Chronic Periodontitis can be defined as “an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss.”
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Chronic Periodontitis can be defined as “an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss.” Chronic Periodontitis can be defined as “an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss.” - Previously known as adult periodontitis or slowly progressive periodontitis. - Occur as a result of extension of inflammation from the gingiva into deeper periodontal tissue. Onset - any age; most common in adults Onset - any age; most common in adults Plaque initiates condition Subgingival calculus common finding Slow-mod progression; periods of rapid progression possible Modified by local factors/systemic factors/stress/smoking Extent: Extent: Severity: entire dentition or individual teeth/siteSlight = 1-2 mm CAL Moderate = 3-4 mm CAL Severe = 5 mm CAL Gingiva moderately swollen Gingiva moderately swollen Deep red to bluish-red tissues Blunted and rolled gingival margin Cratered papilla Bleeding and/or suppuration Plaque/calculus deposits Plaque/calculus deposits Variable pocket depths Loss of periodontal attachment Horizontal/vertical bone loss Tooth mobility DISEASE DISTRIBUTION : It is a site-specific disease DISEASE DISTRIBUTION : It is a site-specific disease CLINICAL SIGNS - - Inflammation ,pocket formation ,attacment loss ,bone loss - All caused by site specific effects of a sub-gingival plaque accumulation - That is why the effect are on one side only –other surface may maintain normal attachment level. - Eg.-proximal surface with plaque may have C.A.L. - And plaque free surface –FACIALsurface of same tooth may be without disease. Patient notices- Patient notices- gum bleed space appear between teeth due to tooth movement May be painless (sleeping disease )goes unnoticed Some time pain due to caries , root hypersensitivity To cold /hot or both PAIN-may be-- dull—deep radiating in the jaw Area of food impaction can cause more discomfort May be gingival tenderness or itchiness found Gram negative organism dominate Gram negative organism dominate P.g., P.i., A.a. may infiltrate: - Intercellular spaces of the epithelium - Between deeper epithelial cells - Basement lamina Pathogens include: Pathogens include: Nonmotile rods: Motile rods: Spirochetes: Bacterial challenge initiates initial lesion of gingivitis With disease progression & change in microorganisms development of periodontitis Cellular & fluid inflammatory exudate degenerates CT Cellular & fluid inflammatory exudate degenerates CT Gingival fibers destroyed Collagen fibers apical to JE destroyed infiltration of inflammatory cells & edema Apical migration of junctional epithelium along root Coronal portion of JE detaches Continued extension of JE requires healthy epithelial cells! Continued extension of JE requires healthy epithelial cells! Necrotic JE slows down pocket formation Pocket base degeneration less severe than lateral Continue inflammation: Continue inflammation: Coronal extension of gingival margin JE migrates apically & separates from root Lateral pocket wall proliferates & extends into CT Leukocytes & edema Infiltrate lining epithelium Varying degrees of degeneration & necrosis Plaque gingival inflammation pocket formation more plaque Plaque gingival inflammation pocket formation more plaque Gingival: Gingival: Coronal migration of gingival margin 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 Connective Tissue: Connective Tissue: Edematous Dense infiltrate: Plasma cells (80%) Lymphocytes, PMNs Blood vessels proliferate, dilate & are engorged. Varying degrees of degeneration in addition to newly formed capillaries, fibroblasts, collagen fibers in some areas. Periodontal pocket: Periodontal pocket: Lateral wall shows most severe degeneration Epithelial proliferation & degeneration Rete pegs protrude deep within CT Dense infiltrate of leukocytes & fluid found in rete pegs & epithelium Degeneration & necrosis of epithelium leads to ulceration of lateral wall, exposure of CT , suppuration Clinical : Clinical : Pocket wall bluish-red Smooth, shiny surface Pitting on pressure Clinical: Clinical: Pocket wall may be pink & firm Bleeding with probing Pain with instrumentation Clinical : Clinical : Exudate Flaccid tissues Periodontal disease affects root surface: Periodontal disease affects root surface: Perpetuates disease Decay, sensitivity Complicates treatment Embedded collagen fibers degenerate cementum exposed to environment Bacteria penetrate unprotected root Necrotic areas of cementum form; clinically soft Necrotic areas of cementum form; clinically soft Act as reservoir for bacteria Root planing may remove necrotic areas firmer surface Stages I-III – inflammation degrades gingival fibers Stages I-III – inflammation degrades gingival fibers Spreads via blood vessels: Interproximal: Loose CT transseptal fibers marrow spaces of cancellous bone periodontal ligament suprabony pockets & horizontal bone loss transseptal fibers transverse horizontally Interproximal: Interproximal: Loose CT periodontal ligament bone infrabony pockets & vertical bone loss transseptal fibers transverse in oblique direction Facial & Lingual: Facial & Lingual: Loose CT along periosteum marrow spaces of cancellous bone supporting bone destroyed first alvoelar bone proper periodontal ligament suprabony pocket & horizontal bone loss Facial & Lingual: Facial & Lingual: Loose CT periodontal ligament destruction of periodontal ligament fibers infrabony pockets & vertical or angular bone loss Bursts of activity followed by periods of quiescence characterized by:Bursts of activity followed by periods of quiescence characterized by:Reduced inflammatory response Little to no bone loss & CT loss Accumulation of Gram negative organisms leads to: Bone & attachment loss Bleeding, exudates May last days , weeks, months Period of activity followed by period of remission: Period of activity followed by period of remission: Accumulation of Gram positive bacteria Condition somewhat stabilized Periodontal destruction is site specific PD affects few teeth at one time, or some surfaces of given teeth Prevalence: Prevalence: Chronic Periodontitis increases in prevalence & severity with age. Affect both the sexes equally. It is an age-associated, not age related disease. RISK FACTORS FOR DISEASE: RISK FACTORS FOR DISEASE: 1) PRIOR HISTORY OF PERIODONTITIS— predictor-more risk for developing damage to periodontium. 2) LOCAL FACTORS: Plaque AccumulationOral Hygiene Tooth Malposition Restoration Preserve & Quantity of certain bacteriaHost defences Subgingival Restoration Environment Calculus, smoking Connective Tissue destructionGenetic influence Inflammation Periodontopathic bacteria Smoking, Calculus Loss of Attachment 3) SYSTEMIC FACTORS: 3) SYSTEMIC FACTORS: Type II or Non – Insulin dependent Diabetes Mellitus (NIIDDM) 4) ENVIRONMENTAL & BEHAVIORAL FACTORS: 5) GENETIC FACTORS: Frequent among family members and across different generations. GENERAL CONCEPT FOR ETIOLOGY OF CHRONIC PERIODONTITIS Plaque accumulation Maturation of Plaque Quality & Quantity of periodontopathic Plaque accumulation Maturation of Plaque Quality & Quantity of periodontopathic bacteria InflammationPlaque accumulation Maturation of Plaque Quality & Quantity of periodontopathic bacteria Inflammation Connective tissue destruction. Connective tissue destruction. bacteria Inflammation Connective tissue destruction. The treatment consists of – The treatment consists of – Non-surgical procedures Scaling Root planing Curettage Surgical procedure Dependent on: Dependent on: Client compliance Systemic involvement Severity of condition # of remaining teeth Dependent on: Dependent on: Attachment levels, bone height Status of adjacent teeth Type of pockets: suprabony, infrabony Furcation involvement Root resorption Dostları ilə paylaş:
