Periodontology by Reyam Jajo https://padlet.com/reyam_jaj/dent1306 Gingival Diseases | Chronic Periodontitis | Aggressive Periodontitis | References: Gehrig, J. S., & Willmann, D. E. (2016). Foundations of periodontics for the dental hygienist. Philadelphia, PA: Wolters Kluwer. en-us 2019-01-26 02:13:04 UTC 2019-01-26 05:04:13 UTC hello@padlet.com Chronic Periodontitis reyam_jaj https://padlet.com/reyam_jaj/dent1306/wish/324537376
  • Chronic periodontitis is the most common form, usually occurring in people over the age of 35
  • Pain is NOT a symptom of chronic periodontitis, hence why patients don’t seek treatment early on or don’t follow through with treatment after diagnosis.
  • Clinical appearance is not a reliable indicator for presence or severity of chronic periodontitis
    • May exhibit pronounce changes in appearance.
    • May exhibit minimal changes in appearance.
    • CLINICAL APPEARANCE IS NOT A RELIABLE INDICATOR OF DISEASE.
  • Pus represents dead WBCs and occur in any infection, including PD.
  • Exudate AKA suppuration is the accumulation of pus.
  • The seriousness of chronic periodontitis is determined by:
    • Rate of disease progression over time.
    • The response of tissues to treatment.
  • Treatment goals for chronic periodontitis:
    • Control bacterial plaque to a level compatible with periodontal health.
    • Alter or eliminate contributing risk factors.
    • Arrest disease progression (stop attachment loss from worsening).
    • Prevent recurrence of disease.
    • Reduction in probing depth.
  • Long-term outcome of periodontal therapy depends on:
    • Patient compliance with self-care.
    • Periodontal maintenance – recall appointments at appropriate intervals.
  • Not all disease sites respond equally to therapy. Signs that disease site is not responding successful to therapy include:
    • Inflammation
    • Increasing attachment loss
    • High plaque levels

    • Recurrent chronic periodontitis involves new signs of destructive periodontitis that reappear after therapy because:
    • Disease was not adequately treated and or patient did not practice adequate self-care.
    Refractory periodontitis was a disease classification category that was eventually removed in 1999.
    • Referred to all types of periodontal disease that do not respond to treatment.
    Refractory chronic periodontitis involves cases of chronic periodontitis that do not respond to periodontal therapy.
    • This means, there was continued attachment loss at one or more sites even with appropriate and adequate therapy, self-care, and full completion of periodic maintenance visits.
    ]]>     2019-01-26 02:17:16 UTC https://padlet.com/reyam_jaj/dent1306/wish/324537376     Overview of Diseases reyam_jaj https://padlet.com/reyam_jaj/dent1306/wish/324537878 3 basic states of periodontium:
    1. Periodontium in health:
      • Clinical picture of health: pink, firm, no bleeding.
      • Histological picture of health - healthy sulcus: JE coronal to CEJ, supragingival fibers intact, alveolar bone intact, and PDL intact.
    2. Gingivitis: a type of PD characterized by changes in colour, contour, and consistency of gingival tissues.
      • Observed clinically from 4 to 14 days after biofilm builds up in the gingival sulcus.
      • Bacterial infection confined to the gingiva.
      • Reversible damage.
      • Clinical picture of gingivitis: red, swollen, bleeding likely
      • Histological picture of gingivitis – gingival pocket: JE at CEJ, supragingival fiber destruction, alveolar bone intact, PDL intact
      • Acute gingivitis: lasts for short period of time, characterized by fluid in gingival connective tissues, and tissue appears swollen.
      • Chronic gingivitis lasts for months or years, new collagen fibers are formed resulting in more fibrotic tissue.
      • Gingivitis may persist for years without progressing to periodontitis. 
    3. Periodontitis: a type of PD characterized by apical migration of JE, loss of connective tissue attachment, and loss of alveolar bone.
      • Tissue damage is permanent.
      • Bacterial infection of all parts of the periodontium.
      • Clinical picture of periodontitis: pink or purplish, swollen or fibrotic, and bleeding.
      • Histological picture of periodontitis – periodontal pocket: JE on cementum, supragingival fiber destruction, alveolar bone destruction, and PDL destruction.
    2 types of periodontal pockets:
    1. Suprabony: occurs when there is horizontal bone loss.
      • JE located coronal to crest of alveolar bone (above crest of bone).
    2. Infrabony: occurs when there is vertical bone loss.
      • JE located apical to the crest of alveolar bone (below the crest of bone).
      • Base of pocket located within cratered-out area of bone alongside root surface.
    Current view/theory of disease progression is known as Intermittent Theory of Disease Progression, and states that:
    • PD is characterized by periods of disease activity and inactivity.
    • Tissue destruction can be sporadic/random, progressing at different rates throughout the mouth.
    • Most cases of untreated gingivitis DO NOT progress to periodontitis.
    • Susceptibility to periodontitis varies greatly between individuals.
    ]]>     2019-01-26 02:25:34 UTC https://padlet.com/reyam_jaj/dent1306/wish/324537878     Gingival Diseases reyam_jaj https://padlet.com/reyam_jaj/dent1306/wish/324537927
  • Gingival diseases are the most common and mildest form of PD.

    • Plaque-induced gingival diseases: PD involving inflammation to gingiva in response to dental plaque.
    • Plaque-induced gingivitis:
      • On a periodontium with no attachment loss:
        • Most common form
        • Plaque at GM
        • Red, tenderness
        • Swollen margins
        • BOP
        • Damage reversible with good homecare
      • On a reduced but stable periodontium:
        • Occurs in patients who have been successfully treated for periodontitis, but then at a later time, develop gingivitis (but NO periodontitis is present at the same time).
        • All other signs of plaque-induced gingivitis, and the attachment loss from history of periodontitis.

    Gingival disease modified by systemic factors:
    • Less common type.
    • Plaque initiates the disease and then specific systemic factors in the host modify the disease process (usually exaggerating it).
      • i.e. puberty-induced gingivitis, pregnancy-induced gingivitis, pregnancy-associated pyogenic granuloma AKA “pregnancy tumor”, diabetes-associated gingivitis, and leukemia-associated gingivitis.

    Gingival diseases modified by medications:
    • Drug-influenced gingivitis: exaggerated inflammatory response to dental plaque and a systemic medication.
    • Drug influenced gingival enlargement: an increase in size of gingiva resulting from systemic medications. This could even occur without plaque accumulation – meticulous plaque control can reduce but will NOT eliminate gingival overgrowth. Examples of medications that cause this are:
      • Anticonvulsants, i.e. phenytoin
      • Calcium channel blockers, i.e. nifedipine
      • Immunosuppressants, i.e. cyclosporine

    Gingival disease modified by malnutrition:
    • Those at risk for vitamin deficiencies, i.e. infants, institutionalized elderly, alcoholics.
    • Example: ascorbic acid-deficient (chronically low vitamin C levels) gingivitis. 

    Non-plaque-induced gingival lesions:

    Gingival disease of a specific bacterial origin:
    • Characterized by a bacterial infection of gingiva by specific bacterium that is not common component of bacteria plaque biofilm, AKA not a periodontal pathogen.

    Gingival diseases of viral origin:
    • Primary herpetic gingivostomatitis: the initial oral infection with the herpes simplex type-1 virus (HSV-1).
      • This infection is contagious during the vesicular stage.
    • Linear gingival erythema (LGE): gingival manifestation of immunosuppression, that is characterized by inflammation that is exaggerated for the amount of plaque present.
      • Does NOT respond well to better homecare or professional therapy.
      • Usually associated with HIV infection.
    • Lichen planus: a disease of the skin and mucous membranes without an exact cause that is characterized by an itchy, swollen rash on skin or in mouth.
      • May be an allergic or immune reaction.
    • Erythema Multiforme: a disease of the skin and mucous membranes caused by an allergic reaction or infection.
      • Characterized by large, symmetrical red blotches, (target-like), that appear all over the sin in circular pattern.

    Other non-plaque induced lesions include:
    • Gingival diseases of fungal origin
    • Gingival diseases of genetic origin
    • Gingival manifestations of systemic conditions
    • Traumatic lesions
    •  Foreign body reactions
    ]]>     2019-01-26 02:26:20 UTC https://padlet.com/reyam_jaj/dent1306/wish/324537927     Aggressive Periodontitis reyam_jaj https://padlet.com/reyam_jaj/dent1306/wish/324537950
    Aggressive periodontitis is a bacterial infection characterized by the rapid destruction of PDL and supporting alveolar bone.
    • High risk for tooth loss with this form of periodontitis.
    • Less common than chronic periodontitis.
    • Poor response to periodontal treatment.

    • Previously known as early onset periodontitis (EAP).
    • Thought to occur only in individuals under the age of 30 years.
      • Renamed because it can really occur at any age.
    • Primary features of aggressive periodontitis:
      • Rapid destruction of attachment.
      • No obvious signs/symptoms of systemic disease.
      • Other family members with aggressive periodontitis, i.e. parents, siblings. 
    • Secondary features of aggressive periodontitis:
      • Relatively small amounts of plaque but disease severity is exaggerated.
      • Elevated proportion of Aggregatibacter actinomycetemcomitans (Aa).
      • Phagocyte abnormalities.
      • Lack of clinical signs of disease – tissue appears healthy, but probing shows deep PPDs.
    • Key difference between chronic and aggressive:
      • CHRONIC: a very slowly progressing disease.
      • AGGRESSIVE: attachment loss is episodic, occurring in a succession of acute destructive phases with intermittent inactive phases.

    Localized aggressive periodontitis (LAP):
    • Onset of disease around puberty.
    • Localized, rapid tissue destruction around permanent first molars and/or incisors.
    • Involving NO more than 2 teeth other than first molars and incisors.
    • Lack of tissue inflammation and minimal amounts of plaque that seem inconsistent with around of periodontal destruction.
    • Usually associated with Aa.
    • Vertical bone loss around first molars and incisors – beginning around puberty.
    • Previously called localized juvenile periodontitis.

    Generalized aggressive periodontitis (GAP): 
    • Onset usually occurs in people under the age of 30 years.
    • Generalized interproximal attachment loss affecting at least 3 permanent teeth other than first molars and incisors.
    • Episodic disease progression.
    • Minimal amounts of plaque that seem inconsistent with amount of periodontal destruction.
    • Bone loss around most teeth.
    • 2 types of appearances:
      • Type 1: gingival tissues may appear acutely, inflamed, ulcerated, and fiery red.
        • Believed to occur in destructive phase of disease progression.
      • Type 2: Gingival tissues appear pink, deep pockets are detected with probe. This appearance occurs during periods of disease inactivity.
    • Previously called generalized juvenile periodontitis or early-onset periodontitis.
    • GENERALIZED AGGRESSIVE PERIO= GENERALIZED JUVENILE PERIO = EARLY-ONSET PERIO.
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