Perio Lecture 4-2

Study Notes

Periodontal health is a state free from inflammatory periodontal disease that allows an individual to function normally and avoid consequences (mental or physical) due to current or past disease.
Clinically, periodontal health is characterized by the absence of bleeding on probing, erythema, edema, patient symptoms and attachment and bone loss.
The 2017 classification system recognizes that periodontal health can occur on either an intact periodontium or on a reduced periodontium.
Periodontal health on an intact periodontium - patient exhibits no clinical signs of gingival inflammation and no previous loss of periodontal tissues; no loss of periodontal tissue (no loss of connective tissue or alveolar bone)
Periodontal health on a reduced periodontium - a periodontium with pre-existing loss of periodontal tissue but, is not currently undergoing loss of connective tissue/alveolar bone.
Three Categories of Periodontal Health are: Periodontal health on an intact periodontium, periodontal health on a reduced periodontium in a non-periodontitis patient, and periodontal health on a reduced periodontium in a successfully treated stable periodontitis patient.
With gingivitis, the position of the gingival margin may move more than normal.
Increased fluid in the inflamed tissue also causes the gingiva to be soft, spongy, and nonelastic.
When pressure is applied to the inflamed gingiva with the side of a probe, the tissue is easily compressed and can retain an imprint of the probe for several seconds.
Inflamed gingival tissue loses its firm consistency becoming flaccid (soft, movable).
When compressed air is directed into the sulcus, it readily deflects (moves) the gingival margin and papillae away from the neck of the tooth.
The increase in fluid due to the inflammatory response can cause the gingival tissues to appear smooth and very shiny.
The tissue almost has a "stretched" appearance that resembles plastic wrap that has been pulled tightly.
With gingivitis, the position of the gingival margin may move more than normal, the gingival margin may become thin, and the gingiva may bleed when pressure is applied.
Gingivitis is an inflammation of the gingiva that can cause the tissue to become red and swollen, to bleed easily, and sometimes to become slightly tender.
Inflammation results in increased blood flow to the gingiva and can cause the tissue to appear bright red.
Gingivitis of a sudden onset and short duration, after which professional care and patient self-care returns the gingiva to a healthy state.
Chronic gingivitis is typically painless and is more commonly encountered than acute gingivitis.
Localized inflammation is confined to the gingival tissue of a single tooth. (Ex: maxillary right first molar or to a group of teeth, such as the mandibular anterior sextant.)
Generalized inflammation involves all or most of the tissue in the mouth.
The distribution of inflammation describes the area where the gingival tissue is inflamed.
In a person successfully treated for periodontitis, if the extent of attachment loss present remains stable over months or years, then the presence of attachment loss is not an indication of active periodontitis.
Plaque-induced gingivitis on a reduced periodontium in a successfully treated periodontitis case is characterized by the return of bacteria-induced inflammation to the gingival margin on a reduced periodontium with no evidence of progressive attachment loss.
If a clinician is going to make the diagnosis of "gingivitis on a reduced but stable periodontium," it is necessary to demonstrate that attachment loss (loss of connective tissue and alveolar bone) is not ongoing.
The common clinical findings on a reduced periodontium are the same as plaque-induced gingivitis except for the presence of pre-existing attachment loss and therefore a higher risk of periodontitis.
Due to this higher risk for recurrence of periodontitis, individualized professional care is of utmost importance for the patient with plaque-induced gingivitis on a reduced periodontium.
Although a successfully treated periodontitis patient exhibits an absence of ongoing, progressive periodontitis, the patient cannot revert to being classified as a "gingivitis case on an intact periodontium."
Periodontitis is an irreversible condition that results in a permanent loss of attachment and alveolar bone.
A periodontitis patient remains a periodontitis patient for life----even following successful periodontal therapy-and requires lifelong supportive care to prevent recurrence of disease.