What is the classification of periodontal disease

What is the classification of periodontal disease
What is the classification of periodontal disease

        Periodontal disease is a chronic inflammatory and destructive disease that invades the gums and periodontal supporting tissues. It is the main cause of tooth loss in adults. Periodontal disease has four major characteristics, namely, periodontal pocket formation, inflammation of the pocket wall, alveolar bone resorption, and gradual loosening of teeth. Adult periodontal disease accounts for about 95% of patients with periodontal disease. It is divided into simple and compound types. Simple periodontal disease is the most common. It is caused by long-standing chronic gingivitis extending to deep periodontal tissues. Also known as marginal periodontal disease.
        Simple periodontal disease generally affects most of the teeth of the entire mouth, and a small number of patients only occur in a group of teeth or individual teeth. The degree of periodontal damage of the affected tooth, is mostly consistent with the amount of dental plaque and calculus. It is more common in the molar area, and the anterior teeth area, because it is easy to accumulate dental plaque and calculus. The course of simple periodontal disease progresses slowly, often alternating active and stationary phases of the disease. The disease can begin in youth, and the medical history can be more than ten years or even decades. Periodontal pockets and alveolar bone resorption can occur in the early stage of the disease, only manifested as red and swollen gums bleeding during tooth brushing and eating, which are often ignored by patients and delayed treatment, which further aggravates the condition. In addition to the four major characteristics of periodontal disease, simple periodontal disease may also have tooth displacement in the late stage; food impaction (due to loose and displaced teeth); secondary occlusal trauma; gum recession and root surface exposure Periodontal abscess; periodontal pouch pus and halitosis and other symptoms.
What is the treatment principle of simple periodontal disease?
        The treatment of adult periodontal disease emphasizes early diagnosis and early treatment. Treatment should adhere to the principle of local treatment as the mainstay and systemic treatment as the supplement. After proper treatment, the condition of most patients can be controlled.
        Local treatment includes the following aspects: control of dental plaque, complete removal of calculus, and leveling of the root surface; drug treatment of periodontal pockets and root surfaces; periodontal surgery; fixation of loose teeth; extraction of unretained teeth for the benefit of adjacent teeth Treatment and tissue recovery. Dental plaque is the main pathogenic irritant of periodontal disease. Brushing is the main method to remove dental plaque. However, patients must choose a scientifically designed toothbrush and master the correct method of brushing to effectively remove dental plaque. Calculus is mineralized dental plaque. The removal of supragingival calculus is called scaling, and the removal of subgingival calculus is called subgingival curettage. Scaling and scaling are the basic treatments for periodontal disease. Any other treatment means It should only be used as a supplement to basic treatment. For some deep periodontal pockets with severe inflammation and granulation hyperplasia, the wall of the pocket needs to be treated with drugs after curettage. Antibacterial drugs, such as metronidazole, tetracycline, chlorhexidine, etc., can be placed in the periodontal pocket. The slow-release dosage form is used for better curative effect. After the above treatment, if there are still deep periodontal pockets, or the root surface calculus is not easy to remove completely, periodontal surgery can be performed. Loose tooth fixation is to ligate the affected tooth with the adjacent stable tooth with a metal wire, and reinforce it with a self-curing plastic (made into a periodontal splint), so that the occlusal force is dispersed on a group of teeth, reducing the burden on individual teeth or Protect it from the damage of lateral torsion force to facilitate the restoration of periodontal tissue.
        Simple periodontal disease is generally a chronic process, and antibiotics are generally not used for systemic treatment unless acute symptoms occur. In severe cases, metronidazole or spiramycin can be taken orally to control the acute inflammation. Some patients have chronic system diseases such as diabetes, anemia, gastrointestinal diseases, etc. These systemic diseases may interact with periodontal disease, and accelerate the destruction of periodontal tissues. Therefore, systemic diseases must be controlled at the same time.
What is compound periodontal disease?
        Compound periodontal disease refers to simple adult periodontal disease with obvious occlusal trauma. Occlusal trauma can be primary or secondary. Simple occlusal trauma will not cause periodontal tissue inflammation and formation of periodontal pockets, but when periodontal disease is accompanied by occlusal trauma, it can accelerate and aggravate the destruction of periodontal tissue, so infection is the main cause of compound periodontal disease The etiology, occlusal trauma is a supplementary factor. The main clinical manifestations of compound periodontal disease are the same as simple periodontal disease, such as periodontal pocket formation, alveolar bone resorption, gingival inflammatory swelling and bleeding, and gradual loosening of teeth. However, due to the obvious occlusal trauma of this disease, periodontal disease is more serious, so it has some other characteristics: periodontal pockets are narrow and deep, and more limited; the absorption of alveolar bone is varied, but mainly vertical Absorption; tooth looseness exceeds the degree of alveolar bone absorption; asymmetrical recession of the gums, gingival cracks, marginal protrusions, and gingival clefts vary in length, which can be as long as 5 to 6mm, mostly on the labial side of the anterior teeth. Ring thickening of the edge, such as a lifebuoy around the tooth neck; there may be isolated posterior root bifurcation lesions; due to uneven tooth wear, abrasion facets may appear on the cusp or occlusal surface; teeth without caries may appear Occlusal disease, apical periodontitis. In addition, the disease may also have symptoms such as cracked teeth and root resorption, and are often accompanied by bruxism, clenching teeth, and temporomandibular joint disorders.
What are the clinical characteristics of juvenile periodontal disease?
        Juvenile periodontal disease mainly occurs in young people from adolescence to 25 years old. It used to be called periodontal degeneration. The onset begins at the age of 11 to 13, and the onset is earlier in women than in men. Because the early symptoms are mild, they are often ignored by patients, and they are often around 20 years old when they see a doctor. Many people in the patient's family often suffer from this disease, and the patient's compatriots have a 50% chance of getting the disease. It can be divided into limited type and diffuse type.
        In limited type of juvenile periodontal disease, the typical prevalent sites are the upper and lower incisors and the first permanent molars, while the canine and bicuspid areas are rarely affected. There are no more than 14 teeth in the whole mouth, including 8 upper and lower incisors, 4 first permanent molars, plus any 2 teeth. The affected teeth are mostly symmetrical. Diffuse adolescent periodontal disease can invade the entire mouth. Generally, deciduous teeth are not violated.
The disease develops rapidly, and the rate of periodontal destruction is 3 to 4 times faster than that of the adult type. In 4 to 5 years, the periodontal attachment loses 50% to 70%. The patient needs to pull out his teeth or lose his teeth when he is about 20 years old. Loosening and movement of teeth can occur in the early stage, the incisors are displaced to the labial and distal site, and interdental spaces appear, which are arranged in a fan shape. The upper incisors are more common, and the posterior teeth can have different degrees of food impaction. Early patients have few dental plaque and calculus, and mild inflammation of the gums, but deep periodontal pockets are formed. There may be subgingival dental plaque at the bottom of the pocket, and the wall of the pocket is inflamed. It is easy to bleed on probing. Periodontal abscess may occur in the late stage. X-ray film showed that the first permanent molars have vertical absorption in the mesial and distal areas, forming a typical "arc absorption". Most of the incisor area is horizontal bone absorption, the periodontal ligament space is widened, and the hard bone plate is blurred. Trabecular bone can become loose and thin.
        Special emphasis is placed on early and thorough treatment. And strengthen the review and treatment during the maintenance period, which should be reviewed every 2 to 3 months for at least 2 to 3 years. The basic treatment of this disease is the same as that of adult periodontal disease, that is, clean treatment, complete removal of tartar, curettage, root leveling, periodontal surgery and other treatment methods. After the inflammation is controlled and the periodontal pockets become shallow, the displaced anterior teeth can be reset and aligned by orthodontic methods. During the entire orthodontic process, the control of dental plaque and inflammation should be strengthened, and the force should be slow and lasting. At the same time of local treatment, patients should take antibiotics, such as tetracycline, etc., allowing patients to take Guchi pills based on Liuwei Dihuang Pills for several months, which can significantly reduce the recurrence rate. In addition, taking Yazhouning for several months also has a certain effect. Juvenile periodontal patients, if the first permanent molar is severely damaged, can remove the first molar, and then transplant the third molar into the alveolar socket of the first molar to perform its function.
What is rapidly progressive periodontal disease?
        The age range of onset of rapidly progressive periodontal disease is wide, roughly between adolescence and 35 years old. Some patients have a history of juvenile periodontal disease. Periodontal damage is diffuse, which can affect most teeth. During the active period of the disease, the gums have acute inflammation, mulberry-like hyperplasia appears in the gingival margin, the alveolar bone is severely and rapidly destroyed and absorbed, and the teeth become loose. In the stationary phase of the disease, the inflammation of the gums disappears, and the process of alveolar bone destruction is significantly slowed down or stopped naturally. Patients may sometimes be accompanied by systemic symptoms such as depression, weight loss, and general malaise. The amount of dental dental plaque deposition varies greatly between cases, and most patients have functional defects of neutrophils and monocytes.
Under normal circumstances, patients have obvious curative effects on treatment, but there are also a small number of patients with poor results after any treatment, and the condition continues to rapidly worsen until the tooth is lost. In order to treat this disease, the patient should be thoroughly treated locally to stop the process of periodontal tissue destruction and promote the disease to turn into a stationary phase. Local treatment includes: periodontal cleansing, root planing, periodontal surgery, etc. At the same time, the patients should be treated with antibacterial treatment. The patients can be instructed to take metronidazole or spiramycin, erythromycin, tetracycline, etc., for 1 to 2 weeks. Placing antibacterial liquids such as iodine glycerin in the deep periodontal bag also has a certain effect. Supportive treatment should also be strengthened, such as oral vitamin C, and oral administration of traditional Chinese medicine Guchi Pills that have the effect of invigorating the kidneys and teeth. Yazhouning is a vegetable oil unsaponifiable preparation, 6 tablets each time, 3 times a day for 3-6 months.
Does periodontal disease occur before puberty?
        It is a consensus for many years that children do not develop periodontal disease. However, in the past few years, 5 cases of periodontal disease occurred in deciduous teeth were reported, and the name of prepubertal periodontal disease was proposed and regarded as an independent disease. The etiology of prepubertal periodontal disease is unknown, and the onset is in the eruption period of deciduous teeth, and the age can be as early as about 4 years old or earlier. It can be divided into two types: limited type and diffuse type.
        Localized prepubertal periodontal disease only invades a small number of deciduous teeth with variable locations. Gum inflammation is mild or moderate, but may have deep periodontal pockets. The rate of alveolar bone destruction is slower than that of the diffuse type, and it is not accompanied by otitis media or other infections. This type of treatment responds well.
        Diffuse prepubertal periodontal disease can spread to full deciduous teeth; permanent teeth can be affected or unaffected. The gums have obvious severe inflammation, and there are gingival proliferation and gingival margin recession or gingival cracks, and the speed of alveolar bone destruction is very fast. , Causing the teeth to loosen quickly and even fall off automatically. The function of neutrophils and monocytes in the peripheral blood of the patient is low. Children are often accompanied by otitis media and repeated skin and upper respiratory tract infections. This type does not respond well to antibiotic treatment.
        The principle of treatment of periodontal disease in preteen is anti-inflammatory treatment. It is difficult to require children around 4 years of age to strictly control the occurrence of dental plaque, but it is also very important. Parents should be asked to assist in urging children to brush their teeth carefully with a soft toothbrush, and to use chlorhexidine and other antibacterial liquids. With cough or periodontal rinse. For patients with localized prepubertal periodontal disease, cleansing and subgingival curettage can be performed with systemic antibiotics such as penicillin, which may prevent the progression of the disease. Long-term follow-up should be followed for diffuse cases. The prognosis is poor and the disease is not easy. control. Even under treatment, the gums tend to continue to shrink, and the alveolar bone is still rapidly absorbed.
How should the disease occur under the root bifurcation be treated?
         Root bifurcation disease refers to the periodontal disease that spreads to the root bifurcation of multiple teeth. It can occur in any type of periodontal disease, with the highest prevalence of mandibular first molars. dental plaque, occlusal trauma and anatomical factors of teeth are the main factors of its pathogenesis.
         The bifurcation area can be directly exposed to the oral cavity, or it can be covered by periodontal pockets. Periodontal inflammation and pus are often present. It is easy to bleed during probing. Acute periodontal abscess can also occur. There may be symptoms such as spontaneous toothache and sensitivity. .


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