Other Conditions Affecting The Periodontium

Chapter 8
Other Conditions Affecting the

Periodontium
Section
Section 1
1
Necrotizing
Necrotizing Periodontal
Periodontal Diseases
Diseases
Copyright © 2016 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Necrotizing Periodontal Diseases
(NPDs)
• Inflammatory destructive infections of periodontal

tissues that involve tissue necrosis (localized tissue
death)
• Three states of NPD may represent different stages of
the same disease as the etiology, clinical
characteristics and treatment are similar
Copyright © 2016 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 2
Necrotizing Periodontal Diseases
(NPDs)
– Necrotizing Gingivitis (NG)

• Limited to gingival tissues
– Necrotizing Periodontitis (NP)
• Necrosis of gingival tissues, periodontal ligament
and alveolar bone
– Necrotizing Stomatitis
• Severe necrosis extends beyond gingiva to other
parts of the oral cavity: tongue,cheeks,palate
• Bone denudation occurs through alveolar
mucosa tissue
• Most severe, rarest form of NPD
Necrotizing Gingivitis (NG)
Necrotizing Periodontitis (NP)
Alternative Terminology
• Trench mouth (soldiers in WWI)

• Vincent infection
• Acute necrotizing ulcerative gingivitis (ANUG)
• Necrotizing ulcerative gingivostomatitis
Necrotizing Periodontal Disease
• Broad category of inflammatory infection

characterized by tissue necrosis
• Very painful
• Gingival tissues are fiery red with spontaneous
bleeding
• Rapidly escalates and can produce loss of periodontal
attachment within days
Necrotizing Periodontal Disease (cont.)
• Characterized by ulcerated and necrotic papillae and

marginal gingiva
• Gives the appearance that papillae and gingival
margins have been “punched out” or “cratered”
• Pseudomembrane---a gray layer of tissue that covers
the necrotic areas of the gingiva
(cont.)
• Evidence of materia alba, plaque biofilm, sloughed

tissue, blood, stagnant saliva
• Excessive salivation with fetid odor
• Excessive oral pain---may stop brushing teeth and
eating
Systemic Signs and Symptoms
• Swollen lymph nodes

– Submandibular
– Cervical
• In severe cases:
– Fever
– Malaise
– Increased pulse rate
– Loss of appetite
Progression
• Within a few days, involved interdental areas are

separated into one facial papilla and one lingual
papilla with a necrotic depression between them
• Craters are formed with the separation
• Once craters are formed, periodontal ligaments and
alveolar bone become destroyed resulting in loss of
attachment
Necrotizing Ulcerative Periodontitis
(NUP)
Ulcerated and Necrotic Papillae and
Marginal Gingiva
Ulcerated and Necrotic Papillae and
Marginal Gingiva
Etiology and Predisposing Factors for
NPD
• Compromised host immune response

• Poor oral self-care
• Emotional stress
• Increased level of personal stress
• Inadequate sleep, fatigue
• Alcohol use
• Smoking
Etiology and Predisposing Factors for
NPD (cont.)
• Caucasian
• Poor nutrition, low protein intake
• Overall poor eating habits of young adults (e.g.,
college students)
• Pre-existing gingivitis or trauma
• Mean age in industrialized countries is 22--24 years
old
Patient Education
• Instruction on proper nutrition and fluid intake

• Smoking cessation
• A liquid dietary replacement, such as Ensure or
Boost, can be recommended since eating is difficult
due to pain.
Section
Section 2
2
Mucogingival
Mucogingival Deformities
Deformities and
and Conditions
Conditions
Around
Around Teeth
Teeth
Mucogingival Deformities and Conditions
Around Teeth
• Periodontal biotype
• Gingival/soft tissue recession
• Lack of keratinized gingiva
• Decreased vestibular depth
• Aberrant frenum/muscle position
• Gingival excess
• Abnormal color
Normal mucogingival condition is defined as the absence
of diseased state.
Periodontal Biotypes
Individual differences in gingival anatomy and

morphology:
1. Thin scalloped biotype
2. Thick flat biotype
3. Thick scalloped biotype
Thin Scalloped Biotype
• Slender triangular-shaped tooth crowns

• Subtle cervical scalloping
• Interproximal contacts close to incisal edge
• Narrow zone of keratinized tissue
• Clear thin delicate gingiva
• Thin alveolar bone
Thick Flat Biotype
• Square-shaped tooth crowns

• Pronounced tissue scalloping
• Large interproximal contact areas more apical
• Broad zone of keratinized tissue
• Thick, fibrotic gingiva
• Thick alveolar bone
Thick Scalloped Biotype
• Slender tooth crowns

• Pronounced gingival scalloping
• Thick fibrotic gingiva
• Narrow zone of keratinized tissue
Mucogingival Deformities
Significant alteration of morphology, size and

interrelationships between gingiva and alveolar mucosa
that may involve underlying bone.
Gingival Recession
• Most common mucogingival deformity

• Apical displacement of gingival margin with respect to
the CEJ
• Associated with attachment loss with root exposure
Recession of the Gingival Margin
Gingival Recession
Tension of a Frenum
Tension of a Frenum
Risk Factors for Gingival Recession
• Thin periodontal biotype

• Absence of attached gingiva
• Reduced thickness of alveolar bone due to abnormal
tooth position in the arch
Miller Classification System for
Recession of Gingival Margin
• Most commonly used

• Sometimes difficult to identify exact location of apical
extent of recession defect with respect to MGJ
• Difficult to differentiate between Class I and II
• Not clear in defining amount of interproximal soft/hard
tissue loss between Class III and IV
• Reliability has never been tested
• Class I – Marginal recession but does not extend to

MGJ. No loss of bone or soft tissue in the inter-dental
area. Roots still covered 100%
• Class II – Marginal recession that extends beyond
MGJ. No loss of bone or soft tissue in interdental
area. Roots still covered 100%
Recession of Gingival Margin (cont.)
• Class III – marginal recession that extends beyond

MGJ. Bone and soft tissue loss in interdental area.
May have tooth malpositioning that prevents coverage
of certain roots
• Class IV – marginal recession that extends beyond
MGJ. Bone and soft tissue loss in interdental area.
May have tooth malpositioning that prevents coverage
of many roots
Cairo Classification System for
• Based on CAL measurements at buccal and

interproximal sites
• Uses objective identifiable criterion to classify extent
and severity of soft tissue recession
• Can be used in clinical practice
Cairo Classification System Recession
Types (RT)
• RT1 - gingival recession with no loss of interproximal

attachment. Most likely associated with traumatic
toothbrushing
• RT2- gingival recession with loss of interproximal
attachment. Most likely associated with periodontitis-
associated horizontal bone loss
• RT3- same as RT2 but with interproximal attachment
loss greater than buccal loss and infrabony defects
Section
Section 3
3
Tooth
Tooth and
and Prosthesis-Related
Prosthesis-Related Predisposing
Predisposing
Factors
Factors
Prosthetic and tooth-related factors can have an adverse
effect on periodontium by enhancing plaque retention
and contributing to initiation and progression of
periodontal disease.
Local contributing factors exacerbate (do not cause) the

condition following onset of disease.
Tooth Anatomic Factors
• Factors that predispose to plaque biofilm retention like

orthodontic appliances and faulty restorations
• Tooth anatomy factors: Cervical enamel projections
– Enamel pearls
– Palatolingual grooves
– Tooth malalignment
Enamel Pearl
Palatolingual Groove

Other Conditions Affecting The Periodontium

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Other Conditions Affecting The Periodontium

Uploaded by

Copyright:

Available Formats

Chapter 8

Other Conditions Affecting the

• Inflammatory destructive infections of periodontal

– Necrotizing Gingivitis (NG)

• Trench mouth (soldiers in WWI)

• Broad category of inflammatory infection

• Characterized by ulcerated and necrotic papillae and

• Evidence of materia alba, plaque biofilm, sloughed

• Swollen lymph nodes

• Within a few days, involved interdental areas are

• Compromised host immune response

• Instruction on proper nutrition and fluid intake

Individual differences in gingival anatomy and

• Slender triangular-shaped tooth crowns

• Square-shaped tooth crowns

• Slender tooth crowns

Significant alteration of morphology, size and

• Most common mucogingival deformity

• Thin periodontal biotype

• Most commonly used

• Class I – Marginal recession but does not extend to

• Class III – marginal recession that extends beyond

• Based on CAL measurements at buccal and

• RT1 - gingival recession with no loss of interproximal

Local contributing factors exacerbate (do not cause) the

• Factors that predispose to plaque biofilm retention like

You might also like