DIFFERENCE BETWEEN

GINGIVITIS & CHRONIC

PERIODONTITIS &
AGGRESSIVE
PERIODONTITIS
 INTRODUCTION
Gingivitis and periodontitis are both
periodontal diseases. The major difference
between the two is that gingivitis is
reversible while periodontitis is not.
If gingivitis is left untreated, it can progress
and spread to the underlying bone and tissue
and can result in periodontitis.
 Difference Between Gingivitis
and Periodontitis
Gingivitis Periodontitis
 It  It is a serious condition
is the mild infection
of the gums. of the infection. In a
Inflammation of the susceptible individual
gingiva is known as with poor oral hygiene
gingivitis. it may advance to
deeper portions of the
periodontium leading
to tissue destruction
and alveolar bone
 Itis described as early resorption.
or initial stages of  It is described as the

gum disease. advanced stages of

the gum disease.
STAGES OF GINGIVITIS
 Stage I- Initial lesion(2-4 days)
Immune cells- Polymorphonuclear leukocytes(PMNs)
C/F- Increase in gingival flow
 Stage II- Early lesion(4-7 days)

Immune cells- Lymphocytes(T cells)

C/F- Erythema & bleeding on probing
 Stage III- Established lesion(14-21 days)

Immune cells- Plasma cells & B lymphocytes

C/F- Change in color,size,texture
 Stage IV- Advanced lesion

Immune cells- Plasma cells and presence of all

inflammatory cells
C/F- Alveolar bone loss , apical migration of JE from CEJ ,
extensive damage of collagen fiber
 Itis caused by  It is caused due to poor
development of adherent oral hygiene where the
plaque on the tooth infection destroys the
surface and results in attachment fibres and
inflammation. underlying bone. Gingivitis
usually precedes
periodontitis.
 Symptoms include
 Symptoms include
loosening of teeth,
redness, swollen gums
receeding gums,
and tender gums that
inflammation and pus in
bleed easily, changes in
gums ,deep periodontal
contour, loss of tissue
pockets, loss of connective
adaptation to the teeth & tissue attachment. Even a
elevated flow of gingival metallic taste & bleeding
crevicular fluid. Mild foul while brushing and
breath that can go away flossing. Chronic bad
with proper dental care. breath that doesn’t go
 Rarelyhappens to
Can occur at any teenagers.
age.
Risk factors-
Conditions
Risk factors- associated with
Pregnancy compromised
Chewing or immune system.
smoking tobacco Medications that
Dry mouth cause drug
Genetics induced gingival
Hormonal changes overgrowth.(some
calcium channel
blockers,cyclospori
ne)
No permanent Permanent
damage occurs. damage to the
No risk of heart tooth bone.
attack and stroke. Increased risk of
heart attack and
Gingival abscess is stroke.
Periodontitis
not affected by
thermal changes. abscess is
affected by
thermal changes.
Treatment- Treatment-
Scaling of teeth. Non surgical
Brushing teeth atleast treatments
twice a day with a Scaling and root
soft bristled planing
brush ,dental floss Antibiotics
and use a
mouthwash. Surgical treatments
Flouride/ Triclosan Flap surgery
toothpaste. Bone and tissue
Treatment of grafts
underlying Gingivectomy
conditions. Gingivoplasty
Professional dental
care
CHRONIC PERIODONTITIS AGGRESSIVE PERIODONTITIS

Distribution-
 Localised when less  Localised when 1st
than 30% of sites molar & incisors & no
involved. more than 2 more
 Generalised when permanent teeth are
involved.
more than 30% of
 Generalised when
sites affected.
atleast 3 permanent
teeth other than 1st
molar & incisors are
affected.
Local Factors-
 Presence of local
 Presence of local
factors doesn’t
factors directly relates
commenserate with
to the amount of
the amount of
destruction present.
Aggressive periodontitis
Chronic periodontitis
 Age-
Most prevalent in Circumpubertal
adults but may be in onset in LAP &
children & under 30yrs of age
adolescent. in GAP.
Rate of progression-
Slow rate of Rapid rate of
progression progression

Microbial aetiology-
Consist of both
Key microorganisms
aerobic & anaerobic
are Aggregatibacter
gram positive and
actinomycetemcomi
gram negative
tans and prevotella.
microorganisms.
 Immunological
aetiology-  Hyper responsive
 No abnormalities macrophage phenotype
detected & phagocyte
abnormalities.
Signs of inflammation-
 Commensurate with  Sometimes lacking
amount of aetiological (especially in pts. With
factors present. localised aggressive
periodontitis).
Relative amount of
plaque and calculus-
 Consistent with  Not consistent with
periodontal destruction. periodontal destruction.
Medical history-
 Contributory  Non- Contributory
 Pattern of
destruction- Usually variable with
Usually uniform with vertical bone loss.
horizontal bone loss.
Familial Evidence of strong
aggregation- familial aggregation.
Lacks strong
evidence.
Amount of microbial
deposits may or
Amount of microbial may not consistent
deposits consistent with the severity of
with the severity of destruction.
destruction. Subgingival calculus
 TREATMENT

1. Non surgical therapy- Past treatment modalities-

 Initial therapy(scaling  1. Extraction-specially in case

and root planing) of 1st molar & substitution of

socket of previous extracted
 Antimicrobial therapy-as
1st molar with developing 3rd
an adjunct to routine molar.
periodontal therapy  2. Standard periodontal
 Instructions,reinforceme therapy-Scaling & root
planing, curettage, flap
nt,evaluation of plaque
surgery with & without bone
control records grafts, root amputations &
 Removal of all the hemisections.
factors contributing to  3. Antibiotic therapy-

plaque Tetracycline 250mg 4 times

accumulation,e.g.correcti daily for 14 days every 8
weeks. Incase tetracycline
on of ill fitting resistant , combn. of
appliances,overcontoure amoxicillin & metronidazole.
d crowns,overhanging  4. Chlorhexidine rinse is given
restorations,etc.
2. Surgical therapy- Current treatment
modalities-
 Periodontal flap
 Early detection
surgery  Education to patient.
 Pocket  Efforts to control
elimination factors that affects
procedures the composition & the
quantity of
 Regenerative
subgingival
therapy including microbiota.
bone grafts &  Providing environment

barrier conducive to long

term maintenance.
membranes.