Periodontitis

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What is Periodontitis?

Periodontitis is an inflammatory condition of the periodontium: periodontal ligament, cementum, alveolar bone, gingivae.

Classification of Periodontitis

  1. Acute periodontitis
  2. Chronic periodontitis
  3. Juvenile periodontitis
  4. Other sub-classifications

1. Acute periodontitis:

  •  This type is relatively uncommon
  • It is usually of of short duration
  • It may be due to trauma, abscess or ulceration
  • It is characterized by pain
  • It may be associated with bleeding, fever, swelling and redness of the mucosa, unpleasant taste in the mouth

2. Chronic periodontitis

  • This is inflammation within the supporting tissues of the teeth with bone loss
  • It is the most frequently occurring form of periodontitis
  • It is characterized by pocket formation and/or recession of the gingiva
  • It is prevalent in adults, but can occur at any age
  • Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur
  • It is actually a sequala to untreated gingivitis

Symptoms and clinical features of Periodontitis

  1. Periodontitis may be asymptomatic initially, with a low grade inflammation of the periodontium and gingiva.
  2. As it progresses, and following attachment, lost gums become red, slightly swollen and bleed on slight touch
  3. Associated teeth show different degrees of mobility

Risk factors for Periodontitis

  1. Diabetes mellitus
  2. Smoking
  3. Certain periodontal bacteria
  4. Aging
  5. Gender
  6. Genetic predisposition
  7. Immunosuppression
  8. Stress
  9. Nutrition
  10. Pregnancy
  11. HIV infection
  12. Substance abuse

Treatment for Periodontitis

Treatment objectives

  • Eliminate, alter, or control above risk factors which may contribute to chronic Periodontitis

Non-drug treatment

  • Instruction, reinforcement, and evaluation of the patient’s plaque control should be performed
  • Supra- and sub-gingival scaling and root planning to remove microbial plaque and calculi
  • Consultation with the patient’s physician may be indicated

Drug treatment

1. Analgesics

Paracetamol

Adult: 1 g orally every 8 hours for 3-5 days

Child:

  • 1-5 years: 125-250 mg;
  • 6-12 years: 250-500 mg orally every 8 hours

2. Antibiotics

Amoxicillin

Adult: 250 mg orally every 8 hours for 5 days

Child:

  • 1 month – 1 year: 62.5 mg orally every 8 hours; dose doubled in severe infections
  • 1-5 years: 125 mg every 8 hours;
  • 5 – 12 years: 250 mg 8 hourly;
  • 12 – 18 years: 500 mg 8 hourly; all doses doubled in severe infections

Metronidazole

  • Adult: 200 mg orally every 8 hours for 5 days
  • Child:
    • 1-3 years 50 mg orally every 8 hours;
    • 3-7 years: 100 mg every 12 hours;
    • 7- 10 years: 100 mg every 8 hours

3. Antiseptic mouthwashes

  • 2% Chlorhexidine gluconate (alcohol free)
  • Rinse mouth with 10 ml for about 1
    minute twice daily for 1 – 2 weeks
  • Hexetidine mouthwashes to alternate with warm saline mouthwashes

Adverse drug reactions, caution

  • Metronidazole: nausea, vomiting and metallic taste. It is contraindicated in pregnancy. Avoid alcohol during treatment with metronidazole, and for at least 48 hours after treatment

Prevention of Periodontitis

  • Oral health education
  • Scaling and polishing every six months

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