Introduction to

Periodontics
 Periodontics
 Difinition : that branch of dentistry that
deals with the diagnosis and treatment of
disease and conditions of supporting and
surrounding tissues of the teeth

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 Periodontology: the scientific study of the periodontium in health
and diseases
 Periodontist: dental practitioner who by virtue of special
knowledge and training in the field limits his practice or activities to
periodontics.
 periodontitis: inflammation of the supporting tissue of the teeth.

 Peri ………. Around

 Odous ………… tooth
 Logous………….study 3

 Itis……………….inflamation
Periodontium
The tissues that invest and support the teeth
including the:
 Gingiva / Alveolar
Mucosa
 Periodontal Ligament
 Alveolar Bone
 Cementum
1. GINGIVA
 The gingiva: is that part of the masticatory
mucosa which covers the alveolar process and
surrounds the cervical portion of the teeth
 Two parts of the gingiva can be differentiated:
1. the free gingiva (FG)
2. the attached gingiva (AG)
 Characteristics of healthy gingiva

 Color of normal gingive is pink

 ContourHealthy gums hold tight to each tooth in that the
gingival surface narrows to "knife-edge" thin at the free
gingival margin.
 Texiture is firm in consistency and firmly attached to the
underlying alveolar bone.
2-Periodontal ligament (PDL):
 the Connective Tissue that surrounds and attaches roots of teeth to the
alveolar bone.

 the average width is about 0.2 mm

 classified into several groups

1. alveolar crest fibers

2. horizontal fibers
3. oblique fibers
4. apical fibers
5. interradicular fibe
Alveolar bone:
 are the parts of the maxilla and mandible providing the housing for the
roots of the teeth.

1- alveolar bone proper (lamina dura in

radiographs)
2- trabecular bone
3- compact bone
 Etiology of Periodontal Diseases

Bacterial Plaque
 The soft deposits that form the biofilm adhering to the tooth surface or
other hard surfaces in the oral cavity including removable and fixed
restorations
Dental Calculus (tartar)
Mineralized dental plaque attached and covering the enamel and/or root
surface. (hard) removable and fixed restorations.
 Classification of Periodontal
Disease
 Gingivitis:
 Inflammation of the gingiva.

Periodontitis
 Inflammation of the supporting tissues of the
teeth.
An extension of inflammation from gingiva to
adjacent bone and ligament

healthy gingivitis periodontitis

 Periodontal Therapy

- Eliminate gingival inflammation

 Improving the oral hygiene
 Scaling and root planning

- Restore normal tissue contours

 Tooth surfaces assessable to daily oral hygiene
- Regenerate periodontal attachment
 -Bone graft, gingival graft, guided tissue regeneration.
CHRONIC GINGIVITIS AND
CHRONIC ADULT PERIODONTITIS

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 CHRONIC GINGIVITIS
 Gingivitis: is an inflammatory
response to plaque bacteria
or other factors, and
inflammation is restricted to
the gingival margins and does
not affect the periodontal
ligament or bone.

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Localized

generalized

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 Clinical features:

 Asymptomatic
 red and slightly swollen with
edema
 Bleeding upon stimulating
 Plaque deposited along the
gingival margins
 probing shows absence of
pocketing and radiographs
show intact crestal alveolar
bone
Factors contributing to or exacerbating chronic gingivitis:

 Local
 Poor tooth brushing technique
 Dental irregularities providing stagnation areas
 Restorations or appliances causing stagnation areas
 Systemic
 Pregnancy
 Down's syndrome
 Poorly-controlled diabetes mellitus

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Management:
 effective oral hygiene
measures :
 Tooth brushing and flossing
habit.
 Scaling and root planning
 calculus removal
 Correction of plaque
retentive factors
 Any other factors must be
dealt with if possible.

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 Other Types of Gingivitis
 Other types of
gingivitis are
associated with
systemic factors
 Systemic factors:
1. Puberty
2. Pregnancy
3. Use of medications .

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Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
CHRONIC ADULT PERIODONTITIS

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Clinical features

 Red, swollen, or tender gingiva

 Bleeding of gingiva during brushing or flossing

 Bacterial plaque and calculus are widespread.

 Loose or separating teeth

 Pain or pressure when chewing

 Pus around the teeth or gingiva

 gingival recession

 foul-smelling breath (halitosis).

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 pocketing
 Etiology and pathology
 Persistence of infection at the gingival margins leads
to progressive inflammation and destruction of the
supporting tissues.
 Pathological processes in chronic periodontitis:
 Chronic inflammation
 Destruction of periodontal ligament fibers
 Resorption of alveolar bone
 Migration of the epithelial attachment towards the apex
 Formation of pockets around the teeth
 Formation of subgingival plaque and calculus
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 General principles of management of chronic
periodontitis
1. Control of bacterial plaque: Anything hampering plaque control
(stagnation area) should be dealt with:
 Calculus
 Overhanging restorations
 Food packing due to faulty contact points
 Irregularities of the teeth
 Mouth breathing
 Pocketing

2. Establishment of healthy gingiva accessible to plaque control

3. Minimization of periodontal tissue loss
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4. Use of antibiotics in selected cases
5. Mucogingival surgery in selected cases
Treatment of advanced periodontal disease
 Once pocketing has extended beyond the point where treatment can
be beneficial, the teeth should be extracted. Because:
 Deep pockets are a source of sepsis which may have remote effects such
as infective endocarditis.
 If infection is allowed to persist, excessive resorption of the alveolar bone
may cause difficulties in retaining dentures.

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 Prognosis in periodontal disease
Factors affecting prognosis of periodontal disease:
 Oral hygiene status and motivation
 Degree of bone loss
 Age
 Tooth factors
 Host resistance

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Complications of chronic periodontitis
 Local
 Periodontal abscess
 Systemic
 Infective endocarditis
stop

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ACUTE PERIODONTAL CONDITIONS-
 Abscesses of the Periodontium
 Gingival Abscess

 Periodontal Abscess

 Pericoronal Abscess
 Gingival Abscess

A localized purulent infection that involves the marginal gingiva or

interdental papilla
 Gingival Abscess
 Etiology
 Acute inflammatory response to foreign substances forced
into the gingiva
 Clinical Features
 Localized swelling of marginal gingiva or papilla
 A red, smooth, shiny surface
 May be painful and appear pointed
 Purulent exudate may be present
 No previous periodontal disease
 Gingival Abscess
 Treatment
 Elimination of foreign object

 Drainage through sulcus with probe or light scaling

 Follow-up after 24-48 hours

 Periodontal Abscess

 A localized purulent infection within the tissues adjacent to the

periodontal pocket that may lead to the destruction of periodontal
ligament and alveolar bone
 Periodontal Abscess
 Usually pre-existing chronic periodontitis present!!!
 Factors associated with abscess development
 Occlusion of pocket orifice (by healing of marginal gingiva following
supragingival scaling)
 Furcation involvement
 Systemic antibiotic therapy (allowing overgrowth of resistant
bacteria)
 Diabetes Mellitus
 Periodontal Abscess
 Clinical Features
 Smooth, shiny swelling of the gingiva
 Painful, tender to palpation
 Purulent exudate
 Increased probing depth
 Mobile and/or percussion sensitive
 Tooth usually vital
 Periodontal Vs. Periapical Abscess
 Periodontal Abscess
 Vital tooth
 No caries
 Pocket
 Lateral radiolucency
 Mobility
 Percussion sensitivity variable
 Sinus tract opens via
keratinized gingiva
 Periapical Abscess
 Non-vital tooth
 Caries
 No pocket
 Apical radiolucency
 No or minimal mobility
 Percussion sensitivity
 Sinus tract opens via alveolar
mucosa
 Periodontal Abscess
 Antibiotics (if indicated due to fever, malaise,
lymphadenopathy, or inability to obtain drainage)
 Without penicillin allergy
 Penicillin
 With penicillin allergy
 Azithromycin
 Clindamycin
 Alter therapy if indicated by culture/sensitivity
 Necrotizing Periodontal Diseases

1. Necrotizing Ulcerative Gingivitis (NUG) An infection characterized

by gingival necrosis presenting as “punched-out” papillae, with
gingival bleeding and pain.
2. Necrotizing Ulcerative Periodontitis (NUP) An infection
characterized by necrosis of gingival tissues, periodontal ligament,
and alveolar bone
 Necrotizing Ulcerative Gingivitis
 Clinical Features
 Gingival necrosis,
especially tips of papillae
 Gingival bleeding
 Pain
 Fetid breath
 Pseudomembrane
formation
 No fever or systemic
upset
 No significant
lymphadenopathy
 Necrotizing Ulcerative Gingivitis
 Predisposing Factors
 Emotional stress
 Poor oral hygiene
 Cigarette smoking
 Poor nutrition
 Immunosuppression

***Necrotizing Periodontal diseases are common in

immunocompromised patients, especially those who
are HIV (+) or have AIDS
Necrotizing Ulcerative Periodontitis
Necrotizing Ulcerative Periodontitis
 Clinical Features
 Clinical appearance of NUG
 Severe deep aching pain
 Very rapid rate of bone destruction
 Deep pocket formation not evident
 Necrotizing Periodontal Diseases
 Treatment
 Local debridement
 Oral hygiene instructions
 Oral rinses
 Pain control
 Antibiotics
 Modify predisposing factors
 Proper follow-up