Periodontitis

Question 1

Types of periodontitis

Answer 1

A). Chronic Periodontitis
B). Aggressive periodontitis
C). Periodontitis as a manifestations of
D). Necrotizing periodontal disease
E). Abscesses of periodontium
F).Periodontal lesions associated with endodontic lesions
G).Developmental or acquired deformities or conditions

Question 2

Chronic periodontitis

generalized (>30%) localized (30%)
- Porphyromonas gingivalis

Answer 2

• Modified by systemic diseases e.g. diabetes mellitus and HIV infection
• Cigarette smoking and emotional stress
• Subgingival calculus

Severity of disease can be :
i). Slight : CAL of 1-2mm
Ii).Moderate : CAL OF 3-4mm
Iii). Severe: CAL of 5mm or more

Question 3

Aggressive periodontitis

Actinobacillus Actinomycetemcomitans

Answer 3

Rapid attachment loss, rapid bone destruction in a clinically healthy individual

Familial aggregation

Phagocyte abnormalities and hyper-responsive monocyte/macrophage phenotype

Increased prostaglandin and interleukins

Localized form: Involves first molar or incisor (usually maxillary teeth) with proximal attachment loss (at least two permanent teeth, one of which is a first molar); onset around puberty

Generalized form: Pt is usually under 30 years of age; Generalized proximal attachment loss affecting at least three teeth other than first molars and incisors; poor serum antibody response to infecting agents

Question 4

Periodontitis as a manifestations of systemic disease

Answer 4

• Acquired neutropenia
• Leukocyte adhesion deficiency syndrome

Question 5

Necrotizing periodontal disease

Answer 5

1. Necrotizing Ulcerative Gingivitis (NUG)
   Fusobacterium nucleatum; Spirochetes and Pi
2. Necrotizing Ulcerative Periodontitis (NUP)
   Fusobacterium nucleatum; Spirochetes and Pi

Question 6

Necrotizing Ulcerative Gingivitis (NUG)

Primary predisposing factor is bacterial plaque

Answer 6

Diseases is complicated by presence of secondary factors such as:

Acute psychological stress, smoking and poor nutrition (all contributing to immunosuppression)

Usually seen in young adults or teens

Question 7

NUG: Clinical features

Fever; lymphadenopathy (submandibular and cervical lymph nodes); malaise

Answer 7

• Punched out, crater like depression at the crest of the interdental papillae
• Involves marginal gingiva and attached gingiva
• Craters are covered by greyish pseudomembranous slough (yellowish white/grayish)
  -Linear erythema demarcates normal and diseased gingiva

Pseudopockets may be present, Gingival haemorrhage, Excessive salivation, Halitosis present, Painful for patient

If not treated, may lead to NOMA

Question 8

Necrotizing Ulcerative Periodontitis (NUP)

Answer 8

Affects deeper tissues of the periodontium, resulting in loss of connective tissue attachment and alveolar bone

Seen in systemically healthy patients, often patients that had multiple episodes of NUG, or at a site previously affected with periodontitis
Patients are often immune-compromised through systemic conditions , such as HIV

In these patients the prognosis depends on not only reducing local and secondary factors, but also dealing with systemic problem

Species found : Fusobacterium nucleatum; Spirochetes and Pi

Question 9

NUP: Clinical features

Answer 9

Same signs and symptoms as NUG
Deep interproximal craters
Denudation and sequestration of interdental alveolar bone
Involvement of buccal and lingual alveolar bone
Periodontal attachment loss (at times with no periodontal pocket formation due to necrosis

Question 10

Abscesses of periodontium

Gingival, Gingival and Gingival abscess

Answer 10

i). Gingival abscess: Usually due to irritation in sulcus region

Ii). Periodontal abscess: Associated with a pre-existing periodontal pocket, caries or both
Swelling located around the involved tooth

Iii). Pericoronal abscess: Usually seen on erupting wisdom tooth(mostly lower 8’s)