Introduction to PeriodontologyDr. Feras Aalam
outline
• Periodontium
• Healthy
• Gingivitis
• Periodontitis
• Periodontal examinations
Gingival crest
Marginal gingiva
Attached gingiva
Alveolar bone
Enamel
Dentine
Gingival sulcus
Cementum
Periodontal ligament
Lamina dura
Epithelial attachment
Alveolar mucosa
Ginigval unit
Attachment unit
Clean tooth
pellicle
plaque
calculus
No Oral hygeine 6-8 H
No Oral hygeine >14 Days
Pellicle
• Glycoprotein pellicle• Initial phase of plaque
formation• Soft and hard surfaces
of O.C (teeth, prothesis,tissue)
Pellicle
• Contents
salivary components
crevicular fluid
bacterial products
tissue cellproducts
debris
Pellicle
• Functions
1. protective barrier (lubrication, prevent tissue desiccation)
2. provides a substrate on which bacteria accumulate to form dental plaque
Clean tooth
pellicle
plaque
calculus
No Oral hygeine 6-8 H
No Oral hygeine >14 Days
Plaque
• Soft deposits, within few hours
• Composition:– A mixed microbial biofilm
growing on dental pellicle
• The prime etiological agent of the two main oral diseases:
dental caries periodontal disease
Plaque formation
• 1-2 days• Initial colonization by pioneer
species on dental pellicle• Outgrowth, microcolonies.....spread
outwards and upwards• Secondary colonization and
multiplication• Species diversity increases
Major sites of plaque accumulation
• Fissures of molar teeth
• Supragingival: on the tooth surface above the gingiva
• Subgingival: in the area bounded by the margin of the gum and the tooth
• Interproximal: between adjacent teeth
Clean tooth
pellicle
plaque
calculus
No Oral hygeine 6-8 H
No Oral hygeine >14 Days
Calculus
Consists of miniralized bacterial plaque that forms on the surfaces
Supragingival or subgingival
Calculus
Composition
• 1. inorganic content 70-90% of calcium phosphate, calcium carbonate, magnesium phosphate
• 2.organic content protein-polysaccharide, desquamated epithelial cells, leukocytes, microorganisms
Calculus formation
• Calculus is dental plaque that has undergone miniralization
• Soft plaque.......precipitation of miniral salts between 1st and 14 days
• Saliva is the source of miniralization
• Gingival Cervicular Fluid (GCF)
Health
Gingivitis
Periodontitis
Periodontal Disease
How do we know there is a problem??
DIAGNOSIS
• Individual complaine
• Clinical examinations
• Radiographic examination
Individual complaine
• Bleeding gums• Red gums• Blood on my pilo• Bad taste • Bad smell (halitosis)• Smokers ....less bleeding
Clinical examinations
• Plaque index
• Gingival index
• Pocket measurment
• Furcation
• Tooth mobility
Plaque IndexSilness & Löe 1964
Score 1
Score 2Score 0
Score 3
Plaque Scoring System for Quigley and Hein
Score
no plaque 0
flecks of stain at the gingival margin 1
definite line of plaque at the gingival margin 2
gingival third of surface 3
two thirds of surface 4
greater than two thirds of surface 5
Plaque Index
total score = = SUM(scores for all facial and lingual surfaces)
index = = (total score) / (number of surfaces examined)
Gingival Index Löe & Silness 1963
Score 0 Score 2
Score 3Score 1
Appearance Bleeding Inflammation Points
normal no bleeding none 0
slight change in color and mild edema with slight change in texture
no bleeding mild 1
redness, hypertrophy, edema and glazing
bleeding on probing/pressure
moderate 2
marked redness, hypertrophy, edema, ulceration
spontaneous bleeding
severe 3
Gingival Index Löe & Silness 1963
Gingival Index Löe & Silness 1963
Teeth examined:
• (1) maxillary right first molar
• (2) maxillary right lateral incisor
• (3) maxillary left first bicuspid
• (4) mandibular left first molar
• (5) mandibular left lateral incisor
• (6) mandibular right first bicuspid
Surfaces examined on each tooth:
• (1) buccal
• (2) lingual
• (3) mesial
• (4) distal
Gingival Index Löe & Silness 1963
Average Gingival Index Interpretation
2.1 - 3.0 severe inflammation
1.1 - 2.0 moderate inflammation
0.1 - 1.0 mild inflammation
< 0.1 no inflammation
Gingival Index Löe & Silness 1963
Gingival sulcus
Furcation
Furcation
Furcation
• Bacterial plque
• Extent of inflammation
• Enamel projection
• Increase with age
• Increase in smokers
Radiographic examination
Horizontal bone resorption
Radiographic examination
Vertical bone resorption
Treatment plan
Hygeinic phase (Phase I therapy)• Oral hygeine instruction (OHI)• Gingivitis treatment
*maintain good OH (brushing, flossing)
*chlorohexidine mouth wash 2%• Supragingival scaling• Subgingival scaling and root planing• 3 weeks follow up
Summary
• Plaque
• Calculus
• Gingivitis
• periodontitis