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Oral
health is an essential and integral
component of health throughout life.
No one can be truly healthy unless
he or she is free from the burden
of oral and craniofacial diseases
and conditions. Millions of people
experience dental caries, periodontal
diseases, and cleft lip and cleft
palate, resulting in needless pain
and suffering; difficulty in speaking,
chewing, and swallowing; increased
costs of care; loss of self-esteem;
decreased economic productivity through
lost work and school days; and, in
extreme cases, death. Further, oral
and pharyngeal cancers, which primarily
affect adults over age 55 years, result
in significant illnesses and disfigurement
associated with treatment, substantial
cost, and more than 8,000 deaths annually.
Oral refers to the mouth, which includes
the teeth, gums, and supporting tissues.
It is easy to take your oral health
for granted, but it is key to living
each day comfortably. These tissues
allow you to speak, smile, sigh, kiss,
smell, taste, chew, swallow, and cry.
They also let you show a world of
feelings through expressions. Taking
good care of these tissues can prevent
disease in them and throughout your
body.
Oral health means more than just an
attractive smile. Poor oral health
and untreated oral diseases and conditions
can have a significant impact on quality
of life. And in many cases, the condition
of the mouth mirrors the condition
of the body as a whole. Recent reports
indicate a relationship between periodontal
(gum) disease and stroke, heart disease,
and pre-term low-birth-weight babies.
Likewise, more than 90 percent of
all systemic diseases have oral manifestations,
meaning your dentist may be the first
health care provider to diagnose a
health problem.
Recent reports show that infections
in the mouth can affect major organs.
One example is bacterial endocarditis,
a condition in which the lining of
the heart and heart valves become
inflamed. Poor mouth care also can
contribute to oral cancer, which now
takes more lives annually than cervical
or skin cancer.
In addition, poor oral health affects
the digestive process, which begins
with physical and chemical activities
in the mouth. Problems here can lead
to intestinal failure, Irritable Bowel
Syndrome and other problems.
Having healthy
gums and teeth is not just about looking
good. It's also about staying healthy.
Unhealthy gums and teeth can cause
painful infections, tooth loss and
difficulty eating and speaking. These
can lead to nutritional and digestive
problems, a low self-image and social
isolation. Poor oral health also puts
seniors at greater risk for developing,
or making worse, serious health problems
such as heart disease, stroke, pneumonia
and diabetes
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Healthy
gums
Healthy teeth and gums are maintained
by daily plaque removal from all surfaces
of the tooth (through tooth brushing
and interdental cleaning)
Healthy gums are characterized by
the following features
Coral
pink colour, (normal variations
in colour
depend on race and complexion).
Consistency:-
Firm, resilient tissues
Orange-peel'
texture (known as stippling).
Shape
that follows the contour of the
teeth and
forms a scalloped edge.
No
areas of redness, swelling or inflammation.
No
bleeding during daily plaque removal.
No
discomfort( pain, tenderness).
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Types
of gum disease
Gingival diseases
Gingival
diseases can be divided into 2 groups
Plaque-induced gingival diseases
associated with plaque &can
be modified by systemic
factors, medications, malnutrition.
Non-plaque induced gingival lesions
[ Bacterial , viral, fungal, genetic,
manifestations of
systemic conditions, allergic reactions,
traumatic, foreign body reactions].
Gum
disease is a common dental problem
that may result in tooth loss. Gingivitis
and
Periodontitis are the most common
types of adult gum disease. |
Gingivitis is inflammation of the
gum tissue bleed easily and appear
puffy, soft and swollen.. The swollen
gums is due to a plaque or calculus
(tartar) buildup along the gumline.
Blood on the toothbrush or dental
floss is one of the earliest and most
common signs of gingivitis. .The good
news about gingivitis is that it is
preventable and reversible. On the
other hand, if oral hygiene habits
are poor, gingivitis may progress
in periodontitis. |
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| (Chronic Generalized diffused Gingivitis |
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What
Is Gum Disease ?
Gum disease is also known as periodontal
disease.
Periodontal disease is an infection
of the tissues and bone that support
the teeth, which can teeth to become
loose or fall out.
Brushing and flossing every day -
and regular trips to the dentist are
so important.
Some may inherit this tendency from
their parents.
The snacks / junk food you eat also
can put you at risk of developing
gum disease. You probably know that
sugar is bad for your teeth, but you
may not know that starchy foods like
fries also feed the acids that eat
into your tooth enamel.
Running yourself down with a lousy
diet, too little sleep, and too much
stress leaves you more vulnerable
to infection anywhere in the body,
including your gums.
Girls have a higher risk of gum disease
than guys. Increases in female sex
hormones during puberty can aggravate
inflammation because of plaque.
For severe and early gum problems,
though, the real bad guy is tobacco.
Not only does smoking lead to bad
breath and stained, yellowed teeth
but recent research also shows that
smoking is a leading cause of gum
disease.
How
It Progresses ?
Gum disease
progresses in stages.
If plaque from
teeth and gums isn't removed by
good daily dental care, over time
it will harden
into a crust called calculus or
tartar.
Once tartar forms,
it starts to destroy gum tissue,
causing gums to bleed and pull away
from the teeth. This is known as
periodontitis , a more advanced
form of gum disease.
With periodontitis,
gums become weakened and form pockets
around the base of teeth.
Bacteria pool in these pockets,
causing further destruction of the
gums. As periodontitis
spreads, it damages deeper gum tissue
and can eventually spread to areas
of the jawbone that support the
teeth. This can cause teeth to become
loose and
fall out. Though periodontitis is
rare in teens, it can happen. If
it's not treated, it can
cause real trouble for your teeth.
Teens can get gum disease too,
and it can cause problems from the
simply embarrassing
(like bad breath) to the serious
- like pain and tooth loss (which
is both embarrassing
and serious!).
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I)
Types of Periodontal Disease
There are many
forms of periodontal disease. The
most common ones include the following.
a) Gingivitis
Gingivitis is the mildest form of
periodontal disease. It causes the
gums to become red, swollen, and bleed
easily. There is usually little or
no discomfort at this stage. Gingivitis
is reversible with professional treatment
and good at home oral care.
b) Aggressive
Periodontitis
A form of periodontitis that occurs
in patients who are otherwise clinically
healthy. Common features include rapid
attachment loss and bone destruction
and familial aggregation.
c) Chronic
Periodontitis
A form of periodontal disease resulting
in inflammation within the supporting
tissues of the teeth, progressive
attachment and bone loss and is characterized
by pocket formation and/or recession
of the gingiva. It is recognized as
the most frequently occurring form
of periodontitis. It is prevalent
in adults, but can occur at any age.
Progression of attachment loss usually
occurs slowly, but periods of rapid
progression can occur.
d) Periodontitis
as a Manifestation of Systemic Diseases
Periodontititis, often with onset
at a young age, associated with one
of several systemic diseases, such
as diabetes, cardiovascular disease.
e) Necrotizing
Periodontal Diseases
An infection characterized by necrosis
of gingival tissues, periodontal ligament
and alveolar bone. These lesions are
most commonly observed in individuals
with systemic conditions including,
but not limited to,HIV infection,
malnutrition and immunosuppression
II)
Clinical types
Mild Periodontitis
Periodontitis
occurs when the inflammation of
the gums progresses into the deeper
underlying
structures and bone.
In the most common
form of periodontitis, plaque (and
sometimes calculus) is found below
the gumline.
The gums may
feel irritated, appear bright red,
and bleed easily.
The ligaments
holding the tooth in its socket
break down and the gums pull away
from the
teeth, resulting in a periodontal
pocket or space between the tooth
and gum.
The periodontal
pocket deepens and fills with more
bacteria. Supportive ligaments and
bone
start to show damage
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Moderate periodontal disease:
notice the accumulation of
calculus around the gumline.
The gums are red, swollen
and tender.
Calculus and plaque do not
have to be evident to the
naked eye for periodontal
disease to be present. You
need regular examinations
performed by your oral health
professional to assess your
periodontal health and determine
if periodontal disease is
active in your mouth.
After non-surgical periodontal
therapy (i.e. scaling). The
gums have been restored to
health. Notice the gums have
receded, exposing the root
of the tooth. This is due
to the irreversible bone loss
as a result of previous periodontal
disease. This can lead to
tooth sensitivity.
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Chronic Periodontitis
Formerly known as
“Adult Periodontitis
“ or “Chronic adult periodontitis”.
Although even though more frequently
observed in adults, it can occur in
children & adolescents. So this
observation underlies recent name
change from adult to a more universal
acceptance of “Chronic periodontitis”
which can occur at any age.
Definition
An infectious disease resulting
in inflammation within supporting tissues
of the teeth, progressive attachment
loss and bone loss.
Clinical Features
and Characteristics
Most
prevalent in adults but can also
occur in children and adolescent.
Supra and Subgingival
plaque and calculus with gingival
inflammation.
Pocket formation,
loss of attachment & loss of
alveolar bone.
Swollen gingiva
with rolled out margins & exhibits
color alteration from pale red to
magenta.
Bleeding gums
on provocation.
Usually painless
but occasionally pain may be present
due to exposed roots that are
sensitive to heat, cold or both.
Areas of localized dull pain, sometimes
radiating deep
into the jaws.
Gingival tenderness
or itchiness.
May be modified
by systemic factors( diabetes, HIV
infection)
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Chronic
Periodontitis
Aggresive Periodontis
Localized
Aggressive Periodontitis
Circumpubertal onset.
Roberst serum antibody response
to infecting agents.
Localised first molar/ incisor
presentn with interproximal loss
on at least two permanent
teeth, one of which is a first
molar,& involving no more
than two teeth tan 1st
and 2nd molars.
Generalized
Aggressive Periodontitis
Usually Affecting persons under
30yrs of age, but pts may be older.
Poor serum antibody response.
Pronounced episodic nature of
desrcn of attachment loss andbone.
Generelasied interproximal attachment
loss affecting at leat 3 permenent
teeth other
than 1st molars and incisors.
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Difference Between
Gingivitis and Periodontitis |
Gingivitis
usually precedes periodontitis.
However, it is important to know
that not all gingivitis progresses
to periodontitis. In the stage of
gingivitis no bone loss is present.
When gingivitis is left untreated,
it can advance to periodontitis.
In a person with periodontitis,
the inner layer of the gum and bone
pull away from the teeth and form
pockets. These small spaces between
teeth and gums collect debris and
can become infected.
Toxins or
poisons
Produced by the bacteria in plaque
as well as the body's "good"
enzymes involved in fighting infections
start to break down the bone and
connective tissue that hold teeth
in place. As the disease progresses,
the pockets deepen and more gum
tissue and bone are destroyed. When
this happens, teeth are no longer
anchored in place, they become looser,
and tooth loss occurs. Gum disease,
in fact, is the leading cause of
tooth loss in adults.
Etiology
of Gum Diseases
Plaque is the primary cause
of periodontal disease. However,
other factors can contribute to
gum disease. Plaque is a sticky
film of bacteria that clings to
the surface of teeth and gums. Brushing
and flossing every day may not completely
remove all the plaque, especially
around the gum line. The bacteria
in the plaque produce toxins that
may injure the gums and supporting
tissues. Plaque that is not completely
removed within 48 hours hardens
into a rough deposit called tartar
or calculus. Once tartar develops,
the only way to remove it is by
having the teeth professionally
cleaned. Tartar below the gum line
causes inflammation and infection.
Because this process is often painless,
a person may be unaware a problem
exists.
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Mild
gingivitis does not cause any symptoms
and so you may not realize that
you have
it. The gums look slightly swollen
and reddened |
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Moderate
gingivitis can cause discomfort
and more marked swelling and reddening
of the gums. The gums often bleed
a little when you clean your teeth |
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Periodontitis can cause |
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halitosis(bad
breath) |
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A foul
taste in your mouth |
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Some
pus to form in small |
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Pockets
between teeth and gums |
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Pain and
difficulty eating. Affected teeth
to become loose. They may eventually
fall out if not treated |
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Because of a dulled immune response
and less oxygen in the mouth,
smokers are 2-7 times more likely
to develop periodontitis than
nonsmokers. |
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Diabetes worsens periodontal disease.
If a person's blood sugar level
is poorly controlled, a worse
infection, poor healing, and a
greater loss of bone and connective
tissue are likely. |
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Stress
increases certain hormones that
make a person more susceptible
to infection. Pregnancy and birth
control pills can also increase
hormone levels |
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Stress
increases certain hormones that
make a person more susceptible
to infection. Pregnancy and birth
control pills can also increase
hormone levels |
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Hormonal
changes such as those occurring
during pregnancy, puberty, menopause,and
monthly menstruation-make gums
more sensitive, which makes it
easier for gingivitis to
develop |
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Steroids,
antiseizure medicines, cancer
medicines, and blood pressure
medicines can all affect
the gums. Some drugs decrease
the flow of saliva, irritating
the mouth and making it
prone to infection |
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Poor
oral hygiene habits such as not
brushing and flossing on a daily
basis, make it easier for
gingivitis to develop |
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Family
history of dental disease can be
a contributing factor for the development
of gingivitis |
Disclosing
Agent use to visualize Plaque |
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What
is dental plaque and gum disease?
Dental plaque is a soft deposit
that forms on the surface of teeth.
It contains many types
of bacteria (germs). You can remove
plaque by good oral hygiene (see
below).
Calculus, sometimes
called tartar, is hardened calcified
plaque. It sticks firmly to teeth.
Generally, it can only be removed
by a dentist or dental hygienist
with special instruments
Supra & Subgingival Calculas
name of the image
Gum disease (periodontal disease)
means infection or inflammation
of the tissues that
surround the teeth. Depending
on the severity, gum disease is
generally divided into
two types - gingivitis and periodontitis.
Gingivitis means inflammation
of the gums. There are various
types. However, most cases
of gingivitis are caused by plaque.
Periodontitis occurs if gingivitis
becomes worse and progresses to
involve the tissue that
joins the teeth to the gums (the
periodontal membrane).
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Supra
& Subgingival Calculas
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What
causes plaque associated gum disease?
The reason why gum disease develops
in some people and not others
is not clear. Almost everyone
develops some dental plaque, but
only some people develop gum disease.
Dental plaque contains many different
types of bacteria (germs) and
some types of bacteria are associated
with developing gum disease. The
gums can often resist the invasion
of bacteria. It is thought that
infection is more likely to develop
if your defence or resistance
against bacteria is reduced in
some way. |
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Smoking
Need another reason
to quit smoking? Smoking is one
of the most significant risk factors
associated with the development
of periodontitis. Additionally,
smoking can lower the chances
of success of some treatments.
Hormonal
changes in girls / women
These changes can make gums more
sensitive and make it easier for
gingivitis to develop.
Diabetes
People with diabetes are
at higher risk for developing
infections, including periodontal
disease.
Stress
Research shows that stress can
make it more difficult for our
bodies to fight infection, including
periodontal disease.
Medications
Some drugs, such as
antidepressants and some heart
medicines, can affect oral health
because they lessen the flow of
saliva. (Saliva has a protective
effect on teeth and gums.)
Illnesses
Diseases like cancer
or AIDS and their treatments can
also affect the
Smoking
Smoking can also lead to gum disease.
Patients who smoke are more likely
to produce bacterial plaque, which
leads to gum disease. The gums
are affected because smoking causes
a lack of oxygen in the bloodstream,
so the infected gums fail to heal.
Smoking causes people to have
more dental plaque and for gum
disease to progress more rapidly
than in non-smokers. Gum disease
still remains the most common
cause of tooth loss in adults.
Smoking
/ Tobacco Use
As you probably already know,
tobacco use is linked with many
serious illnesses such as cancer,
lung disease and heart disease,
as well as numerous other health
problems. Smoking is the number
one environmental/behavioral risk
for periodontal disease.Smokers
are much more likely than non-smokers
to have tartar form on their teeth,
have deeper pockets between the
teeth and gums, and lose more
of the bone and tissue that support
the teeth. In fact, smoking can
cause receding gums and bone loss
even in the absence of periodontal
disease.For these reasons, quitting
has become an important part of
preventing and managing periodontal
disease.
Genetic
Studies of identical twins, family
histories and genetic diseases
all point to heredity as a risk
factor in roughly 50 percent of
patients with periodontal disease.
The heredity factors involved
are most likely minor defects
in how the immune system operates.
People with these abnormalities
cannot fight off the bacteria
responsible for causing plaque
and periodontal disease even with
good oral hygiene. Such heredity
factors may explain why children
of parents with periodontitis
are 12 times more likely to harbor
these harmful.
Pregnancy
The alterations in a
pregnant woman's hormone levels
can increase her chance of getting
gum disease. The milder form of
gum disease which is frequently
called "pregnancy gingivitis"
is readily controlled and in all
likelihood would only be a minor
contributory factor in pre-term
low birth weights, if any factor
at all.
If plaque, the bacterial film
that builds up on your teeth,
is not removed daily by brushing
and flossing, the plaque can irritate
the gums, making them bright red,
tender, swollen, sensitive and
bleed readily.
During pregnancy there is a special
need for good oral hygiene because
pregnancy may exaggerate the body's
normal response to dental plaque.
This is because four basic hormones
vital to the continuation of pregnancy
are produced in large quantities
during the gestation period. This
hormonal increase exaggerates
the way the gum tissues react
to the bacteria in plaque, resulting
in an increased likelihood that
a pregnant women will develop
gum disease if her daily plaque
control is not adequate. It is
important to note, that it is
the plaque, and not the increased
hormone levels that is the major
cause of pregnancy gingivitis.
Swelling
of the gums is usually first seen
in the second month of pregnancy
and generally reaches a peak by
the middle of the last trimester.
It can remain that way for 3-6
months after delivery. The seriousness
of the gingivitis can range from
mild to severe depending on the
gum problems existing before pregnancy.
Pregnancy generally worsens preexisting
gum problems, sometimes dramatically.
The
"old wives" tale of
"a tooth for every pregnancy"
is based on misconceptions that
oral problems during pregnancy
are a normal occurrence and cannot
be prevented. Even though hormonal
changes are occurring, making
the pregnant woman more at risk
of developing pregnancy gingivitis,
a mouth that is clean (i.e. good
plaque control) does not develop
pregnancy gingivitis.
Prevention
Effectively brush your teeth with
a fluoride toothpaste at least
once a day. Use a soft toothbrush
with rounded bristles. Choose
a size and shape that allows you
to clean the chewing surface,
the cheek side, and the tongue
side of the tooth. Brushing should
take 2-3 minutes so DON’T
RUSH YOUR BRUSH!!!
Floss your teeth daily to remove
plaque from the tooth surfaces
not reached by the toothbrush
(like the sides of your teeth).
Visit your oral health professional
such as your dental hygienist
regularly for advice and therapy
on oral disease prevention and
oral health promotion while you
are pregnant. This is a good time
to ask your hygienist if you are
brushing and flossing effectively
and if there is room for improvement
in your daily plaque control.
By practicing good oral hygiene,
and visiting your dental hygienist
regularly, gingivitis can be prevented
during pregnancy.
Emotional
stress could cause periodontal
disease
Stress
Stress -may make it difficult
for the body's immune system to
fight off infection.
As you probably already know,
stress is linked to many serious
conditions such as hypertension,
cancer, and numerous other health
problems. Research demonstrates
that stress can make it more difficult
for the body to fight off infection,
including periodontal diseases
Emotional woes may place a strain
on more than just your heart.
"Stress affects the immune
system which can fight against
the type of bacteria that causes
periodontal disease, making them
more prone to gum infection."
Medication
Medications can affect oral health
because they lessen the flow of
saliva, which has a protective
effect on teeth and gums. Some
drugs, such as the anticonvulsant
medication diphenylhydantoin and
the anti-angina drug nifedipine,
can cause abnormal growth of gum
tissue.
Susceptibility to gum disease
also can be caused by some medications,
including steroids, cyclosporine
(an immunosuppressant), oral contraceptives
(the ones that contain the synthetic
progesterone desogestrel), Dilantin®
(an anti-seizure drug) and Procardia®
(or nifedipine, a calcium channel
blocker used to treat angina).
If you are worried about this,
talk to your doctor. You should
never stop taking a prescribed
medication on your own
Diabetes
Diabetes is a disease that causes
altered levels of sugar in the
blood. Diabetes develops from
either a deficiency in insulin
production (a hormone that is
the key component in the body's
ability to use blood sugars) or
the body's inability to use insulin
correctly. According to the American
Diabetes Association, approximately
16 million Americans have diabetes;
however, more than half have not
been diagnosed with this disease.
If you are diabetic, you are at
higher risk for developing infections,
including periodontal diseases.
These infections can impair the
ability to process and/or utilize
insulin, which may cause your
diabetes to be more difficult
to control and your infection
to be more severe than a non-diabetic.
Grinding of teeth
Clenching and grinding teeth--may
put excess force on the supporting
tissues of the teeth and could
speed up the rate at which these
tissues are destroyed
Poor nutrition
Poor nutrition
May make it difficult for the
immune system to fight off infection,
especially if the diet is low
in important nutrients. Additionally,
the bacteria that cause periodontal
disease thrive in acidic environments.
Eating sugars and other foods
that increase the acidity in the
mouth increases bacterial counts.
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During a periodontal
exam, your dentist or periodontist
typically checks for these things:
Gum bleeding,
swelling, firmness, and pockets
(the space between the gum and
tooth;
the larger and deeper
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