Introduction to periodontology
Transcript of Introduction to periodontology
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Introduction to PeriodontologyDr. Feras Aalam
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outline
• Periodontium
• Healthy
• Gingivitis
• Periodontitis
• Periodontal examinations
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Gingival crest
Marginal gingiva
Attached gingiva
Alveolar bone
Enamel
Dentine
Gingival sulcus
Cementum
Periodontal ligament
Lamina dura
Epithelial attachment
Alveolar mucosa
Ginigval unit
Attachment unit
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Clean tooth
pellicle
plaque
calculus
No Oral hygeine 6-8 H
No Oral hygeine >14 Days
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Pellicle
• Glycoprotein pellicle• Initial phase of plaque
formation• Soft and hard surfaces
of O.C (teeth, prothesis,tissue)
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Pellicle
• Contents
salivary components
crevicular fluid
bacterial products
tissue cellproducts
debris
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Pellicle
• Functions
1. protective barrier (lubrication, prevent tissue desiccation)
2. provides a substrate on which bacteria accumulate to form dental plaque
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Clean tooth
pellicle
plaque
calculus
No Oral hygeine 6-8 H
No Oral hygeine >14 Days
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Plaque
• Soft deposits, within few hours
• Composition:– A mixed microbial biofilm
growing on dental pellicle
• The prime etiological agent of the two main oral diseases:
dental caries periodontal disease
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Plaque formation
• 1-2 days• Initial colonization by pioneer
species on dental pellicle• Outgrowth, microcolonies.....spread
outwards and upwards• Secondary colonization and
multiplication• Species diversity increases
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Major sites of plaque accumulation
• Fissures of molar teeth
• Supragingival: on the tooth surface above the gingiva
• Subgingival: in the area bounded by the margin of the gum and the tooth
• Interproximal: between adjacent teeth
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Clean tooth
pellicle
plaque
calculus
No Oral hygeine 6-8 H
No Oral hygeine >14 Days
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Calculus
Consists of miniralized bacterial plaque that forms on the surfaces
Supragingival or subgingival
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Calculus
Composition
• 1. inorganic content 70-90% of calcium phosphate, calcium carbonate, magnesium phosphate
• 2.organic content protein-polysaccharide, desquamated epithelial cells, leukocytes, microorganisms
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Calculus formation
• Calculus is dental plaque that has undergone miniralization
• Soft plaque.......precipitation of miniral salts between 1st and 14 days
• Saliva is the source of miniralization
• Gingival Cervicular Fluid (GCF)
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Health
Gingivitis
Periodontitis
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Periodontal Disease
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How do we know there is a problem??
DIAGNOSIS
• Individual complaine
• Clinical examinations
• Radiographic examination
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Individual complaine
• Bleeding gums• Red gums• Blood on my pilo• Bad taste • Bad smell (halitosis)• Smokers ....less bleeding
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Clinical examinations
• Plaque index
• Gingival index
• Pocket measurment
• Furcation
• Tooth mobility
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Plaque IndexSilness & Löe 1964
Score 1
Score 2Score 0
Score 3
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Plaque Scoring System for Quigley and Hein
Score
no plaque 0
flecks of stain at the gingival margin 1
definite line of plaque at the gingival margin 2
gingival third of surface 3
two thirds of surface 4
greater than two thirds of surface 5
Plaque Index
total score = = SUM(scores for all facial and lingual surfaces)
index = = (total score) / (number of surfaces examined)
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Gingival Index Löe & Silness 1963
Score 0 Score 2
Score 3Score 1
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Appearance Bleeding Inflammation Points
normal no bleeding none 0
slight change in color and mild edema with slight change in texture
no bleeding mild 1
redness, hypertrophy, edema and glazing
bleeding on probing/pressure
moderate 2
marked redness, hypertrophy, edema, ulceration
spontaneous bleeding
severe 3
Gingival Index Löe & Silness 1963
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Gingival Index Löe & Silness 1963
Teeth examined:
• (1) maxillary right first molar
• (2) maxillary right lateral incisor
• (3) maxillary left first bicuspid
• (4) mandibular left first molar
• (5) mandibular left lateral incisor
• (6) mandibular right first bicuspid
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Surfaces examined on each tooth:
• (1) buccal
• (2) lingual
• (3) mesial
• (4) distal
Gingival Index Löe & Silness 1963
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Average Gingival Index Interpretation
2.1 - 3.0 severe inflammation
1.1 - 2.0 moderate inflammation
0.1 - 1.0 mild inflammation
< 0.1 no inflammation
Gingival Index Löe & Silness 1963
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Gingival sulcus
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Furcation
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Furcation
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Furcation
• Bacterial plque
• Extent of inflammation
• Enamel projection
• Increase with age
• Increase in smokers
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Radiographic examination
Horizontal bone resorption
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Radiographic examination
Vertical bone resorption
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Treatment plan
Hygeinic phase (Phase I therapy)• Oral hygeine instruction (OHI)• Gingivitis treatment
*maintain good OH (brushing, flossing)
*chlorohexidine mouth wash 2%• Supragingival scaling• Subgingival scaling and root planing• 3 weeks follow up
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Summary
• Plaque
• Calculus
• Gingivitis
• periodontitis
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