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7/25/2019 periodontitis chronic
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Defnition
Chronic Periodontitis can be definedasan infectious disease resulting ininflammation within the supporting
tissues of the teeth, progressiveattachment loss, and bone loss.
- Previously known as adult periodontitisor chronic adult periodontitis.
- Occur as a result of extension ofinflammation from the gingiva intodeeper periodontal tissue.
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Common Characteristics
Onset- any age; most common in adults Plaque initiates condition
Subgingival calculus common finding Slow-mod progression; periods of rapid
progression possible Modified by local factors/systemic
factors/stress/smoking
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Extent & Severity
Extent:Localied! "#$% of sites affected
&eneralied! ' #$% of sites affected
Severity: entire dentition or individualteet(/siteSlig(t ) *-+ mm ,L
Moderate ) #-. mm ,L
Severe ) mm ,L
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Clinical Characteristics
&ingiva
moderately swollen
0eep red to bluis(-
red tissues 1lunted and rolled
gingival margin
,ratered papilla 1leeding and/or
suppuration
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Clinical Characteristics
Plaque/calculus
deposits
2ariable pocket
dept(s Loss of periodontal
attac(ment
3oriontal/verticalbone loss
4oot( mobility
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CLASSIFICATION
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A) Based on Disease Distribution:
Localized:Periodontitis is considered localized when
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Sub classifcation o ChronicPeriodontitisSeverity Pocket
0ept(s,L 1one
Loss5urcation
6arly .- mm *-+ mm Slig(t
(oriontal
Moderate -7 mm #-. mm Sl 8 mod
(oriontal
9nvolved
dvanced ' 7 mm mm Mod-severe
(oriontal
vertical
9nvolved
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DISEASE DISTRIBUTION : It is a site-specificdisease
CLINICAL SINS -
- 9nflammation :pocket formation :attac(ment loss :boneloss - ll caused by site specific effects of a sub-gingivalplaque accumulation
- 4(at is w(y t(e effect are on one side only 8ot(ersurface may maintain normal attac(ment level
- 6g-pro
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SYMPTOMS
Patient notices -
* gum bleed
+ space appear between teet( due to toot( movement
# May be painless =sleeping disease >goes unnoticed
. Some time pain due to caries : root (ypersensitivity
4o cold /(ot or bot(
? P9@-may be-- dullAdeep radiating in t(e Baw
7 rea of food impaction can cause more discomfort
C May be gingival tenderness or itc(iness found
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Periodontal Pathogens
D &ram negative organism dominate
D Pg: Pi: a may infiltrate!
D - 9ntercellular spaces of t(e epit(elium
D - 1etween deeper epit(elial cells
D - 1asement lamina
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Periodontal PathogensContn Pathogens include:
@onmotile rods! 5acultative!
Actinoacillus a. E.c
naerobic: P. g.! P. i.! ".f.! #.n.
Motile rods! 5acultative!
$.r.
Spiroc(etes! naerobic: motile!
"reponema denticola
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Pathogenesis Pocketormation
1acterial c(allenge
initiates initial
lesion of gingivitis
Eit( diseaseprogression F
c(ange in
microorganisms
development ofperiodontitis
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Pocket ormation
,ellular F fluid inflammatory e
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Pocket ormation
,ontinued
e
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Pocket ormation
$ontinue inflammation:,oronal e
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Develo!ment o PeriodontalPocket
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Continuous Cycle"
Plaque gingival inflammation
pocket formation more plaque
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Classifcation o Pockets
&ingival:
,oronal migration of gingival margin
Periodontal:
pical migration of epit(elial attac(ment
H Suprabony!1ase of pocket coronal to (eig(t of alveolar crest
H 9nfrabony!1ase of pocket apical to (eig(t of alveolar crest
,(aracteried by angular bony defects
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#isto!athology
$onnective "issue:6dematous
0ense infiltrate!
H Plasma cells =C$%>H Lymp(ocytes: PM@s
1lood vessels proliferate: dilate F are engorged
2arying degrees of degeneration in addition to
newly formed capillaries: fibroblasts: collagenfibers in some areas
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#isto!athology
Periodontal pocket:Lateral wall s(ows most severe
degeneration
6pit(elial proliferation F degenerationIete pegs protrude deep wit(in ,4
0ense infiltrate of leukocytes F fluid found inrete pegs F epit(elium
0egeneration F necrosis of epit(elium leadsto ulceration of lateral wall: e
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Clinical & #isto!athologiceatures $linical :
* Pocket wall bluis(-
red
+ Smoot(: s(inysurface
# Pitting on pressure
'istopathology:
* 2asodilation F
vasostagnation
+ 6pit(elialproliferation: edema
# 6dema F
degeneration of
epit(elium
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Clinical & #isto!athologiceaturesContn $linical:* Pocket wall may be
pink F firm
+ 1leeding wit( probing
# Pain wit(
instrumentation
'istopathology:
* 5ibrotic c(anges
dominate
2. blood flow:
degenerated: t(in
epit(elium
# Jlceration of pocketepit(elium
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Clinical & #isto!athologiceaturesContn $linical :* 6
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Stages o PeriodontalDisease
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$oot Surace %all
Periodontal disease affects root surface:Perpetuates disease
0ecay: sensitivity
,omplicates treatment 6mbedded collagen fibers degenerate
cementum e
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$oot Surace %all
Contn @ecrotic areas of cementum form;clinically soft
ct as reservoir for bacteria
Ioot planing may remove necrotic areas
firmer surface
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n'ammatory Path(ay
Stages 9-999 8 inflammation degradesgingival fibers Spreads via blood vessels!
(nterproximal: Loose ,4 transseptal fibers marrow
spaces of cancellous bone periodontalligament supraony pockets )
hori*ontal one loss transseptal fiberstransverse (oriontally
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n'ammatory Path(ayContn (nterproximal:
Loose ,4 periodontal ligament bone
infraony pockets ) vertical one loss
transseptal fibers transverse in obliquedirection
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n'ammatory Path(ayContn #acial ) +ingual:
Loose ,4 along periosteum marrow
spaces of cancellous bone supporting
bone destroyed first
alvoelar bone properperiodontal ligament supraony pocket
) hori*ontal one loss
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n'ammatory Path(ayContn #acial) +ingual:
Loose ,4 periodontal ligament
destruction of periodontal ligament fibers
infraony pockets ) vertical or angular oneloss
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Periodontal Disease
)ctivity ,ursts of activity followed byperiodsofuiescencec(aracteried by!Ieduced inflammatory response
Little to no bone loss F ,4 loss ccumulation of &ram negative organisms
leads to!1one F attac(ment loss
1leeding: e
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Periodontal Disease
)ctivity Period of activity followed by period ofremission!ccumulation of &ram positive bacteria
,ondition somew(at stabilied
Periodontal destruction is site specific
P0 affects few teet( at one time: or
some surfaces of given teet(
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Prevalence:
Chronic Periodontitis increases inpre!a"ence # se!erit$ %ith a&e'
Affect both the se(es e)*a""$'
It is an a&e-associated+ not a&e re"ateddisease'
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I9SK 5,4OIS 5OI 09S6S6!
*> PI9OI 39S4OI O5 P6I9O0O@4949S A predictor-,ore ris for
de!e"opin& da,a&e to periodonti*,'
+> LO,L 5,4OIS!Plaque ccumulation
Ora" .$&iene
Tooth /a"position
Restoration
Preserve F uantity of certain bacteria
.ost defensesS*b&in&i!a" Restoration
En!iron,ent
Ca"c*"*s+ s,oin&
,onnective 4issue destructionenetic inf"*ence
Inf"a,,ationPeriodontopathic bacteria
S,oin&+ Ca"c*"*s
Loss of ttac(ment
&
'
D(
*
(
+
A
,
#
'
-
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01 S2STE/IC 3ACTORS: T$pe II or Non 4 Ins*"in dependent Diabetes
,e""it*s 5NIIDD/1
61 EN7IRON/ENTAL # BE.A7IORAL3ACTORS:S,oin&E,otiona" Stress
81 ENETIC 3ACTORS:3re)*ent a,on& fa,i"$ ,e,bers and across
different &enerations'
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MANAGEMENT 4(e treatment consists of 8
* @on-surgical procedures Scaling
Ioot planing
,urettage
+ Surgical procedure Pocket reduction surgery
H Resecti!eH Re&enerati!e
,orrection of morp(ological / anatomic defects
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*verall Prognosis
ependent on:,lient compliance
Systemic involvement
Severity of condition
N of remaining teet(
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Prognosis o ndividual
+eeth ependent on:ttac(ment levels: bone (eig(t
Status of adBacent teet(
4ype of pockets! suprabony: infrabony
5urcation involvement
Ioot resorption
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h i
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,C-s on ChronicPeriodontitis
*1acteria considered to be pat(ogenic
in c(ronic periodontitis is/are!
a> P gingivalis
b> P intermedia
c> actinomycetemcomitans
d> 1ot( =a> and =b>
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,C- Ch i
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,C-s on ChronicPeriodontitis
+ 4(e clinical attac(ment loss in
Moderate periodontitis is
a> * to + mm
b> + to # mm
c> # to . mm
d> mm or more
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,C- Ch i
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,C-s on ChronicPeriodontitis
#5ollowing (istopat(ological c(anges occur in
periodontium w(ile pocket formation
e ,ellular F fluid inflammatory e pical migration of Bunctional epit(elium
along root
c> pical portion of G6 detac(es
d> @one of t(e above
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,C- Ch i
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,C-s on ChronicPeriodontitis
. Iisk factors for c(ronic periodontitis
include!
* Prior (istory of periodontitis
+ Plaque accumulation on toot( and
gingival surfaces
# 4ype + diabetes
. ll of t(e above
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,C- Ch i
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,C-s on ChronicPeriodontitis
4(e treatment possibilities of c(ronic
periodontitis include
a> @onsurgical periodontal t(erapy
b> Pocket reduction surgery
c> ,orrection of morp(ological /
anatomic defects
d> ll of t(e above