Sites are defined as the positions at which probing measurements are taken around each tooth and, generally, six probing sites around each tooth are recorded, as follows: If up to 30% of sites in the mouth are affected, the manifestation is classified as "localized"; for more than 30%, the term "generalized" is used. In periodontal health, gingival diseases and conditions, there are 3 sub-types: In the primary, periodontal disease has common symptoms before treatment.  Periodontitis is frequently reported to be socially patterned, i.e. Persons with dexterity problems, such as with arthritis, may find oral hygiene to be difficult and may require more frequent professional care and/or the use of a powered toothbrush. Periodontal literature Most of the attempts to attach a classification for the prognosis of individual teeth come from the periodontal literature. Periodontitis may be associated with higher stress. Many surgical approaches are used in the treatment of advanced periodontitis, including open flap debridement and osseous surgery, as well as guided tissue regeneration and bone grafting. In such a situation, the bone or the gums around that tooth should be surgically altered or it will always have inflammation which will likely result in more bone loss around that tooth.  In English this term can describe, as in Greek, any discharge of pus; i.e. Nonsurgical scaling and root planing are usually successful if the periodontal pockets are shallower than 4–5 mm (0.16–0.20 in). Prognosis. , An ancient hominid from 3 million years ago had gum disease. However, such treatments do not address calculus formations, and so are short-lived, as anaerobic microbial colonies quickly regenerate in and around calculus. ... Periodontal disease – symptoms, causes, and types. Left untreated, it damages the teeth and gums so much that the patient can lose their teeth. The monthly reevaluation of periodontal therapy should involve periodontal charting as a better indication of the success of treatment, and to see if other courses of treatment can be identified. As a review, the periodontal classifications were revised in 1999 and classified as chronic, aggressive (localized and generalized), necrotizing, and a manifestation of systemic disease. Research has shown that smokers have more bone loss, attachment loss and tooth loss compared to non-smokers. The researchers suggest that smoking may be a key to this. Aggressive Periodontitis. Periodontal disease is diagnosed by your dentist during a periodontal examination. Its prevalence in dogs increases with age, but decreases with increasing body weight; i.e., toy and miniature breeds are more severely affected. Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. Case History in Periodontics is the first information taken from the patient to help determine and diagnose the patient and his/her condition and plays a major aspect in treatment planning. Periodontal disease (also known as periodontitis and gum disease) is a progressive disease which affects the supporting and surrounding tissue of the gums, and also the underlying jawbone. Periodontitis can cause teeth to loosen or lead to tooth loss.Periodontitis is common but largely preventable. The tradition-al systems were based on tooth mortality19 and did not look at the possibility of classify-ing a tooth’s prognosis, based on the ability to control the disease process and success- Chronic Gingivitis.  Diagnosis is by inspecting the gum tissue around the teeth both visually and with a probe and X-rays looking for bone loss around the teeth. The diagnosis of periodontal disease involves elinical observation and the use of a probe; the roentgenogram is essential for planning treatment and for determining prognosis.  Research in 2004 indicated three gram negative anaerobic species: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus and Eikenella corrodens. Other contributors are poor nutrition and underlying medical issues such as diabetes. According to the Sri Lankan tea laborer study, in the absence of any oral hygiene activity, approximately 10% will suffer from severe periodontal disease with rapid loss of attachment (>2 mm/year). Classification of Periodontal Diseases 2017. 2019 Jan 25;226(2):98-100. doi: 10.1038/sj.bdj.2019.45. The seven categories are as follows: Moreover, terminology expressing both the extent and severity of periodontal diseases are appended to the terms above to denote the specific diagnosis of a particular person or group of people. Gingivitis is reversible with professional treatment and good oral home care. This is somewhat of a misnomer, as any depth is, in essence, a pocket, which in turn is defined by its depth, i.e., a 2-mm pocket or a 6-mm pocket. When the pocket depths reach 6 to 7 mm (0.24 to 0.28 in) in depth, the hand instruments and ultrasonic scalers used by the dental professionals may not reach deeply enough into the pocket to clean out the microbial plaque that causes gingival inflammation. Genetics – It appears to play a role in regulating the risk of periodontitis. Pocket depths of greater than 5–6 mm (0.20–0.24 in) which remain after initial therapy, with bleeding upon probing, indicate continued active disease and will very likely lead to further bone loss over time. Its occurrence decreases with a higher standard of living. According to the 1999 classification, the severity of chronic periodontitis is graded as follows:. Most patients have short stature and orofacial characteristics such as micrognathia, gingival hyperplasia with varying degrees of hyperkeratosis, and agenesis or microdontia of multiple teeth, accompanied sometimes by increased sensitivity to infection. Periodontitis is an inflammation of periodontium. a prediction of the course or outcome of a disease or disorder. In addition to initial RSI, it may also be necessary to adjust the occlusion (bite) to prevent excessive force on teeth that have reduced bone support. Periodontitis is an inflammation of the periodontium, i.e., the tissues that support the teeth.  Globally 538 million people were estimated to be affected in 2015.  Bad breath may also occur. In the secondary, or serious form, it defines as “Periodontitis”.  It also linked in those over 60 years of age to impairments in delayed memory and calculation abilities. Periodontal disease, also known as gum disease, destroys the bone and soft tissue that supports the teeth. , Treatment involves good oral hygiene and regular professional teeth cleaning.  As of 2017 it was not certain what species were most responsible for causing harm, but gram-negative anaerobic bacteria, spirochetes, and viruses have been suggested; in individual people it is sometimes clear that one or more species is driving the disease. If people have 7-mm or deeper pockets around their teeth, then they would likely risk eventual tooth loss over the years.  In its early stage, called gingivitis, the gums become swollen, red, and may bleed. However, the risk increases exponentially as glycaemic control worsens. What is diabetes and gum (periodontal) disease? Gingivitis is a type of periodontal disease. TYPES OF PROGNOSIS
- EXCELLENT PROGNOSIS
- No bone loss, excellent gingival condition, good patient cooperation, no systemic environmental factors. Persons with periodontitis must realize it is a chronic inflammatory disease and a lifelong regimen of excellent hygiene and professional maintenance care with a dentist/hygienist or periodontist is required to maintain affected teeth. Although the primary cause of both gingivitis and periodontitis is the microbial plaque that adheres to the tooth surfaces, there are many other modifying factors. There were several attempts to introduce an agreed-upon classification system for periodontal diseases: in 1989, 1993, 1999, and 2017. Case prognosis, individual tooth prognosis What outcome measure: Periodontal disease is a group of dental disorder which occurred by bacteria, and poor oral hygeine that infecting tissues around in the teeth. Subgingival microorganisms (those that exist under the gum line) colonize the periodontal pockets and cause further inflammation in the gum tissues and progressive bone loss. Chronic periodontitis affects about 750 million people or about 10.8% of the world population as of 2010. Save my name, email, and website in this browser for the next time I comment. Gingivitis is quite common, with many people having it to different strengths. 2.  Records from China and the Middle East, along with archaeological studies, show that mankind has suffered from Periodontal disease for at least many thousands of years. It results from bacteria that accumulate in the mouth and form plaque, a sticky membrane that forms over the teeth ( x ). It causes the gums to become red, swollen, and bleed easily. Daily oral hygiene measures to prevent periodontal disease include: Typically, dental hygienists (or dentists) use special instruments to clean (debride) teeth below the gumline and disrupt any plaque growing below the gumline. Types of Periodontal Disease. The 2017 classification of periodontal diseases is as follows:, Periodontal health, gingival disease and conditions, Other conditions affecting the periodontium, The goals of staging periodontitis is to classify the severity of damage and assess specific factors that may affect management.. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions: Presentation of a middle-aged patient with localised periodontitis Br Dent J .  Systemic disease may develop because the gums are very vascular (have a good blood supply).  The dentist or hygienist must perform a re-evaluation four to six weeks after the initial scaling and root planing, to determine if the person's oral hygiene has improved and inflammation has regressed. , Local drug deliveries in periodontology has gained acceptance and popularity compared to systemic drugs due to decreased risk in development of resistant flora and other side effects. Nonetheless, the continued stabilization of a person's periodontal state depends largely, if not primarily, on the person's oral hygiene at home, as well as on the go. Your email address will not be published. To determine whether you have periodontitis and how severe it is, your dentist may: 1. Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth. Removal of microbial plaque and calculus is necessary to establish periodontal health.  Although the majority of research has focused on type 2 diabetes, type 1 diabetes appears to have an identical effect on the risk for periodontitis. Dentists and dental hygienists measure periodontal disease using a device called a periodontal probe. Also, the use of an interdental brush is helpful if space between the teeth allows. For smaller spaces, products such as narrow picks with soft rubber bristles provide excellent manual cleaning.  Males are affected more often than females..  In certain cases antibiotics or dental surgery may be recommended.  Factors that increase the risk of disease include smoking, diabetes, HIV/AIDS, family history, and certain medications. It causes the gums to become red, swollen, and sore. In Europe and the Middle East archaeological research looking at ancient plaque DNA, shows that in the ancient hunter-gatherer lifestyle there was less gum disease, but that it became more common when more cereals were eaten. Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. Generally, gum disease isn’t painful. If left undisturbed, microbial plaque calcifies to form calculus, which is commonly called tartar. Several conditions and diseases, including Down syndrome, diabetes, and other diseases that affect one's resistance to infection, also increase susceptibility to periodontitis. people from the lower end of the socioeconomic scale suffer more often from it than people from the upper end of the socioeconomic scale. . Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist. Periodontal disease is a group inflammatory disorder of the tissues surroundings of the teeth called “Gum diseases”. If nonsurgical therapy is found to have been unsuccessful in managing signs of disease activity, periodontal surgery may be needed to stop progressive bone loss and regenerate lost bone where possible. This involves regular checkups and detailed cleanings every three months to prevent repopulation of periodontitis-causing microorganisms, and to closely monitor affected teeth so early treatment can be rendered if the disease recurs. Genetics appear to play a role in determining the risk for periodontitis. This is a standard treatment to prevent any further progress of established periodontitis.  This procedure involves the use of specialized curettes to mechanically remove plaque and calculus from below the gumline, and may require multiple visits and local anesthesia to adequately complete. This process disrupts anaerobic micro-organism colonies and is effective at reducing infections and inflammation when used daily. It's usually the result of poor oral hygiene. The "severity" of disease refers to the amount of periodontal ligament fibers that have been lost, termed "clinical attachment loss". , As dental plaque or biofilm accumulates on the teeth near and below the gums there is some dysbiosis of the normal oral microbiome. If this periodontal condition is not identified and people remain unaware of the progressive nature of the disease, then years later, they may be surprised that some teeth will gradually become loose and may need to be extracted, sometimes due to a severe infection or even pain. PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES It can be divided into two categories: - periodontitis associated with hematologic disorders such as leukemia and acquired neutropenia. Copyright © 2021 | WordPress Theme by MH Themes. , Plaque may be soft and uncalcified, hard and calcified, or both; for plaques that are on teeth the calcium comes from saliva; for plaques below the gumline, it comes from blood via oozing of inflamed gums. Classification according to sites – sites defines as the positions searching measurement can take around each tooth. Chronic periodontal disease, unlike gingivitis, involves the destruction of the supporting jawbone around the teeth. diagnosis of diabetes with diabetes with diabetes available, direct evidence Tables from Tonetti, Greenwell, Kornman. However, there are a number of different ways in which periodontal infections can manifest. Although many periodontal prognosis systems have been developed, most of the prognoses are based on tooth mortality (i.e., extractions).5–8 Assigning an accurate prognosis for each tooth be… Vising a dentist will help to stop bone and tissue loss. Long-term studies have shown, in moderate to advanced periodontitis, surgically treated cases often have less further breakdown over time and, when coupled with a regular post-treatment maintenance regimen, are successful in nearly halting tooth loss in nearly 85% of diagnosed people. B: moderate progression; <2 mm of bone loss last 5 years. Dr Ismail Hossain This is due to several effects of smoking on the immune response including; decreased wound healing, refreshing antibody production, and reduction of phagocytosis by neutrophils. Purpose: Research indicates clinicians face barriers when attempting to utilize evidence-based protocols for periodontal disease and periodontal disease diagnosis often varies between dental providers. An additional way to stop the inflammation would be for the person to receive subgingival antibiotics (such as minocycline) or undergo some form of gingival surgery to access the depths of the pockets and perhaps even change the pocket depths so they become 3 mm or less in depth and can once again be properly cleaned by the person at home with his or her toothbrush. The goal of periodontal surgery is access for definitive calculus removal and surgical management of bony irregularities which have resulted from the disease process to reduce pockets as much as possible. This thin "measuring stick" is gently placed into the space between the gums and the teeth, and slipped below the gumline. Therefore if the brushing techniques are not modified, a periodontal recurrence is probable. Therefore, in well managed diabetes there seems to be a small effect of diabetes on the risk for periodontitis. , Periodontal disease is generally due to bacteria in the mouth infecting the tissue around the teeth. Gingivitis is often caused by inadequate oral hygiene. It is possibly the most important environmental risk for people. Its types include: Chronic periodontitis – is the commonest form and is identified by evidence of gum recession and pocket formation. PLAY. We will discuss the management of periodontal diseases.  To avoid killing beneficial oral microbes, only small doses of doxycycline (20 mg) are used.. In Israeli population, individuals of Yemenite, North-African, South Asian, or Mediterranean origin have higher prevalence of periodontal disease than individuals from European descent. C: Rapid progression or future progression at high risk; >/- 2 mm of bone over 5 years. Gingival inflammation and bone destruction are largely painless. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. It is very important to understand that in many cases, periodontal disease can progress without symptoms like pain. If it is not treated in time it can develop …  So far, the mechanisms underlying the link are not fully understood, but it is known to involve aspects of inflammation, immune functioning, neutrophil activity, and cytokine biology. , Periodontal disease is the most common disease found in dogs and affects more than 80% of dogs aged three years or older. The disease is generally occurred by bacteria in the mouth infecting the tissues around the teeth. The "extent" of disease refers to the proportion of the dentition affected by the disease in terms of percentage of sites. Aggressive periodontitis – Causes rapid bone destruction and gum loss. The American Academy of Periodontology Classifications are designed to help dental hygienists …  New finger prick tests have been approved by the Food and Drug Administration in the US, and are being used in dental offices to identify and screen people for possible contributory causes of gum disease, such as diabetes. The clinical team, including the dentist, assistant, and dental hygienist, are involved in collecting the information and synthesizing it into a proper diagnosis. Canadian Academy of Periodontology — What is periodontitis? Additional diseases that may result from periodontitis include chronic bronchitis and pulmonary fibrosis. A periodontist can do a gum graft, where they take tissue, usually from the roof of your mouth, and use it to cover the receded gum line. , It is estimated that lost productivity due to severe periodontitis costs the global economy about US$54 billion each year. Also, it may be necessary to complete any other dental needs, such as replacement of rough, plaque-retentive restorations, closure of open contacts between teeth, and any other requirements diagnosed at the initial evaluation. The prognosis can be classified in two ways. It is characterized by red and irritated gums.  The extent of the increased risk of periodontitis is dependent on the level of glycaemic control. It has 3 main parts: Periodontal health, gingival diseases and conditions; Periodontitis; Other conditions affecting the periodontium.