2. GINGIVAL DISEASES
Dental Plaque-Induced Gingival Diseases
Gingivitis that is associated with dental plaque formation' is
the most common form of gingival disease characterized by
the presence of clinical signs of inflammation that are
confined to the gingiva and associated with teeth showing no
attachment loss

3. Gingivitis associated with Dental Plaque Only:
is the result of an interaction between the microorganisms
found in the dental plaque biofilm and the tissues and
inflammatory cells of the host.
The plaque-host interaction can
be altered by the effects of
*Local factors
*Systemic Factors
*Medications
*Malnutrition

4. Gingival Diseases Modified by Systemic Factors
*endocrine changes
*leukemia
gingival enlargement
bleeding
swollen, spongy

5. Gingival Diseases Modified by Medications
anticonvulsant drugs phenytoin
immunosuppressive cyclosporine
drugs
calcium channel nifedipine
blockers

6. Oral contraceptive pills

7. Gingival Diseases Modified by Malnutrition
bright red, swollen, and bleeding
gingiva associated with severe
ascorbic acid (vitamin C)
deficiency or scurvy.
Nutritional deficiencies are
known to affect immune function
and may have an impact on the
host's ability to protect itself
against some of the detrimental
effects of cellular products such
as oxygen radicals.

8. Non-Plaque-Induced Gingival Lesions
They are observed in lower socioeconomic groups, developing
countries, and immunocompromised individuals

9. Gingival Diseases of Specific Bacterial Origin:
Streptococcal gingivitis or
gingivostomatitis is a rare
condition that may present as an
acute condition with fever,
malaise, and pain associated with
acutely inflamed, diffuse, red, and
swollen gingiva with increased
bleeding and occasional gingival
abscess formation.
preceded by tonsillitis and have been associated with group
A hemolytic streptococcal infections.

10. Gingival Diseases of Viral Origin:
the most common being the herpes
viruses-Primary herpetic
gingivostomatitis Clinically appear
as: Multiple tiny vesicles that
progress to form painful ulcers.
Painful erythematous swollen
gingival. Fever, malaise, cervical
lymphadenopathy.

11. Gingival Diseases of Fungal Origin:
under prosthetic devices
in individuals using topical steroids
in individuals with decreased salivary flow
increased salivary glucose
decreased salivary pH.

12. A generalized candidal infection may manifest as white patches on
the gingiva, tongue or oral mucous membrane that can be
removed with gauze, leaving a red, bleeding surface.
In HIV-infected individuals,
candidal infection may present
as erythema of the attached
gingiva and has been referred
to as linear gingival erythema
or HIV-associated gingivitis
Diagnosis of candidal infection can be made by culture, smear.

13. Gingival Diseases of Genetic Origin:
hereditary gingival fibromatosis
that exhibits autosomal
dominant or (rarely) autosomal
recessive modes of inheritance.
The gingival enlargement may
completely cover the teeth,
delay eruption, and present as
an isolated finding or be
associated with several more
generalized syndromes.

14. Traumatic Lesions:
factitial iatrogenic accidental
as in the case of as in the case of as in the case of
tooth brush trauma preventive or damage to the
resulting in gingival restorative care gingiva through
ulceration, that may lead to minor burns from hot
recession both; traumatic injury foods and drinks.
of the gingiva

15. Foreign Body Reactions:
Foreign body reactions' lead to localized inflammatory
conditions of the gingiva and are caused by the introduction of
foreign material into the gingival connective tissues through
breaks in the epithelium. Common examples are the
introduction of amalgam into the gingiva during the placement
of a restoration or extraction of a tooth, leaving an amalgam
tattoo, or the introduction of abrasives during polishing
procedures.

16. PERIODONTITIS
Periodontitis is defined as "an inflammatory disease of the
supporting tissues of the teeth caused by specific
microorganisms or groups of specific microorganisms,
resulting in progressive destruction of the periodontal
ligament and alveolar bone with pocket formation, recession,
or both." The clinical feature that distinguishes periodontitis
from gingivitis is the presence of clinically detectable
attachment loss.

17. Chronic Periodontitis
Chronic periodontitis is the most common form of periodontitis
Chronic periodontitis is most prevalent in adults but can be
observed in children therefore the age range of >35 years
previously designated for the classification of this disease has
been discarded. Chronic periodontitis is associated with the
accumulation of plaque and calculus and generally has a slow to
moderate rate of disease progression

18. Local factors may influence plaque accumulation systemic diseases
such as diabetes mellitus and HIV infection may influence the host
defenses; environmental factors such as cigarette smoking and stress
also may influence the response of the host to plaque accumulation
Chronic periodontitis may occur as a
localized disease wherein <30% of
evaluated sites demonstrate
attachment and bone loss, or as a
more generalized disease wherein
>30% of sites are affected. The disease
also may be described by the severity
of disease as slight, moderate, or
severe based on the amount of clinical
attachment loss.

19. Aggressive Periodontitis
Aggressive periodontitis differs from the chronic form primarily
by the rapid rate of disease progression seen in an otherwise
healthy individual, an absence of large accumulations of plaque
and calculus, and a family history of aggressive disease
suggestive of a genetic trait.
early onset periodontitis
usually affect young individuals at
or after puberty and may be
observed during the second and
third decade of life (i.e., 10 to 30
years of age). The disease may be
localized (LJP) or generalized
(GJP)

20. NECROTIZING PERIODONTAL DISEASES
Necrotizing Ulcerative Gingivitis
Clinical features of necrotizing periodontal disease may
include necrosis and/or punched out ulceration of the
interdental papillae ("punched-out papillae") or gingival
margin, pseudomembranous formation painful, bright red
marginal gingiva that bleed upon gentle manipulation,
halitosis

21. Treatment
*irrigation
*and debridement of necrotic areas
oral hygiene instruction and the •
uses of mouth rinses
* pain medication. •
* As these diseases are often •
associated with systemic medical
issues, proper management of
the systemic disorders is
appropriate

22. Necrotizing Ulcerative Periodontitis
NUP" differs from NUG in that loss of clinical attachment and
alveolar bone is a consistent feature.
Several case reports have
described extensive destruction
leading to exfoliation of teeth
within 3-6 months of onset, with
sequestration of necrotic alveolar
bone and necrotic involvement of
the adjacent mandible and
maxilla. Patients may present
with concomitant malnutrition
resulting from inability to take
food by mouth.

23. Treatment
*Removal of plaque and debris from the site of
infection and inflammation
* Debridement of necrotic hard and soft tissues
*Chlorhexidine gluconate rinse (0.12%) twice daily after
brushing and flossing
*Antibiotic therapy Metronidazole is the drug of choice,
500 mg for 7-10 days.

24. PERIODONTITIS ASSOCIATED WITH ENDODONTIC
LESIONS
Endodontic-Periodontal Lesions
In endodontic-periodontal lesions, pulpal necrosis precedes
periodontal changes. A periapical lesion originating from
pulpal infection and necrosis may drain to the oral cavity
through the periodontal ligament, resulting in destruction of
the periodontal ligament and adjacen alveolar bone. This
may present clinically as a localized deep, periodontal pocket
extending to the apex of the tooth. Pulpal infection also may
drain through accessory canals, especially in the area of the
furcation, and may lead to furcal involvement through loss of
clinical attachment and alveolar bone.

25. Periodontal-Endodontic Lesions
In periodontal-endodontic lesions, bacterial infection from a
periodontal pocket associated with loss of attachment and root
exposure may spread through accessory canals to the pulp,
resulting in pulpal necrosis. In the case of advanced periodontal
disease, the infection may reach the pulp through the apical
foramen.
Scaling and root planing removes cementum and underlying
dentin and may lead to chronic pulpitis through bacterial
penetration of dentinal tubules.

26. Combined Lesions
Combined lesions occur when pulpal necrosis and a
periapical lesion occur on a tooth that also is periodontally
involved. A radiographically evident infrabony defect is seen
when infection of pulpal origin merges with infection of
periodontal origin

27. Diagnostic Methods
*Initially a detailed medical and dental history must be obtained
from the patient.
*The clinical examination should include inspection of the
gingival and mucosal tissues, palpation, mobility testing,
percussion
*Periodontal probing is essential to identify and determine the
depth of periodontal pockets and the degree of loss of
attachment.
*Pulp testing should be carried out with both carbon dioxide (dry
ice) and an electric pulp tester
*Radiographs are an essential tool to the diagnosis of any
endodontic or periodontal condition.

28. Treatment
periodontal disease
*scaling
*root planing
*oral hygiene instructions follow-up
maintenance therapy, including surgery in
some cases.
Diseased pulp tissue or infected root canals
*cleaning
* shaping
* medicating
* filling of the root canal system

29. DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND
CONDITIONS
Tooth Anatomic Factors
Anatomic factors such as
* cervical enamel projections and
enamel pearls have been associated with clinical attachment loss, especially in
furcation areas.
*Palatogingival grooves, found primarily on maxillary incisors
* Proximal root grooves on incisors and maxillary premolars
Cervical enamel
projection
Enamel pearl

30. Dental Restorations or Appliances
Dental restorations or appliances are frequently associated
with the development of gingival inflammation, especially
when they are located subgingivally. This may apply to
subgingivally placed onlays, crowns, fillings and orthodontic
bands.

31. Root Fractures
Root fractures caused by traumatic forces or restorative or
endodontic procedures may lead to periodontal involvement
Cervical Root Resorption and Cemental Tears
Cervical root resorption and
cemental tears may lead to
periodontal destruction when the
lesion communicates with the oral
cavity and allows bacteria to
migrate subgingivally