Periodontitis Flashcards
Clinical features of chronic periodontitis
Widespread periodontal damage, redness, swelling (not always present) BOP, amount of plaque compatible with destruction
Associated with variable microbial pattern and local predisposing factors
SubG calculus
Progression rate of untreated periodontitis
0.2 mm per year
Chronic periodontitis extent and severity
Local if 30% sites affected and general if more than 30%
Slight 1-2 mm CAL
Moderate 3-4 mm
Severe 5 mm or more
Aggressive periodontitis general characteristics
Rapidly progressing in otherwise healthy individual
Absence of large amount of plaque
Altered immunoinflammatory response
Fam Hx of aggressive disease suggestive of genetic trait
Aggressive periodontitis non-universal features (6)
Hyper-responsive macrophages producing increased prostaglandins E2 and IL-1 B
Can be self arresting disease
Infected with A. Actinomycetemcomitans (green complex)
Abnormal phagocyte function
Neutrophil defective chemotaxis
Increased production of superoxide anion by neutrophils
Clinical signs of Aggressive Periodontitis
Inflammation but not as much as chronic
Plaque may not be compatible with destruction
Histology same as chronic
Deep pockets 6 mm commonly present
Localized Periodontitis
Circumpubertal onset
Robust serum antibody to infecting agents
Localized first molar and or incisors: proximal attachment loss on at least 2 permanent teeth and one of which is molar
Generalized
30 or older
Poor serum antibody to infection
Episodic destruction
Inter proximal attachment loss 3 permanent teeth other 1st molar and incisors
Microbiology of aggressive periodontitis
5 serotypes
Endotoxin
Leukotoxin (forms pores in neutrophil granulocytes, monocytes and lymphocytes, which die due to osmotic pressure)
Significant role in pathogenicity
Collagenase
Protease (cleaves IgG)
Tx for aggressive periodontitis
Used to be 1g TTC but 25% didn’t respond
Metronidazole 400 mg or amoxicillin 500 mg
Drugs for A.P
Metronidazole and amoxicillin for 7 days - localized/generalized A.P. Mixed infection from a.a + gram negative anaerobes
Metronidazole and ciproflaxcin for 7 days - instead of amoxicillin if allergic to penicillin
Histology of chronic and aggressive periodontitis (7)
Acute inflammatory changes (vasculitis) in response to microbial invasion
Influx of neutrophils toward microbial components of subg biofilms
Detachment of JE with conversion to pocket epithelium
Inflammatory destruction of CT adjacent to JE
Accumulation of chronic inflammatory cells
Apical migration of epithelium onto root surface
Osteoclast resorbs the alveolar bone
Revision to classification system
Reduction in gingival disease taxonomy + added extent and severity
Mild - minor change in colour
Moderate - glazing, redness, oedema, BOP and enlargement
Severe - overt redness, oedema, bleeding on touching
Case definition
Interdental CAL detectable at >2 non-adjacent teeth
Or buccal/lingual cal >3 with pocketing >3 is detectable at >2 teeth
Necrotizing periodontitis
Inflammatory process characterized by a prominent bacterial invasion and ulceration of epithelium with inter proximal necrosis and ulceration, pain and bleeding
Necrotizing gingivitis
Lesions involving only gingival tissue and no loss of periodontal attachment
Necrotizing periodontitis
Central necrosis of papillae may result considerable destruction leading to attachment loss
Necrotizing stomatitis
Ulceration extending >1 cm from gingival margin, including tissue beyond MGJ
Mucogingival deformity gingival recession
Inter proximal loss of clinical attachment
Periodontal phenotype
Assessment of exposed root and CEJ
Good prognosis
Tx highly recommended
Teeth with no attachment loss, no furcation, no pulpal, no PA involvement
Fair prognosis
For bridge abutment
Attachment loss <25%
Class I and class II Furcation
Tooth can be maintained
Poor prognosis
Risk of teeth loss despite tx
Surgical correction improve px
Bone loss 50%
Class I and II furcation
Tooth can be maintained to some degree
Anatomical features make maintenance more difficult
Questionable px
Tooth loss is inevitable
Greater than 50% attachment loss, poor crown to root ratio, class II or III furcation
Grade 2 or more mobility
Significant root proximity
Hopeless prognosis
Grade III or IV furcation
Extraction advised initial therapy
Bone loss 80%
Grade 3 mobility
Severe root fluting, vertical root fracture
Tooth can’t be maintained
