Gingivitis: Gingivitis
Plaque Induced Gingivitis: Plaque Induced Gingivitis Prevalence: It is evident world wide 82% of US adolescents More than 50% of adult have bleeding from gingiva
Gingival Inflammation: Gingival Inflammation
Gingivitis Histopathologic Stages: Gingivitis Histopathologic Stages Stage I (Initial Stage) Vascular changes, dilation of capillaries and increase blood flow Occur in 1 week Mainly PMNs predominate. Increase in gingival fluid
Neutrophiles Chemotaxis: Neutrophiles Chemotaxis
Chemotaxis: Chemotaxis
Stage II gingivitis (Early Lesion): Stage II gingivitis (Early Lesion) Erythema due to increase in capillary loops between rete pegs. Bleeding on probing Lymphocytes predominate Rete pegs in JE Collagen destruction around inflam. cells
Marginal inflammation and edema: Marginal inflammation and edema
Host Bacterial Interaction: Host Bacterial Interaction
Junctional Epithelium in stage III: Junctional Epithelium in stage III Wide intercellular spaces filled with lysosomes Prominent rete pegs and destroyed basal lamina Collagenase enzyme produced by bacteria and PMNs destroy collagen
Clinical Features: Clinical Features
Plasma Cell Domination: Plasma Cell Domination
Plasma Cell Degeneration: Plasma Cell Degeneration
Advanced Lesion: Advanced Lesion
Distribution: Distribution Localized gingivitis Generalized Marginal Papillary Diffuse
Generalized defuse gingivitis: Generalized defuse gingivitis
Localized defuse: Localized defuse
Generalized papillary gingivitis: Generalized papillary gingivitis
Generalized marginal with localized defuse: Generalized marginal with localized defuse
Course and Duration: Course and Duration Acute: sudden onset, short duration and can be painful Recurrent: reappear after treatment Chronic: Slow onset, long duration, painless, fluctuating (inflammation appear and disappear)
Course and Duration: Course and Duration Acute gingivitis (ANUG) Recurrent gingivitis Chronic gingivitis Comes slowly and of long duration
Clinical Features: Clinical Features 1- Redness 2- Sponginess (softness) 3-Bleeding on provocation 4- Presence of plaque and calculus 5- No evidence of bone loss
Clinical Findings in Gingivitis : Clinical Findings in Gingivitis Bleeding on probing Color changes Changes in consistency Surface texture
Signs and Symptoms of Gingivitis: Signs and Symptoms of Gingivitis
Gingival bleeding: Gingival bleeding
Change in Gingival Position: Change in Gingival Position
Gingival Recession: Gingival Recession
Gingival Recession: Gingival Recession
Change in consistency: Change in consistency
Fibrosis of the gingiva: Fibrosis of the gingiva
Color change in gingiva Bithmus line: Color change in gingiva Bithmus line
Embedded Metal : Embedded Metal
PowerPoint Presentation: Required Reading: Carranza’ Clinical Periodontology 10 th edition, Chapter 21 and 22
Chronic periodontitis: Chronic periodontitis
Chronic Periodontitis: Chronic Periodontitis Inflammation of the supporting periodontal tissues as a result of transition of inflammation from the gingiva.
Pathways of Gingival inflammation from the gingiva into supporting periodontal tissues: Pathways of Gingival inflammation from the gingiva into supporting periodontal tissues
Clinical Features of Periodontitis: Clinical Features of Periodontitis Signs and symptoms of gingivitis Periodontal pocket formation Tooth mobility Furcation involvement Alveolar bone loss
Radiographic Images: Radiographic Images
Periodontal Pocket: Periodontal Pocket Pathologically deepened gingival sulcus Careful probing is the reliable method for its detection
Clinical Signs: Clinical Signs Enlarged bluish gingiva Red blue vertical zone Break in continuity of interdental papilla Gingival bleeding Exudate from gingival margin Mobility and extrusion of teeth Development of diastema
Symptoms: Symptoms Localized pain or sensation of pressure after eating A foul taste Tendency to suck material from interproximal spaces Itchiness in the gum Sensitivity to heat and cold
Classification of Periodontal Pockets Simple, Compound, Complex: Classification of Periodontal Pockets Simple, Compound, Complex
True or false pockets Suprabony Or Infrabony: True or false pockets Suprabony Or Infrabony
Bone Destruction Pattern in Periodontal Disease: Bone Destruction Pattern in Periodontal Disease Horizontal Bone loss Vertical or angular defects
Tooth Mobility: Tooth Mobility
Histopathologic Features Soft Tissue Wall of Periodontal Pocket: Histopathologic Features Soft Tissue Wall of Periodontal Pocket
Ulceration of surface epithelium: Ulceration of surface epithelium
Root Surface Changes: Root Surface Changes
Furcation Involvement Definition: Furcation Involvement Definition It refers to the denuded furcation area of multirooted teeth affected by periodontal disease
Examination and Detection: Examination and Detection
When to suspect furcation: When to suspect furcation Deep pockets more than 5 mm in multirooted teeth Rdiolucency in the furcation Teeth with B and Li pockets In all molars and maxillary first premolars
Classification Class I – Incipient Furcation: Classification Class I – Incipient Furcation
Class II – Patent Furcation: Class II – Patent Furcation
Class III – Communicating Furcation: Class III – Communicating Furcation
Subclassification: Subclassification Subclass A: 0-3 mm probable depth from the roof Subclass B: 4-6 mm Subclass C: 7 mm or more from the roof of furcation
Examination and Detection of Upper molars: Examination and Detection of Upper molars
Etiology: Etiology Same etiology of periodontal disease Furcation is a plaque retentive area Role of T F O Enamel projections (E Pearls) Proximity of furcation to CE junction Accessory canals in the furcation area
Clinical Features: Clinical Features Sensitivity to thermal changes Throbbing pain caused by pulp changes Sensitivity to percussion caused by inflammation in the periodontium
Clinical Feature: Clinical Feature