Periodontal

Disease

MDA: Chapter 16
Test: 2 hrs 30 mins
Pass 70%
Periodontal Disease
Disease of the Oral Soft
Tissues
Perio: around - Dontal: tooth
✓Periodontal disease is an infectious disease process that
involves inflammation of the structures of the periodontium.
✓The periodontium is made up of structures that surround,
support, and are attached to the teeth.
✓Periodontal disease causes a breakdown of the
periodontium, resulting in loss of tissue attachment and
destruction of alveolar bone.
• Periodontal diseases are the leading cause of tooth loss in
adults.
• Almost 75 percent of American adults have some form of
periodontal disease, and most are unaware of the condition.
• Almost all adults and many children have calculus on their
teeth.
• Fortunately, with early detection and treatment of
periodontal disease, most people can keep their teeth for
life.

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There are two basic forms of Periodontal Disease:

Gingivitis - Inflammation of gingival tissue.

Periodontitis - Inflammatory disease of supporting teeth resulting in mobility and bone loss.

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Gingivitis
✓Gingivitis is inflammation of the gingival
tissue. Which includes: Inflammation,
redness, and bleeding of the gingiva.
✓Gingivitis can be localized or generalized,
depending on the location.
✓Usually painless
✓It may be the most common human disease
and is one of the easiest to treat and control
because it is reversible with treatment but
often goes unrecognized until a dental
professional emphasizes the importance of
daily oral hygiene.

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Gingivitis
Overhanging restoration

•Gingivitis is found only in the epithelium and in gingival connective

tissues. No tissue recession or loss of connective tissue or bone is
associated with gingivitis.
•Can be caused by accumulation of plaque or calculus poor oral
health or hormonal.
•Irritants and injurious agents such as toothbrush bristles, toothpicks,
overhanging margins may also cause inflammation
•Orthodontic patients are more susceptible as orthodontic appliances
(braces) tend to retain more bacterial plaque and food debris. Proper
home care is a critical part of orthodontic treatment.

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Note: Bleeding isn’t always a sign of inflammation.
Four signs of
inflammation:
1. Redness
2. Edema (swelling).
3. Heat
4. Pain 6
 Gingivitis
type I
• Inflammation of the gingiva
with plaque present at the
gingival margin.
• Characterized by absence of
attachment loss; clinical
redness; bleeding, and
changes in contour, color,
and consistency.
• No radiographic evidence of
bone loss is found.
• Local contributing factors
may enhance susceptibility.
• Improved daily oral hygiene
practices may reverse
gingivitis.

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Type II Plaque-Induced Gingival
Disease Modified by Systemic
Factors
Hormone induced Gingival Disease: Includes
puberty-associated gingivitis, pregnancy-associated
gingivitis, and menstrual cycle gingivitis

Diabetes

Hematologic (Leukemic) - bone marrow and other

blood-forming organs produce increased numbers of
immature or abnormal white blood cells. Medication-induced gingivitis.

Drug-Influenced

Poor Nutrition
FIG. 14.6 Gingival inflammation and enlargement
associated with orthodontic appliance and poor
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oral hygiene.
 Periodontitis

Inflammation of the supporting tissues

of the teeth. The inflammatory
process progresses from the gingiva
into the connective tissue and alveolar
bone that support the teeth.

✓It is not reversible

✓Destruction of the soft tissue

and bone support

✓Involves disease of the

supporting structure

✓Destruction of the
periodontium structure

✓Disease can be localized (IF less

then 30 percent of sites in the
mouth are affected), or
generalized (more then 30
percent of sites in mouth are
affected).

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 The periodontium
gives support
needed to
maintain the
teeth in function
Clinical Changes in Periodontitis.
Periodontitis is characterized by
inflammation within the
supporting tissues of the teeth,
progressive destruction of the
periodontal ligament, and loss of
supporting alveolar bone.

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Generalized chronic periodontitis in a 38-year-old woman with a 20-year history of smoking at least one pack of cigarettes per day. Maxillary and
mandibular molars have already been lost through advanced disease and furcation involvement.

BRadiographs show severe, generalized, horizontal pattern of bone loss.

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Causes of periodontal
disease:

Calculus:
• formed by calcium and phosphate salts in saliva.
• Commonly known as tartar.
• A hard stone like material that attaches to the tooths
surface. It cannot be removed by patient and must be
removed by the dentist or hygienist.
Common Risk Factors:
• Smoking, Diabetes, poor oral hygiene, osteoporosis,
human immunodeficiency (HIV/AIDS), Stress, Medications,
Local factors (Overhanging restorations, subgingival
placements of crowns, orthodontic appliances, removable
appliances).

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 Calculus is
divided into
two types:
1. Supragingival

forms on the clinical crown

(yellowish white deposit that may
darken over time).

2. Subgingival

forms below root surfaces below

the gingival margin and can
extend to the periodontal pockets
(dark green to black in
appearance).

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 Fluctuations in
hormones may
also cause the
following types
of diseases:
• Early-Onset Periodontitis: also
known as Juvenile Periodontitis. In
young healthy individuals or young
adults. localized or generalized.
• Prepubertal Periodontitis: occurs in
children at the time of eruption of
the primary teeth, Localized
• Pubertal Periodontitis: Increased
severity of gingivitis, occurs during
puberty

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 Warning sign
and
symptoms of
Periodontal
Disease:
• Bleeding gingiva while
brushing or flossing
• Pain or pressure when
chewing
• Red, swollen or tender
gingiva
• Pus around the teeth or
gingival tissues
• Loose teeth or
separated teeth
• Receding gums
• Change in fit of partial
denture
• Shifting or elongation
• Halitosis (chronic bad
breath).

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Chlorhexidine:

✓Chemotherapeutic agent
best suited to reduce the
amount of plaque and
gingivitis
✓Chlorhexidine works by
reducing the number of
cariogenic bacteria in the
mouth and is
recommended for high-
risk caries patients.

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Severity stages of Chronic
Periodontitis:
Slight/early -slight bone loss 1-2 mm and probing debths of 3-4 mm.

Moderate -bone loss up to 4mm/deep pockets 5-7 mm,

severe/advanced -severe destruction of periodontal structures, clinical attachment

loss greater then 5 mm, increased tooth bone loss/mobility/furcations greater then
class 1 in molars/pocket debths usually 7 mm or greater.

❖ Comparison of Probe Readings. Measurement of same 5-mm pocket with four

different probes.

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 Characteristics:
• Inflamed gingiva
• Receding gingiva
• Periodontal pockets deeper than
3mm
• Bone loss; if there is too much
bone loss there will not be
enough support and furcation
involvement
• Bacteria is etiologic: calculus is
the contributing cause of
Periodontal Disease

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 Mobility of
Teeth:

1. M1: Evident, very

little movement
2. M2: Marked,
moderate movement
3. M3: Extreme, very
loose

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 COMPLICATIONS
RESULTING FROM
PERIODONTAL DISEASE
PROGRESSION
Furcation Involvement

Furcation involvement means that the

clinical attachment level and bone loss
have extended into the furcation area
between the roots of a multirooted
tooth
This extracted molar has mineralized
deposits (calculus) in the furcation. Once
disease progresses into the furcation area,
access for removal becomes difficult.

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 Recording of
Probing
Measurements
• The pocket/sulcus is
measured completely around
each tooth.
• Record the deepest
measurement for each of the
six areas around the tooth.

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 Clinical
Attachment
Level
Attachment level refers to the
position of the periodontal
attached tissues at the base of a
sulcus or pocket.

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A periodontal examination must be done to determine
Periodontal Disease:

1. Visual signs
2. Periodontal Probing
3. Radiographic records (bone loss)
4. Physical signs (Mobility)

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Periodontal Disease Detection

A basic examination
performed to
recognize the signs
and effects of
inflammation
includes
• A basic examination performed to
recognize the signs and effects of
inflammation includes information
about at least the following markers:

• Gingival tissue changes (color, size,

shape, surface texture, position)

• Mucogingival involvement (adequate

width of attached gingiva)

• Probing depths; pocket formation

(attachment levels)

• Bleeding and exudate

• Furcation involvement

• Dental biofilm and calculus present

• Mobility of teeth

• Radiographic evidence.
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Questions??
REVIEW: MODERN Dental Assisting chapter 13,14,17.

SUBMIT RECALL Questions and Critical thinking 1-4

Label anatomical structures on diagram.

Once I have received everyone’s by email, I will send answers for Recall questions and
the diagram.

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