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08-May-09

Periodontal Diseases
PDS 372
Dr. Aim Al-Ansari

•
•
•
•
•

Understanding periodontal Diseases
Distribution of PD
Demographic Risk Factors in Periodontitis
Risk Factors in Periodontitis
Periodontitis and Systemic Diseases

Understanding Periodontal Diseases
• Gingivitis and periodontitis
– Gingivitis
• Inflammation of the gingiva in which the junctional
epithelium remains attached to the tooth at its original
level

– Periodontitis
• Inflammation of the periodontium characterized by the
clinical attachment loss (CAL)
– Loss of periodontal ligament and the bony support

1
08-May-09

Understanding Periodontal Diseases
• Gingivitis and periodontitis
– Not every gingivitis turns into periodontitis
– Teeth have supragingival plaque that serve as a
reservoir (storage)
– Strong infection overcomes the host defense
– Pathogenic organisms migrate subgingivally
creating a biofilm
– The inflammatory process starts and mediators
are realease

Understanding Periodontal Diseases
• Gingivitis and periodontitis
– The way the disease progresses after this is a
determined by the nature and extent of the host
response to the infection
– It is believed now that:
• 25% of periodontal disease is attributed to bacteria
• 50% to genetic variance
• 25% to tobacco

Understanding Periodontal Diseases
• Gingivitis and periodontitis
– Based on this periodontitis is believed to be of
two major types based on cause:
• Plaque and local factors type:
–
–
–
–

The most common
Pathogens dominate the host response
It happens in bursts (burst theory)
Usually site specific

• Compromised host type
– Less common
– Aggressive
– Less responsive to standard treatment

2
08-May-09

Distribution of Periodontal Diseases
• Geographic Distribution
– Over 70% of adults in different parts of the world
have some degree of gingivitis or periodontitis
– WHO:
• Gingivitis and calculus is more in low-income countries
• Periodontitis is not so much different between low- and
high-income countries

Distribution of Periodontal Diseases
• Prevalence of Gingivitis
– Gingivitis “may” be found in children but it is more
prevalent and severe in adolescence
– In U.S., 40% - 60% of school children have gingivitis

Distribution of Periodontal Diseases
• Prevalence of Periodontitis
– Prevalence of “generalized severe periodontitis” is
in the range of 5% - 15% in almost all populations,
regardless of “economic status”, “oral hygiene”, or
“availability of dental care.”

3
08-May-09

Distribution of Periodontal Diseases
• Incidence of Periodontitis
– Difficult and expensive
– A study of measuring CAL
• CAL in the first period of the study was positively related
to CAL in the second period at the “individual level”
rather than on the “site level”

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• Men > women
• No inherent differences
in susceptibility to
periodontitis

4
08-May-09

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• According to WHO
Global Oral Health Data
Bank… Periodontal
Disease is uniform
around the world
• Race and Ethnicity
cannot in themselves
be considered as
demographic risk
factors for Periodontitis

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• Generally, CAL is greater
among older than
among younger persons
• The prevalence and
severity of CAL in older
people is not due to
susceptibility but due to
cumulative progression
of the disease

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• When PD starts in
susceptible person, it
starts early in life
• Those who retain their
teeth into old age are
likely to be less
susceptible individuals

5
08-May-09

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• Gingivitis and poor OH
are clearly related to
SES.
• The relationship
between periodontitis
and SES is less direct

Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics

• It is clear that
periodontitis has a
genetic component
• Specific genotype of
polymorphic
interleukin-1 gene was
associated with severe
periodontitis
• The strength of the
association is not fully
determined

Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

• The clear causal
relationship between
gingivitis and OH
was established back
in 60s
• Periodontitis and OH
are not the same
because of the host
response issue

6
08-May-09

Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

• Overhangs
• Have minor role in
the etiology of
periodontitis

Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

• Nutritional adequacy
is important in the
treatment of any
disease
• No nutritional or
dietary factors have
been shown to be
directly related to the
prevalence or
intensity of
periodontitis

Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

• Smoking is a “clear”
risk factor for
periodontitis
• Higher prevalence of
periodontitis among
smokers
• Healing is slower
• Smokers have higher
prevalence of bacteria

7
08-May-09

Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

• Smoking reduces
vascularity of the area
• Smoking affects host
response

Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress

• Psychosocial stress
seems associated with
periodontitis
• More studies are
needed to fully
understand the
mechanism

Periodontitis and Systemic Conditions
• Diabetes Mellitus (DM)
– DM is a risk factor for periodontitis
– Periodontitis is inversely related to “metabolic
control” in diabetic patiens
– Periodontitis is a risk factor for more severe DM
patients because they have exaggerated host
response to bacterial burden
– Periodontitis more rapidly in patients with poorly
controlled DM

8
08-May-09

Periodontitis and Systemic Conditions
• Diabetes Mellitus (DM)
– Patients with type 2 DM have greater CAL, loss of
alveolar bone, and tooth loss
– They also have a 2-3 times higher risk of
developing destructive periodontitis
– The relationship between periodontitis and DM is
not a result of change in flora. Rather, it is due to
vascular changes, abnormal collagen synthesis,
and genetic predisposition

Periodontitis and Systemic Conditions
• Cardiovascular Disorders (CVD)
– Chronic inflammation anywhere in the body is
believed to have an effect on the heart function
– An association between periodontitis and CVD is
recognized but causality is yet to be established

Periodontitis and Systemic Conditions
• Osteoporosis
– Bone fragility characterized by low bone mass and
structural deterioration.
– It is common in old age, especially postmenopausal
women
– Alveolar bone loss is often seen with generalized
osteoporosis
– How much of alveolar bone loss is due to
osteoporosis rather than periodontitis?

9
08-May-09

Periodontitis and Systemic Conditions
• Pregnancy
– An association seems to exist between “maternal
Periodontitis” and the “risk” of delivering a
“preterm low-birth-weight” infant
– The relationship cannot be established as “causal”
– The association is strong enough to indicate that
periodontal care and treatment are important
during pregnancy

Periodontitis and Systemic Conditions
• HIV
– The relationship between periodontal diseases and
HIV is not yet fully understood.
– The results of the studies are not uniform and are
sometimes contradictory
– A systematic review might be the solution to
establishing the relationship

•
•
•
•
•

Understanding periodontal Diseases
Distribution of PD
Demographic Risk Factors in Periodontitis
Risk Factors in Periodontitis
Periodontitis and Systemic Diseases

10

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Periodontal Diseases

  • 1. 08-May-09 Periodontal Diseases PDS 372 Dr. Aim Al-Ansari • • • • • Understanding periodontal Diseases Distribution of PD Demographic Risk Factors in Periodontitis Risk Factors in Periodontitis Periodontitis and Systemic Diseases Understanding Periodontal Diseases • Gingivitis and periodontitis – Gingivitis • Inflammation of the gingiva in which the junctional epithelium remains attached to the tooth at its original level – Periodontitis • Inflammation of the periodontium characterized by the clinical attachment loss (CAL) – Loss of periodontal ligament and the bony support 1
  • 2. 08-May-09 Understanding Periodontal Diseases • Gingivitis and periodontitis – Not every gingivitis turns into periodontitis – Teeth have supragingival plaque that serve as a reservoir (storage) – Strong infection overcomes the host defense – Pathogenic organisms migrate subgingivally creating a biofilm – The inflammatory process starts and mediators are realease Understanding Periodontal Diseases • Gingivitis and periodontitis – The way the disease progresses after this is a determined by the nature and extent of the host response to the infection – It is believed now that: • 25% of periodontal disease is attributed to bacteria • 50% to genetic variance • 25% to tobacco Understanding Periodontal Diseases • Gingivitis and periodontitis – Based on this periodontitis is believed to be of two major types based on cause: • Plaque and local factors type: – – – – The most common Pathogens dominate the host response It happens in bursts (burst theory) Usually site specific • Compromised host type – Less common – Aggressive – Less responsive to standard treatment 2
  • 3. 08-May-09 Distribution of Periodontal Diseases • Geographic Distribution – Over 70% of adults in different parts of the world have some degree of gingivitis or periodontitis – WHO: • Gingivitis and calculus is more in low-income countries • Periodontitis is not so much different between low- and high-income countries Distribution of Periodontal Diseases • Prevalence of Gingivitis – Gingivitis “may” be found in children but it is more prevalent and severe in adolescence – In U.S., 40% - 60% of school children have gingivitis Distribution of Periodontal Diseases • Prevalence of Periodontitis – Prevalence of “generalized severe periodontitis” is in the range of 5% - 15% in almost all populations, regardless of “economic status”, “oral hygiene”, or “availability of dental care.” 3
  • 4. 08-May-09 Distribution of Periodontal Diseases • Incidence of Periodontitis – Difficult and expensive – A study of measuring CAL • CAL in the first period of the study was positively related to CAL in the second period at the “individual level” rather than on the “site level” Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Men > women • No inherent differences in susceptibility to periodontitis 4
  • 5. 08-May-09 Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • According to WHO Global Oral Health Data Bank… Periodontal Disease is uniform around the world • Race and Ethnicity cannot in themselves be considered as demographic risk factors for Periodontitis Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Generally, CAL is greater among older than among younger persons • The prevalence and severity of CAL in older people is not due to susceptibility but due to cumulative progression of the disease Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • When PD starts in susceptible person, it starts early in life • Those who retain their teeth into old age are likely to be less susceptible individuals 5
  • 6. 08-May-09 Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • Gingivitis and poor OH are clearly related to SES. • The relationship between periodontitis and SES is less direct Risk Factors and Periodontitis • Demographic – Gender – Race or Ethnicity – Age – SES – Genetics • It is clear that periodontitis has a genetic component • Specific genotype of polymorphic interleukin-1 gene was associated with severe periodontitis • The strength of the association is not fully determined Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • The clear causal relationship between gingivitis and OH was established back in 60s • Periodontitis and OH are not the same because of the host response issue 6
  • 7. 08-May-09 Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Overhangs • Have minor role in the etiology of periodontitis Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Nutritional adequacy is important in the treatment of any disease • No nutritional or dietary factors have been shown to be directly related to the prevalence or intensity of periodontitis Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Smoking is a “clear” risk factor for periodontitis • Higher prevalence of periodontitis among smokers • Healing is slower • Smokers have higher prevalence of bacteria 7
  • 8. 08-May-09 Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Smoking reduces vascularity of the area • Smoking affects host response Risk Factors and Periodontitis • Health – Oral Hygiene – Local factors – Nutrition – Tobacco use – Stress • Psychosocial stress seems associated with periodontitis • More studies are needed to fully understand the mechanism Periodontitis and Systemic Conditions • Diabetes Mellitus (DM) – DM is a risk factor for periodontitis – Periodontitis is inversely related to “metabolic control” in diabetic patiens – Periodontitis is a risk factor for more severe DM patients because they have exaggerated host response to bacterial burden – Periodontitis more rapidly in patients with poorly controlled DM 8
  • 9. 08-May-09 Periodontitis and Systemic Conditions • Diabetes Mellitus (DM) – Patients with type 2 DM have greater CAL, loss of alveolar bone, and tooth loss – They also have a 2-3 times higher risk of developing destructive periodontitis – The relationship between periodontitis and DM is not a result of change in flora. Rather, it is due to vascular changes, abnormal collagen synthesis, and genetic predisposition Periodontitis and Systemic Conditions • Cardiovascular Disorders (CVD) – Chronic inflammation anywhere in the body is believed to have an effect on the heart function – An association between periodontitis and CVD is recognized but causality is yet to be established Periodontitis and Systemic Conditions • Osteoporosis – Bone fragility characterized by low bone mass and structural deterioration. – It is common in old age, especially postmenopausal women – Alveolar bone loss is often seen with generalized osteoporosis – How much of alveolar bone loss is due to osteoporosis rather than periodontitis? 9
  • 10. 08-May-09 Periodontitis and Systemic Conditions • Pregnancy – An association seems to exist between “maternal Periodontitis” and the “risk” of delivering a “preterm low-birth-weight” infant – The relationship cannot be established as “causal” – The association is strong enough to indicate that periodontal care and treatment are important during pregnancy Periodontitis and Systemic Conditions • HIV – The relationship between periodontal diseases and HIV is not yet fully understood. – The results of the studies are not uniform and are sometimes contradictory – A systematic review might be the solution to establishing the relationship • • • • • Understanding periodontal Diseases Distribution of PD Demographic Risk Factors in Periodontitis Risk Factors in Periodontitis Periodontitis and Systemic Diseases 10