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Chapter 032. Oral Manifestations of Disease (Part 2)

Periodontal Disease Periodontal disease accounts for more tooth loss than caries, particularly in the elderly. Like dental caries, chronic infection of the gingiva and anchoring structures of the tooth begins with formation of bacterial plaque. The process begins invisibly above the gum line and in the gingival sulcus. Plaque, including mineralized plaque (calculus), is preventable by appropriate dental hygiene, including periodic professional cleaning. Left undisturbed, chronic inflammation ensues and produces a painless hyperemia of the free and attached gingivae (gingivitis) that typically bleeds with brushing. If ignored, severe periodontitis occurs, leading to deepening of the physiologic sulcus and destruction. | Chapter 032. Oral Manifestations of Disease Part 2 Periodontal Disease Periodontal disease accounts for more tooth loss than caries particularly in the elderly. Like dental caries chronic infection of the gingiva and anchoring structures of the tooth begins with formation of bacterial plaque. The process begins invisibly above the gum line and in the gingival sulcus. Plaque including mineralized plaque calculus is preventable by appropriate dental hygiene including periodic professional cleaning. Left undisturbed chronic inflammation ensues and produces a painless hyperemia of the free and attached gingivae gingivitis that typically bleeds with brushing. If ignored severe periodontitis occurs leading to deepening of the physiologic sulcus and destruction of the periodontal ligament. Pockets develop around the teeth and become filled with pus and debris. As the periodontium is destroyed teeth loosen and exfoliate. Eventually there is resorption of the alveolar bone. A role for the chronic inflammation resulting from chronic periodontal disease in promoting coronary heart disease and stroke has been proposed. Epidemiologic studies demonstrate a moderate but significant association between chronic periodontal inflammation and atherogenesis though a causal role remains unproven. Acute and aggressive forms of periodontal disease are less common than the chronic forms described above. However if the host is stressed or exposed to a new pathogen rapidly progressive and destructive disease of the periodontal tissue can occur. A virulent example is acute necrotizing ulcerative gingivitis ANUG or Vincent s infection characterized as trench mouth during World War I. Stress poor oral hygiene and tobacco and alcohol use are risk factors. The presentation includes sudden gingival inflammation ulceration bleeding interdental gingival necrosis and fetid halitosis. Localized juvenile periodontitis seen in adolescents is particularly destructive and appears to be associated with .