periodontal disease development

Question 1

process of care assessment:

Answer 1

• is the disease limited to the gingival tissues
• is there evidence of:
• pocket formation
• bleeding
• bone loss
• loss of lamina dura

Question 2

if the disease is limited to the gingival tissues

Answer 2

• reversal of infection is considered first

- patient is guided daily infection control along with professional dental hygiene care

Question 3

is the disease is now periodontitis

Answer 3

• can conservative non-surgical therapy provide sufficient professional treatment
• overall tx is determined on individual basis

Question 4

how can we determine the case type

Answer 4

• determined by putting together the following to determine an initial diagnosis:
• history
• clinical examination:
• gingival assessment
• probing and BOP or POP
• radiographs - bone loss

Question 5

periodontal case types

Answer 5

I: gingival disease
II: stage 1
III: stage 2
IV: stage 3
V: stage 4
- grading describes stability of disease

Question 6

additional treatment after initial treatment for periodontitis

Answer 6

• client can be put on a 3 month, 4 month, 6 month or yearly recall/maintenance schedule
• sometimes a 4-6 week tissue check is required

Question 7

the initial lesion (gingival disease):

Answer 7

• an inflammatory response to dental biofilm
• occurs within 2-4 days
• leukocytes into JE and gingival sulcus
• increase sulcular fluid
• early breakdown of collagen in supporting gingival fiber groups
• fluid fills the spaces in the CT

Question 8

clinical appearance (gingival disease):

Answer 8

• no clinical evidence of changes in earliest phases

- slight marginal redness with enlargement due to fluid collection as infection develops

Question 9

the early lesion (stage 1)

Answer 9

1. increased inflammatory responses
   - biofilm matures and thickens (7-14 days)
   - infiltration of fluid, leukocytes and neutrophils into CT
   - breakdown of collagen fiber support group to gingival margin
2. clinical appearance:
   - slight gingival enlargement
   - is reversible with control of biofilm
   - individual susceptibility varies

Question 10

the established lesion (stages 2 and 3)

Answer 10

1. progression from the early lesion
   - fluid and leukocyte migration into tissues and sulcus increases
   - plasma cells are related to areas on chronic inflammation
   - formation of pocket epithelium
   - CT fiber support is lost
   - can progress to a periodontal lesion or may remain stable for extended periods of time
2. clinical appearance
   - clear evidence of inflammation
   - marginal redness
   - BOP
   - spongy marginal gingivae

Question 11

the advanced lesion (stage 4)

Answer 11

1. extension of inflammation:
   - bacteria from supraG biofilm enters sulcus & is the source of subG biofilm
   - biofilm microbes produce irritants
   - alveolar bone destruction:
   Inflammation spreads thru CT beside the bld vessels to the alveolar bone
   - commonly – inflammation enters the bone thru the small vessel channels to the alveolar crest
   - inflammation spreads thru the bone marrow & out into the PDL
2. characteristics of the advanced lesion
   - signs of periodontitis:
   pocket formation, BOP, mobility, bone loss
   - chronic inflammatory process persists
   - JE continues to migrate down the root
   - fluctuations in active vs inactive lesion expected

Question 12

risk factors for periodontitis

Answer 12

• identification of risk factors provides insight for assessment & care planning for indiv
• periodontal pathogens do not affect all indiv. the same, therefore host factors play a significant role in disease progression
• genetic factors difficult to control