Basic Guide to Oral Health Education and Promotion. Alison Chapman
or vertical (and only apparent on X‐rays).
In the advanced stage of the disease, the dental professional will notice:
Periodontal abscess (see Chapter 8).
Drifting and/or mobility of teeth due to loss of attachment (Figure 4.2). Fifty per cent of UK dentate adults over 16 years old have more than 4‐mm attachment loss [1]. It is characterised by true pocketing (Figures 4.3 and 4.4), which may be either:Suprabony (horizontal) – when the base of the pocket is above the crest of the alveolar bone.Infrabony (vertical) – when the base of the pocket is below the crest of alveolar bone.
Figure 4.2 Drifting.
Source: Professor Nicola West, Bristol University. Reproduced with permission of Professor Nicola West.
Figure 4.3 True pocketing, with probe inserted.
Source: Alison Chapman.
Figure 4.4 True pocketing.
Source: Alison Chapman.
Symptoms of periodontitis
In the early stages of periodontitis, the patient may complain of:
Recession – gums recede, and teeth may be hot and cold sensitive.
Halitosis or a bad taste due to accumulation of bacteria in pockets and pus formation.
In the advanced stage of periodontitis, the patient may complain of:
Drifting/mobility – loose/moving teeth.
Pain (sometimes – from periodontal abscess).
Pus oozing from pockets.
Treatment and management
Treatment and management of periodontitis includes the following:
Encouragement and help to stop smoking (see Chapter 13).
Regular maintenance and monitoring by:Diagnosing and monitoring with pocket charting, bleeding indices (see Chapter 29), and removal of plaque retentive factors.Effective regular plaque removal using manual or powered brush, and interdental brushes, plus (in severe cases) chlorhexidine mouthwash.Toothpaste and mouthwashes containing fluoride are antibacterials and interfere with bacterial metabolism, reducing the number of bacteria present in the mouth.Scaling, root surface debridement with ultrasonic scalers and hand scalers.Air polishing – use of low abrasive agents, such as glycine or erythritol on the root surface to remove subgingival bacteria and reduce recolonisation.Laser treatment in which light and a photosensitiser are used to destroy bacteria.
Antibiotics – systemic or local.
Chlorhexidine‐impregnated chip placed in pocket.
Surgery – re‐contouring of gingivae and removal of pockets.
Remember! No periodontal treatment carried out by the dentist or hygienist will work if the patient does not maintain their oral hygiene.
Classification of Periodontal diseases (Figure 4.5 a,b)
Periodontal diseases are classified by the British Society of Periodontology (BSP) by the:
Extent – localised or generalised.
Stage – ranging from stage I (early, mild) to stage IV (severe) using X‐rays to measure the extent of interdental bone loss on the worst site (Figure 4.6).
Grade – A, B, or C. Dividing the percentage of bone loss at the worst site due to periodontitis by the patient’s age to determine the rate of progression of the disease.
Current status of the disease – stable, in remission, or unstable.
Risk factors – e.g. smoking, medically compromised.
NECROTISING ULCERATIVE GINGIVITIS
Necrotising ulcerative gingivitis (NUG) (Figure 4.7 a,b), also known as acute necrotising ulcerative gingivitis (ANUG), trench mouth, or Vincent’s angina, is one of the most unpleasant acute illnesses to affect the oral cavity, and can make a patient feel extremely ill.
Figure 4.5 (a,b) Implementing the 2017 Classification of Periodontal Diseases to Reach a Diagnosis in Clinical Practice.
Source: From [6]. Reproduced with permission of The British Society of Periodontology.
Figure 4.6 25‐year‐old woman; localised periodontitis, stage III (severe), grade‐C, currently unstable, no risk factors.
Source: Professor Nicola West, Bristol University. Reproduced with permission of Professor Nicola West.
Figure 4.7 (a,b) Necrotising ulcerative gingivitis.
Source: [7]. Reproduced with permission of Blackwell.
Aetiology of NUG
Causes of NUG are not fully understood – various microorganisms are involved, mainly anaerobic bacteria – the principle bacterium being Treponema denticola, which is capable of invading oral tissues [4].
NUG was common in the