Perio, 11/22/11

Front 1

Chronic periodontitis

Back 1

An infectious disease resulting in inflammation within the
supporting tissues of the teeth, progressive attachment, and bone
loss.
Characterized by pocket formation and/or gingival recession.
Most frequently occurring form of periodontitis.
Its onset may be at any age, but is most commonly detected in
adults.
The prevalence and severity of the disease increases with age. It
may affect a variable number of teeth and it has variable rates of
progression.

-created by bacterial plaque and can only be diagnosed if followed over time

-disease will progress further if not treated

Front 2

Chronic form - clinical findings

Back 2

-More prev in adults than kids
-Doesn't make sense to do microbial testing on plaque samples
-Slow to mod rate of progression but can have rapid bursts of attachment loss.

-Recession on teeth, calculus, radiographs will show recession

Front 3

Chronic perio - localized vs. generalized

Back 3

Localized - only certain sextent. Molar to premolar, or canine to canine, etc. Less than 30% of teeth are affected.

General - affects entire mouth. Greater than 30%.

Front 4

Refractory periodontitis

Back 4

-A pt whose gone through therapy (surgical or nonsurgical) but continues to break down.
-Almost alwasy current smokers.

However theoretically this category never existed but the pts still exist. Known as recurrent periodontitis.

-No test to see if pt is accurately breaking down. Monitor pts as frequently as you can get them in to make sure areas aren't continuing to break down.

Front 5

What is CAL?

Back 5

Clinical attachment loss = takes into account probing depth in addition to recession.

Slight - 1 -2 mm
Mod - 3 -4 mm
Severe - > 5 mm

Front 6

What is early onset periodontitis/aggressive?

What's the key clinical characteristic for local and generalized?

What type of bacteria do you find in each one?

Back 6

-Can be localized or generalized also.
Localized - mostly in younger pop, under age 21.
-Blood sample will ahve high titer to bacteria that's suspected which is AA (aggrebacter).

Clinical : bone loss and pockets in anteriors and 1st molars. Having bone loss in 1st molars is the key characteristic here.

Generalized: amy not have same antibody
-more robust loss of attachment.
-bone and attachment loss extends beyond 1st molars ( includes p1 p2, m2)
-Will see porphyromonas ginigivalis in this group.

-Disease tends to run in families so may want to check all siblings esp around that age 20s. Can intervene in young pts but managing recalls.

Front 7

Periodontitis as a manifestation of systemic disease

What are the categories?

Back 7

-Systemic problem is far more life threating than the perio disease.
-Manage the perio but more actively attack the systemic.

-Prematuraly exfoliated primary teeth. Adult teeth are rapidly exfoliated too.
-Diseases are assoacited with blood disorders, genetic, and not otherwise specified disorders (NOS).

Front 8

Blood disorders assoacited with perio

Back 8

1. Acquired neutropenia: rare disorder and pts dont live too long. reduction in number and fcn in PMNs.
bacteria overwhelms host defenses.
-Ulceration, necrosis of gingiva, deep pockets, generalized bone loss.
-Burshing and flossing isnt helpful in getting bacteria checked.

Leukemia: can also cause this.

Normal: 5 - 10,000 cells/ mm 3
Neutropenia - < 2,000 cells/mm3
Agranulocytosis - no neutrophils

Front 9

Genetic disorders associated with perio

1. Trisomy 21
2. Leukocyte Adhesion deficiency
3. Papillon Lefevre syndrome
4. Chediak Higashi syndrome
5. Ehlers Danolos syndrome
6. Hypophosphatasia

Back 9

1. Trisomy 21 (Down's) - aggressive perio starts to develop.
-family members often called to help
-prescription mouth rinses used on a daily basis.
-see these pts frequently (3 mos)

2. Leukocyte adhesion deficiency (LAD) - normal number of PMNs but defects in adhesion molecules.
-PMNs recognized problem in CT but have no means to leave the blood stream. bact extends subgingivally, and you get rapid loss of bone and teeth.
-pts don't make it to their teens.
-Autosomal recessive disease

3. Papillon Lefevre Syndrome (PLS) - autosomal recessive.
-excessive keratin on palms and soles. Palmar plantar keratosis is cahracteristi.
-rapid bone loss, early exfoliation of teeth at fairly young age.

4. Chediak Higashi syndrome:
autosomal recessive.
Hypopigmentation of the skin, eyes, and hair. Bruise pretty easily.
-Same clnical pic as others

5. Ehlers Danolos Syndrome (EDS)
-defects in collagen synthesis. Joints are hypermobile, skin is very elastic
-Type 4 and type 8 has periodontitis.
-Cigarrette pape

Front 10

Necrotizing periodontal disease

Back 10

-Will come to you early on when things are treatable.
-ANUG aka. Either NUG or NUP.
aka Vincent's angina, or Trench mouth.
-Open sore or ulcer forms in the gingiva that is very painful. If it becomes longstanding, pt will have systemic symptoms.
-Main cause: stress, med centers, common in young population, and happens more in smokers
-Gingiva only: NUG
-Bone and gingiva: NUP. Not sure if one leads to another but diagnosis is based on the areas affected.

Front 11

Clinical characteristics of NUP and NUG

What bacteria are involved? What you find on pt?

Back 11

-punched out papilla - raw and red, bleeds spontaneously.
-pseudomembrane formation on gingiva
-Extremely horrible bad breath

Bacteria prevotella intermedia, spirochetes. Clinical signs are strinking that you can do diagnosis w/o culturing bacteria.

-Don't pull off pseudomembrane. Treat pts for their symptoms.
-often seen in HIV pts.

NUP: interdental tissue is completely gone.
-bone has been damaged, and can see root surfaces. can do chlorhexidine mouth rinses.

Front 12

Periodontal abscess - 3 types?

Back 12

-Collection of WBCs, pus, can have mild or pain.
-SWollen lymph nodes, fever.

Ginigval, periodontal, pericoronoal abscess are 3 types. All depends on location. Peri coronal - around 3rd molar or unerupted tooth.

Can be acute or chronic. Only time you see chronic is in uncontrolled diabetics.
localized purulent infection invovles marginal gingiva or interdental papilla.

ginigiva - may have something lodged in the gingiva.
periodontal absecss- preexisting pocket or bone loss. collections of wbcs, often see titled molars.
-deep pockets.
-will see mixed anaerobic population.
Treatment - incision and drainage of the abscess.
Not serious if its not frequent.
But if it is, there's something underlying - something fractured, lodged onto root surface, enamel pearl.

Pericoronal - near unerupted or partially erupted teeth. Operculum or tissue tag over the tooth. Pts chewing traumatizes it and results in acute inflammation.
-extract 3rd molar, remove operculum.
-not worth testing fluid - just shows

Front 13

Combined periodontal w/ endodontic lesions

Back 13

-status of pulp is questionable.
-if endo was problem, treat that first before perio. If tooth is worth saving, do endo first.

Perio first - down to root surface or apex.