CDM 1070 Module 4 2011 Lecturer Diana Bronstein Doctor of Dental Surgery Master of Science in Oral Biology Diplomate

of the American Academy of Periodontology Diplomate and Fellow of the International Congress of Oral Implantology

I.
II. III.

IV.
V.

VI.
VII. VIII.

Gingival Diseases Chronic Periodontitis Aggressive Periodontitis Periodontitis as a Manifestation of Systemic Diseases Necrotizing Periodontal Diseases Abscesses of the Periodontium Periodontitis Associated with Endodontic Lesions Developmental or Acquired Deformities and Conditions

A.

Plaque Induced** 1. Associated with plaque only 2. Modified by systemic factors 3. Modified by medications 4. Modified by malnutrition

**can occur in a periodontium with no attachment loss or on a periodontium with attachment loss that is not progressing

1. 2. 3. 4.

Tooth anatomic factors Dental restorations/appliances Root fractures Cervical root resorption and cemental tears

Phenytoin-Incidence ~50% Cyclosporine-Incidence ~30% Nifedipine -Incidence ~15%

1. Gingival diseases of specific bacterial origin:

a. b.

c.
d.

Neisseria gonorrhea Treponema pallidum Streptococcal species other

a. Herpesvirus infections 1. Primary Herpetic Gingivostomatitis 2. Recurrent Oral Herpes 3. Varicella-Zoster Infections b. Other

a. Candida-species infections 1. Generalized gingival candidosis b. Linear gingival erythema c. Histoplasmosis d. other

a.

Mucotaneous Disorders 1. Lichen planus 2. Pemphigoid 3. Pemphigus vulgaris 4. Erythema multiforme 5. Lupus erythematosus 6. Drug-induced 7. Other

1.

Dental restorative materials a. Mercury b. Nickel c. Acryllic d. Other

a. b. c. d.

Toothpastes/dentifrices Mouthrinses/mouthwashes Chewing gum additives Food and additives

3. Other

a. b. c.

Chemical injury Physical injury Thermal injury

7. 8.

Foreign Body Reactions Not otherwise specified (NOS)

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

An infectious disease resulting in inflammation within the supportive tissues of the teeth, progressive attachment, and bone loss. It is characterized by pocket formation and/or gingival recession. It is recognized as the most frequently occurring form of periodontitis. Its onset may be at any age, but is more commonly detected in adults. The prevalence and severity increases with age. It may affect a variable number of teeth and it has variables rates of progression.

Can be further characterized by extent and severity.

A.
B.

Localized ( 30%) Generalized ( 30%)

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

A. B.

Localized Generalized

13 years old

15 years old

Aggressive Periodontitis

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

Microbial dental plaque is the initiator of periodontal disease but whether it affects a particular subject, what form the disease takes, and how it progress, are all dependent on the host defenses to this challenge.

Systemic factors modify all forms periodontitis principally through their effects on the normal immune and inflammatory defenses.

The possible role of systemic diseases and systemic exposures in initiating or modifying the progress of periodontal disease is clearly a complex issue.

It is however generally agreed that several conditions may give rise to an increased prevalence, incidence or severity of gingivitis and periodontitis.

A. Associated with Hematological disorders B. Associated with Genetic Disorders C. Not otherwise specified (NOS)

A. Associated with Hematological Disorders B. Associated with Genetic Disorders C. Not otherwise specified (NOS)

IV. Periodontitis as a Manifestation of Systemic Diseases

A. Associated with Hematological Disorders

1. Acquired neutropenia 2. Leukemias 3. Other

IV. Periodontitis as a Manifestation of Systemic Diseases

A. Associated with Hematological disorders B. Associated with Genetic Disorders C. Not otherwise specified (NOS)

IV. Periodontitis as a Manifestation of Systemic Diseases

B. Associated with Genetic Disorders
1. 2. 3. 4. 5.

6.
7. 8. 9.

10.
11. 12.

Familial and cyclic neutropenia Down syndrome Leukocyte adhesion deficiency syndromes Papillon-Lefvre syndrome ChediakHigachi syndrome Histiocytosis syndrome Glycogen storage disease Infantile genetic agranulocytosis Cohen Syndrome Ehlers-Danlos syndrome (Types IV and VIII) Hypophosphatasia Other

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

A. B.

Necrotizing Ulcerative Gingivitis (NUG) Necrotizing Ulcerative Periodontitis (NUP)

Necrotizing Ulcerative Gingivitis (NUG) This is an infection characterized by gingival necrosis presenting as punched-out papillae, with gingival bleeding, and pain.

Fetid breath and pseudomembrane formation may be secondary diagnostic features.

Necrotizing Ulcerative Periodontitis (NUP) This is an infection characterized by necrosis of gingival tissues, periodontal ligament, and alveolar bone. These lesions are most commonly observed in individuals

with systemic conditions including, but not limited to HIV infection, severe malnutrition, and immunosuppression.

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

A. B. C.

Gingival Abscess Periodontal Abscess Pericoronal Abscess

A.
B.

C.

Gingival Abscess: A localized purulent infection that involves the marginal gingiva or interdental papilla. Periodontal Abscess: A localized purulent infection within the tissues adjacent to the periodontal pocket that may lead to the destruction of periodontal ligament and alveolar bone. Pericoronal Abscess: A localized purulent infection within the tissue surrounding the crown of a partially erupted tooth.

Gingival Abscess

Periodontal Abscess

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

A.

Combined periodontic-endodontic lesions

Gingival Diseases II. Chronic Periodontitis III. Aggressive Periodontitis IV. Periodontitis as a Manifestation of Systemic Diseases V. Necrotizing Periodontal Diseases VI. Abscesses of the Periodontium VII. Periodontitis Associated with Endodontic Lesions VIII. Developmental or Acquired Deformities and Conditions
I.

A.

B. C. D.

Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis Mucogingival deformities and conditions around teeth Mucogingival deformities and conditions on edentulous ridges Occlusal trauma

A.

B.

C.

D.

Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis Mucogingival deformities and conditions around teeth Mucogingival deformities and conditions on edentulous ridges Occlusal trauma

A.

Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis

1. 2. 3. 4. Tooth anatomic factors Dental restorations/ appliances Root fractures Cervical root resorption and cemental tears

Dental restorations

Tooth anatomic factors

Root fractures

A.

B.

C.

D.

Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis Mucogingival deformities and conditions around teeth Mucogingival deformities and conditions on edentulous ridges Occlusal trauma

A departure from the normal dimension and morphology of and/or interrelationship between gingiva and alveolar mucosa. The abnormality may be associated with a deformity of the underlying alveolar bone.

B. Mucogingival deformities and conditions around teeth

1.
2. 3. 4. 5.
a. b.

Gingival/soft tissue recession

Facial or lingual surfaces Interproximal (papillary)

a. b. c. d.

Lack of Keratinized gingiva Decreased vestibular depth Aberrant frenum/muscle position Gingival excess
Pseudopocket Inconsistent gingival margin Excessive gingival display Gingival enlargement

6.

Abnormal color

Gingival/soft tissue recession

Aberrant frenum/muscle position

A.

B.

C.
D.

Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis Mucogingival deformities and conditions around teeth Mucogingival deformities and conditions on edentulous ridges Occlusal trauma

C. Mucogingival deformities and conditions on edentulous ridges 1. Vertical and/or horizontal ridge deficiency 2. Lack of gingiva/keratinized tissue 3. Gingival/soft tissue enlargement 4. Aberrant frenum/muscle position 5. Decreased vestibular depth 6. Abnormal color

Vertical and/or horizontal ridge deficiency Lack of gingiva/ keratinized tissue

A.

B.

C.

D.

Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis Mucogingival deformities and conditions around teeth Mucogingival deformities and conditions on edentulous ridges Occlusal trauma

D. Occlusal Trauma

1. Primary occlusal trauma 2. Secondary occlusal trauma

Injury resulting in tissue changes within the attachment apparatus as a result of occlusal force(s).

1.

1) 2) 3)

Primary occlusal trauma Injury resulting in tissue changes from excessive occlusal forces applied to a tooth or teeth with normal support. It occurs in the presence of : normal bone levels, normal attachment levels, and excessive occlusal force(s).

2.

1)
2) 3)

Secondary occlusal trauma Injury resulting in tissue changes from normal or excessive occlusal forces applied to a tooth or teeth with reduced support. It occurs in the presence of : bone loss, attachment loss, and normal/ excessive occlusal force(s).