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Bacteria / viral associated with periodontal disease • 700 different microbial species > 100–200 species commonly colonise an individual’s mouth, reflecting great diversity pathways for the oral bacteria to exert their effects • tooth surfaces (either crown or root) • periodontal tissues (either sulcular, junctional or pocket epithelium lining), • connective tissues (if access is gained via ulcerated pocket • epithelium) or other bacteria already attached to these surfaces. pioneer • Gram positive and include: • streptococci (with Streptococcus sanguis, S. oralis and S. mitis being • pioneer species), Neisseria, Nocardia and Actinomyces. ‘Milleri’ streptococci • (S. anginosus, S. constellatus and S. intermedius) Gingivitis • capnophylic (especially Capnocytophaga spp.) • obligately anaerobic Gram-negative bacteria • rises; Fusobacteria are common and there is an increased proportion of Actinomyces Periodontitis • a diverse subgingival • microflora and a large number of obligately anaerobic Gram-negative • rods and filament-shaped bacteria, many of which are asaccharolytic • but proteolytic Designated periodontal pathogens: Suspected periodontal pathogens include: • Aggregatibacter actinomycetemcomitans • Porphyromonas gingivalis • Tannerella forsythia Prevotella intermedia – Split into two distinct species Prevotella intermedia and Prevotella nigrescens in 1992 • Fusobacterium nucleatum • Campylobacter rectus • Eikenella corrodens • Peptostreptococcus micros • Selenomonas species • Eubacterium species • Spirochaetes – Only 10 cultivated so far Prognosis of tooth • Prediction of probable course, duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease. Prognosis of tooth 1. 2. 3. 4. 5. 6. 7. % of bone loss-CAL Probing depth Distribution and type of bone loss (anatomy of intrabony defects) Furcation : presence & severity Mobility Crown to root ratio 8. Bleeding upon probing 9. Root morphology 10. Pulpal involvement/Caries 11. Tooth position and occlusal 12. relationship / strategic value/ cost 13. Patient risk factor CAL Recession PD How do you use PD and CAL? • CAL is often used to monitor disease progression- determine prognosis • PD is commonly used to develop type of treatment- grafting Glickman’s Furcations Miller Index Classification: • 1- First sign of movement greater than normal • 2 - Up to 1 mm in any direction • 3 - More than 1 mm in any direction and/or vertical depression Radiographic exam • Full-mouth series • Vertical Bite wings • Panorex – developmental anomalies – Pathology – fractures • Previous radiographs Classification of Prognosis Modified McGuire’s • • • • • Good Fair Poor Questionable Hopeless • *Note: the textbook uses the orginial McQuire’s classification. In the Modified McGuire the classification criteria remains the same but the names for questionable and poor have been switched. Prognosis feature Excellant No bone loss Excellent gingival condition Good patient cooperation No risk factors Good Adequate remaining bone support No or Controlled risk factors Adequate patient cooperation Fair 25-40% Attachment Loss Grade I furcation Adequate maintenance possible Acceptable patient cooperation Questionable 40-50% attachment loss Grade I or II furcation Allows proper maintenance but difficult Doubtful patient cooperation Risk factors present Prognosis feature Poor >50% attachment loss Inaccessible Grade II furcatio Grade III furcation Poor crown to root ratio with Class 2 or 2+ mobility Risk factors present or poorly controlled Hopeless >75% Bone loss Non-maintainable areas Grade III Furcation Class 3 Mobility Recurrent Abscesses Uncontrolled risk factors Overall Factors that Affect Prognosis • • • • • Age Medical status/systemic background Rate of Progression Patient Cooperation