Classification of periodontal diseases Flashcards
Classifications
Gingival diseases
Chronic periodontitis
Aggressive periodontitis
Periodontitis as a manifestation of systemic diseases
Necrotising periodontal diseases
Abscesses of the periodontium
Periodontitis associated with endodontic lesions
Developmental or acquired deformities and condition
Gingival diseases - surgical sieve
Developmental - acquired or hereditary Infective Non-plaque induced or plaque induced Allergic Modified by or attributable to systemic factors Inflammatory or non-inflammatory Traumatic Elephantine - overgrowth (hypertrophy, hyperplasia, oedema) - e.g. from anti-epileptic drugs
Plaque related gingivitis
Purely affecting gingiva
Thermal trauma
From hot food, damages gingiva
Herpes
Painful, inflamed gingiva
Viral infection
Gingival diseases
Contained within gingival tissue
-no evidence of periodontal attachment loss
-may produce pseudo-pocketing
Inflammation usually = bleeding no probing
Chronic periodontitis
Progression of infection and inflammation of gingivitis into deeper tissues
All periodontitis develops from gingivitis but not vice versa
Local/ generalised (30% of sites affected)
Destruction consistent with local factors (e.g. overcrowding, furcation areas)
Subgingival calculus is a frequent finding
Associated with variable microbial pattern
Progression slow but rapid bursts can occur
Associated with local predisposing factors
-overhangs, grooves, crowding
Breakdown of periodontal fibre bundles at cervical margin, alveolar bone resorption and apical proliferation of junctional epithelium beyond ACJ
Severity of chronic periodontitis
Mild: 1-2mm
Moderate: 3-4mm
Severe: 5mm +
(clinical attachment loss, attachment loss + recession)
Chronic periodontitis risk factors
Non modifiable: genetics, age, gender
Modifiable risk factors: smoking, plaque levels (test by painting fluid on), systemic disease (diabetes), stress
Lots of abscesses in the mouth
Suggest they go to the doctors and get tested for diabetes
Aggressive periodontitis
Rarer, often severe
Rapid attachment loss and bone destruction
Possible familial aggregation of disease
Patients are systemically healthy, non smokers
Onset - earlier age, less than 30 years
Amount of plaque out of proportion with severity of disease
Aggressive periodontitis subcategories
Localised (1st molar and incisor involvement)
Generalised >/ 3 teeth other than in localised
Bone loss aggressive vs chronic
Aggressive more vertical, deep pockets
Chronic slower, more sloping
Generalised aggressive periodontitis
Severe, generalised form, young adults <30
Interproximal attachment loss affecting at least 3 permanent teeth other than 1st molar and incisors
Episodic nature of destruction of AB and attachment
1-2% of Western pop, > in Afro-carribeans
Localised aggressive periodontitis
Severe, localised
Onset around puberty
Localised attachment loss of at least 2 permanent teeth one of which is a first molar and involving no more than 2 teeth other than first molars and incisors
Aggressive perio secondary features that may be present
Destruction greater than local factors suggest
Elevated levels of
-Ag. actinomycetemcomitans
-Porph. gingivalis
Phagocyte abnormalities and > PGE2 and IL-1β
Attachment and bone loss may be self-arresting
Where are aggressive perio bacteria found
Often in soft tissues not pockets
Systemic antibiotics prescribed
e.g. metronidazole
Periodontitis as a manifestation of systemic diseases
Systemic diseases can modify -immune function -inflammatory response -tissue organisation These include -haematological disorders -genetic disorders
Haematological disorders
Acquired neutropenia
Leukamias
Anaemia
Genetic disorders
Familial and cyclic neutropenia Down syndrome Leukocyte adhesion deficiency syndromes Papillon-Lefevre syndrome Chesiak-Higashi syndrome Histiocytosis syndromes Glycogen storage disease Infantile genetic agranulocytosis Cohen syndrome Ehlers-Danlos syndrome types IV and VIII Hypophosphatasia
Ehrles Danlos syndrome types IV and VIII
Hyperflexibility of joints > bleeding and bruising Hyperextensible skin Underlying molecular abnormality of collagen Type 4 -bleeding more common Type VIII - AP, early onset ALl types - pulp stones
Papillon-Lefevre
Palmoplantar hyperkeratosis and AP
affects 1. and 2. dentition
Normal dental development until hyperkeratosis of palms and soles appears
Mechanisms poorly understood
Necrotising periodontal diseases
Includes
-necrotising ulcerative gingivitis (NUG)
-necrotising ulcerative periodontitis (NUP)
Related to < systemic resistance to bacterial infection
Destructive inflammatory condition - rapid, debilitating, acute
Only differ in term of tissue affected, with NUP extending into periodontal attachment
Down syndrome
Commonest malformation syndrome
1:6000 births
> risk with age
Bradycephaly, mid-face retrusion, small nose, flattened nasal brudge, upward sloping palpebral fissues
Macroglossia, delayed eruption of teeth
Heart defects, atlanto-axial subluxation (C1-C2 disorder causing impairment in rotation of teeth), anaenia, > risk of leukaemia
Chediak-Higashi syndrome
Combination of defective neutrophil function, abnormal skin pigmentation and > susceptibility to infection
NUG and NUP symptoms
Painful ulcerated necrotic papillae and gingival margins, ‘punched out’ appearance’
Ulcers with yellow-grey slough
Metallic taste, teeth feel wedged, foetor oris
Craters- interproximal, loss of crestal bone
Loss of attachment can lead to NUP
Regional > LN, fever, malaise can occur
Associated with poor OH, stress, smoking
Gram -ve anaerobic infection
Abscesses of the periodontium
A localised, purulent infection
- Gingival abscess: involves marginal gingivae/ interdental papilla
- Periodontal abscess: in tissue adjacent to PD pocket and leads to destruction of perio ligament and bone
- Pericoronal abscess: in tissue around crowns of partially erupted teeth
Periodontitis associated with endodontic lesions
Periodontal origin
Endodontic origin
Combination of both
-sensibility testing heavily restored teeth with periodontal involvement essential
-management depends upon primary cause
-when combined, usually endo then perio treatment
Developmental or acquired deformities and conditions: localised factors
Developmental -groove (e.g. mesial side of upper 4 root) -enamel pearl Acquired -root fracture
Developmental or acquired deformities and conditions: mucogingival deformities and conditions around teeth gingival soft tissue
Recession
Abnormal gingival contour (incomplete eruption)
Aberrant fraenum
Developmental or acquired deformities and conditions
Localised -developmental -acquired Mucogingival deformities and conditions around teeth gingival soft tissue Occlusal trauma e.g. toothbrushing
