Dr. Majdy IDREES
Dr. Majdy IDREES
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 Gingivitis
 Periodontitis
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Dr. Majdy IDREES
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 Periodontitis is defined as "an inflammatory disease of
the supporting tissues of the teeth caused by specific
microorganisms or groups of specific microorganisms
 The clinical feature that distinguishes periodontitis from
gingivitis is the presence of;
Clinically detectable attachment loss (CAL)
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Histologically
 Junctional epi is usually
present at CEJ or coronal
to it
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Replacement of “Adult Periodontitis” With “Chronic
Periodontitis”
 Age-dependent nature of the adult periodontitis
designation created problems
 Chronic periodontitis can occur prior to the age of 35
years
 Rates of progression should not be used to exclude
people from receiving the diagnosis of Chronic
Periodontitis
The onset of chronic periodontitis occurs at anytime
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Replacement of “Early-Onset Periodontitis”
With “Aggressive Periodontitis”
 It is true that this disease often occurs in people under
35 years of age, but it may also affect older patients
 The term early-onset periodontitis was too restrictive
 Diagnosis of aggressive periodontitis is made on
clinical, radiographic and historical findings which
show rapid attachment loss and bone destruction,
and possible familial aggregation of disease
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1989 classification had many shortcomings including:
1)
2)
3)
4)
5)
6)
Considerable overlap in disease categories,
Lack of a category for strictly gingival diseases
Difficulty in fitting certain patients into any of the existing
categories
Similarity of microbiological and host response features in
different disorders
An emphasis on age of onset that became a problem as
patients aged into a new category
Some unclear classification criteria
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Actual and apparent positions of the gingiva
 The actual position is the
level of the coronal end of
the epithelial attachment on
the tooth
 Apparent position is the
level of the crest of the
gingival margin
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 The severity of recession is determined by the
actual position of the gingiva, not its apparent
position
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Classification of Pockets
 Gingival (pseudo pocket):
 Coronal migration of gingival margin
 Without destruction of the underlying periodontal
tissues
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Classification of Pockets
 Periodontal:
 Apical migration of
epithelial attachment


Suprabony:
 Base of pocket coronal to
height of alveolar crest
Infrabony:
 Base of pocket apical to
height of alveolar crest
 Characterized by angular
bony defects
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Pattern of bone loss
 Vertical bone loss (angular bony defect) is usually
associated with intrabony pocket
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Pattern of bone loss
 Horizontal bone loss is usually associated with
suprabony pocket
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Radiographically
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Radiographically
 Best radiographic view to diagnose alveolar bone
defect is vertical bitewing followed by horizontal
bitewing
 The worst is OPG & in between is PA
 Panoramic view is the worst way to diagnose the
periodontal disease ???


Magnification (25 – 30%)
Lack of clarity
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Presence of gingival inflammation without loss
of attachment
Gingivitis
Presence of gingival inflammation with loss of
attachment
Periodontitis
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Chronic periodontitis
 Formerly known as "adult periodontitis“ or "chronic adult





periodontitis,“
Chronic periodontitis is characterized as occurring
mostly in adults, but it can be seen in younger people
Most prevalent form of periodontitis
Destruction is consistent with the amount of plaque
present and other local factors
Subgingival calculus is also commonly found
In general the disease progresses slowly but there may be
bursts of destruction
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Continuous Cycle!
 Plaque  gingival inflammation  pocket formation
 more plaque
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Common Characteristics




Onset - any age; most common in adults
Plaque initiates condition (primacy etiological factor)
Subgingival calculus common finding
Slow-mod progression; periods of rapid progression
possible
 Modified by local factors/systemic factors/stress/smoking
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CLINICAL FEATURES
 Supragingival and





subgingival plaque
accumulation
Gingival inflammation
Pocket formation
Loss of gingival stippling
Bone resorption
Tooth mobility
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 Pus
 Changes in the surface




topography
Halitosis
Tooth migration
Pain
Loss of clinical
attachment
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 Probing depth (PD) : measured clinically as the distance
between gingival margin & base of the pocket
 Gingival recession is measured as the distance between
CEJ & gingival margin
 Clinical attachment level (CAL): measured clinically as
the distance between CEJ & base of the pocket
 CAL= Probing Depth + gingival recession
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Gingival Recession
PD
Gingival
Margin
Gingival
Recession
CEJ
CAL = recession + PD
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CAL ???
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 Keratinized gingiva (KG) is the distance between
mucogingival junction & the gingival margin.
 Attached gingiva is the distance between
mucogingival junction and the external surface of the
bottom of the gingival junction. This means that the
attached gingiva is calculated by subtracting the PD
from the keratinized gingiva
 KG = free gingiva + attached gingiva
 Attached gingiva = KG - PD
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Keratinized (KG) and Attached (AG) gingiva
KG = 5 mm
PD = 2 mm
AG = ?
Attached gingiva AG = KG-PD
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Disease Distribution
 Site-specific disease
 Site specific effects of subgingival plaque accumulation
 Localized : if < 30% of examined site posses attachment
loss & bone loss
 Generalized : if > or equal 30% of examined sites
posses attachment loss & bone loss
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Disease severity
 Based on attachment loss
• Slight (mild): 1-2 mm of clinical attachment loss has
occurred
• Moderate: 3-4 mm of clinical attachment loss has occurred
• Severe: 5 mm or more clinical attachment loss has occurred
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 The distribution of periodontitis in individual cases is
described by combining the preceding terms as
follows:
Generalized
OR
Localized
Mild
OR
Moderate
OR
Sever
Chronic periodontitis
Generalized moderate chronic periodontitis
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Risk factors for chronic periodontitis
Periodontitis is considered to be a multifactorial disease in
which the normal balance between microbial plaque &
host response is disrupted
 Systemic factors
 Environmental & behavioral factors
 Genetic predisposition
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Systemic Factors
 Rate of progression of chronic periodontitis is generally
considered to be slow
 Systemic disease that influences the effectiveness of the
host response, the rate of periodontal destruction may be
significantly increased
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Environmental and Behavioral Factors
 Positive association between smoking & PD diseases
 Smokers with chronic periodontitis have more
attachment & bone loss, more funation involvements, &
deeper pockets
 Emotional stress also may influence the extent and
severity of chronic periodontitis
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Genetic Factors
 The twin studies have
indicated that risk of chronic
periodontitis has a high
inherited component
 Patients with the IL-1
genotype increased the risk
for tooth loss by 2.7 times
 The combined effect of the
IL-1 genotype & smoking
increased the risk of tooth
loss by 7.7 times
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Thank you
Your references for this lecture:
•Carranza 11th edition
•Parameters of periodontal diseases, J Perio, may 2000 (supplement)
•Power point presentation
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