I. Chronic Periodontitis

1. Definition

• Chronic Periodontitis is a chronic bacterial infection that affects the supporting tissues of the teeth, including the gums, periodontal ligaments, and alveolar bone. It is the result of the accumulation of bacterial plaque and the body’s inflammatory response to these bacteria.
• Chronic Periodontitis is the most common type of periodontitis, progressing slowly and may not have any symptoms for a long time. However, if left untreated, it can lead to alveolar bone loss, tooth loss, and other health problems.

2. Causes

• Bacterial plaque: Plaque is a sticky, colorless film that forms on the surface of the teeth, containing disease-causing bacteria. Plaque is the primary cause of chronic periodontitis.
• Predisposing factors:
  • Diabetes: High blood sugar weakens the immune system, making the body more susceptible to infections, including periodontitis.
  • Smoking: Smoking weakens the immune system, damages periodontal tissues, and reduces the effectiveness of treatment.
  • Stress: Stress weakens the immune system, making the body more susceptible to infections, including periodontitis.
  • Age: Older adults are at higher risk for periodontitis due to the degeneration of periodontal tissues over time.
  • Genetics: Some people have a higher genetic predisposition to periodontitis.
  • Medication: Some medications, such as antibiotics and steroids, can weaken the immune system and increase the risk of periodontitis.

3. Symptoms

• Early Stage:
  • Plaque above and below the gum line
  • Gingivitis: swollen, red gums, bleeding when brushing or flossing.
  • Increased gingival fluid secretion.
• Progressive Stage:
  • Periodontal pockets: spaces between the teeth and gums, containing plaque and bacteria.
  • Attachment loss: gum tissue recedes, exposing the tooth roots.
  • Alveolar bone loss: alveolar bone is destroyed, leading to tooth loosening.
  • Tooth loosening: teeth become loose due to attachment loss and alveolar bone loss.
  • Gum recession: gums recede, exposing the tooth roots.
  • Pain during acute inflammation: pain when chewing, sensitivity to hot and cold foods.

4. Classification

• Localized Periodontitis: < 30% of teeth have attachment loss and alveolar bone loss.
• Generalized Periodontitis: >= 30% of teeth have attachment loss and alveolar bone loss.

5. Diagnosis

• Clinical Examination:
  • Chronic gingivitis
  • Periodontal pockets
• Radiographs:
  • Crestal bone loss in radiographs
  • Horizontal bone loss in radiographs
• Attachment loss:
  • Mild: 1-2mm
  • Moderate: 3-4mm
  • Severe: >= 5mm

6. Treatment

• Goal:
  • Control infection
  • Prevent alveolar bone loss and tooth loss
  • Restore periodontal tissue health
• Local Treatment:
  • Scaling and root planing: removing plaque and calculus from the tooth surfaces.
  • Root debridement: removing plaque and bacteria from periodontal pockets.
• Systemic Treatment:
  • Antibiotics: using antibiotics for abscesses, acute conditions, and weak individuals.
  • Dietary adjustments: limiting sugar, starch, hard, and chewy foods.
  • Vitamin and mineral supplements: supplementing vitamin C, D, calcium, and magnesium.
• Surgery:
  • Flap surgery: removing infected gum tissue, creating conditions for tissue healing.
  • Bone grafting: adding bone to the area of bone loss to regenerate alveolar bone.

7. Prevention

• Daily oral hygiene: brushing twice a day, flossing once a day.
• Regular dental checkups: visiting a dentist at least twice a year for checkups and oral hygiene.
• Healthy diet: limiting sugar, starch, hard, and chewy foods.
• Supplementing vitamins and minerals: supplementing vitamin C, D, calcium, and magnesium.
• Quitting smoking: smoking is a major risk factor for periodontitis.
• Controlling diabetes: maintaining stable blood sugar levels.

II. Aggressive Periodontitis

1. Definition

• Aggressive Periodontitis is a form of periodontitis that progresses rapidly and causes severe damage to periodontal tissues.
• It can occur at any age but is more common in younger individuals.
• It is characterized by rapid destruction of supporting tooth tissues, leading to premature tooth loss.

2. Causes

• Abnormal host response: the body overreacts to bacterial plaque, leading to rapid destruction of periodontal tissues.
• Resistant pathogenic microorganisms: some bacteria may be resistant to antibiotics, making treatment more difficult.

3. Symptoms

• Common in adolescence:
  • R1, R6 bone loss and attachment loss on the facial surface.
  • Diastema between the two central incisors.
  • Tooth loosening, sensitivity to cold due to open contacts, mild pain while chewing.
  • Radiograph shows vertical or angular bone loss on R1 and R6.
  • R1 and R6 lesions are often symmetrical on both sides and have lesions of 4 mm or more.
• Common in individuals aged 20-30 or older:
  • Bone loss affecting many teeth
  • Poor immune response
  • Gingival response on the bone loss area: swollen, easily bleeds, may have pus.
  • Normal gums
  • Radiographs show angular bone loss on one or more teeth.
  • Family history

4. Diagnosis

• Clinical examination:
  • No systemic diseases
  • Rapid rate of destruction
  • Rapid destruction of many teeth but little plaque
• Radiographs:
  • Rapid and extensive bone loss
  • Determine the difference in the degree of bone loss between two examinations at least two weeks apart.

5. Treatment

• Goal:
  • Control infection
  • Prevent alveolar bone loss and tooth loss
  • Restore periodontal tissue health
• Local Treatment:
  • Scaling and root planing: removing plaque and calculus from the tooth surfaces.
  • Root debridement: removing plaque and bacteria from periodontal pockets.
• Systemic Treatment:
  • Antibiotics: using metronidazole and amoxicillin orally.
• Surgery:
  • Flap surgery: if bacteria persist after antibiotic treatment.

6. Prevention

• Regular oral hygiene: brushing twice a day, flossing once a day.
• Regular dental checkups: visiting a dentist at least twice a year for checkups and oral hygiene.
• Healthy diet: limiting sugar, starch, hard, and chewy foods.
• Supplementing vitamins and minerals: supplementing vitamin C, D, calcium, and magnesium.
• Quitting smoking: smoking is a major risk factor for periodontitis.
• Controlling diabetes: maintaining stable blood sugar levels.

III. Necrotizing Ulcerative Periodontitis

1. Definition

• Necrotizing Ulcerative Periodontitis is a severe form of periodontitis that can occur in both people with and without HIV.
• It is characterized by rapid destruction of gum tissue, alveolar bone, and surrounding soft tissues.

2. Causes

• Bacteria:
  • Necrotizing ulcerative gingivitis not related to AIDS: often caused by infection with Prevotella intermedia, Fusobacterium nucleatum, Porphyromonas gingivalis.
  • Necrotizing ulcerative gingivitis related to AIDS: often caused by infection with opportunistic bacteria, such as Candida albicans, spirochetes, gram-negative bacteria.
• Weakened immune system: a weakened immune system makes the body more susceptible to infections and less able to fight off disease-causing bacteria.
• Predisposing factors:
  • Malnutrition
  • Smoking
  • Stress
  • Long-term antibiotic use

3. Symptoms

• Necrotic ulcers in the gums:
  • Necrotic ulcers in the gingival margin.
  • Ulcers are covered with a soft white pseudomembrane.
  • There is a bright red halo around the edges of the ulcer.
  • The ulcerations are often painful and bleed.
  • Systemic symptoms: fever, fatigue.
• Alveolar bone lesions:
  • Deep lesions resembling volcanoes.
  • Bone lesions are often localized.

4. Progression

• Can progress to necrotizing stomatitis.
• Cancrum oris.
• Exposed bone.
• Bone necrosis.
• Formation of bone fragments in the alveolar bone.

5. Microscopic Image

• Polymorphonuclear leukocyte infiltration.
• Lymphocytes and plasma cells in the peripheral and deeper regions.

6. Treatment

• Local Treatment:
  • Scaling and root planing: removing plaque and calculus from the tooth surfaces.
  • Root debridement: removing plaque and bacteria from periodontal pockets.
  • Antiseptics: using antiseptics to kill bacteria.
• Systemic Treatment:
  • Antibiotics: using antibiotics to kill disease-causing bacteria.
  • Antifungal medications: using antifungal medications if infected with Candida albicans.
  • Immune-enhancing medications: using immune-enhancing medications to improve the patient’s health.

7. Prevention

• Regular oral hygiene: brushing twice a day, flossing once a day.
• Regular dental checkups: visiting a dentist at least twice a year for checkups and oral hygiene.
• Healthy diet: limiting sugar, starch, hard, and chewy foods.
• Supplementing vitamins and minerals: supplementing vitamin C, D, calcium, and magnesium.
• Quitting smoking: smoking is a major risk factor for periodontitis.
• Controlling diabetes: maintaining stable blood sugar levels.

IV. Refractory Periodontitis

1. Definition

• Refractory Periodontitis is a form of periodontitis that is difficult to treat, often seen in patients with rapidly progressing periodontitis that begins in preadolescence.
• It is characterized by rapid destruction of periodontal tissues, despite treatment.
• The cause is either an abnormal host response or resistant pathogenic microorganisms.

2. Symptoms

• Common in preadolescence: patients have rapidly progressing periodontitis.
• Subsequent examinations: the condition of periodontitis often worsens.
• Response to treatment: often does not respond well to conventional treatment.
• Associated with areas difficult to control plaque: such as interdental spaces, areas around wisdom teeth.
• Common in adults: but often without obvious symptoms.
• Reduced neutrophil count: in patients with rapidly progressing periodontitis that begins early in adolescence and preadolescence.

3. Treatment

• Local Treatment:
  • Scaling and root planing: removing plaque and calculus from the tooth surfaces.
  • Root debridement: removing plaque and bacteria from periodontal pockets.
• Systemic Treatment:
  • Antibiotics: using appropriate antibiotics, based on bacterial culture results.
  • Immune-enhancing medications: may help improve the patient’s immune response.
• Surgery:
  • May be performed to remove infected tissue or create conditions for tissue healing.

Note:

• Chronic periodontitis, aggressive periodontitis, and necrotizing ulcerative gingivitis are all serious diseases that can lead to tooth loss if not treated promptly.
• Diagnosis and treatment of periodontitis should be performed by a professional dentist.
• Patients need to follow the dentist’s instructions for effective treatment.

Additional Information:

• Chronic periodontitis is a common condition, affecting oral health and overall health.
• Aggressive periodontitis and necrotizing ulcerative gingivitis are severe forms of periodontitis that need to be treated promptly.
• Maintaining regular oral hygiene and seeing a dentist regularly are effective ways to prevent periodontitis.