Periodontitis

Aka: Periodontitis, Pyorrhea

1. Definition
   1. Loss of tooth supporting bone structure due to chronic Gingivitis
2. Epidemiology
   1. Common cause of adult tooth loss (esp. men ages 30-50 years)
   2. Diabetes Mellitus is a common cause
3. Pathophysiology
   1. Chronic Gingivitis results in inflammation of deeper tissues around teeth
      1. Crevices between gums and teeth enlarge
      2. Pockets develop in crevices with
         1. Debris
         2. Purulent materials
   2. Consequences
      1. Loss of tooth supporting bone structure
      2. Periodontal ligament detaches from tooth
4. Types
   1. Localized Juvenile Periodontitis
      1. Onset as adolescent (ages 12 to 17 years old)
      2. Not related to Plaque
      3. Vertical alveolar bone loss
   2. Adult Periodontitis
      1. Onset after age 30 years
      2. Associated with subgingival dental Plaque
5. Symptoms
   1. Halitosis
   2. Tooth Pain or sensitivity (esp. with eating)
6. Signs
   1. Red, swollen gums
   2. Gum margins recede exposing roots of teeth (deep pockets may be present)
   3. Subgingival dental Plaque
   4. Friable gums that bleed easily when probed or with flossing or brushing
   5. Teeth may be loose
7. Management
   1. Surgical Debridement of infected or necrotic tissue by dentist or periodontist
      1. Scaling and root planing removes Plaque and tartar
   2. Mouth rinses
      1. Chlorhexidine Gluconate 0.12% Rinse (Peridex)
      2. Hexetidine 0.1% Rinse (Oraldene)
   3. Systemic antibiotics in diffuse involvement
      1. Oral: Doxycycline or Metronidazole
      2. Topical: Minocycline
8. Complications
   1. Periodontal Abscess
9. References
   1. Albandar (1997) J Am Dent Assoc 128:1393-9 [PubMed]
   2. Nguyen (2008) Am Fam Physician 77:797-806 [PubMed]
   3. Stephens (2018) Am Fam Physician 98(11): 654-60 [PubMed]