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Perio Disease

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Mind map: Perio Disease

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Perio Disease

Signs and Symptoms
- Redness and swelling of gingiva
- bleeding and or suppuration
- Mobility/ Drifting
- Recession
- Tooth loss
- Halitosis
- Furcation
- Pockets/ CAL
- Bone loss
Definition
- Inflammatory disease that can lead to the destruction of the tissues of the supporting structures of the tooth
Pathogenesis
- Plaque Biofilm
  - Host response
    - Neutrophils: Phagocutosis
    - Macrophages and monocytes: Upregulate proinflammatory cytokine release
    - T- cell release
    - B cell release- IgE
    - Enter through intercellular gaps in JE -> CNT
  - Dysbiosis
  - Bacteria
    - Aerobic
      - Early colonisers: gram positive facultative anaerobes cocci (strep/actinomyses)
    - Anaerobic
      - Late colonisers: Obligate gram negative anaerobes: Prevotella intermedia. P gingivalis. F. nucleatum.
  - Formation
    - Acquired Pellicle
      - salivary glycoproteins
    - Multiplication + Co-adhesion
      - Adhesins
      - Proline rich proteins
    - Co-aggregation + Maturation
      - Polysaccharides
  - Components
    - Organic
      - Saliva
        Water
        Glycoproteins
      - Crevicular fluid
      - Bacteria
      - Polysaccharides: Glycans/ fructans
      - Lipids
    - Inorganic
      - Calcium and Phosphorus
      - Sodium
      - Potassium
      - Fluoride
  - Definition: Bacterial communities in matrix of exfoliated epithelial cells, bacterial and salivary proteins
  - Stages of Gingivitis
    - Initial Lesion (2-4 days)
      - Pathogen trigger release of neutrophil + mast cells -> vasodilation + increased BF-> vascular pereability-> plasma proteins (GCF)
    - Early Lesion (4-7 days)
      - Lymphocytes, monocytes, macrophages- causes angiogenesis/ phagocytosis/ proinflammatory cytokine release- (Redness + BoP)
    - Established Lesion (14-21 days)
      - Persistant inflammation- RBC breakdown (erythema), plasma cells predominate and further destruction of collagen fibres
    - Advanced Lesions
      - Periodontitis
Diagnosis and Limitations
- Diagnosis
  - Histories
    - Medical
      - Genetic Conditions
      - Bleeding disorders
      - Systemic Conditions
      - Medications
      - Pregnancy
    - Dental
      - Appliances
      - OHR
      - Prev perio tx
      - Motivation/ understanding
    - Social
      - Smoking
      - Alcohol
      - Habits
        Grinding
        Nail biting
      - Stress
      - Diet
    - Age
      - Elderly: systemic conditions, polypharmacy, osteoporosis, cell-turnover reduced
      - Adolescence: hormonal effect- increase pro-inflammatory markers
    - Family
      - Genetic link: Diabetes
      - Genetic link: Periodontal Disease
  - Clinical Examination/ Screening
    - Gingival Health?
      - Colour, contour, consistency
      - Recession
    - BOP
      - Immediate
      - Delayed
    - Deposits
      - Plaque (PS)
      - Calculus
        Supra
        Sub
    - Hard tissue
      - missing teeth
      - Malpositioned
      - Traumatic occlusion
      - Furcation
    - Restorative
      - open contacts
      - poor contours
      - overhangs
  - Radiographs
    - Bone loss
      - Furcation
      - vertical bony defects
    - Calculus spurs
    - Widening PDL
    - Dense Lamina Dura
    - Pathology
      - Perio radiolucency
      - Caries
    - Root anomalies
      - Enamel pearls
      - CE projections
  - Probing
    - Limitations
      - Op variable
        fatigue
        experience
        mood
      - Pt variable
        gag
        limited opening
        low pain threshold
      - Recording errors
      - Inflammation
      - Obstructions
        calculus
        Root grooves and concavities
        Root anomalies: enamel pearls
Classification System
- New- 2017 Workshop
  - Why?
    - Ambiguity with health/disease-diagnosis
    - Advances in knowledge
    - Live system- can be updated
    - Perio patient for life
      - More realistic treatment goals
  - Classification
    - Periodontitis
      - Necrotising
        Gingivitis
        Perio
        Stomatitis
      - Periodontitis
        Stage
        Severity- I-V
        Diagnostic Statement
        Grade
        Rate- A/B/C
        Extent
        Localised, generalised, MI
        Stability
        Stable/ in remission/ unstable
        Risk Factor profile
        Smoking Hx/uncontrolled diabetes
      - Manifestation of systemic disease
        Classfication based on ICD codes
    - Other conditions affecting the periodontium
      - Systemic disease association
      - Abscesses and perio-endo lesions
      - Mucogingival deformities and conditions
      - Traumatic Occlusal forces
      - Tooth and prosthesis related- factors
    - Perio Health and gingival diseases and conditions
      - Perio Health and gingival health
        Intact
        Reduced
        Stable perio patient
        No perio
      - Gingivitis- biofilm induced
        Biofilm alone
        Mediated by systemic or local factors
        DIGO
      - Gingival diseases- non biofilm induced
        Genetics
        Infections and reactive processes
        Traumatic lesions
        Endocrine, Nutritional and metabolic disorders
        Inflammatory/immune conditions
        Neoplasms
        Gingival Pigmentations
    - Peri-implant diseases and Conditions
      - Peri-implant health
      - Peri-implant mucositis
      - Peri-impantitis
      - Peri-implant soft and hard tissue deficiencies
- Old-1999 Workshop
  - 8 categories
    - Chronic perio
    - Necrotising ulcerative g/p
    - Manifestation of systemic disease
    - Aggressive perio
    - Combined Perio-endo lesion
    - Gingivitis
    - Abscesses of periodontium
    - Developmental or acquired deformities (occlusal trauma)
  - Severity and Extent
    - Severity
      - Slight : 1–2 mm CAL
      - Moderate: 3-4 CAL
      - Severe: >5mm CAL
    - Extent
      - Localised: <30%
      - Generalised: > 30%
- Recession
- Mobility
- Furcation
- Gingival diseases
  - Gingival overgrowth
    - DIGO
Treatment Options
- Phases
- Surgery
- NSPT
  - Implants
  - Patient Behaviour and Motivation
    - Motivational Interviewing
      - Readiness to change
    - Motivators?
      - Aesthetics?
        Polishing
      - Visual Indicators
        Disclosing Tablets
      - Smell
  - Hand Instrumentation
    - Instruments
      - Scalers
      - Curettes
        Site- specific
        Universals
      - Probes
      - Discoid
    - RSD Optimisation
    - Calculus Detection
  - Power-drive Scalers
    - Types
    - Contraindication
    - Technique
    - Advantages
  - Polishing
- Maintainance/Supportive Care
Risk Factors
- Modifiable
  - Smoking
  - Systemic Conditions- control
    - Diabetes
    - CVD
  - Poor Diet
  - Traumatic Occlusion/ Grinding- mouthguard
  - Medications- alternatives
    - Xerostomia
    - DIGO
  - Stress
  - Secondary Local Factors
    - Calculus
    - Overhangs/poorly contoured restorations
    - Partial Dentures
  - Leukaemia
  - Anatomical
    - Root anomalies- grooves
    - CE Projections
    - Enamel pearls
    - Malpositioned teeth
    - Open contacts
    - Furcations
    - Thin gingival biotype
    - High fraenal attachments
    - Periodontal Bony defects
  - Plaque biofilm
  - Mouth breathing
- Non-modifable
  - Age
  - Pregnancy/hormonal
  - Osteoporosis
  - Leukaemia
  - Genetics
  - SES

Informações

Descrição: Mapa Mental sobre Perio Disease, criado por Anusha Sivabalan em 03-07-2020.
Criado por: Anusha Sivabalan
Visualizações: 3
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