Gingivitis versus Periodontitis Gingivitis is the inflammation of a periodontium with no attachment loss or with previous attachment loss that is stable and not progressing. Periodontitis is the inflammation of a periodontium caused by specific microorganisms resulting in progressive destruction of the PDL and alveolar bone (attachment loss) with pocket formation, recession or both.
Periodontitis Chronic Periodontitis Aggressive Periodontitis Periodontitis as a Manifestation of Systemic Diseases: 1. Associated with hematological disorders 2. Associated with genetic disorders 3. Not otherwise speciﬁed (NOS)
Chronic Periodontitis Also known as adult periodontitis The most common form of periodontitis Most prevalent in adults (about 35??????), can occur in children Associated with plaque and calculus accumulation Subgingival calculus is frequently found Slow to moderate progression of destruction
Chronic Periodontitis Clinical characteristics: Microbial plaque formation Periodontal inflammation Loss of attachment and alveolar bone
Chronic Periodontitis Subclassified into: Localized chronic periodontitis (< 30% of sites involved) Generalized chronic periodontitis (> 30% of sites involved) Slight chronic periodontitis 1 to 2 mm clinical attachment loss Moderate chronic periodontitis 3 to 4 mm of clinical attach. loss Severe chronic periodontitis ≥ 5 mm of clinical attachment loss
Chronic Periodontitis Some factors cause an increase of disease progression: Local factors influence the plaque accumulation systemic factors influence the host response Environmental factors such as smoking and stress influence also the host response No clear evidence for genetic predisposition???
Aggressive Periodontitis Clinically healthy patient Rapid rate of disease progression Absence of large accumulations of plaque and calculus Family history (genetic predisposition) Diseases sites often infected with actinobacillus actinomycetemcomitans Abnormalities in phagocyte function Hyperresponsive macrophages Self arresting progression
NUG: Necrotizing Ulcerative Gingivitis Is the most common type of acute gingivitis. It has been described since ancient Greek times, and frequently affected troops fighting in the trenches during WW1. Develop quickly eg hours to days; Usually associated with PAIN, discomfort, perhaps swelling, fever, feeling unwell
NUG: Necrotizing Ulcerative Gingivitis usually associated with spontaneous gingival bleeding require immediate attention Other (older) names: Trench mouth Ulcero-membranous g. Vincent’s gingivitis
NUG: Necrotizing Ulcerative Gingivitis Etiology and risk factors: Caused by specific bacterial groups: Fusiform bacillus spirochetes Smoking Poor oral health / pre-existing chronic gingivitis Stress HIV infection malnutrition
NUG: Necrotizing Ulcerative Gingivitis Signs: Cater-like depressions at the crest of the crest of the interdental papilla The depressions are necrotic, covered by a gray (white yellowish) pseudomembranous slough. Red erythematous halo Very severe halitosis Spontaneously bleeding gingiva May have fever, swollen submandibular lymph nodes Increased salivation
NUG and HIV Non-resolving NUG after conventional treatment could indicate that the patient has HIV infection that is progressing to AIDS. The best thing to do is send the patient to their general medical practitioner to have blood screen
NUP: Necrotizing Ulcerative periodontitis May be an extension of NUG (different severity levels) More commo by immuno-compromised Patients (HIV) Clinical appearance same as NUG with Presence of attachment loss Interdental osseous craters No pockets because of recessions Etiology same as NUG