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Classifying Periodontal disease (Chronic Periodontitis: A complex within…
Classifying Periodontal disease
Probing depth
: The distance from the gingival margin to the most apical extent of the probe or where the physical resistance of the probe is met
Pocket
: Pathologically deepened gingival sulcus
Gingival Pocket
: The junctional epithilium is at the CEJ with no loss of attachment, increased probing depth is due to enlarged or swollen gingiva.
Periodontal pocket
:
Are the result of DESTRUCTION of the coronal part of the junctional epithelium and CT. attachment to the tooth surface at the junctional epithelium
The J.E. has migrated apically due to the gingival or peridontal fiber loss attachment, the gingiva may or may not be enlarged or swollen, Bone loss is usually present.
Attachment loss
: measurement from the CEJ to the to the approximate location of the junctional epithelium
Gingivitis:
MOST COMMON TYPE OF PERIDONTAL DISEASE Inflammation and No Attachment loss
3 STAGES
:
INITIAL LESION
:develops within 4 days of plaque biofilm accumulation; sulcus heavily populated with gram-positive cocci.
EARLY LESION
: inflammation can be detected clinically after 7 days; gram negative bacteria begin to flourish.
ESTABLISHED LESION
:Bleeding upon probing; spirochetes and gram-neg. rods are detected microscopically.
ACUTE
: Gingivits of short duration, after which professional care and patient self care returns to the gingiva to healthy state.
Chronic gingivitis
: Long lasting gingivitis; gingivitis may exist for years without ever progression to periodontitis
Chronic Periodontitis
: A complex within the supporting tissues of the teeth, progressive destruction of the PDL and loss of supporting alveolar bone. It is initiated and sustained by plaque biofilms, host factors determine pathogenesis and rate of progression.
Signs and symptoms
: Swelling redness, gingival bleeding, periodontal pockets, bone loss, tooth mobility, suppuration, moderate or heavy deposits of biofilms, and dental calculus. Painless.
Overview
: Irreversible loss of attachment, most frequent occurring form of peridontitis, MADE MORE SEVERE: by smoking, and systemic diseases. May involve one area of a tooths attachment, several teeth, or all teeth. TX: includes stopping progression of disease and prevent further attachment loss. Scaling and root planning, changing home care and introducing adjuncts as necessary. Shorter recare appts
Histologically
: Vasodialation,Increase or decrease in collagen Increase or decrease in fluid. Microbiologically: P.Gingivalis T. Forsythensis P. Intermedia E. Corrodens
Slight
: Good if caught early, home care is adopted, there are few residual pockets and no systemic disease. 1-2 mm CAL
Moderate
: Good if few residual pockets and no systemic diseases, Fair if many residual pockets/or systemic disease. Poor is you are a Smoker.3-4mm CAL
Severe
or ADVANCED: Fair or guarded due to root surface involvement and difficult areas to maintain. Poor if your a Smoker. 5mm or more CAL
Localized: 7-8 teeth involved
Generalized: more than 8 teeth
Agressive Periodontitis
: A complex bacterial infection characterized by a rapid destruction of the PDL, rapid loss of supporting bone, high risk for tooth loss, and poor response to periodontal therapy in and otherwise healthy individual.
Signs and symptoms
: Gingiva WNL or slight signs of inflammation. Onset happens around age 13 or puberty. Localized attachment loss confined to central incisors and 1st molars. By age 30 if not self arresting Generalized Severe Periodontitis
Histologically
: Tissue invaded with bacteria, rapid destruction of collagen fibers and bone, Immune response impaired. Microbiologically: Aggregatibacter actinomycetemcomitans, T. Forsynthesis, F. Nuleatum, E. Corrodens, and Spirochetes. FAMILY HISTORY (genetic) Decreased immune response: decreased PMN's and granulocytes, Decrease in chemotaxis, Decrease in phagocytosis. A.A. involvement.
Tx
: scaling and root planning, Antibiotics, Frequent recare, Refer to periodontist.
Outcomes
: Fair , limited, gaurded- if caught early enough and there is a response to treatment. Poor is there is severe destruction or no response to therapy.
Localized: 7-8 teeth involved
Generalized: more than 8 teeth
NUP: Necrotizing Ulcerative Periodontitis
, Tissue necrosis of the gingival tissues combined with loss of attachment and alveolar bone loss.
NUG: Necrotizing Ulcerative Gingivitis
-Tissue necrosis that is limited to the gingival tissues. ALSO KNOWN AS :green_cross:TRENCH MOUTH, VINCENT INFECTION
TX:
Depends upon comfort level of patient for instrumentation: supra gingival debridement with H202 and cotton swab or ultrasonic.
OHI
: brush gently with a soft brush. Nutritional counseling. Refrain from smoking, Antibiotics. Outcomes: 2-3 days acute symptoms should subside. 1 wk cont. assesment and treatment care plan. Conditions will reoccur if untreated , if no resolution following treatment; consider an immunodeficiency problem (AIDS)
Etiologic factors
: Presence of pathogens, Poor OH. Smokers, Poor nutrition, , Lack of sleep,Under stress, HIV +
Histologically
: Tissue death. Invasion of tissue by spirochetes:
Pathogens
: P. intermedia and F. nucleatum. People with AIDS also have P. gingivalis and Candida alibicans (yeast)
Signs and sympotoms
: Clinical: Red, edematous,PAINFUL, ulcerated papilla, Pseudomembrane, gray, sloughing, Fetor oris, metalic taste, spontaneous bleeding, low grade fever, general malaise, lymphodenopathy, NUP-CAL
Gingival Hyperplasia
: Overgrowth of tissue.
Histologically
: Increase in # of fibroblasts., Increase in fibers, Increase collagen, May have edema and corresponding symptoms.
Etiologic factors: Medication induced
: Phenytoin (dilantin): seizure disorder
Cyclosporine: organ transplant anti-rejection.
Ca channel blockers: HTN, or heart disease
Orthodontics: poor hygiene.
TX
: Home care, Referral to periodontist for surgical intervention (gingivectomy)
Discuss medication changes with physician
Furcation involvement:
CLASS I
: Curvature of concavity leading to furca can be felt. No more than 1mm of penetration.
CLASS II
: definitely into the furca but not all the way through.
CLASS III
: through and through the furca
CLASS IV
: Furca is visible: probe goes all the way through it
Gingival Diseases:
Dental plaque induced:
Gingivitis: associated with dental plaque only
: Without local factors, or With local contributing factors
Gingival diseases modified by systemic fatcors:
Puberty-gingivitis
Menstrual cycle-gingivits
Pregnancy-gingivitis or pyogenic granuloma
Diabetes mellitus- gingivitis
Blood Dyscrasias
:
Lukemia-gingivitis
Medications
: drug-induced gingival enlargments.
Drug-induced gingivitis( oral contraceptive gingivitis)
Gingival diseases modified by malnutrition
:
Ascorbic Acid-deficiency gingivitis
Non-plaque induced gingival lesions:
1.
Gingival diseases of specific bacterial orgin
2.
Gingival diseases of viral orgin
3.
Gingival diseases of fungal ogin
4
.Gingival lesions of genetic orgin
5.
Gingival manifestations of systemic conditions
6.
Traumatic lesions 1.Factitious(artificially produced)
2.Iatrogenic(Self-inflicted)
Accidental (Dorito)
7.
Foreign body reactions (popcorn husk)
8.
.Not otherwise specified