PERIO- ETIOLOGY OF PDL DISEASE

PDL DISEASE

an infectious disease caused by

microorganisms that colonize the tooth surface

at or below the gingival margin

PDL DISEASE

an infectious disease in such a way that there

is an interplay between the host response and

the 600 microorganisms

PDL DISEASE

NOT acquired through air NOR hand shake

GINGIVITIS

limited to inflammation of gingiva

wherein no destruction of the bone and

connective tissue attachment

GINGIVITIS

reversible

GINGIVITIS

the level of the bone as well as your

periodontal ligament, biological width and

other supporting structures are all intact

GINGIVITIS

alveolar crest is 2 mm below the CEJ

correlated to biologic width which is 1mm

junctional epithelium and 1mm

connective tissue attachment

GINGIVITIS

consists only of the site, meaning you

have Inflammation on the gingiva

2mm

measurement of the alveolar crest from the cej

1mm

biological width of the alveolar crest with the functional epithelium and connective tissue attachment

3mm

normal measurement of the alveolar crest below the cej sa elders

PERIODONTITIS

wherein the supporting structures or

attachment apparatus such as the bone

and connective tissue attachment are

already damaged

PERIODONTITIS

irreversible

SUPRACRESTAL ATTACHED WIDTH

formerly called as the "Biologic Width"

SUPRACRESTAL ATTACHED WIDTH

the distance from the crest of the bone to the

base of the pocket

2.04mm

measurement of the supracrestal attached width

1. Attach to one or more surfaces

2. Know the environment

3. Regulate virulence factors

3 COMMON FEATURES OF PATHOGENS THAT

CAN CAUSE PDL DISEASE

STRATUM CORNEUM

part of the epidermis na

nagsshatter everyday

BIOFILM

a well organized, cooperating community of

microorganisms adherent to a sólid substrate which

forms in fluid environments

BIOFILM

acts to protect the bacteria

BIOFILM

must be present for periodontal disease to occur

BIOFILM

soft, adherent, structured deposits that accumulate

on teeth and other surfaces of the mouth, which

consists of continually growing bacterial flora in an

intermicrobial matrix

BIOFILM

a complex aggregation of microorganisms growing

on a solid substrate

BIOFILM

are characterized by structural heterogeneity,

genetic diversity, complex community interactions,

and an extracellular matrix of polymeric substances

BIOFILM

product ng moisture and solid surface

BIOFILM

where bacteria are not evenly distributed

Exopolysaccharide

an enveloping

intermicrobial matrix that surrounds the

bacteria

QUORUM SENSING

chemical signal sent out by the bacteria in

biofilm where they communicate with each

other

BELLEVUE STRATFORD HOTEL

site of the first known outbreak of

Legionnaires' disease

BELLEVUE STRATFORD HOTEL

closed in November, 1976, four months after

the outbreak

LEGIONELLA BACTERIUM

was finally identified and isolated and was

found to be breeding in the cooling tower of

the hotel's airconditioning system

● Teeth and other surfaces of the mouth

● Dentures

● Tongue

SITES OF PLAQUE ACCUMULATION

DENTAL PLAQUE

are soft deposits that form the biofilm adhering to

the tooth surface or other hard substance in the oral

cavity

DENTAL PLAQUE

provides sheltered area for plaque and bacterial

accumulation

DENTAL PLAQUE

does not irritate the gingiva directly, but it provies a

tixed nidus for the continued accumulation of plaque

and holds it against the gingiva

DENTAL PLAQUE

composed of microorganisms, epithelial cells, and interbacterial matrix

SUPRAGINGIVAL PLAQUE

found at or above the gingival margin

SUPRAGINGIVAL PLAQUE

the source of inorganic constituent is primarily

saliva

SUPRAGINGIVAL PLAQUE

can grow on other hard surfaces in the mouth:

restorations or artificial crowns, orthodontic bands,

dental implants, removable orthodontic appliance,

dentures

SUBGINGIVAL PLAQUE

found below the gingival margin, between the tooth

and the gingival sulcular tissue

SUBGINGIVAL PLAQUE

the inorganic component is

derived from crevicular fluid

Crevicular fluid

a serum transudate where

the inorganic component of subgingival

plaque is derived from

Pellicle

derived from components of saliva

and crevicular fluid

Pellicle

a transparent/colorless film which

forms over the tooth surface 30

minutes after brushing

Pellicle

provides lubrication for the surfaces

and preventing tissue dessication

Pellicle

provide a substrate to w/ acteria in

environment attach

Pellicle

if formed on the

crown surface

Cuticle

if formed on the root

surface

Gram positive cocci (actinomyces

and streptococcus sanguis)

the initial colonizers which are

part of the normal oral

microflora

Gram positive cocci (actinomyces

and streptococcus sanguis)

predominant bacteria that

initially colonized the pellicle

Gram positive cocci (actinomyces

and streptococcus sanguis)

adheres to the pellicle through

the specific molecules termed

adhesins

Adhesin

specific

molecule where the

gram positive cocci

(actinomyces and

streptococcus sanguis)

adhere to

Extracellular matrix

acts as

the bacteria’s backbone and

source of nutrients

Dynamic environment

where

there are symbiotic and

antagonistic mechanisms

taking place

Gram-positive bacteria

secrete

enzymes that ward off other harmful

bacteria

Gram negative bacteria

when this bacteria

increase in number, the

biofil is already said to

be mature and are now

able to migrate

Gram negative bacteria

a major key factor in

having gingivitis

SPECIFIC PLAQUE HYPOTHESIS

States that only certain plaque is pathogenic

and its pathogenecity depends on the

presence of or increase in specific

microorganisms

SPECIFIC PLAQUE HYPOTHESIS

nakadepende sa microorganism na meron

ang plaque

Autoaggregation

bacteria sf the same species will

attach to one another

Co-aggregation

different species of bacteria can

recognize and adhere with the others

Co-aggregation

what they do is they attach to other

bacteria to be able to become a part

of the plaque

NONSPECIFIC PLAQUE HYPOTHESIS

States that it is the total bulk of plaque which

determines its pathogenicity rather than the

individual species w/in it

NONSPECIFIC PLAQUE HYPOTHESIS

“Plaque will cause disease regardless of

composition”

DENTAL CALCULUS

an adherent calcified or calcifying mass that forms

on the surface of natural teeth and dental prosthesis

DENTAL CALCULUS

consists of mineralized bacterial plaque

DENTAL CALCULUS

keeps plaque in close

contact w/ gingival tissue and creates areas where

plaque removal is impossible

Supragingival calculus

salivary calculus

Supragingival calculus

Located coronal to the margin and therefore

is visible in the oral cavity

Supragingival calculus

is usually white or whitish yellow, has hard,

clay like consistency and is easily detached

from the tooth surface

Supragingival calculus

occurs most frequently and in greatest

quantity on the buccal surfaces of maxillary

molars opposite Stensen's Duct and on the

lingual surfaces of the mandibular anterior

teeth, particularly the centrals, opposite the

Wharton's Duct

Supragingival calculus

well calcified deposits are readily

detectable, forming irregular contours

on the radiographic crown

Stensen's Duct

opposite of the buccal surfaces of maxillary

molars

Wharton's Duct

opposite the lingual surfaces of the mandibular anterior

teeth, particularly the centrals

Subgingival calculus

located below the crest of the marginal

gingiva

Subgingival calculus

not visible in routine clinical examination

Subgingival calculus

is usually dense, dark brown or greenish

black and hard or flint like in consistency

Subgingival calculus

serumal calculus

Subgingival calculus

is firmly attached to the root surface

●

calcium phosphate - 75.9%

●

calcium carbonate - 3.1%

●

magnesium phosphate

inorganic composition of calculus

➔ hydroxyapatite

➔ magnesium whitlockite,

➔ octacalciumphosphate

➔ brushite

four main crystal forms of calculus

CALCULOCEMENTUM

calculus morphologically similar to cementum

that is embedded deeply into it

SALIVA

a meta-stable solution of calcium and

phosphate ions

• CARBON DIOXIDE TENSION THEORY

• BOOSTER MECHANISM THEORY

• INHIBITION THEORY

• NUCLEATION THEORY

THEORIES ON CALCULUS FORMATION

Pyrophosphate

assists in

maintaining ions in supersaturated solution

Organic matrix of plaque

acts as a seeding

agent for crystallization

MATERIA ALBA (ngima)

refers to soft accumulations of bacteria and tissue

cells that lack the organized structure of plaque

MATERIA ALBA (ngima)

are easily displaced by water spray but mechanical

cleansing is required to ensure complete removal

MATERIA ALBA (ngima)

a yellow or grayish white, soft, sticky deposit

MATERIA ALBA (ngima)

less adherent than dental plaque

MATERIA ALBA (ngima)

visible w/o disclosing solution

DENTAL STAINS

pigmented deposits on tooth surface

DENTAL STAINS

results from a pigmentation of ordinarily colorless

developmental and acquired dental coatings by

chromogenic bacteria, foods and chemicals

DENTAL STAINS

they vary in color and composition and in the

firmness w/ wi cney adhere to the tooth surface

CHLORHEXIDINE STAINS

impart a yellowish brown to brownish color to

the tissues of the oral cavity

CHLORHEXIDINE STAINS

the staining appears in the cervical and

interproximal regions of the teeth,

CHLORHEXIDINE STAINS

most effective na plaque agent and can

cause black stains within 1-2 weeks

ALDEHYDES AND KETONE

intermediates of

both mammalian and microbial metabolism

ALDEHYDES AND KETONE

essential for formation of

discoloration of chlorhexidine

BROWN STAINS

thin, translucent, acquired, usually

bacteria-free, pigmented pellicle