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periodontitis

periodontitis

Introduction

Epidemiology

  • in Western countries, over half of adults older than 30yrs have some degree of periodontitis, and 70% have it by age 60yrs
  • males are more affected than females

Risk factors

  • poor dental hygiene / lower socioeconomic class
  • retained calculus plaque
  • smoking
  • genetic factors such as immune response factors
  • high stress levels
  • dysglycaemia (2.5x risk)1) and exponential risk with poor diabetic control in diabetes mellitus
  • excessive dental restorative material (fillings) which overhand the dental margin to trap material near the gum
  • Down syndrome
  • Papillon–Lefèvre syndrome (palmoplantar keratoderma)

Clinical features

  • early phase is gingivitis:
    • poor dental hygiene allows plaque build up causing inflammation of the gums
    • easy painless bleeding of the gums when brushing or flossing
  • periodontitis:
    • the tissue and bone damage is caused by the immune responses
    • destruction of the gingival fibers
    • gum tissues separate from the tooth
    • deepened sulcus, called a periodontal pocket which is colonised by bacteria which cause further inflammation and progressive bone loss
    • quantified by measuring the extent of gingival recession + the probing depth into the periodontal socket
      • mild disease = 1-2mm separation
      • moderate disease = 3-4mm separation
      • severe disease = 5mm or more separation
    • late stage results in loose teeth

Mx

  • cease smoking - smokers often fail to respond to Rx
  • improve dental hygiene - twice daily brushing and daily flossing
  • ensure good glucose control
  • 6 monthly dentist visits for deep clean of any periodontal sockets, scaling and tartar removal
  • advanced cases may require flap surgery +/- bone grafting
periodontitis.txt · Last modified: 2019/06/11 00:46 (external edit)