Epidemiology of periodontal

disease
Taibah University

Objectives

Etiology of periodontal disease

Prevention of perio diseases
Epidemiology of perio diseases

PERIODONTAL DISEASE
Like Dental caries Both Gingivitis & Periodontitis

Mostly Gram
negative,
anaerobic bacteria

Bacterial infections and

the causative bacteria
are found in the plaque

Like Actinomyces,

DEFINITION OF GINGIVITIS
Gingivitis is defined as an inflammatory process of
gingival tissue, most forms of gingivitis are plaque
induced, mainly supragingival plaque is associated
with early lesions

Early stage of gingivitis

DEFINITION OF
PERIODONTITIS

Periodontitis
is
also
an
inflammatory condition of gingival
tissues and in found when the
attachments of the periodontal
ligament and some bony support
have been lost. It is thought to be
an extension of gingivitis.
Thus periodontal disease is a term
which includes all pathological
condition of the periodontium
including gingival and supporting
structures

(Cementum, Periodontal membrane

and alveolar bone)

HEALTH
Coral pink color
Gums hug teeth tightly
No bleeding

GINGIVITIS
Bleeding while brushing or during probing
Inflamed, sensitive gums
Possible bad breath/taste

MILD PERIODONTITIS
More pronounced gingival bleeding, swelling
Gums may begin to pull away from teeth
Bad breath/taste
Pockets 3-4 mm deep
MODERATE PERIODONTITIS
Teeth may look longer due to gum recession
Gum boils or abscesses may develop
Bad breath, bad taste
Teeth may begin to drift and show spaces
Pockets 4-6 mm deep
ADVANCED PERIODONTITIS
Teeth may become mobile or loose
Constant bad breath and bad taste
Teeth sensitive due to exposed roots
Pockets > 6mm deep
Some teeth may be extracted (pulled)

PREVENTIVE MEASURE
For the last several decades we are concern on
prevention of two major families of oral diseases
# Dental Caries
# Periodontal Diseases
The above diseases are mainly concern to control
bacterial plaque. From the above point of view the
dental plaque is the major etiological agent and
thus it is major risk factors in the diseases.

RECENT CONCEPT OF DISEASE

But in recent concept host response is also very
important for the disease prevalence and its
increase.
The oral epithelium is keratinized but the crevicular
epithelium (sulcus) and the junctional epithelium
are not keratinized. The junctional epithelium is
attached to the enamel surface and underlying
connective tissue by a basal lamina and
hemidesmosome. From this point desquamation
takes place.

IMPLECATION OF PREVENTION
Control of supragingival plaque is very important
because it start the development of gingivitis and
periodontitis. Therefore regular and frequent
dental visits are indicated to maintain good oral
hygiene and to identify inflammatory changes at an
early and reversible stage.

EPIDEMIOLOGY
-More common in male, female usually exhibit
better oral hygiene than male.
- Cross sectional survey data was generally that the
severity of disease increased with advanced age
- Low socioeconomic group are generally more
affected in developing countries.
-Inadequate oral hygiene practice leads to induce
periodontal diseases.

EPIDEMIOLOGY Continued
- Smoking and smokeless tobacco are also directly
associated with poorer oral health.
- Systemic condition such as neutropenia, aplastic
anemia, AIDS, diabetics all produce severe
gingivitis and predispose to more severe
periodontitis.
AIDS
Patient

AIDS Patient

PREVALENCE AND SEVERITY

-Disease increases with increase of age and
hormonal changes such as puberty.
-Rough estimation and occurrence of periodontitis
have been obtained by enumerating pocket depth
in excess of 3mm, by measuring loss of
attachment, loss of marginal bone in radiograph

INTRAORAL DISTRIBUTION OF
PERIODONTAL DISEASE
-Most commonly affected:
-First teeth affected:

Molars and Lower

Anteriors
First molars

-Moderately affected :

Lower canine, molars,

upper incisors, and
premolars.

-Least affected:
-

Lower Premolars and

upper canine

TOOTH MORTALITY
66% teeth loss after the age of

Figure may
rose to

30 years

Because of Periodontal
Disease

80 % as the age increase

RATE OF PERIODONTAL
DISTRUCTION

(Sri Lankan labours in tea garden)

- 8 % of total population exhibit rapidly
progressive periodontitis
1 mm / year
-81 % exhibits moderately progressive periodontitis

0.5 mm / year
- 11 % no progression beyond gingivitis

Etiology
- Plaque > 70 % bacteria & 30 % matrix
Factor Predisposing to plaque accumulation
1. Teeth malalignment
2. Overhanging restoration
3. Removable partial denture
4. Calculus

PREVENTION & MANAGEMENT OF

PERIODONTAL DISEASES
-Dental Health Education
Belief the susceptibility of disease
Belief the disease is undesirable
Belief the prevention is possible
Belief the prevention is desirable

-Scaling
-Root Planning
-Polishing
-Surgical pocket therapy
-Correction of other predisposing factors which
help in accumulation of plaque
-Reinforcement of host defense mechanism

HOME CARE
-Manual tooth brush
-Mechanical tooth brush
-Interdentally clean (Dental floss & tooth picks)
-Irrigation device
-Tooth paste
-Frequency of teeth cleaning
-Duration and technique of teeth cleaning
-Diet

PREVENTIVE PROGRAM
-Long Prevention program in children:
* Fluoride program
* Fissure sealant
* Class room education
* Motivation
* Primary school health teachers education
* Lastly Regular school dental health check up

-Prevention Program in adult:

* Regular epidemiological studies and keeping data bank
* Health motivated program
* Regular check up

MOUTH WASH
-Chlorohexidine mouth wash
-Hydrogen peroxide mouth wash (H2O2)
-Antibiotics
-Other antiseptics
-Quaternary ammonium compound
-Phenolic compound
-Hexitidine
-Stanous fluoride

CHLOROHEXIDINE
Mode of action:
Act on both gram positive
and gram negative chlorohexidine binds to
bacterial cells walls and to
various oral surfaces including
the hydroxiapetite of tooth
enamel, organic pellicle covering
the tooth surfaces, mucous membrane
and salivary protein.
Use : 0.2 % chlorohexidine 1 minute twice daily

HYDROGEN PEROXIDE
Its effervative effect removes
desquamated epithelium, blood
clot and other biomaterials as
well as highly affected on
anaerobic bacteria because of
oxygen present in the hydrogen peroxide.

H2O2 H2O + O flooded with oxygen

kills bacteria