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)  Gingival margin swollen  Interdental papillae bulbous, swollen Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Bleeding upon gentle probing  Probing depths greater than 3 mm Microscopic Picture of Gingivitis  Hemidesmosomes still attach to enamel  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 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 alternations 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 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 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 alveolar bone  Weakened crestal periodontal ligament fibers no longer barrier © Wolters Kluwer Bone Defects in Periodontitis  Infrabony defect  Base of defect extends apical to residual alveolar crest  Type of osseous defect  Intrabony defect Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Bone resorption occurs in uneven, oblique direction  Primarily affects one tooth 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 demolished home after hurricane  Not necessarily indicator of active disease Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Most pockets in adult patients 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 entire mouth in slow, constant rate over adult life  All untreated gingivitis cases progress to periodontitis.  All cases of periodontitis progress at 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  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Continuous Disease Model of Disease Progression © 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  Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com Intermittent Disease Progression Theory © 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  Gender  Race/ethnicity  Education and socioeconomic status Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Age  Behavior  Access to dental care Measuring Disease Prevalence  Clinical examinations performed on cross-sections of groups using indices  Prevalence affected by new cases, cures or deaths within population, and longer lives of subjects Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Gingival indices to measure variables of inflammation  Clinical indices include variable of probing depth, clinical attachment level, and radiographic bone levels Difficulties in Measurement of Periodontal Disease  Involves hard and soft tissues  Must consider multiple variables  Multiple methods of assessment Copyright © 2024 by Jones & Bartlett Learning, LLC. www.jblearning.com  Multiple variables for defining periodontal disease make numbers for prevalence and incidence less specific, more of a range, and more subject to change  NHANES may not accurately represent disease 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