Dr. Salem Manasra MSc. Of oral implantology Periodontal disease Dr. Salem Manasra MSc. Of oral implantology

PERIODONTIUM Four anatomical structures support the teeth (tooth- supporting structures) 1.Gingiva 2.Periodontal ligaments 3.Cementum 4.Alveolar bone The tissues of periodontium attach the tooth to alveolar bone and to support the tooth during function.

Gingiva: This part of masticatory mucosa that covers the alveolar process and surround the cervical portion of the tooth The gingiva is composed of connective tissue and epithelium which can be divided into three histologically distinct areas: Oral epithelium Sulcular epithelium Junctional epithelium

Healthy gingivae: Firm with scalloped outline Pink knife edged Has Stippled appearance (orange appearance) Do not Bleed on probing

Gingivitis It is an inflammatory process of the gingiva in which the junctional epithelium altered by disease, remain attached to the tooth at its original level.

Stages of development of gingivitis: Initial lesion: Inflammatory response to bacterial plaque, it occurs within 2-4 days. The first change occur around the small gingiva blood vessels apical to the junctional epithelium .There is migration and infiltration of white blood cells into the junctional epithelium and gingival sulcus.There is increased exudation of tissue fluid from gingival crevice.There may be no clinical signs of tissue change.

Early lesion: If plaque deposition persists, become older & thicker, inflammatory changes continue with increase flow of gingival fluid and migration of PMNs .There is small increase in inflammmatory cells 75% of which are lymphocytes.There is breakdown of collagen fibers. Early signs of gingivitis become apparent with slight gingival enlargement

Established gingivitis: Clinically obvious within 7-14 days. Clinical signs of inflammation and interdental papillae become swollen and bleed on probing Predominat inflammatory cells are plasma cells Marginal gingiva becomes spongy With the increased the destruction of collagen and inflammatory swelling, the gingival margin can be separated easily from the surface giving rise to false pocket

Periodontitis A group of inflammatory diseases that affect all the periodontal structures .It results in the destruction of the attachment apparatus and the development of periodontal pocket

Causes of periodontal disease Direct Causes: Poor oral hygiene leading to accumulation of dental plaque and calculus.

Indirect Factors: Food impaction Tobacco smoking & chewing Faulty restoration Badly designed dentures Orthodontic appliance Lack of lip-seal Malnutrition

Endocrine disturbance Decrease immunity Blood disorder Malaligmment Improper brushing technique Drugs

Risk factors for periodontal disease: Sociodemographic factors: Age Gender Socioeconomic status Ethnicity

Hereditary or acquired conditions: Diabetes mellitus Cardiovascular disease Obesity HIV Osteoporosis

Microbial risk factors: Behavioral fators: Tobacco use and cigarrette smoking Patient compliance Microbial risk factors: Tannerella forsythenesis Porphyromonas gingivalis Aggregatibacter actinomycetemcomitans

Psychologic and cognitive factors Stress Bruxism Host defence factors Genetic risk factors

Local risk factors Faulty dental restorations Untreated dental disease Crowding Furcation

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