02 Periodontal Disease

UPDATINGNG OF THE BASIC ORAL CARE NOTEBOOK 2012 FOUSP - MINISTRY OF HEALTH, BRAZIL

Periodontal Disease Periodontal disease should be seen as an unbalanced process between the actions of aggression and defense in the protective and supporting tissues of the tooth.

CHAPTERS

UPDATING AND ILUSTRATING

1. Conceptual and Epidemiological Aspects

2. Principal Risk Factors

3. Collective Approach Page 2

4. Individual Approach a. Gingivitis

Page 2 Page 1

Page 2

5. Prevention

7. Credits Page 4

6. Clinical case Page 4

b. Periodontitis Pages 3 e 4

biological

1. Conceptual and Epidemiological Aspects !

consistent

between the actions of aggression

with

the

d i s e a s e ’ s etiopathogenesis that

Periodontal disease should

be seen as an unbalanced process

variables

xxxxxx

allows patients who once were diseased

and defense in the protective and

and presented sequels

supporting tissues of the tooth. The principal determinant is the

such as recession and mobility, to return to a

bacterial

healthy

biofilm

(biofilm

is

a

periodontal

microbial consortium included in that may support living organisms. condition.

Today, periodontal the ECP mass [extracellular Wikipedia in Nov 2012) and the disease is an important risk factor to polysaccharides] resulting from different responses given by the low weight preterm labor, diabetes, binding, multiplication and host. It is no longer considered a vascular and cardiac diseases. development of microorganisms on slow and continuous progression In Brazil, the percentage of people solid surfaces – substrate – in water but it can exhibit variable with periodontal problems in the environment h t t p : / / progressive standards.

It is age groups from 15 to 19, 35 to 44 www.farmaconline.ufg.br in Nov understood as an infectious disease and 65 to 74 is 53.8%, 78.1% e 92.1% 2012. Substrate in ecology refers to where alterations in shape and respectively, according to the results the surface, sediment, base, function are considered signs. The of the SB Brazil 2003 environment or any other surface normal periodontium is defined by Epidemiological Survey.

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2. Principal Risk Factors

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a. Gingivitis

•Cultural, social and economic factors.

!

Gingivitis is an inflammatory manifestation of

• Smoking.

the marginal gingiva triggered by the accumulation of supragingival bacterial plaque and the breakdown of

• Lack of biofilm control.

the aggression/defense balance. It is an inflammatory

• Diabetes.

process that must be prevented and treated.

3. Collective Approach •Organizing actions such as surveillance of the risk signs in oral health: social risk, no access to brushing, bleeding/gingival

secretion,

diabetes

mellitus,

immunosuppression and smoking.

• Actions to promote health (educational and interrelated actions) principally associated to the groups that provide care to diabetes mellitus, smoking, pregnancy, among others.

Diagnosis •To diagnose gingivitis, it is important:

4. Individual Approach !

It is important to have a total approach in the

treatment of periodontal disease involving the actions of health promotion and prevention (to control the disease activity and its risk factors) and surgical

•Plaque control evaluation •Bleeding evaluation •Woman’s health evaluation

rehabilitating treatment that is increasingly becoming a

•Evaluation of systemic alterations or smoking that

rare procedure due to the possibility of solving the

may be influencing the periodontal condition.

cause. This means addressing the causes of the disease, not only its consequences in order to impact the health/ Treatment

disease process. !

Two

manifestations

classical of

the

ways

are

as

Treatment can be performed in many weekly individual

disease

or collective visits. Their number will depend on the

described

health/periodontal

disease control.

process: gingivitis and periodontitis. !

With

the

evolution

in

the

concept

of

understanding periodontal diseases, it was concluded that gingivitis and periodontitis are independent

• Removal or treatment of biofilm retention factors.

processes, that is, gingivitis does not necessarily evolve

• Professional supragingival scaling and polishing.

to periodontitis but gingivitis is an important risk factor to periodontitis.

• Educational actions for biofilm control.

• Use of biofilm chemical control (only when necessary and for a limited time).

• Monitoring and control of risk factors such as diabetes, pregnancy, hormonal alterations, among others. If gingivitis is related to systemic factors or

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medications, the possibility of intervention in these factors should be evaluated.

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Diagnosis !

• Treatment

progress should be assessed by the biofilm control and the disease’s activity. The patients may be discharged if there is no gingival bleeding and a minimum amount of

!

It is connected to the evaluation of active disease, the type of progression and causal and modifying factors:

biofilm compatible to their periodontal health condition.

•

attachment loss and inflammatory signs (bleeding and secretion).

Maintenance !

Establishment of the disease activity: defined by

To maintain periodontal health, the frequency of

recalls varies individually according to the risk,

•

Biofilm control evaluation.

•

Evaluation of systemic conditions, smoking and aspects

gingival bleeding and biofilm control.

of

social

and

economical

risk

and

medications use.

b. Periodontitis !

The

inflammatory

Treatment conditions

present

in

gingivitis cause a virulent subgingival bacterial biofilm responsible for inflammation of the supporting tissues. !

Periodontitis is a group of diseases that

characterizes for inflammation of the supporting tissues and teeth’s protection, followed by loss of connective

! !

Periodontal health maintenance and treatment

success basically depend on the ability of controlling the biofilm by the user/professional binomial and risk factors.

tissue attachment. This is a consequence of the

Control, mainly smoking and diabetes.

aggression caused by the subgingival bacterial biofilm.

Treatment will basically consist of actions connected to DISEASE CONTROL PHASE, and a PHASE OF TREATING THE CLINICAL MANIFESTATIONS:

•

Treatment

of

Gingivitis

as

previously

described, including the educational actions.

•

Treatment of Periodontitis by means of controlling the subgingival biofilm, scaling and subgingival planning. These procedures do not depend on depth and should always

Chronic periodontitis is slow and the most

be done as a first option. If periodontitis is

prevalent type. Attachment loss is associated to oral

related to systemic factors or noxious habits the possibility of intervention should be

!

hygiene standards and risk factors. Aggressive periodontitis is rare but fast, presenting high dental

considered.

morbidity and mortality. These periodontitis have a genetic component that is important in preventing them.

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References !

If Periodontitis is chronic and

slow, the cases where subgingival scaling failed should be referred to surgery. Special attention must be given to the evaluation of the failure cause, because many times the patient’s lack of controlling the biofilm is the main reason of failure and this should be the principal focus of professional care.

Periodontal Therapy Monitoring !

Treatment may last several weekly visits that

can be individual or in group. The number will depend

Return after 7 days: note the color change of the gums

on the disease’s control.

(pale pink) and consequent desinflamation of the gum.

!

At

short

term

monitoring,

treat

the

inflammatory signs and at long term the lack of progression in attachment loss. !

Clinical discharge must be given to the users

when they have no signs of disease activity and present adequate plaque control.

Rehabilitation !

The

surgical,

restorative

or

rehabilitating

procedures necessary to reestablish esthetics, shape and function impaired by the disease.

5. Prevention !

To prevent periodontal problems just the

individual to use dental floss and toothbrush in accordance with a correct technique of handling. !

6. Credits Updating of the Primary Oral Care Notebook 2012 FOUSP - Ministry of Health: images and glossary: Prof. Dr. Cláudio Pannuti – FOUSP

6. Clinical case The patient presented gingival inflammation (note the color red-blue gum) and prostheses with marginal excess. Initial procedure: orientation for oral hygiene and removal of marginal excess.

Dr. Marco Antonio Kulik - FOUSP (imagem gengivite e pediodontite) Dr. André Hespanhol - FOSUP (imagem conceitos epidemiológicos) Profa. Dra. Mary caroline Skelton-Macedo - FOUSP

! !

UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

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