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Periodontal disease [autosaved]
- 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)
- 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
- 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