Understanding Periodontitis: A Comprehensive Guide to Periodontal Disease for Dentists, Dental Hygienists and Dental Patients
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Understanding Periodontitis: A Comprehensive Guide to Periodontal Disease for Dentists, Dental Hygienists and Dental Patients
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Product Details
| ISBN-13: | 9781546276968 |
|---|---|
| Publisher: | AuthorHouse |
| Publication date: | 09/27/2011 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 1 |
| File size: | 10 MB |
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Understanding Periodontitis
A COMPREHENSIVE GUIDE TO PERIODONTAL DISEASE FOR DENTISTS, DENTAL HYGIENISTS AND DENTAL PATIENTSBy Nkem Obiechina
AuthorHouse
Copyright © 2011 Dr. Nkem ObiechinaAll right reserved.
ISBN: 978-1-4634-4611-6
Chapter One
Periodontal Disease Overview
Periodontal disease is a condition that affects the supporting tissue around the root of teeth. Periodontal disease is caused by bacterial plaque which calcifies around teeth becoming tartar or calculus. Bacterial plaque can secrete an enzyme, collagenase, which can cause destruction of gingival tissue and bone.
As bacterial plaque accumulates in the mouth, inflammation results as the body releases cells such as PMN(neutrophils) that target bacteria and attempt to engulf bacterial pathogens. The body also releases chemical mediators in response to the bacterial invasion such as cytokines like interleukin 1-Beta and prostaglandins to target bacterial plaque and to fight periodontal infection.
Excessive production of these mediators can become destructive, and instead cause further break down of bone and connective tissue attachment. In essence, the protective process the body uses to fight infection goes awry, destroying bone and connective tissue.
When inflammation occurring in a person's gums is localized to gingival tissue but does not result in bone or attachment loss, this condition is called gingivitis. Gingivitis is the initial manifestation of periodontal disease, but it does not always progress to become periodontitis. It typically can present as bleeding during brushing and flossing or spontaneous bleeding in a person's gums.
Once gingivitis is treated, usually by generalized cleaning or scaling, and oral hygiene measures such as brushing and flossing are back in place, it can be reversed. If left untreated, gingivitis can lead to loss of bone and supporting tissue attachment around teeth, known as periodontitis.
Symptoms of gingivitis can include: redness of gums, swelling, and bleeding in gums that is often spontaneous or that can occur during brushing and flossing. Gingivitis can also result in bad breath and gingival enlargement in gums. Sensitivity as a result of the inflammation can also be present in patients with gingivitis.
Following initial phase of periodontal therapy including full mouth debridement or scaling and other measures in addition to instituting good oral hygiene practices, gingivitis progression is often reversed. The remainder of this book as a result focuses on periodontitis.
Currently, many forms of periodontitis exist, but typically seven types are widely recognized. These include: chronic periodontitis, aggressive periodontitis, periodontitis associated with systemic disease, necrotizing periodontal diseases consisting of necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative periodontitis(NUP), periodontal disease related to abscesses, as well as periodontal disease associated with endodontic lesions. These periodontal conditions will be reviewed in this book, as well as the types of periodontal therapy that are necessary to treat them.
Chapter Two
Diagnosing Periodontal disease
Typically, the most common sign that is found with periodontal disease is bleeding that can be spontaneous or occur during brushing and flossing. Other indications of the presence of periodontal disease can also include changes in the form of gum tissue such as recession or gingival enlargement, swelling in gums, as well as spacing or crowding in teeth.
Symptoms such as food impaction in between teeth following meals, tooth mobility, sensitivity or dull throbbing pain around a person's gums may also be indications of underlying periodontal disease. Any of these signs and symptoms being present may indicate a need for periodontal examination and periodontal treatment.
Diagnosis of periodontal disease involves a periodontal exam which measures both the depth of periodontal pockets around teeth, and the actual loss of tissue attachment that is missing from the tooth measured from a fixed point on a tooth such as the cemento-enamel junction is referred to as clinical attachment loss. These measurements are compared against the findings that are present on a full series of x-rays in order to give an accurate diagnosis of a person's periodontal condition.
Periodontal disease can be classified using recommendations made by American Dental Association (ADA) and Academy of Periodontology (AAP). This classification is based on the severity of periodontal disease using both probing measurements and dental x-rays.
Based on their classification, Case type 1 refers to Gingivitis. When a person has gingivitis, clinically, there may be bleeding on probing. Gums may also appear red and inflamed, but no connective tissue attachment loss or bone loss occurs as a result of gingivitis. Following appropriate therapy and institution of oral hygiene, gingivitis can be resolved.
Case Type II refers to mild periodontitis. It manifests as bleeding on probing, in addition to probing depth and attachment loss of 3-4mm. There might also be recession, and mild furcation involvement as well due to mild periodontitis. Findings on x-rays can be able to identify horizontal bone loss, and bone level typically between 3-4mm from the cemento-enamel junction.
Case type III is classified as moderate periodontitis. Teeth that are affected have probing depth of 4-6mm, bleeding during probing measurements, furcation involvement and tooth mobility. Radiographic findings often include bone loss that is 4-6mm from the CEJ around the roots of teeth.
Moderate to severe amount bone loss is typically present resulting in a crown to root ratio that is 1:1, with root size being equal to the amount of tooth structure that is present in the mouth. The size of the crown that is visible is the same amount as the size of the root supporting it, therefore there is diminished support and stability around teeth.
Case Type IV is referred to as advanced periodontitis. Probing depth is typically more that 6mm, with some teeth that can have furcation involvement that can extend from one side of the tooth to the opposite side (grade III furcation involvement), and mobility that is severe in nature. On dental x-rays, there is horizontal as well as vertical bone loss. Bone loss around teeth with advanced periodontitis is usually greater than 6mm.
The crown to root ratio is now 2:1, meaning that twice as much tooth structure is present in the mouth compared to the root underneath. When advanced periodontitis occurs, this means that the support around a tooth has been severely compromised, and the stability and prognosis of the tooth have become diminished as a result of it.
Periodontitis can also be classified according the damage to the gingiva and connective tissue supporting a tooth. This is called clinical attachment loss or level around a tooth. This is based on a measurement that takes into consideration the level of tissue loss that have occurred around the root of a tooth.
Mild periodontal attachment destruction is believed to be present when there is 2mm of clinical attachment loss around a tooth. Moderate periodontal destruction occurs when 3-4mm of clinical attachment loss occurs around the roots of teeth. Severe periodontal destruction occurs when 5mm or more of attachment loss occurs around the root of a tooth. Both attachment loss measurements and probing depth measures can be used to classify the severity of periodontal destruction.
Periodontal disease typically occurs with a pattern of some sites in the mouth breaking down while other sites in the mouth stay stable at a given time. As a result, it can be classified by its extent. When more than thirty percent of the sites in the mouth are affected, the extent of the periodontal disease is classified as generalized. Localized periodontitis refers to periodontal involvement of thirty percent or less sites in the mouth.
In recommending periodontal therapy for a patient, identifying the type and stage of periodontal disease, the severity and extent of periodontal disease all play an important role in adequately diagnosing and treating a patient's periodontal condition and preventing further progression of the disease.
Chapter Three
Chronic Periodontitis
Although over fifty forms of periodontitis have been identified, seven major types are largely recognized, and will be reviewed in this book. The most prevalent form of periodontitis is chronic periodontitis.
Two major forms of chronic periodontitis exist, which are generalized and localized chronic periodontitis. Patients who have chronic periodontitis typically have a significant amount of local causative factors that are causing periodontal disease such as plaque and tartar deposits. The level of plaque and tartar deposits matches the level of destruction in the periodontal tissues, and the amount of bone loss present on x-rays corresponds to the amount of periodontal disease present.
People with chronic periodontitis are usually adults who are thirty years and older who present with plaque and tartar deposits on their teeth. Factors such as smoking and systemic conditions like diabetes are able to affect and modulate the extent and severity of chronic periodontitis.
Radiographic assessment tends to reveal horizontal bone loss rather than vertical patterns of bone loss, although vertical bone loss can sometimes occur with chronic periodontitis.
Bacterial analysis shows that while the major pathogens that cause periodontal disease are typically present, they are variable in nature. The typical bacteria that are responsible for causing chronic periodontitis are: P. gingivalis, E.corredens, B. forsythus, C. rectus E. nodatum, P. micros and P.intermedia, S. intermedia and Treponema species. These bacterial pathogens are found in varying amounts in people with chronic periodontitis.
In addition, there is not really any major genetic aggregation for chronic periodontitis, which means that members of the same family do not typically manifest traits for chronic periodontitis unlike the familial pattern that is found in aggressive periodontitis.
Probing depth formation and loss of clinical attachment is typically slower in nature compared to aggressive periodontitis, which means that loss of bone on x-rays and probing depth formation, as well as progression of probing depth measures occur over a longer period of time.
With regard to the extent of chronic periodontitis, both types of chronic periodontitis have the same manifestations, with the only varying feature being the extent of the two diseases. Localized chronic periodontitis refers to periodontitis that affects less than thirty percent of the sites, while generalized chronic periodontitis affects thirty or more percent of sites on teeth in the mouth.
Periodontal therapy to treat chronic periodontitis typically involves initial therapy comprised of scaling and root planning and sometimes locally delivered chemotherapeutic agents such as Arrestin and Chlorhexidine. The main goal of initial therapy is to reduce inflammation and help to reduce probing depth in order to prevent further progression of periodontal disease.
When moderate or advanced chronic periodontitis is diagnosed, involving probing depth of 5mm and more, there is a need for surgical intervention to reduce probing depth around teeth as well as to get access for further removal of bacterial plaque. Flap surgery and osseous surgery are typically performed to remove bacterial plaque and for probing depth reduction. Guided tissue regeneration surgery utilizing bone grafts and membranes may also be necessary in order to regain lost periodontal support around teeth.
Chapter Four
Aggressive Periodontitis
Aggressive periodontitis is another major form of periodontitis, which is less prevalent than chronic periodontitis and affects a younger population of people who are typically under the age of thirty. The pattern of bone and attachment loss around teeth is very rapid, and a significant amount of bone and attachment can be lost in a very short period of time.
Typically, the level of clinical attachment loss and probing depth levels does not coincide with the amount of plaque and calculus that is present. People with aggressive periodontitis have very little plaque and calculus deposits present in comparison to the extent of their periodontal destruction, but at the same time have rapidly occurring bone and attachment loss around their teeth.
A combination of the lack of plaque and tartar and the aggressive nature of destruction can often leave the patient unaware of the condition until severe periodontal destruction has occurred. People with aggressive periodontitis are usually systemically healthy, and do not have systemic conditions such as diabetes and heart disease that can contribute to the manifestation of periodontal disease. The typical person with this condition is a young adult who has no contributing factors and very little plaque or tartar deposits present, but at the same time manifests with a significant amount of periodontal destruction present.
People with Aggressive periodontitis often have malfunction of monocytes, macrophages and neutrophils, with excessive amount of inflammatory phenotypes being present on these cells. As a result, there is an excessive accumulation of inflammatory bi-products that can cause further bone loss and loss of attachment.
There is also an impairment in how neutrophils can be able to engulf and destroy invading bacterial cells, with decreased ability of neutrophils to be able to do this. There are also increased levels of PGE2 and IL-1B in gingival-crevicular fluid (GCF) and serum of people with aggressive periodontitis, these two mediators are usually associated with inflammation and periodontal break down.
Two major bacteria are typically found in most people with aggressive periodontitis. These bacteria include Actinobacillus actinomycemcomitans (Aa) and Porphomonas gingivalis (Pg). Both bacteria are responsible for the severe destruction that occurs during aggressive periodontitis.
Unlike in chronic periodontitis where the bacteria pattern varies, either bacteria or both are typically present in the gums of people with aggressive periodontitis. Periodontal destruction is very quick and happens within a very short time. Looking on radiographs would reveal vertical patterns of bone loss that can be severe in nature.
Two types of aggressive periodontitis exist: generalized and localized aggressive periodontitis. Both types have varying characteristics and manifest as different diseases.
Localized aggressive periodontitis typically affects only first molars and incisors. Its onset is in the earlier part of life, typically, pre pubertal to pubertal age, there is also a strong antibody response to bacterial invasion, and the IgG2 antibody is the antibody most often involved in the response.
Generalized aggressive periodontitis affects people who are under the age of thirty years. There is a poor serum antibody response to bacterial invasion, and at least three other permanent teeth which are not first molars and incisors are involved. Periodontal destruction is episodic with random bursts of destructive activity followed by a period of quiescence.
(Continues...)
Excerpted from Understanding Periodontitis by Nkem Obiechina Copyright © 2011 by Dr. Nkem Obiechina. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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