Overview of the Diseases of the Periodontium PDF

CHAPTER 3 Overview of the Diseases of the Periodontium Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com. Three Basic States of the Periodontium  Gingivitis  Confined to gingiva  Periodontitis  Affects all of periodontium...

CHAPTER 3 Overview of the Diseases of the Periodontium Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com. Three Basic States of the Periodontium  Gingivitis  Confined to gingiva  Periodontitis  Affects all of periodontium Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Periodontium in Health © Wolters Kluwer  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Periodontium in Health (cont.) © Wolters Kluwer  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Gingivitis—Reversible Tissue Damage © Wolters Kluwer  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Gingivitis—Reversible Tissue Damage (cont.) © Wolters Kluwer Gingivitis—Reversible Tissue Damage (cont.)  Onset 4 to 14 days after plaque biofilm accumulation in gingival sulcus  Chronic gingivitis lasts months or years Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Gingival enlargement due to swelling (acute gingivitis) or fibrosis (chronic gingivitis)  May persist for years without becoming periodontitis Clinical Picture of Gingivitis  Gingival tissue red or reddish-blue (cyanotic)  Figure 3-7  Gingival margin swollen (edematous) Figure 3-8 Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Interdental papillae bulbous, swollen  Bleeding upon gentle probing  Probing depths greater than 3 mm  No apical migration of the junctional epithelium  Copyright © 2024 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 03.F08A: Rolled, swollen (Edematous) gingival margins of a gingivitis patient. A. Note the edematous gingival tissues of all six mandibular anterior teeth along with the erythematous gingiva of the facial aspects of the mandibular canines. B. Radiographic View of the same case. Note the absence of bone loss around the mandibular anterior teeth. Microscopic Picture of Gingivitis  Hemidesmosomes still attach to enamel (Figure 2-10)  Epithelial ridges form and extend from junctional epithelium into adjacent connective tissue zone Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Reversible damage to gingival fibers  No infection in the alveolar bone or periodontal ligament fibers and cementum is normal  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Periodontitis—Permanent Tissue Destruction © Wolters Kluwer Characteristics of Periodontitis  Characterized by:  Apical migration of junctional epithelium  Loss of connective tissue attachment  Loss of alveolar bone Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Tissue destruction in intermittent manner at different rates throughout mouth Clinical Picture of Periodontitis  Visible changes in color, contour, and consistency  Gingival margin may be swollen or fibrotic  Interdental papillae may balloon out or be blunted Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Bleeding upon probing common  Suppuration possible  Pocket depths 4 mm or greater  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Periodontitis Patient Microscopic Picture of Periodontitis  Apical migration of junctional epithelium  Coronal-most portion detaches from tooth surface  Extracellular matrix of gingiva and collagen fibers destroyed  Junctional epithelium and sulcular epithelium extend Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com into connective tissue  Small ulcerations of pocket epithelium expose underlying inflamed connective tissue  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Microscopic Picture of Periodontitis (cont.) © Wolters Kluwer Gingival Connective Tissue  Widespread destruction of collagen and supragingival fiber bundles, allowing junctional epithelium migration  Pathologic tooth migration possible Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Destruction of alveolar bone, ligament fiber bundles  Cementum exposed to plaque biofilm  Inflamed pulp, pulpal necrosis, vascular congestion, and dentin demineralization possible  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Pathologic Tooth Migration Pathogenesis of Bone Destruction  Inflammation  Response to injury or pathogenic invasion  In periodontitis, permanently destroys tissues  Alveolar bone loss Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Resorption of alveolar bone due to periodontitis Progression of Alveolar Bone Loss (pg 63) Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer © Wolters Kluwer Changes in Alveolar Bone Height in Disease  Bone height in health and gingivitis  Crest of alveolar bone 2 to 3 mm apical to CEJs of teeth  Horizontal bone loss most common in periodontitis  Even, overall height reduction with perpendicular margin Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Vertical bone loss (angular bone loss) less common  Uneven reduction in height with more rapid resorption Horizontal and Vertical Patterns of Bone Loss Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com 03.F16B: Horizontal Pattern of Bone Loss. A. Horizontal bone loss results in bone levels that are approximately at the same height on adjacent tooth roots. B. As depicted on the radiograph, alveolar bone resorption is uniform on both mesial and distal surfaces. On a radiograph, if an imaginary line drawn between the CEJs of adjacent teeth is approximately parallel, then the bone loss is described as horizontal bone loss. © Wolters Kluwer  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com 03.F17B: Vertical Pattern of Bone Loss. A. Vertical bone loss results in an uneven reduction in bone height on adjacent tooth roots, resulting in a trench-like area of missing bone alongside the root of one tooth. B. On a radiograph, if an imaginary line drawn between the CEJs of adjacent teeth is not parallel, then the bone loss is described as vertical bone loss. © Wolters Kluwer Pathway of Inflammation in Horizontal Bone Loss  Within gingival tissue along connective tissue sheaths  Into alveolar bone Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Into periodontal ligament space  Path of least resistance © Wolters Kluwer Pathway of Inflammation in Vertical Bone Loss  Within gingival connective tissue  Directly into periodontal ligament space Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Into the alveolar bone  Weakened crestal periodontal ligament fibers no longer barrier can be related to occlusal trauma © Wolters Kluwer Bone Defects in Periodontitis  Infrabony defect  Base of defect extends apical to residual alveolar crest  Type of osseous defect  2 types of Infrabony defects Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com 1. Intrabony defect  Bone resorption occurs in uneven, oblique direction  Primarily affects one tooth 2. Osseous Crater:  Interdental bone loss  Affects 2 adjacent teeth One-Wall Intrabony Defect  Also called hemiseptal defect  Half of interdental septum lost Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Other half remains attached to tooth © Wolters Kluwer Two-Wall and Three-Wall Intrabony Defects Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer © Wolters Kluwer Proximal Bone Contour  Bone contour from facial to lingual dips apically  Forms osseous crater  Affects two adjacent root Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com surfaces  Interdental area difficult to clean © Wolters Kluwer Bone Loss in Furcation Areas  Furcation involvement  Occurs on multirooted tooth when periodontal infection invades area between and around roots  Results in loss of alveolar bone between roots Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  May be hidden by gingival tissue or clinically visible Bone Loss in Furcation Areas (cont.) Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Courtesy of Dr. Richard J. Foster, Educational Courtesy of Dr. Richard J. Foster, Educational Courtesy of Dr. Richard J. Foster, Educational Solutions and Design, Greensboro, NC. Solutions and Design, Greensboro, NC. Solutions and Design, Greensboro, NC. Attachment Loss in Periodontal Pockets  Destruction of fibers and bone that support teeth  Spreads apically and laterally Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Pocket on different root surfaces can have different depths © Wolters Kluwer Disease Sites  Areas of tissue destruction  Inactive disease site  Junctional epithelium attachment level stable over time Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Active disease site  Shows continued apical migration of junctional epithelium  Assess with periodontal probe and record in chart Periodontal Pockets  Areas of tissue destruction left by disease process  Much like a demolished home after a hurricane  Not necessarily an indicator of active disease Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Most pockets in adult patients are inactive disease sites Gingival Sulcus  In health, average sulcus 1 to 3 mm deep  Junctional epithelium coronal to CEJ Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Attaches along entire length to tooth © Wolters Kluwer Gingival Pockets or Pseudopockets (False Pockets)  Deepening of gingival sulcus due to swelling  Causes of increased probing depth: Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Detachment of coronal portion of junctional epithelium  Increased tissue size due to swelling of tissue © Wolters Kluwer © Wolters Kluwer Periodontal Pockets  Pathological deepening of gingival sulcus  Occurs as result of:  Apical migration of junctional epithelium  Destruction of periodontal ligament fibers Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Destruction of alveolar bone Suprabony Pocket  Occurs with horizontal bone loss, but pocket base is coronal to alveolar crest Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Junctional epithelium located coronal to crest of alveolar bone © Wolters Kluwer Infrabony Pocket  Occurs with vertical bone loss  Types:  Intrabony defect Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Osseous defect  Junctional epithelium apical to crest of alveolar bone © Wolters Kluwer Theories of Disease Progression  Pattern of disease progression may vary from:  One individual to another  One site to another in person’s mouth  One type of periodontal disease to another Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Continuous Progression Theory (Historical View of Disease Progression: Prior to 1980)  Periodontal disease progresses throughout the entire mouth in slow, constant rate over adult life  All untreated gingivitis cases progress to periodontitis.  All cases of periodontitis progress at a slow, steady rate Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Research in early 1980s indicated periodontal disease:  Does not progress at constant rate  Does not affect all areas of mouth simultaneously Continuous Disease Model of Disease Progression Prior to 1980 Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer Intermittent Progression Theory (Current View)  Periodontal disease characterized by periods of disease activity and inactivity (remission)  Tissue destruction sporadic and occurs at different rates  Most untreated gingivitis does not progress to periodontitis Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Different forms may progress at different rates  Susceptibility to periodontitis varies greatly by individual Intermittent Disease Progression Theory Current Research Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer Epidemiology of the Diseases of the Periodontium  What is epidemiology?  Study of health and disease within total population and behavioral, environmental, and genetic risk factors  Epidemiologists work to: Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Determine occurrence and identify risk factors  Provide current information about treatment and prevention Questions Epidemiologists Ask when Researching Periodontal Disease Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com © Wolters Kluwer Disease Incidence and Prevalence  Incidence  Number of new cases in population over given period  Prevalence  Number of all cases identified in specific population at given Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com point in time Variables Associated with Prevalence of Disease Page 76  Gender  Race/ethnicity  Education and socioeconomic status Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Age  Behavior  Access to dental care What the Research Shows  Periodontal disease one of most widespread diseases in adult Americans  Most individuals with disease unaware of its presence Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Findings based on data collected as part of CDC’s 2009–2010 NHANES Public Health Surveillance of Periodontal Disease  AAP and CDC  Describe periodontal disease as public health concern  Working toward improved disease surveillance  CDC’s Division of Oral Health and the Association of Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com State and Territorial Dental Directors collaborate to monitor burden of oral disease and track state data