Transcript Tissue of the teeth

Pre-clinical Periodontics
Periodontitis
Dr Jamal Naim
PhD in Orthodontics
Classification of periodontal diseases
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.
Gingivitis versus Periodontitis
Periodontitis
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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
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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
Normal
moderate
Severe
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/generalized
Chronic Periodontitis
Some factors cause an increase of disease
progression:

Local factors influence the plaque accumulation

systemic factors influence the host response
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Environmental factors such as smoking and stress
influence also the host response
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No clear evidence for genetic predisposition???
Aggressive Periodontitis
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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
Aggressive Periodontitis
Aggressive Periodontitis/localized
Aggressive Periodontitis/localized
Aggressive Periodontitis
Aggressive Periodontitis
Periodontitis as a Manifestation of
Systemic Diseases
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Influence of host response
Confusing with other forms
Normally no major predisposing factors (plaque etc.)
are evident
Periodontitis as a Manifestation of
Systemic Diseases
Periodontitis as a Manifestation of
Systemic Diseases
Periodontitis as a Manifestation of
Systemic Diseases
Papillon lefevre syndrom
Classification of periodontal diseases
NUG: Necrotizing Ulcerative Gingivitis
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Is the most common type of acute gingivitis.
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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
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require immediate attention
Other (older) names:
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Trench mouth
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Ulcero-membranous g.
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Vincent’s gingivitis
NUG: Necrotizing Ulcerative Gingivitis
Etiology and risk factors:
Caused by specific bacterial groups:
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Fusiform bacillus
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spirochetes
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Smoking
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Poor oral health / pre-existing chronic gingivitis
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Stress
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HIV infection
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malnutrition
NUG: Necrotizing Ulcerative Gingivitis
Signs:
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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.
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Red erythematous halo
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Very severe halitosis
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Spontaneously bleeding gingiva
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May have fever, swollen submandibular lymph nodes
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Increased salivation
NUG: Necrotizing Ulcerative Gingivitis
Generalised ANUG
Localised NUG
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)
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More commo by immuno-compromised Patients (HIV)
Clinical appearance same as NUG with
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Presence of attachment loss
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Interdental osseous craters
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No pockets because of recessions
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Etiology same as NUG
NUP: Necrotizing Ulcerative periodontitis