Periodontitis Dental study

1. PERIODONTITIS
Done by
Godara Ashok Kumar
Pratik Hirapara
Group-0404-09

2. Contents
• Definition
• Clinical features
• Changes in the nomenclature of case definition of Periodontitis
• Chronic Periodontitis Aggressive Periodontitis
• The most recent Case definition of Periodontitis
• References

3. Definition
• Clinical definition of periodontitis
• Periodontitis is a chronic multifactorial inflammatory disease associated with
dysbiotic plaque biofilms and characterised by the progressive destruction of the
tooth-supporting apparatus.
• Periodontitis is characterised by inflammation that results in the loss of
periodontal attachment.
• While the formation of bacterial biofilm initiates gingival inflammation, the
disease of periodontitis is characterised by three factors
• 1. The loss of periodontal-tissue support, manifested through clinical attachment
loss (CAL) and radiographically assessed alveolar bone loss
• 2. The presence of periodontal pocketing
• 3. Gingival bleeding

4. • Signs and symptoms of periodontitis can include:
• Swollen or puffy gums
• Bright red, dusky red or purplish gums Gums that feel tender when
touched
• Gums that bleed easily
• Pink-tinged toothbrush after brushing
• Spitting out blood when brushing or flossing your teeth
• Bad breath
• Pus between your teeth and gums

5. Types of periodontitis
• Chronic Periodontitis
• A. Localized
• B. Generalized (30% of sites are involved)
• Aggressive Periodontitis
• A. Localized
• B. Generalized (30% of sites are involved)

6. • Periodontitis as a
• Manifestation of Systemic Diseases
• A. Associated with hematological disorders B. Associated with genetic
disorders
• C. Not otherwise specifiedNecrotizing Periodontal Diseases A.
Necrotizing ulcerative gingivitis B.
• Necrotizing ulcers
• A. Necrotizing ulcerative gingivitis
• B. Necrotizing ulcerative periodontitiserative periodontitis

7. • Periodontitis Associated With Endodontic Lesions lesions
• A. Combined periodontic-endodontic

8. Chronic Periodontitis
• Chronic periodontitis has been defined as “an infectious disease
resulting in inflammation within the supporting tissues of the teeth,
progressive attachment loss, and bone loss.”
• Site-specific disease
• Slight (mild) periodontitis: No more than 1 to 2 mm of clinical
attachment loss
• Moderate periodontitis: 3 to 4 mm of clinical attachment loss
• Severe periodontitis: 5 mm or more of clinical attachment loss

9. Clinical Diagnosis
• Detection of chronic
• inflammatory changes in the marginal gingiva
• Presence of periodontal pockets
• Lots of clinical attachment
• It is diagnosed rudin graphically by: Localizes or generalized loss of
alvular supporting bone, horizontal or vertical

10. • Localized periodontitis: less than 30% of the sites demonstrate
attachment loss and bone loss
• Surgical exposure of the vertical, angular defect associated with the
chronic plaque accumulation

12. • Aggressive Periodontitis
• Lang et al in 1999 defined aggressive periodontitis on the basis of:
• Primary features
• Except for the presence of periodontitis, putin um otherwise clinically
heathy
• Rapid anachment low and bone destruction
• Secondary features (often present)
• Amounts of microbial deposits are incomitent with the severity of
periodontal tisuae destruction Elevated proportions of Actinobacillus
actinymcomitans and, in some populations, Porphyromonas gingivali may
be elevated
• Phagocyte abnormalities
• Hyperresponsive macrophage phenotype, including elevated levels of
prostaglandin E (PGE) and interleukin 1
• Progression of attachments and bone loss may be self arresting

13. Localized Aggressive Periodontitis
• A striking feature is lack of clinical inflammation despite the presence
of deep periodontal pockets and advanced bone loss.
• The plaque that is present forms a thin biofilm on the teeth and rarely
mineralizes to form calculus.
• Rate of bone loss about three to four times faster than in chronic
periodontitis.

14. Other clinical forms of localized aggresive
perioditites may include
• Distolabial migration of the maxillary incisors with concomitant
diastema formation,
• Increasing mobility of the first molars.
• Sensitivity of denuded root surfaces to thermal and tactile stimuli,
and Deep, dull, radiating pain during irritation of the supporting
structures.

15. Radiographic Findings
• Vertical loss of alveolar bone around the first molars and incisors,
• beginning around puberty in otherwise healthy teenagers.
• Radiographic findings may include an “are-shaped loss of alveolar
bone extending from the distal surface of the second premolar to the
mesial surface of the second molar”.

16. Generalized Aggressive Periodontitis
• Usually affects individuals <30 yrs, may be older.
• A poor antibody response to the pathogens present.
• “Generalized interproximal attachment loss affecting at least three
permanent teeth other than first molars and incisors”,
• Periods of advanced destruction followed by stages of quiescence of
variable length (weeks to months or years).

17. • Patients often have small amounts of bacterial plaque, inconsistent with the
amount of periodontal destruction.
• Qualitatively, P. Gingivalis, A. Actinomycetemcomitans, and Bacteriodes forsythias
frequently are detected in the plaque.GAP represents the most heterogeneous
group and includes the most severe
• forms of periodontitis
• They comprise forms originally described as:
• Generalized juvenile periodontitis (emphasis on a possible relationship with LAP)
• Severe periodontitis(emphasis on the advanced destruction in comparison with
patient age)
• Rapidly progressing periodontitis (emphasis on the fast rate of progression of
lesions in these forms).

18. Radiographically
• Can range from severe bone loss associated with minimum number of
teeth to advanced bone loss affecting the majority of teeth in the
dentition

21. • Stage II represents established periodontitis in which a carefully
performed clinical periodontal examination identifies the
characteristic damages that periodontitis has caused to tooth
support.
• At this stage of the disease process, however, management remains
relatively simple for many cases as application of standard treatment
principles.
• Careful evaluation of the stage II patient’s response to standard
treatment principles is essential, and the case grade plus treatment
response may guide more intensive management for specific patients.

23. • At stage III, periodontitis has produced significant damage to the
• attachment apparatus
• In the absence of advanced treatment, tooth loss may occur.
• The stage is characterized by the presence of deep periodontal lesions that
extend to the middle portion of the root
• Management is complicated by the presence of deepintrabony defects,
furcation
• involvement, history of periodontal tooth loss/exfoliation, and presence of
localized ridge defects that complicate implant tooth replacement.
• In spite of the possibility of tooth loss, masticatory function is preserved.
• Treatment of periodontitis does not require complex rehabilitation of
function.

24. • Periodontitis causes considerable damage to the periodontal support and
may cause significant tooth loss, and this translates to loss of masticatory
function.
• In the absence of proper control of the periodontitis and adequate
rehabilitation, the dentition is at risk of being lost.
• This stage is characterized by the presence of Deep periodontal lesions that
extend to the apical portion of the root
• 2. History of multiple tooth loss
• 3. Tooth hypermobility due to secondary occlusal trauma & the sequelae of
tooth loss Posterior bite collapse
• 3. Drifting Case management requires stabilization/restoration of
masticatory function.

26. Risk Factors
• Currently validated risk factors for Periodontitis include
• 1. Smoking
• 2. Diabetes
• Smoking and Diabetes are termed as Grade modifiers since they are
considered to influence the rate of progression of Periodontitis.
• Emerging risk factors like obesity, specific genetic factors, physical
• activity, or nutrition may one day contribute to assessment of
Periodontitis.

29. The main features to identify periodontitis
• Loss of periodontal tissue support due to inflammation is the primary
• feature of periodontitis. A threshold of interproximal, CAL of 22 mm or 23
mm at 22 non-adjacent
• teeth Presence of interproximal tissue loss through radiographic
assessments of bone loss
• Clinically meaningful descriptions of periodontitis should include the
proportion of sites
• 1. Bleed on probing
• 2. The number and proportion of teeth with probing depth over certain
thresholds (commonly 24 mm and 26 mm) 3. Teeth with CAL of 23 mm and
3 mm

30. Diagnosis of Periodontitis
• A periodontitis diagnosis for an individual patient should encompass
three dimensions:
• 1. Definition of a periodontitis case based on detectable CAL loss at
two non-adjacent teeth
• 2. Identification of the form of periodontitis: necrotizing periodontitis,
periodontitis as a manifestation of systemic disease or periodontitis
• 3. Description of the presentation and aggressiveness of the disease
by stage and grade

31. • Characterization of periodontitis by stage and grade
• Stage is largely dependent upon the severity of disease at
• presentation Staging, further includes a description of extent and
distribution .Of the disease in the dentition
• Grade provides supplemental information about biological features of
the disease including
• 1. A history-based analysis of the rate of periodontitis progression
• 2. Assessment of the risk for further progression:
• 3. Analysis of possible poor outcomes of treatment
• 4. Assessment of the risk that the disease or its treatment may
negatively affect the general health of the patient.

32. Thank you