Periodontal Disease

Periodontal Disease
     By Najam us Sahar

INTRODUCTION

Periodontitis is the inflammation of periodontal tissue, i.e. periodontium, comprises of soft tissue and periodontal ligaments  that help in  attachment of  tooth in its socket. As inflammation of periodontium progresses, destruction of underlying alveolar bone started. Periodontitis occurs when inflammation of gingiva left untreated. If periodontitis also left untreated loosening of teeth would occur.  Periodontitis is characterized by the detachment of gingiva, forming a periodontal pocket, gingival bleeding, loss of periodontal ligament, loss of bone and at the end, loss of tooth would happen

       Local factors which can cause or intensify periodontal disease:

              Gingivitis: Gingivitis is the inflammation of Gingiva that leads to periodontal disease when it is           left untreated.

Plaque: Plaque is the sticky layer formed naturally, pale yellow in color  that adheres the enamel of teeth. Bacteria attached to this layer on the enamel form Bio- film.Bacteria propagate in an acidic environment, the sugar and acidic food, i.e. meat and cold drink make mouth environment acidic.

Calculus: is formed by the calcium deposition in the plaque causes irritation to the gingiva

Poorly contoured or overhanging restorations Caries:Overhanging restoration can cause periodontal diseases to help accumulation of dental plaque beneath the restoration , causes irritation to the soft tissue .

Root length and morphology: Root length and morphology effects on stress distribution on periodontal ligaments that causes loss of periodontal tissues and alveolar bone loss during rotational movement in orthodontic treatments

Crown to root ratio: It is the ratio of the length of the tooth appears above the alveolar bone. Crown to root ration effects  in prognosis of the tooth.

Anatomic issues: Anatomical tooth abnormalities increase the risk of Periodontitis

Maxillary sinus: Regular Maxillary sinusitis may cause periodontitis

Missing, supernumerary and impacted teeth: Missing teeth ,supernumerary and impacted teeth   produce crowding ,difficulty in  keeping good  oral hygein due to  improper proximal contacts that causes periodontal diseases

Clinical Evaluation of Periodontitis

Gingival Indices

                                                                                                                              PapillaryMarginalAttachedgingiva(PMA)                                                                                                                                                                                              

     It is the first attempt to evaluate gingival health in numeral system that evaluates the degree of gingivitis for each of the papilla (P), marginal (M) and attached gingiva (A). Only labial surface is examined         Gingival Index (G. I)                                                                                                                    Gingival Index is used to asses gingival condition. It marks marginal and Interdental tissues separately. All surfaces of the tooth are examined                                                                                                         Many of other indexes are formed by different authors to assess gingival condition.

Index Name Instrument Graded response Purpose PMA Index Probe            0-5 To detect  the degree of gingival attachment Gingival Index Probe          0-3 To detect gingival condition Sulcus bleeding Index Probe         0-5 To detect gingival bleeding Gingival bleeding Index Unwaxed dental Floss Dichotomous (Yes/no bleeding) To detect the presence  of  bleeding Papillary bleeding Index Probe         0-4 To detect a bleeding tendency of gingival papillae  Bleeding Time Index Probe       0-4 To detect the degree of bleeding, according to time

Probing Depths:

Periodontal pocket depth is measured by periodontal probe to assess periodontal condition. Healthy pocket depth is 3mm without bleeding on probing.

Edema                                                                                                  Edema (swelling) is the  accumulation of fluid due to inflammation  occurs with the pocket depth of 4mm or more and bleeding on probing is also found.

                                                                                         

Erythema

Erythema means  bluish red color, diseased gingiva is clinically evaluated by change in color. Erythema is associated with Periodontitis and caused by plaque irritation

Gingival Texture

In Periodontitis the gingiva become swollen and less firm in texture. Which can be restored after treatment .

The Role of Radiology in Assessment of Periodontal Disease 

      Radiograh assessment is an important in determining the degree of bone loss or amount of bone present Loss of alveolar bone is the characterstics feature of periodonttitis that canonly  be evaluated  by radiograph , it also reveals the relationship of the maxillary sinus to the periodontally involved area,root fractures,condition of the alveolar crests,Bone loss in the furcation areas,width of the PDL space.

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