Epidemiology of periodontal disease

Taibah University

Objectives

• Etiology of periodontal disease• Prevention of perio diseases• Epidemiology of perio diseases

PERIODONTAL DISEASELike Dental caries Both Gingivitis & Periodontitis

Bacterial infections and the causative bacteria are found in the plaque

Mostly Gram negative,

anaerobic bacteria

Like Actinomyces,

DEFINITION OF GINGIVITISGingivitis is defined as an inflammatory process of gingival tissue, most forms of gingivitis are plaque induced, mainly supragingival plaque is associated with early lesions

Early stage of gingivitis

DEFINITION OF PERIODONTITIS

Periodontitis is also an inflammatory condition of gingival tissues and in found when the attachments of the periodontal ligament and some bony support have been lost. It is thought to be an extension of gingivitis.

Thus periodontal disease is a term

which includes all pathological condition of the periodontium including gingival and supporting structures

(Cementum, Periodontal membrane

and alveolar bone)

HEALTHCoral pink color Gums hug teeth tightly No bleeding

 

GINGIVITISBleeding while brushing or during probing Inflamed, sensitive gums Possible bad breath/taste  

MILD PERIODONTITISMore pronounced gingival bleeding, swelling Gums may begin to pull away from teeth Bad breath/taste Pockets 3-4 mm deep

MODERATE PERIODONTITISTeeth may look longer due to gum recession Gum boils or abscesses may develop Bad breath, bad taste Teeth may begin to drift and show spaces Pockets 4-6 mm deep

ADVANCED PERIODONTITISTeeth may become mobile or loose Constant bad breath and bad taste Teeth sensitive due to exposed roots Pockets > 6mm deep Some teeth may be extracted (pulled)

PREVENTIVE MEASUREFor the last several decades we are concern on prevention of two major families of oral diseases

# Dental Caries# Periodontal Diseases

The above diseases are mainly concern to control bacterial plaque. From the above point of view the dental plaque is the major etiological agent and thus it is major risk factors in the diseases.

RECENT CONCEPT OF DISEASEBut in recent concept host response is also very important for the disease prevalence and its increase.The oral epithelium is keratinized but the crevicular epithelium (sulcus) and the junctional epithelium are not keratinized. The junctional epithelium is attached to the enamel surface and underlying connective tissue by a basal lamina and hemidesmosome. From this point desquamation takes place.

IMPLECATION OF PREVENTIONControl of supragingival plaque is very important because it start the development of gingivitis and periodontitis. Therefore regular and frequent dental visits are indicated to maintain good oral hygiene and to identify inflammatory changes at an early and reversible stage.

EPIDEMIOLOGY-More common in male, female usually exhibit better oral hygiene than male.

- Cross sectional survey data was generally that the severity of disease increased with advanced age

- Low socioeconomic group are generally more affected in developing countries.

-Inadequate oral hygiene practice leads to induce periodontal diseases.

EPIDEMIOLOGY Continued- Smoking and smokeless tobacco are also directly associated with poorer oral health.

- Systemic condition such as neutropenia, aplastic anemia, AIDS, diabetics all produce severe gingivitis and predispose to more severe periodontitis. AIDS

Patient

AIDS Patient

PREVALENCE AND SEVERITY-Disease increases with increase of age and hormonal changes such as puberty.

-Rough estimation and occurrence of periodontitis have been obtained by enumerating pocket depth in excess of 3mm, by measuring loss of attachment, loss of marginal bone in radiograph

INTRAORAL DISTRIBUTION OF PERIODONTAL DISEASE

-Most commonly affected: Molars and Lower Anteriors

-First teeth affected: First molars

-Moderately affected : Lower canine, molars, upper incisors, and premolars.

-Least affected: Lower Premolars and - upper canine

TOOTH MORTALITY66% teeth loss after the age of

Because of Periodontal Disease

Figure may rose to

80 % as the age increase

30 years

RATE OF PERIODONTAL DISTRUCTION

(Sri Lankan labours in tea garden)

- 8 % of total population exhibit rapidly progressive periodontitis

-81 % exhibits moderately progressive periodontitis

- 11 % no progression beyond gingivitis0.5 mm / year

1 mm / year

Etiology - Plaque > 70 % bacteria & 30 % matrix

Factor Predisposing to plaque accumulation

1. Teeth malalignment2. Overhanging restoration3. Removable partial denture4. Calculus

PREVENTION & MANAGEMENT OF PERIODONTAL DISEASES

-Dental Health Education

-Scaling-Root Planning-Polishing-Surgical pocket therapy-Correction of other predisposing factors which help in accumulation of plaque-Reinforcement of host defense mechanism

Belief the susceptibility of diseaseBelief the disease is undesirableBelief the prevention is possibleBelief the prevention is desirable

HOME CARE-Manual tooth brush-Mechanical tooth brush-Interdentally clean (Dental floss & tooth picks)-Irrigation device-Tooth paste-Frequency of teeth cleaning-Duration and technique of teeth cleaning-Diet

PREVENTIVE PROGRAM-Long Prevention program in children:

-Prevention Program in adult:

* Fluoride program* Fissure sealant* Class room education* Motivation* Primary school health teacher’s education* Lastly Regular school dental health check up

* Regular epidemiological studies and keeping data bank* Health motivated program* Regular check up

MOUTH WASH-Chlorohexidine mouth wash-Hydrogen peroxide mouth wash (H2O2)-Antibiotics-Other antiseptics

-Quaternary ammonium compound-Phenolic compound-Hexitidine-Stanous fluoride

CHLOROHEXIDINEMode of action:Act on both gram positive and gram negative chlorohexidine binds to bacterial cells walls and to various oral surfaces including the hydroxiapetite of tooth enamel, organic pellicle covering the tooth surfaces, mucous membrane and salivary protein.Use : 0.2 % chlorohexidine 1 minute twice daily

HYDROGEN PEROXIDEIts effervative effect removes desquamated epithelium, blood clot and other biomaterials as well as highly affected on anaerobic bacteria because of oxygen present in the hydrogen peroxide.

H2O2 H2O + O flooded with oxygen kills bacteria