periodontitis chronic

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Defnition

Chronic Periodontitis can be definedasan infectious disease resulting ininflammation within the supporting

tissues of the teeth, progressiveattachment loss, and bone loss.

- Previously known as adult periodontitisor chronic adult periodontitis.

- Occur as a result of extension ofinflammation from the gingiva intodeeper periodontal tissue.

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Common Characteristics

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

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Extent & Severity

Extent:Localied! "#$% of sites affected

&eneralied! ' #$% of sites affected

Severity: entire dentition or individualteet(/siteSlig(t ) *-+ mm ,L

Moderate ) #-. mm ,L

Severe ) mm ,L

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Clinical Characteristics

&ingiva

moderately swollen

0eep red to bluis(-

red tissues 1lunted and rolled

gingival margin

,ratered papilla 1leeding and/or

suppuration

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Clinical Characteristics

Plaque/calculus

deposits

2ariable pocket

dept(s Loss of periodontal

attac(ment

3oriontal/verticalbone loss

4oot( mobility

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CLASSIFICATION

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A) Based on Disease Distribution:

Localized:Periodontitis is considered localized when


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Sub classifcation o ChronicPeriodontitisSeverity Pocket

0ept(s,L 1one

Loss5urcation

6arly .- mm *-+ mm Slig(t

(oriontal

Moderate -7 mm #-. mm Sl 8 mod

(oriontal

9nvolved

dvanced ' 7 mm mm Mod-severe

(oriontal

vertical

9nvolved

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DISEASE DISTRIBUTION : It is a site-specificdisease

CLINICAL SINS -

- 9nflammation :pocket formation :attac(ment loss :boneloss - ll caused by site specific effects of a sub-gingivalplaque accumulation

- 4(at is w(y t(e effect are on one side only 8ot(ersurface may maintain normal attac(ment level

- 6g-pro


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SYMPTOMS

Patient notices -

* gum bleed

+ space appear between teet( due to toot( movement

# May be painless =sleeping disease >goes unnoticed

. Some time pain due to caries : root (ypersensitivity

4o cold /(ot or bot(

? P9@-may be-- dullAdeep radiating in t(e Baw

7 rea of food impaction can cause more discomfort

C May be gingival tenderness or itc(iness found


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Periodontal Pathogens

D &ram negative organism dominate

D Pg: Pi: a may infiltrate!

D - 9ntercellular spaces of t(e epit(elium

D - 1etween deeper epit(elial cells

D - 1asement lamina

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Periodontal PathogensContn Pathogens include:

@onmotile rods! 5acultative!

Actinoacillus a. E.c

naerobic: P. g.! P. i.! ".f.! #.n.

Motile rods! 5acultative!

$.r.

Spiroc(etes! naerobic: motile!

"reponema denticola

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Pathogenesis Pocketormation

1acterial c(allenge

initiates initial

lesion of gingivitis

Eit( diseaseprogression F

c(ange in

microorganisms

development ofperiodontitis

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Pocket ormation

,ellular F fluid inflammatory e


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Pocket ormation

,ontinued

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Pocket ormation

$ontinue inflammation:,oronal e


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Develo!ment o PeriodontalPocket

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Continuous Cycle"

Plaque gingival inflammation

pocket formation more plaque

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Classifcation o Pockets

&ingival:

,oronal migration of gingival margin

Periodontal:

pical migration of epit(elial attac(ment

H Suprabony!1ase of pocket coronal to (eig(t of alveolar crest

H 9nfrabony!1ase of pocket apical to (eig(t of alveolar crest

,(aracteried by angular bony defects

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#isto!athology

$onnective "issue:6dematous

0ense infiltrate!

H Plasma cells =C$%>H Lymp(ocytes: PM@s

1lood vessels proliferate: dilate F are engorged

2arying degrees of degeneration in addition to

newly formed capillaries: fibroblasts: collagenfibers in some areas

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#isto!athology

Periodontal pocket:Lateral wall s(ows most severe

degeneration

6pit(elial proliferation F degenerationIete pegs protrude deep wit(in ,4

0ense infiltrate of leukocytes F fluid found inrete pegs F epit(elium

0egeneration F necrosis of epit(elium leadsto ulceration of lateral wall: e


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Clinical & #isto!athologiceatures $linical :

* Pocket wall bluis(-

red

+ Smoot(: s(inysurface

# Pitting on pressure

'istopathology:

* 2asodilation F

vasostagnation

+ 6pit(elialproliferation: edema

# 6dema F

degeneration of

epit(elium

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Clinical & #isto!athologiceaturesContn $linical:* Pocket wall may be

pink F firm

+ 1leeding wit( probing

# Pain wit(

instrumentation

'istopathology:

* 5ibrotic c(anges

dominate

2. blood flow:

degenerated: t(in

epit(elium

# Jlceration of pocketepit(elium

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Clinical & #isto!athologiceaturesContn $linical :* 6


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Stages o PeriodontalDisease

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$oot Surace %all

Periodontal disease affects root surface:Perpetuates disease

0ecay: sensitivity

,omplicates treatment 6mbedded collagen fibers degenerate

cementum e


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$oot Surace %all

Contn @ecrotic areas of cementum form;clinically soft

ct as reservoir for bacteria

Ioot planing may remove necrotic areas

firmer surface

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n'ammatory Path(ay

Stages 9-999 8 inflammation degradesgingival fibers Spreads via blood vessels!

(nterproximal: Loose ,4 transseptal fibers marrow

spaces of cancellous bone periodontalligament supraony pockets )

hori*ontal one loss transseptal fiberstransverse (oriontally

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n'ammatory Path(ayContn (nterproximal:

Loose ,4 periodontal ligament bone

infraony pockets ) vertical one loss

transseptal fibers transverse in obliquedirection

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n'ammatory Path(ayContn #acial ) +ingual:

Loose ,4 along periosteum marrow

spaces of cancellous bone supporting

bone destroyed first

alvoelar bone properperiodontal ligament supraony pocket

) hori*ontal one loss

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n'ammatory Path(ayContn #acial) +ingual:

Loose ,4 periodontal ligament

destruction of periodontal ligament fibers

infraony pockets ) vertical or angular oneloss

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Periodontal Disease

)ctivity ,ursts of activity followed byperiodsofuiescencec(aracteried by!Ieduced inflammatory response

Little to no bone loss F ,4 loss ccumulation of &ram negative organisms

leads to!1one F attac(ment loss

1leeding: e


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Periodontal Disease

)ctivity Period of activity followed by period ofremission!ccumulation of &ram positive bacteria

,ondition somew(at stabilied

Periodontal destruction is site specific

P0 affects few teet( at one time: or

some surfaces of given teet(

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Prevalence:

Chronic Periodontitis increases inpre!a"ence # se!erit$ %ith a&e'

Affect both the se(es e)*a""$'

It is an a&e-associated+ not a&e re"ateddisease'


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I9SK 5,4OIS 5OI 09S6S6!

*> PI9OI 39S4OI O5 P6I9O0O@4949S A predictor-,ore ris for

de!e"opin& da,a&e to periodonti*,'

+> LO,L 5,4OIS!Plaque ccumulation

Ora" .$&iene

Tooth /a"position

Restoration

Preserve F uantity of certain bacteria

.ost defensesS*b&in&i!a" Restoration

En!iron,ent

Ca"c*"*s+ s,oin&

,onnective 4issue destructionenetic inf"*ence

Inf"a,,ationPeriodontopathic bacteria

S,oin&+ Ca"c*"*s

Loss of ttac(ment

&

'

D(

*

(

+

A

,

#

'

-


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01 S2STE/IC 3ACTORS: T$pe II or Non 4 Ins*"in dependent Diabetes

,e""it*s 5NIIDD/1

61 EN7IRON/ENTAL # BE.A7IORAL3ACTORS:S,oin&E,otiona" Stress

81 ENETIC 3ACTORS:3re)*ent a,on& fa,i"$ ,e,bers and across

different &enerations'


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MANAGEMENT 4(e treatment consists of 8

* @on-surgical procedures Scaling

Ioot planing

,urettage

+ Surgical procedure Pocket reduction surgery

H Resecti!eH Re&enerati!e

,orrection of morp(ological / anatomic defects


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*verall Prognosis

ependent on:,lient compliance

Systemic involvement

Severity of condition

N of remaining teet(

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Prognosis o ndividual

+eeth ependent on:ttac(ment levels: bone (eig(t

Status of adBacent teet(

4ype of pockets! suprabony: infrabony

5urcation involvement

Ioot resorption

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,C-s on ChronicPeriodontitis

*1acteria considered to be pat(ogenic

in c(ronic periodontitis is/are!

a> P gingivalis

b> P intermedia

c> actinomycetemcomitans

d> 1ot( =a> and =b>

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+ 4(e clinical attac(ment loss in

Moderate periodontitis is

a> * to + mm

b> + to # mm

c> # to . mm

d> mm or more

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#5ollowing (istopat(ological c(anges occur in

periodontium w(ile pocket formation

e ,ellular F fluid inflammatory e pical migration of Bunctional epit(elium

along root

c> pical portion of G6 detac(es

d> @one of t(e above

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. Iisk factors for c(ronic periodontitis

include!

* Prior (istory of periodontitis

+ Plaque accumulation on toot( and

gingival surfaces

# 4ype + diabetes

. ll of t(e above

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4(e treatment possibilities of c(ronic

periodontitis include

a> @onsurgical periodontal t(erapy

b> Pocket reduction surgery

c> ,orrection of morp(ological /

anatomic defects

d> ll of t(e above

periodontitis chronic

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