Periodontal Diseases
Oral Pathology

Author: Andrea Roccuzzo
Date: 11/01/2011



In 1999 the American Academy of Periodontology (AAP) convened an international workshop to revise the classification of periodontal diseases and conditions (PDS).
The previous classification had a verity of problems and missing criteria.

According to Armitage 1999 there are eight major groups of periodontal diseases

1. Gingival Diseases
• Dental plaque-induced gingival diseases [Gingivitis] (includes 4 more subcategories)
• Non-plaque-induced gingival diseases (includes 8 more subcategories)
2. Chronic Periodontitis
• Localized and Generalized
3. Aggressive Periodontitis
• Localized and Generalized
4. Periodontitis Associated with Systemic Diseases
5. Necrotizing Periodontal Diseases
• Necrotizing ulcerative gingivitis (NUG)
• B. periodontitis (NUP)
6. Abscess of the Periodontium
7. Periodontitis associated with Endodontic Lesions
8. Development or Acquires Deformities and Conditions

The disease definition according to a specific consensus conference or to The Diseases Database(NLM)


According to recent researches, risk factors can be classified in two different main
groups Modifiable and Non-modifiable

• Bacterial plaque
• Age and sex Periodontal disease in Norwegian old-age pensioners and Sex Differences in destructive periodontal diseases: Exploring the biologic bases
• Smoking Effect of smoking on subgingival microflora of patients with periodontitis in Japan
• Systematic diseases Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis
• Stress
• Genetics Evaluation of telomerase expression in chronic periodontitis.


Periodontitis is very common, and is widely regarded as the second most common disease worldwide, after dental decay, and in the United States has a prevalence of 30–50% of the population, but only about 10% have severe forms.
Like other conditions that are intimately related to access to hygiene and basic medical monitoring and care, periodontitis tends to be more common in economically disadvantaged populations or regions. Its occurrence decreases with higher standard of living.
In Israeli population Ethnic origin and alveolar bone loss in Israeli adults, individuals of Yemenite, North-African, South Asian, or Mediterranean origin have higher prevalence of periodontal disease than individuals from European descent.
Presumably, individuals living in East Asia (e.g. Japan, South Korea and Taiwan) have the lowest incident of periodontal disease in the world.
Epidemiology picture


In the early stages, periodontitis has very few symptoms and in many individuals the disease has progressed significantly before they seek treatment. Symptoms may include the following:

• Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples)
• Gum swelling that recurs
• Halitosis, or bad breath, and a persistent metallic taste in the mouth
• Gingival recession, resulting in apparent lengthening of teeth. (This may also be caused by heavy handed brushing or with a stiff tooth brush.)
• Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)
• Loose teeth, in the later stages
Symtoms chronic conditions
Symtoms aggressive conditions and Bone loss


A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe (i.e. a clinical exam) and by evaluating the patient's x-ray films (a radiographic exam), to determine the amount of bone loss around the teeth


Perio-treatment aim is to reduce plaque. It is possible with non-surgial methods:

• Ultrasonic cleaning preferable (Lindhe)
• No toothbrushing /0.2 chlorehexidine

• 3
H202 + warm water (50-50)
• Metronidazole 250 mg ( or Penicillins or Tetracyclines)

but also with surgical procedures:

There are many surgical approaches used in treatment of advanced periodontitis, including soft tissue and osseous surgery, as well as guided tissue regeneration and bone grafting. The goal of periodontal surgery is access for definitive calculus removal and surgical management of bony irregularities which have resulted from the disease process to reduce pockets as much as possible.

Also the link to the corresponding Mesh term has to be created

The Diseases DatabaseURL
OMIM single geneFabry
Kegg PathwayAGAL

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