Periodontal Diseases

Lecture of Dr. Rola Alhabashneh

Notes organized by Mohamed Harun
July 19th 2010.

Introduction
Periodontics is one of the several branches of dentistry
that deals with the study and treatment of oral diseases. It is extensively
evolving day by day as it is believed to be in a close connection to the
overall systematic health of the oral cavity.
In order to understand Periodontics we must first have a previous
knowledge of the structure of the tissues surrounding the teeth; here is a
brief note on the Periodontium.

Periodontium
It refers to the specialized tissue that both surrounds and
supports the teeth thus maintaining the maxillary and mandibular bones. It
is divided into four main parts;

1. Gingiva: the soft layer of pink tissue generally seen surrounding the
teeth which is commonly known as the ‘gum’
2. Alveolar bone: the tissue surrounding the root of the teeth
3. Peridontal ligaments: i-they support the teeth from pressure exerted
hence keeping it vital and functioning (if not the teeth would be
subjected to fractures under pressure due to it being fixed in place)
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 ii- It helps the cementum to attach to the
alveolar bone.
4. Cementum: It is a specialized substance covering the root of a tooth

The Gingiva
Gingiva is part of the soft tissue lining of the mouth. It
surrounds the teeth and provides a seal around them. It is anatomically
divided into three parts;

Interdental Gingiva (Papillary); It occupies the interproximal space

beneath the area of tooth contact (between the teeth), therefore is there is
tissue or bone loss, the papillary shall disappear leaving wide spaces
between each tooth in the area affected.

Marginal Gingiva; It is the terminal edge of gingiva surrounding the teeth

in a collar like fashion. It’s healthy state in identified by a ‘knife edge’
lining of the gingiva (very thin layer).

Attached Gingiva; is continuous with the margined gingiva. It is firm,

resilient and tightly bound to the underlining periosteum of the alveolar
bone. It is made out of collagen fibers hence the firmness.

Peridontal Diseases
They are those diseases that effect one or
more of the peridontal tissues, causing clinical inflammation and further
side effects if not dealt with. They are usually present before their
symptoms as they are mostly silent diseases.

Recognition
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 Healthy Unhealthy
Pinkish gingiva Coloration (red)
Clear observable papillary Papillary recession
Firm texture Suppulation/exadule (Puss)
Stretched attached collagen fibers Clinical Inflammation (swelling,
bleeding, pain, etc.)

Causes of Peridontal Diseases

The main cause of the peridontal
diseases is the formation of Plaque. It is a sticky film of different
microbial species joined/mixed with saliva which resides over the surface
of the teeth thus leading to the destruction of the tissue around the teeth. It
is only removed via mechanical means i.e. brushing or flossing. To
identify plaque a Disclosing agent is used which sticks to the surface of
the plaque present on the teeth and coloring it.

The Intensity of peridontal diseases depends on the immune system of the

host hence its susceptibility to the disease.

Stages of Peridontal Diseases:

1. Gingivitis; It is the early and reversible stage of peridontal diseases

where the symptoms are only of clinical inflammations and if
treated quickly cured.
2. Chronic Peridontal; its symptoms are post-clinical inflammations.
Now sever damage has occurred causing fracture and weakening in
the teeth bone and further damage.

Bacteria

• Gram-Positive bacteria: they are aerobic bacteria which are healthy

bacteria present within the oral cavity.
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 • Anaerobic bacteria: they are unhealthy bacteria* that release toxins
into the oral cavity affecting the immune system thus causing
inflammation.

Causes Peridontal Diseases

I. CALCULUS: It is a form of hardened dental plaque. It is caused by

the continuous accumulation of minerals from saliva on plaque on the
teeth. Its surface is rough thus providing an ideal medium for further
plaque formation, threatening the health of the gingiva.

II. CROWDING: When the teeth are crooked and in close contact with
each other the plaque will crowed up between the unreachable spaces
between them making it difficult to clean. Patients at this level usually
undergo ortho-straightning of their teeth that they become much more
cleansable.

III. SMOKING: It causes stains that not only encourage the formation
of plaque but also the vascularity of the tissue. It also affects the
general immune system of the individual thus making it the most
dangerous factor to peridontal diseases.

IV. BRACES: It increases the susceptibility to plaque formation due

to the difficulty of cleaning the teeth.

V. POOR RESTORTION: This is caused by the malpractice of the

treating dentist. For example, placing shorter crowns thus exposing the
roots or forming rough tooth surface to which in both cases leads to
plaque accumulation (trapping).

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 VI. BLOOD DYSCARSIAS: General blood diseases such as leukemia
and anemia which changes the vascularity of the gingiva making it
more susceptible to diseases.

VII. MEDICATIONS: Some Medications may cause the

enlargement of the gums hence further inflammation. Medications
may include blood pressure medications and immune modulators,
therefore before treating a patient the medications used must be known
first.

VIII. VITAMIN ‘C’ DEFICIENCY: As vitamin C helps in the

formation of collagen fibers its deficiency will be vital (causing
bleeding in the gingiva)

IX. AUTO IMMUNE DISEASES: Such as HIV, as it attacks the

immune system directly leading to the drastic susceptibility to
diseases.

Periodontal Examination
Before the treatment of periodontal
diseases, Introdontal procedures and tests must me made first in order to
understand the main cause of the case before applying treatment. These
procedures are:

a) Plaque control; to peruse and get rid of plaque

b) Inflammation control; to treat the inflammation
c) Periodontal probe; It’s the measurement of the pocket depths
around a tooth in order to establish the health status of the
Perodontium. The margin of probing must be up between 2-3mm if
the gingiva is naturally thick and 1mm if thin. Exciding the margin
indicates loss in tissue.

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 The probing must be in an inclined direction in
order to follow the anatomy of the root and not miss the pocket.
d)Radiation; an X-ray of the teeth must be taken to find out whether
there is loss in the bone. A dark shadow under the tooth would
indicate loss in the bone tissue.

For peridontal diseases to occur the following must be present:

a) Bacterial challenge; the presence of bacteria

b) Behavioral factors; absence of oral hygiene, smoking, stress*
c) Biological factors; genetically inherited diseases
d) Host’s immune system; it simply marks the susceptibility of the host
to the disease which is in inverse proportion with each other. The
stronger the immune system, the weaker the susceptibility and vise
versa.

Important side notes: 1-Bad breath is caused by bacteria known as

halitosis which is present on the tongue. It secrets sulphur products which
causes the smell
2- Stress causes elevations in the blood pressure and cholesterol levels.
This highly affects the immune system thus its susceptibility to disease.
Human emotion also plays a role as the attention to oral cavity will
decrease if a person is stressed.

THE END
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