Periodontitis - Dental Disorders - MSD Manual ...

Periodontitis is a chronic inflammatory oral disease that progressively destroys the tooth-supporting apparatus. It usually manifests as a worsening of ... MSDManual Pleaseconfirmthatyouareahealthcareprofessional Yes No LeavethisSite? Thelinkyouhaveselectedwilltakeyoutoathird-partywebsite.Wedonotcontrolorhaveresponsibilityforthecontentofanythird-partysite. 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Ankylosisofthetemporomandibularjoint(TMJ)isdefinedasimmobilityorfusionofthejoint.Thisconditionmostoftenresultsfromwhichofthefollowing?  Acongenitalcondition  Traumaorinfection  Rheumatoidarthritis  Toothache MoreContent Videos 3DModels SOCIALMEDIA Periodontitis (Pyorrhea) By JamesT.Ubertalli ,DMD,Hingham,MA Lastfullreview/revisionJul2020|ContentlastmodifiedAug2020 ClickhereforPatientEducation TopicResources 3DModels(0) Audios(0) Calculators(0) Images(2) LabTest(0) Tables(0) Videos(0) Periodontitis(RecedingGums) Periodontitis Periodontitisisachronicinflammatoryoraldiseasethatprogressivelydestroysthetooth-supportingapparatus.Itusuallymanifestsasaworseningofgingivitisandthen,ifuntreated,withlooseningandlossofteeth.OthersymptomsarerareexceptinpatientswithHIVinfectionorinwhomabscessesdevelop,inwhichcasepainandswellingarecommon.Diagnosisisbasedoninspection,periodontalprobing,andx-rays.Treatmentinvolvesdentalcleaningthatextendsunderthegingival(gum)tissuesandavigoroushomehygieneprogram.Advancedcasesmayrequireantibioticsandsurgery.PathophysiologyofPeriodontitisPeriodontitisusuallydevelopswhengingivitisGingivitisGingivitisisatypeofperiodontaldiseasecharacterizedbyinflammationofthegums(gingivae),causingbleedingwithswelling,redness,exudate,achangeofnormalcontours,and,occasionally...readmore,usuallywithabundantplaqueandcalculus(aconcretionofbacteria,foodresidue,saliva,andmucuswithcalciumandphosphatesalts)beneaththegingivalmargin,hasnotbeenadequatelytreated.Inperiodontitis,deeppocketsformintheperiodontaltissueandcanharboranaerobicorganismsthatdomoredamagethanthoseusuallypresentinsimplegingivitis.ColonizingorganismsincludeAggregatibacteractinomycetemcomitans,Porphyromonasgingivalis,Eikenellacorrodens,andmanygram-negativebacilli.Theorganismstriggerchronicreleaseofinflammatorymediators,includingcytokines,prostaglandins,andenzymesfromneutrophilsandmonocytes.Theresultinginflammationaffectstheperiodontalligament,gingiva,cementum,andalveolarbone.Thegingivaprogressivelylosesitsattachmenttotheteeth,bonelossbegins,andperiodontalpocketsdeepen.Withprogressiveboneloss,teethmayloosen,andgingivarecedes.Toothmigrationiscommoninlaterstages,andtoothlosscanoccur.RiskFactorsforPeriodontitisModifiableriskfactorsthatcontributetoperiodontitisincludePlaqueSmokingTobaccoTobaccouseisamajorindividualandpublichealthproblem.Dependencedevelopsrapidly.Majorconsequencesincludeprematuredeathandmorbiditycausedbycardiovasculardisease,lungand...readmoreObesityObesityObesityisexcessbodyweight,definedasabodymassindex(BMI)of≥30kg/m2.Complicationsincludecardiovasculardisorders(particularlyinpeoplewithexcessabdominalfat)...readmoreDiabetesDiabetesMellitus(DM)Diabetesmellitusisimpairedinsulinsecretionandvariabledegreesofperipheralinsulinresistanceleadingtohyperglycemia.Earlysymptomsarerelatedtohyperglycemiaandincludepolydipsia...readmore(especiallytype1)EmotionalstressVitaminCdeficiencyVitaminCDeficiencyIndevelopedcountries,vitaminCdeficiencycanoccuraspartofgeneralundernutrition,butseveredeficiency(causingscurvy)isuncommon.Symptomsincludefatigue,depression,andconnective...readmore(scurvy)Addressingtheseconditionscanimprovethetreatmentoutcomesofperiodontitis.ClassificationofPeriodontitisTheAmericanAcademyofPeriodontology's(AAP)2017reclassificationofperiodontaldiseasesandconditionsnowdistinguishes3formsofperiodontitis:NecrotizingperiodontitisPeriodontitisasadirectmanifestationofsystemicdiseasePeriodontitisOtherAAPdesignationsareabscessesoftheperidontium,periodontitisassociatedwithendodonticlesions,anddevelopmentaloracquireddeformitiesandconditions.Periodontalabscessesareaccumulationsofpusthatusuallyoccurinpre-existingpockets,sometimesrelatedtoimpactedforeignmaterial.Tissuemayberapidlydestroyed,riskingtoothloss.Periodontitisassociatedwithendodonticlesionsinvolvesacommunicationbetweenthepulpandperiodontaltissues.Indevelopmentaloracquireddeformitiesandconditions,faultyocclusion,causinganexcessivefunctionalloadonteeth,plustherequisiteplaqueandgingivitismaycontributetoprogressionofaparticulartypeofperiodontitischaracterizedbyangularbonydefects.NecrotizingperiodontitisNecrotizingperiodontitisisaparticularlyvirulent,rapidlyprogressingdiseasecharacterizedbyNecrosisorulcerationoftheinterdentalpapillaeBleedinggingivaPainInsomepatients,inflammationalsoinvolvestheoralcavity,causingnecrotizingstomatitisStomatitisOralinflammationandulcers,knownasstomatitis,maybemildandlocalizedorsevereandwidespread.Theyareinvariablypainful.(SeealsoEvaluationoftheDentalPatientandGingivitis...readmore.NecrotizingperiodontitistypicallyoccursinpatientswithanimpairedimmunesystemandthusisoftencalledHIV-associatedperiodontitisbecauseHIVisacommoncause.Clinically,itresemblesacutenecrotizingulcerativegingivitisAcuteNecrotizingUlcerativeGingivitis(ANUG)Acutenecrotizingulcerativegingivitisisapainfulinfectionofthegums.Symptomsareacutepain,bleeding,andfoulbreath.Diagnosisisbasedonclinicalfindings.Treatmentisgentledebridement...readmorecombinedwithgeneralizedaggressiveperiodontitis.Patientsmaylose9to12mmofattachmentinaslittleas6months.PeriodontitisasadirectmanifestationofsystemicdiseasePeriodontitisasadirectmanifestationofsystemicdiseaseisconsideredinpatientswhohaveinflammationdisproportionatetoplaqueorotherlocalfactorsandwhoalsohaveasystemicdisease.However,distinguishingwhetheradiseaseiscausingperiodontitisorcontributingtoplaque-inducedperiodontitisisoftendifficult.SystemicdiseasesassociatedwithhematologicdiseasethatcanmanifestasperiodontitisincludeAcquiredneutropeniaNeutropeniaNeutropeniaisareductioninthebloodneutrophilcount.Ifitissevere,theriskandseverityofbacterialandfungalinfectionsincrease.Focalsymptomsofinfectionmaybemuted,butfever...readmoreAgranulocytosisNeutropeniaNeutropeniaisareductioninthebloodneutrophilcount.Ifitissevere,theriskandseverityofbacterialandfungalinfectionsincrease.Focalsymptomsofinfectionmaybemuted,butfever...readmoreLeukemiasOverviewofLeukemiaLeukemiaisamalignantconditioninvolvingtheexcessproductionofimmatureorabnormalleukocytes,whicheventuallysuppressestheproductionofnormalbloodcellsandresultsinsymptoms...readmoreLazyleukocytesyndromeHypogammaglobulinemiaX-linkedAgammaglobulinemiaX-linkedagammaglobulinemiaischaracterizedbylowlevelsorabsenceofimmunoglobulinsandabsenceofBcells,leadingtorecurrentinfectionswithencapsulatedbacteria.(SeealsoOverview...readmoreSystemicdiseasesassociatedwithgeneticdisordersthatcanmanifestasperiodontitisincludeFamilialandcyclicneutropeniaDownsyndromeDownSyndrome(Trisomy21)Downsyndromeisananomalyofchromosome21thatcancauseintellectualdisability,microcephaly,shortstature,andcharacteristicfacies.Diagnosisissuggestedbyphysicalanomaliesand...readmoreLeukocyteadhesiondeficiencysyndromesPapillon-LefèvresyndromeChédiak-HigashisyndromeAtaxia-TelangiectasiaAtaxia-telangiectasiaresultsfromaDNArepairdefectthatfrequentlyresultsinhumoralandcellulardeficiency;itcausesprogressivecerebellarataxia,oculocutaneoustelangiectasias,and...readmoreHistiocytosissyndromesGlycogenstoragediseaseGlycogenStorageDiseasesGlycogenstoragediseasesarecarbohydratemetabolismdisorders.Therearemanynumberedandnamedtypes,allofwhicharecausedbydeficienciesofenzymesinvolvedinglycogensynthesisor...readmoreInfantilegeneticagranulocytosisEhlers-DanlossyndromeEhlers-DanlosSyndromeEhlers-Danlossyndromeisahereditarycollagendisordercharacterizedbyarticularhypermobility,dermalhyperelasticity,andwidespreadtissuefragility.Diagnosisisclinical.Treatmentis...readmore(typesIVandVIII)HypophosphatasiaCongenitalHypophosphatasiaCongenitalhypophosphatasiaisabsenceorlowlevelsofserumalkalinephosphataseduetomutationsinthegeneencodingtissue-nonspecificalkalinephosphatase(TNSALP).Becauseserumalkaline...readmoreCohensyndromeCrohndiseaseCrohnDiseaseCrohndiseaseisachronictransmuralinflammatoryboweldiseasethatusuallyaffectsthedistalileumandcolonbutmayoccurinanypartofthegastrointestinaltract.Symptomsincludediarrhea...readmorePeriodontitisTheprevious(1999)classificationdistinguishedbetweenchronicandaggressiveperiodontitis.However,althoughtheage,rateofonsetandseverityofperiodontitisvarysignificantly,theunderlyingpathophysiologyisnowrecognizedtobesimilarandcurrentevidencedoesnotsupportsuchadistinction.DiseaseseverityisnowclassifiedasstageIthroughIV,andrateofprogressionasgradeAthroughC.Periodontitiscanbeginanywherebetweenearlychildhoodandolderadulthood.About85%ofthepopulationisaffectedtoamilddegree,butthemostadvancedcasesareseenin<5%ofthepopulation.ImportantseverityfactorsincludeAmountoflossofattachment(ofsofttissuetoteeth)DepthofpocketsAmountofbonelossseenonx-raySymptomsandSignsofPeriodontitisPainisusuallyabsentunlessanacuteinfectionformsinoneormoreperiodontalpocketsorifHIV-associatedperiodontitisispresent.Impactionoffoodinthepocketscancausepainatmeals.Abundantplaquealongwithredness,swelling,andexudatearecharacteristic.Gumsmaybetenderandbleedeasily,andbreathmaybefoul.Asteethloosen,particularlywhenonlyonethirdoftherootisinthebone,chewingbecomespainful.DiagnosisofPeriodontitisClinicalevaluationSometimesdentalx-raysInspectionoftheteethandgingivacombinedwithprobingofthepocketsandmeasurementoftheirdepthareusuallysufficientfordiagnosis.Pocketsdeeperthan4mmindicateperiodontitis.Dentalx-raysrevealalveolarbonelossadjacenttotheperiodontalpockets.TreatmentofPeriodontitisTreatmentofriskfactorsScalingandrootplaningSometimesoralantibiotics,antibioticpacks,orbothSurgeryorextractionTreatmentofmodifiableriskfactorssuchaspoororalhygiene,diabetes,andsmokingimprovesoutcomes.Forallformsofperiodontitis,thefirstphaseoftreatmentconsistsofthoroughscaling(professionalcleaningwithhandorultrasonicinstruments)androotplaning(removalofdiseasedortoxin-affectedcementumanddentinfollowedbysmoothingoftheroot)toremoveplaqueandcalculusdeposits.Thoroughhomeoralhygieneisnecessaryandincludescarefulbrushingandflossingtohelpclean.Itmayincludechlorhexidineswabsorrinses.Atherapistshouldhelpteachthepatienthowtodotheseprocedures.Thepatientisreevaluatedafter3weeks.Ifpocketsarenodeeperthan4mmatthispoint,theonlytreatmentneededisregularcleanings.Sometimesaflapofgumtissueismadetoallowaccessforscalingandplaningofdeeperpartsoftheroot.Ifdeeperpocketspersist,systemicantibioticscanbeused.Acommonregimenisamoxicillin500mgorally3timesadayfor10days.Inaddition,agelcontainingdoxycyclineormicrospheresofminocyclinecanbeplacedintoisolatedrecalcitrantpockets.Thesedrugsareresorbedin2weeks.Anotherapproachistosurgicallyeliminatethepocketandrecontourthebone(pocketreduction/eliminationsurgery)sothatthepatientcancleanthedepthofthenormalcrevice(sulcus)betweenthetoothandgingiva.Incertainpatients,regenerativesurgeryandbonegraftingaredonetoencouragealveolarbonegrowth.Splintingoflooseteethandselectivereshapingoftoothsurfacestoeliminatetraumaticocclusionmaybenecessary.Extractionsareoftennecessaryinadvanceddisease.Contributingsystemicfactorsshouldbecontrolledbeforeinitiatingperiodontaltherapy.NinetypercentofpatientswithnecrotizingulcerativeperiodontitisduetoHIV(HIV-associatedperiodontitis)respondtocombinedtreatmentwithscalingandplaning,irrigationofthesulcuswithpovidone-iodine(whichthedentistapplieswithasyringe),regularuseofchlorhexidinemouthrinses,andsystemicantibiotics,usuallymetronidazole250mgorally3timesadayfor14days.Localizedaggressiveperiodontitisrequiresperiodontalsurgeryplusoralantibiotics(eg,amoxicillin500mg4timesadayormetronidazole250mg3timesadayfor14days).KeyPointsPeriodontitisisaninflammatoryreactiontriggeredbybacteriaindentalplaque.Thereislossofalveolarbone,formationofdeepgumpockets,andeventuallylooseningofteeth.Treatmentinvolvesscalingandrootplaningandsometimesantibioticsand/orsurgery. ClickhereforPatientEducation NOTE: ThisistheProfessionalVersion. CONSUMERS: ClickherefortheConsumerVersion ©2022MerckSharp&DohmeCorp.,asubsidiaryofMerck&Co.,Inc.,Kenilworth,NJ,USA TongueTrauma WasThisPageHelpful? Yes No AcuteNecrotizingUlcerativeGingivitis(ANUG) OTHERTOPICSINTHISCHAPTER Periodontitis AcuteNecrotizingUlcerativeGingivitis(ANUG) GingivalHyperplasia Gingivitis Peri-ImplantDiseasesandConditions Professionalsalsoread HowToDrainaToothAbscess Gingivitis DentalAnatomyandDevelopment Testyourknowledge AnkylosisoftheTemporomandibularJoint(TMJ) Ankylosisofthetemporomandibularjoint(TMJ)isdefinedasimmobilityorfusionofthejoint.Thisconditionmostoftenresultsfromwhichofthefollowing?  Acongenitalcondition  Traumaorinfection  Rheumatoidarthritis  Toothache     MSDandtheMSDManuals Merck&Co.,Inc.,Kenilworth,NJ,USA (knownasMSDoutsideoftheUSandCanada)isaglobalhealthcareleaderworkingtohelptheworldbewell.Fromdevelopingnewtherapiesthattreatandpreventdiseasetohelpingpeopleinneed,wearecommittedtoimprovinghealthandwell-beingaroundtheworld. TheManualwasfirstpublishedin1899asaservicetothecommunity.ThelegacyofthisgreatresourcecontinuesastheMSDManualoutsideoftheUnitedStatesandCanada. LearnmoreaboutourcommitmenttoGlobalMedicalKnowledge. 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