Académique Documents
Professionnel Documents
Culture Documents
Disease
The Periodontal Pocket
Furcation Involvement
Juvenile Periodontitis
Furcation Involvement
Juvenile Periodontitis
2-4 mm 4-6 mm 7 mm ↑
Clinical features:
1. Increased tooth mobility
2. Widening of the periodontal space, particularly
in the gingival region of the root (angular
destruction of bone.
Disuse atrophy
Results when the functional stimulation for the
maintenance of the periodontal tissues is markedly
diminished or absent.
characterized by thinning of periodontal ligament,
thinning and reduction in the number of periodontal fibers
and disruption of fiber bundle arrangement, thickened
cementum, reduction in height of alveolar bone, and
osteoporosis
Furcation Involvement
Juvenile Periodontitis
A periodontal pocket is a
pathologically deepened sulcus: it
is one of the important clinical
features of periodontal disease.
Gingival
inflammation
Pocket formation
2. Attached plaque
3. Unattached plaque
4. Junctional epithelium
6. Intact CT fibers
Furcation Involvement
Juvenile Periodontitis
1. From gingiva
along the outer
periosteum
2. From the
periosteum into
the bone
3. From the gingiva
into the PDL
Tooth Mobility
The inflammatory exudate reduces tooth support
by causing degeneration and destruction of the
principal fibers and a break in the continuity
between the root and the bone
Pain
Superimposed acute inflammation may be the
cause of considerable pain
Furcation Involvement
Juvenile Periodontitis
Furcation Involvement
Juvenile Periodontitis
Furcation Involvement
Clinical Features:
1. The tooth may or may not be mobile and is
usually symptom free.
2. Tooth is sensitive to thermal changes
(caused by caries or lacunar resorption of the
root in furcation area)
3. Recurrent or constant throbbing pain (caused
by pulp changes)
4. Sensitivity to percussion (caused by acute
inflammatory involvement of the periodontal
ligament.
Furcation Involvement
Possible Etiologies:
Furcation Involvement
Diagnosis:
Furcation involvements have been classified as
Grades I, II, III, and IV according to the amount
of tissue destruction
Grade I – incipient bone loss
Grade II – partial bone loss
Grade III – total bone loss with through-and-
through opening of the furcation
Grade IV – similar to Grade III but with
gingival recession exposing the furcation to view.
Furcation Involvement
Furcation Involvement
Furcation Involvement
Classification of Periodontal
Disease
The Periodontal Pocket
Furcation Involvement
Juvenile Periodontitis
Furcation Involvement
Juvenile Periodontitis
Furcation Involvement
Juvenile Periodontitis
Juvenile Periodontitis
Juvenile Periodontitis
GENERALIZED FORM
This type of juvenile periodontitis attacks
the whole dentition or a large part of it and is
associated with systemic disturbances
Papillon-lefevre syndrome
Down’s Syndrome
Neutropenias
Hypophosphatasia
Acute and Subacute Leukemia
Prepubertal periodontitis
Juvenile Periodontitis
Generalize
d
Papillon-Lefevre Syndrome form
a syndrome characterized by hyperkeratotic
skin lesions, severe destruction of the
periodontium, and in some cases, calcification of
the dura
Periodontal lesions consist of early
inflammatory involvement leading to bone loss
and exfoliation of teeth
By the age of 15 years, patients are usually
edentulous except for the third molars
The syndrome is inherited and appears to
follow an autosomal recessive pattern of
inheritance
Juvenile Periodontitis
Generalize
d
Down’s Syndrome form
a congenital disease caused by a
chromosomal abnormality and characterized
by mental deficiency and growth retardation
Periodontal disease in Down’s syndrome is
characterized by formation of deep periodontal
pockets associated with a substantial plaque
accumulation and moderate gingivitis
these findings are usually generalized,
although they tend to be more severe in the
lower anterior region
Juvenile Periodontitis
Generalize
d
Neutropenia form
destructive generalized periodontal lesions have
been described in children with neutropenia
Hypophosphatasia
a rare familial skeletal disease, which in some cases
results in loss of primary teeth, particularly the incosors
Juvenile Periodontitis
Generalize
d
form
Prepubertal periodontitis
these cases are rare, and they start during or
immediately following eruption of the primary teeth
An extremely acute inflammation and
proliferation of the gingival tissues, with rapid
destruction of bone, are found
All primary teeth are affected, but the permanent
dentition may not be affected
Juvenile Periodontitis
LOCALIZED FORM
previously known as diffuse atrophy of the
alveolar bone, deep cementopathia, parodontitis
marginalis progressiva, paradontosis,
periodontosis
Disease of the periodontium occurring in an
otherwise healthy adolescent which is
characterized by a rapid loss of alveolar bone
about more than one tooth of the permanent
dentition
Juvenile Periodontitis
Localized
form
Distribution of Lesions
The classic distribution is in the region of the
first molars and incisors, with the least destruction
in the cuspid-premolar area
Juvenile Periodontitis
Localized
form
Clinical Findings
The most striking feature of early juvenile
periodontitis is the lack of clinical inflammation in
the presence of deep periodontal pockets
There is a small amount of plaque, forming a
thin film on the tooth and rarely mineralizing to
become calculus
Clasically, one sees a distolabial migration of
the maxillary incisors, with diastema formation
Juvenile Periodontitis
Localized
form
Clinical Course
The rate of bone loss is about three to four
times faster than that in typical periodontitis
Histopathology
A thin, frequently ulcerated pocket epithelium,
infiltrated by numerous leukocytes covers large
areas of inflammatory cell accumulation
composed mainly of plasma cells and blast
cells, with lymphocytes and macrophages
present in small numbers
Juvenile Periodontitis
Localized
form
Histopathology
Collagen and other tissuecomponents
constitute only a small proportion of the
diseased site as compared with the situation in
adult-type periodontitis
Bacteriology
The two bacteria that have been considered
pathogens in juvenile periodontitis are
Actinobacillus actinomycetemcomitans and
Capnocytophaga
Juvenile Periodontitis
Classification of Periodontal
Disease
The Periodontal Pocket
Furcation Involvement
Juvenile Periodontitis
Calculus component of
OHI-S
0 = No calculus
1 = Supragingival
calculus covering not
more than 1/3 of root
surface
2 = Supragingival
calculus cover 1/3 - 2/3
3 = Supragingival
calculus cover more than
2/3
Epidemiology of Gingival and Periodontal
Disease
Indices Used to
Measure Calculus
1. Age
-prevalence and severity of periodontal disease
increases directly with increasing age
2. Sex
- In general, males consistently have a higher
prevalence and severity of periodontal disease
3. Race
- Blacks had more periodontal disease than
whites
1. Oral Hygiene
- the strong positive association that exists between
poor oral hygiene and gingival and periodontal
disease makes poor hygiene the primary etiologic
agent
2. Nutrition
- A secondary factor in the etiology of periodontal
disease
- The nutrients that have been specifically associated
with the periodontal tissues are vit. A, B complex, C,
and D and calcium and phosphorus
Epidemiology of Gingival and Periodontal
Disease
Etiological Factors of Gingival and Periodontal
Disease
3. Fluorides
- some investigators reported lower prevalence and
severity of gingival and periodontal disease in
optimally fluoridated areas
4. Adverse Habits
- tobacco smoking and betel nut chewing have been
associated with increased periodontal disease
5. Professional Dental Care
- The incidence and severity of periodontal disorders
are lower under in individuals having regular dental
care