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Periodontal Diseases
‫وصال علي‬.‫د‬.‫ا‬
‫العبيدي‬
‫حكمة اليوم‬
‫»إذا أحسست باأللم ‪ ..‬فأنت «حي‬
‫وإذا أحسست بآآلم اآلخرين ‪..‬‬
‫»فأنت « إنسان‬
Healthy gingiva
Diseases which attack the supporting structures of the teeth

are of two main types:
1.Those which attack the gingivae and
are commonly described as "Gingivitis".
2. Those which involve chronic and
progressive destruction of the
periodontal membrane and alveolus
termed as "Periodontitis".
Etiology of periodontal diseases
I. Local factors : are those related to the teeth and their
supporting structures.
A. Deposits on teeth:\
Calculus.
Material alba
Mucinous plaques.
Protein pellicle
B. Abnormal
Exa. Unilateral mastication and bruxism
C. Food Impaction:
D. Other irritants:
Exa. Overhang restoration, cigarettes, mouth breather, improper
tooth brushing.
E. Abnormal Anatomy:
Exa. Tooth position (crowding), eruption of teeth. (pericoronitis).
F. Factors of occlusal function:
(high spot. non occlusion)
II. Systemic factors are related to the general health of
the patient.
Faulty Nutrition ( Vit C)

Debilitating diseases (GI disorder,
TB)
Radiation ( dose).
When the tooth begins to erupt, it is exposed to saliva. At this point
the formation of the dental plaque begins. This development occurs
in two phases:
1. Acquired pellicle formation: Within seconds after saliva first
contacts the external tooth surface, a coating of salivary materials,

called the acquired pellicle, begins to develop on the tooth. This
organic layer is acquired after tooth eruption mainly glycoprotein.
An acquired pellicle also forms on dental restorations and
dentures.
This layer will subsequently colonized by bacteria. Pellicle
components can serve as nutrients for bacterial colonization.
2. Dental plaque formation (Mucinous plaque) This gelatinous,
sticky or gummy material is composed of mucin, bacteria and
bacterial products. It begins on the clinical crown of a tooth and may
take as long as 2 hours. The colonization process usually begins as a
series of isolated colonies, often limited to abrasion tooth lines and
pits. It forms the biofilm adhering to the tooth surface or other hard
surfaces. At time, the plaque demonstrates staining due to tea, iron
salts, drugs, and chromogenic bacteria.
It is visualized on teeth after 2 days around the necks of teeth. If
proper oral hygiene procedures are absent, gingivitis can arise.
In individuals with poor oral hygiene, a further outer
layer of material can cover the supra gingival dental plaque.
This layer from its color, is called material alba (white
matter), unlike plaque, is usually removed easily by rinsing
with water.
Material alba: In an unhygienic environment in which there is
an absence of regular tooth brushing, this white, soft deposit
occurs around the necks of the teeth, and on gingiva. The
deposit consists of food debris, dead tissue elements and
infected materials.
Calculus: The term calculus is derived from the Latin word
meaning stone. It is a hard deposit that forms by mineralization of
dental plaque. Calculus results from the fact that saliva is saturated
with respect to its concentration of calcium and phosphate ions.
These mineral elements contribute to the formation of dental
calculus, which is mineralization dental plaque.
Most common sites of calculus are usually the buccal surfaces of
maxillary molars and the lingual surfaces of mandibular anterior
teeth. There is usually an increase in supragingival calculus when
the patient is on a non detergent diet or has poor oral hygiene.
Calculus is not in itself harmful. The major reason to
prevent or remove calculus is because:
1- It is always covered by a layer of plaque which
contain bacteria.
2- It makes routine oral hygiene more difficult.
There are two types of calculus these
are:
Supra gingival calculus.

The two types of calculus may differ:
1- Supra gingival calculus
Sub gingival is about 30% mineralized.
calculus.
2- Sub gingival calculus is about 60% mineralized. Because of its
greater hardness, being thinner and more closely interlinked to
tooth surface, so can be more difficult to remove.
1- The supra gingival calculus usually appears as a yellow to
white mass.
2- The sub gingival calculus appears gray to black. The dark
coloration may be due to bacterial degradation of components of
hemorrhagic exudates resulting from gingival inflammation.
Distribution of periodontal diseases in different areas of the
mouth:
Interproximal area was the most severely affected by gingivitis,
followed by buccal and lingual surfaces.
For interproximal and buccal area, gingivitis was more severe in
the upper arch than lower arch.
For the lingual areas, gingivitis was found to be more severe in
the lower arch.
Upper molars and lower incisors are the most severely affected
teeth by periodontal disease, whereas the least affected are lower
premolars and upper canines.
Higher tendency toward gingivitis is the right half of the area
than on left half. This may be because of difficulty that right-
handed person has in brushing the right half of the mouth.
Prevalence of periodontal diseases
A.Prevalence of gingivitis:
In general. The prevalence and severity of gingivitis increase
with age, beginning at approximately 5 years of age, reaching their
highest point in puberty and then very gradually decreasing but
remaining relatively high throughout life. The rapid increase in the
incidence of gingivitis prior to 10 years of age is associated with
the eruption of the permanent dentition.
B. Prevalence of periodontitis:
Periodontitis accounts for the greatest loss of teeth in
humans. Severe periodontal diseases are estimated to affect
around 20% of the global adult population. Almost 50 percent
of adults in the U.S., who are over the age of 30, have the
advanced form of periodontal disease. The main risk factors for
periodontal disease are poor oral hygiene and tobacco use.

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Periodontal Diseases

Diseases which attack the supporting structures of the teeth

Faulty Nutrition ( Vit C)

contacts the external tooth surface, a coating of salivary materials,

Supra gingival calculus.

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