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

2. 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.

3. 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

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

5. 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.

6. 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.

7. 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

8. 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

9. 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

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

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

12. Endocrine disturbance
Decrease immunity
Blood disorder
Malaligmment
Improper brushing technique
Drugs

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

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

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

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

17. Local risk factors Faulty dental restorations Untreated dental disease
Crowding
Furcation

18. Any question? Thank you!