Inflammatory periodontal disease

1
Inflammatory periodontal disease

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• ???? ???
• ???

2
Inflammatory periodontal disease

• ?? ??? 10-20? ??
• ? ? 40 plaque-induced periodontal disease
• Gingivitis ??, ????
• Advanced periodontitis 30, 40?
• ???? ??? ?? ??? microbial
• plaque? ?? ??

3
Gingivitis

• ??? ?? ??
• Redness, swelling, loss of stippling
• ???, ??? X
• Gingival swelling? ?? pseudo-pocket

4
Types of Gingivitis

• Acute traumatic gingivitis
• Acute non-specific gingivitis
• Acute hypersensitivity reations
• Acute necrotising ulcerative gingivitis
• HIV-associated gingivitis
• Acute herpetic gingivostomatitis
• Chronic marginal gingivitis
• Chronic desquamative gingivitis

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Acute traumatic gingivitis

• Physical cause
• Tooth brush trauma
• Damage from sharp item
• Hard food
• Iatrogenic damage by bur and brush
• Gingivitis artefacta
• ??? ??? ?? ??? ??
• Gingivitis artefacta major psychiatric disorder
• Gingivitis artefacta minor innocent habit

6
Acute traumatic gingivitis

• Thermal causes
• Hot food
• Dental cautery or overheated ultrasonic scaler
• Chemical causes
• Burns caused
• by the application of aspirin

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Acute non-specific gingivitis

• ??? ???? chronic
• gingivitis? ?? ???
• ?? ?? ??
• ?? ??? ?? ? ??
• ??? ??? ??
• ?? ?? ??? ?? ?? ???? ??
• ???

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Acute hypersensitivity reactions

• ?? ??(cinnamonaldehyde)? ?? ?? ??
• Allergic gingivitis
• Common features
• ?? ?? ??? ?? ????
• diffuse granular gingivitis
• Oral ulcerations
• glossitis and cheilitis
• ?????? plasma cell infiltration

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Acute necrotizing ulcerative gingivitis

• necrotizing interdental ulcer
• ?? ?? ???? ??? ??
• Fusiforms, spirochetes ???
• ??? yellowish pseudomembrane
• ?? ????
• Painful, very sore to touch, halitosis
• ??? ??, ??? ??? ??? ?? ? T/d
• ???? ???? adult-type periodontitis?
• ??? ?? ??? ?? ???

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Acute necrotizing ulcerative gingivitis

• Common predisposing condition
• 18-20?
• ??? ?? ??
• Smoker
• ?? ???? ??? ?? ??, stress
• HIV-infection
• Microbiology
• Fusospirochaetal complex of Bacillus fusiformis
  Borrelia vincentii (Vincent 1898)
• Vibrios, Bacteroides and Selenomonas species

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HIV-associated gingivitis

• HIV ?? ???? ??? acute form
• ?? ?? ??? dental plaque? unusual
• or exaggerated response
• Commonest symptom
• HIV ?? ??? intense marginal gingivitis
• ANUG? ??? ulceration

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Acute herpetic gingivostomatitis

• HSV infection
• Type I ????, ??? ??
• Type II ???? ??(sexually transmitted)
• Oral sign
• Soreness of oral mucosa
• Small vesicle
• ulcer surrounded by red halo
• Marginal herpetic gingivitis
• Systemic symptom
• Malaise, fever and lymphadenitis
• Dehydration

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Chronic marginal gingivitis

• Dental plaque
• Initiate and maintaine gingivitis
• Gram-negative anaerobic flora
• irritant metabolites
• destructive enzyme and
  antigen
• breakdown of gingival tissue
• ??? symptomless, but
• ?? ??, ?? ?? ?
• ? ??, ?? ??(?? ??)
• ??, ?? ??

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Chronic desquamaitive gingivitis

• 40-50? ???? ??
• thin, poorly keratinized,
• red, sore gingiva
• ??? ??? ?? ????
• ??? ??? ??? ???
• ??? dermatological problem
• lichen planus or lichenoid reaction
• BMMP

?? ??? ?? ?? ?? ??
15
Periodontitis

• loss of attachment with bone loss
• by apical migration of
  
• junctional
  epithelium
• Pocketing and/or recession
• Mobility and drifting of affected teeth
• Bleeing on deep probing
• Pus formation lateral periodontal abscess
• halitosis

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Adult periodontitis

• Commest type of periodontitis
• Plque-induced damage
• Break down slowly probing depth ?? ??
• Large amount of reparative fibrosis
• in the inflamed gingiva

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Adult periodontitis

• Clinical features
• Loss of attachment pocketing and/or recession
• Bone resorption
• Tooth mobility
• Drifting
• Suppuration from the active sites

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Aggressive forms of periodontal disease

• Prepubertal periodontitis
• Juvenile periodontitis
• Rapidly progressive periodontitis
• Refractory periodontitis
• Acute necrotising ulcerative periodontitis
• HIV-associated periodontitis
• occur in younger age
• progress at a more rapid rate
• ? aggressive or progressive disease

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Prepubertal periodontitis

• ??? ? ????,
• ??? ?? ??? ??
• acute gingival inflammation
• Gingival recession
• Rapid destruction of alveolar bone
• granulation or proliferation from active site
• epulide (gingival swelling)
• Little known about microbiology

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Prepubertal periodontitis

• associated with systemic disease
• Papillon-Lefevre syndrome
• Insulin-dependent diabetes
• Primary or acquired immunodeficiency
• Leukemia
• Hypophosphatasia
• Histiocytosis X
• Neutropenia
• Chediak-Higashi syndrome
• Agranulosytosis

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Juvenile periodontitis

• ???? ??? ??? ??
• 11-13?, ?? ??
• ? 1 ???, ??
• gingival inflammation low
• breakdown excessive
• ??? ? ??? ?? ?
• Fuctional defect of neutrophil or monocyte
• A.actinomycetemcomitans
• Capnocytophaga

phagocytic function ??
Toxin
22
Rapidly progressive periodontitis

• Severe, generalized, rapidly advancing lesion
• 25-35? ??
• Porphyromonas gingivalis
• A. actinomycetemcomitans
• Active phase
• Acute inflamed
• Proliferate granulomatous gingival epulides
• Fuctional defects of neutrophil or monocyte
• Systemic disorder

• Papillon-Lefevre syndrome
• Downs syndrome
• Chediak-Higashi syndrome
• Insulin-dependent diabetes

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Refractory periodontitis

• Continued signs of inflammation, pus formation or
  pocket deepening depite active tx.
• Common reason
• Inadequate oral hygiene
• Persistence of root surface
• deposits
• Root surface defects
• Inadequate host reponse
• Unidentified systemic factor
• Periodontic-endodontic lesions

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Refractory periodontitis

• Inadequate oral hygiene
• Supragingival plaque? ??
• Marginal gingiva? ???
• ??? ??
• Root surface deposit
• due to difficulties with access,
• visibility or root contour
• Root surface defects
• Groove, flute, gingival pit
• enamel projection

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Refractory periodontitis

• Inadequate host response
• Defects of PMNL of monocyte
• Difficult to detect
• Impossible to treat reduce the level of
  plaque
• Unidentified systemic factor
• Multiple active site, tissue highly inflamed
• plaque levels low hematological
  screening
• periodontic-endodontic lesions
• Perisistent periradicular infection
• Endodontic tx. Periodontal tx.

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Acute necrotizing ulcerative periodontitis

• ANUG? ??? ? ?? ?? ???? ??
• HIV infection?? ?? host resistance? ??? ??

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HIV-associated periodontitis

• Manifestation
• Inflammatory periodontal disease
• HIV-associated gingivitis
• ANUG, ANUP
• Acute necrotizing stomatitis
• Gingival ulceration associated with
• herpes simplex, herpes zoster, human
  cytomegalovirus
• Non-Hodgkins lymphoma
• Kaposis sarcoma
• neutropenia

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HIV-associated periodontitis

• intense marginal gingiva
• necrotic overlying soft tissue
• marginal bone exposure
• deep pocketing
• associated candidal infection

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Acute periodontal abscess

• not a type of periodontitis but a particular
  feature or symptom
• Periradicular abscess? ???? ?? ??
• history
• clinical examination
• vitality test
• appropriate radiograph

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Acute periodontal abscess

• Main cause
• Pocket? ??? connective tissue? organism entry
• SRP? plaque, calculus ?? pocket? ??
• Impaction of foreign body
• Blockage of a pocket with obstruction of drainage
• Reduction of host resistance

31
Acute periodontal abscess

• T/d to biting or percussion
• Throbbing pain relieved by pressure
• Fluctuant swelling
• Lymphadenitis, ?? ??
• ?? acute??, ?? drainage?? abscess? chronic??? ???
  ??