Periodontitis Lecture Notes PDF

Chapter 6 Periodontitis Instructor: Cindy Yeon Hee Lee RDH, BSc., Cert. Adult Ed. Copyright © 2019 Wolters Kluwer All Rights Reserved 1 Copyright © 2014 Wolters Kluwer All Rights Reserved 1. A bacterial infection of the periodontium character...

Chapter 6 Periodontitis Instructor: Cindy Yeon Hee Lee RDH, BSc., Cert. Adult Ed. Copyright © 2019 Wolters Kluwer All Rights Reserved 1 Copyright © 2014 Wolters Kluwer All Rights Reserved 1. A bacterial infection of the periodontium characterized by a slow destruction of the periodontal ligament, slow loss of supporting bone, and a good response to periodontal therapy is termed: A. Periodontitis B. Refractory periodontitis C. Necrotizing periodontal disease D. Recurrent periodontal disease Copyright © 2019 Wolters Kluwer All Rights Reserved 2 2. New signs and symptoms of destructive periodontitis that reappear after periodontal therapy because the disease was not adequately treated and/or the patient did not maintain adequate self- care is termed: A. Refractory form of disease B. Recurrent form of disease Copyright © 2019 Wolters Kluwer All Rights Reserved 3 3. Periodontitis in which 30% or LESS of the sites in the mouth have experienced attachment loss and bone loss is termed: A. Non-plaque-induced gingivitis B. Localized periodontitis C. Generalized periodontitis Copyright © 2019 Wolters Kluwer All Rights Reserved 4 4. Periodontitis in which MORE than 30% of the sites in the mouth have experienced attachment loss and bone loss is termed: A. Non-plaque-induced gingivitis B. Localized periodontitis C. Generalized periodontitis Copyright © 2019 Wolters Kluwer All Rights Reserved 5 5. Probing depth of 5 mm or less that shows as even horizontal bone loss on radiographs occurs in which of the following stages of periodontitis? A. Stage I B. Stage II C. Stage III D. Stage IV Copyright © 2019 Wolters Kluwer All Rights Reserved 6 6. Tissue destruction that is characterized by increased CAL of 2 mm or more over a 5-year period has a grade of: A. Grade A B. Grade B C. Grade C Copyright © 2019 Wolters Kluwer All Rights Reserved 7  A B B C B C Copyright © 2019 Wolters Kluwer All Rights Reserved 8  Periodontitis Necrotizing Periodontitis as a Periodontal Periodontitis Manifestation of Disease Systemic Disease Copyright © 2019 Wolters Kluwer All Rights Reserved 9 Periodontitis Number 1 cause of tooth loss in adults: – 47% of adults over 30 have periodontitis. Is a bacterial infection Causes progressive destruction of the periodontal ligament. Gradual loss of supporting alveolar bone. Copyright © 2019 Wolters Kluwer All Rights Reserved 10  Periodontitis (cont.) Can have onset of any age, but more common over age of 35. Usually progresses at slow to moderate rate. Begins as plaque- induced gingivitis that progressed to periodontitis. Plaque-induced gingivitis is reversible, periodontitis is not reversible. Copyright © 2019 Wolters Kluwer All Rights Reserved 11 Alternative Terminology May see references in literature to: – Chronic Periodontitis – Aggressive Periodontitis – Localized Juvenile Periodontitis These are older terms that have been replaced with the larger umbrella of PERIODONTITIS with stages and grades. Copyright © 2019 Wolters Kluwer All Rights Reserved 12 Signs and Symptoms of Periodontitis Abundance of mature plaque and calculus. Reddish to purplish tissue OR tissues may appear pale pink. Gingival bleeding. Loss of attachment – mobility. Tissue Edema (swelling). Suppuration (pus). Copyright © 2019 Wolters Kluwer All Rights Reserved 13  Patient Complaints Red, swollen gingiva Bleeding during brushing Bad taste in mouth Bad breath Sensitive teeth Loose teeth Pus Copyright © 2019 Wolters Kluwer All Rights Reserved 14 Alterations of Color, Texture, and Size of Marginal Gingiva Tissue appears red-purple Rolled gingival margins Flattened papillae BUT!!! Tissue can appear pale pink Copyright © 2019 Wolters Kluwer All Rights Reserved 15 Do Not Rely on Clinical Appearance Clinical appearance is NOT a reliable indicator of the presence or severity of chronic periodontitis: – May exhibit pronounced changes in appearance – May exhibit minimal changes in appearance Copyright © 2019 Wolters Kluwer All Rights Reserved 16  The Clinical Appearance Of This Tissue Suggests Health... However... If gingival tissues are pale pink……. Look for firm, fibrotic tissue. Check for attachment loss. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2019 Wolters Kluwer All Rights Reserved 17 When assessed with a probe, a deep pocket reveals bone loss on the mesial surface of the canine Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2019 Wolters Kluwer All Rights Reserved 18  Bleeding and Gingival Crevicular Fluid Gingival bleeding is common. Can be spontaneous or in response to instrumentation (ex: probing). Increased flow of gingival crevicular fluid and pus from pockets. Copyright © 2019 Wolters Kluwer All Rights Reserved 19 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Exudate from the gingival tissue Copyright © 2019 Wolters Kluwer All Rights Reserved 20 Plaque Biofilm and Calculus Periodontitis characterized by mature supra- and subgingival soft and hard deposits. Can have very thick and complex deposits of plaque on affected root surfaces. Host factors determine pathogenesis and rate of progression of the disease. Copyright © 2019 Wolters Kluwer All Rights Reserved 21  Clinical Attachment Loss (CAL) Can occur in one site of a single tooth or several teeth or entire dentition: 1. Apical migration (relocation) of the JE to the tooth root. 2. Destruction of fibers of the gingiva. 3. Destruction of periodontal ligament fibers. 4. Loss of alveolar bone support around the tooth. Copyright © 2019 Wolters Kluwer All Rights Reserved 22 Clinical Attachment Loss (cont.) Loss of alveolar bone support from around the tooth: – Progressive bone loss may result in tooth loss – Furcation involvement becomes evident in multirooted teeth – Tooth mobility and/or drifting occurs Copyright © 2019 Wolters Kluwer All Rights Reserved 23  Radiographic Evidence of Periodontitis Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2019 Wolters Kluwer All Rights Reserved 24  What conditions can you have (contributing factors) that contributes to periodontitis? Copyright © 2019 Wolters Kluwer All Rights Reserved 25  Contributing Factors Environmental factors: smoking. Systemic factors: diabetes or HIV. Genetics can increase an individual’s susceptibility to periodontitis. Intraoral factors such as tooth crowding or overhanging restorations. Copyright © 2019 Wolters Kluwer All Rights Reserved 26 Absence of Pain With periodontitis pain usually is NOT a symptom. This may be why: – Patients do not seek treatment early in the disease. – Patients do not follow through with treatment after the disease is diagnosed. Copyright © 2019 Wolters Kluwer All Rights Reserved 27 Extent of Destruction Distribution of disease throughout the entire dentition. Characterized on percentage of affected teeth: – Localized: may involve one site on a single tooth or several sites on several teeth. Involves 30% or less of the teeth. – Generalized: may involve most or entire dentition. Involves more than 30% of teeth. Copyright © 2019 Wolters Kluwer All Rights Reserved 28  Disease Progression Progression in untreated periodontitis is usually a continual and slow process: – Periods of remission or exacerbation may occur. In limited number of individuals, there is rapid progression (4x typical) of destruction of periodontal ligament and supporting alveolar bone. Tissue destruction in untreated periodontitis does not affect all teeth evenly. Can be site-specific. Rapidly progressing disease occurs more frequently in interproximals with heavy deposits – Why??? 29 Copyright © 2019 Wolters Kluwer All Rights Reserved Desired Outcome of Therapy For progression of periodontal disease to stop and prevent further attachment loss! Copyright © 2019 Wolters Kluwer All Rights Reserved 30 Before and After Periodontal Therapy Copyright © 2019 Wolters Kluwer All Rights Reserved 31 Before—Case 1 Copyright © 2019 Wolters Kluwer All Rights Reserved 32 After—Case 1 Copyright © 2019 Wolters Kluwer All Rights Reserved 33 Before—Case 2 Copyright © 2019 Wolters Kluwer All Rights Reserved 34 After—Case 2 Copyright © 2019 Wolters Kluwer All Rights Reserved 35 Before—Case 3 Copyright © 2019 Wolters Kluwer All Rights Reserved 36 After—Case 3 Copyright © 2019 Wolters Kluwer All Rights Reserved 37 Therapeutic Endpoints of Periodontal Therapy 1. Elimination of microbial etiology and contributing factors that perpetuate inflammation. 2. Preservation of state of the teeth and periodontium in a state of health, function and stability. 3. Prevention of disease recurrence. Copyright © 2019 Wolters Kluwer All Rights Reserved 38  Treatment Modalities Focus on reinforcing daily self-care. Periodontal instrumentation to remove microbial etiology. Eliminate local intraoral factors. Periodontal surgery. Adherence to periodontal maintenance regimen. Copyright © 2019 Wolters Kluwer All Rights Reserved 39 Recurrent Form of Periodontal Disease Return of destructive periodontitis that had been previously arrested. Happens especially with noncompliant self and professional care. Anyone with a prior history of disease is at risk for recurrence. Copyright © 2019 Wolters Kluwer All Rights Reserved 40 Refractory Form of Periodontal Disease Unknown etiology Patient being monitored and exhibits continued attachment loss despite: – Receiving continuous professional therapy. – Practicing effective self-care. – Following recommended schedule for maintenance visits. Copyright © 2019 Wolters Kluwer All Rights Reserved 41 Refractory Form of Periodontal Disease (cont.) Treatment for the refractory form includes: – Reviewing self-care – Scaling and root planing – Use of systemic and local antibiotics – Removal of hopeless teeth – Correcting restoration with overhangs – Surgery – Frequent maintenance visits Copyright © 2019 Wolters Kluwer All Rights Reserved 42  Periodontitis Staging and Grading System Copyright © 2019 Wolters Kluwer All Rights Reserved 43 Periodontitis Case A patient is a periodontitis case if there is: – Interdental clinical attachment loss detectible at two or more nonadjacent teeth OR: – Facial or lingual clinical attachment loss of 3 mm or more with pocketing greater than 3 mm detectible at 2 or more teeth Copyright © 2019 Wolters Kluwer All Rights Reserved 44 Copyright © 2019 Wolters Kluwer All Rights Reserved 45 Periodontitis Case (cont.) Attachment loss can not be due to non periodontitis causes such as: – Gingival recession of traumatic origin – Dental caries extending to or apical to CEJ – Presence of CAL on the distal aspect of a second molar associated with extraction of a third moor – Endodontic lesion draining through marginal gingiva – Vertical root fracture Copyright © 2019 Wolters Kluwer All Rights Reserved 46 Pathophysiology Related to Periodontitis Study of pathologic manifestations of periodontitis on the periodontium. Explains the processes within the body that results in the signs and symptoms of periodontitis. Copyright © 2019 Wolters Kluwer All Rights Reserved 47 3 Forms of Periodontitis Based on Pathophysiology 1. Necrotizing Periodontitis 2. Periodontitis as a direct manifestation of systemic diseases 3. Periodontitis Copyright © 2019 Wolters Kluwer All Rights Reserved 48 Periodontitis categories Copyright © 2019 Wolters Kluwer All Rights Reserved 49 4 Stages of Periodontitis Stage at presentation of periodontitis case is defined by: – Disease severity – Complexity of management Copyright © 2019 Wolters Kluwer All Rights Reserved 50 Staging: Copyright © 2019 Wolters Kluwer All Rights Reserved 51 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2019 Wolters Kluwer All Rights Reserved 52 Stage I Periodontitis (Initial Stage) Severity: – Interdental CAL of 1-2 mm at site of greatest loss – Radiographic bone loss extending to coronal one-third of root – No tooth loss due to periodontitis. Complexity of management: – Maximum probing depths of 4 mm or less – Mostly horizontal bone loss. Copyright © 2019 Wolters Kluwer All Rights Reserved 53 Stage II Periodontitis (Established Periodontitis) Severity: – Interdental CAL of 3-4 mm at site of greatest loss – Radiographic bone loss extending to coronal one-third of root – No tooth loss due to periodontitis. Complexity of management: – Maximum probing depths of 5 mm or less – Mostly horizontal bone loss. Copyright © 2019 Wolters Kluwer All Rights Reserved 54 Stage III Periodontitis (Severe Periodontitis) Severity: – Interdental CAL ≥5 mm at site of greatest loss – Radiographic bone loss extends to mid one-third of root – Tooth loss due to periodontitis of 4 or fewer teeth. Complexity of Management: – Maximum probing depths of 6 mm or greater – Vertical bone loss of 3 mm or greater – Class II or III furcation involvement – Moderate alveolar ridge defect complicating implant placement. Copyright © 2019 Wolters Kluwer All Rights Reserved 55  Stage IV Periodontitis (Advanced Periodontitis) Severity: – Interdental CAL of ≥5 mm at site of greatest loss – Radiographic bone loss extends to mid one-third of root – Tooth loss due to periodontitis of 5 or more teeth Complexity of Management: – Maximum probing depths of >6 mm – Masticatory dysfunction, occlusal trauma – Tooth mobility > Class II – Less than 20 remaining teeth. Copyright © 2019 Wolters Kluwer All Rights Reserved 56 3 Grades: A, B, or C Indicator of rate of progression. Determines likelihood of CAL progressing more quickly than typical for majority of periodontal cases. Based on direct evidence using longitudinal observations: – in a form of older diagnostic radiographs. Based on indirect evidence on assessment of bone loss: – assessment of bone loss at the worst affected tooth in the dentition as a function of age (% bone loss/age). Copyright © 2019 Wolters Kluwer All Rights Reserved 57 Grading: Copyright © 2019 Wolters Kluwer All Rights Reserved 58 25 years old VS. 80 years old Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2019 Wolters Kluwer All Rights Reserved 59 Grade A: Slow Rate of Progression No evidence of CAL or radiographic bone loss over a 5-year period. Heavy biofilm deposits with low level of tissue destruction. Modified by nonsmokers and normoglycemic patient. Copyright © 2019 Wolters Kluwer All Rights Reserved 60 Grade B: Moderate Rate of Progression Less than 2 mm CAL or radiographic bone loss over a 5-year period. Tissue destruction in line with expectations given amount of biofilm deposits. Modified by smoking less than 10 cigarettes a day. HbA1c of less than 7% in patients with diabetes. Copyright © 2019 Wolters Kluwer All Rights Reserved 61 Grade C: Rapid Rate of Progression 2 mm or more of CAL over a 5-year period. Tissue destruction exceeds expectations given the amount of biofilm deposits. Modified by smoking 10 or more cigarettes in a day. HbA1c of 7% or greater in patients with diabetes. Copyright © 2019 Wolters Kluwer All Rights Reserved 62 Periodontal Diagnosis Confirmation that a patient is a periodontal case should include: – CAL at 2 nonadjacent teeth. – Whether it is necrotizing periodontitis, a manifestation of systemic disease, or periodontitis. – Description of aggressiveness of disease by providing Stage and Grade. Copyright © 2019 Wolters Kluwer All Rights Reserved 63 LET’S LOOK AT SOME CASE STUDIES! Copyright © 2019 Wolters Kluwer All Rights Reserved 64 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 65 Copyright © 2019 Wolters Kluwer All Rights Reserved 66 Copyright © 2019 Wolters Kluwer All Rights Reserved 67 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 68 Copyright © 2019 Wolters Kluwer All Rights Reserved 69 Copyright © 2019 Wolters Kluwer All Rights Reserved 70 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 71 Copyright © 2019 Wolters Kluwer All Rights Reserved 72 Copyright © 2019 Wolters Kluwer All Rights Reserved 73 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 74 Copyright © 2019 Wolters Kluwer All Rights Reserved 75 Copyright © 2019 Wolters Kluwer All Rights Reserved 76 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 77 Copyright © 2019 Wolters Kluwer All Rights Reserved 78 Copyright © 2019 Wolters Kluwer All Rights Reserved 79 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 80 Copyright © 2019 Wolters Kluwer All Rights Reserved 81 Copyright © 2019 Wolters Kluwer All Rights Reserved 82 What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 83 Copyright © 2019 Wolters Kluwer All Rights Reserved 84 Copyright © 2019 Wolters Kluwer All Rights Reserved 85  What Stage/Grade is this? Copyright © 2019 Wolters Kluwer All Rights Reserved 86 Copyright © 2019 Wolters Kluwer All Rights Reserved 87 Copyright © 2019 Wolters Kluwer All Rights Reserved 88 Assignment! A16B16 https://www.dentalcare.ca/en-ca/ce-courses/ce610 Assignment Number: 164351 Submit by using assignment number ☺ Pdf and questions are available with this lecture, but answers can be reviewed on the website after taking the online test! Start Date: October 21 2024, 12:00 AM (Dates and time are based on Eastern Standard Time.) Due Date and Time: November 17 2024, 12:00 AM (Dates and time are based on Eastern Standard Time.) Copyright © 2019 Wolters Kluwer All Rights Reserved 89 YouTube Video https://youtu.be/92tmU0AxT5o Copyright © 2019 Wolters Kluwer All Rights Reserved 90 Quizlet https://quizlet.com/_9hmfal?x=1jqt&i=2ha2hg https://quizlet.com/_8gynem?x=1jqt&i=2ha2hg Copyright © 2019 Wolters Kluwer All Rights Reserved 91 References: Jill S. Gehrig, Daniel E. Shin, Donald E. Willmann. Foundations of Periodontics for the Dental Hygienist. 6th edition. Lippincott, Williams & Wilkins, 2024. ISBN: 978-1-4963-8402-7. https://thepoint.lww.com/gateway https://www.perio.org/2017wwdc https://www.perio.org/sites/default/files/files/201 7%20World%20Workshop%20on%20Disease%2 0Classification%20FAQs.pdf Google images. Copyright © 2019 Wolters Kluwer All Rights Reserved 92