1. Dr Jamal Naim PhD in Orthodontics Pre-clinical Periodontics Periodontitis

2. Classification of periodontal diseases

3. 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.

4. Gingivitis versus Periodontitis

5. 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)

6. 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

7. Chronic Periodontitis Clinical characteristics: Microbial plaque formation Periodontal inflammation Loss of attachment and alveolar bone

8. Chronic Periodontitis Normal moderateSevere

9. 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

10. Chronic Periodontitis/generalized

11. 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???

12. 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

13. Aggressive Periodontitis

14. Aggressive Periodontitis/localized

16. Aggressive Periodontitis

18. Periodontitis as a Manifestation of Systemic Diseases Influence of host response Confusing with other forms Normally no major predisposing factors (plaque etc.) are evident

19. Periodontitis as a Manifestation of Systemic Diseases

21. Papillon lefevre syndrom

22. Classification of periodontal diseases

23. 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

24. NUG: Necrotizing Ulcerative Gingivitis usually associated with spontaneous gingival bleeding require immediate attention Other (older) names: Trench mouth Ulcero-membranous g. Vincent’s gingivitis

25. 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

26. 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

27. NUG: Necrotizing Ulcerative Gingivitis Localised NUG Generalised ANUG

28. 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

29. 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

30. NUP: Necrotizing Ulcerative periodontitis