Transcript Bacteria / viral associated with periodontal disease

Bacteria / viral associated with
periodontal disease
• 700 different microbial species > 100–200
species commonly colonise an individual’s
mouth, reflecting great diversity
pathways for the oral bacteria to exert
their effects
• tooth surfaces (either crown or root)
• periodontal tissues (either sulcular, junctional
or pocket epithelium lining),
• connective tissues (if access is gained via
ulcerated pocket
• epithelium) or other bacteria already attached
to these surfaces.
pioneer
• Gram positive and include:
• streptococci (with Streptococcus sanguis, S. oralis and S. mitis being
• pioneer species), Neisseria, Nocardia and Actinomyces. ‘Milleri’ streptococci
• (S. anginosus, S. constellatus and S. intermedius)
Gingivitis
• capnophylic (especially Capnocytophaga spp.)
• obligately anaerobic Gram-negative bacteria
• rises; Fusobacteria are common and there is an increased proportion of Actinomyces
Periodontitis
• a diverse subgingival
• microflora and a large number of obligately anaerobic Gram-negative
• rods and filament-shaped bacteria, many of which are asaccharolytic
• but proteolytic
Designated periodontal pathogens:
Suspected periodontal pathogens
include:
• Aggregatibacter
actinomycetemcomitans
• Porphyromonas gingivalis
• Tannerella forsythia
Prevotella intermedia
– Split into two distinct species
Prevotella intermedia and
Prevotella nigrescens in 1992
• Fusobacterium nucleatum
• Campylobacter rectus
• Eikenella corrodens
• Peptostreptococcus micros
• Selenomonas species
• Eubacterium species
• Spirochaetes
– Only 10 cultivated so far
Prognosis of tooth
• Prediction of probable course, duration, and
outcome of a disease based on a general
knowledge of the pathogenesis of the
disease and the presence of risk factors for
the disease.
Prognosis of tooth
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7.
% of bone loss-CAL
Probing depth
Distribution and type of bone loss
(anatomy of intrabony defects)
Furcation : presence & severity
Mobility
Crown to root ratio
8. Bleeding upon probing
9. Root morphology
10. Pulpal involvement/Caries
11. Tooth position and occlusal
12. relationship / strategic value/ cost
13. Patient risk factor
CAL
Recession
PD
How do you use PD and CAL?
• CAL is often used to monitor disease
progression- determine prognosis
• PD is commonly used to develop type of
treatment- grafting
Glickman’s Furcations
Miller Index Classification:
• 1- First sign of movement greater than
normal
• 2 - Up to 1 mm in any direction
• 3 - More than 1 mm in any direction and/or
vertical depression
Radiographic exam
• Full-mouth series
• Vertical Bite wings
• Panorex
– developmental anomalies
– Pathology
– fractures
• Previous radiographs
Classification of Prognosis
Modified McGuire’s
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Good
Fair
Poor
Questionable
Hopeless
• *Note: the textbook uses the orginial McQuire’s
classification. In the Modified McGuire the
classification criteria remains the same but the names
for questionable and poor have been switched.
Prognosis
feature
Excellant
No bone loss
Excellent gingival condition
Good patient cooperation
No risk factors
Good
Adequate remaining bone support
No or Controlled risk factors
Adequate patient cooperation
Fair
25-40% Attachment Loss
Grade I furcation
Adequate maintenance possible
Acceptable patient cooperation
Questionable
40-50% attachment loss
Grade I or II furcation
Allows proper maintenance but difficult
Doubtful patient cooperation
Risk factors present
Prognosis
feature
Poor
>50% attachment loss
Inaccessible Grade II furcatio
Grade III furcation
Poor crown to root ratio with Class 2 or
2+ mobility
Risk factors present or poorly controlled
Hopeless
>75% Bone loss
Non-maintainable areas
Grade III Furcation
Class 3 Mobility
Recurrent Abscesses
Uncontrolled risk factors
Overall Factors that
Affect Prognosis
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Age
Medical status/systemic
background
Rate of Progression
Patient Cooperation