Treating gum disease with homemade remedies

Freedom From Dental Disease

The Primary Care Oral Health Action Pack can Favorably change the way you look at your oral health and what affects it. Increase your knowledge of YOUR teeth and gums, YOUR entire oral environment and yes, your SMILE! Reveal the TRUE CAUSE of cavities, decay of bone and tissue and disclose the proper biological balance. Put YOU in command over this contagious, yet EASILY preventable disease which runs rampant thoughout our population. Allow you to TAKE ACTION to restoring your teeth and gums to optimum health while preventing further decay and damage, as well as preventing any potentially related problems such as heart disease, diabetes, and so on. How to Become Dentally Self Sufficient. Research Advocates OraMedics The science behind the program! The 7 Factors Transcript - Dr. Nara's Last speech before the World Health Federation. Continue reading...

Freedom From Dental Disease Overview

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Chronic Periodontitis

Periodontitis is inflammation ol the periodontium that extends beyond the gingiva and produces destruction of the connective tissue attachment of the teeth.'* No longer considered a single disease, periodontitis is now considered to exist in three primary forms chronic, aggressive, and as a manifestation of systemic diseases (see Box 4-4). ( hronic periodontitis is the most common U.S. Population-Based Prevalence Studies* of Periodontal Disease U.S. Population-Based Prevalence Studies* of Periodontal Disease

Aggressive Periodontitis

Aggressive periodontitis (formerly known as curly onset kWilontitis) is periodontal destruction that becomes clinically significant around adolescence or early adulthood. Till' disease has been classified into two types localized ami generalized.s Other terms found in the literature that have been used to describe aggressive forms of periodontitis include juvenile, localized juvenile, generalized juvenile, rapidly progressive, severe, and prepubertal periodontitis (see lable 4-3).'* Ihe distinction between the localized and generalized forms is based on the distribution ol the periodontal destruction in the mouth. Localized aggressive periodontitis is characterized by bone loss around the first molars and incisors. As the name implies, generalized aggressive peiiodoniitis is characterized by a more widespread pattern of periodontal destruction. Although aggressive periodontitis is characterized l> age at onset and pattern of periodontal destruction, case definitions for early onset...

Pulmonary Disease Periodontal Disease And Acute Respiratory Infections

PERIODONTAL MEDICINE IN CLINICAL PRACTICE Periodontal Disease and Systemic Health in the Periodontal Disease, CHD, COPD, and Pregnancy Tdvances in science and technology over the last n I century have greatly expanded our knowledge ot U-L the pathogenesis of periodontal diseases. Periodontal disease is an infectious disease. However, environmental, physical, social, and host stresses may affect and modify disease expression. Ii is clear that certain systemic conditions ina> affect the Initiation and progression of gingivitis and periodontitis. Many of these are discussed in Chapters 10 and 12. Systemic disorders af fecting neutrophil, monocyte macrophage, and lymphocyte function result in altered production or activity ot host inflammatory mediators.5** Nurse alterations may manifest clinically as early onset of periodontal destruction or a more rapid rate of destruction than would occur in the absence of such disorders. on the converse side of the relationship between systemic...

Periodontal Disease And Acute Respiratory Infections

Bacteria.' ntibiotic therapy is highly successful in resolution of most cases of communitv-acqiiired bacterial pneumonia. To date, no associations have been found between oral hygiene or periodontal disease and the risk tor acute respiratory conditions such as pneumonia in community-dwelling individuals.'1 abscesses that have significant morbidity and mortality.*1 Although considerable circumstantial evidence suggests I hat periodontal pathogens may cause acute nosocomial pulmonary infections, currently no published studies specifically demonstrate an increased risk of such infections in patients with periodontal disease. Likewise, there is no research evaluating the effects of periodontal treatment on the incidence of bacterial pneumonia.

Effects Of Aging On The Progression Of Periodontal Diseases

In a classie experimental gingivitis study, subjects were rendered plaque free and inflammation free through frequent professional cleaning. Once this was achieved, the subjects abstained from oral hygiene measures for periods ot i weeks to allow gingivitis to develop.22 n this experimental model, a comparison ol developing gingivitis between young and older individuals demonstrated a greater inflammatory response in older subjects, both in humans and dogs. 1 1 14 In the older age group (65 to SO years), the findings included a greater size of infiltrated connective tissue, increased gingival crevicular fluid llow. and increased gingival index. '' Other stud I'he phrase getting long in the tooth expresses .i widespread belief that age is inevitably associated with in increased loss of connective tissue attachment. However, this observation might equally well relied a cumulative exposure to i number of potentially destructive processes. I liese exposures might include plaque-associated...

Effects Of Smoking On The Prevalence And Severity Of Periodontal Disease

Gingivitis Controlled clinical studies have demonstrated that in human models of experimental gingivitis, the development of inflammation in response to plague accumulation is reduced in smokers compared with nonsmokers (Table 14-1).(U In addition, cross-sectional studies have consistently demonstrated that smokers present with less gingival inflammation than nonsmokers. svSI These data suggest that smokers have a decreased expression ol clinical inflammation in the presence of plague accumulation when compared with nonsmokers. The microbiologic, immunologic, and physiologic factors that might account for this observation are discussed in detail later. Periodontitis

Necrotizing Ulcerative Periodontitis

NUP is an extension of necrotizing ulcerative gingivitis (NUG) into the periodontal structures, leading to attachment and bone loss. NUP may include combinations ol the following signs and symptoms necrosis and ulceration of the coronal portion of the interdental papillae and or gingival margin painful, bright-red marginal gingiva that bleeds on even slight manipulation mouth malodor (halitosis) and systemic manifestations including fever, malaise, and lymphadenopathy. In addition, increased levelsot stress. heav smoking, and poor nutrition have been shown to be contributing factors to NUP.

Refractory Periodontitis

I'ypical c hanges ot inflammatory periodontal diseases can arise in the course of infection by the human immunodeficiency virus < IfI ). The prevalence of these illnesses may be up to 5 the 111V associated periodontal diseases in- Refractory periodontitis has been defined In the American cademy of Periodontology as those patients who tire unresponsive to any treatment provided, whatever the thoroughness or frequency. Refractory periodontitis should be distinguished from recurrent disease, in which a complete remission occurs after therapy, lollowed by recurrence of the disease as a result ot reformation of plaque, and calculus, to classify cases as refractory (unresponsive), the clinician must clearly differentiate them from incompletely treated cases. In such patients the irritants may not have been completely removed, and the disease may temporarily have become less severe hut never completely resolved. Because of the lac k ot clear guidelines and parameters tor the diagnosis and...

Risk Factors For Aggressive Periodontitis

Although several specific microorganisms frequently are detected in patients with localized aggressive periodontitis A. actinomycetemconntans, (Atpnocytophaga sp., Tikcncllu corrodens, Prevotella intermedia, and Campylobacter rectus), A. actinomycetemcomitans has been implicated as the pri mary pathogen associated with this disease. As summarized by Tonetti and Mombelli,4'' this link is based on the following evidence (1) A. actinomycetcmcomitans is found in high frequency (approximately 90 ) in lesions characteristic of localized aggressive periodontitis, (2) sites with evidence of disease progression often show elevated levels of .4. actinomycetemcomitans, M) many patients with the clinical manifestations of localized aggressive periodontitis have significantly elevated serum antibody titers to A. actinomycetemcomitans, (4) (linical studies show a correlation between reduction in the subgingival load of A. uctinomycetemcomitans during treatment and a successful clinical response,...

Clinical Risk Assessment For Periodontal Disease

Information concerning individual risk for developing periodontal disease is obtained through careful evaluation of the patient's demographic data, medical history, dental history, and clinical examination (Table 32-2). The elements that contribute to increased risk that can be identified through the collection of demographic data include the patient's age, gender, and Sl.S. The medical history may reveal elements such as a history of diabetes, smoking, II1V AIDS, or osteoporosis, as well as the perceived level of stress. I he dental history can reveal a Clinical Risk Assessment for Periodontal Disease Clinical Risk Assessment for Periodontal Disease

Risk Indicators For Periodontal Disease

It has been hypothesized that the immune dysfunction associated with human immunodeficiency virus (HIV) infection and acquired immunodcfic iency syndrome (AIDS) increases susceptibility to periodontal disease. Marly reports on the periodontal status of patients with AIDS or individuals who are 111V seropositive revealed that these patients often had severe periodontal destruction characteristic of necrotizing ulcerative periodontitis.44 More recent reports, however, have failed to demonstrate significant differences in the periodontal status of individuals with IIIV infection and healthy controls.' Ihe apparent discrepancy in these reports may have been clue to the inclusion of patients with AIDS (as opposed to patients who were exclusively HIV seropositive) in some studies.-*1 ( ontlicting results also exist in studies examining the level of immunosuppression and severity of periodontal destruction. In a 20-month study ol 114 homosexual and bisexual men, the relative risk of...

Influence Of Trauma From Occlusion On Progression Of Marginal Periodontitis

Mine the mechanisms by which trauma from occlusion may affect periodontal disease. I'lte accumulation oj bacterial plaque that initiates gingivitis and results in periodontal pocket formation affects the marginal gingiva, but trauma from occlusion occurs in the supporting tissues ami does not affect the gingiva d ig. 24-9). I he marginal gingiva is unaffected by trauma from occlusion because its blood supply is sufficient to maintain it, even when the vessels of the periodontal ligament are obliterated by excessive occlusal forces 1 It has been repeatedly proven that traunhi from occlusion does not cause pockets or gingivitis,- ' s so* nor does it increase gin As long as inflammation is confined to the gingiva, the inflammatory process is not affected by occlusal forces.'- When inflammation extends from the gingiva into the supporting periodontal tissues (i.e., when gingivitis becomes periodontitis), plaque-induced inflammation enters the zone influenced by occlusion, which Cilickman...

Bone Destruction Patterns In Periodontal Disease

One Wall Alveolar Bone Defect

Periodontal disease alters the morphologic features of the bone in addition to reducing bone height. An understanding of the nature and pathogenesis of these alterations is essential for effective diagnosis and treatment. Horizontal bone loss is the most common pattern ol bone loss in periodontal disease. I he bone is reduced in height, but the bone margin remains roughly perpendicular to the tooth surface. The interdental septa and facial and lingual plates are affected, but not necessarily to an equal degree around the same tooth (I ig. 23-12, A). Different types of bone deformities can result from periodontal disease. These usually occur in adults and have been reported in human skulls with deciduous dentitions.'0 Their presence may be suggested on radiographs, but careful probing and surgical exposure of the areas is required to determine their exact conformation and dimensions. The term furcation involvement refers to the invasion of the bifurcation and trifurcation of...

Chronic Desquamative Gingivitis

Gingivitis

Although first recognized and reported in 1894,118 I the term chronic < lestpiainutivc giitgivitis was coined > - in l< M2 by Prinz' to describe a peculiar condition characterized by intense erythema, desquamation, and ulceration of I he free and attached gingiva dig. 21-1). Patients may be asymptomatic, however, when symptomatic, their complaints range from a mild burning sensation to an intense pain. Approximately 50 of desquamative gingivitis cases are localized to the gingiva, although involvement of the gingiva plus other intraoral and even extraoral sites is not uncommon.*' Initially, the cause of this condition was unclear with a variety of possibilities suggested. because most cases were diagnosed in women in the fourth to fifth decades of life (although desquamative gingivitis may occur as early as puberty or as late as the seventh or eighth decades), a hormonal derangement was suspected However, in I960 McCarthy and colleagues ' suggested that desipiuntiitivc...

Periodontal Diseases In Older Adults Etiology

The relationship between age and periodontal disease is age associated and not a consequence of aging.4 Periodontal disease in older adults is commonly referred to as chronic periodontitis.11,1 Because periodontitis is a chronic disease, much of the ravages of the disease detected in older adults results from an accumulation of the disease over time. Research has shown that the advanced stages of periodontitis are less prevalent than the moderate stages in the older-adult population. 1,1 One theory is that many sites of advanced periodontal disease have resulted in tooth loss earlier in life, suggesting that older age is not a risk factor for periodontal disease. Little evidence is available as to whether the risk lac-tors for periodontal disease differ with age.4 General health status, immune status, diabetes, nutrition, smoking, genetics, medications, mental health status, salivary flow, functional deficits, or finances may possibly modify the relationship between periodontal...

Diseases Clinically Presenting As Desquamative Gingivitis

Localized Gingival Margin Enlargement

Color Fig. 17-1 Gingivitis clinical features. A, Localized, diffuse, intensely red area facial of tooth H7 and dark pink marginal changes in the remaining anterior teeth B, Generalized papillary gingivitis. C, Generalized marginal inflammatory lesion D, Generalized diffuse inflammatory lesion. E, Papillary gingival enlargement. F, Different degrees of recession. Recession is slight in teeth 26 and 29 and marked in 27 and 28. Note the irregular contours of the gingiva in 28 and the lack of attached gingiva in 27. G, Insertion of a probe into the gingival sulcus. Note the lack of stippling, the slightly rolled margins, and the dark red color. H, Bleeding appears about 30 seconds after probing. C -tu Ficj. ' I A, Necrotizing ulcerative gingivitis typical punched out interdental papilla between mandibular canine and lateral incisor. B, Necrotizing ulcerative gingivitis typical lesions with progressive tissue destruction.

Necrotizing Ulcerative Periodontitis Radiographs

Intraoral Radiographic Survey

Panoramic radiographs are a simple and convenient method ol obtaining a survey view of the denial arch and surrounding structures (see Fig. 30-1). I'hc are helpful tor the detection of developmental anomal es, pathologic lesions ol the teeth and jaws, and fractures (l ig. '0-2). as well as dental screening examinations of large groups. I hev provide an informative overall radiographic picture ol the distribution and severity of hone destruction in periodontal disease, but < complete intraoral scries is required for periodontal tliagnosis itnd trait men planning. ( hapler > I gives 1 detailed description of radiographic interpretation in periodontics. Oral Hygiene. I he cleanliness ot the oral cavity is appraised in terms ot the extent ol accumulated food debris, plaque, materia alba, and tooth surface stains (lig. M)-M. Disclosing solution may be used to detect plaque that would otherwise be unnoticed. The amount of plaque detected, however, is not necessarily related to the...

Generalized Aggressive Periodontitis

Generalized Aggressive Periodontitis

Generalized aggressive periodontitis usually affects individuals under the age of 30, but older patients also may be affected.22 In contrast to localized aggressive periodontitis, evidence suggests that individuals affected with generalized aggressive periodontitis produce a poor antibody response to the pathogens present. Clinically, generalized aggressive periodontitis is characterized by generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors (Figs. 28-1, A and H, and 28-2, ,1 and ). The destruction appears to occur episodically with periods of advanced destruction followed by stages of quiescence of variable length (weeks to months or years). Radiographs often show bone loss that has progressed since the previous evaluation (see Fig. 28-2, H and C). As seen in localized aggressive periodontitis, patients with generalized aggressive periodontitis often have small amounts of bacterial plaque associated with the affected...

Generalised Juvenile Periodontitis

Necrotizing Ulcerative Periodontitis

Anusaksathicn c> , Dolby W Autoimmunity in periodontal disease. J Oral Pathol Med 1991 20 101. Bontil II. Dillier I I, Mercicr P A case control study on the role of III A DU4 in severe periodontitis and rapidly progressive periodontitis. Identification of types and subtypes using molecular biology. I < Tin Periodontal 1999 26 77, 4. Butler III A familial pattern ol juvenile periodontitis (periodontosis). I Periodontal 1969 40 1 I S. 5. Burmeister I A, Bust AM. Palcanis KG, et at localized iuvenile periodontitis and generalized severe periodontitis ( linical findings. J ( lin Periodontol 1984 11 181. 6. Carranza FA Sr. Carranza FA Ir A suggested classification of common periodontal disease. I Periodontol 1959 30 110. 7. Carranza I A Jr, Saglie R, Newman MG Scanning and trans-mission electron microscopy study of tissue invading microorganisms in localized juvenile periodontitis. J Periodontol 1983 54 598. 9. ( hristersson I A, Alhini B, Zamhon J, et al Demonstration of...

Periodontal Disease And Mortality

Cardiac Tn1

Changes in the oral cavity and to identify risk factors for oral disease.,M t linical examinations were performed and alveolar bone level measurements were determined trom full-mouth radiographs. The mean percentage ol alveolar bone loss and the mean probing depth were determined for each subject. A recent study of data from this subject population sought to determine whether periodontal disease status was a significant predictor ol mortality independent of other baseline characteristics within the population.1 Irom the original sample ol 804 dentate, medically healthy subjects, a total of 166 died during the study. Periodontal status at the baseline examination was a significant predictor of mortality independent ol other factors such as smoking, alcohol use, cholesterol levels, blood pressure, family history of heart disease, education level, and body mass, lor those subjects with the most alveolar bone loss, having an average of greater than 21 alveolar bone loss at baseline, the...

Nidcr Protocol For Periodontal Disease Assessment

Yield scores that represent the severity of periodontal disease in individuals or populations, hut these scores do not provide information on the extent of disease. The extent and severity index (ESI) of periodontal disease was developed to provide separate estimates of the extent and severity of periodontal disease in individuals and populations. ' Unlike the PI and IM)l, the ESI does not assess gingival intlainmation. Instead, il estimates the loss ol periodontal attac hmerit using Ihe periodontal probing method developed by Ram fjord for the PDI. A threshold of disease has to be established to calculate the extent score lor an individual. In their initial study of the I SI, Carlos et al considered a site to be diseased when attachment loss exceeded I mm.20 (Because the measurements are always rounded down to the next lowest millimetei, greater than I mm means -2 nun.) Ibran individual. Ihe extent score is the percentage of sites examined thai have attachment loss greater than I mm....

Nonaids Type Necrotizing Ulcerative Periodontitis

Necrotizing Ulcerative Perio

I his type of periodontitis occurs titter repeated long-term episodes of NUG. NUC is characterized by areas of ulceration and necrosis of the gingival margin that become covered by a whitish-yellowish sott material known .is a pscudonwndmtne. I he ulcerated margin is surrounded by an erythematous halo. I he lesions are painful and bleed often, giving rise to localized lymphadenopathy and even lever and malaise. Microscopically, NUC lesions are the result of nonspecific necrotizing inflammation presenting a predominantly polymorphonuclear neutrophil (PMN) infiltrate in the ulcerated areas with an abundant chronic component (lymphocytes and plasma cells) in the peripheral and deeper areas.w Fig. 27 1 Necrotizing ulcerative periodontitis in a 42-year-old, HIV-necjative, white male. Fig. 27 1 Necrotizing ulcerative periodontitis in a 42-year-old, HIV-necjative, white male.

Association Of Plaque Microorganisms With Periodontal Diseases

Microbial Specificity of Periodontal Diseases In the mid-ll> 00s. periodontal disease was believed to result from an accumulation of plaque over time in conjunction wilh a diminished host response and increased host suscept ibility with age. This thinking was supported b epidemiologic studies that correlated both age and the amount of plaque with evidence of periodontitis ' ' Periodontal disease was clearly associated with plaque, and all plaque was thought to he alike and equally capable of causing disease. However, several observations contradicted these conclusions. First, some individuals with considerable amounts ol plaque and calculus, as well as gingivitis, never developed destructive periodontitis. Furthermore, individuals who did present with periodontitis demonstrated considerable site specificity in the pattern of disease. Some site s were unaffected, whereas advanced disease was found in adjacent sites In the presence ot a uniform host response, these findings were...

Periodontal Disease Activity

For many years the loss of attachment produced l> periodontal disease was thought to be a slow but continuously progressive phenomenon. More recently, as a result of studies on the specificity of plaque bacteria, the concept of periodontal disease activity has evolved. According to this concept, periodontal pockets go through periods ol exacerbation and quiescence, resulting from episodic bursts of activity followed by periods of remission. Periods of quiescence are characterized l a reduced inflammatory response and little or no loss ol bone and connective tissue attachment. A buildup of unattached plaque, with its gram-negative, motile, and anaerobic bacteria (see ( liapter 6), starts a period of-exacerbation in which bone and connective tissue attachment are lost and the pocket deepens. This period ma last foi days, weeks, or months and is eventually followed by a period of remission or quiescence in which gram-posi-tive bacteria proliferate and a more stable condition is...

Periodontitis In Adults

Clinicians have long suspected that susceptibility to periodontitis differs among racial and ethnic groups. In the U.S. African-Americans have more severe disease than Caucasians. s Elsewhere, Sri Tankans and South Pacific islanders appear to be more prone to disease than other groups with similar environments.' Although these differences may be clue to unrecognized environmental factors, they also may be the result of differences in genetic makeup. Measures of periodontitis and gingivitis are correlated within families.1 The basis of this similarity whether it be shared environmental factors or genes has been investigated in several large family studies. Initially, studies of Japanese and Hawaiian c hildren suggested that gingivitis was due to recessive genes.*4 Later, correlations within families (e.g., sibling, parent-offspring) were used to estimate genetic and environmental variances lor periodontitis among various racial groups in Hawaii. It was concluded that similarities...

Prepubertal Periodontitis

Periodontal Systemic Disease

A, Hemorrhagic gingivitis in patient with thrombocytopenic purpura B, Marked reduction in severity of gingival disease alter removal of surface debris and careful scaling Fig 1 74 Prepubertal periodontitis (A), clinical picture and panoramic radiograph (B). The palient is a 10-year-old boy with cyclic neutropenia and agammaglobulinemia. Fig 1 74 Prepubertal periodontitis (A), clinical picture and panoramic radiograph (B). The palient is a 10-year-old boy with cyclic neutropenia and agammaglobulinemia. the oral cavity, oropharynx, and throat is characteristic. The mucosa exhibits isolated necrotic patches that are black and gray and arc sharply demarcated from the adjacent uninvolved areas.104-1 *2 The absence of a notable inflammatory reaction due to lack of granulocytes is a striking feature. The gingival margin may or may riot be involved. Gingival hemorrhage, necrosis, increased salivation, and fetid odor are accompanying clinical features. The...

Microbiology And Immunology In Periodontal Diseases

Gingivitis Ihe most common form ol gingivitis is plaque-iiuluccd gingivitis.1* Common clinical findings in gingivitis include erythema, edema, tissue enlargement, and bleeding. I wo forms of plaque-induced gingivitis have been investigated a naturally occurring gingivitis and experimental gingivitis. I'.xpcri mental gingivitis is a longitudinal clinical model that has been widely used in human and animal studies.1'* In humans, experimental gingivitis is induced through abstinence from oral hygiene measures in animal studies a soft diet favoring plaque accumulation is instituted, I he studies of experimental gingivitis have provided a clear demonstration that plaque accumulation invariably causes gingivitis and that gingivitis is reversible with removal ol the plaque deposits. Page and Schroeder reviewed the histopathology of human and animal experimental gingivitis in a classic article110 that delineated three temporal stages of gingivitis, including the initial, early, and...

Gingivitis and Periodontal Disease

The periodontal tissues consist of three components the gums, the bone in which the teeth are set, and the periodontal ligament, a thin layer of connective tissue that attaches the roots of teeth to the bone. Gingivitis (redness and inflammation of the gums) is caused by a nearly invisible sticky film of bacteria and other debris along the gum line, called dental plaque. An early sign of gingivitis is easy bleeding when brushing or flossing the teeth. Dental plaque contains harmful bacteria that can damage both the teeth and periodontal tissues. Early gingivitis is reversible. But untreated it progresses over months to years to periodontal disease. Periodontal disease is marked by permanent damage to the underlying bone and tissue, causing swollen and receding gums, and, ultimately, loose, unstable teeth.

Pathobiology Of Periodontitis Focal Infection Theory Revisited Evidencebased Clinical Practice The Subgingival

OF BACTERIA PERIODONTAL DISEASE AND MORTALITY PERIODONTAL DISEASE AND CORONARY HEART DISEASE ATHEROSCLEROSIS The Effect of Periodontal Infection The Role of Periodontal Disease in Myocardial or Cerebral Infarction PERIODONTAL DISEASE AND STROKE Periodontal Infection Associated with Stroke PERIODONTAL DISEASE AND DIABETES MELLITUS Periodontal Infection Associated with Glycemic Control in Diabetes PERIODONTAL DISEASE AND PREGNANCY OUTCOME Bacterial Vaginosis The Role of Periodontitis in Pregnancy Outcome PERIODONTAL DISEASE AND CHRONIC OBSTRUCTIVE

Periodontal Disease In Hivpositive Individuals

Pictures Scharosis

As described in ( hapter 29, gingival and periodontal manifestations may be found in HIV-positive individuals. I he former include linear gingival erythema and necrotizing ulcerative gingivitis < Uti), both of which may develop into rapidly progressive necrotizing ulcerative stomatitis (NUS) or necrotizing ulcerative periodontitis (MM'). Management of these conditions should be preceded by a thorough medical evaluation, including determination of the (1)4 and viral load status, in consultation with the treating physician. Necrotizing Ulcerative Gingivitis Necrotizing Ulcerative Periodontitis Conventional periodontitis should be managed based on the considerations outlined in Periodontal Treatment Protocol.

Treatment Of Acute Necrotizing Ulcerative Gingivitis

Necrotizing ulcerative gingivitis (NUii) can occur in a mouth essentially free of any other gingival involvement or he superimposed on underlying chronic gingival disease. Treatment should include the alleviation ol the acute symptoms and the correction ol the underlying chronic gingival disease. Flic former is the simplest part of the treatment, whereas the latter requires more comprehensive procedures. Patients are told to report back to the clinician in I to 2 days. The patient should be advised of the extent of total treatment the condition requires and warned that treatment is not complete when pain stops. He or she should be informed of the presence of chronic gingival or periodontal disease, which must be eliminated to prevent recurrence ot the acute sy mptoms. Unfortunately, treatment is often stopped at this time because the acute condition has subsided, but this is when comprehensive treatment of the patient's chronic periodontal problem should start. Appointments are...

Periodontal Disease And Diabetes Mellitus

The relationship between diabetes mellitus and periodontal disease has been extensively examined. It is clear from epidemiologic research that diabetes increases the risk for and severity of periodontal diseases. I he biologic mechanisms through which diabetes influences the periodontium are discussed in Chapter 12. t he increased prevalence and severity of periodontitis commonly seen in patients with diabetes, especially those with poor metabolic control, led to the designation of periodontal disease as the sixth complication of diabetes.35 In addition to the five classic complications of diabetes (Box 13-2), the merican Diabetes Association has officially recognized that periodontal disease is common in patients with diabetes, and its Standards of Care include taking a history of current or past dental infections as part of the physician's examination. '1 Does the presence or severity of periodontal disease affect tlie metabolic state in diabetic patients In a longitudinal study of...

Diagnosis Of Refractory Periodontitis

Although refractory periodontitis is not a currently accepted diagnosis (see ( haptcr 4), many patients fail to respond to conventional therapy, and their management will be discussed. A diagnosis of refractory periodontitis requires the gathering of baseline data and a subsequent evaluation. This is the major way in which the clinician can determine the normality of the patient's response to treatment (see Chapter 27). A few individuals may appear for the first time with unusually severe forms of periodontal destruction for their age. In these cases the initial diagnosis is not refractory periodontitis, but one of the other aggressive diseases discussed later in this chapter. patient with refractory periodontitis often does not have any distinguishing clinical characteristics on initial examination compared with other types of periodontitis. Therefore the initial treatment would follow conventional therapeutic modalities for chronic periodontitis.

Pathobiology Of Periodontitis

Our understanding of the pathogenesis of periodontitis has changed remarkably over the last M) years. Nonspecific accumulation of bacterial plaque was once thought to be the cause of periodontal destruction, but it is now recognized that periodontitis is an infectious disease iissociated with a small number of predominantly gram-negative microorganisms. Furthermore, the importance of the host in disease initiation and progression is clearly recognized. Although pathogenic bacteria are necessary for periodontal disease, they are not in and of themselves sufficient to cause the disease. A susceptible host is also imperative. In a host who is not susceptible to disease, pathogenic bacteria may have no clinical effect. Conversely, the susceptible host experiences clinical signs of periodontitis in the presence of pathogenic bacteria. Recognition of the importance of host susceptibility opens a door to understanding the differences in the onset. natural history, and progression of...

Periodontitis Associated With Endodontic Lesions

In periodontal endodontic lesions, bacterial infection from a periodontal pocket associated with loss of attach ment and root expostire may spread through accessory canals to the pulp, resulting in pulpal necrosis. In the case of advanced periodontal disease, the infection may-reach the pulp through the apical foramen. Scaling and root planing removes ccinentuin and underlying dentin and may lead to chronic pulpitis through bacterial penetration of dentinal tubules. However, many periodon titis-affected teeth that have been scaled and root planed show no evidence of pulpal involvement. In ill cases of periodontitis associated with endodontic lesions, the endodontic infection should be controlled before beginning definitive management ot the periodontal lesion, especially when regenerative or bone-grafting techniques are planned.

Periodontal Disease And Stroke

In case-control studies, poor denial health was a significant risk factor for cerebrovascular ischemia. In one study, bleeding on probing, suppuration, subgingival calculus, and the number of periodontal or periapical lesions were significantly greater in male stroke patients than in controls.7 Overall, 25 of all stroke patients had significant dental infections compared with only 2.5 of controls. Ibis study supports an association between poor oral health and stroke in men under age SO. In the other study, men and women age 50 and older who had a stroke had significantly more severe periodontitis and more periapical lesions than did nonstroke control subjects. Poor dental health was an independent risk factor for stroke. In a longitudinal study over IS years, subjects with greater than 20 mean radiographic bone loss at baseline were almost three times as likely to have a stroke than were subjects with less than 20 hone loss. Periodontitis was a greater risk factor for stroke than was...

Periodontal Disease And Chronic Obstructive Pulmonary Disease

COPD shares similar pathogenic mechanisms with periodontal disease. In both diseases, a host inflammatory response is mounted in response to chronic challenge by bacteria in periodontal disease and by fac tors such as cigarette smoke in (OPD. t he resulting neutrophil influx leads to release of oxidative and hydrolytic enzymes that cause tissue destruction directly. Recruitment of monocytes and macrophages leads to further release of pro-inflammatory mediators. Less is known about the clinical relationship between periodontal disease and ( OPI) compared with ( I ID and other systemic conditions. In analyzing data from a longitudinal study of more than 1100 men, alveolar bone loss was associated with the risk for CIOI'D. ' Over a 25-year period, 23 of subjects were diagnosed with t OPD. Subjects with more severe bone loss at the baseline dental examination had a significantly increased risk of subsequently developing COPP compared with subjects with less bone loss. I he increase in...

Periodontitis Drugs

Rams and Slots reviewed combination therapy using systemic metronidazole along with amoxicillin, Augmenting or ciprofloxacin. ' I he metronidazole-amoxicillin and metronidazole-Augment in combinat ions provided excellent elimination of many organisms in adult and localized aggressive periodontitis that had been treated unsuccessfully with tetracyclines and mechanical debridement. These drugs have an additive effect regarding suppression of A, actinomycetemcomitans. Ilnoco and coworkers' found metronidazole and amoxicillin to be clinically effective in treating localized aggressive periodontitis, although 50 of patients harbored uctinomycetenhnmi-tiins one year later. Metronidazole-ciprofloxacin combination is effective against .1. actinomycetemcomitans. Metronidazole targets obligate anaerobes, and ciprofloxacin targets facultative anaerobes. Ibis is a powerful combination against mixed infections. Studies of this drug combination in the treatment of refractory periodontitis have...

Periodontal Disease

Necrotizing Ulcerative Stomatitis Nus

Considerable interest has been directed toward the nature and incidence ol dental and periodontal diseases in HIV-infected individuals. Available evidence indicates that those diseases are more common among HIV-infected intravenous (IV) drug users. I his appears to relate to poor oral hygiene and lack of dental care rather than decreased CI> 4 cell counts. lo A persistent, linear, easily bleeding, erythematous gingivitis (I.(iK) has been described in some HIV-positive patients. This may or may not serve as a precursor to rapidly progressive necrotizing ulcerative periodontitis (NUpj- Mi.Ki (See Color Fig. 29-1, H and ( , and I ig. 29-14). T he microflora of LGE may closely mimic that ol periodontitis rather than gingivitis.41 1 inear gingivitis lesions may be localized or generalized in nature. Ihe erythematous gingivitis may (1) be limited to marginal tissue, (2) extend into attached gingiva in a punctate or a diffuse erythema, or (3) extend into the alveolar mucosa. Necrotizing...

Periodontal Red Complex

Scanning Periodontal Disease

Fig. 6 10 Scanning electron micrograph of cocci and filaments associated with surface of pocket epithelium in a case of marginal gingivitis. (Magnification 3000.) fig. 6 10 Scanning electron micrograph of cocci and filaments associated with surface of pocket epithelium in a case of marginal gingivitis. (Magnification 3000.) complexes (A. odontolythns) d ig. 6-1 I he microorganisms primarily considered secondary colonizers fell into the green, orange or red complexes. The green complex includes . corrodent, Actinohai illus actinomycetenuomitans serotype a. and < apnocytophaga sjpp. I he orange complex includes Fusabactcrium, I'revotella. and Campylobacter spp. The green and orange complexes include species recognized as pathogens in periodontal and nonperiodontal infections. Hie red complex consists of '. gingival iis, li. forsy tints, and I. denticola. I he red complex is of particular interest because it is associated with bleeding on probing, which is an important clinical...

Immunologic Aspects Of The Microbial Interaction With The Host

Periodontal disease is dependent on bacteria, as discussed previously, and bacteria may directly interact with the host tissues in mediating tissue destruction. In addition, many tissue changes associated with periodontal diseases appear to be well-orchestrated responses, suggesting the influence of host regulation. Among the orchestrated responses are the antimicrobial activities by acute inflammatory cells (neutrophils) and the adaptive activities brought about by monocytes macrophages and lymphocytes. Adaptive responses include the epithelial alterations, angiogencsis, episodic remodeling of the underlying of hard and soft connective tissues, and antigen-specific immune responses. Remodeling ol the connective tissues appears to be episodic and occurs in cycles of destruction and reconstruction. Excessive destruction or inadequate reconstruction can result in periodontal disease. MS PAR I * tioloxy of Periodontal Diseases

Periodontal Pathogens Future Advances In Periodontal Microbiology

Attached Acid Tooth Surface

Eriodontal disease comprises a group of inflammatory conditions of the supporting tissues of the teeth that are caused by bacteria. Our understanding of the etiology of periodontal diseases has undergone major advances in recent decades.1'* In the mid- 1900s, all bacterial species found in dental plaque were believed to he equally capable of causing disease, and periodontitis was believed to be the result of cumulative exposure to dental plaque. The association of specific bacterial species with disease came about in the early 1960s, when microscopic examination of plaque revealed that different bacterial morphotypes were found in periodontally healthy versus periodontally diseased sites. In the 1960s and 1970s, technical improvements were made in the procedures used to isolate, cultivate, and identify periodontal microorganisms. This resulted ir. refinements in bacterial taxonomy ( fable 6-1) and clarification of the specific groups of microorganisms present with diseases of the...

Developmental Or Acquired Deformities And Conditions

Localized Tooth-Related Factors That Modify or Predispose to Plaque-Induced Gingival Diseases or Periodontitis In general, these factors* arc considered to be those local factors that contribute to the initiation and progression of periodontal disease through an enhancement of plaque accumulation or the prevention ol eltective

Host-bacterial Interaction In The Sulcus Gingiva

Sulcus Gingival

Adapted from Socransky SS, Halfajee AD Microbial mechanisms in ihe pathogenesis ol destructive periodontal diseases A critical assessment Periodontal Res 1991 76 195 and data compiled from references''1 1 m.w ters IS and 21 i regarding periodontal diseases. Phe paradigm is tlnii in I espouse to bacterial infection I) innate factors si tili lis complement, resident leukocyte.s, and especially iihisi cells p u tm important role in signaling endothelium, ihus initiating inflammation 2i a utc inflammatory cells (i.e., neutrophils) protect loud tissues by controlling the periodontal mictobioia within the gingival m vice and jum-tional epithelium ami finally. A) chronic inflammdtorv cells. ntacrophages. iind lymphocytes protect the entire laist from within the subjacent cornice live tissues und do all that is necessary to prevent a local infection from becoming systemic and life threatening, including the sacrifice of local tissues. In this paradigm, periodontal disease represents a...

Can Opsonization Be Cured

Opsonization

Systemic Neutrophil Abnormalities Associated with Aggressive Periodontitis Severe aggressive periodontitis Aggressive periodontitis and oral ulceration. The syndrome is caused by a mutation in the vesicle trafficking regulator gene, LYST. Aggressive periodontitis, at an early age and affecting primary and permanent dentition, in individuals who are homozygous for the defective gene. Aggressive periodontitis at a young age Irophils whereas MMI' I is expressed hy resident cells including fibroblasts, monocytes macrophages, and epithelial cells (see Pig. 8-0). ( ollagcnase is elevated in tissues and ii< I associated with periodontitis, as compared with gingivitis or healthy controls.'* 14K Other proteinases associated with periodontitis include the neutrophil serine proteinases, elasta.se and calhepsin (L I lastasc is capable of degrading a wide range of molecules including elastin, collagen, and li-hronectin. ( athepsin ii is i bactericidal proteinase that also may tunc tion in the...

Nutritional Influences

Peridontal Disease Patients

Some clinicians enthusiastically adhere to the theory in periodontal disease that assigns a key role to nutritional deficiencies and imbalances. Research conducted up to the present in general does not support this view, but numerous problems in experimental design and data interpretation may render these research findings itiadc quate.s I he majority of opinions and research findings on the effects of nutrition on oral and periodontal tissues point to the following 2. There are no nutritional ile iciencies that by themselves can cause gingivitis or periodontal pockets. However, nutritional deficiencies can affect the condition of the periodontium and thereby can aggravate the injurious effects of local factors and excessive occlusal forces. Theoretically, it can be assumed that there may be a border one in which local lactors of insufficient severity can Cause gingival and periodontal disorders, if their effect on the periodontium is aggravated by nutritional deficiencies. This...

Hematologic Disorders

Sickle Cell Crisis

Gingival hemorrhage is a common finding in leukemic patients (see l ig. 12-10), even in the absence ol clinically detectable gingivitis. Bleeding gingiva tan be an earls sign of leukemia.,so It is due to the thrombocytopenia that results from replacement of the bone marrow cells by leukemic cells and also from the inhibition of normal stem cell function by leukemic cells or their products.1'* (lingival bacterial infection in leukemic patients can be a primary bacterial infection or result from an increased severity of existing gingival or periodontal disease. Acute gingivitis and lesions of necrotizing ulcerative gingivitis are more frequent and severe in terminal cases of acute leukemia19 (Figs. 12-17 and 12-18).

Psychosomatic Disorders

Nail Biting Adults Photos

Foreign objects (e.g., pencils or pipes) nail biting or excessive use of tobacco, which are all potentially injurious to the periodontium.Self-inflicted gingival injuries such as gingival recession have been described in both children and adults. Correlation between psychiatric and anxiety states and the occurrence of periodontal disease have been reported, but these reports have been questioned by some investigators.''1,1 Psychologic factors in the cause of necrotizing ulcerative gingivitis are discussed in Chapter 19.

Enlargements Associated With Systemic Diseases

Papilloma Gingiva

Conditioned enlargement occurs when the systemic condition of the patient exaggerates or distorts the usual gingival response to dental plaque. I lie specific manner in which the clinical picture of conditioned gingival enlargement differs from that of chronic gingivitis depends on the nature of the modifying systemic influence. bacterial plaque is necessary for the initiation of this type of enlargement. However, plaque is not the sole determinant of the nature of the clinical features. A longitudinal study of 127 children I I to 17 years of age showed a high initial prevalence of gingival enlargement that tended to decline with age.120 When the mean number of inflamed gingival sites per child was determined and correlated with the time at which the maximum number of Inllamed sites was observed and the oral hygiene index at that time, it could be clearly seen that a pubertal peak in gingival inflammation that was unrelated to oral hygiene factors occurred. A longitudinal study ol...

To Pocket Depth Area Between The Base Of The Pocket

Rhe periodontal pocket, defined as a pathologically deepened gingival sulcus, is one of the most important clinical features of periodontal disease. All different types ol periodontitis, outlined in Chapter 4, share histopathologic features such is tissue changes in the periodontal pocket, mechanisms ot tissue destruction, and healing mechanisms. They differ, however, in their etiology, natural history, progression, and response to therapy.*'

Pathologic Tooth Migration

Labialy Inclined Maxillary Incisor

Pathologic migration refers to tooth displacement that results when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease. Pathologic migration is relatively common and may he an early sign of disease, or it ma occur in association with gingival inflammation and pocket formation as the disease progresses. Weakened Periodontal Support. I he inflammatory destruction of the periodontium in periodontitis creates an imbalance between the forces maintaining the tooth in position and the occlusal and muscular forces on which it is ordinarily called to bear. I he tooth with weakened support is unable to maintain its normal position in the arch and moves away from the opposing force unless it is restrained by proximal contact. Ihe force that moves the weakly supported tooth may he created by factors such as occ lusal contacts or pressure from the tongue. Pathologic migration is also an early sign of localized aggressive periodontitis....

Experimental Occlusal Trauma Bhaskar Orban

12. ( omar MP, Kollar I A, Gargiulo AW Local irritation and occlusal trauma as cofactars in the periodontal disease process. J Periodontol 1969 40 193. 18. Ericsson I. I indhe j Lack ol ellect of trauma Irom occlusion on the recurrence of experimental periodontitis. J Clin Periodontal 1977 4 115. 19. Ericsson I. Lindhe J Effect of longstanding jiggling on experimental marginal periodontitis in the Ix-agle dog. I ( lin Periodontol 19X2 9 497. 22. Cher ME ( hanging concepts. I he effects ol occlusion on periodontitis. IX lin N Amer 1998 42(2) 2X.S. 29. Glickman I, Smulow JB I he combined effects of inflammation and trauma from occlusion to periodontitis. Int Dent J 1969 19 393. 43. Kohayashl k. Kohayashi K. Soeda V . el al Gingival crevicu-lar pi I in experimental gingivitis and occlusal trauma in man. I Periodontol 1998 69 1036. 49. l.indhe I. Svanberg G Influence ol trauma from occlusion on progression of experimental periodontitis in Ihe beagle dog. Clin Periodontal 1974 1 3. 52....

Bone Destruction Caused By Systemic Disorders

Bone Destruction

Local and systemic factors regulate the physiologic equilibrium of bone When a generalized tendency toward bone resorption exists, bone loss initiated by local inflammatory processes may be magnified. Ibis systemic influence on the response of alveolar bone has been termed the bone factor in periodontal disease.11 nent in all cases of periodontal disease. In addition to the amount and virulence of plaque bacteria, the nature of the systemic component, not its presence or absence, influences the severity of periodontal destruction. Although the term bone factor is not in current use, the concept of a role played by systemic defense me hanisms has been validated, particularly by studies of immune deficiencies in severely destructive types of periodontitis, such as the juvenile forms of the disease.

Relationship to Systemic Disease

A recent review of the literature conducted by I.oesche indicates poor oral health has been associated with medical conditions such as aspiration pneumonia and cardiovascular disease. In particular, periodontal disease can be associated with coronary heart disease and cerebrovascular accidents.1 In addition, the Surgeon General's Report on Oral Health emphasizes that animal and population-based studies demonstrate an association between periodontal disease and diabetes, cardiovascular disease, and stroke.22

Clinical Features

Generalized Periodontitis

RISK FACTORS FOR DISEASE Prior History of Periodontitis Local Factors Systemic Factors Chronic periodontitis, formerly known as adult periodontitis or chronic adult periodontitis, is the most prevalent form of periodontitis. It is generally considered to he a slowly progressing disease. However, in the presence of systemic or environmental factors that may modify the host response to plaque accumulation, such as diabetes, smoking, or stress, disease progression may become more aggressive. Although chronic periodontitis is most frequently observed in adults, it can occur in children and adolescents in response to chronic plaque and calculus accumulation. Ihis observation underlies the recent name change from adult periodontitis, which suggests that chronic, plaque-induced periodontitis is only observed in adults, to a more universal description of chronic periodontitis that can occur at any age (reviewed in Chapter 4). Chronic periodontitis has recently been defined as in infectious...

Advances In Characterizing The Host Response

Periotron For Gcf Collection

Our understanding ol the initiation and progression of periodontal disease and the pathogenic processes in-volved has expanded enormously in light of advances in clinical and basic science research. Diagnostic tests have been developed that add measures of the inflammatory process to conventional clinical measures. I hese tests may provide information on the destructive process itself, current activity of the disease, rate of disease progression, patterns of destruction, extent and severity of future breakdown, and likely response to therapy. With this information the clinician would be able to better individualize his therapeutic approach, thus customizing the recommended treatment. Assessment ol the host response refers to the study of mediators, by immunologic or biochemical methods, that are recognized as part of the individual's response to the periodontal infection. These mediators are either specifically identified with the infection, such as antibody to a putative pathogen, or...

Supragingival Irrigation

Supragingival irrigation with water alone does not sufficiently prevent plaque accumulation nor gingivitis. In this respect, supragingival irrigation is clearly inferior to mechanical plaque control such as using conventional oral hygiene measures.4* Fhus supragingival irrigation Gingivitis Gingivitis Periodontitis Periodontitis Periodontitis Subgingival Irrigation Periodontitis Periodontitis Periodontitis Periodontitis strated that this method in conjunction with toothbrushing can improve the periodontal health in patients with gingivitis and or periodontitis, particularly for patients with clinical signs of gingival inflammation and or poor oral hygiene -' u 19 (Fig. 44-4). However, patients with low plaque scores (i.e., good oral hygiene) have no additional benefit from supragingival irrigation dig. 44-S).

Bone Destruction Caused By Extension Of Gingival Inflammation

Histologic View Periodontal Ligament

I he most common cause of bone destruction in periodontal disease is the extension of inflammation from the marginal gingiva into the supporting periodontal tissues. I he inflammatory invasion of the bone surface and the initial bone loss that follows mark the transition from gingivitis to periodontitis. Periodontitis is always preceded by gingivitis, but not til gingivitis progresses to periodontitis. Some cases of gingivitis apparently never become periodontitis, and others go through a brief gingivitis phase and rapidly develop into periodontitis. The factors that are responsible for the extension of inflammation to the supporting structures and bring about the conversion of gingivitis to periodontitis are not known at this time. The transition from gingivitis to periociontilis is associated with changes in the composition of bacterial plaque. In advanced stages of disease, the number of motile organisms and spirochetes increases whereas the number of coccoid rods and straight rods...

Inflammatory Enlargement

Lobster Shell Disease

Gingival ( hanges Associated with Mouth Breathing. Gingivitis and gingival enlargement are often seen in mouth breathers. ' ihe gingiva appears red and edematous with a diffuse surface shininess ol the exposed area. The maxillary anterior region is the common site of such involvement. In many cases the altered gingiva is clearly demarcated from the adjacent unexposed normal gingiva (I ig. 18-5 see ( olor Fig. 18-1. IU. ihe exact manner in which mouth breathing affects gingival changes has not been demonstrated. Its harmful effect is generally attributed to irritation from surface dehydration. However, comparable changes could not be produced by air drying the gingiva of experimental animals. Fig. 18-5 Gingivitis in a mouth breather A, High lip line in a mouth breather B, Gingivitis and inflammatory gingival enlargement in the exposed area of the gingiva.

Maxillary First Molar

Molars Concavities

Fig. 53-5 Generalized aggressive periodontitis, poor crown-to-root ratio, overall prognosis poor. A, A 24-year-old patient with generalized periodontal attachment loss and pocket formation B, Moderate to advanced bone destruction. The contrast between the well-formed crowns and the relatively short, tapered roots worsens the prognosis. Fig. 53-5 Generalized aggressive periodontitis, poor crown-to-root ratio, overall prognosis poor. A, A 24-year-old patient with generalized periodontal attachment loss and pocket formation B, Moderate to advanced bone destruction. The contrast between the well-formed crowns and the relatively short, tapered roots worsens the prognosis. The influence ol genetic lactors on prognosis is not simple. Although microbial and environmental factors Can be altered through conventional periodontal therapy and patient education, genetic lactors currently cannot be altered. However, detection ol genetic variations that are linked with periodontal disease can...

Draining Apical Abscess

Chronic Apical Periodontitis Treatment

I he presence of an abundant number of neutrophils in the gingival fluid transforms it into a purulent exudate ' Several studies' 10 ' have evaluated I he assoc iation between suppuration and the progression of periodontitis and reported that this sign is present in a ver low percentage ol sites with the disease l.l to .S ).4 Therefore ii is noi by itself a good Indicator. 450 I VMM 5 treatment of Periodontal Disease (see Chapters IS and 65). I he gingival abscess is confined to the marginal gingiva, and it often occurs in previously disease-free areas (Fig. 30-33). It is usually an acute inflammatory response to forcing of foreign material into the gingiva. I he periodontal abscess involves the supporting periodontal structures and generally occurs in the course of chronic destructive periodontitis.

Effects Of Aging On The Response To Treatment Of The Periodontium

Ihe successful treatment of periodontitis requires both meticulous home-care plaque control by the patient and meticulous supragingival and subgingival debridement by the therapist.,n Unfortunately, only a few studies have directly compared such an approach among patients of different age groups. I he lew studies that have done so clearly demonstrate that despite the histologic changes in the periodontium with aging, no dilferences in response to nonsurgical or surgical treatment have been shown for periodontitis However, il plaque control is not ideal, continued loss of attachment is inev itable. A purely biologic or physiologic review indicates th.it the effects ol aging on the struc ture of the periodontium, function of the immune response, and nature of either supragingival or subgingival plaque have a negligible impact on an individual's experience ot periodontal diseases. Aging might affect other aspects ol managing the periodontal diseases (see Chapter .'W), and the resulting...

Focal Infection Theory Revisited

Recent research in the area ol periodontal medicine marks a resurgence in the concept ol focal inlection. In 1 WO, William Hunter, a British physician, first developed the idea that oral microorganisms were responsible for a wide range ol systemic conditions that were not easily recognized as being infectious in nature' 1 and claimed that restoration of carious teeth rattier than extraction resulted in trapping of infectious agents under restorations. In addition to caries, pulpal necrosis, and periapical abscesses, Hunter also identified gingivitis and periodontitis as foci of infection. He advocated extraction of teeth with these conditions to eliminate the source of sepsis. Hunter believed that teeth were liable to septic infection primarily due in their structure and their relationship to alveolar bone. He stated that the degree of systemic effec t produced by oral sepsis depended on the virulence of the oral infection and the degree of resistance of the individual. He also felt...

Toothbrushing Methods

Bass Sulcular Brushing Method

Controlled studies evaluating the effectiveness of the most common brushing techniques have not demonstrated any c tear superiority for any one method. The scrub technique is probably the simplest and most common method of brushing. Patients with periodontal disease are most frequently taught a sulcular brushing technique using a vibratory motion to improve access in the gingival areas. The roll technique seems to be the least effective method, perhaps because it generates only intermittent pressure against the teeth compared with the sustained force applied with the sulcular and scrub techniques.

Subgingival Irrigation

Numerous studies have assessed the potential benefit of subgingival irrigation using various irrigants in the treat-men t ol periodontitis however, iis benefit remains questionable due to controversial results. To penetrate the periodontal pocket near its base by 75 to 93 IVI2 rubber tip nozzles are positioned at the gingival margin12 or blunted cannulas with an end or side port are inserted into the periodontal pocket(see Fig. 44-*). I jection site pressures al the opening of various tip designs have been demonstrated to range from 0.7 kPa to 45 kPa (0.1 psl to 5 psi) and were lowest in side port systems.11,41 Care should be taken not to block the opening of the canula to prevent excessive pressure buildup. Irrigating devices similar to those employed tor supragingival irrigation or syringes have been used for the delivery of solutions. Similar subgingival penetration can be achieved using the side or end port cannulas.41 Subgingival Irrigation as a Monotherapy for Periodontitis...

Systemic Administration Of Antibiotics

Hie treatment of periodontal diseases is based on the infectious nature of these diseases ( Table SO-1). Ideally, the causative microorganism(s) should be identified and the most effective agent selected using antibiotic sensitivity tests. Although this appears simple, the difficulty lies pri I he possible c linical benefits of administering antibiotics to help control periodontal disease must be weighed against possible adverse reactions. Some adverse reactions include anergic anaphylactic reactions, superinfections of opportunistic bacteria, development of resistant bacteria, interactions with other medications, upset stomach nausea, and vomiting.tK Common and indiscriminate use of antibiotics worldwide has contributed to increasing numbers of resistant bacterial strains over the last IS to 20 years, and this trend is likely to continue given the widespread use of antibiotics. The overuse, misuse, and widespread prophylactic application of antimicrobial drugs are some of the factors...

Interdental Cleaning Aids

Images Healthy Periodontium

Any toothbrush, regardless ol the brushing method used, does not completely remove interdental plaque. I bis is true both in individuals with healths periodontal conditions and those with periodontal destruction resulting in open embrasures.''*1 nl Interdental plaque removal is crucial to augment the effects of tooth brushing because, as previously noted, the majority of dental and periodontal disease originates in interproximal areas. Other conditions found in periodontal and gingival diseases also demand an emphasis on interproximal cleaning. The gingival tissues are swollen in the presence of gingival inflammation, rendering the self-cleansing mechanisms of the mouth less effective than in a healthy periodontium. lso, tissue destruction associated with periodontal disease may leave large open spaces between teeth and long-exposed root surfaces with anatomical concavities and furcations. These are difficult areas to Teflon-type material are preferred by some individuals because they...

Advances In Microbiologic Analysis

Subtraction Radiography Periodontics

Since subgingival oral bacteria are the main initiating agents in the development ot periodontal disease, it makes sense to look for specific bacteria in the subgingival microflora of patients with disease.*4,81 These microbiologic tests have the potential to support the diagnosis of the various forms ot periodontal disease, to serve as indicators of disease initiation and progression (i.e., disease activity), and to determine which periodontal sites are at higher risk for active destruction. Microbial tests can also be used to monitor periodontal therapy directed at the suppression or eradication of periodontopathy microorganisms.87 Several methods have been employed for the detection of putative periodontal pathogens in subgingival samples. Some of these methods have been strictly used for research purposes, whereas others have been adapted or modified for clinical use. All of these methods share the common need for an appropriate subgingival plaque sample. Selecting the proper...

Chemical Plaque Control

Mechanical plaque removal remains the primary method used to prevent dental diseases and maintain oral health. However, an improved understanding of the infectious nature of dental diseases has dramatically revitalized interest in chemical methods of plaque control. The ADA Council on Scientific Affairs has adopted a program for acceptance of plaque control agents. The agents must be evaluated in placelxxontrolled clinical trials of 6 months or longer that demonstrate significantly improved gingival health compared with controls. To date, the ADA has accepted two agents tor treatment of gingivitis prescription solutions of chlorhexidine digluconatc mouthrinse and nonprescription essential oil inouthrinse. The agent that has shown the most positive results to date is chlorhexidine. a diguanidohexane with pronounced antiseptic properties. Fhe initial finding that two daily rinses with 10 ml of a 0.2 aqueous solution of chlorhexidine digluconatc almost completely inhibited the...

The Subgingival Environment As A Reservoir Of Bacteria

The subgingival microbiota in patients with periodontitis provides a significant and persistent gram-negative bacterial challenge to the host (see Chapters 6 and 8). These organisms and their products, such as lipopolysac-charide (LPS), have ready access to the periodontal tissues and to the circulation via the sulcular epithelium, which is frequently ulcerated and discontinuous. Kvcn with treatment, complete eradication of these organisms is difficult, and their recmergence is often rapid. The total surface area of pocket epithelium in contact with subgingival bacteria and their products in a patient with generalized moderate periodontitis has been estimated to be approximately the size of the palm of an adult hand, with even larger areas of exposure in cases of more advanced periodontal destruction.57 Bacteremias are common after mechanical periodontal therapy and also occur frequently during normal daily function and oral hygiene procedures.2* 'Just as the periodontal tissues mount...

Therapeutic Procedures

Although the phases of treatment have even been numbered, as mentioned above, their recommended sequence does not follow their numbers. The etiotrojre phase, even when successfully performed, stops the progression of dental and periodontal disease. Immediately after completion of Phase I therapy, the patient should be placed on the Maintenance Phase (Phase IV) to preserve* the results obtained and prevent any further deterioration and recurrence of disease. While the patient b on the Maintenance Phase, with its periodic checkups and controls, he she enters into the surgical and reparative phases of treatment (Phases III and IV). This includes periodontal surgery to repair and improve the condition of the periodontal and surrounding tissues and esthetics, rebuild lost structures, place implants,and construct the necessary restorative work.

Plaque Control Record the OLcary Index17

Significance of Plaque Scores and Bleeding Scores. Plaque scores are helpful as indicators of patient compliance and success with daily plaque control procedures. They once were used as an educational tool to demonstrate improvement in patient technique and give positive reinforcement. However, plaque levels themselves do not necessarily reflect gingival health or risk of disease progression, even though plaque is highly correlated with the presence of gingivitis.,ot In terms of predicting success in controlling inflammation and reducing the chance of disease progression, bleeding is by far the better indicator. Bleeding on probing is not the most specific and sensitive of measures of health however, it has a strong negative correlation to disease progression. If bleeding is absent at any given site in the mouth, reflecting good plaque control and disease management, the chance that periodontal disease will progress is unlikely. '1 Patients can reduce the incidence of plaque and...

Advances In Radiographic Assessment

Periodontal Disease Radiographic Images

Dental radiographs are the traditional method used it) assess the destruction ot alveolar bone associated with periodontitis. Although radiographs cannot accurately reflect the bone morphology buccally and lingually, they provide useful information on interproximal bone levels. Moreover, they provide information on the periodontium that cannot be obtained by any other noninvasive methods (e.g., root length, root proximity, and presence of periapical lesions and estimates of remaining alveolar bone) (Fig 34-1, . However, it is well known that substantial volumes ol alveolar bone must he destroyed before the loss is detectable in radiographs-'* specifically, more than 30 of the bone mass at the alveolar crest must be lost for a change in bone height to be recognized on radiographs. Therefore conventional radiographs arc very specific, but lack sensitivity. (See Chapters .32 and

Periodontal Manifestations Of Pregnancy

Cancer Disease Images

The link between pregnancy and periodontal inflammation has been known for many years. In 177S, Ver-meeren discussed toothpains in pregnancy In ISIS, Pitcarin described gingival hyperplasia in pregnancy 1 Despite awareness regarding pregnancy and its effect on periodontal disease, onl recently has evidence indicated an inverse relationship to systemic health. Current research implies periodontal disease may al.er the systemic health ol the patient and adversely affect the well-being ol the fetus by elevating the risk lor low-birth-weight, preterm infants. Periodontal Diseases In IS77, Pinard n recorded the first case of pregnancy gingivitis. Only recently has periodontal research begun to focus on causative mechanisms. I he occurrence of pregnancy gingivitis is extremely common, occurring in approximately 30 to 100 of all pregnant women.VUI It is characterized by erythema, edema, hyperplasia, and increased bleeding. Histologically, the description is the same as gingivitis. However,...

Factors To Consider When Determining A Prognosis

Tooth Center Rotation

For two patients with comparable levels of remaining connective tissue attachment and alveolar bone, the prognosis is generally better in the older of the two. lor the younger patient, the prognosis is not as good because of the shorter time frame in which the periodontal destruction has occurred. In some cases this may be because the younger patient suffers from an aggressive type of periodontitis or disease progression may have increased due to systemic disease or smoking. In addition, although the younger patient would ordinarily be expected to have a greater reparative capacity, the occurrence of so much destruction in a relatively short Disease Severity. Studies have demonstrated that a patient's history ot previous periodontal disease may he indicative of their susceptibility lor future periodontal breakdown (see Chapter 5). I herefore I lie following variables should be carefully recorded because they are important for determining the patient's past history ol...

Benefits Of Orthodontics

Orthodontic tooth movement may be a substantial benefit lo the adult pcriorestorative patient. Many adults who seek routine restorative dentistry have problems with tooth malposition that compromise their ability to adcquatels dean and maintain their dentitions. It these individuals also are susceptible lo periodontal disease, tooth malposition could he an exacerbating factor that could cause premature loss ol specific teeth. Orthodontic appliances have become smaller, less noticeable, and easier to maintain during orthodontic therapy. Many adults are taking advantage of the opportunity to have their teeth aligned to improve the esthetics ol their smiles. II these individuals also have underlying gingival or osseous periodontal detects, these detects often can be improved during orthodontic therapy il the orthodontist is aware of the situation and designs the appropriate tooth movement. In addition, implants have become a major part til the treatment plan for many adults with missing...

Risk Factors For Disease

Prior History of Periodontitis Although not a true risk factor for disease but rather a disease predictor, i prior history of periodontitis puts patients at greater risk for developing further loss of attachment and bone, given a challenge from bacterial plaque accumulation. Fhis means that a patient who presents with pocketing and attachment and bone loss will continue to lose periodontal support il not successfully treated. In addition, a chronic periodontitis patient that has been successfully treated will develop continuing disease if plaque is allowed to accumulate. Ibis stresses the need for continuous monitoring and maintenance of periodontitis patients to prevent a reoccurrence of the disease. Ihe risk factors that contribute to patient susceptibility ire discussed in the following sections. Plaque accumulation on tooth and gingival surfaces at the dentogingival junction is considered the primary initiating agent in the etiology of chronic periodontitis. Attachment and hone...

Relationship Between Diagnosis And Prognosis

Many of the criteria used in the diagnosis and classification of the different forms of periodontal disease1 (see Chapter 4) are also used in developing a prognosis (see Table 33-1). Factors such as patient age. severity > l disease, genetic susceptibility, and presence of systemic disease are important criteria in the diagnosis of the condition. These are also important in developing a prognosis. I'hese common factors suggest that tor any given diagnosis, there should be an expected prognosis under ideal conditions. I he following section discusses the potential prognoses of the various periodontal diseases outlined in (Ihapter 4. GINGIVITIS ASSOCIATED WITH DENTAL PLAQUE ONLY. Plaque-induced gingivitis is a reversible disease that occurs when bacterial plaque accumulates at the gingival margin.-' I his disease can occur on a periodontium that has experienced no attachment loss, or on a periodontium with nonprogressing attachment loss (see Chapter 4). In either case, the prognosis...

Locally Delivered Antiseptics

R he various periodontal diseases result from susceptible hosts having their periodontal tissues colonized by specific oral pathogens in numbers sufficient to overwhelm their tissue defenses. (Tmical success in the treatment of these diseases thus requires reduction of the bacterial load or enhancement ol the host tissues' ability to defend or repair itself. Traditionally, the foundations of clinical success include education of patients in daily oral hygiene surgical and nonsurgical mechanical root debridement to remove subgingival bac teria and their accretions from root surfaces and supportive periodontal therapy generally at A- to o-month intervals. In certain types of periodontal disease including chronic advanced periodontitis, refractors periodontitis, aggressive periodontitis, and periodontitis as a manifestations of systemic diseases, adjunc tive chemotherapeutic agenls may be necessary to control the disease process.* This chapter reviews the indications and use of...

Local Delivery Of Antibiotics

The limitations of niouthrinsing and irrigation have prompted research tor the development of alternative delivery systems. Recently, advances in delivery technology have resulted in the controlled release of drugs (Table 50-3). I he requirements for treating periodontal disease include a means for targeting an antimicrobial to infection sites and sustaining its localized concentration at effective levels lor a sufficient time while concurrently evoking minimal or no side effects.

Supportive Periodontal Therapy

Antimicrobial Therapy For Periodontitis

Chronic periodontitis Aggressive, refractory, or medically related periodontitis Ictracyclines are effective in treating periodontal diseases in part because their concentration in the gingival crevice is 2 to 10 times that in serum.' this allows a high drug concentration it be delivered into periodontal pockets. In addition, several studies have demonstrated that tetracyclines at a low gingival crevicular fluid con-central ion (2 to 4 eg ml) are very effective against many periodontal pathogens. Sl Clinical Use. Ictracyclines have been investigated as adjuncts in the treatment of localized aggressive periodontitis (l AIM. A. thtiiioinyicU'mcomitiiiis is a frequent causative microorganism in LAP and is tissue invasive. Therefore mechanical removal of calculus and plaque from root surfaces may not eliminate Ibis bacterium from the periodontal tissues. Systemic tetracycline can eliminate tissue bacteria and has been shown to arrest bone loss and suppress A. iictinumyci'tcmLomiUins...

Serial And Combination Antibiotic Therapy

Microbial flora associated with the various periodontal disease syndromes.8 Ihese mixed infections can include i variety of aerobic, microaerophilic, and anaerobic bacteria, both gram negative and gram positive. In these instances, it may be necessary to use more than one antibiotic, cither serially or in combination However, before combinations of antibiotics are used, the periodontal palhogen(s) being treated must he identified and antibiotic susceptibility testing performed.

Armitage G Periodontal Maintenance Therapy Berkeley Calif 1974

Clinical Attachment Loss

C Axelsson P, l.indhc I I he effect ol ,i preventive- programme on dental plaque, gingivitis and caries in school children. Results after one and two years. c tin Perlodontol 1974 1 126. 4 ( arran a I A, )r, Newman Mir. Preface In ( arranza I . r, Newman Mil (eds) Clinical Pcriodontologv. ed .S. Philadelphia, Saunders, 1996. s. ( hawla IN. Nanda US. kapoor KK Dental prophylaxis procedures in control of periodontal disease in 1 iu know (rural). Indian J Periodontol I97.S 4< > 498 < > . ( obh c M Non-surgical pocket therap Mechanical. nn 9. Lindhe I, Kock (. Ihe effect of supervised oral hygiene on the gingiva of children. Progression and inhibition ol gingivitis. I Periodont Res 1966 1 260. chronic adult or generalized early-unset periodontitis. II. Long-term impact on microbial load. I Periodontal 1W

Examination And Treatment Planning With Resective Surgery

Ihe potential loi the use of lesective osseous surgery is usually identified during a comprehensive periodontal examination. Suitable patients display the signs and symptoms of periodontitis (see < hapler M)). The gingiva may be inflamed and deposits of plaque, calculus, and oral debris may be present. An increased flow of crevicular fluid may be detected, and bleeding on probing and exudation are commonly observed. Routine dental radiographs do not identify the presence ot periodontitis, nor do they accurately document the extent of bony defects. Ihe number of bony walls and the presence or extent of bony lesions on the facial buccal or lingual palatal walls cannot be accurately determined by radiographs. Well-made radiographs provide useful information about Ihe extent of interproximal bone loss, the presence ol angular bone loss, caries, root trunk length, and root morphology. I hey also facilitate the identification of other dental pathoses that require treatment. In addition, a...

Factors In The Selection Of Resective Osseous Surgery

Positive Negative Bony Architecture

Two-walled defects craters occur at the expense of the interseptal bone. As a result, ilu-y have buccal and lingual palatal walls that extend from one toot i to the adjacent tooth. T he interdental loss ol bone exposes the proximal aspects of both adjacent teeth. The buccal-Ungual interproximal contour that results is opposite to the contour ol the ceineutoenainel junction of the teeth (Fig. 62-6, I and H). Two-walled defects (cratersi are IInmost common bom defects found in patients with periodontitis. It the tacial and or lingual plates of this bone are resected, the resultant interproximal contour would become more flattened or ovate (Fig. 62-6, < and D). However, confining resection only to ledges and the interproximal lesion results in a facial and lingual bone form in which the interproximal bone is located more apicallv than is the bone on the facial or lingual aspects of the tooth. I his resulting anatomic form is reversed or negative arcTiitecturc,v(see l ig. 62-6, ( and i)...

Osseous Surgery Examination And Treatment Planning With

Osseous Surgery

Rhc damage resulting from periodontal disease reveals It sell in variable destruction of the tooth-supporting hone, ( enerally, bony deformities tire not uniform. Ihey are not indicative ot the alveolar housing ol the tooth before the disease process, nor do they reflect the overlying gingival architecture. Bone loss has been classified .is either horizontal or vertical, but in fact, bone loss is most often a combination of horizontal and vertical loss. Horizontal bone loss generally results in .1 relative Ihic kening of the marginal alveolar hone, since bone lapers as it approaches its most coronal margin. Osseous surgery may be defined as the procedure by which changes in the alveolar bone can be accomplished to rid it of deformities induced by the periodontal disease process or other related factors, such as exostosis and tooth supraeruption.

Independent Periodontal And Endodontic Lesions

Endo Perio Lesions Images

Patients with pulpal disease may also present with inflammatory periodontal disease. Gingivitis or early periodontitis, other than tenderness, bleeding on brushing, or probing, commonly results in little discomfort. Pulpal disease, however, is associated with more noxious signs and symptoms. The progress of periodontitis is slow, with the exception of acute disease such as periodontal abscesses or necrotizing ulcerative gingivitis. Therefore the prompt management of the pulpal lesion is the primary concern. Pulpal extirpation and filling of the canals is the proper course of therapy, since extirpation of the pulp usually leads to the elimination of the patient's acute symptoms. Although residual sensitivity to percussion or movement of the tooth may persist for a period, therapy for gingivitis or early periodontitis may A different scenario may result if 1 patient with chronic periodontitis experiences a loss of pulpal vitality. Such a patient may simultaneously have the clinical...

Referral Of Patients To The Periodontist

I he majority ol periodontal care belongs in the hands ol the general dentist. I his is because of the overwhelming number of patients with periodontal disease and the intimate relationship between periodontal disease and restorative dentistry. more teeth will he it risk of periodontal disease Hence the prev alence of patients requiring ST I is likely to increase in the future

Professional Organizations On The Internet

Periodontal professional organizations throughout the world have a presence on the World Wide Web. The American Academy of Periodontology lias developed a broad spectrum of information available at 1111p IIyvwfw.perio.org. Visitors to this site can access information on periodontal disease and treatment in segments designed for patient education. Pages also are devoted to members, with courses, practice administration information, a buyer's guide with direct links to dental companies and manufacturers, classified advertisements and bulletin boards, educational and career opportunities, and links to the Journal of Periodontology and the American Board of Periodontology.

Retrieval Of Scientific Data

The pace of growth of information technology ensures that networks will spread wider and wider in the coining years. t present, I6(),()()() new connections to the Internet are made everyday, and the number ol host sites continues to show dramatic growth (Appendix I ig. I). This has important implications lor periodontics. New proven procedures will be used In more clinicians in much shorter time periods than previously. The race to solve the problems of treatment prevention and control ol human periodontal disease now has a much more optimistic time tor the finish line.

Overview Of Genetic Study Designs

Polygenic Model For Periodontitis

The term genetic marker refers to any gene or nucleotide sequence that can be mapped to a specific location or region on a chromosome, from a genetic epidemiologic viewpoint, any marker that is sufficiently polymorphic, or variable, in the population can be used to map or locate disease alleles. Finally, there is an important distinction between the role of genes in monogenic disorders such as Huntington's disease and their role in complex multifactorial diseases such as periodontitis. In monogenic disorders, genes are referred to as causative because nearly everyone with the mutation develops the condition Knvironmcntal factors generally play a minor role in determining the phenotype. In contrast, genes involved in complex multifactorial diseases are often referred to as susceptibility genes (or more correctly, susceptibility alleles), l or these diseases, individuals who inherit susceptibility alleles will not develop disease unless they are exposed to deleterious environments. Tor...

Surgical Techniques For Treatment Of Periimplantitis

As in the treatment of certain types of periodontitis, systemic antibiotics have been advocated as a supportive regimen during the treatment phase of periimplant disease.' I bis may be especially important due to the close proximity of the inflammatory lesion to the implant and the bone marrow (see Fig. 73-2, < > . '' r Antibiotics frequently used without sensitivity testing are doxvcycline and metronidazole.20 W If bacterial sensitivity testing is done, the antibiotic regimen is determined by the laboratory result.

Course And Duration Distribution Clinical Findings

fcute gingivitis is of sudden onset and short du- - l ration and can be painful. A less severe phase of v JLthe acute condition has been termed subacute. Recurrent gingivitis reappears after having been eliminated by treatment or disappearing spontaneously. Chronic gingivitis is slow in onset and ot long duration, and is painless, unless complicated by acute or subacute exacerbations. Chronic gingivitis is the type most commonly encountered (Fig. 17-1 and Color Bg. 17-1). Chronic gingivitis is a fluctuating disease in which inflammation persists or resolves and normal areas become inflamed.NJS

Definition Of Prognosis

Prognosis is often confused with the term risk. Risk generally deals with the likelihood that an individual will get a disease in a specified period (see Chapter S). Risk factors are those characteristics of an individual that put them at increased risk lor getting a disease. In contrast, prognosis is the prediction of the course or outcome of a disease. Prognostic factors are characteristics that predict the outcome of disease once the disease is present. In some cases, risk factors and prognostic factors are the same (see Chapter 5). lor example, patients with diabetes or patients who smoke are more at risk for acquiring periodontal disease, and once they have it, they generallv have a worse prognosis.

Differentiation Between Pulpal And Periodontal Abscesses

Endodontic Periodontal Lesion

Periodontal abscesses (see ( hapter 22) are not usually severely painful lesions. They occur in the pocket or sulcus at the level of the connective tissue attachment, so there is little or no elevation of the periosteum to cause significant pain. The patient becomes aware of a sore or tender area in the gingiva and may notice swelling of the tissues to form a lump. Ibis area may be sensitive to touch, mastication, or toofhhnishing and or tlossing. Any stimulus to the site can indeed be painful. The formation of it fistula is less common than with apical periodontitis. II a fistula does form, it may he tound in both the gingiva and mucosa. The path ot the sinus tract can be determined by carefully placing a fine gutta pcrcha The endodontic sinus tract is usually a narrow, constricted lesion directed from the apex of the tooth laterally. In the absence of inflammatory periodontal disease, a tract emptying into the sulcus exerts little effect on the remainder of the sulcus. Prichard...

Phase I Therapy Periodontal Surgery

Dive periodontal disease must he treated and controlled prior to any restorative dentistry. II restorative dentistry is performed on teeth where the periodontal prognosis is not determined and disease not treated, the loss of the restored tooth can occur. Restorative dentistry must he performed on a periodontium free of inflammation and pockets, without any mucogingival involvement, and with the contour and shape of the periodontium corrected for a good functional and esthetic restorative result. Implant dentistry also requires site development and preparation, not onh for hone Where it may he lacking hut also tor the augmentation o gingival soft tissues. I lie following are reasons why periodontal disease must he eliminated prior to restorative dentistry 2. The position ot teeth is frequently altered in periodontal disease. Resolution of inflammation and

Papila Interdentaria Cancer

Diabetes And Periodontal Disease

Color Fig. 12-1 Diabetes and periodontal disease. A, An adult patient with diabetes (blood glucose level of 400 mg 100 ml). Note the gingi val inflammation, spontaneous bleeding, and edema. B, Same patient as in A after 4 days of insulin therapy (glucose level less than 100 mg 100 ml). The clinical periodontal picture has improved in the absence of local therapy. C, An adult patient with uncontrolled diabetes. Note the enlarged, smooth red gingiva with initial enlargement in the anterior area. D, Lingual view of right mandibular area in the same case as in C. Note the inflamed enlarged area around teeth 27-30. Continued

Prevention And Treatment Of Loss Of Attachment

Levels Periodontal Disease

longitudinal investigation to study the natural development and progression ol periodontal disease was ion-ducted by loe and co-workers.K,,k 1 he first group, established in Oslo, Norway in 1969, consisted of 565 healthy male nondental students and academicians between 17 and 40 years of age. I he principal reason lor selecting Oslo is a study site was that this city had had a preschool, school, and post school dental program offering systematic preventive, restorative, endodontic, orthodontic . and surgical therapy on .in annual recall jasis lor all children and adolescents, complete with i documented attendance record, lor the previous 40 years. Members ol the study population had had maximum exposure to conventional dental care throughout their lives. A second group, established in Sri lanka in 1970, consisted ol 480 male tea laborers between IS and 40 years ol age. I hev were healthy and well built by local standards, and their nutritional condition was clinically fair. I he...

Prognosis Of Combined Lesions

With proper treatment the healing of an endodontic lesion is highly predictable. However, the prognosis for teeth with combined lesions varies with the extent that each lesion contributes to the loss of attachment, lesions resulting from pulpal disease tend to resolve with endodontic therapy, whereas the repair regeneration of attachment loss from periodontitis is less predictable. The long-term prognosis lor a tooth with a combined lesion is therefore closely related to the extent and configuration of the periodontal attachment loss. With advanced horizontal attachment loss, even an optimal endodontic result may not be sufficient to retain the tooth as a functioning member of the dentition. It the periodontal lesion is an advanced, multiwallcd bony de

Clinical Implications Of Genetic Studies

The role of host genes in the etiology and pathogenesis ot the periodontal diseases is just beginning to be understood. (ienetic tests may prove useful lor identifying patients who are most likely to develop disease, suffer from recurrent disease, or suffer tooth loss as a result of disease. I he utility of any screening tool, however, must be evaluated in diverse populations, tiiven the complex etiology of the periodontal diseases, it is likely that any genetic test will be useful in only a subset of patients or populations. (ienetic testing to determine risk lor complex diseases (e.g., cancer) is becoming increasingly more common. With the availability ot such tests, practitioners have the responsibility to fully inform the demanding public what genetic tests can do, act on the results, and advise and support individuals before and after testing. 1 The Identification ol genetic risk factors lor periodontitis in no way mitigates the importance of recognizing and controlling important...

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