Perio - FINAL

Chapter 1: Tissues of the Periodontium & Main Functions

Structures and Functions

• Gingiva
  • Provides a tissue seal around the cervical portion of teeth
  • Protects underlying tooth-supporting structures
• Periodontal Ligament (PDL)
  • Suspends and maintains the tooth in its socket
• Cementum
  • Anchors PDL fibers to teeth
  • Protects the dentin
• Alveolar Bone
  • Surrounds and supports the roots of the tooth

Disease vs. Health Characteristics

• Health: JE coronal to CEJ, intact fibers, and bone
• Gingivitis: JE at CEJ, CT damage, widened junctions
• Periodontitis: JE apical to CEJ, destruction of fibers and bone

Desmosomes and Hemidesmosomes

• Desmosome: Connects epithelial cells (cell-to-cell junction)
• Hemidesmosome: Connects epithelial cells to basement membrane (cell-to-basal lamina)

Junctional Epithelium (JE) Functions

• Forms the base of the sulcus and joins gingiva to tooth
• Thin and nonkeratinized, thus an entry point for bacteria

Gingival Fibers

• Supragingival Fiber Bundles: Strengthen attachment of JE to tooth
• Types based on orientation and insertion:
  • Alveologingival (AG)
  • Circular (C)
  • Dentogingival (DG)
  • Other fiber types: Periosteogingival, Intergingival, Intercircular, etc.

Pathogenesis

• Sequence of events in disease development

Gingivitis vs. Periodontitis

• Gingivitis: Infection confined to gingiva, reversible
• Periodontitis: Apical migration of JE, intermittent, and episodic

Chronic vs. Acute Disease

• Acute: Sudden onset, short duration
• Chronic: Long-lasting, painless

Bone Loss Patterns

• Horizontal: More common
• Vertical: Rapid progression
• Infrabony vs. Suprabony: Base of pocket positioning

Stages and Grades of Periodontitis

• Stages: Based on CAL, radiographic bone loss, tooth loss
• Grades: Rate of disease progression over 5 years

Refractory vs. Recurrent Periodontitis

• Refractory: Unknown etiology, continued attachment loss
• Recurrent: New signs of destruction after therapy

Periodontal Disease Forms

• Gingivitis: Most common, reversible
• Pregnancy Granuloma: Tissue enlargement, regresses postpartum

Medications Causing Gingival Enlargement

• Anticonvulsants: Phenytoin
• Calcium Channel Blockers: Nifedipine
• Immunosuppressants: Cyclosporine

Gingival Diseases

• Primary Herpetic Gingivostomatitis: Painful
• Erythema Multiforme: Allergic reaction
• Lichen Planus: Chronic inflammatory condition

Plaque-Induced Gingival Diseases

• Modified by systemic factors (e.g., hormonal changes, diabetes)

Gingival vs. Periodontal Pocket

• Gingival Pocket: Deepening due to tissue swelling
• Periodontal Pocket: Pathologic deepening due to JE migration

Implant-Related Conditions

• Peri-implant Diseases: Peri-implantitis and mucositis

Periodontal Therapy Phases

• From assessment to maintenance, including surgical and restorative phases

Shared Decision-Making in Periodontal Care

• Engage patients, assess values, reach decisions collaboratively

Common Periodontal Maintenance Practices

• Regular exams, cleaning, and monitoring

Host Modulation and Behavior Change

• Motivational interviewing and host modulation therapies