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Course: PERIO511
7/1/2016
NEW CLASSIFICATION OF
PERIODONTAL DISEASE
I. Gingival Diseases:
Dental plaque induced gingival diseases
Non-plaque induced gingival diseases
II. Chronic Periodontitis (Localized/Generalized)
III. Aggressive Periodontitis (Localized/Generalized)
IV. Periodontitis as a manifestation of systemic diseases.
Associated with hematologic disorders
Associated with genetic disorders
Not otherwise specified (NOS)
V. Necrotizing Periodontal Diseases
a) Necrotizing Ulcerative Gingivitis (NUG)
b) Necrotizing Ulcerative Periodontitis (NUP)
VI. Abscesses of the Periodontium
a) Gingival abscess
b) Periodontal abscess
c) Pericoronal abscess
VII. Periodontitis Associated + Endodontic Lesions
a) Endodontic periodontal lesion
b) Periodontal endodontic lesion
c) Combined lesion
VIII. Developmental or Acquired deformities & conditions
a) Localized tooth related factors that predispose to plaque
induced gingival diseases or periodontitis.
- Tooth anatomic factor
- dental
restoration/appliance
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- Root fracture
resorption/ C tears
- cervical root
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- Less restrictive
- No age dependent
- No rate of progression dependent
Classification of chronic Periodontitis is according to:
Extent
(Nr. of sites involved)
1. Localized = < 30%
2. Generalized > 30%
Severity
(Amount of CAL)
- Slight 1-2 mm
- Moderate 3-4 mm
- Severe > 5 mm
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Course: PERIO511
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I. Gingival Diseases
1. Dental plaque induced gingival diseases
A) Gingivitis with D.P only without/with local contributing factors
B) Modified by Systemic Factors:
a. Endocrine system
- Puberty
- Menstrual cycle
- Pregnancy
- Diabetes mellitus
b. Blood dyscrasias
e.g. leukemia associated gingivitis
C) Modified by medications:
a. Drug influenced gingival enlargement
b. Drug influenced gingivitis (oral contraceptive)
D) Modified by Malnutrition
- Ascorbic acid deficiency
- other
2. Non-plaque induced Gingival Lesions
a) Bacterial origin
b) Viral origin
c) Fungal origin
d) Genetic origin (hereditary gingival fibromatosis)
e) Gingival manifestations of systemic conditions
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- Mucocutaneous
- Allergic reactions : dental restorative material (Hg, Acrylic),
reaction to (tooth paste, mouth wash, food)
f) Traumatic lesions (chemical, physical, thermal)
g) Foreign body reactions
h) Not otherwise specified (NOS)
CHRONIC PERIODONTITIS
Black pigmented
Anaerobic
Gram ve
Site of colonization gingival sulcus
Pathogenesis of chronic periodontitis
P. gingivalis cytotoxic metabolic end products, have low molecular
easily penetrate periodontal tissue and interrupt the host cell
activity.
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TANNERELLA FORSYNTHESIS
- When colonizes in periodontally healthy sites, it converts diseased
sites.
Attachment
loss
Furcation
involvement
Mobility
Bone loss
MILD
1-2 mm
MODERATE
3-4 mm
SEVERE
5 or >
minimal
moderate
Severe T-T
Little
minimal
Slight/moderate excessive
horizontal
horizontal/angul
ar
++
+++
Plaque/calculu +
s
Bleeding
+
+/exudate
+/exudate
Clinical Features:
a) Supragingival and subgingival plaque accumulation
b) Gingival inflammation and pocket formation
c) Increase crevicular fluid and suppuration
d) Gingival bleeding spontaneous upon slight provocation
e) Loss of attachment and alveolar bone
f) Vertical and horizontal bone loss
g) Tooth mobility
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Radiographically:
Bone loss (horizontal or vertical)
Disease Distribution
- Site specific disease
- Clinical signs due to direct site specific effects of subgingival
plaque
- One tooth surface, other surfaces (normal A.L.)
Extent (Nr. of sites involved)
- Localized Periodontitis: when <30% sites affected
- Generalized Periodontitis: as > 30% of sites affected
Pattern of bone loss:
Horizontal: when A.L. and bones loss proceed at uniform rate.
Associated + Suprabony pockets
Vertical: when attachment and bone loss on tooth > than on
adjacent surface associated + angular bony and Infrabony pocket
formation
Disease Severity:
Mild: periodontal destruction not more than 1-2 mm CAL
Moderate: periodontal destruction not more 3-4 CAL
Severe destruction not more 5 mm or > CAL
Symptoms:
Usually painless
Sensitivity to hot, cold or both
Areas of localized dull pain sometimes radiate deep into jaw
Areas of food impaction
Gingival tenderness and itching
Prevalence:
Increased in age
Females and males
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ACTINOBACILLUS ACTINOMYCETEMCOMITANS
The star-shaped
Etiology of localized aggressive periodontitis
A gram ve bacteria
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Localized Aggressive
Periodontitis
- Onset around puberty
- Serum antibody response to
infecting agents
- Localized 1st molars/incisors
(interproximal AL affect at
least 2 permanent teeth one
of which is 1 molar) affecting
no more than 2 teeth.
Generalized Aggressive
Periodontitis
- Usually under 30 years or
older
- Poor serum antibody response
to infecting agents.
- Generalized interproximal AL
affecting at least 3 permanent
teeth other than 1st molar and
incisor
- Episodic destruction of
attachment and alveolar bone
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Radiographically:
- Vertical bone loss around 1 molars and incisors
- Arc shaped bone loss extending from distal of 2 nd permanent PMs o
mesial of 2nd permanent molars.
- Gives a characteristic mirror image
N.B: Why are the 1st molars and incisors affected first?
1. Production of adequate immune defenses after initial attack of Aa
to the periodontal sites of 1st permanent teeth to erupt, so
colonization of other sites will be prevented.
2. A.a may be prevented from further colonization via bacterial
antagonist to Aa.
3. A.a may lose its leukotoxins producing ability for unknown reasons
so progression of disease is arrested or retarded.
4. Defect in cement formation responsible for localization of teeth
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- Grafting procedures
Antibiotic Therapy:
- Tetracycline and its derivatives are used
- Systemic antibiotics used as an adjunct to mechanical
debridement
Mechanical therapy + oral hygiene clinically re-assessed after 4-6
weeks (surgery) and antibiotics selection depending on culture
sensitivity tests
- Combination therapy is appropriate
- Recommended to start drug administration immediately
following a mechanical instrumentation.
Surgical Management:
- Surgery is not advisable until there are clinical and microbial
signs of periodontal stability is achieved.
- Monitor every 3-4 weeks is while the disease is in active state.
Outcome assessment:
- Reduction of clinical signs of gingival inflammation
- Reduction of probing depths
- Gain of clinical attachment
- Radiographic evidence of resolution of osseous lesions
REFRACTORY PERIODONTITIS
Not a single disease, because small % of cases of all forms of
periodontitis might not be responsive to treatment, it either:
- Refractory chronic periodontitis
- Refractory aggressive periodontitis
Etiology
1. Abnormal host response
2. Pathogenic virulent bacteria
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Areas
-
In refractory Cases:
Tetracycline-resistant Actinobacillus species suspected.
So combination therapy is preferred
Amoxicillin 375 mg and Metronidazole- 250 mg TID for 7 days
AIDs associated
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Manifestations:
Macroglossia
Fissured geographic tongue
Hypoplastic teeth
Severe periodontitis deep PP
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Course: PERIO511
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Oral
Features:
Oral mucosa fragile, bruising
Bleeding after tooth brushing
Gingival bleeding, periodontitis
Wound healing slightly delayed
Hypermobility of TMJ
Patients touch nose with tongue tip
Supernumery or hypodontia
Many caries
Multiple pulp stones on dental radiographs
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