1. Periodontal Disease Chapter 14 1
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2. Chapter 14 Lesson 14.1
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3. Learning Objectives Pronounce, define, and spell the Key Terms.
Name and describe the tissues of the periodontium.
Name the structures that make up the periodontium.
Describe the prevalence of periodontal disease.
(Cont’d)
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4. Learning Objectives
(Cont’d)
Describe the systemic conditions that are linked to periodontal disease.
Identify systemic factors influencing periodontal disease.
Explain the significance of plaque and calculus in periodontal disease.
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5. Learning Objectives
(Cont’d)
Identify the risk factors that contribute to periodontal disease.
Identify and describe the two main types of periodontal disease.
Describe the clinical characteristics of gingivitis.
Describe the progression of periodontitis.
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6. Introduction
Periodontal disease is an infectious disease process that involves inflammation. Periodontal diseases involve the structures of the periodontium.
Periodontal disease can cause a breakdown of the periodontium, resulting in loss of tissue attachment and destruction of the alveolar bone.
What is the periodontium? (The structures that surround, support, and are attached to the teeth.)
Failure to recognize periodontal disease and refer patients to a periodontist is a very common cause of this type of malpractice suit.
Periodontal disease is a silent disease. Patients rarely experience pain and are often unaware that a problem exists.
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7. Prevalence of Periodontal Disease
Periodontal disease is the leading cause of tooth loss in adults.
Almost 75% of American adults have some form of periodontal disease, and most are unaware of the condition.
Almost all adults and many children have calculus on their teeth.
Fortunately, with the early detection and treatment of periodontal disease, most people can keep their teeth for life.
What is calculus, and how is it removed from the teeth? (Calcium and phosphate salts in saliva that become mineralized and adhere to tooth surfaces; it is scaled off the teeth by hand or with the use of ultrasonic instrumentation.)
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8. Systemic Conditions: Links to Periodontal Disease
Certain systemic conditions increase the patient’s susceptibility to periodontal disease, and periodontal disease may actually increase a patient’s susceptibility to certain systemic conditions:
Cardiovascular disease
Preterm birth and low birthweight
Respiratory disease
Oral bacteria can spread into the bloodstream, attach to fatty plaques in the coronary arteries, and contribute to clot formation and heart attacks.
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9. Fig Structures of the periodontium: junctional epithelium, gingival sulcus, periodontal ligaments, and cementum.
Periodontal disease:
Involves inflammation.
Involves the structures of the periodontium.
Can cause a breakdown of the periodontium, resulting in:
Loss of tissue attachment.
Destruction of the alveolar bone.
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10. Periodontal Disease
Periodontal diseases are infectious diseases and are the leading cause of tooth loss in adults.
Nearly 75% of American adults suffer from various forms of periodontal disease and most are unaware of it.
Almost all adults have calculus on their teeth.
With the early detection and treatment of periodontal disease, it is possible for most people to keep their teeth for a lifetime.
The American Dental Association (ADA) and the American Academy of Periodontology (AAP) have developed systems for classifying periodontal diseases. What are the two main types of periodontal disease?
Periimplantitis is a new category established by the AAP. Patients in this category have implants that exhibit a "periodontitislike process" similar to that of natural teeth.
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11. Causes of Periodontal Disease
Dental plaque is the major factor in periodontal disease.
Dental calculus provides a surface to which plaque can attach.
Subgingival calculus
Supragingival calculus
What is dental plaque? (It is a soft deposit of bacteria and bacterial byproducts.)
How is most plaque removed? (Plaque is removed by brushing and flossing.)
What is calculus? (Calculus is calcium and phosphate salts that adhere to tooth surfaces.)
What is the difference between subgingival and supragingival calculus? Which is more harmful for the periodontium?
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12. Fig. 14-2 Clinical photo of 10-day old supragingival plaque
Fig Clinical photo of 10-day old supragingival plaque. The first symptoms of gingival inflammation (arrows) are becoming visible. (From Newman M, et al, editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders.)
Plaque cannot be removed by rinsing.
Bacteria produce enzymes and toxins that destroy the periodontal tissues and lower defenses.
The dental team must explain the need for improved home care to the patient and document the instructions.
Failure by the patient to improve home care is contributory negligence leading to the development of periodontal disease.
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13. Fig Heavy calculus deposits on the lingual surfaces of the lower anterior teeth. (Courtesy of Dr. Edward J. Taggart, San Francisco, Calif.)
How are the tissues in the figure responding to the calculus?
What structures does this infection involve?
What would the symptoms be?
What would the radiographs look like?
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14. Types of Periodontal Disease
“Periodontal disease” is an inclusive term describing any disease of the periodontium.
Gingival diseases and periodontitis are the two basic forms of periodontal disease, and each has a variety of forms.
What are the differences between gingival disease and periodontitis?
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15. Gingival Disease Gingivitis is inflammation of the gingival tissue.
Gingivitis is characterized by areas of redness and swelling, and there is a tendency for the gingiva to bleed easily.
Gingivitis is limited to the epithelium and gingival connective tissues.
It is important to note that there is no tissue recession or loss of connective tissue or bone.
How does gingivitis compare to periodontitis?
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16. Fig Gingivitis type I.
Gingivitis is limited to the epithelium and gingival connective tissues.
When would these gums bleed?
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17. Other Types of Gingivitis
Other types of gingivitis are associated with:
Puberty
Pregnancy
Use of birth-control medications
Gingivitis is painless and often goes unrecognized until a dental professional emphasizes its importance. Improved daily oral hygiene will reverse gingivitis.
Necrotizing ulcerative gingivitis (NUG) is characterized by sudden onset of pain, necrosis of the tips of the gingival papillae, and bleeding.
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18. Fig. 14-5 Medication-induced gingivitis
Fig Medication-induced gingivitis. (From Perry D, Beemsterboer P, Taggart E: Periodontology for the dental hygienist, Philadelphia, 2001, Saunders.)
Antiseizure drugs and hormones such as estrogen and progesterone can cause gingival enlargement.
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19. Periodontitis
“Periodontitis” means “inflammation of the supporting tissues of the teeth.”
Periodontitis is the extension of the inflammatory process from the gingiva into the connective tissue and alveolar bone that supports the teeth.
The progression of periodontitis involves the destruction of connective-tissue attachment at the most apical portion of a periodontal pocket.
What is periodontitis?
How is severity determined?
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20. Risk Factors for Periodontal Disease
Smoking
Diabetes
Poor oral hygiene
Osteoporosis
HIV/AIDS
Medications
Stress
Smokers have greater (1) loss of attachment; (2) bone loss; (3) depth of periodontal pockets; (4) calculus formation; and (5) tooth loss.
Periodontal treatments are less effective in smokers than in nonsmokers.
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21. Fig Cross-section of a tooth and the associated anatomic structures. A, Illustration of the depth of a normal gingival sulcus. B, Illustration of a periodontal pocket.
The main area involved in periodontal disease is the gingival sulcus, a pocket between the teeth and the gums.
What is a periodontal pocket? (It is a pathologically deepened gingival sulcus, a feature of periodontal disease.)
How is this pocket measured? (The dentist or dental hygienist can measure these pockets with a small probe to determine the extent of the disease.)
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22. Fig The arrows indicate varying amounts of bone loss due to periodontal disease. (From Miles DA, et al: Radiographic imaging for dental auxiliaries, ed 3, Philadelphia, 1999, Saunders.)
The resulting bone loss is irreversible; the bone will not usually grow back.
If the bone loss continues and the tooth support is compromised, the teeth become mobile and eventually are lost.
Bone loss is also a major problem for dental patients who have had teeth extracted.
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23. Signs and Symptoms of Periodontal Disease
Red, swollen, or tender gingiva
Bleeding of gingiva during brushing or flossing
Loose or separating teeth
Pain or pressure when chewing
Pus around the teeth or gingiva
Periodontal disease is described in terms of the severity of the disease and how much of the mouth is affected.
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