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1

The Periodontium

2

Periodontal Diseases

____ and___ of ___ ___and___associated with the tooth

______trauma

_____trauma

____ (___ associated)

¡Most common etiology is the presence of ___ ssociated with the________

____/____

_____ ____ ______
___ ____ ____ _____

¡Chronic Periodontitis is a major cause of ___ ___ in ___ populations.

¡LAP and ANUG are found in ______populations.

¡

¡

¡Inflammation and destruction of connective tissue and bone associated with the tooth

▪Physical-occlusal trauma

▪Thermal/chemical trauma

▪Microbial (plaque associated)

¡Most common etiology is the presence of bacteria associated with the subgingival crevice

§Gingivitis /Chronic Periodontitis

§Localized Aggressive Periodontitis (LAP)

§Acute Necrotizing Ulcerative Gingivitis (ANUG)

¡Chronic Periodontitis is a major cause of tooth loss in aging populations.

¡LAP and ANUG are found in immuno-compromised populations.

¡

¡

3

Quantitative clinical changes=

changes in microbial habitat

 

 

4

Factors in Disease

5

 Periodontal disease is multifactorial

¡

¡Simple diseases

§Condition is ___  or ___, ______factors influence

___ ___: sickle-cell anemia, cystic fibrosis

___ ____: Small-pox, Anthrax

¡

¡Complex diseases

___ of ___ ( ___ ___)

____ factors influence the diagnosis

____

___

§Large numbers subjects are affected “__ ___ ___"

 

Periodontal disease is multifactorial

¡

¡Simple diseases

§Condition is present or absent, one (or few) factors influence

§Host genetics: sickle-cell anemia, cystic fibrosis

§Infectious disease: Small-pox, Anthrax

¡

¡Complex diseases

§Spectrum of severity (Bell Curve)

§Many factors influence the diagnosis

▪Host

▪Environment

§Large numbers subjects are affected “to some degree”

¡

6

Periodontal Disease Factors

¡Host

  • ____
    • ___ ___
    • ___ ___ ___
    • __ __ ___
  • ____
    • ___ ___
    • ___
    • ___

¡Environment

  • §Bacterial flora
    • ____
    • ___
    • ____

¡Host

§Genetics

▪Immune response

▪Connective tissue healing

▪Type 2 Diabetes

§Habits

▪Oral hygiene

▪Smoking

▪Diet (diabetes)

¡Environment

§Bacterial flora

▪Composition

▪Load of pathogenic species

▪Virulence potential of strains

7

Natural History of Periodontal Disease in Man

¡J Clin Periodontol. 1986 May;13(5):431-45.

¡480 male laborers at two tea plantations in Sri Lanka

___ oral hygiene

¡Oral examinations in ___ 1973, 1977, 1982,1985,___

¡Aggregates of ___ ,___ and ___ on their teeth

¡Based on ____ ____ of ___ and tooth ___ rates, three subpopulations were identified:

__ ___  of ___ ___ beyond ____ (___ )

___ ___ (  )

___ ____of periodontal disease (    )

¡J Clin Periodontol. 1986 May;13(5):431-45.

¡480 male laborers at two tea plantations in Sri Lanka

¡No oral hygiene

¡Oral examinations in 1971, 1973, 1977, 1982,1985, 1990

¡Aggregates of plaque, calculus and stain on their teeth

¡Based on interproximal loss of attachment and tooth mortality rates, three subpopulations were identified:

§no progression (NP) of periodontal disease beyond gingivitis (~ 11%)

§moderate progression (MP) (~ 81%) 

§rapid progression of periodontal disease (RP) (~ 8%) 

8

CDC's Healthy Aging Data Portfolio

 

¡The percentage of older adults who have retained their natural teeth (i.e., lost _ or fewer teeth) has ____ steadily over the past few decades.

¡Reflects a change in treatment philosophy, from___ teeth to making efforts to ____ natural teeth and supporting structures.

¡

¡This is significant as the mouth reflects a person's___  and ___ ___ throughout life.

¡From a dental perspective, more elderly adults with natural dentition requires___ ____ of ___ ___

 

¡

¡The percentage of older adults who have retained their natural teeth (i.e., lost 5 or fewer teeth) has increased steadily over the past few decades.

¡

¡Reflects a change in treatment philosophy, from extracting teeth to making efforts to preserve natural teeth and supporting structures.

¡

¡This is significant as the mouth reflects a person's health and well-being throughout life.

¡From a dental perspective, more elderly adults with natural dentition requires greater management of periodontal health.

¡

¡

9

Biofilms as Dental Plaque

  • ¡The ___________ link has been investigated over centuries
    •  
    •  
  • ¡Plaque in health and disease has ____ composition
    • §“___ ___ __ ___”
    • §Gingivitis (___complex) and Periodontitis (___ complex)
  • ¡Dental plaque biofilms form in an ___ fashion
    • ____/____
    • §Driven by ____/____ relationships
    • §Local changes in the____
  • ¡Pioneer bacteria ___ the ___ for the ___ colonizers
  • ¡Biofilm growth is restricted by __ ___

Biofilms as Dental Plaque

¡The plaque-oral health link has been investigated over centuries

§Microscopy

§Molecular techniques

§

¡Plaque in health and disease has different composition

§“Experimental gingivitis in man”

§Gingivitis (orange complex) and Periodontitis (red complex)

¡Dental plaque biofilms form in an orderly fashion

§Structurally/temporally

§Driven by adhesion/coaggregation relationships

§Local changes in the environment

§

¡Pioneer bacteria prepare the environment for the late colonizers

¡

¡Biofilm growth is restricted by host factors

§

¡

10

Health- Clinical parameters

Gingiva is ___ AND ___

No ___ on ___

Probing depth =______

___ plaque at___ ____

  Genus:

____
___
____

Gingiva is firm and tight

No bleeding on probing

Probing depth = 0-3 mm

Little plaque at gingival margin

  Streptococci

  Actinomyces

  Veillonella

11

Streptococcus salivarius group

Streptococcus oris group

Complex? 

O2?

+/-

Shape?

Form _____

Comments: ___ on the ___, __ ___. ____ ___ of the ___ ___

 

Streptococcus salivarius group

Streptococcus oris group

Yellow

Facultative anaerobes

G+ cocci

Long chains

Pioneers on the pellicle, mucosal surfaces. Largest component of the oral flora.

12

Actinomyces spp.

Complex?

O2?

+/-

Shape?

Form ____ ___

_____ numbers in ____ and ___ dental plaque.

Actinomyces spp.

Blue

Facultative anaerobes

G+ bacilli

Branching rods

High numbers in approximal and marginal dental plaque.

13

 

Veillonella spp.

Complex?

O2?

+/-

Shape?

___ numbers from __ ___ and __ ___

Veillonella spp.

Purple

Obligate anaerobes

G- cocci

High numbers from dental plaque and mucosal surfaces.

14

Capnocytophaga spp.

complex?

O2?

+/-

shape ___ ___

Comments

_____________

Capnocytophaga spp.

Green

Capnophilic anaerobe

Gram -  filamentous

bacilli

Gliding motility

15

Aggregatibacter actinomycetemcomitans serotype a

Complex

O2

Gram ___

Shape?

Comment:

Aggregatibacter actinomycetemcomitans serotype a

Green

Capnophilic facultative anaerobe

Gram – short bacilli

Internal “star” in colonies

16

Eikenella corrodens

Complex?

O2

Gram ___

Shape?

Comments: _____

Eikenella corrodens

Green

Facultative anaerobe

Gram - bacilli

Microaerophilic

17

¡Capnocytophaga spp.

§Gram negative

§Filamentous ___

§Capnophilic anaerobe

§Gliding motility

§Grooms ___ from cell surfaces

§

¡Aggregatibacter actinomycetemcomitans serotype a

§Gram negative

§Short ___

§Capnophilic facultative anaerobe

______

§Internal “star” in colonies

§

¡Capnocytophaga spp.

§Gram negative

§Filamentous rod

§Capnophilic anaerobe

§Gliding motility

§Grooms glycan from cell surfaces

§

¡Aggregatibacter actinomycetemcomitans serotype a

§Gram negative

§Short rod

§Capnophilic facultative anaerobe

§Non-motile

§Internal “star” in colonies

§

18

¡Eikenella corrodens

§Gram negative bacillus

§Facultative anaerobe

Found in ___ __ and ___ ___

§Can be elevated in ___

___ ___ __

___ and ____ lesions

§

¡Eikenella corrodens

§Gram negative bacillus

§Facultative anaerobe

§Gingival margin and Subgingival plaque

§Can be elevated in gingivitis

§Human bite infections

▪Clenched fist

▪Occlusal bite

▪Other saliva-associated wounds

§painful and necrotic lesions

§

19

Gingivitis\

Gingiva ___ , ____

___ on ___

PD =_____

Increased plaque at ___

___ complex

  

Gingiva red, swollen

Bleeding on probing

PD =2 - 5 mm

Increased plaque at margin

  Orange complex

  

20

Gingivitis

¡An ___ process limited to the ___ ___ ___ around the ___ potion of the tooth

¡

¡Classifications

§Etiology

▪___ induced,  ____, ___ , ___ induced

¡Most common form of gingivitis is ___, __ induced

¡

¡Inflammation begins with ___ ___ ____ (aging plaque)

___ ___and ___ ____ increase

§Tissue bleeds when disturbed.

§

¡

¡An inflammatory process limited to the mucosal epithelial tissue around the cervical potion of the tooth

¡

¡Classifications

§Etiology

▪Drug-induced, hormonal, nutritional, plaque induced

¡

¡Most common form of gingivitis is chronic, plaque induced

¡

¡Inflammation begins with undisturbed plaque accumulation (aging plaque)

§GCF flow and neutrophil infiltration increase

§Tissue bleeds when disturbed.

§

¡

21

Bacteria in Chronic Gingivitis

¡Orange complex bacteria

____ ___

___ ____

_____

____ ___

___ ____

_____ ___

¡Many are Gram ___, ___

__ ___ of __ ___ (pathogenicity)

¡Orange complex bacteria

§Fusobacterium nucleatum

§Prevotella intermedia

▪Campylobacter spp.

▪Eubacterium nodatum

▪Strep. constellatus

▪Peptostreptococcus micros

¡Many are Gram negative, anaerobes

¡Opportunistic pathogens of soft tissue

22

¡Fusobacterium nucleatum

O2 

§Gingivitis

_____ plaque

Shape ____

§Bridge bacterium

§

¡Fusobacterium nucleatum

§Obligate anaerobe

§Gingivitis

§Subgingival plaque

§Long filamentous rod

§Bridge bacterium

§

23

¡Prevotella species

§P._____

§P. _____

O2

____ of Gingivitis

§Elevated in ____

___ plaque

§Many are __ ___on __ __

___ ___

¡Prevotella species

§P. intermedia

§P. nigrescens

§Obligate anaerobe

§Initiation of Gingivitis

§Elevated in Periodontitis

§Subgingival plaque

§Many are black pigmented on blood agar

§Antibiotic resistance

24

¡Campylobacter spp.

§Gram ___

__ via ___

Shape?

O2? 

_____

¡

¡

¡

 

¡Campylobacter spp.

§Gram negative

§Motile via flagella

§Curved rod

§Anaerobe

▪microaerophilic

¡

¡

¡

 

25

¡Eubacterium nodatum

§Gram ___

Shape: 

▪Similar appearance to ____

O2

§

 

¡Eubacterium nodatum

§Gram positive

§Filamentous rods

▪Similar appearance to Actinomyces

§Anaerobe

§

26

¡Strep. constellatus

§Gram ___

Shape 

___  group

___-hemolytic

O2

___

 

¡

¡

¡

¡Strep. constellatus

§Gram positive cocci

§Milleri group

§Beta-hemolytic

§Anaerobe

▪microaerophilic

¡

¡

¡

27

 

¡Peptostreptococcus micros

Gram ___

Shape?

Form ___ and ___ ___

O2

§

§

¡Peptostreptococcus micros

§Gram positive cocci

§Pairs & short chains

§Anaerobe

§

§

28

Virulence of Gram Negative Bacteria

¡Endotoxin

§Structural component of outer membrane of gram ___ bacteria only

§ Also known as lipopolysaccharide (LPS)

_____ portion of LPS is the toxic component

§Released as ___ ___

¡Innate immune response recognizes lipid A and triggers inflammation

¡Endotoxin

§Structural component of outer membrane of gram negative bacteria only

§ Also known as lipopolysaccharide (LPS)

§Lipid A portion of LPS is the toxic component

§Released as membrane “blebs”

¡Innate immune response recognizes lipid A and triggers inflammation

29

Periodontitis

¡Periodontitis is a ___ infection of the __ ___ of the tooth, characterized by ___ of ___between the ___ and ___

¡

¡Periodontitis is the leading cause of __ __ in US adults.

¡

¡Approximately __% of adults will suffer from ___ ___ of ____

¡Periodontitis is a chronic infection of the connective tissues of the tooth, characterized by loss of attachment between the tooth and the bone.

¡

¡Periodontitis is the leading cause of tooth loss in US adults.

¡

¡Approximately 50% of adults will suffer from some degree of periodontitis.

30

Fun Facts about Periodontal disease

  • ¡Usually develops from ___ __ ____
    • __ __ ___develops into periodontitis
  • ¡Disease is ___, ___, and ___ in nature
    • §Chronic-takes ___or ___s to develop. Once it develops, is __ ___, but ___
    • §Insidious-___ until later stages. Later symptoms are advanced ___ and __ gums,  ___ ___, change in __, ___ ___
    • §Episodic- bone loss occurs in ___ in different sites in mouth, in an __/_ fashion. 
  • ¡Periodontal disease-___ ___ of the ____
    • ____
    • ___ __ of ____
  • ¡Periodontitis –inflammation/infection that results in loss of attachment between the tooth and the bone.
    • §Chronic periodontitis
    • §Localized Aggressive Periodontitis
    • §Acute necrotizing ulcerative gingivitis/periodontitis
  •  

¡Usually develops from pre-existing gingivitis

§Not all gingivitis develops into periodontitis

§

¡Disease is chronic, insidious, and episodic in nature

§Chronic-takes months or years to develop. Once it develops, is never cured, but managed.

§Insidious-silent until later stages. Later symptoms are advanced swollen and bleeding gums, loose teeth, change in bite, bad breath.

§Episodic- bone loss occurs in phases in different sites in mouth, in an on/off fashion. 

§

¡Periodontal disease-all diseases of the periodontium

§Gingivitis

§All forms of periodontitis

¡

¡Periodontitis –inflammation/infection that results in loss of attachment between the tooth and the bone.

§Chronic periodontitis

§Localized Aggressive Periodontitis

§Acute necrotizing ulcerative gingivitis/periodontitis

§

¡