontium. Diagnostic methods and typical treatments are mentioned for several conditions.
Splinting is one of the oldest forms of aids to periodontal therapy. By redistribution of forces on the affected teeth the splint minimizes the effects caused by loss of support. Splinting teeth to each other allows weakened teeth to be supported by neighbouring teeth. This presentation reviews the rationale, techniques, advantages and ill effects of stabilization of teeth by splinting as an aid to periodontal therapy. With the acceptance and clinical predictability of adhesive procedures, the use of conservative bonding techniques to splint teeth offers a useful alternative to more invasive restorative procedures. Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient’s comfort. Splints are used to overcome all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics.
Splinting is one of the oldest forms of aids to periodontal therapy. By redistribution of forces on the affected teeth the splint minimizes the effects caused by loss of support. Splinting teeth to each other allows weakened teeth to be supported by neighbouring teeth. This presentation reviews the rationale, techniques, advantages and ill effects of stabilization of teeth by splinting as an aid to periodontal therapy. With the acceptance and clinical predictability of adhesive procedures, the use of conservative bonding techniques to splint teeth offers a useful alternative to more invasive restorative procedures. Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient’s comfort. Splints are used to overcome all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics.
Necrotising periodontal diseases, Necrotising periodontal diseases as a manifestation of systemic diseases.
By Dr. Ritam Kundu, MDS PGT, Dr. R. Ahmed Dental College & Hospital, Kolkata, India.
Described here are the clinical features of gingiva, the various stages of gingivitis and the clinical features associated with them. The microscopic features have been described on a different slide presentation.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
Necrotising periodontal diseases, Necrotising periodontal diseases as a manifestation of systemic diseases.
By Dr. Ritam Kundu, MDS PGT, Dr. R. Ahmed Dental College & Hospital, Kolkata, India.
Described here are the clinical features of gingiva, the various stages of gingivitis and the clinical features associated with them. The microscopic features have been described on a different slide presentation.
INTRODUCTION
DEFINITION
TYPES OF TRAUMA FROM OCCLUSION
GLICKMAN CONCEPT
WAERHAUG CONCEPT
STAGES OF TISSUE RESPONSE TO INJURY
CLINICAL AND RADIOGRAPHIC FEATURES OF TFO
CLINICAL DIAGNOSIS OF TFO
TFO AND IMPLANTS
TREATMENT OF TFO
CONCLUSION
REFRENCES
Periodontal instruments are designed for speciic purposes, such as
calculus removal, bioilm removal, and root planing. On irst investigation,
the variety of instruments available for similar purposes appears
confusing. With experience, however, clinicians select a relatively
small set that fulills all requirements.
Classification of Periodontal Instruments
Periodontal instruments are classiied according to the purposes they
serve, as follows:
1. Periodontal probes are used to locate, measure, and mark pockets,
as well as determine their course on individual tooth surfaces.
2. Explorers are used to locate calculus deposits and caries.
3. Scaling, root-planing, and curettage instruments are used for
removal of bioilm and calciied deposits from the crown and
root of a tooth, removal of altered cementum from the subgingival
root surface, and debridement of the soft tissue lining the poc ket.
Scaling and curettage instruments are classiied as follows:
• Sickle scalers are heavy instruments used to remove supragingival
calculus.
• Curettes are ine instruments used for subgingival scaling,
root planing, and removal of the soft tissue lining the pocket.
• Hoe, chisel, and ile scalers are used to remove tenacious
subgingival calculus and altered cementumT. heir use is limited
compared with that of curettes.
• Implant instruments are plastic or titanium scalers and curettes
designed for use on implants and implant restorations.
• Ultrasonic and sonic instruments are used for scaling and
cleansing tooth surfaces and curetting the soft tissue wall of
the periodontal pocket.42,43,66
4. Periodontal endoscopes are used for deep visualization into
subgingival pockets and furcations, thereby alloinwg the detectio n
of deposits.
5. Cleansing and polishing instruments, such as rubber cups, brushes,
and dental tape, are used to clean and polish tooth surfaces.
Air-powder abrasive systems are also available for supragingival
and subgingival cleaning and polishing of tooth, root, and implant
surfaces.
The wearing and cutting qualities of some types of steel used in
periodontal instruments have been tested,88,89,157 but speciications
vary among manufacturers.157 Stainless steel is used most often in
instrument manufacture. High–carbon content steel instruments are
available and are considered by some clinicians to be superior. Newer
advanced proprietary manufacturing processes for heat treating and
cryogenically tempering stainless steel are producing blades that ar e
sharper and longer lasting than ever before. In addition, ohter processes
produce stainless steel instruments with titanium nitride or other
surface coatings that are not embedded or diffused into the base
material. Their cutting edges are sharp when new, but these coatings
wear down during normal use and cannot be resharpened. Each
group of instruments has characteristic features; individual therapist s
often develop variations with which they operate most effectivelyuuw
Periodontal instruments are designed for speciic purposes, such as
calculus removal, bioilm removal, and root planing. On irst investigation,
the variety of instruments available for similar purposes appears
confusing. With experience, however, clinicians select a relatively
small set that fulills all requirements.
Classification of Periodontal Instruments
Periodontal instruments are classiied according to the purposes they
serve, as follows:
1. Periodontal probes are used to locate, measure, and mark pockets,
as well as determine their course on individual tooth surfaces.
2. Explorers are used to locate calculus deposits and caries.
3. Scaling, root-planing, and curettage instruments are used for
removal of bioilm and calciied deposits from the crown and
root of a tooth, removal of altered cementum from the subgingival
root surface, and debridement of the soft tissue lining the poc ket.
Scaling and curettage instruments are classiied as follows:
• Sickle scalers are heavy instruments used to remove supragingival
calculus.
• Curettes are ine instruments used for subgingival scaling,
root planing, and removal of the soft tissue lining the pocket.
• Hoe, chisel, and ile scalers are used to remove tenacious
subgingival calculus and altered cementumT. heir use is limited
compared with that of curettes.
• Implant instruments are plastic or titanium scalers and curettes
designed for use on implants and implant restorations.
• Ultrasonic and sonic instruments are used for scaling and
cleansing tooth surfaces and curetting the soft tissue wall of
the periodontal pocket.42,43,66
4. Periodontal endoscopes are used for deep visualization into
subgingival pockets and furcations, thereby alloinwg the detectio n
of deposits.
5. Cleansing and polishing instruments, such as rubber cups, brushes,
and dental tape, are used to clean and polish tooth surfaces.
Air-powder abrasive systems are also available for supragingival
and subgingival cleaning and polishing of tooth, root, and implant
surfaces.
The wearing and cutting qualities of some types of steel used in
periodontal instruments have been tested,88,89,157 but speciications
vary among manufacturers.157 Stainless steel is used most often in
instrument manufacture. High–carbon content steel instruments are
available and are considered by some clinicians to be superior. Newer
advanced proprietary manufacturing processes for heat treating and
cryogenically tempering stainless steel are producing blades that ar e
sharper and longer lasting than ever before. In addition, ohter processes
produce stainless steel instruments with titanium nitride or other
surface coatings that are not embedded or diffused into the base
material. Their cutting edges are sharp when new, but these coatings
wear down during normal use and cannot be resharpened. Each
group of instruments has characteristic features; individual therapist s
often develop variations with which they operate most effectively
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.
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Classification of disseases
1.
2. GINGIVAL DISEASES
Dental Plaque-Induced Gingival Diseases
Gingivitis that is associated with dental plaque formation' is
the most common form of gingival disease characterized by
the presence of clinical signs of inflammation that are
confined to the gingiva and associated with teeth showing no
attachment loss
3. Gingivitis associated with Dental Plaque Only:
is the result of an interaction between the microorganisms
found in the dental plaque biofilm and the tissues and
inflammatory cells of the host.
The plaque-host interaction can
be altered by the effects of
*Local factors
*Systemic Factors
*Medications
*Malnutrition
7. Gingival Diseases Modified by Malnutrition
bright red, swollen, and bleeding
gingiva associated with severe
ascorbic acid (vitamin C)
deficiency or scurvy.
Nutritional deficiencies are
known to affect immune function
and may have an impact on the
host's ability to protect itself
against some of the detrimental
effects of cellular products such
as oxygen radicals.
9. Gingival Diseases of Specific Bacterial Origin:
Streptococcal gingivitis or
gingivostomatitis is a rare
condition that may present as an
acute condition with fever,
malaise, and pain associated with
acutely inflamed, diffuse, red, and
swollen gingiva with increased
bleeding and occasional gingival
abscess formation.
preceded by tonsillitis and have been associated with group
A hemolytic streptococcal infections.
10. Gingival Diseases of Viral Origin:
the most common being the herpes
viruses-Primary herpetic
gingivostomatitis Clinically appear
as: Multiple tiny vesicles that
progress to form painful ulcers.
Painful erythematous swollen
gingival. Fever, malaise, cervical
lymphadenopathy.
11. Gingival Diseases of Fungal Origin:
under prosthetic devices
in individuals using topical steroids
in individuals with decreased salivary flow
increased salivary glucose
decreased salivary pH.
12. A generalized candidal infection may manifest as white patches on
the gingiva, tongue or oral mucous membrane that can be
removed with gauze, leaving a red, bleeding surface.
In HIV-infected individuals,
candidal infection may present
as erythema of the attached
gingiva and has been referred
to as linear gingival erythema
or HIV-associated gingivitis
Diagnosis of candidal infection can be made by culture, smear.
13. Gingival Diseases of Genetic Origin:
hereditary gingival fibromatosis
that exhibits autosomal
dominant or (rarely) autosomal
recessive modes of inheritance.
The gingival enlargement may
completely cover the teeth,
delay eruption, and present as
an isolated finding or be
associated with several more
generalized syndromes.
14. Traumatic Lesions:
factitial iatrogenic accidental
as in the case of as in the case of as in the case of
tooth brush trauma preventive or damage to the
resulting in gingival restorative care gingiva through
ulceration, that may lead to minor burns from hot
recession both; traumatic injury foods and drinks.
of the gingiva
15. Foreign Body Reactions:
Foreign body reactions' lead to localized inflammatory
conditions of the gingiva and are caused by the introduction of
foreign material into the gingival connective tissues through
breaks in the epithelium. Common examples are the
introduction of amalgam into the gingiva during the placement
of a restoration or extraction of a tooth, leaving an amalgam
tattoo, or the introduction of abrasives during polishing
procedures.
16. PERIODONTITIS
Periodontitis is defined as "an inflammatory disease of the
supporting tissues of the teeth caused by specific
microorganisms or groups of specific microorganisms,
resulting in progressive destruction of the periodontal
ligament and alveolar bone with pocket formation, recession,
or both." The clinical feature that distinguishes periodontitis
from gingivitis is the presence of clinically detectable
attachment loss.
17. Chronic Periodontitis
Chronic periodontitis is the most common form of periodontitis
Chronic periodontitis is most prevalent in adults but can be
observed in children therefore the age range of >35 years
previously designated for the classification of this disease has
been discarded. Chronic periodontitis is associated with the
accumulation of plaque and calculus and generally has a slow to
moderate rate of disease progression
18. Local factors may influence plaque accumulation systemic diseases
such as diabetes mellitus and HIV infection may influence the host
defenses; environmental factors such as cigarette smoking and stress
also may influence the response of the host to plaque accumulation
Chronic periodontitis may occur as a
localized disease wherein <30% of
evaluated sites demonstrate
attachment and bone loss, or as a
more generalized disease wherein
>30% of sites are affected. The disease
also may be described by the severity
of disease as slight, moderate, or
severe based on the amount of clinical
attachment loss.
19. Aggressive Periodontitis
Aggressive periodontitis differs from the chronic form primarily
by the rapid rate of disease progression seen in an otherwise
healthy individual, an absence of large accumulations of plaque
and calculus, and a family history of aggressive disease
suggestive of a genetic trait.
early onset periodontitis
usually affect young individuals at
or after puberty and may be
observed during the second and
third decade of life (i.e., 10 to 30
years of age). The disease may be
localized (LJP) or generalized
(GJP)
20. NECROTIZING PERIODONTAL DISEASES
Necrotizing Ulcerative Gingivitis
Clinical features of necrotizing periodontal disease may
include necrosis and/or punched out ulceration of the
interdental papillae ("punched-out papillae") or gingival
margin, pseudomembranous formation painful, bright red
marginal gingiva that bleed upon gentle manipulation,
halitosis
21. Treatment
*irrigation
*and debridement of necrotic areas
oral hygiene instruction and the •
uses of mouth rinses
* pain medication. •
* As these diseases are often •
associated with systemic medical
issues, proper management of
the systemic disorders is
appropriate
22. Necrotizing Ulcerative Periodontitis
NUP" differs from NUG in that loss of clinical attachment and
alveolar bone is a consistent feature.
Several case reports have
described extensive destruction
leading to exfoliation of teeth
within 3-6 months of onset, with
sequestration of necrotic alveolar
bone and necrotic involvement of
the adjacent mandible and
maxilla. Patients may present
with concomitant malnutrition
resulting from inability to take
food by mouth.
23. Treatment
*Removal of plaque and debris from the site of
infection and inflammation
* Debridement of necrotic hard and soft tissues
*Chlorhexidine gluconate rinse (0.12%) twice daily after
brushing and flossing
*Antibiotic therapy Metronidazole is the drug of choice,
500 mg for 7-10 days.
24. PERIODONTITIS ASSOCIATED WITH ENDODONTIC
LESIONS
Endodontic-Periodontal Lesions
In endodontic-periodontal lesions, pulpal necrosis precedes
periodontal changes. A periapical lesion originating from
pulpal infection and necrosis may drain to the oral cavity
through the periodontal ligament, resulting in destruction of
the periodontal ligament and adjacen alveolar bone. This
may present clinically as a localized deep, periodontal pocket
extending to the apex of the tooth. Pulpal infection also may
drain through accessory canals, especially in the area of the
furcation, and may lead to furcal involvement through loss of
clinical attachment and alveolar bone.
25. Periodontal-Endodontic Lesions
In periodontal-endodontic lesions, bacterial infection from a
periodontal pocket associated with loss of attachment and root
exposure may spread through accessory canals to the pulp,
resulting in pulpal necrosis. In the case of advanced periodontal
disease, the infection may reach the pulp through the apical
foramen.
Scaling and root planing removes cementum and underlying
dentin and may lead to chronic pulpitis through bacterial
penetration of dentinal tubules.
26. Combined Lesions
Combined lesions occur when pulpal necrosis and a
periapical lesion occur on a tooth that also is periodontally
involved. A radiographically evident infrabony defect is seen
when infection of pulpal origin merges with infection of
periodontal origin
27. Diagnostic Methods
*Initially a detailed medical and dental history must be obtained
from the patient.
*The clinical examination should include inspection of the
gingival and mucosal tissues, palpation, mobility testing,
percussion
*Periodontal probing is essential to identify and determine the
depth of periodontal pockets and the degree of loss of
attachment.
*Pulp testing should be carried out with both carbon dioxide (dry
ice) and an electric pulp tester
*Radiographs are an essential tool to the diagnosis of any
endodontic or periodontal condition.
28. Treatment
periodontal disease
*scaling
*root planing
*oral hygiene instructions follow-up
maintenance therapy, including surgery in
some cases.
Diseased pulp tissue or infected root canals
*cleaning
* shaping
* medicating
* filling of the root canal system
29. DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND
CONDITIONS
Tooth Anatomic Factors
Anatomic factors such as
* cervical enamel projections and
enamel pearls have been associated with clinical attachment loss, especially in
furcation areas.
*Palatogingival grooves, found primarily on maxillary incisors
* Proximal root grooves on incisors and maxillary premolars
Cervical enamel
projection
Enamel pearl
30. Dental Restorations or Appliances
Dental restorations or appliances are frequently associated
with the development of gingival inflammation, especially
when they are located subgingivally. This may apply to
subgingivally placed onlays, crowns, fillings and orthodontic
bands.
31. Root Fractures
Root fractures caused by traumatic forces or restorative or
endodontic procedures may lead to periodontal involvement
Cervical Root Resorption and Cemental Tears
Cervical root resorption and
cemental tears may lead to
periodontal destruction when the
lesion communicates with the oral
cavity and allows bacteria to
migrate subgingivally