Symptoms of Periodontitis Smoking and Periodontitis DiabetesEssay

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Symptoms of Periodontitis

Smoking and periodontitis

Diabetes and periodontitis

Diagnosis of periodontitis

Types of probes

Probing force and probe diameter

Histopathological alteration in the periodontal tissues

Bleeding on probing (BOP) refers to bleeding of the gums induced by gentle manipulation of the tissue at the depth of the gingival sulcus or at the interface between the gingival and a tooth. This is frequently accomplished by the use of a periodontal probe. BOP is a sign of inflammation of the gums and is indicative of some sort of destruction and erosion to the lining of the sulcus.

Periodontal disease is a set of inflammatory diseases usually affecting the tissues that surround and support the teeth otherwise called periodontium. This disease involves progressive loss of the alveolar bone around the teeth, and without treatment it can lead to loosening and possible eventual loss of teeth. Periodontitis is caused by microorganisms adhering and growing on the tooth surface, along with an overly aggressive immune response against this microorganism. The diagnosis is through inspecting the soft gum tissues around the teeth with a probe and x-ray films and visual analysis to determine the amount of bone loss around the teeth (Lang & Tonetti, 1996).

The cause of gingivitis is poor oral hygiene leading to the accumulation of mycotic and bacterial matrix at the gum line, called dental plaque. Other causes are poor nutrition and underlying medical problem such as diabetes. Finger nick tests have been approved to identify and screen patients for possible contributory causes of gum disease such as diabetes. In a number of patients, gingivitis worsens into to periodontitis. This comes about as a result of destruction of the gingival fibers; the gum tissues separate from the tooth and deepened sulcus. Sub-gingival microorganisms colonize the periodontal pockets causing advanced inflammation in the gum tissues and progressive bone loss.

Another strong risk factor that could predispose one periodontitis is one's genetic susceptibility. Several conditions and diseases, such as diabetes, Down syndrome and other diseases affecting one's resistance to infection increase susceptibility to periodontitis. Another factor making periodontitis a difficult disease to study is that human host response can also affect the alveolar bone resorption. Host response to the bacteria is mainly determined by genetics, however, immune development may play a role in susceptibility (Heins & Karpinia, 1998).

1.1 Symptoms of Periodotitis

Periodontitis has very few symptoms in early stages and in many individuals it goes undetected till it has significantly progressed and that is when they seek treatment.

Symptoms include redness or bleeding of gums while brushing teeth or biting into hard food, gum swelling that recurs, halitosis and a persistent metallic taste in the mouth. Also gingival recession, causing apparent lengthening of teeth, deep pockets between the teeth and the gums and loose teeth, in the later stages. However, gingival inflammation and bone destruction are painless; hence, most patients assume that painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis.

Periodontitis is associated to increased inflammation in the body indicated by raised levels of C-reactive protein and Interleukin-6 which increases the risk of stroke myocardial infarction and atherosclerosis. It also associated to those over 60 years of age to impairments in delayed memory and calculation abilities. (Heins & Karpinia,1998).

1.2 Smoking and periodontitis.

Cigarette smoking has been highly associated with impaired healing of surgical wounds and related to periodontitis. (Silverstein et al., 2000). The harmful effects of cigarette smoking on the periodontal status have also been well-documented. The adverse effect of smoking in implants has been described in a study of the outcome of 2,194 implants placed in 540 subjects. The study showed that a considerably higher percentage of implant failures occurred in smokers than in non-smokers. Smokers had total implant failure rate of 11.3%, and only 4.8% of the implants failure rate in non-smokers (Chaves et al., 1993).

However, limited information exists with consideration of the consistently natural occurring plaque and bleeding on probing in the oral cavity under normal oral hygiene measures. The study was to explain the distribution of tooth surfaces covered by supragingival plaque and gingival units bleeding on probing in a steady state environment of no dental interference. Also relative consistency of plaque and bleeding was studied. 65 volunteers, 14 women and 51 men ranging from the age of 19 to 30 years, participated. 33 volunteers were heavy smokers and 32 non-smokers.

Clinical examinations discovered mild, plaque-induced gingivitis without clear destructive periodontitis. Within a 6-month period, occurrence and amount of plaque, calculus and gingival bleeding was site-specifically examined four times. Well-defined, symmetric and regular patterns of plaque and calculus distribution in the oral cavity were observed, which were rather the same in smokers and non-smokers. It is worth noting that smokers had uniformly more plaque in all regions of the oral cavity as compared to non-smokers.

In contrast, there was no obvious pattern of bleeding on probing. Stability of observations was considerably less than for plaque scores and it was particularly true for smokers, where the relationship between bleeding scores was smaller than in non-smokers. A large part of the difference in gingival bleeding may be due to presently unknown factors other than plaque and calculus with extensive consequences for preventive program (Lang et al., 2001).

1.3 Diabetes and periodontitis

Another risk factor for periodontitis is uncontrolled diabetes. So far, facts related to disease-free implant survival in diabetics is still preliminary. A one-year report of implant survival in Type II diabetics showed a 7.3% failure rate. This shows that osseointegration can be obtained in the most diabetic patients. However, the standard of a long-term prognosis of implants placed in these subjects is presently unknown.

1.4 Diagnosis of periodontitis

Periodontal probing is commonly used criteria for diagnosis of gingival inflammation. Periodontal Screening and Recording (PSR), a painless procedure used to measure and determine the severity of periodontitis, where the dentist uses a mirror and a periodontal probe to measure pocket depth. The probe is held along the length of the tooth with the tip placed in the pocket. The tip of the probe will then touch the point where the connective tissue attaches to the tooth. The dentist will 'walk' the probe to six specific points on each tooth, three on the buccal and 3 on the lingual side.

The dentist measures the depth of the probe at each point. Pocket depth greater than 3mm indicates disease presence. These measurements help establish the condition of the connective tissues and amount of gingival overgrowth or recession. Tooth mobility is determined by pushing each tooth between two instrument handles and observing any movement. Mobility is a strong indicator of bone support or loss of the same. X-rays are taken to show any loss of bone structure supporting the teeth. 18 x-rays make up the full mouth series necessary for diagnosis (Nguyen, 2008).

A periodontal probe is an instrument used in the dental armamentarium .It's usually long, thin and blunted at the end. Its main use is to measure pocket depths around a tooth to determine the state of health of the periodontum. There are markings inscribed onto the head of the instrument for accuracy and readability. Proper use of the periodontal probe is required to maintain accuracy. The tip of the instrument is positioned with light pressure of 10-20g into the gingival sulcus. It is essential to keep the periodontal probe parallel to the contours of the root of the tooth and to put in the probe down to the base of the pocket.

This results in obscuring a part of the periodontal probe's tip. The first marking visible over the pocket indicates the size of the pocket depth. It has been establish that the average, healthy pocket depth is around 3mm without bleeding upon probing. Depths more than 3mm can be linked with "attachment loss" of the tooth to the adjacent alveolar bone, which is a feature in periodontitis. Pocket depths more than 3mm can also be an indication of gingival hyperplasia.

1.5 Types of probes.

There are different types of periodontal probes, and each has its own mode of indicating measurements on the tip of the device. They include, Michigan O. probe with markings at 3mm, 6mm and 8mm, Williams probe with circumferential lines at 1mm, 2mm, 3mm, 5mm, 7mm, 8mm, 9mm, and 10mm and PCP12 probe with Marquis markings has alternating shades every 3mm. Unlike other types of probes, Naber's probe is curved and used for measuring into the furcation area between the roots of a tooth. Periodontal probe can also be used for measurement and tooth preparations during restorative procedures, gingival recession, attached gingiva, and oral lesions or pathologies (James et al., 2001).

1.6 Probing force and probe diameter

The relationship between bleeding on probing, probing force and probe diameter is usually determined by the pressure exerted on the gingival tissues and resistance from the healthy or inflamed tissue. This pressure is directly proportional to the force on the probe and inversely proportional to the probe tip diameter. Large… [END OF PREVIEW]

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