gingival and periodontal diseases
TRANSCRIPT
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Gingival and periodontal
diseasesBYMOHD MOHSIN JAMAL
UNDERDR. ANSHUL AGGARWAL
DEPT. OF ORAL MEDICINE AND RADIOLOGY
DR. ZIAUDDIN AHMAD DENTAL COLLEGEA.M.U
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Gingival diseases
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Gingival Diseases Gingivitis is inflammation of the gingival
tissue. Gingivitis is characterized by areas of redness
and swelling, and there is a tendency for the gingiva to bleed easily.
Gingivitis is limited to the epithelium and gingival connective tissues. It is important to note that there is no tissue recession or loss
of connective tissue or bone.
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Gingivitis
Gingivitis associated with poor oral hygiene is usually classified asa. Initial lesionb. Early lesionc. Moderate lesiond. Advanced lesion
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Stages of gingivitisstage Initial
stageEarly stage
Established stage
Time (days)
2-4 4-7 14-21
Blood vessels
Vascular dilatation
Vascular proliferation
Vascular proliferation,Blood stasis
Junctional &Sulcular epi.
Infiltration by PMNs
Same as stage 1,
Same but more advanced
Predominant immune cells
PMNs Lymphocytes
Plasma cells
Collagen Perivascular loss
Increased loss
Continuous loss
Clinical findings
Gingival fluid flow
Erythema,Bleeding on probing
Changes in color, texture, size
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Plaque removal
may progress
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Acute gingival diseases
Primary herpetic gingivostomatitis Recurrent aphthous ulcer Acute necrotizing ulcerative gingivitis (vincent
infection) Acute candidiasis (thrush, c)
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Primary herpetic gingivostomatitis
Caused by Herpes simplex virus type 1 Age-Children younger than 6 yrs, but also may
be seen in adolescents and adults. Primary infection is asymptomatic Location- lesions mainly involve hard palate,
attached gingiva and oral mucosa. Manifestations include blister outside the lip so
disease commonly called recurrent herpes labialis.
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….contd. Characteristic oral finding:
a. Diffuse erythematous involvement of gingiva.
b. Initial stage in characterized by discrete spherical gray vesicles.
c. Lip- excoriation involving lip become hemorrhagic
d. Course is self limited to 7-10 days.
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Oral symptoms:a. Generalized sorenessb. Ruptured vesicles – focal site of painc. Infants show irritability and refusal to eatd. Pain upon swallowing
Extra oral symptoms:a. Cervical lymphadenopathyb. Fever ( 101- 105℃)c. Generalized malaise, irritability
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Treatment
Symptomatic & supportive. Application of mild anesthetic such as
dyclonine hydrochloride(0.5%) Bed rest , soft diet are recommended during the
febrile stage & the person should be kept well hydrated.
Pyrexia - paracetamol suspension and secondary infection of ulcers may be prevented using chlorhexidine.
In severe case, systemic acyclovir(200 mg daily for 5 days).
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Recurrent aphthous ulcer
Characterized by painful ulceration on the oral mucosa
Occurs between school age and adults Recurrent ulceration with painful discrete and
confluent lesions. Lesions are round to oval crateriform base,
raised and reddened margins.
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Clinical features: Occur between second and third decade of life. Buccal and labial mucosa tongue and gingiva
are commonly involved. Symptoms- lesions are typically very painful. Signs- begins as single or multiple superficial
erosion covered by grey membrane, surrounded by localized area of erythema.
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Treatment
Symptomatic treatment Topical corticosteroid triamcinolone 3-4 times
daily by rinse and expectorate method. Nutritional diet. Maintenance of oral hygiene.
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Acute necrotizing ulcerative gingivitis
Characterized by sloughing of gingival tissue Predisposing factors: Local: poor oral hygiene, pre-existing gingivitis
and smoking Systemic: Emotional stress Nutritional deficiency –Vit B and C
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Clinical features Characteristic lesions are punched out, crater
like depression at the crest of interdental papillae
Surface of gingival craters is covered by pseudomembranous slough.
Linear erythma.
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Treatment Perform debridement under local anesthesia. Remove pseudo membrane. Patient counselling should include specific oral
hygiene instructions, instruction on proper nutrition,
For any signs of systemic involvement, the recommended antibiotics are:
Amoxicillin, 250 mg 3 x daily for 7 days and/or Metronidazole, 250 mg 3 x daily for 7 days
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Gingival enlargement
Inflammatory enlargementa. Chronic inflammatory enlargementb. Acute inflammatory enlargement
Drug induced gingival enlargement Vitamin C deficiency associated gingival
enlargement
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Chronic inflammatory gingival enlargement
Long standing gingivitis in young patient sometimes results in chronic inflammatory gingival enlargement, which may be localized or generalized.
Etiology: Prolonged exposure to plaque Factors that favor plaque accumulation and
retention. Chronically dried gingiva in mouth breathing
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Clinical features Characterized by slight ballooning of interdental
papilla and marginal gingiva. In early stage , it produces a life preserver-
shaped bulge around the involved teeth. Treatment: Removal of local irritants Oral hygiene maintenance
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Acute inflammatory enlargement
Gingival abscessIs a localized, painful rapidly expanding lesion that is usually of sudden onset
Etiology:a.Irritation from foreign substanceb.Tooth brush bristle c.Piece of apple cored.Lobster shell fragment –embedded in to gingiva
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Clinical feature:a. Localized, painful, rapidly expanding lesionb. Limited to the marginal gingiva or interdental
papillaec. Early stage: red swelling with smooth shiny
surfaced. With in 24 hours to 48 hours- lesion will be
fluctuant. Management: Incision and drainage
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Drug-induced gingival enlargement
Drug-induced gingival enlargement: Anticonvulsant Immunosuppressant cyclosporine Calcium channel blocker
Clinical and microscopic features of enlargement caused by different drugs are similar.
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Clinical features The growth starts as a painless, beadlike
enlargement of the interdental papilla and extends to the facial and lingual margins.
As the condition progress, marginal and papillary enlargement units and may develop into a massive tissue fold.
May interfere with occlusion.
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Treatment modalities
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Ascorbic Acid Deficiency Gingivitis
Associated with Vit C deficiency Involves marginal and papillary gingiva in the
absence of local predisposing factors Complains of severe pain and spontaneous
hemorrhage Treatment: Complete dental care, improved
dental hygiene, and supplementation with Vit C – improves gingival conditions
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Eruption Gingivitis
Gingivitis associated with tooth eruption. Tooth eruption usually does not cause gingivitis,
however inflammation associated with plaque accumulation around erupting tooth.
perhaps secondary to discomfort caused by brushing these friable areas, may contribute to gingivitis.
Treatment: Complete dental care, improve oral hygiene.
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Fig:- Medication-induced gingivitis (From Perry D, Beemsterboer P, Taggart E: Periodontology for the dental hygienist, Philadelphia, 2001, Saunders.)
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Fig:- Pregnancy gingivitis (From Perry D, Beemsterboer P, Taggart E: Periodontology for the dental hygienist, Philadelphia, 2001, Saunders.)
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Periodontal diseases
Periodontal disease is an infectious disease process that involves inflammation. Periodontal diseases involve the structures of the periodontium.
Periodontal disease can cause a breakdown of the periodontium resulting in loss of tissue attachment and destruction of the alveolar bone.
Introduction
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Prevalence of Periodontal Disease
Periodontal diseases are the leading cause of tooth loss in adults.
Almost 75% of American adults have some form of periodontal disease, and most are unaware of the condition.
Almost all adults and many children have calculus on their teeth.
Fortunately, with the early detection and treatment of periodontal disease, most people can keep their teeth for life.
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Systemic Conditions: Links to Periodontal Disease
Certain systemic conditions increase the patient’s susceptibility to periodontal disease, and periodontal disease may actually increase a patient’s susceptibility to certain systemic conditions. Cardiovascular disease Preterm low birthweight Respiratory disease
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Fig:- Structures of the periodontium: junctional epithelium, gingival sulcus, periodontal ligaments, and cementum
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Periodontal Diseases Infectious diseases that are the leading
cause of tooth loss in adults. Nearly 75% of American adults suffer from
various forms of periodontal disease and most are unaware of it.
Almost all adults have calculus on their teeth.
With the early detection and treatment of periodontal disease, it is possible for most people to keep their teeth for a lifetime.
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Classification:-Periodontal problems
PERIODONTAL CONDITIONS WITH LOSS OF CONNECTIVE TISSUE ATTACHMENT Early-onset periodontitis
a. Localized aggressive periodontitisb. Generalized aggressive periodontitis
Prepubertal periodontitis associated with systemic disease
a. Papillon-Lefevre syndrome b. Ehlers-Danlos syndromec. Chediak-Higashi syndromed. Leucocyte adhesion deficiency syndromee. Neutropenia
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Periodontitis
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…contd.
It is inflammatory disease of gingiva and deeper tissues of periodontium.
Characterized by pocket formation and destruction of supporting alveolar bone.
Periodontal probing for attachment loss and bitewing radiograph are often used to clinically confirm the diagnosis.
In its classification of periodontitis, the American Academy of Periodontology categorized the early-onset form under Aggressive Periodontitis.
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Page and colleagues believe that there are four different forms of
periodontitis : prepubertal, juvenile, rapidly progressing and
adult.
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COMMON FEATURES OF LAP AND GAP
Aggressive forms of periodontal disease have been defined based on the following primary features (Lang et al. 1999)a. Non-contributory medical historyb. Rapid attachment loss and bone destructionc. Familial aggregation of cases
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Localized Aggressive periodontitis(LAP):
Clinical features: characterized by “localized loss of attachment and
bone around permanent incisors and first permanent molars”
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….contd.
Prevalence is 1% It is linked to presence of Actinobacillus
actinomycetemcomitans and successful treatment outcomes correlate well with eradication of bacteria.
Treatment : local measures in combination with systemic antibiotic therapy.
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Generalized aggressive periodontitis (GAP):
It occurs in adolescents and teenagers. Characterized by generalized interproximal
attachment loss affecting at least three permanent teeth other than incisor and first molar.
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Radiographs showing the severe generalized nature of disease
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Causes of Periodontal Diseases Dental plaque is the major factor in causing periodontal
disease. Dental calculus provides a surface for plaque to attach.
Subgingival calculus Supragingival calculus
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Fig:- Buildup of bacterial plaque on the teeth affects the gingival tissues
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Fig:- Periodontal disease (Courtesy Dr. Edward J. Taggart, San Francisco, CA.)
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Treatment:
A combined regimen of regular SRP with 2-week course of systemic tetracycline therapy (250 mg, four times daily) .
Aa is sensitive to tetracycline, which also has the ability to be concentrated up to 10 times in gingival crevicular fluid when compared with serum.
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….cont. A combination of metronidazole (250 mg) &
amoxicillin (amoxicillin) (375 mg), three times a day for 8 days, in association with subgingival scaling, has also been found to be effective.
A more radical approach is to undertake flap surgery so that better access is achieved for root cleaning, and the superficial, infected connective tissues are excised.
An antimicrobial regimen can also be implemented in conjunction with a surgical approach.
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