PERIODONTAL

DISEASE

PERIODONTAL DISEASE
Is a result of accumulation of dental plaque
at the marginal gingiva leading to
inflammation of the periodontal tissue
Prevalent in most human populations premature tooth
loss in severely affected individuals
gingivitis
Periodontal disease
- Acute
periodontitis
- Chronic
Most cases chronic condition

The Normal Periodontium

Gingival
Periodontal Ligament
Alveolar Bone
Cementum

The function : to attach the teeth into jaws

and support them effectively
during masticatory function

Healthy Periodontium

- 3 mm sulcus depth

No

suppuration

No

bleeding

The fundamental elements of the

normal periodontium

The components of the coronal part

of the normal periodontium

 Gingival : - protects the underlying connective tissue

during mastication
- the junctional epithelium attaches the
epithelium lining the mouth to the teeth.

Periodontal Ligament : fibers inserted into bone

and cementum
Alveolar Bone : the part of the mandible and
maxilla which surrounds and
supports the teeth.
Cementum : anchors the periodontal ligament fibers
to the surfaces of the tooth.

AETIOLOGY OF PERIODONTAL
DISEASE
Primary factors : bacterial plaques;

anaerob.
Secondary factors (modify the disease) :
- Locally : plaque traps, lack of saliva,
occlusal trauma
- Systemic : infections, hormonal, druginduced, haemotologycal,
nutritional, genetic.

Local Secondary Factors

mechanical plaque traps promoting
accumulation of specific site

Calculus
Carious Cavities
Overhanging Margins of Restorations
Partial dentures
Anatomic Variations
Crowding
Mal Occlusions
Persistent mouth breathing lack of saliva
drying in the anterior regions hyperplastic
gingivitis plaque accumulation

Systemic Secondary Factors

a.

Conditions which cause gingival hyperplastic

Pregnancy increase progesterone secretion alteration

in gingival vasculature and inflammatory response :
- pregnancy gingivitis
- pregnancy epulis
(pyogenic granuloma of pregnancy)
Puberty
Contraceptive pill
Anticonvulsant drug phenytoin
Immunosuppressive drug cyclosporine A
Calcium channel blocker nifedipine

pregnancy

b.

Defects in defenses resulting in

accelerated periodontal breakdown

Insulin dependent diabetes mellitus

increased periodontal breakdown
susceptibility to periodontal abscess
due to impaired neutrophil function
Leukaemia severe destructive periodontitis
associated with neutropenia
Ascorbic acid deficiency
haemmorrhagic gingivitis
increased periodontal destruction
associated with defective collagen synthesis and
vascular

leukaemia

IDDM

GINGIVITIS /
CHRONIC GINGIVITIS

Inflammations of the marginal tissues due to

accumulation of dental plaque.
Redness
Swelling
Bleeding
Painless ; may persists unchanged for many
years
Fully reversible following treatment
Untreated gingivitis to be a prerequisite for
development of periodontitis

Plaque Associated
Gingivitis

Disclosing solution to reveal

plaque

ANUG
(Acute Necrotizing Ulcerative Gingivitis)
Affect young adults : - poor oral hygiene
- defecting host response
Clinical features :
- Severely inflammed gingiva
- Necrotic ulcers interdental papillae gingival margins
- The ulcers are painfull, covered by grayish slough, with
punched out appearance
- Localized, or generalized
- foetor oris
- Acute, in absence of treatment may loss for a couple of
weeks a chronic gingivitis
- Tends to recur unless it is treated destruction of periodontal
tissues loss of interdental papillae, gingival craters

Predisposing factors :
- Pure oral hygiene
- Smoking
- emotional stress
Mixed bacterial infection by anaerobic organisms :
spirochaetes: fusiform : F. nucleatum,
Resolves rapidly following short term treatment
with metronidazole

 Pain and

(spontaneous)
bleeding
Fetor ex oris
punched out
papillae
Grey pseudomembrane
Fusospirochetal
infection

HIV- associated gingivitis/ linear

gingival erythema
It occurs before other opportunistic

infections, can be an early presenting

symptom
Un usually erythematous generalized
marginal gingivitis
Affecting wide band of both the free and
attached gingiva

HIV- associated gingivitis/ linear

gingival erythema

Periodontitis
Defined as plaque-induced inflammation of periodontal tissues which
has resulted in:
- destruction of the periodontal ligament
- loss of crestal alveolar bone
- apical migration of ephitelial attachment
(junctional epithelium)/ loss of attachment
Clinical features :
- inflammation of marginal gingiva
- Loss of attachment
- Pocket formation
- Radiographicaly : loss of alveolar bone
- Painless
- Adequate treatment result in resolution of inflammation, reduction in
pocket depth, but the tissue destruction in periodontitis is irreversible

Adult periodontitis (chronic periodontitis)

- seen in adult population
- acute exacerbation lateral periodontal
abscess : pus, swelling, pain
Early onset periodontitis :
- in young people, onset and rapid progression
- localized juvenile periodontitis
rapidly progressive periodontiitis
prepubertal periodontitis

Generalized Severely Advanced

Chronic Periodontitis

The stages of the disease

Swollen, reddened
gingiva, bleeding on
probing
Increased crevicular fluid
flow
Increased numbers of
neutrophil in junctional
epithelium and gingival
crevice
Vascularity increases
Perivascular collagen
loss

The connective tissue

infiltrate becomes
dominated by :
lymphocites,
macrophage
Cell damage,
collagen loss

Establish lesion (chronic marginal

gingivitis)

More marked edema

and reddening of
gingival margin and
interdental papillae
Gingival crevice
becomes deepened
due to gingival
swelling, no loss of
attachment

The advanced lesion (destructive

periodontitis)

True pocket formation

Loss of connective
tissue attachment
Loss of alveolar bone

Tissue Damage and disease

progression

thank
you