LECTURE 8 أستاذ د رائد عزيز The classification presented in this chapter is based on the most recent internationally accepted presented and discussed at the 1999 International Workshop for the Classification of the Periodontal Diseases organized by the American Acad ID: 926743
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Slide1
classification of Periodontal Disease
LECTURE
8
أستاذ
د. رائد عزيز
Slide2The classification presented in this chapter is based on the most recent, internationally accepted, presented and discussed at the 1999 International Workshop for the Classification of the Periodontal Diseases organized by the American Academy of Periodontology (AAP).
The overall classification system is presented in (Box 1)
Slide3Slide4Slide5Slide6GINGIVAL DISEASES
Dental Plaque-Induced Gingival Diseases
Gingivitis that is associated with dental plaque formation' is the
most common form of gingival disease.
Gingivitis also affect the
gingiva of periodontitis-affected teeth
that have previously lost attachment but have received periodontal therapy to stabilize any further attachment loss.
Slide7Gingival Diseases Modified by Systemic Factors
Such as the
endocrine
changes associated with
puberty
, the
menstrual
cycle,
pregnancy
, and
diabetes
.Hormonal changes alterations in the gingival inflammatory response to plaque.
2-
Multilobulated
appearance of an early pregnancy
epulis
(pregnancy tumor).Treatment surgical remval.
Slide8Blood
dyscrasias
such as leukemia
may alter immune function by disturbing the normal balance of immunologically competent white blood cells supplying the periodontium.
Gingival diseases modified by malnutrition''
have received attention because of clinical descriptions of bright red, swollen, and bleeding gingiva associated with severe ascorbic acid (vitamin C) deficiency or scurvy.
Slide9Gingival Diseases Modified by Medications
Gingival diseases modified by medications‘
anticonvulsant
drugs induce gingival enlargement, such as
phenytoin
immunosuppressive
drugs such as
cyclosporine A,
calcium channel
blockers
such as
nifedipine
,
verapamil
,
diltiazem
, and sodium
valproate
.
Slide10Non-Plaque-Induced Gingival Lesions
Gingival Diseases of Specific Bacterial Origin
Sexually transmitted diseases such as
gonorrhea
(
Neisseria
gonorrhoeae
),
syphilis
(
Treponema
pallidum
).
Slide11Gingival Diseases of Viral Origin
Caused by viruses, the most common
herpes viruses.
Lesions appeared by reactivation of latent viruses,
especially as a result of reduced immune function.
Slide12Gingival Diseases of Fungal Origin
Oral flora has been disturbed by the long-term use of
broadspectrum
antibiotics.
The most common oral fungal infection is
candidiasis
by
Candida
albicans
,
Slide13Gingival Diseases of Genetic Origin
One of the most
clinically evident
conditions is
Hereditary gingival fibromatosis
Slide14Gingival Manifestations of Systemic Conditions
The most important of these diseases are lichen planus, pemphigoid, pemphigus vulgaris, erythema multiforme and lupus erythematosus. As gif. of Oral lichen planus
Slide15Foreign Body Reactions
Introduction of amalgam into the gingiva during the
placement of a restoration or extraction of a tooth, leaving an amalgam tattoo,
Introduction of abrasives during polishing procedures.
Slide16PERIODONTITIS
Three general clinical manifestations of periodontitis:
Chronic periodontitis.
Aggressive periodontitis.
Periodontitis as a manifestation of systemic diseases.
Slide17Chronic Periodontitis
Chronic periodontitis is the most common form of periodontitis
Chronic periodontitis is mostly in
adults
, but can be observed in
children.
Chronic periodontitis is in
poor O.H has a slow to moderate rate
of disease progression,
Slide18Slide19Aggressive Periodontitis
Differs from the chronic form by the
rapid rate of disease progression
seen in
No large amount of
plaque and calculus
.
Healthy individual
.
Family history of aggressive disease .
Slide20Clinical appearance of the periodontal tissues of a 15-year-old girl suffering from
localized aggressive periodontitis
. Note the proper oral hygiene conditions and the scalloped outline of the gingival margin. In the lower anterior region, the interdental papilla between teeth 31 and 32 has been lost. Intraoral radiographs (d) show the
presence of localized angular bony defects
, associated with clinical attachment level loss, at the mesial aspect of tooth 46, 36 and at the distal aspect of tooth 31. No significant bone loss and/or attachment loss was detectable in other areas of the dentition. Diagnosis: localized aggressive periodontitis (LAP).
Slide21Periodontitis as a Manifestation of Systemic Diseases
Hematologic and genetic disorders.
Alterations in host defense mechanisms such as
neutropenia
.
Leukocyte adhesion deficiencies.
Slide22Necrotizing Ulcerative Gingivitis
The defining characteristics of NUG are its
bacterial etiology
, its
necrotic lesion
.
predisposing factors such as
psychologic
stress, smoking, and
immunosuppression
.
In addition,
malnutrition may be a contributing factor
in developing countries.
Slide23Necrotizing Ulcerative Periodontitis
NUP: in HIV infection local
ulceration
and
necrosis
of gingiva with exposure and rapid destruction of underlying bone,
spontaneous bleeding
, and
severe pain.
HIV- patients with NUP are 20.8 times more than HIV-patients without NUP,
Slide24ABSCESSES OF THE PERIODONTIUM
periodontal abscesses:
chronic
or
acute,
gingival
or
periodontal,
occurring in the supporting
periodontal tissues or in the gingiva.
Periodontitis-related abscess,
when the acute infection originates from a biofilm present in a
deepened periodontal pocket
Non-periodontitis-
related,abscess
(gingival)
,
when the acute infection from local source, such as foreign body impaction.
Slide25Slide26Endodontic-Periodontal Lesions
In endodontic-periodontal lesions,
pulpal
necrosis precedes periodontal changes.
A periapical lesion originating in
pulpal
infection
and necrosis may drain to the oral cavity through the
periodontal ligament
, resulting in destruction of the periodontal ligament and adjacent alveolar bone.
This may present clinically as a localized, deep, periodontal pocket extending to the apex of the tooth.
Pulpal
infection
also may drain through
accessory canals
, especially in the area of the furcation, and may lead to
furcal involvement through loss of clinical attachment and alveolar bone.
Slide27Periodontal-Endodontic Lesions
In periodontal-endodontic lesions, bacterial infection from a
periodontal pocket
root exposure may spread through
accessory canals
to the pulp, resulting in
pulpal
necrosis
.
Advanced periodontal disease, the infection may reach the pulp through the
apical foramen.
Scaling and root planing
removes cementum and dentin may lead to chronic
pulpitis
through bacterial penetration of dentinal tubules.
Slide28The end
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