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Epidemology, etiology and prevention of periodontal disease 1


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Epidemology, etiology and prevention of periodontal disease 1

  1. 1. SMIJAL
  2. 2. INTRODUCTIONThe periodontium, defined asthose tissues supporting andinvesting the tooth,comprises ofCEMENTUMPDLALVEOLAR BONEDENTOGINGIVAL JUNCTION
  3. 3. EPIDEMIOLOGY The epidemology of periodontal disease is one of the most important challengesThere are 3 main type of chronic destructive periodontal disease.1.Inflammatory disease is the commonest form,usually called “peridontitis” or “marginal periodontitis”.In this, destruction of alveolar bone by the formation of subgingival pockets at the site of chronic inflammation.
  4. 4. 2.The second type of periodontal disease is apparently systemic in origin and is called “periodontosis” or “juvenile periodontitis”/”diffuse alveolar atrophy”.Which is charecterized by bone loss usually generalized.3.The third type of periodontal disease is “atrophy” associated with such conditions as old age or disease.
  5. 5.  In India,data from the National Oral Health Survey (2002-2003) states that in children aged 12yrs, the prevelence of periodontal disease was 57%. In 15yr age group,it was 67.7%. The prevalence was 89.6% and 79.9% in the 35-44 year and the 65-74 year age group respectively.
  6. 6. ETOIOLOGY OF PERIODONTALDISEASE Gingivitis: is a disease charecterized by inflamation restricted to the gingival soft tissues with no loss of alveolar bone or apical migration of the PDL along the root surface. Periodontal disease: it is an inflammatory disease of the supporting tissues of the teeth caused by specific microorganism resulting in progressive destruction of the PDL and alveolar bone with pocket formation ,recession or both.
  7. 7. ETIOLOGYLOCAL FACTORS SYSTEMIC FACTORS Deposits on teeth  Faulty nutrition Abnormal habits  Debilitating disease Food impaction  Blood dyscrasias Non-detergent diet  Endocrine Other irritants dysfunctions Abnormal anatomy  Radiation Factors of occlusal  Psychogenic factors function  Iatrogenic factors
  8. 8. LOCAL FACTORSDEPOSITS ON TEETH1. Supragingival Calculus It is found above the gingival margins consists of mineral salts from the saliva embedded ina bacterial and fungus matrix.2. Subgingival Calculus The calcified deposits found on the root surface in the periodontal pocket.3. Materia Alba This white, soft deposits occur around the necks of the crown.Which consist of food debris,dead tissue etc.
  9. 9. ABNORMAL HABITS1.Unilateral mastication One side of the mouth is affected by periodontal disease.Mouth in the non functional side with loss of tone,accumulation of food&calculus.2.Abnormal biting habits It includes pencil biting,nail biting,lip biting,cheek biting etc.These traumatic injury affects both periodontium&tooth.3.Clenching and bruxism These excessive pressure may cause necrosis of the periodontal membrane.
  10. 10. FOOD IMPACTION It is the wedging of food b/w 2 teeth because of faulty contact creating a constant source of irritation leads to the tissue inflammation.TYPES1.Vertical:wedging of food between the teeth by occlusal pressure.2.Horizontal: wedging of food by the action of the cheecks&tongue during the mastication.
  11. 11. OTHER IRRITANTS1.Mechanical irritants Bridges, clasp,overhanging margins of any restoration will irritate the gingiva.2.Chemical irritants Alcohol,cigarettes and others causes necrotizing ulcerative gingivitis .3.Atmospheric irritants Mouth breathing leads to the dehydration of the mucous membrane&lowered tissue resistance4.Improper orthodontic procedures also irritate the periodontium
  12. 12. ABNORMAL ANATOMY Underdeveloped cingulum,improper tooth position,improper contact area will cause the inflammation of gingiva.FACTORS OF OCCLUSAL FUNCTION1.Over function:a)Excessive stress on teeth b)Insufficient periodontal support c)Powerful masticatorymusculature2.Under function:a)Premature wear b)Non-occlusion c)Indolent mastication
  13. 13. SYSTEMIC FACTORSA.FAULTY NUTRITIONDietary deficiency conditions such as scorbutic gingivitis,rachitic gingivitis and non detergent diet gingivitis are often responsible in part for the development of periodontal disease.Deficiency in vit.c may be accompanied by gingival bleeding.B.DEBILITATING DISEASEGastrointestinal disorders,syphilis,nephritis,liver diseases,tuberculosis and other systemic diseases may show signs in the mouth.
  14. 14. c.BLOOD DYSCRASIAS In myelogenous leukemia,the gingival lesion may be described as a symptom of the blood disease or as myeloid infiltration of gingivae.D.ENDOCRINE DYSFUNCTIONMiller believed that even mild uniglandular or polyglandular aberrations my create a periodontal susceptibility which together with local etiologic factors could create a periodontal lesion.E.DIABETESThere is a tendency toward alveolar bone destruction in patients with uncontrolled diabetes, Periodontal abscesses with profuse exudative flow are common.
  15. 15. F.PITUITARY DISORDERS In hypopituitarism,crowding of teeth and enlargement of gingival tissues have been noted.. Spacing of the lower teeth due to enlargement of the jaws may occur in hyperpituitarism.G.PUBERTY,PREGNANCY AND CLIMACTERIC Susceptibility to gingival disturbances is more prevalent during puberty,pregnancy,and climacteric, usually because of endocrine adjustments taking place during these periods. Gingival enlargements accompanied by discolouration,bleeding,and mulberry like swelling can be seen. .
  16. 16. H.PSYCHOGENIC FACTORS Persons under stress and tension often develop habits antagonistic to the health of the periodontium such as pencil bitingI.IATROGENIC FACTORS Iatrogenic dental and periodontal disease may occur from overhanging margins of fillings which irritate the gingiva and cause inflammation.J.ATOMIC RADIATIONRadiations of intense dose/higher dose disturbs the normal alveolar bone pattern resulting in periodontal destruction.
  17. 17. NO: AUTHORS YEAR POPULATION FINDINGS1. Mehta and 1956 1640 school children of Prevalence of gingivitis was Sanjana Bombay city(11-17yrs) 93.7%&increased with age.2. Gupta 1962 800 people in TVM(11-50yrs) Periodontal disease- 100%after 30 yrs,90% in(11- 30yrs)3 Ramachandr 1973 6,647 rural & 1,536 urban Prevalence of periodontal an et al population in Tamilnadu. disease(95.3% &95.5%)respectively.4. Nagaraj Rao 1980 500 children in Udupi(5- 28%-marginal gingivitis et al 10yrs) 7.2%-chronic generalized gingivitis5. Anil.S,Hari.S 1990 2756 subjects(15-44)in TVM. Calculus & bleeding(86%) in and 15-19yrs.shallow Vijayakumar pocketing(80%)in 25- 29yrs.deep pockets(33%)in 35-44 yrs.6 Mathew 1996 1513 subjects(15yrs) in Udupi 0.4%-healthy Kurian et al periodontium.Shallow pockets in(26.6%) & deep pockets in(24.1%).
  18. 18. CURRENT CONCEPTS OFPATHOGENESIS OF PERIODONTITIS Bacteria of dental plaque Activati Direct on of Immune bacterial immune dysfunc tissue mechani tion damage sm Periodontal disease
  19. 19. Prevalence of Periodontosis among Indians Marshall Day & Shourie {1949}, Belting& Massler reported {1953}, Miglani & Sharma {1965}, Tewari & S.S Rao conducted Studies & reported that 95-100% population has been shown to be suffring from periodontal disease in various population groups only differing in severity from one to another. In the younger age group i.e. till the age of 20 years it is gingivitis in its various severities; above that specially above the age of 30 years, 99-100% of the population has been reported to be suffering from periodontal disease & as high as 70% from periodontal pockets or bone resorption. Habits such as smoking & betel leaf chewing are associated with an above average severity of periodontal disease. Such group have more plaque & calculus & are much less concerned about their dental health.
  20. 20. Distribution of Disease in differentareas of mouth Dividing each of areas into upper & lingual arches, revealed that gingivitis was more severe in upper arch than lower for interproximal areas. Most severly affected teeth by periodontal disease are upper molars & lower incisors. Least affected are lower premolars & upper canines. Higher tendency is right half than left, it may be due to difficulty of right handed person in brushing right half.
  21. 21. Other important studies done on descriptive epidemiology of gingival & periodontal disease:A. Prevelance of Gingivitis:.1. Macall 1933 {New York} 4,600 children Age group l-14years Percentage of persons affected with gingivitis - 98.0%2. Messner et al in 1938. {us} 1,438,318 children 6-14 years age group 3.5 - 8.6% with gingivitis
  22. 22. Surveys on prevalence of gingivitis conducted in India:. Marshall - Day and Tandon in 1940 {Lahore} 756 children Age group approximately 13 years 68.0% affected with gingivitis2. Marshall - Day in 1940 {fluoride endemic area in Northern India} 203 individuals Age group 5-18 years 59.6% gingivitis3. Marshall - Day in 1944 {Kangra district of India} 200 boys Approximately 13 years 81.0% of gingivitis
  23. 23. Other survey:. McHugh et al in 1964{ Boys and girls in Dundee, Scotland}1 2905 individuals 13 years age group 99.4% gingivitis2. King in 1940 {Isle of Lewis} 2280 individuals 6-15yr age group 90% gingivitis3. Stahl & Goldman 1953 {children in Massachusetts} 1300 children 13-17 age group 29% gingivitis4. Russel 1957 {urban area in US} Survey among white & black.
  24. 24. B. Prevelance of Periodontal Diseases: Periodontal diseases accounts for greatest loss of teeth in humans. Lack of public concern & general unawareness of consequences of periodontal diseases have contributed to its broad prevalence. In India PDL disease caused loss of 11,960 teeth for all patients of age & was responsible for loss of 79.2% of al teeth in all patients over 30years of age. This was estimated in a study conducted by Mehta et al 1958. Levels of PDL disease such as those found in US have also been recorded in Scandinavian Countries according to Shei et al in 1959.
  25. 25. Reports of some important periodontal surveys conducted in India:. Marshall - Day & Shourie K.L in 1947 {Lahore} 1054 individuals 9-17 years age group 99.496 gingivitis2. Mehta FS & Sanjana in 1956 {Bombay City School children} 1640 children 11-16 years age group 96.9% gingivitis3. I.C. Greene in 1960 {Bombay} 1613 individuals 1 l-17years age group 96.9% gingivitis
  26. 26. Samples Age group Gingivitis Periodontal Destruction155 11-20 years 90.396 16.8%275 21 -30 years 96.796 55.6%153 31- 40 years 100% 87.6%74 41 -50 years 100% 94.8%43 51 -60 years 100% 0.0%33 61 -70 years 100% 94.8%25 71 -80 years 100% 100%
  27. 27. C. Prevalence of juvenile periodontitis Its difficult to arrive at statement of prevalence for juvenile periondotitis because few studies have been specifically designed determine extend of this degenerative disease. An examination percentage distribution of PDL disease for person in US shows that prevalence of destructive periodontal disease is: 58% for adolesants 12-17 yr age 10% for young adults 18-24 yr age 17% for adults 30-34 yr age Assuming that approx.half of these individuals had juvenile periodontitis, it would be reasonable to expect that true prevalence of juvenile periodontitis would be some what less than 8%.
  28. 28. RISK FACTORS IN PERIODONTALDISEASE1.AGE Chronic destructive periodontal disease has always been associated with older age groups.2.SEX The males have a higher prevalence and severity of periodontal disease than females.But relatively high incidence of juvenile periodontitis has been found in females.3.RACE The severity among Spanish-Americans appear to be higher than that of whites&blacks.
  29. 29. 4.EDUCATION Occupation which is so closely tied to education,shows a relationship to periodontal disease that is similar to that of education.5.INCOME Periodontal disease is inversly related to increasing levels of income.6.PLACE OF RESIDENCE Prevelance of periodontal disease are slightly higher in rural areas than in urban areas.
  30. 30. 7.DIET Vegetarians tends to consume more CHO containg sticky prevalence is more evident among vegetarians.8.NUTRITION Higher severity of periodontal disease in areas where protein calorie malnutrition and vitamin A deficiency are common.9.SOCIO-ECNOMIC FACTORS Lower income group have a higher rate of periodontal disease than the higher income group.
  31. 31. PREVENTION OF PERIODONTALDISEASE Adequate plaque removal has been shown to prevent gingivitis as well as subtantially limit the progression of periodontitis. Regular and thorough removal of plaque by dentist and dental hygienist can successfully control periodontal disease. Oral hygiene practices involve the thorough daily removal of dental plaque and other debris by tooth brushing and flossing.
  32. 32. Levels of PRIMARY SECONDARY TERTIARYprevention Health Specific Early diagnosis Disability Rehabilitation promotion protection & prompt limitation treatmentServices periodic visit to Avoidance of Self Utilization of Utilization ofprovided by dental office known examination & dental dentalthe individual irritants referral services servicesServices Dental health Avoidance of Periodic Provision of Provision ofprovided by education known screening & dental dentalthe dental programs irritants referral services servicescommunityServices Patient Removal of Complete Chemotherapy -Plasticprovided by education known examination surgerythe dental irritants -speechprofessional therapy
  33. 33. ORAL HYGIENE PRACTICESMECHANICAL PLAQUE CHEMICAL PLAQUECONTROL CONTROL Tooth brushes and  Chlorhexidine dentifrices gluconate(0.2%) Interdental aids  Triclosan Dental floss Interdentalbrushes  Delmopinol Wooden tips  Metallic ions Aids for gingival  Quaternary ammonium stimulation compounds Gingival massage  Enzymes Waterirrigationdevices Tongue scrapers  Antibiotics
  34. 34. CONCLUSION Periodontal disease accounts for a majority of missing teeth in adults and result in tremendous economic and social burdens both to the individual and society. Periodontal disease is so prevalent that the only possible solution is the “prevention”