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periodontitis

Etiology: 1) accumulation of bacterial plaque* 2) pathogens a) adult periodontitis 1] Porphyromonas gingivalis 2] Prevotella intermedia 3] other gram-negative organisms b) juvenile periodontitis 1] Actinobacillus actinomycetemcomitans 2] Capnocytophaga 3] Eikenella corrodens 4] other anaerobes 3) necrotizing ulcerative periodontitis is associated with HIV 4) host factors a) defects in neutrophil chemotaxis b) Down's syndrome c) diabetes mellitus * mineralization of plaque is called calculus Pathology: 1) starts as gingivitis 2) spreads to involve the periodontal ligament & alveolar bone 3) resorption of alveolar bone & loss of periodontal ligament attachment of tooth to bone 4) soft tissue separates from tooth surface 5) acute inflammation may be superimposed on chronic process 6) abscess formation may occur 7) loosening & loss of tooth 8) association with cardiovascular disease, not causal [3] Clinical manifestations: - acute inflammatory process of the periodontium - necrosis or ulcer of the interdental papilla - gingival bleeding - pain - rapid bone loss - not common at the of a prior extraction [4] Management: 1) prevention: a) oral hygiene (brushing, flossing, mouthwash) b) professional cleaning, plaque removal 2) root canal 3) tooth extraction may become necessary - antibiotic prophylaxis indicated for patients with valvular heart disease 4) systemic antibiotics may be indicated

Specific

juvenile periodontitis (prepubertal periodontitis) pericoronitis; operculitis

General

periodontal disease; gum disease; gingival disease bacterial infection

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 185-86
  2. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Friedewald VE, Kornman KS, Beck JD, The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol. 2009 Jul 1;104(1):59-68. PMID: 19576322 - Lockhart PB et al AHA Scientific Statement Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association? A Scientific Statement From the American Heart Association Circulation April 18, 2012 PMID: 22514251 http://circ.ahajournals.org/content/early/2012/04/18/CIR.0b013e31825719f3
  4. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  5. Darveau RP. Periodontitis: a polymicrobial disruption of host homeostasis. Nat Rev Microbiol. 2010 Jul;8(7):481-90. PMID: 20514045
  6. Papapanou PN, Sanz M, Buduneli N et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1):S173-S182 PMID: 29926951 https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.17-0721