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Gingivitis Periodontitis 2Dr. Majdy IDREES

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Periodontitis is defined as "an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of specific microorganisms The clinical feature that distinguishes periodontitis from gingivitis is the presence of; Clinically detectable attachment loss (CAL) 4Dr. Majdy IDREES

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Histologically Junctional epi is usually present at CEJ or coronal to it 6Dr. Majdy IDREES

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Replacement of “Adult Periodontitis” With “Chronic Periodontitis” Age-dependent nature of the adult periodontitis designation created problems Chronic periodontitis can occur prior to the age of 35 years Rates of progression should not be used to exclude people from receiving the diagnosis of Chronic Periodontitis The onset of chronic periodontitis occurs at anytime 8Dr. Majdy IDREES

Replacement of “Early-Onset Periodontitis” With “Aggressive Periodontitis” It is true that this disease often occurs in people under 35 years of age, but it may also affect older patients The term early-onset periodontitis was too restrictive Diagnosis of aggressive periodontitis is made on clinical, radiographic and historical findings which show rapid attachment loss and bone destruction, and possible familial aggregation of disease 9Dr. Majdy IDREES

1989 classification had many shortcomings including: 1) Considerable overlap in disease categories, 2) Lack of a category for strictly gingival diseases 3) Difficulty in fitting certain patients into any of the existing categories 4) Similarity of microbiological and host response features in different disorders 5) An emphasis on age of onset that became a problem as patients aged into a new category 6) Some unclear classification criteria 10Dr. Majdy IDREES

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Actual and apparent positions of the gingiva The actual position is the level of the coronal end of the epithelial attachment on the tooth Apparent position is the level of the crest of the gingival margin 12Dr. Majdy IDREES

The severity of recession is determined by the actual position of the gingiva, not its apparent position 13Dr. Majdy IDREES

Classification of Pockets Gingival (pseudo pocket): Coronal migration of gingival margin Without destruction of the underlying periodontal tissues 14Dr. Majdy IDREES

Classification of Pockets Periodontal: Apical migration of epithelial attachment Suprabony: Base of pocket coronal to height of alveolar crest Infrabony: Base of pocket apical to height of alveolar crest Characterized by angular bony defects 15Dr. Majdy IDREES

Pattern of bone loss Vertical bone loss (angular bony defect) is usually associated with intrabony pocket 16Dr. Majdy IDREES

Pattern of bone loss Horizontal bone loss is usually associated with suprabony pocket 17Dr. Majdy IDREES

Radiographically 18Dr. Majdy IDREES

Radiographically Best radiographic view to diagnose alveolar bone defect is vertical bitewing followed by horizontal bitewing The worst is OPG & in between is PA Panoramic view is the worst way to diagnose the periodontal disease ??? Magnification (25 – 30%) Lack of clarity 19Dr. Majdy IDREES

Presence of gingival inflammation without loss of attachment Gingivitis Presence of gingival inflammation with loss of attachment Periodontitis 20Dr. Majdy IDREES

Chronic periodontitis Formerly known as "adult periodontitis“ or "chronic adult periodontitis,“ Chronic periodontitis is characterized as occurring mostly in adults, but it can be seen in younger people Most prevalent form of periodontitis Destruction is consistent with the amount of plaque present and other local factors Subgingival calculus is also commonly found In general the disease progresses slowly but there may be bursts of destruction 21Dr. Majdy IDREES

Continuous Cycle! Plaque  gingival inflammation  pocket formation  more plaque 22Dr. Majdy IDREES

Common Characteristics Onset - any age; most common in adults Plaque initiates condition (primacy etiological factor) Subgingival calculus common finding Slow-mod progression; periods of rapid progression possible Modified by local factors/systemic factors/stress/smoking 23Dr. Majdy IDREES

CLINICAL FEATURES Supragingival and subgingival plaque accumulation Gingival inflammation Pocket formation Loss of gingival stippling Bone resorption Tooth mobility Pus Changes in the surface topography Halitosis Tooth migration Pain Loss of clinical attachment 24Dr. Majdy IDREES

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Probing depth (PD) : measured clinically as the distance between gingival margin & base of the pocket Gingival recession is measured as the distance between CEJ & gingival margin Clinical attachment level (CAL): measured clinically as the distance between CEJ & base of the pocket CAL= Probing Depth + gingival recession 28Dr. Majdy IDREES

Gingival Recession Gingival Margin Gingival Recession CAL = recession + PD CEJ PD 29Dr. Majdy IDREES

CAL ??? 30Dr. Majdy IDREES

Keratinized gingiva (KG) is the distance between mucogingival junction & the gingival margin. Attached gingiva is the distance between mucogingival junction and the external surface of the bottom of the gingival junction. This means that the attached gingiva is calculated by subtracting the PD from the keratinized gingiva KG = free gingiva + attached gingiva Attached gingiva = KG - PD 31Dr. Majdy IDREES

KG = 5 mm PD = 2 mm AG = ? Keratinized (KG) and Attached (AG) gingiva Attached gingiva AG = KG-PD 32Dr. Majdy IDREES

Disease Distribution Site-specific disease Site specific effects of subgingival plaque accumulation Localized : if < 30% of examined site posses attachment loss & bone loss Generalized : if > or equal 30% of examined sites posses attachment loss & bone loss 33Dr. Majdy IDREES

Disease severity Based on attachment loss Slight (mild): 1-2 mm of clinical attachment loss has occurred Moderate: 3-4 mm of clinical attachment loss has occurred Severe: 5 mm or more clinical attachment loss has occurred 34Dr. Majdy IDREES

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The distribution of periodontitis in individual cases is described by combining the preceding terms as follows: Generalized OR Localized Mild OR Moderate OR Sever Chronic periodontitis Generalized moderate chronic periodontitis 36Dr. Majdy IDREES

Risk factors for chronic periodontitis Periodontitis is considered to be a multifactorial disease in which the normal balance between microbial plaque & host response is disrupted Systemic factors Environmental & behavioral factors Genetic predisposition 37Dr. Majdy IDREES

Systemic Factors Rate of progression of chronic periodontitis is generally considered to be slow Systemic disease that influences the effectiveness of the host response, the rate of periodontal destruction may be significantly increased 38Dr. Majdy IDREES

Environmental and Behavioral Factors Positive association between smoking & PD diseases Smokers with chronic periodontitis have more attachment & bone loss, more funation involvements, & deeper pockets Emotional stress also may influence the extent and severity of chronic periodontitis 39Dr. Majdy IDREES

Genetic Factors The twin studies have indicated that risk of chronic periodontitis has a high inherited component Patients with the IL-1 genotype increased the risk for tooth loss by 2.7 times The combined effect of the IL-1 genotype & smoking increased the risk of tooth loss by 7.7 times 40Dr. Majdy IDREES

Thank you 41Dr. Majdy IDREES Your references for this lecture: Carranza 11 th edition Parameters of periodontal diseases, J Perio, may 2000 (supplement) Power point presentation