PERIODONTAL DIAGNOSIS: FROM DOC'S PPT

examples of systemic diseases associated with periodontitis

diabetes mellitus

agranulocytosis

leukemias

down syndrome

leukemias

are malignant neoplasms of WBC precursor

tend to displace normal components of the bone marrow elements with leukemic cells resulting in reduced production of normal RBCs, WBCs, platelets

oral manifestations of leukemias

bleeding

oral ulcerations

infections

agranulocytosis

a marked decrease in the number of granulocytes, neutrophils — neutropenia

due to failure of granulocyte production or increased destruction of granulocytes

oral manifestations of agranulocytosis

sore throat

fever, malaise

gingival hemorrhage

ulceration of the oral cavity

systemic manifestations of diabetes mellitus

retinopathy & nephropathy

cardiovascular & cerebrovascular diseases

oral manifestations of diabetes mellitus

alteration of oral flora

burning mouth & tongue

cheilosis, mucosal drying

candidiasis, diminished salivary flow

periodontal manifestations of diabetes mellitus

gingivitis

periodontitis

loosened teeth

abscess formation

down syndrome

mongolism, trisomy 21

caused by chromosomal abnormality

characterized by mental deficiency & growth retardation

poor chemotaxis, phagocytosis, intracellular killing leading to delayed healing

oral manifestations of down syndrome

malocclusion, diastema

periodontal pockets

plaque accumulation

moderate to severe gingivitis

drug idiosyncrasy

peculiar, strange, unusual

the most common cause of agranulocytosis

a condition in which a side effect of a drug is seen only in very less population

hypoglycemia

most common dental office complication of diabetes mellitus

polyphagia

excessive hunger or increased appetite

coined as ‘starvation in the midst of plenty’

polydipsia

excessive thirst & increased water intake, most likely as a result of frequent urination

polyuria

increased frequency of urination & passing abnormally large amounts or urine

mostly as a result of increased renal activity due to increased need to filter excess sugar in the bloodstream

examples of wasting diseases

attrition

abrasion

abfraction

erosion

attrition

reduction of cusp height

presence of wear facets

loss or flattening of biting surfaces

physiologic wearing of the tooth resulting from tooth-to-tooth contact

management for attrition

desensitizing agents such as fluoride varnish, composite restorations, crown lengthening, protective splints

abrasion

wearing away of teeth due to mechanical process such as vigorous brushing

saucer-shaped or wedge-shaped ditch at the CEJ with gingival recession

smooth & shiny surfaces

management for abrasion

use of soft-bristled toothbrush, composite restoration, GI filling

abfraction

wedge-shaped defects on facial aspect with sharp margins & internal line angles

loss of tooth structure due to biomechanical loading forces resulting in flexure & fatigue of enamel and & dentin

management for abfraction

occlusal adjustment

erosion

dissolution due to acid

loss of dental hard tissue by chemical process

sharply defined wedge-shaped defects involving enamel & dentin, surface appears smooth & polished

px education on avoidance of acidic food intake, desensitizing agents

primary trauma

due to the result of alterations in occlusal forces

examples:

• parafunctional habits

• high filling composites

• prosthodontic procedures

• tooth drifting & extrusion

• ortho movement

secondary trauma

due to the reduced ability of the tissues to resist occlusal forces

previously tolerated occlusal forces become traumatic

note:

• loss of bone

• no pocket formation

• thickening of the lamina dura

• widened periodontal ligament

• loss of clinical attachment level

type 1 DM

require insulin therapy

cannot be prevented

tends to develop at a young age

occurs when the pancreas is unable to produce enough insulin

type 2 DM

tends to develop at an older age

can be managed with lifestyle modifications alone if diagnosed early

occurs due to insulin resistance (when the body doesn’t respond well to insulin)

pulpal in origin

throbbing & pulsating

cannot be localized, can be radiating

periodontal in origin

dull & gnawing

cold

vital pulp

hot

non-vital pulp