Chronic Periodontitis and associated risk factors

Chronic periodontitis

1. CHRONIC PERIODONTITIS Adult periodontitis Chronic adult periodontitis Slowly progressive periodontitis

2. CHRONIC PERIODONTITIS Definition Clinical Features General Characteristics/Signs Symptoms Disease Distribution/ Extent Disease Severity Disease Progression Prevalence Risk Factors for Disease Microbiological Aspects Local Factors Systemic Factors Immunologic Factors Genetic Factors Environmental and Behavioral Factors Management Summery

3. Chronic Periodontitis “AN INFECTIOUS DISEASE (in response to dental plaque) RESULTING IN INFLAMMATION WITHIN THE SUPPORTING TISSUES OF THE TEETH, PROGRESSIVE ATTACHMENT LOSS, AND BONE LOSS.”

4. CHRONIC PERIODONTITIS most prevalent form slowly progressing Systemic and environmental factors (e.g., diabetes mellitus, smoking) modify the host’s immune response to the dental biofilm >>>> leads to increased destruction most frequently observed in adults,  it can occur in children and adolescents 

5. CHRONIC PERIODONTITIS  Effects systemic health(e.g., cardiovascular disorders, diabetes mellitus, pre term low birth weight )  patients with systemic diseases  may also show periodontal destruction

6. Clinical features of chronic periodontitis General Characteristics/Signs Supragingival and subgingival plaque and calculus Inflammation Bleeding on probing Swelling Redness loss of gingival stippling altered gingival margins /Position (e.g., rolled/blunted, flattened, cratered papillae, recessions) Pocket formation Attachment loss

7. General Characteristics/Signs Bone loss(mostly horizontally but can be angular ) Root furcation involvement Furcation exposure if recession Increased tooth mobility Change in tooth position Suppuration (not always) Tooth loss (severe attachment/bone loss)

8. Symptoms Slowly progressive disease Usually no feeling of pain, therefore patients are unaware of their disease.  Most of the time gingival bleeding may be the first self-reported sign  gingival recession >>>  black triangles between the teeth or tooth sensitivity in response to temperature changes, due to recession (in the absence of caries).

9. Symptoms I n patients with advanced attachment and bone loss, tooth mobility, tooth movement (Spacing/Flaring), tooth loss With advanced disease progression, areas of localized, deep seated dull pain because of food stagnation Food impaction may add to the patient’s discomfort. Gingival tenderness or “itchiness” may also be found.

10. Disease distribution/Extent It is a site-specific disease Localized chronic periodontitis less than 30% of the sites show attachment and bone loss Generalized chronic periodontitis 30% or more of the sites show attachment and bone loss

11. Disease Severity Mild chronic periodontitis,  1 mm to 2 mm of clinical attachment loss  M oderate chronic periodontitis,  3 mm to 4 mm of clinical attachment loss S evere periodontitis, when 5 mm or more of clinical attachment loss

12. Disease Progression Usually slow, but it may be modified by local factors Interproximal areas, furcation areas, overhanging margins of restorations, sites of malposed teeth, areas of food impaction. Systemic factors like  uncontrolled diabetes  Leukemia Environmental factors like  Smoking And genetic factor as well

13. Models of disease progression C ontinuous model  

14. Models of disease progression Random or episodic Burst model  proposes that periodontal disease  progresses by short bursts of  destruction followed by periods  of no destruction.  This pattern of disease is random  with respect to the tooth sites  affected and the chronology of the disease process.

15. Models of disease progression Asynchronous, multiple burst model A combination of the previous two models  suggests that periodontal destruction occurs around affected teeth during defined periods of life  that these bursts of activity are interspersed with periods of inactivity or remission. The chronology of these bursts of disease is asynchronous for individual teeth or groups of teeth.

16. Prevalence Increases in prevalence and severity with age affects both genders equally.  Periodontitis is an age-associated (not an age-related) disease.

17. Risk Factors for Disease The composition of the oral microflora (Plaque/Biofilm) is a major etiologic factor  the host’s immune competence Genetic predispositions Systemic diseases and environmental factors

18. Risk Factors for Disease Microbiological Aspects/ Composition of microflora of the Biofilm/Plaque gram-negative organisms in the subgingival biofilm,  Porphyromonas gingivalis , Tannerella forsythia , and Treponema denticola — known as the “ red complex”

19. Local Risk Factors for Disease Calculus >>> most important plaque-retentive factor. Root grooves or concavities, enamel projections furcation entrances, Subgingival and overhanging margins of restorations, carious lesions that extend sub gingivally, Furcations exposed by loss of bone

20. Systemic Risk Factors Periodontitis is associated with different syndromes.  Diseases that impair the host immune response (e.g., human immunodeficiency virus, acquired immunodeficiency syndrome) diabetes mellitus, cardiovascular disorders,   Osteoporosis, osteoporosis,  severely unbalanced diet, Stress dermatologic, hematologic, and neoplastic factors interfere with periodontal inflammatory responses.

21. Immunologic Risk Factors The onset, progression, and severity of the disease depend on the individual host’s immune response. Neutropenia

22. Genetic Factors Periodontitis is considered to be a multifactorial disease that is influenced by local, systemic, and immunologic factors, as described previously.  Each factor is in turn directly related to individual genetic conditions.

23. Environmental and Behavioral Factors Such as smoking and psychological stress . Smoking is a major risk factor dose dependent

24. Psychological factors (e.g., stress, depression) Psychological factors (e.g., stress, depression) also negatively influence the progression of chronic periodontitis. A Positive correlations between cortisol levels and periodontal indices, bone loss, and missing teeth have been recorded.

25. Risk Factors Age  Previous history of Periodontitis

26. Management The goals of periodontal therapy are to eliminate or alter the microbial etiology and contributing risk factors for periodontitis. Many factors affect the decisions Patient-related factors include systemic health, age, compliance, therapeutic preferences, and patient’s ability to control plaque.  Clinician’s related factors restorative and prosthetic demands,  and the presence and treatment of teeth with more advanced chronic periodontitis.

27. Treatment considerations for patients with slight to moderate loss of periodontal support Elimination, alteration, or control of risk factors  Consultation with the patient’s physician may be indicated. diabetes, smoking, aging,  gender,  Genetic predisposition,  systemic diseases and conditions (immunosuppression),  stress,  nutrition,  HIV infection, substance abuse and medications.

28. Management Ideal Therapy Compromised therapy