Recognizing Diseased Periodontal States
Gingivitis and periodontitis are classified as separate diseases. Gingivitis is an inflammation of the marginal gingiva that does not produce attachment loss nor loss of bone. Pockets that may occur with gingivitis are actually pseudopockets, and are due to gingival enlargement and do not involve apical migration of the gingival attachment nor bone loss.
Periodontitis occurs when the junctional epithelium and periodontal attachment move apically along the tooth root. Alveolar bone also resorbs towards the apex of the tooth during the disease process. It is believed that pathogenic bacterial plaque induces an inflammatory immune response, which may compromise periodontal structures. The plaque would be comprised of pathogenic organisms in numbers large enough to effect a response in a susceptible host. Genetic and systemic factors may affect these events. Since bacterial plaque is generally considered the common denominator of periodontal disease, there has been a strong focus on antimicrobial strategies including scaling and root planing and routine oral hygiene measures.
Bone loss is routinely evaluated during the periodontal examination. Clinically, tooth mobility is measured as well as furcation involvement. Tooth mobility may vary from 1st degree, a horizontal movement of the tooth crown up to 1 mm, to 3rd degree, both horizontal and vertical movements of the crown. Radiographically, the alveolar bone is examined for height and horizontal or vertical bone loss and signs of furcation involvement. Radiographic bone loss findings may be confirmed by direct visualization if open flap surgery is performed. If bone loss is horizontal, bone grafting is not indicated. If bone loss forms in an angular fashion forming infrabony defects, regenerative procedures may be helpful.
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