1. Bacteria / viral associated with periodontal disease

2. 700 different microbial species > 100–200 species commonly colonise an individual’s mouth, reflecting great diversity

3. pathways for the oral bacteria to exert their effects tooth surfaces (either crown or root) periodontal tissues (either sulcular, junctional or pocket epithelium lining), connective tissues (if access is gained via ulcerated pocket epithelium) or other bacteria already attached to these surfaces.

4. pioneer Gram positive and include: streptococci (with Streptococcus sanguis, S. oralis and S. mitis being pioneer species), Neisseria, Nocardia and Actinomyces. ‘Milleri’ streptococci (S. anginosus, S. constellatus and S. intermedius) Gingivitis capnophylic (especially Capnocytophaga spp.) obligately anaerobic Gram-negative bacteria rises; Fusobacteria are common and there is an increased proportion of Actinomyces Periodontitis a diverse subgingival microflora and a large number of obligately anaerobic Gram-negative rods and filament-shaped bacteria, many of which are asaccharolytic but proteolytic

5. Designated periodontal pathogens:Suspected periodontal pathogens include: Aggregatibacter actinomycetemcomitans Porphyromonas gingivalis Tannerella forsythia Prevotella intermedia – Split into two distinct species Prevotella intermedia and Prevotella nigrescens in 1992 Fusobacterium nucleatum Campylobacter rectus Eikenella corrodens Peptostreptococcus micros Selenomonas species Eubacterium species Spirochaetes – Only 10 cultivated so far

11. Prognosis of tooth Prediction of probable course, duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease.

12. Prognosis of tooth 1.% of bone loss-CAL 2.Probing depth 3.Distribution and type of bone loss 4.(anatomy of intrabony defects) 5.Furcation : presence & severity 6.Mobility 7.Crown to root ratio

13. 8. Bleeding upon probing 9. Root morphology 10. Pulpal involvement/Caries 11. Tooth position and occlusal 12. relationship / strategic value/ cost 13. Patient risk factor

14. Recession PD CAL

15. How do you use PD and CAL? CAL is often used to monitor disease progression- determine prognosis PD is commonly used to develop type of treatment- grafting

16. Glickman’s Furcations

17. Miller Index Classification: 1- First sign of movement greater than normal 2 - Up to 1 mm in any direction 3 - More than 1 mm in any direction and/or vertical depression

18. Radiographic exam Full-mouth series Vertical Bite wings Panorex – developmental anomalies – Pathology – fractures Previous radiographs

19. Classification of Prognosis Modified McGuire’s Good Fair Poor Questionable Hopeless *Note: the textbook uses the orginial McQuire’s classification. In the Modified McGuire the classification criteria remains the same but the names for questionable and poor have been switched.

20. Prognosisfeature ExcellantNo bone loss Excellent gingival condition Good patient cooperation No risk factors GoodAdequate remaining bone support No or Controlled risk factors Adequate patient cooperation Fair25-40% Attachment Loss Grade I furcation Adequate maintenance possible Acceptable patient cooperation Questionable40-50% attachment loss Grade I or II furcation Allows proper maintenance but difficult Doubtful patient cooperation Risk factors present

21. Prognosisfeature Poor>50% attachment loss Inaccessible Grade II furcatio Grade III furcation Poor crown to root ratio with Class 2 or 2+ mobility Risk factors present or poorly controlled Hopeless>75% Bone loss Non-maintainable areas Grade III Furcation Class 3 Mobility Recurrent Abscesses Uncontrolled risk factors

22. Overall Factors that Affect Prognosis Age Medical status/systemic background Rate of Progression Patient Cooperation