5. function of the periodontium
1. is to attach the tooth to the bone tissues of the jaws
2. to maintain integrity of the surface of the masticatory mucosa of
the oral cavity
6. Healthy periodontium
Healthy gingiva:
1. Fits snugly around the teeth, filling each inter proximal space
between the contact area
2. Color : Coral pink
3. Consistency: Firm
4. Stippling (orange peel appearance)
7.
8. Periodontal ligament
is made up of
1. Collagen fibers
2. Oxytalan fibers
3. Fibroblasts
4. Amorphous ground substance & interstitial tissue
5. Cementoblasts
6. Osteoblasts
7. Osteoclasts
8. Epithelial rests of Malassez
9. Thin walled blood vessels
10. Lymphatic vessels
11. Sensory nerves
9. Deposits on teeth
Organic coverings of tooth enamel are divided in to 2 types
1. Anatomic structures (Nasmyths membrane)
2. Acquired pellicle
10. Nasmyths membrane (enamel cuticle)
• Anatomical covering formed during the developmental and eruptive
stages of teeth
• Remnants of this membrane persists throughout the life
11. Pellicle
1. Thin deposit on the exposed surface of the teeth
2. Shortly formed after eruption
3. Usually invisible
4. Fully formed in 30 mins and reaches its mature thickness of 0.1 –
0.8 microns within 24 hrs
5. Free of bacteria and covers the tooth surface
6. Its of salivary origin composed of mucoproteins or glycoproteins
12. CLASSIFICATION OF PERIODONTALDISEASE
1. Gingival diseases
2. Chronic periodontitis
3. Aggressive periodontitis
4. Periodontitis as a manifestation of systemic disease
14. Signs of gingival disease
1. Chronic gingivitis in which the intradental papillae are edematous
and blunted.
2. There is some loss of gingival tissue.
3. The gums bleed with brushing.
15. Gingivitis
Gingivitis is the inflammation of the gingiva (gums).
Gingivitis alone does not affect the underlying supporting structures of
the teeth and is reversible
16.
17. Gingival Diseases
1. Gingivitis is inflammation of the gingival tissue.
2. Gingivitis is characterized by areas of redness and
swelling, and there is a tendency for the gingiva to
bleed easily.
3. Gingivitis is limited to the epithelium and gingival
connective tissues.
4. It is important to note that there is no tissue
recession or loss of connective tissue or bone.
19. Other Types of Gingivitis
Other types of gingivitis are associated with:
1. Puberty
2. Pregnancy
3. Use of birth control medications
20. Gingivitis
Gingivitis is painless and often unrecognized until a
dental professional emphasizes its importance.
Improved daily oral hygiene practices will reverse
gingivitis.
31. necrotizing ulcerative gingivitis
• Specific type of gingivitis with characteristic signs and symptoms
• Disease manifests as both acute and recurrent (subacute) phases
36. Epidemiology
Not a contagious infection
Occur at any age, but is more common among young and middle- aged
adults
In developing countries, it is seen almost exclusively in children,
related to poverty and malnutrition
39. Necrotizing ulcerative gingivitis
Etiology
• Number of factors disturb the host-parasite relationship, facilitating
overgrowth of the organisms of the fuso- spirochaetal complex
• Increase in IgG and IgM antibody titers to spirochetes and increased
IgG titers to Bacteroides melaninogenicus
45. Necrotizing ulcerative
Predisposing Factors
1. Highest incidence occurring between October and February
respiratory infections and exanthemas are at their peak
2. Lowest incidence occurring in July and August
46. Clinical features - necrotizing ulcerative
Painful, hyperemic gingiva and sharply punched-out crater like erosions
of the interdental papillae of sudden onset
47. Clinical features - necrotizing ulcerative
Ulcerated remnants of the papillae and the free gingiva bleed when
touched
48. Clinical features - necrotizing ulcerative
Become covered by a grayish green, necrotic pseudomembrane
49. Clinical features - necrotizing ulcerative
Ulceration tends to spread and may eventually involve all gingival
margins
50. Clinical features - necrotizing ulcerative
• It begins rather commonly at a single isolated focus, with a rapid
onset
51. Clinical features - necrotizing ulcerative
• A fetid odor ultimately develops that is extremely unpleasant.
Halitosis
52. Clinical features - necrotizing ulcerative
• The patient almost always complains of an inability to eat because of
the severe gingival pain and the tendency for gingival bleeding
53. Clinical features - necrotizing ulcerative
The patient usually suffers from headache, malaise, and a low-grade
fever
54. Clinical features - necrotizing ulcerative
• Excessive salivation with the presence of a metallic taste to the saliva
is often noted
55. Clinical features - necrotizing ulcerative
Regional lymphadenopathy is usually present.
56. Clinical features - necrotizing ulcerative
In advanced and more serious cases, there may be generalized or
systemic manifestations
1. Leukocytosis
2. gastrointestinal disturbances
3. Tachycardia.
57. Clinical features - necrotizing ulcerative
After the NUG is cured, the crests of the interdental papillae, which
have been destroyed leaving a hollowed-out area
Constitute an area which retains debris and microorganisms –Serve as
an ‘incubation zone.’
58. Diagnosis
1. Smear studies - nonspecific findings
2. Although the presence of the disease can often be confirmed when
vast numbers of the spirochete and fusiform bacteria are seen
3. It may be also present in ‘normal mouths,’ acute herpetic
gingivostomatitis, simple pericoronitis, marginal gingivitis and
chronic gingivitis
4. Final diagnosis is made clinically
59. Treatment
1. Superficial cleansing in the early acute stage with –Chlorhexidine –
Diluted hydrogen peroxide –or Warm Salt water
2. This is followed by thorough scaling and polishing
3. Topical anesthetics may be required to reduce the pain during this
procedure
4. Recontouring of gingival papillae is usually required –proper use of
round toothpicks –or gingivoplasty
60. Prognosis
1. Treatment cannot be considered complete until the gingival tissue
contours almost normal.
2. High recurrence rate
3. Occasional serious sequelae such as gangrenous stomatitis or
noma, septicemia and toxemia
4. Even death have also been reported following this disease
66. Periodontitis
usually develops when gingivitis, usually with abundant plaque and
calculus beneath the gingival margin, has not been adequately treated.
67. Periodontitis (periodontal disease)
• is a chronic inflammatory disease, which includes gingivitis along with
loss of connective tissue and bone support for the teeth.
• It damages alveolar bone (the bone of the jaw in which the roots of
the teeth are connected) and the periodontal ligaments that hold the
roots in place.
It is a major cause of tooth loss in adults
68.
69.
70. Introduction
• Periodontal disease is an infectious disease process that involves
inflammation. Periodontal diseases involve the structures of the
periodontium.
• Periodontal disease can cause a breakdown of the periodontium
resulting in loss of tissue attachment and destruction of the alveolar
bone.
71. Prevalence of Periodontal Disease
• Periodontal diseases are the leading cause of tooth loss in
adults.
• Almost all adults and many children have calculus on their
teeth.
• Fortunately, with the early detection and treatment of
periodontal disease, most people can keep their teeth for
life.
72. Systemic Conditions:
Links to Periodontal Disease
Certain systemic conditions increase the patient’s susceptibility to
periodontal disease, and periodontal disease may actually increase
a patient’s susceptibility to certain systemic conditions.
1. Cardiovascular disease
2. Preterm low birthweight
3. Respiratory disease
73. Causes of Periodontal Diseases
Dental plaque is the major factor in causing periodontal
disease.
74. Causes of Periodontal Diseases
Dental calculus provides a surface for plaque to attach.
1. Subgingival calculus
2. Supragingival calculus
78. Types of Periodontal Diseases
• Periodontal disease is an inclusive term describing any disease of the
periodontium.
• Gingival diseases and periodontitis are the two basic forms of
periodontal disease, and each has a variety of forms.
79. Periodontitis
• Periodontitis means inflammation of the supporting
tissues of the teeth.
• Periodontitis is the extension of the inflammatory
process from the gingiva into
the connective tissue and alveolar bone that supports
the teeth.
• The progression of periodontitis involves the destruction
of connective tissue attachment at the most apical
portion of a periodontal pocket.
96. fenestration
a fenestration is a buccal or lingual window defect of either denuded
bone or soft tissue occurring over a tooth root, implant, or alveolar
ridge.
104. Signs and Symptoms of Periodontal Disease
1. Red, swollen, or tender gingiva
2. Bleeding gingiva while brushing or flossing
3. Loose or separating teeth
4. Pain or pressure when chewing
5. Pus around the teeth or gingiva
110. Radiographic signs
The following characteristic are indicative of periodontal tissue change.
1. The crest of interdental bone will be 2 mm or more apical to the
CEJ; this is very important to determine if there is bone loss.
2. The crest of alveolar bone will appear fuzzy in appearance.
3. Lamina dura will be ill-defined
4. Density of interdental bone will be decreased .
5. Furcation areas of molar areas will be involved, and you will find
radiolucency in that area.
125. ISOLATED REACTIVE LESIONS OF THE GINGIVA
ISOLATED REACTIVE LESIONS OF THE GINGIVA
1. Fibrous epulis/peripheral fibroma
2. Angiogranuloma/pyogenic granuloma
3. Peripheral giant cell lesion/granuloma.
126. Fibrous epulis/peripheral fibroma
lesion frequently represents as firm, pink, un-inflammed mass, and it
seems to grow from below the free gingival margin/interdental papilla
Most often the lesion is painless.
129. the fibroma may show additional focus of calcification
1. Peripheral calcifying fibroma), foci of cementicles - peripheral
cementifying fibroma
2. Trabeculae of bone - peripheral ossifying fibroma,
132. Angiogranuloma/pyogenic granuloma
• The mass may penetrate interdentally and present as bilobular
(buccal and lingual) mass connected through the col area, but bone
erosion in uncommon
137. Peripheral giant cell granuloma
• They occur particularly in anterior region in young patients or in
posterior mouth during mixed dentition phase and in adults.
• They are very aggressive lesions with significant growth potential.
138. Peripheral giant cell granuloma
• The high vascularity of these lesions can be understood by their
purplish-red color and tendency to bleed.
• They also tend to penetrate interdentally and erosion of adjacent
bone along with separation of adjacent teeth is a common occurrence
140. Neoplastic
Benign masses could be;
1. Fibroma
2. Peripheral Giant Cell Granuloma
3. Central Giant Cell Granuloma
4. Papilloma
5. Leukoplakia
6. Nevus
7. Myoblastoma
8. Hemangioma
9. Neurilemoma
10. Neurofibroma
11. Ameloblastoma
Malignant tumors could be squamous cell carcinoma or melanoma. Among sarcomas, Kaposi’s sarcoma[12] is more common, and
fibrosacroma, lymphosarcoma and reticulum cell sarcoma are rarely reported[13]. Other rare lesions (< 2% prevalence) include
angioma, osteofibroma, myxoma, fibropapilloma, adenoma and lipoma[
141. Neoplastic
Malignant tumors could be;
1. squamous cell carcinoma or melanoma
2. Among sarcomas, Kaposi’s sarcoma is more common
3. fibrosacroma
4. lymphosarcoma
5. reticulum cell sarcoma
158. These pseudo-enlargements
False enlargement: appears as a result of increase in size of underlying;
1. osseous (tori, exostosis, Paget’s disease, cherubism, osteoma)
2. dental tissues (during tooth eruption).
167. Summary
There is loss of alveolar bone, formation of deep gum pockets, and
eventually loosening of teeth.
168.
169.
170.
171.
172.
173. Periodontitis (pyorrhea) is a chronic inflammatory disease of the gums
resulting from an opportunistic infection of endogenous plaque biofilm.
Which of the following typically precedes periodontitis?
a) viral URI
b) Gingivitis
c) Candidiasis
d) Root infection
174. Periodontitis (pyorrhea) is a chronic inflammatory disease of the gums
resulting from an opportunistic infection of endogenous plaque biofilm.
Which of the following typically precedes periodontitis?
a) viral URI
b) Gingivitis
c) Candidiasis
d) Root infection
175. Aggressive periodontitis is characterized by rapid progression of alveolar
bone loss and even tooth loss. Which of the following statements about
aggressive periodontitis is FALSE?
a) It usually occurs in children.
b) Extent of destruction is usually disproportionate to the extent of
plaque or calculus.
c) It is the most common type of peridontitis.
d) It runs in families.
176. Aggressive periodontitis is characterized by rapid progression of alveolar
bone loss and even tooth loss. Which of the following statements about
aggressive periodontitis is FALSE?
a) It usually occurs in children.
b) Extent of destruction is usually disproportionate to the extent of
plaque or calculus.
c) It is the most common type of peridontitis.
d) It runs in families.
177. In patients with HIV infection and periodontitis, presentation is
clinically similar to which of the following?
a) Chronic periodontitis
b) Vitamin C deficiency
c) Acute necrotizing ulcerative gingivitis
d) Periodontitis as a manifestation of systemic disease
178. In patients with HIV infection and periodontitis, presentation is
clinically similar to which of the following?
a) Chronic periodontitis
b) Vitamin C deficiency
c) Acute necrotizing ulcerative gingivitis
d) Periodontitis as a manifestation of systemic disease
179. Which of the following is the most common cause
of gingivitis?
a) Malocclusion
b) Poor oral hygiene
c) Food impaction
d) Xerostomia
180. Which of the following is the most common cause
of gingivitis?
a) Malocclusion
b) Poor oral hygiene
c) Food impaction
d) Xerostomia
181. The diagnosis of gingivitis is confirmed by which of
the following?
a) Petechiae throughout the mouth
b) Erythematous, friable tissue at the gum line
c) Gum pain when food is chewed
d) Culture of the affected gum area that identifies typical pathogens
182. The diagnosis of gingivitis is confirmed by which of
the following?
a) Petechiae throughout the mouth
b) Erythematous, friable tissue at the gum line
c) Gum pain when food is chewed
d) Culture of the affected gum area that identifies typical pathogens
