SK2A W1-3

junctiional epi

• non keratinised, fast turnover

• wide spaces allows fluid, inf flow

• attaches via hemidesmosomes

repair

not identical replacement, JE froms

Regeneration

full restoration PDL, bone, cem

post deb changes

• hist: tissue healing

• microbial: gram -ve > gram +ve / dec. path

• clinical and radio improvements

perio re-eval timing

• gingivitis: 6 months

• severe perio + risk factors : 6-8 weeks

• mod to sev: 8-12 weeks

unresponsive sites

due to poor oral hygiene

modifiable risks

smoking, hygiene

non-modifiable risks

age, genetics

patient level risk

overall risk and recall freq

tooth/site risk

prognosis and breakdown risk

why ongoing treatment

• disease is chronic and reccurent

• pockets recolonise bacteria

• debridement only reduces bacteria

recolonisation causes

• external reservoirs

• incomplete cleaning

• poor oral hygiene

exam and treatment sequence

1. history

2. clinical exam

3. radiographs

4. diagnosis

5. prognosis

6. treatment plan

treatment phases

1. systemic

2. initial (cause-related)

3. corrective

4. maintenance

pregnancy hormone effects

• dec. epi barrier

• ^ inf

• ^ anaerobic bacteria

common preg conditions

• pregnancy gingivitis

• pregnancy epulis

• perio may worsen

risk of perio

• linked to preterm birth & low birth weight

• mechanism: ^ inf mediators ( prostaglandins)

preg perio treatment

• safe during preg

• best in 2nd tri

normal children and ad features

• redder gingiva

• shallow pockets

child conditons

• puberty gingivitis (hormone)

• gingival overgrowth ( plaque, hormones ,meds)

• viral infection (herpes)

child agressive perio

• ass. w A.actinomycet

• requires: debridement, antibiotics, surgery

child/ad challenges

• mixed dentition> hard diagnosis

• pseudo pocketing is common

eldery risk factors

• dry mouth (polypharmacy)

• reduced dexterity

• cognitive decline

• poor access to care

outcomes of eldery perio

^recession ,attachment loss and tooth loss

elderly management

• prevention focus

• interdental brushes

• mouth rinses

• electric toothbrushes

smoking

• major risk factor

• dec. in b.o.p, masked inf

• ^ pocket depth, bone loss & tooth loss

vaping

• alters oral microbiome

• caries risk

• less link to perio

diabetes

strong bi directional relationship w perio

down syndrome characteristics

intirnsic immune system defects

DS mechanisms and symp

• characteristic physical appearance

• cognitive impairment

• physical disorders

DS perio

agressive early onset generalised perio, affecting lower inc and 1st M w severe attachment and bone loss

Leukocyte adhesion deficiency syndrome disease char

neutro are trapped w in blood vessels and cannot migrate to perio sites

LADS mech and symp

• history of severe reccurrent infections w out pus formation

LADS perio

severe gen perio w ^ gin inf, rapid At loss and B loss due to defective neut adhesion and migration

Papillion- Lefevre mech and symp

hyperkeratoic lesions affecting multiple organs including the skin, palms, feet ect

Papillion- leferve perio

severe destructive perio affecting prim and perm dent, resulting in early tooth loss

Haim-munk syndrome mech and symp

overgrown and curved fingernails and defromed fingers

Haim- munk syndrome perio

sevre destructive perio aff both prim and perm dent, result in early tooth loss

Chediak-Higashi syndrome disease char

gene mutations result in decrease in phagocytosis

Chediak-H syndrome mech and symp

• partial albinism

• intelectual deficit

• abnormal bleeding

Chediak-H syndome perio

severe early onset perio due to neutro dysfunction w rapid CAL and bone destruction

Hyperimmunoglobulin E syndromes char

mutations in STAT3 gene affecting intracellular signalling

Hyper E syndrome mech and symp

• recurrent skin abscesses w out pus form

• eczema/ itchy rash

• pulmonary infections

Hyper E syndromes perio

retained primary dent and delayed eruption, gingival changes, high arched palate and reccurent oral candidasis

Ehlers- Danlos syndrome char

mutations in genes encoding fibrillar collagens

Ehlers- D synd mech and symp

• joint hypermobility

• extensible skin

• easy brusing

• abnormal scarring

• vascular complications

Ehlers- D syn perio

• Type V111 present w severe early onset rapid prog perio, gen gin rec, lack of attached gin, fragile perio tissue and prem tooth loss

• Type 1V not clascially agressive perio

Hypophosphatasia char

mutations in alkaline phosphate gene

Hypophos. mech and symp

• foot pain

• stress fractures

• skeletal deform

• short stature

• bone fractures

Hypophos. perio

prem exfoliation of prim due to defective cem and loss of perio attachment, reduced alv bone, perm dent also may be affected

smoking clinical features

• les ob gin inf

• red gin red

• red b.o.p

• ^ prob dep

• ^ gin rec

• ^ bone loss

• ^ furcation inv

• ^ tooth mobility

• poor healing post therapy

smoking effects on host response

• neutrophil dysfunction

• altered cytokine production (inf mediators)

• red vasculatiry bc nicotine

• ^ oxidative stress- fibroblasts, collagen

• suppressed clinical inf

smoking effects on biofilm

dysbiotic pathogen sub gin biofilm, facilitating early colonisation creatinf less resilient microbial community

smoking effects on healing

• impairs healing after therapy

• smokers less pocket reduction, less CAG, less bone refill, poor wound healing

• reducing blood flow impairs healing, fibro attachment, collagen synth

smoking effects on perio

• deeper probing depths

• ^ CAL

• ^ bone loss

• ^ extensive and severe disease

• ^ risk of tooth loss

• dose response relationship

smoking effects on treatment outcomes

• red clinical benefits of therapy

• impairs regen results

• ^ risk of reccurent perio

smoking effects of cessation

• red risk perio progression

• red risk tooth loss

• imp treatment outcomes

unc diabetes clinical features

ass w more severe perio inf and destruction, including bleeding, pocketing, attachment loss, alv bone loss and perio abscess

unc diabetes effect on host response

• neutrophil dysfunction

• ^ pro inf cytokine activity

• AGE-RAGE

• mediated tissue injury

• oxidative stress

• abnormal collagen metabolism

unc diabtes effect on biofilm

• favours dysbiotic perio biofilm, host enviroment that supports periodontopathogens

unc diabetes effects on healing

• impaired fibroblast function

• abnormal collagen metabolism

• delayed angiogensis

• increased sustainability to infection

unc diabetes effect on perio

• HbA1c <7.0% = GRADE B

• HbA1c > 7% = GRADEC

• increases risk ,extent,severity rate of prog

unc diabetes effect of treatment outcome

ass w poorer perio treatment, response less predictible, may improve glycamic control

unc diabetes effects of control

glycameic control reduces perio risk and imp healing and treatment outcomes

effects of vaping comp to smoking

bw smokers and NS, similar pathogensis of smoking, pro inf cytokine releas, ^ path microflora > ^ CAL, probing depth & bone loss

obesity disease characteristics

chronic excess adiposity, low grade syst inf, ass w insulin resistance, metabolic syndrome

obesity mech and symp

adipose tissue releases pro inf mediators eg leptin, ev supports ob as risk factor, may enhance perio inf

Obesity perio

ass w inc prevelance, severity and progression, risk factor, may worsen response to therapy

osteoporosis char

systemic skeletal disease w low bone min density and michroarchitectural deteriotation

osteoporosis mech and symp

• red bone mass

• estrogen def

• altered RANK/OPG balance

• shared inf pathways may inc alv bone loss

• shared risk factors: age, smoking and diab

osteoporosis perio

• ^ att loss

• ^ alv bone loss

• not direct cause of perio/ ass w risk factors

Inflammatory Bowel disease char

chronic relapsing inf disease of GI tract, Crohns disease and ulcerative colitis

IBD mech and symp

• dysreg mucosal immunity

• altered microbiome

• oral-gut axis interactions

• accompanied by oral lesions

• mucosal swelling

• angular cheilitis

IBD perio

• higher prev and risk of perio

• bidirectional rel thru dysbiosis and inf pathways

Rheumatoid A char

chronic autoimmune inf joint disease w synovitis pain, stiffness, swelling and progressive joint destruction, anti-CCP /ACPA antibiodies

RA mech and symp

• shared inf pathways such as TNF-a, IL-1, IL-6

• bone reabsorption

• protein sitrullination

• perio pathogens p.gin

RA perio

• pos ass w perio although the ass

• bidirectional relationship, perio may red RA inf

Neutropenia char

• abnormal low neut count

• congenital or acquired

• causes recurrent infections, fever, oral ulceration

neutropenia mech and symp

^ risk for infections correlated w severity of neutropenia

neutropenia perio

^ risk for perio correlated w severity of neutropenia

HIV char

• chronic viral inf affecting CD4+T lymphocytes, causing progressive immune deficiency

• untreated> AIDS

HIV mech and symp

• ^ risk of infections

• kaposi sarcoma

• oral candidiasis

• oral hairy leukoplakia

• severe aphthous ulcers

HIV perio

^ risk of necrotising perio disease

emotional stress and depression char

• activation of hypothalamic pituitary adrenal axis

• leads to the release of peptides and hormons that modulate immune response

emotional stress and depression mech and symp

changes in behaviour, mood and physiological markers

emotional stress and depression perio

may worsen perio disease by disregulating immune and inf respones and by adversely affecting oral health behaviours, leading to increased perio breakdown and poorer treatment outcomes

oral squamous cell carcinoma char

• malignant epi neo arising from strat squam epi

  • perssistent non healing uler, indurated mass

OSC carcinoma mech and symp

• regional lymphadenopathy

• risk for late-stage metastases

OSC carcinoma perio

• localised gingival swelling/ulceration

• typically mand molar region

• look similar to local perio

odontogenic tumours char

• neoplasms of odontogenic epi

odontogenic tumours mech and symp

• slow growing jaw lesions

• asymptomatic, found on radio

• jaw swelling, cortical expansion

• unerupted tteth

• tooth displacement

• mobility

• altered occlusion

odontogenic tumours perio

• late features can look similar to local perio

Wegners granulomatosis char

necrotising granulomas associated w vasculitis

Wegners granulomatosis mech and symp

• hearing loss

• scarring

• kidney damage

• blood clots in legs

• fatal if untreated

Wegners granulomatosis perio

strawberry gingivitis, ginigval enlaregement, may cause gin necrosis, localised perio attachment loss and bone loss

Langerhans cell histiocytosis char

cell proliferation of cells similar to bone marrow derived langerhans cells

Langerhans cell histocytosis mech and symp

• wide spectrum of presentations

• solitary chronic bone lesions

• diabetes insipidus

  • proptosis

Langerhans cell histocytosis perio

• destructive alveolar bone loss

• ging inf, recess,bleeding

• tooth mobility- floating teeth appearance

Giant cell granuloma char

• reactive proliferation

giant cell granuloma mech and symp

• peripheral or central lesions

• root and bone resorption