Diseases of paradont

Periodontitis. Idiopathic progressive

paradontoliz. Parodontomy.
Prof.Kogan E.A.
2016
Theeth Anatomy
Teeth are firmly implanted in the jaw and are
surrounded by the gingival mucosa .
The anatomic crown of the tooth projects
into the mouth and is covered by enamel, a
hard, inert,acellular tissuethe most highly
mineralized tissue in thebody.
The enamel rests upon dentin, which is a
specialized form of connective tissue that
makes up most of the remaininghard-tissue
portion of the tooth. Unlike enamel, dentin is
cellular and contains numerous dentinal
tubules, which containthe cytoplasmic
extensions of odontoblasts.
Cells line the interface between the dentin
and the pulp and can, when properly
stimulated, produce new (secondary) dentin
within the interior of the tooth

The pulp chamber itself is surroundedby the

dentin and consists of loose connective
tissue stroma rich in nerve bundles,
lymphatics, and capillaries.
 Attachment
In mammals, teeth are attached to the alveolar
ridge of the jaws by the periodontal ligament,
which provides a strong yet fl exible attachment
that can withstand the forces of mastication. The
periodontal ligamentattaches to the alveolar
bone of the jaw on one side and to cementum,
present on the roots of the teeth, which acts as
a cement to anchor the periodontal ligament to
the tooth.
 Diseases of paradont
1. Gingivitis - an inflammation of the gums caused by the adverse effects of local and
general factors and proceeding without compromising the integrity of the periodontal
attachment and displays of destructive processes in other parts of the periodontal.
Form: catarrhal, hypertrophic, peptic ulcer.
Current: acute, chronic, acute, in remission.
The severity of the process: light, moderate, heavy.
The prevalence of the process: localized (focal), generalized.

2. Periodontitis - inflammation of periodontal tissues, characterized by progressive

destruction of the periodontal ligament apparatus and the alveolar bone.
Current: acute, chronic, Aggravated (including abscess), remission.
The severity of the process (defined by clinical and radiological picture, the main
criterion - the degree of destruction of the alveolar bone):
light,
moderate,
heavy.
The prevalence of the process: localized (focal), generalized.
 Diseases of paradont
3. Periodontal disease - atrophic-dystrophic process, which applies to all
periodontal structures; feature - the absence of inflammation in the gingival
edge of the periodontal pockets.
Current: chronic, remission.
The severity of the process: light, moderate, heavy.
The process of propagation: only generalized.

4. Idiopathic periodontal disease with progressive lysis of tissue - periodontal

lesions at sindome Papillon-Lefevre. Cushing, eosinophilic granuloma (b-no
Taratynova), blood diseases, and others.

5. Parodont tumors and tumor processes:

fibromatosis gums,
periodontal cyst,
epulis.
The course - chronic
The prevalence of the process - a localized (focal), generalized
 Local predisposing factors
Anomalies and strain of jaw
Dystrophy and crowding of the teeth
malocclusion
Abnormalities of the soft tissue of the oral
cavity
Distinct bands mucosa
Anomalies attachment bridle
 Systemic predisposing factors
Endocrine diseases (diabetes, hormonal
function of the reproductive system, etc.)
Neuro-somatic diseases (rheumatism,
metabolic disorders, etc.)
Diseases of the blood
Eating disorders (hypovitaminosis)
Diseases of the digestive tract
Reduced reactivity
 GINGIVITIS

Gingiva is the designation of the

squamous mucosa in between the teeth
and around them.
Gingivitis is inflammation of the mucosa
and the associated soft tissues.
Typically, the development of gingivitis is
the result of a lack of proper oral hygiene,
leading to an accumulation of dental
plaque and calculus.
 Epidemiology of Gingivites
Gingivitis occurs at any age but is most
prevalent and severe in adolescence
(ranging from 40% to 60%), after which
the incidence tapers off. It is a reversible
disease;
 Dental plaque
Dental plaque is a sticky, usually colorless, biofilm
that builds in between and on the surface of the teeth.
It is formed by a complex of the oral bacteria, proteins
from the saliva, and desquamated epithelial cells. If
plaque continues to build andis not removed, it becomes
mineralized to form calculus (tartar).
The bacteria in the plaque release acids from
sugarrich foods, which erode the enamel surface of the
tooth.
Repeated erosions lead to dental caries. Plaque
build-up beneath the gumline can cause gingivitis.
 Gingivitis
Gingivitis - an inflammation of the gums caused by the
adverse effects of local and general factors and
proceeding without compromising the integrity of the
periodontal attachment and displays of destructive
processes in other parts of the periodontal.
Form: catarrhal, hypertrophic, peptic ulcer.
Current: acute, chronic, acute, in remission.
The severity of the process: light, moderate, heavy.
The prevalence of the process: localized (focal),
generalized.
 Forms of catarral gingivites
Acute
Bright redness of the mucous membrane
gums. The surface of the gums smooth,
shiny, swollen, bleeding on probing.
Chronic
Desna with symptoms of congestive
hyperemia, cyanotic, edematous, friable,
valikoobrazno thickened, easily bleeding
on probing.
 Chronic gingivitis
Chronic gingivitis is characterized by
gingival
erythema,
edema,
bleeding,
Changes in contour,
loss of soft-tissue adaptation to the teeth.
 Ulceratet gingivites

Prevalent in young patients with a decrease in reactivity and

decreased resistance to auto-infection of periodontal tissues of the
oral cavity (especially Gram bacteria)
The rate of 0.2-6%
Grossly - ulceration of the gingival margin with truncated tops of
papillae, the affected gum devoid of epithelial layer and covered with
fibrinous raid dirty yellow color, when you try to remove is causing
severe pain and bleeding increases; necrotic areas are separated
from the healthy line of demarcation. When removing masses
exposed painful ulcer bleeding surface, interdental papilla loses its
original shape. Regional LU enlarged and painful
Diff Diagnosis: necrotic changes of blood diseases, in case of
poisoning with heavy metal salts, HIV
APHTHOUS ULCERS (CANKER SORES)

These extremely common superfi cial

ulcerations of the oral mucosa affect up to
40% of the population in the United States.
They are more common in the first two
decades of life, are extremely painful and
often recurrent, and tend to be prevalent
within certain families.
 Hypertrophic gingivitis
gum tissue grows, covering the crown of the tooth.
In the initial stage of the process (edematous) gums soft, reddish-
bluish.
In the later stage (fibrotic) occurs seal the gum tissue, it becomes
pale.

Microscopic examination:
in edematous stage of hypertrophic gingivitis revealed dramatically
enhanced and full-blooded microvessels, edema,
limfogistioplazmotsitarnaya infiltration, proliferation of fibrous tissue
such as granulation;
Fibrous stage is characterized by a significant increase in the
amount of gum tissue collagen fibers.
 The severity of hypertrophic
gingivitis

Grade 1 (mild) - hypertrophy of the

gingival papillae 1/3 crown
Grade 2 (moderate severity) - hypertrophy
of the papillae half crown
Grade 3 (severe) - hypertrophic papilla
reach more than half, and sometimes up
to the cutting edge and the chewing
surface of the tooth
 Complications and outcomes.

Acute local gingivitis while eliminating its

cause may result in recovery.
Acute generalized gingivitis in the
liquidation of the disease, a complication
of which he is also usually disappears.
Chronically current catarrhal, ulcerative
and hypertrophic gingivitis are often
preliminary stages of periodontitis.
 Therapy of Gingivites

Therapy is primarily aimed at reducing the

accumulation of plaque andcalculus via
brushing, fl ossing, and regular dental visit
 Periodontitis
Periodontitis - inflammation of periodontal tissues,
characterized by progressive destruction of the
periodontal ligament apparatus and the alveolar bone.
Current: acute, chronic, Aggravated (including abscess),
remission.
The severity of the process (defined by clinical and
radiological picture, the main criterion - the degree of
destruction of the alveolar bone):
light,
moderate,
heavy.
The prevalence of the process: localized (focal),
generalized.
 PERIODONTITIS

Periodontitis refers to an inflammatory process that

affects the supporting structures of the teeth:
periodontal ligaments,
alveolar bone,
cementum.

With progression, periodontitis can lead to serious

sequelae, including the loss of attachment caused by
complete destruction of the periodontal ligament and
alveolar bone.
Loosening and eventual loss of teeth are possible.
 Pathogenesis of Periodontitis
Until the 1960s it was believed that longstanding
gingivitis uniformly progressed to periodontal
disease. However, this is no longer thought to be the case.

Development of periodontal disease is now considered

to be an independent process, which, for reasons that
are still unclear, is associated with a marked shift in the
types and proportions of bacteria along the gingiva. This
shift, along with other environmental conditions such as
poor oral hygiene, is believed to be important in the
pathogenesis of periodontitis.
 Paradontos
Periodontal disease - atrophic-dystrophic process, which
applies to all periodontal structures; feature - the
absence of inflammation in the gingival edge of the
periodontal pockets.
Current: chronic, remission.
The severity of the process: light, moderate, heavy.
The process of propagation: only generalized.

4. Idiopathic periodontal disease with progressive lysis of

tissue - periodontal lesions at sindome Papillon-Lefevre.
Cushing, eosinophilic granuloma (b-no Taratynova),
blood diseases, and others.


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2. -
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5.
 Paradontos
dystrophic lesions
Morphology - characterized by the
absence of inflammation in marginal
periodontitis,
the gums keratinization of
epithelium in the connective tissue
framework and sclerosis


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DESMODONTOZ
(periodontosis)
chronic generalized periodontal
lesion of unknown etiology
degenerative nature, in which
there are no effects of
inflammation; - first described in
1920 Gotlieb B. diffuse atrophy
of alveolar bone"
 Inflammatory/Reactive
Tumor-like Lesionsof Oral
Cavaty
Kogan E.A.
2016
 Epidemiology
The most common fibrous proliferative lesions of the
oral cavity include
fibroma (61%),
peripheral ossifying fibroma (22%),
pyogenic granuloma (12%),
peripheral giant-cell granuloma (5%).

The most common infl ammatory/reactive ulcerations

of the oral cavity are
traumatic
aphthous ulcers.
 Irritation fibroma
The so-called irritation fi broma primarily
occurs in the buccal mucosa along the bite
line or at the gingivodental margin. It
consists of a nodular mass of fi brous
tissue, with few infl ammatory cells,
covered by squamous mucosa.
Treatment is complete surgical excision.
 Pyogenic granuloma
The pyogenic granuloma is a highly vascular
pedunculated lesion, usually occurring in the gingiva of
children, young adults, and, commonly, pregnant women
(pregnancy tumor).

The surface of the lesion is typically ulcerated and red to

purple in color. In some cases growth is alarmingly rapid,
raising the fear of a malignant neoplasm.

Histologically these lesions demonstrate a highly

vascular proliferation that is similar to granulation tissue.
Because of this histologic picture, pyogenic granulomas
are considered by some authorities to be a form of
capillary hemangioma
 Outcomes
either regression, particularly after
pregnancy,
undergo fibrous maturation, and they may
develop into a peripheral ossifying
fibroma.

Treatment is complete surgical excision.

 Peripheral ossifying fibroma
The peripheral ossifying fi broma is a relatively common
growth of the gingiva that is considered to be reactive in
nature rather than neoplastic.
E
Etiology of the lesion is unknown. Some may arise as a result of the
maturation of a long-standing pyogenic granuloma. With a peak
incidence in young and teenage females,

Peripheral ossifying fibromas appear as red, ulcerated, and nodular

lesions of the gingiva. They are often mistaken clinically for
pyogenic granulomas.

Complete surgical excision down to the periosteum is

the treatment of choice, since these lesions have a recurrence
rate of 15% to 20%.
 Peripheral giant cell granuloma
The peripheral giant cell granuloma is a
relatively common lesion of the gingiva.
It is generally covered by intact
gingivalmucosa, but it may be ulcerated.
The clinical appearance of peripheral giant-
cell granuloma can be similar to that of pyogenic
granuloma, but which is generally more bluish
purple in color while the pyogenic granuloma is
more bright red.
 Types of giant-cell granuloma
Peripheral giant-cell granuloma is made up of a
striking aggregation of multinucleate, foreign
bodylike giant cells separated by a fi
broangiomatous stroma. Although not
encapsulated, these lesions are usually well
delimited and easily excised.
Central giant-cell granulomasfound within the
maxilla or the mandible and from the istologically
similar but frequently multiple brown tumors
seen in hyperparathyroidism
 Classifiication of GCG
Giant cell
Angiomatous
Fibrous
 Infections

The oral mucosa is highly resistant to its

indigenous flora,
having many defenses, including
the competitive suppression of potential
pathogens by organisms of low virulence,
The elaboration of secretory IgA and other
immunoglobulins by
submucosal collections of lymphocytes and
plasma cells,
The antibacterial effects of saliva,
the irrigating effects of foodand drink.
 HERPES SIMPLEX VIRUS INFECTIONS

Most orofacial herpetic infections are caused by herpes simplex

virus type 1 (HSV-1). However, because of changes in sexual
habits, an increase in HSV-2 (genital herpes) has been observed
in the oral cavity.

Primary HSV infection typically occurs in children age 2 to 4 years,

is often asymptomatic, and does not cause signifi cant morbidity.

Approximately 10% to 20% of the time, primary infection presents as

acute herpetic gingivostomatitis, in which there is an abrupt onset of
v esicles and ulcerations throughout the oral cavity, especially in the
gingiva.

These lesions are also accompanied by lymphadenopathy,

fever, anorexia, and irritability.
 Recurrent herpetic stomatitis
occurs either at the site of primary inoculation or
in adjacent mucosal areas that are associated
with the same ganglion; it takes the form of
groups of small (13 mm) vesicles.
The lips (Herpes labialis), nasal orifi ces, buccal
mucosa, gingiva, and hard palate are the most
common locations for recurrent lesions.
 OTHER VIRAL INFECTIONS

herpes zoster,
Epstein-Barr virus (EBV; mononucleosis),
cytomegalovirus,
enterovirus (herpangina, hand-foot-and-
mouth disease, acute lymphonodular
pharyngitis),
rubeola (measles).
ORAL CANDIDIASIS (THRUSH)

The many localizations of candidal

infection are fully described in the oral
cavity. Candidiasis is by far the most
common fungal infection in the oral cavity.
Candida albicans is a normal component
of the oral fl ora in approximately 50% of
the population.
 Predisposition to Candidosis
immunosuppression, as occurs in patients with
diabetes mellitus,
immunosuppression organ or bone marrow
transplant recipients,
immunosuppression those with neutropenia,
chemotherapy-induced immunosuppression,
AIDS.
In addition, broad-spectrum antibiotics
that eliminate or alter the normal bacterial fl ora
of the mouth can also result in the development
of oral candidiasis.
Three factors seem to influence the
likelihood of a clinical infection:

(1) immune status of the individual;

(2) the strain of C. albicans present;
(3) the composition ofan individuals oral
flora.
58


59
 Clinical forms of oral candidiasis

pseudo-membranous (thrush),
erythematous,
hyperplastic, with several different
variations
 DEEP FUNGAL INFECTIONS

deep fungal infections have a signifi cant predilection for

the oral cavity and the head and neck region. Such fungi
include

histoplasmosis, blastomycosis, coccidioidomycosis,

cryptococcosis, zygomycosis, and aspergillosis.

With an increasing number of patients who are

immunocompromised due to diseases such as AIDS or
therapies for cancer and organ transplantation,
Periodontal and systemic diseases
Periodontal disease can also be a component of several different
systemic diseases, including acquired immunodefi ciency
syndrome (AIDS), leukemia, Crohns disease, diabetes mellitus,
Down syndrome, sarcoidosis, and syndromes associated
with polymorphonuclear defects (Chdiak-Higashi syndrome,
agranulocytosis, and cyclic neutropenia).

Periodontal infections can also be etiologic factors in several

important systemic diseases. These include, for example, infective
endocarditis, pulmonary and brain abscesses, and adverse
pregnancy outcomes.
Oral manifistations of systemic
diseases
Oral manifistations of systemic
diseases
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